A decision pathway for the staged management of foot problems in diabetes mellitus.

This review describes a decision pathway for the conservative management of foot problems in persons with diabetes mellitus. The decision pathway was developed by the Louisiana State University Health Sciences Center Diabetes Foot Program as part of the Statewide Diabetes Disease Management Initiative to standardize foot care in a medically underserved population. The pathway describes the prevention and/or management of foot problems through 5 clinical subpathways: injury prevention, warm swollen foot, ulcer, osteomyelitis, and remodeling. The pathway provides physiatrists and other rehabilitation practitioners with a framework to evaluate and manage neuropathic foot problems in a multidisciplinary setting.

Acute disseminated encephalomyelitis after accidental injection of a hog vaccine: successful treatment with plasmapheresis.

Acute disseminated encephalomyelitis, an inflammatory demyelinating disease of the central nervous system, can occur after viral infections or vaccinations. We report the clinical and neuroimaging findings in a 52-year-old man in whom acute disseminated encephalomyelitis developed after accidental self-injection of an industrial hog vaccine. The protracted and progressive clinical course, despite high-dose parenteral corticosteroid therapy, was altered by aggressive plasmapheresis.

Patent foramen ovale causing stroke in an elderly woman.

A patent foramen ovale (PFO) was fully documented as the cause of a cerebral infarction in a 78-year-old woman, with asymptomatic deep venous thrombosis and pulmonary embolism as secondary causes. The report is unique in view of the patient's age and lack of history or clinical evidence of cardiac or pulmonary disease, thromboembolic disease, or systemic embolism at or before the stroke. This case emphasizes the etiologic role of PFO in cryptogenic strokes even in elderly patients with no obvious clinical risk factors for paradoxical embolism.