Diabetic neuropathy and peri operative period in general surgery: about 164 cases

The objective of our study is to evaluate the morbidity of diabetic neuropathy, during peri operative time in a general surgery unit. This retrospective study was conducted between January 2002 and December 2004 in the Military Hospital Mohamed V in Rabat. All diabetic patients with a diabetic neuropathy and who had surgery were included [164 upon 516 diabetic patients]; mean age is 54.6 +/- 10.2 years and type 1 diabetes was present in 56% of the cases. The diagnosis of diabetic neuropathy was based on a careful clinical examination. A distal and symmetrical neuropathy was found in 91% of the cases; a proximal and symmetrical neuropathy in 10% and a diabetic foot in 68%. In these patients, neuropathy was associated to hypertension [29%], to renal insufficiency [9%] and to cardiac disease 4%. Diabetic neuropathy was significantly associated to a higher hospitalization duration [p<0.05] and to a higher postoperative incidence of infection

Infection in diabetic patient in emergency

This retrospective study was conducted to evaluate the place of infection in diabetic ketoacidosis in an emergency unit. It included 214 patients who were admitted for ketoacidosis and in whom an infection was identified. The infection was present in almost all patients and it seemed to be the direct cause of decompensation in 41%. The diagnosis was made on the clinical signs and the biological evaluation. On the 112 urinalysis performed, 45 were positive and on the 43 hemocultures, 9 were positive. An empirical antibiotherapy was started on admission in 88 cases. Thirty four patients had a severe sepsis of whom 21 developed a septic shock and 13 [6%] were transferred to the Intensive Care Unit; 4 patients died [1.9%]. We found a strong correlation between the initial presence of infection and the occurrence of at least one organ dysfunction [p=0.0001]