The effects of peripheral vascular disease with osteomyelitis in the diabetic foot.

BACKGROUND: Osteomyelitis in the diabetic foot is a difficult problem with multiple etiologies. The effects of peripheral vascular disease, neuropathy, and repetitive trauma all interact to produce complex lesions with exposed bone, surrounding cellulitis, and gangrenous changes. METHODS: We performed a retrospective study over a 14-year period at a community hospital looking at osteomyelitis in the diabetic foot. We looked at the contributing factors, organisms involved, most common locations, physical findings, and surgical procedures necessary to treat this condition. The purpose of the study was to determine the incidence and effect of peripheral vascular disease in diabetic patients with foot ulcers. RESULTS: There were a total of 150 patients requiring 278 hospitalizations over the 14-year period who represented 14% of all diabetic admissions. A total of 438 surgical procedures were necessary in these patients, with the most common being debridement (39%) and toe amputation (19%). There were 6 deaths (4%) in this series, and leg amputation was necessary in 21 patients (14%). A vascular bypass was necessary for healing and limb salvage in 36 patients (24%). Most of the bypasses (85%) were with autogenous tissue to the distal leg in order to limit the extent of amputation and to preserve a functional limb. CONCLUSION: Ischemia is often a contributing factor in the diabetic foot ulcer that must be recognized and treated to avoid prolonged hospitalization, spreading infection, and unnecessary amputation.

A structural and relational approach to handwritten word recognition.

In this paper, we present a new off-line word recognition system that is able to recognize unconstrained handwritten words using grey-scale images. This is based on structural and relational information in the handwritten word. We use Gabor filters to extract features from the words, and then use an evidence-based approach for word classification. A solution to the Gabor filter parameter estimation problem is given, enabling the Gabor filter to be automatically tuned to the word image properties. We also developed two new methods for correcting the slope of the handwritten words. Our experiments show that the proposed method achieves good recognition rates compared to standard classification methods.

Use of magnetic resonance imaging and P-31 magnetic resonance spectroscopy to detect and quantify muscle dysfunction in the amyopathic and myopathic variants of dermatomyositis.

OBJECTIVE: To investigate the use of magnetic resonance imaging (MRI) and P-31 magnetic resonance spectroscopy (MRS) in characterizing the metabolic and functional status of muscles in patients with amyopathic dermatomyositis (DM) and to compare the findings with those in patients with classic myopathic DM. METHODS: Nine patients with amyopathic DM, 11 patients with myopathic DM, and 11 normal individuals were studied. MRI images of thigh muscles were obtained, and T1 and T2 relaxation times were calculated. Biochemical status was quantitated with P-31 MRS, by determining concentrations of phosphate metabolites during rest and exercise. RESULTS: Patients with amyopathic DM showed no muscle inflammation, and MRS data obtained during rest were normal. During exercise at 25% and 50% maximum voluntary contractile force, the MRS data revealed significant differences between amyopathic DM patients and control subjects indicating inefficient metabolism. In contrast, muscles of patients with myopathic DM showed inflammation and metabolic abnormalities even during rest. CONCLUSION: Metabolic deficiencies in patients with amyopathic DM were unmasked by exercise, suggesting that the 2 DM syndromes may share muscle abnormalities. MRI/MRS may be useful in diagnosis and optimization of treatment.

Influence of constant and oscillating dissolved oxygen concentrations on keto acid production by Gluconobacter oxydans subsps. melanogenum.

Gluconobacter species are known to oxidise glucose via a direct oxidation pathway which is distinct from the pentose phosphate pathway. In the present communication results of an investigation on the influence of different dissolved oxygen concentrations (DO) on the production of 2,5-diketogluconic acid in batch and chemostat cultures are given. DO of 30% relative to air at 1 bar was found as a threshold level for optimum productivity. The positive influence of continuous availability of dissolved oxygen on the process of rapid glucose oxidation was unambiguously shown as the result of induction of membrane bound dehydrogenases involved in direct glucose oxidation. Furthermore data of scale-down experiments in which the organism was cultivated under oscillations of dissolved oxygen, are given. The influences of such oscillations of DO in the region of the established threshold (30% saturation) were found to result in a prolonged lag phase for growth and product formation. The data obtained in this study revealed critical residence times at low DO that could be employed as a criterion for scale up of this aerobic process.

[Preoperative anxiety--anxiety about the operation, anxiety about anesthesia, anxiety about pain?]. / Präoperative Angst--Angst vor der Operation, Angst vor der Narkose, Angst vor Schmerzen?

Questioning for the content of presurgical anxiety a situative examination of different contents of anxiety was performed combined with a correlational analysis of problem relevant personality traits (Freiburger Personality Inventory, FPI; Eigenschaftswörterliste, EWL). Preoperatively the anxiety in young patients is higher than it is in old ones, women anticipating thoracotomy name the highest anxiety scores. Generally the anxiety before important surgery is higher than before operations, which are calculated as being not so impressive; women show higher anxiety than men. Postoperatively anxiety does not decrease, but remains nearly unchanged, but very high scoring anxiety preoperatively turns back to low scoring postoperatively. From the contents of anxiety that of mutilations by surgery ranges firstly in major surgery, followed by anxiety of unreversible lost of consciousness by anesthesia, in "minor surgery" this ratio is turned back, here anxiety of complicated anesthesia ranges firstly. With growing age anxiety of mutilation by surgery becomes apparent. The informations about anxiety are related to content of anxiety, rarely to other variables, which were examined together with. The information is correlated to the personality traits, esp. to extraversion-introversion and emotional lability/stability, both are similarly correlated with pain, but not to postoperative complications. The idea that preoperative anxiety may reactively induce postoperative complications cannot be supported by the results.