Management of patients hospitalized for diabetic foot infection: results of the French OPIDIA study.

Aim: This study was an analysis of how diabetic patients with infected foot wounds are managed in hospital by departments specializing in diabetic foot pathology, including an evaluation of the outcome 1 year after discharge.

Methods: This was a prospective study of a cohort of patients hospitalized for diabetic foot infection at 38 hospital centres in France and followed-up for 1 year after discharge.

Results: Altogether, 291 patients were included (73% male; 85% type 2 diabetes; mean age: 64.

[Peripheral vascular disease and diabetic foot].

Peripheral vascular disease is one component of the diabetic foot. Diabetic patients should be assessed for lower limb arterial disease resulting from the high prevalence of this complication. Medical management includes the treatment of vascular risk factors, anti-thrombotic agents, and walking rehabilitation.

[Transient neurological symptoms in puerperas after epidural analgesia during labor].

The investigation was undertaken to elucidate the impact of epidural analgesia (EA) during labor on the incidence of transient neurological symptoms (TNS). By the agreement of a local ethics committee, an informed consent was obtained from 90 healthy puerperas enrolled in the investigation. The patients were randomized into 3 groups, with 30 patients in each.

[Necessary multidisciplinary management of diabetic foot].

The pathogenesis of diabetic foot is multifactorial and optimal management requires a multidisciplinary team. In most cases, the diabetic foot complication is seen as a wound subsequent to trauma, less often as an acute neuroarthropathy or cellulitis without any apparent skin lesion. Patients look for medical care more or less rapidly, depending on the information received previously concerning foot problems.

[Transcutaneous oxygen pressure (TcPO2): advantages and limitations].

The measurement of transcutaneous oxygen pressure (TcPO2), a non-invasive method to quantify skin oxygenation, is particularly useful in advanced stages of arteriopathy of the lower limbs for evaluation of cutaneous ischaemia. It is a predictive factor for spontaneous healing when pressure is above 30 mmHg or, on the contrary, of an unfavourable course when pressure is less than 10 mmHg. Dynamic tests (change in limb position, exercise test, induced ischaemia test, O2 inhalation) have been used to improve prognostic value for measurements between 10 and 30 mmHg.

Minimal model for determination of insulin sensitivity: repeatability in control and obese subjects.

A mathematical model was recently developed (minimal model) to estimate insulin sensitivity from the analysis of blood glucose and insulin concentration after a modified intravenous glucose tolerance test. This approach was successfully compared with the euglycemic glucose clamp in humans. In this study, we have analysed the distribution and reproducibility of this method in 10 healthy subjects and seven obese patients.

Lower-extremity arterial disease in diabetes mellitus due to chronic pancreatitis.

Objective: To determine the prevalence of lower-extremity arterial disease and the sites of arterial obstruction in patients with pancreatic diabetes.

Patients And Methods: The retrospective study included 83 patients with diabetes due to chronic pancreatitis (age [m +/- SD] 54.5 +/- 9.

[Medical and surgical management of septic diabetic foot].

Infected wounds in diabetic patients are still frequent and the main cause of amputations. The experience of 180 patients admitted for foot lesions between june 1988 and september 1993 shows us the importance of combined medical and chirurgical cares. Non invasive vascular evaluation is reliable and often sufficient for preoperative vascular assessment.

[Medical treatment of diabetic arteriopathy].

Medical care of arteriopathy of leg in a diabetic patient involves control of diabetes combined with a series of non specific measures applicable to all atheromatous arteriopathies. Allowance must be made for the often silent nature of the arterial lesion, explicable by the associated peripheral neuropathy and the site of the lesions, generally more distal or staged than in non diabetics. A stable blood sugar level must be obtained to provoke improvement in hemorrheologic parameters and to slow the atheromatous process.

[Classification of primary dyslipoproteinemias].

The prevention of atherosclerosis implies a better knowledge of dyslipoproteinemias. The metabolic disease must first be defined before considering its treatment and evaluate the atherogenic risk. The clinician must take advantage of two different classifications.

[Diet therapy of hypercholesterolemia. From theory to practice].

Hypercholesterolemia, quite frequent in industrialized countries is a major risk factor of atherosclerosis, especially in the coronary arteries. Consensus conferences, in the United States as well as Europe, have established a practical approach to this field. The dietetic treatment, from a population standpoint, remains the corner-stone of the treatment of primary dyslipoproteinemias.

Visual evoked potentials in diabetic patients.

Visual evoked potentials (VEPs) were assessed in 50 adult type I (insulin-dependent) and 19 type II (noninsulin-dependent) diabetes mellitus patients and in 54 controls. P100 wave latency was significantly longer in diabetic patients (P less than .001).

Reliability of self-monitoring of blood glucose by CSII-treated patients with type I diabetes.

The reliability of patient-generated data from self-monitoring of blood glucose (SMBG) was studied in 14 patients with type I (insulin-dependent) diabetes mellitus treated by continuous subcutaneous insulin infusion (CSII) (7 women, 7 men). The reflectance meters (Glucometer I, Ames, Elkhart, IN) used by the patients were replaced for a period of 21 days by memory-reflectance meters; patients were unaware of the memory capacity of the new meters and were instructed to continue their practice of recording the meter readings in their logbook. This study compares the data recorded in the memory-reflectance meters with those reported in the logbook.

[Impotence in the diabetic].

Two-hundred-and-two impotent diabetic patients gave their consent to be investigated. Impotence is linked to diabetes mellitus in 58.9% of patients so all the other etiologies have to be systematically eliminated.

[Holter erectometry. A new approach to erectile disorders].

A Holter-type portable computerised electronic system for measurement of the apparent volume of the penis, eye movements and heart rate over 12 hours, enables investigation of erectile disorders by the patient himself, under more physiological conditions at home. Data processing and ease of use will permit scientific use on a large scale.