RESUMO
A prospective, randomized study was conducted to determine the effect of biofeedback-assisted relaxation training on foot ulcer healing. For patients with chronic nonhealing foot ulcers, medical care was combined with a standardized biofeedback-assisted relaxation training program in the experimental group. The intervention was designed to increase peripheral perfusion, thereby promoting healing. A total of 32 patients with chronic nonhealing ulcers participated in the study. In the experimental group, 14 out of 16 ulcers (87.5%) healed, as compared with 7 out of 16 ulcers (43.8%) in the control group.
Assuntos
Biorretroalimentação Psicológica , Úlcera do Pé/fisiopatologia , Úlcera do Pé/terapia , Terapia de Relaxamento , Cicatrização , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Terapia Combinada , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Temperatura CutâneaRESUMO
Diabetic transplant recipients are at a high risk for foot pathology leading to amputation. This retrospective study from 1/85 to 2/95 examines the risk of foot complications in a population (n = 340) of diabetic renal and combined renal/pancreas transplant recipients. All groups suffered high lower extremity amputation and foot fracture rates. Patients with better circulation and protective sensation intact fared better. Smoking had a profoundly negative effect on the amputation rate as did an amputation prior to the transplant. Patients with pretransplant dialysis were at a higher risk for post-transplant amputation. Concomitant pancreas transplant did not in general significantly affect the risk of amputation or fracture. Females had almost twice the fracture rate of males.
Assuntos
Diabetes Mellitus/cirurgia , Doenças do Pé/etiologia , Transplante de Rim , Adulto , Amputação Cirúrgica , Complicações do Diabetes , Feminino , Seguimentos , Pé/irrigação sanguínea , Pé/inervação , Doenças do Pé/cirurgia , Traumatismos do Pé/etiologia , Fraturas Ósseas/etiologia , Humanos , Imunossupressores/uso terapêutico , Transplante de Rim/efeitos adversos , Masculino , Transplante de Pâncreas/efeitos adversos , Cuidados Pré-Operatórios , Pulso Arterial , Fluxo Sanguíneo Regional/fisiologia , Diálise Renal , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sensação/fisiologia , Fatores Sexuais , Fumar/efeitos adversosRESUMO
The case of a patient with diabetes mellitus and renal failure is presented and discussed. This case represents the very successful course of a diabetic patient who received peritoneal dialysis for 14 years. Not all patients with end-stage renal disease (ESRD) from diabetic nephropathy are this fortunate. The success and complications of dialytic modalities are discussed by a nephrologist and nurse dialysis coordinator. Renal transplantation, the preferred treatment for most diabetic ESRD patients, is discussed by a nurse transplant coordinator. Simultaneous pancreas kidney transplantation, with its potential benefits in the future is discussed by an experienced transplant surgeon. In addition, the psychosocial issues of renal failure, dialysis, and transplantation in the diabetic patient are addressed by clinical social workers. Lastly, the very important issue of foot care and treatment, and prevention of vascular-related morbidity is discussed by a practicing podiatrist. With such a multidisciplinary approach, medical and psychosocial outcomes can be optimized for diabetic patients with renal failure.
