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Biomedical subjects

D G Armstrong

Publications and source records attributed to D G Armstrong.

At least 109 records · Page 6Linked to original sources
PubMed1996

The acutely infected diabetic foot is not adequately evaluated in an inpatient setting.

OBJECTIVE: To evaluate the standard of evaluation and treatment of the infected diabetic foot ulceration at a 551-bed university teaching institution. DESIGN: A retrospective review of a 4-year consecutive sample (1991-1994). POPULATION: Two hundred fifty-five patients who were admitted to a hospital for care of an infected diabetic foot ulceration. Patients were subdivided into the following 4 dichotomous variables: (1) whether the patient underwent a lower-extremity amputation, (2) whether the patient was admitted once or multiple times, (3) whether the patient underwent intraoperative debridement, and (4) whether the patient was admitted to medical or surgical services. RESULTS: All groups that were evaluated had undergone a less than adequate foot examination. Of the admitted patients, 31.4% did not have their pedal pulses documented; 59.7% of the admitted patients were not evaluated for the presence or absence of protective sensation. Nearly 90% of the wounds were not evaluated for involvement of underlying structures, and foot radiographs were not performed in 32.9% of the patients. There were more blood cultures ordered (62.0%) than wound cultures (51.4%). CONCLUSION: The results of this study highlight the need for a systematic, detailed lower-extremity examination for every diabetic patient who is admitted to a hospital, particularly those who are admitted with a primary diagnosis that involves a foot complication.

Aged↗
PubMed1996

Puncture wounds: normal laboratory values in the face of severe infection in diabetics and non-diabetics.

PURPOSE: Using infected puncture wounds as a basis for comparison, we pose the question of whether white blood cell count (WBC) and erythrocyte sedimentation rate (ESR) is lower in diabetic patients with foot infections as compared with nondiabetic patients. PATIENTS AND METHODS: This case control study consisted of two groups, both with infected puncture wounds of the foot, admitted to a 700-bed urban university teaching hospital between 1985 and 1992. The experimental group contained 77 patients with diabetes mellitus. The control group consisted of 69 patients without diabetes. All subjects received emergent incision and drainage of the affected site. RESULTS: Results revealed a normal WBC count in 57.6% of patients. The ESR was normal in 36.3% of admissions. More nondiabetic patients presented with normal ESR than diabetic patients (62.3% versus 13.7%, respectively; P < 0.0001). Diabetic patients had a significantly higher mean WBC count and ESR than did nondiabetic patients. Pain was the principal complaint more frequently in nondiabetic patients (92.9% NDM versus 70.1% DM, respectively; P < 0.005). Erythema (72.7% versus 51.4%; P = 0.008), and drainage (36.4% versus 7.1%; P < 0.001) were more common in diabetic patients. CONCLUSION: We conclude that, while a glaringly elevated WBC count or ESR should alert the clinician to the possibility of infection, normal values should not be relied upon to rule out a serious event.

Adult↗
PubMed1996

Insulin-like growth factor (IGF)-binding protein production by primary cultures of ovine granulosa and theca cells. The effects of IGF-I, gonadotropin, and follicle size.

Insulin-like growth factor-binding protein (IGFBP) production by the ovine ovary was examined using Western ligand blots and immunoblots. During follicle development, the follicular fluid content of the 39- to 42-kDa binding protein (IGFBP-3) increased, whereas that of the 34-kDa (IGFBP-2), 32-kDa, 30-kDa, and 25-kDa (IGFBP-4) binding proteins decreased. The granulosa and theca cell cultures produced different complements of binding proteins. IGFBP-2 and the 30- and 32-kDa binding proteins were produced by granulosa cells, and there was no obvious effect of the size of follicle from which the cells were isolated. Both FSH and insulin-like growth factor (IGF-I) were necessary for maximum production of IGFBP-2. The main binding proteins detected in theca cell cultures were IGFBP-4 and -2. The IGFBP-4 concentration increased when the cells were exposed to LH. In contrast, IGFBP-2 concentration in theca cell-conditioned medium decreased when the cells were incubated with LH. Theca cell cultures produced more IGFBP-4 when the cells were isolated from small follicles as opposed to large follicles. Neither granulosa nor theca cell cultures produced significant quantities of IGFBP-3, and the source of this binding protein in the follicular fluid from large ovine follicles is probably the circulation. The results indicate that IGFBP production in the developing ovine ovarian follicle is dependent on both cell type and follicle size and is regulated by IGF-I and gonadotropins.

