A case of metastatic lung adenocarcinoma of the bladder in a patient with no documented history of lung cancer.

Metastatic lesions of non-urological malignancies to the bladder are rare and often secondary to spread from a contiguous site. Distant metastasis to the bladder is even more uncommon. There are less than 10 previously described cases of metastatic pulmonary adenocarcinoma to the bladder in the literature over the past 20 years.

Effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral artery disease: a systematic review.

Symptoms or signs of peripheral artery disease (PAD) can be observed in up to 50% of the patients with a diabetic foot ulcer and is a risk factor for poor healing and amputation. In 2012, a multidisciplinary working group of the International Working Group on the Diabetic Foot published a systematic review on the effectiveness of revascularization of the ulcerated foot in patients with diabetes and PAD. This publication is an update of this review and now includes the results of a systematic search for therapies to revascularize the ulcerated foot in patients with diabetes and PAD from 1980 to June 2014.

The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI).

Critical limb ischemia, first defined in 1982, was intended to delineate a subgroup of patients with a threatened lower extremity primarily because of chronic ischemia. It was the intent of the original authors that patients with diabetes be excluded or analyzed separately. The Fontaine and Rutherford Systems have been used to classify risk of amputation and likelihood of benefit from revascularization by subcategorizing patients into two groups: ischemic rest pain and tissue loss.

Use of negative pressure wound therapy to help facilitate limb preservation.

Because of changes in demography, non-communicable diseases cause more deaths worldwide than infectious disease for the first time in history. One of the most prevalent of these maladies is diabetes mellitus, which resulted in 4.6 million deaths in 2011.

Bypass grafts: the state of the art.

The treatment options for infra-renal arteriosclerotic occlusive (ASO) vascular disease have never been more varied. The history of open revascularization procedures now exceeds 60 years. This represents three generations of vascular surgeons, the most recent of whom have witnessed more than 30 years of endovascular surgery development and dissemination.

Diagnosis and treatment of peripheral arterial disease in diabetic patients with a foot ulcer. A progress report of the International Working Group on the Diabetic Foot.

The International Working Group on the Diabetic Foot (IWDGF) has produced in 2011 a guideline on the diagnosis and treatment of peripheral arterial disease in patients with diabetes and a foot ulcer. This document, together with a systematic review that provided the background information on management, was produced by a multidisciplinary working group of experts in the field and was endorsed by the IWDGF. This progress report is based on these two documents and earlier consensus texts of the IWDGF on the diagnosis and management of diabetic foot ulcers.

A systematic review of the effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral arterial disease.

In several large recent observational studies, peripheral arterial disease (PAD) was present in up to 50% of the patients with a diabetic foot ulcer and was an independent risk factor for amputation. The International Working Group on the Diabetic Foot therefore established a multidisciplinary working group to evaluate the effectiveness of revascularization of the ulcerated foot in patients with diabetes and PAD. A systematic search was performed for therapies to revascularize the ulcerated foot in patients with diabetes and PAD from 1980-June 2010.

External fixation techniques for plastic and reconstructive surgery of the diabetic foot.

Wound healing in high-risk patients with diabetes is often lengthy and fraught with complications. Techniques in plastic and reconstructive surgery of the diabetic foot continue to develop as a result of advances in external fixation. This article highlights the surgical aspect of the diabetic foot with an emphasis on the indications, advantages, technical pearls, and complications with use of external fixation as an adjunct to plastic and reconstructive surgery of the diabetic foot.

Toe and flow: essential components and structure of the amputation prevention team.

At the end of an anatomical peninsula, the foot in diabetes is prone to short- and long-term complications involving neuropathy, vasculopathy, and infection. Effective management requires an interdisciplinary effort focusing on this triad. Herein, we describe the key factors leading to foot complications and the critical skill sets required to assemble a team to care for them.

Toe and flow: essential components and structure of the amputation prevention team.

At the end of an anatomic peninsula, the foot in diabetes is prone to acute and chronic complications involving neuropathy, vasculopathy, and infection. Effective management requires an interdisciplinary effort focusing on this triad. In this article, we describe the key factors leading to foot complications and the critical skill sets required to assemble a team to care for them.

