It is estimated that around 347 million people in the world are diagnosed with diabetes mellitus. 1 Indian is one of the country with very high prevalence of diabetes in the world which is predicted to increase to 120.9 million by 2030. 2 It is estimated that approximately 23.6 million people in United States have diabetes mellitus. 3 It is predicted that 1 in 3 American adults will have diabetes by 2050. 4 Diabetes affect 3% of the UK population. 5 Diabetic foot is one of the most common and distressing complication of diabetes. This devastating complication has major medical, social and economic consequences. 5 Around 15% of diabetic patients will develop foot ulcer during their life time. 6 Around 6% of hospital admission in people who have diabetes are related to foot ulcers. 7 Every year 5% of the patients with diabetes will develop a foot ulcers. 5 Foot ulcers are known to carry a 25% risk of major amputation. Diabetic foot ulceration is known to precede amputation in 85% of the cases. 8 Around 40% of the patients presenting to hospital with diabetic foot will require some form of amputation. 9 In ABSTRACT Background: Aim of current study was to analyse major amputation occurring in patients with diabetic foot complication through the new principle and practice of diabetic foot. Methods: A 5 year retrospective study was done in a single surgical unit in department of surgery of St John's medical college, Bangalore, India. Results: 26 patients were included in this study. 76.9% of the patients who underwent major amputation had type 1 diabetic foot complications. Infected ulcers were the most common cause for major amputation. Most patients who underwent major amputation had a score ranging from 16-20. 11.54% of the patients who underwent major amputation had osteomyelitis with type 3C diabetic foot osteomyelitis being most common. Conclusions: This unique study for the first time utilizes the new Amit Jain's principle and practice of diabetic foot to study major amputation in diabetic foot. Majority of the patients who undergo major amputation in India has type 1 diabetic foot complication. Most of the patients undergoing major amputation belongs to the high risk category for major amputation.

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A 78-year-old man presented to the accident and emergency department with a 12-hour history of sudden onset, rapidly progressive swelling of the scrotum followed by collapse. He was clammy (temperature: 36º Celsius), tachycardic (110/ min) and hypotensive (90/60mmHg). There was no history of trauma to the scrotum. The patient was on anticoagulants for a metallic valve replacement but the international normalised ratio (INR) on admission was only 1.08.A pelvic x-ray did not show a fracture or any other bony pathology but only mild degenerative joint changes. Ultrasonography showed a large haematoma in the scrotum. Post-contrast computed tomography (CT) revealed a large (15.0cm x 12.2cm x 9.7cm) right-sided haematocoele of mixed attenuation consistent with acute haemorrhage and evidence of extravasation of contrast (sign of active bleeding) at the superior pole of the haematocoele (Fig 1A). There was no evidence of any abdominal, pelvic or testicular pathology. The left testicle was displaced further laterally along with displacement of the posterior urethra ( Fig 1B). The right testicle could not be visualised on either CT or ultrasonography.Emergency scrotal exploration was carried out on account of an expanding tense scrotal haematoma (Fig 2A), a significant drop in haemoglobin levels (from 12g/dl to 8g/ dl) on serial monitoring over six hours and signs of haemorrhagic shock. There was an extensive haematoma in the layers of the scrotal wall, septum and tunica vaginalis. There was minimal reactive hydrocoele of the tunica with a non-traumatised testis but considerably contused cord structures. A litre of haematoma was evacuated and an inguinal orchidectomy was performed because of the contused cord structures (Fig 2B), thereby removing any possible or potential source of intrascrotal bleeding. Histology revealed normal cord structures, epididymis and testis with no evidence of malignancy. DiscussionAcute scrotal haemorrhage with haematoma formation is a rare phenomenon and a non-traumatic scrotal haematoma presenting with haemorrhagic shock is even rarer. Scrotal haemorrhage is characterised by sudden onset of pain, swelling and mass in the scrotum. It has been misdiagnosed as torsion of the testis, a spermatic cord tumour and an incarcerated hernia. [1][2][3][4][5][6] Spontaneous haemorrhage can occur in all organ systems and is frequently the cause of diagnostic difficulties. Scrotal haematomas caused by haemorrhage in the spermatic cord, 1 varicocoeles 2 and adrenals 3 have been reported in the literature. Within the spermatic cord, bleeding has been associated with Henoch-Schönlein syndrome, 4 trauma and, occasionally, anticoagulant therapy.5 Sometimes other conditions such as lipomas 6 masquerade as scrotal haematomas. A non-traumatic, acutely expanding scrotal wall haematoma leading to haemorrhagic shock has not been described previously.This case report also highlights that although CT can be a very useful diagnostic tool, it does have limitations. In this instance, CT suggested a right haematocoele, ra...

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To analyze diabetic foot patients treated in surgical ward of tertiary care teaching hospital and evaluate the surgical outcomes. Methods & Materials: A descriptive retrospective analysis was carried out in Department of Surgery of St John's Medical College, Bangalore, India. The study period was from July 2014 to December 2014. Statistical analysis was done using SPSS 18.0. The study was approved by the institution ethics committee. Results: A total of 30 male patients were studied. Right foot was most commonly affected in 63.5% of the cases. Type 1 diabetic foot complications were the most common complications in this study accounting for 76.7% followed by type 3 diabetic foot complication (20%). The most common lesion seen was Wet gangrene (40%) followed by abscess (20%) both of which accounted for 60% of the cases and belonged to type 1 diabetic foot complication (P<0.001). Toe amputation was the commonest surgical procedure done. Wet gangrene accounted for 50% of amputation (P=0.017, statistically significant). Most cases were operated by junior team members of the surgical units. There was one mortality in this study. Conclusion: Diabetic foot is a serious complication of diabetes mellitus and is often a neglected entity. Our study showed that Amit Jain's type 1 diabetic foot complication, which are acute in nature and infective complication, are the most common cause of hospitalization in teaching hospital. Majority surgeries are performed on them in late evening as emergencies.