Urokinase treatment in patients with diabetes mellitus with diabetic foot syndrome and critical limb ischaemia is feasible

The number of patients with diabetes mellitus in the Andijan region who were registered according to endocrinologists from 2000 to 2015 increased almost fourfold from 26,000 to more than 110,000 in 2016 (14). This also shows that the number of patients with various purulent-necrotic complications of diabetes mellitus also increases proportionally, in addition, there is an increase in patients with severe purulent-septic complications of these processes, with widespread, deep purulent-necrotic fasciitis [3]. Of patients in the department of surgical infection of the ASMI clinic, patients with purulent-necrotic complications of diabetes mellitus account for almost 78%, which indicates a significant increase in the number of these patients. This tendency continues and goes up every year. According to the WHO, by 2030 every 15 people will have diabetes, and by 2050 this figure will be equal to every 6 people.

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Morphological research of the effectiveness of perioperative local use of anesthetics and antiseptics in patients with purulent-necrotic lesions of lower extremities in diabetes mellitus

Reports of Morphology ◽

10.31393/morphology-journal-2021-27(3)-03 ◽

2021 ◽

Vol 27 (3) ◽

pp. 22-28

Author(s):

Yu.M. Babina ◽

D.V. Dmyrtriiev ◽

O.A. Nazarchuk ◽

P.P. Hormash

Keyword(s):

Diabetes Mellitus ◽

Wound Healing ◽

Granulation Tissue ◽

Diabetic Foot ◽

Povidone Iodine ◽

Local Treatment ◽

Lower Extremities ◽

Diabetic Foot Syndrome ◽

Patients With Diabetes ◽

Infiltration Anesthesia

Ulcer-necrotic lesions of the feet are detected in 5-15% of patients with diabetes mellitus (DM). According to the literature today in Ukraine, patients with DM perform high amputation of the lower extremities with diabetic foot syndrome with a frequency of 19.6-42.6%, at the same time, mortality ranges from 8.9% to 25.0%, and the total mortality rate at the DM varies from 6.6% to 13.5%, often associated with the occurrence of postoperative complications. The aim of the work was to study morphological indicators of reparation of soft tissues of the lower extremities in patients with diabetic foot syndrome on the background of local treatment during the perioperative period. We investigated changes in histologic structure and character of reactions of skin tissues, muscles and fascia during the period of visceral disease in patients with diabetes mellitus after different types of local treatment. Then, samples of skin tissues, muscles and fascia were photographed and analyzed using a light microscope OLIMPUS BX 41. In the first group of the comparison, which used standard methods of anesthesia and local antiseptic povidone-iodine, granulation tissue was characterized by the complete absence of fibrous structures (collagen fibers) and the presence of a small number of newly formed small diameter vessels with blistered endothelium. Vessels of young granulation tissue were dilated, full-blooded, the endothelium was swollen, there was significant perivascular edema. In the second group of patients (where povidone-iodine and infiltration anesthesia with 2% lidocaine solution anesthetic was used locally) there were almost no remains of necrotic tissues in the affected tissues. It should be noted that there was better granulation development with fewer inflammatory-cell elements, more young forms of fibroblasts and a moderate pathological vascular reaction. In the first (control) group, wound healing by 3-7 days is characterized by somewhat slow regeneration. Wound healing was most favorable in patients of the second group, where infiltration anesthesia was used by local anesthetic and antiseptic povidone-iodine.

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THE PREVALENCE OF MODIFIABLE RISK FACTORS IN THE POPULATION AND IN PATIENTS WITH DIABETES MELLITES, INCLUDING DIABETIC FOOT SYNDROME

Tavricheskiy Mediko-Biologicheskiy Vestnik ◽

10.37279/2070-8092-2020-23-2-85-91 ◽

2020 ◽

Vol 23 (2) ◽

pp. 85-91

Author(s):

T. Yu. Kravtsova ◽

M. F. Zarivchatskiy ◽

P. S. Lukin ◽

S. F. Blinov ◽

M. V. Bacheva

Keyword(s):

