From 1990 to 1993, 115 diabetic patients were consecutively hospitalized in our diabetologic unit for foot ulcer and 27 (23.5%) major amputations were carried out. The major amputation rate of this series of cases was compared with that occurring in diabetic subjects taken into our hospital for foot ulcer in two previous periods: 1979-1981 (17 major amputations in 42 inpatients or 40.5%) and 1986-1989 (26 major amputations in 78 inpatients or 33.3%). The comparison shows a progressive reduction in major amputation rate [Odds ratio 0.66, 95% confidence interval (CI) 0.46-0.96]. Univariate and multivariate analysis, carried out in the population of the 1990-1993 period, in order to detect the independent factors associated with major amputation show the following prognostic determinants of major amputation: Wagner grade (odds ratio 7.69, CI 1.58-37.53), prior stroke (odds ratio 35.05, CI 3.14-390.53), prior major amputation (odds ratio 3.49, CI 1.26-9.38), transcutaneous oxygen level (odds ratio 1.06, CI 1.01-1.12), and ankle-brachial blood pressure index (odds ratio 4.35, CI 1.58-12.05), while an independent protective role was attributed to hyperbaric oxygen treatment (odds ratio 0.15, CI 0.03-0.64). In accordance with other studies, we, therefore, conclude that a comprehensive protocol as well as a multidisciplinary approach in a dedicated center can assure a decrease in major amputation rate. The parameters of limb perfusion were the modifiable prognostic determinants most strongly predictive for amputation.
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http://dx.doi.org/10.1016/s1056-8727(97)98004-1 | DOI Listing |
Vasc Med
January 2025
Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Foot ulceration is a significant and growing health problem worldwide, particularly due to rises in diabetes mellitus (DM) and peripheral artery disease. The prediction of ulcer healing remains a major challenge. In patients with foot ulcers, medial arterial calcification (MAC) can be present as a result of concomitant DM or chronic kidney disease and is a prognostic factor for unfavorable outcome.
View Article and Find Full Text PDFInt J Orthop Trauma Nurs
January 2025
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark. Electronic address:
Background: Patients undergoing major lower extremity amputation (LEA) due to vascular disease face an increased risk of post-surgery anxiety and depression. The Hospital Anxiety and Depression Scale (HADS), widely used to identify anxiety and depressive symptoms, has been translated into Danish, but its content validity has not previously been tested in LEA patients. This study aims to test the validity and reliability of HADS in this population.
View Article and Find Full Text PDFClin Rheumatol
January 2025
Rheumatology Unit, Scleroderma Unit, University Hospital of Modena, Via del Pozzo, 71-41125, Modena, Italy.
The aims of this study were to investigate the prevalence of cryofibrinogenemia in a cohort of patients with systemic sclerosis (SSc) regardless of clinical manifestations, who were admitted to our hospital and determine the associations among CF positivity, disease features and ongoing therapies. This was a monocentric and retrospective study. The inclusion criteria were a diagnosis of SSc (according to the ACR/EULAR 2013 classification criteria), regular administration of i.
View Article and Find Full Text PDFBMJ Open Diabetes Res Care
January 2025
Department of Surgery, Woodlands Health, Singapore
Introduction: To compare the clinical outcomes and healthcare utilization of patients enrolled in the multidisciplinary Diabetic Foot in Primary and Tertiary (DEFINITE) Care program with a matched historical cohort and estimate the program's long-term cost-effectiveness using simulation.
Research Design And Methods: This study consisted of two components: a 1-year observational outcome evaluation and a long-term simulation-based cost-effectiveness analysis (CEA). We conducted an observational study to analyze 2798 patients with diabetic foot ulcers (DFUs) enrolled in the program between June 2020 and June 2021 (DEFINITE Care group) and 5462 patients with DFUs from June 2016 to December 2017 as historical controls.
Int Heart J
January 2025
Department of Cardiology, Kameda Medical Center.
Current classifications of chronic limb-threatening ischemia (CLTI) are insufficient to identify Rutherford (R) 4 patients with a poor prognosis. This study aimed to investigate the prognostic factors for patients with R4 CLTI who undergo endovascular treatment (EVT) using data from the Tokyo-taMA peripheral vascular intervention research COmraDE (TOMA-CODE) registry and to propose a risk-scoring system. We analyzed the data of 2,248 prospectively enrolled patients from the registry, divided into 3 groups: intermittent claudication (IC), n = 1,185; R4, n = 401; and R5-6, n = 662.
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