Animals↗
PubMed1996

Insulin-like growth factor I (IGF-I), IGF-II and type-I IGF receptor gene expression in the ovary of the laying hen.

Expression of genes encoding insulin-like growth factor I (IGF-I), insulin-like growth factor II (IGF-II) and type I insulin-like growth factor receptor (IGFr) was measured in theca and granulosa cells from the ovary of the laying hen, using an RNase protection assay. Expression of genes encoding IGF-I and -II was confined to theca tissue and expression was not detected in granulosa cells. In contrast, expression of genes encoding IGFr in granulosa cells was significantly greater than that in theca tissue. The 98 base IGF-II probe was similar to a region of the second coding exon of chicken IGF-II and produced multiple RNase-protected RNA hybrids. Theca RNA from follicles at all stages of development produced RNase-protected hybrids of size 98, 96 and 90 bases; however, an additional band (66 bases) was also observed in theca RNA from small yellow follicles. The stage of follicular development during which maximum amounts of the 66 base RNase-protected fragment was detected correlates with the stage at which small follicles are selected for recruitment into the follicular hierarchy. The results provide evidence for the involvement of IGFs in the intraovarian control of ovarian function in a non-mammalian species, and highlight the importance of IGF-II in this process.

Amino Acid Sequence↗
PubMed1996

Pedal manifestations of meningococcal septicemia.

While there have been several reports of upper and lower extremity amputations secondary to meningitis and purpura fulminans in the literature, the incidence is probably rare. Delmas et al studied five pediatric subjects with gangrene caused by meningococcemia, with four requiring amputation. Weiner reported that all 12 patients in his review received a lower extremity amputation, with several requiring upper extremity amputation. Joint contracture, while not as commonly discussed as amputation, is nonetheless an important and perhaps more common finding. Urbaniak et al indicated that of six patients reviewed, three developed significant joint contractures. With the exception of the gangrenous changes discussed, it was joint contracture that was the most limiting factor in progression to full activity and weightbearing in the authors' subject. Prompt, aggressive physical therapy is tantamount to effecting an acceptable long-term outcome.

Adult↗
PubMed1996

Value of white blood cell count with differential in the acute diabetic foot infection.

The authors reviewed the admission leukocyte indices of 338 consecutive admissions (203 males, 135 females, mean age of 60.2 +/- 12.9 years) with a primary diagnosis of diabetic foot infection in a multicenter retrospective study. The mean white blood cell count on admission for all subjects studied was calculated at 11.9 +/- 5.4 x 103 cells/mm3. Of all white blood cell counts secured for patients admitted with a diabetic foot infection, 56% (189 out of 338) were within normal limits. The average automated polymorphonuclear leukocyte percentage was calculated at 71.4 +/- 11.1% (normal range 40% to 80%). Normal polymorphonuclear leukocyte values were present in 83.7% of subjects. The authors stress that the diagnosis of a diabetic pedal infection is made primarily on the basis of clinical signs and symptoms, and that a normal white cell count and white cell differential should not deter the physician from taking appropriate action to mitigate the propagation of a potentially limb-threatening pedal infection.

Aged↗
PubMed1996

Treatment-based classification system for assessment and care of diabetic feet.

Appropriate care of feet of patients with diabetes requires a clear, descriptive classification system that may be used to direct appropriate therapy and possibly predict outcome. Ideally, this system would be used by all participants in a multidisciplinary limb-salvage team. The authors report on a logical, treatment-oriented system that may improve communication, leading to a less complex, more predictable treatment course and, ultimately, an improved result.

Diabetic Foot↗
PubMed1996

Evaluation and treatment of the infected foot in a community teaching hospital.