Physical Activity ◽

Diabetes Mellitus ◽

Risk Factors ◽

Diabetic Foot ◽

Age Groups ◽

Social Study ◽

Diabetic Foot Syndrome ◽

Modifiable Risk Factors ◽

Patients With Diabetes ◽

Poor Nutrition

Goal of work - identify modifiable risk factors for chronic non-infectious diseases in patients with type 2 diabetes mellitus and in the formation of diabetic foot syndrome. Material and methods. A comparative medical and social study was conducted - a survey of patients in clinics of the city of Perm, suffering and not suffering from diabetes. The study involved 230 people who were assigned according to the presence/absence of diabetes mellitus. The first group included 178 patients with an average age of 45.8 (30.0; 59.0). The second group included 27 patients with diabetes mellitus, with an average age of 61.7 years (50.0; 62.0). The third group included 25 patients with diabetic foot syndrome, whose average age was 64.72 years (61.0; 69.0). Women predominated in all groups. Original and generally accepted questionnaires were used to study the presence of common risk factors for chronic diseases among respondents. Results. The analysis of the studied materials showed a clear qualitative and quantitative pattern of accumulation of risk factors in the age exponent. Most risk factors tend to grow up to 54-65 years. Risk factors such as smoking, alcohol abuse, poor nutrition and overweight, depression and hypertension predominate (р<0,05) in older age groups of respondents. In patients with diabetes mellitus, low physical activity, poor nutrition, and obesity predominate (р<0,05). In patients with diabetic foot syndrome, the same risk factors were identified as in patients without this pathology. At the same time, in respondents with diabetic foot syndrome, physical activity was minimal, and body mass index values were much higher (р<0,05); in addition, patients with diabetic foot syndrome are more likely (р<0,05) to be depressed and perceive their health as «very poor.»

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Integrated surgical management of neuroischemic diabetic foot syndrome, abdominal aortic aneurysm and renal artery lesionsin patients with diabetes mellitus type 2

Diabetes Mellitus ◽

10.14341/2072-0351-5826 ◽

2011 ◽

Vol 14 (4) ◽

pp. 100-106

Author(s):

Sergey Anatol'evich Terekhin ◽

Victor Afanas'evich Kalashnikov ◽

Valeriy Afanas'evich Mitish ◽

Lyudmila Petrovna Doronina ◽

Alla Yur'evna Tokmakova ◽

...

Keyword(s):

Diabetes Mellitus ◽

Chronic Kidney Disease ◽

Abdominal Aortic Aneurysm ◽

Surgical Management ◽

Diabetic Foot ◽

Diabetes Mellitus Type 2 ◽

Diabetic Foot Syndrome ◽

Abdominal Aortic ◽

Patients With Diabetes

The article presents a clinical example of integrated surgical management in patient with multifocal atherosclerosis, chronic kidney disease andneuro-ischemic form of diabetic foot syndrome

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The process of repair of trophic ulcers in patients with diabetes

Problems of Endocrinology ◽

10.14341/probl11391 ◽

2004 ◽

Vol 50 (2) ◽

pp. 34-38

Author(s):

N. A. Myskina ◽

A. Yu. Tokmakova ◽

M. B. Antsiferov

Keyword(s):

Diabetes Mellitus ◽

Blood Flow ◽

Diabetic Foot ◽

Neurological Disorders ◽

Sharp Increase ◽

Lower Extremities ◽

Late Complications ◽

Diabetic Foot Syndrome ◽

Industrialized Countries ◽

Patients With Diabetes

In the last 30 years, there has been a sharp increase in the incidence of diabetes mellitus (DM), especially in industrialized countries, and its prevalence tends to further increase [3]. The main cause of disability and death of patients are late complications of this disease. Among them, it is especially important to identify developing diabetic foot syndrome (DFS), which is defined as infection, ulcer and / or destruction of deep tissues, associated with neurological disorders and decreased main blood flow in the arteries of the lower extremities of varying degrees severity (International Diabetic Foot Agreement, Netherlands, 1999)

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Severe Vitamin D3 Deficiency in the Majority of Patients with Diabetic Foot Ulcers

Hormone and Metabolic Research ◽

10.1055/a-0648-8178 ◽

2018 ◽

Vol 50 (08) ◽

pp. 615-619 ◽

Cited By ~ 9

Author(s):

Joachim Feldkamp ◽

Karsten Jungheim ◽

Matthias Schott ◽

Beatrix Jacobs ◽

Michael Roden

Keyword(s):