Digital planimetry results in more accurate wound measurements: a comparison to standard ruler measurements.

Background: Cutaneous wound measurements are important to track the healing of a wound and direct appropriate therapy. The most commonly used method to calculate wound area is an estimation by multiplying the longest length by the widest width. Other devices can provide an accurate and precise measurement of the true area (TA).

The role of interdisciplinary team approach in the management of the diabetic foot: a joint statement from the Society for Vascular Surgery and the American Podiatric Medical Association.

The Society for Vascular Surgery (SVS) and the American Podiatric Medical Association (APMA) recognize the beneficial impact of a multidisciplinary team approach on the care of patients with critical limb ischemia, especially in the diabetic population. As a first step in identifying clinical issues and questions important to both memberships, and to work together to find solutions that will benefit the shared patient, the two organizations appointed a representative group to write a joint statement on the importance of multidisciplinary team approach to the care of the diabetic foot.

The role of interdisciplinary team approach in the management of the diabetic foot: a joint statement from the Society for Vascular Surgery and the American Podiatric Medical Association.

The Society for Vascular Surgery (SVS) and the American Podiatric Medical Association (APMA) recognize the beneficial impact of a multidisciplinary team approach on the care of patients with critical limb ischemia, especially in the diabetic population. As a first step in identifying clinical issues and questions important to both memberships, and to work together to find solutions that will benefit the shared patient, the two organizations appointed a representative group to write a joint statement on the importance of multidisciplinary team approach to the care of the diabetic foot.

Defining success in clinical trials of diabetic foot wounds: the Los Angeles DFCon consensus.

Regulatory requirements for new products should be guided by clinical trials that protect the public by a thorough evaluation of safety and efficacy, while not creating unnecessary barriers to their development and ultimate approval. While healing a wound is the ultimate goal of treating an individual with a diabetic foot ulcer, achieving this goal is physiologically complex requiring the initiation and interaction of many events and therefore unlikely to be achieved by one compound. We believe that developing new, more meaningful, study outcomes or end points in wound care trials would both aid in determining the true efficacy of wound management modalities and facilitate the product development cycle.

Consensus statement on negative pressure wound therapy (V.A.C. Therapy) for the management of diabetic foot wounds.

Unlabelled: In 2004, a multidisciplinary expert panel convened at the Tucson Expert Consensus Conference (TECC) to determine appropriate use of negative pressure wound therapy as delivered by a Vacuum Assisted Closure device (V.A.C.

Infragenicular polytetrafluoroethylene bypass with distal vein cuffs for limb salvage: a contemporary series.

Hypothesis: Infragenicular polytetrafluoroethylene (PTFE)-venous cuff bypass grafting provides acceptable graft patency and limb salvage rates for limb salvage.

Design: Retrospective clinical review of a consecutive series.

Setting: Vascular surgical practice during the interval October 1, 2000, to September 1, 2004.

Diagnostic and therapeutic arterial interventions in the ulcerated diabetic foot.

Whether diabetic foot ulcerations arise from an amalgam of neuro-ischemic factors or because of arterial occlusive disease alone, the arterial circulation must be thoroughly evaluated. Clinical evaluation is foremost, but numerous non-invasive diagnostic options such as duplex ultrasonography and MRA are often enlisted. Contrast arteriography remains unrivaled for delineating the causative occlusive lesions and the possibilities for arterial reconstruction.

Modified alpha wrap techniques for dynamic urethral graciloplasty in an animal model.

Urethral sphincter reconstruction with a stimulated skeletal muscle flap has been used for treatment of severe intrinsic sphincter deficiency. Urethral strictures and failures were reported in some of the initial experiences. The etiology of these problems is not known, but elevated resting urethral pressures and excessive urethral displacement with stimulation are possible causes.

Urodynamic verification of noninvasive back-pressure recordings from the urinary bladder.

Obstructive voiding is best evaluated with urodynamics, especially simultaneous measurement of bladder-pressure and urine flow rates. As an alternative to catheterization for urodynamics, noninvasive back-pressure methods using an external condom system have been introduced. This device uses one side tube in the condom for pressure recording and an outlet tube that is clamped for short periods of time during voiding.