ABSTRACT
OBJECTIVE: To describe the procedure and outcomes of metatarsal excision in seven patients treated for osteomyelitis in the diabetic foot. RESULTS: Average age was 60.6 (48-83) years. The mean length of hospital stay was 33.5 (3-50) days (excluding one patient who died from hospital acquired pneumonia). All remaining patients had negative wound cultures after a mean 7.4 (0-20) days of antibiotic treatment after procedure and were discharged from hospital 16.9 (2-48) days after surgery. Two patients developed wound infections after discharge. Pre-operative levels of mobility were achieved within a mean of 12.6 days (range 2-40). CONCLUSIONS: In diabetic patients, metatarsal excision may be better than transmetatarsal amputation.
Subject(s)
Diabetic Foot/surgery , Metatarsus/surgery , Orthopedic Procedures/methods , Osteomyelitis/surgery , Adult , Aged , Aged, 80 and over , Diabetic Foot/complications , Female , Humans , Length of Stay , Male , Middle Aged , Osteomyelitis/etiology , Treatment OutcomeABSTRACT
Schizophrenia has long been associated with abnormal patterns of arousal that are thought to reflect disturbances in the reticular-activating system of the brain. Psychophysiological investigations of sensory responsivity have repeatedly demonstrated reduced reactivity and habituation to moderately intense stimuli in patients with schizophrenia. While not traditionally used as a measure of physiological arousal, the startle reflex represents an alternative method for studying reactivity and habituation in schizophrenia. This study examined eye blink responsivity to a repeatedly presented intense acoustic startle probe in men with chronic schizophrenia and healthy normal controls. Subjects' personality profiles were also measured, as increased reactivity and arousal have been traditionally implicated as a physiological component to the personality trait of neuroticism. Results indicated that schizophrenic subjects did demonstrate significantly reduced rates of habituation to the acoustic startle probe and higher scores on measures of neuroticism in comparison to normal controls. However, no correlation between habituation rate and neuroticism emerged. These studies replicate previous findings of habituation in schizophrenia and provide further evidence for sensory reactivity disturbances in schizophrenia. The relationship of these findings to cognitive disturbances in schizophrenia is considered and directions for future research are discussed.
Subject(s)
Arousal/physiology , Blinking/physiology , Habituation, Psychophysiologic/physiology , Personality Inventory , Reflex, Startle/physiology , Schizophrenia/physiopathology , Schizophrenic Psychology , Acoustic Stimulation , Adult , Chronic Disease , Electromyography , Female , Humans , Loudness Perception/physiology , Male , Middle Aged , Personality Inventory/statistics & numerical data , Psychiatric Status Rating Scales , Psychometrics , Psychophysiology , Schizophrenia/diagnosis , Statistics as TopicABSTRACT
Subjects with hypertension are hyperinsulinemic and resistant to insulin-stimulated glucose uptake. A similar paradigm is found in the spontaneously hypertensive rat (SHR). These findings suggest the possibility that insulin resistance and hyperinsulinemia may play an important role in blood pressure regulation. Pioglitazone, a thiazolidinedione derivative, sensitizes target tissues to insulin and decreases hyperglycemia and hyperinsulinemia in various insulin-resistant animals. The purpose of this study was to assess the influence of pioglitazone administration on pre- and postprandial glucose and insulin concentrations and determine whether changes in beta-cell secretion resulted in any change in blood pressure measurements. Twelve SHR were fed custom diets ad libitum, six with and six without pioglitazone (20 mg/kg chow). Fasting and postprandial glucose levels were unaltered by pioglitazone treatment. Fasting insulin concentrations were similar at week 1, but were significantly lower (P < .01) in the pioglitazone group at weeks 3 (1.89 +/- 0.3 v7.94 +/- 1.5 ng/mL) and 4 (4.5 +/- 1.4 v9.1 +/- 0.7 ng/mL), compared with the control group. Pioglitazone also significantly (P < .01) lowered postprandial insulin concentrations after an oral glucose challenge. Systolic, mean, and diastolic blood pressures were significantly lower (P < .01), 177 +/- 3 v190 +/- 4.7 mm Hg, 162 +/- 2.1 v175 +/- 5.9 mm Hg, and 156 +/-2.1 v168 +/- 6.2 mm Hg, respectively, in the animals receiving pioglitazone versus the control group. Heart rate, body weight, serum cholesterol, and triglyceride levels were comparable between the two groups. In conclusion, pioglitazone significantly decreased fasting and postprandial insulin concentrations and effectively lowered blood pressure in the SHR.