Diabetes Mellitus ◽

Diabetic Foot ◽

Cell Function ◽

Glycosylated Hemoglobin ◽

Diabetic Foot Syndrome ◽

Foot Ulcers ◽

Control Group ◽

Diabetic Foot Ulcers ◽

Healthy Humans ◽

Patients With Diabetes

AbstractDiabetic foot ulcers are a severe complication in patients with diabetes mellitus. Vitamin D is associated with impaired β-cell function and insulin resistance, and is necessary for wound healing and bone metabolism. We measured the serum concentrations of 25-hydroxyvitamin D3 in 104 patients (63 inpatients, 41 outpatients) with diabetic foot ulcers and compared them to 99 healthy humans (control) and 103 patients with diabetes mellitus type 2 without diabetic foot ulcers. Calcium, creatinine, and parathyroid hormone were measured in patients with diabetic foot ulcers. The data were analysed together with glycosylated hemoglobin A1c and the severity of diabetic foot lesions according to the Armstrong classification. Levels of 25-hydroxyvitamin D3 were lower (11.8±11.3 ng/ml, p<0.001) in patients with diabetic foot ulcers (mean age 70±12 years) than in the control group (27.2±12.2 ng/ml). No difference was found between in- and outpatients. Fifty-eight (55.8%) of patients with diabetic foot ulcers had a severe 25-hydroxyvitamin D3 deficiency with levels below 10 ng/ml. Only 12% of the patients had 25-hydroxyvitamin D3 levels above 20 ng/ml. Secondary hyperparathyroidism was found in 27.9% of patients and 11.5% of the patients were hypocalcemic. There was a negative correlation (r=–0.241) (p<00.1) between Armstrong classification and 25-hydroxyvitamin D3 status. In conclusion, patients with diabetic foot syndrome are at high risk of 25-hydroxyvitamin D3 deficiency. Thus, any patient with diabetic foot syndrome should undergo 25-hydroxyvitamin D3 measurement and supplementation, if values are found to be decreased.

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The clinical effectiveness of cryopreserved human amniotic membrane in diabetic foot syndrome

Cell and Organ Transplantology ◽

10.22494/cot.v9i2.129 ◽

2021 ◽

Vol 9 (2) ◽

Author(s):

A. Ustymenko ◽

◽

P. Nemtinov ◽

S. Bolgarska ◽

L. Zaika ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Glucose ◽

Amniotic Membrane ◽

Diabetic Foot ◽

Diabetic Foot Syndrome ◽

Human Amniotic Membrane ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Patients With Diabetes

Diabetic foot syndrome with long-term unhealed wounds is the most common complication and cause of limb amputation in diabetes. The search for effective therapeutic agents and their inclusion in treatment protocols is a priority due to the increase in the number of cases of this socially significant disease and disability among the working population every year. The aim of the study is to evaluate the effectiveness of cryopreserved human amniotic membrane in the treatment of long-term non-healing wounds of the lower extremities in diabetic foot syndrome. Materials and methods. The pilot clinical study described 4 clinical cases of treatment of patients with diabetes mellitus type I and II (1 woman and 3 men aged 52 to 68 years) with long-term unhealed wounds of the limbs under standard therapy. After previous wound sanation the applications of the cryopreserved human amniotic membrane were performed. Once a week after the application, the dynamics of wound healing was assessed. Blood glucose levels were determined before amniotic membrane treatment and two hours after the procedure. Results. As a results of weekly applications of human amniotic membrane there was a gradual decrease in the area of the wound from the original size and increase the rate of healing. Thus, at the time of the second visit (after 7 days) the reduction in the area of the ulcer from the initial size in patient 1 was 33 %, patient 2 – 25 %, patient 3 – 33 % on the sole and patient 4 – 3 %, and the healing rate – 4.7 %, 3.6 %, 4.7 % and 0.43 % per day, respectively. The use of human amniotic membrane did not affect blood glucose levels when comparing values before application and two hours after the procedure. Regular follow-up visits of patients 3, 6, 9 and 12 months after the start of the study showed no recurrence of ulcers. Conclusions. It has been shown that the use of cryopreserved human amniotic membrane in patients with diabetes mellitus and diabetic foot syndrome with long-term unhealed wounds results in complete healing of ulcers with stable remission during the year of observation.

