Infections in feet of patients with diabetes mellitus is common, complex and costly. The aim of this study to investigate the isolated microorganisms in infected diabetic foot ulcers, and the impact of these infectious agents in limb loss in a tertiary medical center in Mexico City. We conducted a retrospective review in diabetic patients with infected foot ulcers from 1997 to 2014. Diabetic foot was defined according to the World Health Organization (WHO), the bacteriology of wound cultures and the impact of microorganisms in limb loss (major amputation) was studied. Patient's demographics, comorbidities, wound characteristics, and other factors associated in clinical outcomes were determined. A total of 165 subjects with soft tissue infections and/or osteomyelitis and positive cultures were included. One hundred and five (64%) were male, with a mean age of 60 year old +/- 15. One hundred fifty-nine (96%) had Type 2 diabetes mellitus, 68 (41%) history of peripheral arterial disease (PAD) and 97 (59%) patients had osteomyelitis. In 89 patients (54%), cultures were polymicrobial and one single organism was isolated in 76 cultures (46%). During the follow up, 96 (58%) patients preserved their limbs and 69 (42%) required major amputation (above or below knee). Sixty percent of patients that suffered from limb loss had polymicrobial culture (p = 0.13). Growth of Escherichia coli and Enterococcus faecium (p = 0.03) and E. coli and Morganella morgagnii (p = 0.03) was associated to limb loss. Among monomicrobial cultures, infections associated with Proteous mirabilis had higher rate of progression to limb loss (p = 0.03). PAD was associated to limb loss (p = 0.001). Management of diabetic foot requires a multimodality approach. In this study, in patients that received appropriate antibiotic therapy and optimal surgical management, we observed that history of PAD, polymicrobial and isolated P. mirabilis infections were variables associated with higher rate of limb loss.

A solitary fibrous tumor originates in the pleura with variable degrees of invasion. Hypertrophic osteoarthropathy, known as Pierre-Marie-Bamberger syndrome, is characterized by clubbing of the fingers due to bone surface and soft tissue calcification, historically known as a bronchogenic carcinoma paraneoplastic syndrome; however, a few cases have been associated with solitary fibrous tumors. We describe the case of a 38-year-old woman who presented with clubbing of the fingers. Studies revealed an intrathoracic fibrous tumor that was successfully treated with improvement in symptoms.

Nutcracker syndrome is uncommon, and a high index of suspicion is needed. Macroscopic haematuria is not always present, and in our case stent placement demonstrated effectiveness in the resolution of symptoms at 12 months' follow--up. We also present a brief review of the literature.

Despite revascularization, the limb was preserved in less than 50% of patients. Early referral to vascular surgery and appropriate patient-selection criteria might increase limb salvage.

Introduction: Diabetic foot is a common cause of hospitalization. Objective: To examine the impact of revascularization on lower limb salvage. Method: Retrospective study of diabetic patients with foot ulcers. The extent of tissue loss was assessed according to the PEDIS and Wagner classifications, and revascularization indications and techniques were evaluated. Factors involved with major amputation and limb salvage were assessed with Fisher's and chi-square tests. Results: A total of 307 patients with a mean age of 61 years were included in the study; 198 (64%) were males; 53 (17%) underwent limb revascularization, 26 (8%) with endovascular techniques and 27 (9%) with open surgery; 27 belonged to PEDIS grade 3 (51%) and 21 (41%) to Wagner's classification grade 4; 52% of revascularized patients required major amputation versus 25% of those without revascularization. Comorbidities, demographic variables, complications and mortality showed no differences when patients who required major amputation were compared with those who didn't. Conclusion: Despite revascularization, the limb was preserved in less than 50% of patients. Early referral to vascular surgery and appropriate patient-selection criteria might increase limb salvage.