Background: Foot complications are the major reason for hospital admission among diabetic patients. Natural Honey is proposed as an alternative dressing for a variety of wounds including diabetic foot ulcers, pressure ulcers, ostomy wound and central vein catheter exit wounds. Main observations:We report a case of a 50-year-old diabetic man with an erosive -bullous eruption and hyperemia and second degree burns of both feet following the wearing of a new pair of leather sandals and the immersion of both feet in hot water whirlpool. The patient was treated with Natural Honey impregnated cotton gauzes on a daily basis and the lesions have healed after six weeks. Conclusion:The use of Natural Honey is effective in treating allergic contact dermatitis complicated by a second degree thermal burn in a diabetic patient and offers a natural and cost effective alternative to expensive wound dressing material.

Charcot Arthropathy in the diabetic foot can result in permanent deformity if not diagnosed and treated promptly. We report four diabetic patients in whom the diagnosis of neuropathy was delayed by up to six months, with misdiagnoses including deep venous thrombosis, cellulitis, gout and ankle sprain. In all cases, the clinical scenario and appearances were typical of charcot arthropathy. Fortunately, only minor deformity occurred in one patient. A higher index of suspicion for the possibility of charcot foot is needed. Copyright © 2004 John Wiley & Sons, Ltd.

with pustule palmar psoriasis (Figure 1), on her feet, showing numerous small flat pustules (2-3 mm in diameter), yellowish in color, on an erythematous basis.

A 34 year old woman presented at outpatients with a four month history of dull left iliac fossa pain associated with a vague mass. There was no past medical or family history of note and all blood tests, including liver function tests and tumour makers, were normal. Ultrasound revealed a subcutaneous lipoma in the region of the abdominal mass but, in addition, multiple hyperechoic lesions in the liver. Urgent computed tomography and magnetic resonance imaging scans of the abdomen were performed to characterise these multiple liver lesions (figs 1, 2). Figure 1 Computed tomography (CT) with contrast shows low attenuation lesions in the liver and a mass within the left kidney, with some low attenuation within it (fat is dark on CT). Figure 2 The two magnetic resonance imaging sequences are of the same slices of the liver (marked by the arrow 1) and kidney (marked by the arrow 2) lesions with (A) T1 weighted (T1W) image without fat suppression and (B) T2 weighted image without fat suppression. The lesions contain both fatty and non-fatty elements, as indicated by the high signal intensity of the lesions in the T1W without fat suppression which indicates fat (A), and the high signal intensity on the T2W without fat suppression (B) indicates abundant free water-that is, non-fatty elements. 983 www.gutjnl.com Questions

The case is presented of a 74-year-old lady with type 1 diabetes of 42 years' duration, who had recurrent diabetes-related hospitalisations. These were due to both hypo-and hyperglycaemic emergencies and, over the last 20 years, 41 such admissions (2.0 per year) had occurred -56% hypoglycaemic, 27% diabetic ketoacidosis (DKA), and 17% with non-ketotic hyperglycaemia. There was a close relationship between social and family crises and admissions. This patient demonstrates the unusual syndrome of 'elderly brittle diabetes'. The mixed metabolic picture is typical of this syndrome, but the psychosocial impact on hospital admission is more commonly seen in younger female brittle patients with recurrent DKA.