More inpatient hospital days are used for the care of diabetic foot infection than for any other diabetic sequela. Both the number of lower extremity amputations and the overall treatment cost of treating diabetic infections may be reduced by using a team approach in the care of the infected diabetic pedal wound. The authors propose an evaluation and treatment protocol of infected pedal ulcerations in an urban, community teaching institution when admitted to an established, multidisciplinary diabetic foot care team. The hospital course of 111 patients admitted with a primary diagnosis of infected pedal ulceration are retrospectively reviewed. Results revealed an average-length hospital stay of 7.4 days with a 96% limb-salvage rate. The authors suggest that in the treatment of the infected pedal wound, a diabetic foot care team with a well developed treatment protocol may yield a consistently favorable outcome and a cost-effective hospital course.

Diabetic Foot↗
PubMed1996

The combined hammer toe-mallet toe deformity with associated double corns: a retrospective review.

The authors discuss a commonly encountered, but poorly documented, condition of the lesser digits. Unlike the clawtoe deformity, which normally occurs in the cavus-foot type, the combined hammer toe-mallet toe (double corn) deformity is perhaps most frequently associated with the pronated foot type undergoing flexor stabilization. This article reviews 20 patients undergoing 62 double resectional arthroplasty procedures for treatment of the deformity.

Adult↗
PubMed1995

Expression of transforming growth factor-beta mRNA in chicken ovarian follicular tissue.

RNA was isolated from chicken thecal tissue from the largest (F1), third largest (F3), and fifth largest (F5) preovulatory follicles, from small yolky follicles, and from granulosa tissue from F1 follicles. Transforming growth factor-beta (TGF-beta) gene expression was measured using reverse transcription polymerase chain reaction. Thecal cells from all follicle sizes expressed all three isoforms of TGF-beta. TGF-beta 1 mRNA was detected in granulosa cells at levels comparable to those seen in thecal cells. However, TGF-beta 2 and TGF-beta 3 mRNA was expressed at significantly lower levels in granulosa than in thecal tissue. This is the first demonstration of TGF-beta gene expression in the ovary of a nonmammalian species. The similarities between mammalian and avian TGF-beta gene expression are remarkable, especially in light of the distinctive patterns of avian follicular development and the differing steroidogenic capacities of ovarian cell types of the two classes of vertebrates.

Animals↗
PubMed1995

1995 William J. Stickel Bronze Award. Prevalence of mixed infections in the diabetic pedal wound. A retrospective review of 112 infections.

This retrospective study reviewed the culture results of 112 admissions to a multidisciplinary diabetic foot care team with a primary diagnosis of infected diabetic pedal ulceration. An average of 1.5 +/- 0.9 species per patient (P < 0.0001) were isolated. Eighty-nine percent of wounds cultured grew two or fewer organisms. Anaerobic species were isolated in only 5% of all cultures. Of these isolates, the distinction between anaerobic colonization and true anaerobic infection is made. Results suggest that aggressive early hospitalization, coupled with aggressive intraoperative debridement, may yield less microbiologically complex infections that may be controlled with less expensive narrow spectrum antibiotic therapy. Diagnosis of the infected pedal ulceration of a patient with diabetes is a clinical one. If this diagnosis is combined with appropriate surgical intervention, microbiologic correlation, and antimicrobial therapy, the result may be a less complex hospital course and improved outcome.

Adult↗
PubMed1995

Contralateral limb during total contact casting. A dynamic pressure and thermometric analysis.

The authors draw attention to the importance of evaluation of the contralateral limb when treating unilateral sequelae secondary to distal symmetrical polyneuropathy. Plantar pressure measurements of the contralateral limb during total contact casting are reviewed. The results of thermometric evaluation before and after initiation of repetitive stress were reviewed. The results suggest that the patient walking in a total contact cast may experience a reduced focal pressure on the contralateral limb when compared with uncasted walking and three-point walking with crutches. Dermal thermometry may be a highly sensitive tool in evaluating even mild increases in repetitive stress. To explain this decrease in contralateral stress, the authors examine the features inherent to the total contact cast and propose the concept of proprioceptive stability.

Casts, Surgical↗
PubMed1995

Analgesic efficacy of topical butamben picrate.

Over the past generation, advents in topical antibiotics and oral analgesia have obscured butamen and its family of topical anesthetics. Using a modified version of the McGill University pain questionnaire, this study attempts to establish the efficacy and clinical utility of this overlooked topical anesthetic.

