The Therapeutic Attitude in Treating Lesions of the Arteriopathic Predominant Diabetic Foot

Abstract

Background. The diabetic foot is a complex pathologic entity that includes modifications occurred at the foot level, which can be found either at the layer of nerve, skin, bone or muscle tissue, either on blood vessels. A special issue is that of tardiness in coming to the doctor in such patients that have severe lesions, for the most part requiring the performance of a minor or major amputation, long periods of treatment and permanent social assistance. Data from the medical literature are showing that early and adequate care given to diabetic foot lesions may prevent amputation of the injured limb in as many as 80% of cases. The aim of the research is to clarify the surgical indication for the arteriopathic predominant diabetic foot lesions. Material and methods. A retrospective analysis was performed on a number of 320 predominantly arteriopathic diabetic patients, from the case records of the Cantacuzino Hospital, "I.Juvara" Surgery Clinic, taking into account all aspects related to the compensation and evolution of the diabetic disease, as well as the study of diabetic foot lesions, the surgical therapeutic attitude and the results obtained.Results. An examination of the obtained results reveals the fact that a large number of amputations were performed in 93% of cases (298 patients), of which minor amputations (transphalangeal, transmetatarsal, toe/s and foot) accounted for 69% of cases (220 patients), and major amputations (lower leg and upper leg) accounted for 24% of cases (78 patients). For the rest of the patients, excisional debridements were performed, accompanied by complementary therapy, namely done by applying local topicals. The post surgery evolution has been unfavourable in 7% (22 patients) of the transphalangeal amputation cases, in 16% (51 patients) of the toe amputation patients (transmetatarsal toe/s) and in 4% (13 patients) of the transmetatarsal foot amputation cases, the surgical solution has consisted of a major amputation. Conclusions. The arteriopathic terrain of the diabetic patient, evaluated with the ankle-brachial index, is a major factor in determining the evolution towards amputation.

Engineered Ultrasmall Nanoparticle Drug‐Immune Conjugates with “Hit and Run” Tumor Delivery to Eradicate Gastric Cancer

“…An optimal dose for efficacy studies was determined on the basis of the median lethal dose (or LD 50 ), or the dose at which 50% of animals experience mortality. [ 89 ] In addition, the dose of a drug required to elicit the desired pharmacological effect (i.e., 50% reduction of the maximum tumor volume loss) in 50% of animals, or median effective dose (ED 50 ), [ 90 ] was determined by fitting a sigmoidal mathematical function (Excel, Microsoft, Redmond, WA) to the dose‐response data (i.e., normalized tumor volume vs drug dose) 4 days after the final particle dose. Such functions were commonly used to model pharmacological dose‐response data.…”

“…Such functions were commonly used to model pharmacological dose‐response data. Based on the fitted sigmoidal function, the ED 50 was determined and the therapeutic index computed (i.e., the ratio of TD 50 to ED 50 ) [ 89 ] for these preclinical studies.…”

“…[69,70] Multiple endpoint criteria were specified to capture the following target and off-target biological responses of the C′ dot drug-immune conjugate: i) high tumor activityconcentrations, ii) target-specific tissue penetration and distribution, iii) therapeutic index indicating a wide safety margin, and iv) high treatment efficacy. For the first endpoint, specific tumor accumulations of 10-15 percentage injected dose per gram of tissue (%ID/g) were prescribed for the 89 Zr-labeled scFv-SG4015-PEG-Cy5-C′ dot; these were expected to be significantly greater than those for the radiolabeled particle control, accompanied by significantly higher tumor-to-background ratios (or enhancements). The 10-15% activity concentration is several-fold higher than that expected for a uniformly distributed agent, or 4% ID/g, the latter estimated to be 100% of the injected dose (ID) distributed throughout a ≈25-gram murine body mass.…”

“…At early time points (≈3-h p.i. ), dominant cardiac activity (i.e., 16.0 ± 2 %ID/g) was observed after i.v.-injection of 89 Zr-DFO-scFv-SG4015-PEG-Cy5-C′ dots, indicating particles were largely confined to the blood pool (Figure S6A and Table S3, Supporting Information). Cardiac activity-concentrations gradually declined with time to 8 ± 1.1 %ID/g and 3.1 ± 0.5 %ID/g at 24-and 72-h p.i., respectively (Figure 3C and Table S3, Supporting Information).…”

Skin Grafting in the Treatment of Diabetic Foot Soft Tissue Defects

“…Broad, deep wounds pose the greatest reconstructive challenge. For large, extensive defects, free flaps may be used, but isolating suitable recipient vessels may be problematic, and the donor site morbidity is substantial, due to peripheral arterial disease (8,9,10,11).…”