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Decreasing incidence of major amputations in people with diabetes

VASA ◽

10.1024/0301-1526.30.s58.28 ◽

2001 ◽

Vol 30 (Supplement 58) ◽

pp. 28-31 ◽

Cited By ~ 4

Author(s):

Holstein ◽

Ellitsgaard ◽

Bornefeldt Olsen ◽

Ellitsgaard

Keyword(s):

Diabetes Mellitus ◽

Diabetic Foot ◽

Type I Diabetes ◽

Type Ii Diabetes Mellitus ◽

Diabetic Patients ◽

Limb Ischaemia ◽

Type I ◽

Patients With Diabetes ◽

Revascularization Procedures ◽

Foot Clinic

Aims/hypothesis. To assess the results of the strategy used in avoiding major amputations in patients with diabetes mellitus. Methods. A retrospective study for the years 1981 to 1995 in a central district hospital in Copenhagen with a catchment area population of about 178000. Results. There were 463 major leg amputations and the incidence decreased from 27.2 to 6.9/100000 population (minus 75%). The decrease in patients with Type I diabetes mellitus was from 10.0 to 4.1 (minus 59%) and in Type II diabetes mellitus from 17.2 to 2.8/100000 people (minus 84% ). Analysis showed that the diabetic population remained constant despite a considerable fall in the number of older people. During the study period infra-popliteal arterial bypass was introduced for the treatment of critical lower limb ischaemia and in diabetic patients the number of bypasses increased from 0 to 13/100000 population. The total number of revascularisation procedures in people with diabetes increased from 2.6 to 19.2/100000 population. Moreover, a multidisciplinary diabetic foot clinic was established. Conclusion/interpretation. A 75% reduction in the incidence of major amputations coincided with a sevenfold increase in revascularization procedures and the establishment of a multidisciplinary diabetic foot clinic suggesting these measures are important in the prevention of diabetic leg amputations.

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The morphological characteristic of tissue repair in patients with neuropathic and neuroischemic forms of diabetic foot syndrome

Diabetes Mellitus ◽

10.14341/dm7587 ◽

2015 ◽

Vol 18 (4) ◽

pp. 72-78 ◽

Cited By ~ 3

Author(s):

Ekaterina L. Zaitseva ◽

Ludmila P. Doronina ◽

Roman V. Molchkov ◽

Iya A. Voronkova ◽

Alla Y. Tokmakova

Keyword(s):

Diabetes Mellitus ◽

Granulation Tissue ◽

Diabetic Foot ◽

Tissue Repair ◽

Diabetic Foot Syndrome ◽

Inflammatory Infiltration ◽

Intense Staining ◽

Repair Processes ◽

Patients With Diabetes ◽

Immunohistochemical Studies

Aim. To evaluate the morphological and immunohistochemical features of granulation tissue formation in patients with diabetic foot syndrome.Materials and methods. We analysed the histological (light microscopy) and immunohistochemical (CD31, CD68, osteopontin, MMP-9 and TIMP-1) features of tissue repair processes in patients with diabetes mellitus. The study involved 63 patients with diabetic foot syndrome after surgical debridement.Results. We found severe intercellular oedema, poorly organised extracellular matrix, small amounts of fibroblast-like cells and expressed inflammatory infiltration, along with the presence of young granulation tissue. According to the results of the immunohistochemical studies, there were a moderate number of macrophages (immunopositive with antibodies to CD68), intense staining of MMP-9 and weak staining of TIMP-1 and osteopontin.Conclusion. According to the findings of the histological and immunohistochemical studies, tissue repair processes in patients with diabetes mellitus are decelerated.

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Critical limb ischaemia in diabetes: definition, assessment, prognosis

VASA ◽

10.1024/0301-1526.30.s58.21 ◽

2001 ◽

Vol 30 (Supplement 58) ◽

pp. 21-27

Author(s):

Luther

Keyword(s):

Diabetic Foot ◽

Laboratory Tests ◽

Critical Limb Ischaemia ◽

Limb Ischaemia ◽

Clinical Use ◽

Arterial Reconstruction ◽

Arterial Circulation ◽

Diabetic Foot Disease ◽

Foot Disease ◽

Fontaine Classification

In diabetic foot disease, critical limb ischaemia (CLI) cannot be precisely described using established definitions. For clinical use, the Fontaine classification complemented with any objective verification of a reduced arterial circulation is sufficient for decision making. For scientific purposes, objective measurement criteria should be reported. Assessment of CLI should rely on the physical examination of the limb arteries, complemented by laboratory tests like the shape of the PVR curve at ankle or toe levels, and arteriography. The prognosis of CLI in diabetic foot disease depends on the success of arterial reconstruction. The best prognosis for the patients is with a preserved limb. Reconstructive surgery is the best choice for the majority of patients.

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