Adolescent↗
PubMed1995

Potential risks of accommodative padding in the treatment of neuropathic ulcerations.

In order to appropriately treat the pedal diabetic wound, the treatment plan must have as its central focus the elimination or reduction of foci of stress. The purpose of this study is to analyze the off-weighting ability of aperture pads in an effort to help the practitioner choose an appropriate and effective stress relieving modality. Patients were fitted and measured while ambulating using 3 different accommodative modalities. Utilizing an electronic measurement system for the recording of pressure distribution, the plantar pressure of each subject was recorded. Measurements taken during accommodative padding were compared with the same foot or corresponding site during unpadded ambulation. The data indicates that when apertures are created in an attempt to off-weight a given ulceration or area of stress, an area of increased vertical pressure is created at the periphery of the ulceration; and that while the central aspect of the aperture pad seems to off-weight the area, the periphery bears an undue amount of vertical stress, thus amplifying shear forces and tearing of tissue as the metatarsal moves proximally during gait. We therefore conclude that none of the devices reviewed are ideal for off-weighting the plantar neurotrophic wound.

Adult↗
PubMed1994

Glucose and L-lactate metabolism in pregnant and in lactating ewes fed barley- or ground maize-based diets.

The contribution of glucose absorbed from the small intestine to whole-body glucose metabolism was examined in ewes during late pregnancy and early lactation, using diets based on ground barley or ground maize. Glucose and L-lactate turnover in the whole body and the mesenteric-drained viscera were investigated in these ewes using isotope dilution techniques. The net absorption of glucose by the mesenteric-drained viscera and whole-body glucose turnover were unaffected by diet or reproductive status. Arterial and mesenteric venous blood glucose concentrations, arterial and mesenteric venous L-lactate concentrations and whole-body lactate turnover were all significantly higher in lactation than in pregnancy. The whole-body rates of lactate conversion to glucose and to other products were significantly higher in lactation than in pregnancy. Using a two-pool model of whole-body glucose and lactate metabolism, a relatively high percentage of glucose was converted to lactate (64-84%), accounting for 60-80% of whole-body lactate turnover. A model of glucose and lactate metabolism by the mesenteric-drained viscera was constructed. Both the calculated endogenous glucose production and the visceral conversion of glucose to lactate were greater in lactation than in pregnancy when barley was fed. Calculated total glucose absorption was relatively constant, contributing between 26 and 59% of whole-body glucose turnover. Diet had little effect on glucose and lactate metabolism in either the mesenteric-drained viscera or the whole-body of breeding ewes.

Animals↗
PubMed1994

The effect of LH, FSH and pregnant mares' serum gonadotrophin on ornithine decarboxylase activity in thecal and granulosa tissue during follicular growth and atresia in laying hens (Gallus domesticus).

The effect of ovine LH, porcine FSH and pregnant mares' serum gonadotrophin (PMSG) on the activity of ornithine decarboxylase activity in theca and granulosa tissue during folliculogenesis in laying hens is described. The changes in the activity of ornithine decarboxylase induced by hormonal challenge was used to measure the sensitivity of the tissue to the hormone. Thecal tissue from small (< 6 mm) follicles showed a large increase in the activity of ornithine decarboxylase 3 h after treatment with LH, FSH and PMSG, in vivo, whereas ornithine decarboxylase activity in thecal tissue from large (> 8 mm) preovulatory follicles and atretic follicles did not respond to any of the hormonal treatments. Ornithine decarboxylase activity in granulosa tissue from the largest preovulatory follicle increased significantly 3 h after treatment with LH and PMSG in vivo; no effect was observed with FSH. Granulosa tissue from the third largest and fifth largest preovulatory follicles were refractory to the hormonal treatments. Basal activity of ornithine decarboxylase in granulosa tissue from preovulatory follicles increased as the follicles approached ovulation, whereas the activity in thecal tissue from the same follicles decreased. The difference in sensitivity of thecal tissue from small and large preovulatory follicles towards gonadotrophin treatment in vivo is correlated with the difference in the observed rate of atresia occurring within the two groups of follicles. Atresia is the common fate for small follicles, whereas it is a rare event for large preovulatory follicles under normal physiological conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