0000000000142157
AUTHOR
Ernst Küstner
Sympathetic Vasomotor Response of the Radial Artery in Patients With Diabetic Foot Syndrome
OBJECTIVE—Neurophysiological assessment of the peripheral autonomic system is characterized by various limitations. An alternative approach to laser Doppler and venous plethymography is the assessment of the sympathetic vasomotor response of the radial artery obtained by continuous wave Doppler sonography. Nomogram data have been established and demonstrate the temporary disappearance of diastolic flow after coughing or deep inspiration. RESEARCH DESIGN AND METHODS—We assessed the sympathetic vasomotor response in 25 patients (mean age 64 years, range 43–76) with diabetic foot syndrome. The Doppler data were correlated with nerve conduction studies of the median and peroneal nerve, the exte…
Rheopheresis in patients with ischemic diabetic foot syndrome: results of an open label prospective pilot trial.
: Rheopheresis is a specific application of membrane differential filtration, synonymous with double filtration plasmapheresis, for extracorporeal hemorheotherapy. Safety and efficacy of Rheopheresis for wound healing and skin oxygenation were investigated in patients with ischemic diabetic foot syndrome. Eight patients with type 2 diabetes mellitus and non-healing foot ulcers caused by severe ischemic diabetic foot syndrome were treated by a series of seven Rheopheresis sessions in a time span of 11 weeks. Wound healing had not been detectable under conditions of standardized wound care during at least 2 months. Wound status was classified by its morphology, severity and location, accordi…
The impact of Syme amputation in surgical treatment of patients with diabetic foot syndrome and Charcot-neuro-osteoarthropathy
Charcot-neuro-osteoarthropathy with its severe destruction of bones remains a challenge for physicians and surgeons. The aim of the study was to characterise a patient population treated in a specialised foot care centre who underwent surgical treatment for their diabetic foot syndrome. Special attention was paid to patients who suffered from Charcot-neuro-osteoarthropathy and the impact of Syme amputation if amputation of the foot was inevitable. A total of 121 patients with diabetic foot syndrome and ulcerations underwent an interdisciplinary strategy for diagnostic and therapeutic procedures including MRI and surgical interventions. If peripheral arterial vessel disease was present, reva…
Diabetes and Peripheral Arterial Occlusive Disease
The purpose of this study was to compare contrast-enhanced three-dimensional MR angiography with conventional digital subtraction angiography (DSA) for identifying and evaluating arteries of the distal calf and foot in diabetic patients with severe arterial occlusive disease who will undergo distal bypass surgery.Twenty-four feet of 24 consecutive patients with diabetes and limb-threatening lower extremity ischemia were prospectively imaged using an ultrafast three-dimensional fast low-angle shot sequence on a 1.5-T MR scanner. All patients also underwent DSA of the diseased extremity within 5 days. Images were interpreted in a randomized manner by two observers in conference. Each lower ex…
Comparison of glycemic response and insulin requirements after mixed meals of equal carbohydrate content in healthy, type-1, and type-2 diabetic man
The postprandial insulin requirements after three mixed meals of equal carbohydrate and energy content were assessed in 10 type-1 and 12 type-2 diabetics by a glucose-controlled insulin infusion system. These were compared with the glycemic response to the same meals of 10 healthy individuals (glycemic index). In type-1 diabetics, we found the highest insulin requirements after consumption of a continental breakfast (low fibre, low protein, high fat). Ten percent less insulin was infused after milk (low fat, high protein) and 30% less after an English breakfast (high fibre, high protein). Type-2 diabetics showed no significant differences in insulin requirements between the three test meals…
Die interdisziplin�re Therapie des diabetischen Fu�syndroms
Noch immer werden in Deutschland 28.000 Amputationen/Jahr bei Patienten mit diabetischem Fussyndrom (DFS) durchgefuhrt.Bei gleichzeitig haufig vorhandener ischamischer und osteomyelitischer Komponente fuhrt ein operatives Vorgehen in der Regel zu Wundheilungsstorungen,Nachamputationen und oft auch Extremitatenverlust.Die Ergebnisse eines interdisziplinaren Therapieregimes werden evaluiert und im Literaturvergleich bewertet. Nach Diagnostik hinsichtlich des Vorliegens einer Polyneuropathie,Osteomyelitis und vor allen Dingen einer pAVK hat nach Infektkontrolle die primare distale Bypasschirurgie hochste Prioritat, ihr Erfolg ist richtungsweisend fur den weiteren Verlauf der Erkrankung.Die spa…
Interdisziplinäre Diagnostik und Therapie des ischämisch-osteomyelitischen diabetischen Fußsyndroms
Fortgeschrittene Stadien des diabetischen Fussyndroms (DFS) mit ischamischer und osteomyelitischer Komponente fuhren im Rahmen gangiger Versorgungsstrukturen regelhaft zur Minoramputation, gefolgt von ischamisch bedingter Wundheilungsstorung und Extremitatenverlust. Selbst in spezialisierten Behandlungseinrichtungen stellen periphere arterielle Verschlusskrankheit (pAVK) und Osteomyelitis die groste Herausforderung im Bemuhen um den Extremitatenerhalt dar. Wahrend die Behandlung von polyneuropathischen Fuslasionen in den Handen von Diabetologen zur erfolgreichen Domane der konservativen Medizin geworden ist, ist fur die Therapie von fortgeschrittenen, ischamisch und osteomyelitisch komplizi…
The influence of different generations of computer algorithms on diabetes control
With all control schedules, the management of diabetes is possible using Skyler's algorithm. In general, those control algorithms which do not allow the individual adaptation to changing conditions lead to overinsulinisation. So-called meal-related algorithms do usually minimise the fluctuations in blood sugar. The introduction of self-adapting algorithms, detecting peripheral insulin resistance, may further improve metabolic diabetes control.
Associations between type of treatment and illness-specific locus of control in type 1 diabetes patients
Abstract This study examined differences in diabetes-specific locus of control beliefs of 82 insulin-treated Type I diabetes patients undergoing either conventional therapy (CT), intensified conventional therapy (ICT) or continuous subcutaneous insulin infusion (CSII). Compared to CT with its adherence to a strict regimen, ICT and CSII allow a much greater flexibility in timing of meals and daily activities. On the other hand, such flexibility requires a much more active role of the patient. The hypotheses of higher internality and lower powerful others locus of control beliefs in ICT and CSII patients than in CT patients could be supported for powerful others locus of control only. A one-y…
Was misst der FKV?
Zusammenfassung. Theoretischer Hintergrund: Der Fragebogen zur Krankheitsverarbeitung (FKV-LIS; Muthny, 1989 ) ist ein im deutschsprachigem Raum häufig eingesetzter Fragebogen zur Messung von Krankheitsbewältigung. Fragestellung: Das Ziel der vorliegenden Studie ist die Überprüfung der Subskalen-Reliabilität und -Spezifität bei unterschiedlichen Erkrankungsgruppen. Methode: Die Gütekriterien der FKV-LIS Skalen werden bei Patienten mit chronisch-entzündlichen Darmerkrankungen (n = 1265), Typ-I-Diabetes (n = 552) oder Harnblasenkarzinom (n = 81) berechnet. Konvergente und divergente Trennschärfen der einzelnen Items werden analysiert. Ergebnisse: “Aktive Bewältigung“ und “Depressive Verarbei…