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Biomedical subjects

L A Lavery

Publications and source records attributed to L A Lavery.

At least 73 records · Page 4Linked to original sources
PubMed1996

Variation in the incidence and proportion of diabetes-related amputations in minorities.

OBJECTIVE: To identify the age-adjusted and level-specific incidence of amputations associated with diabetes in Hispanics, African-Americans, and non-Hispanic whites. RESEARCH DESIGN AND METHODS: We used a database from the Office of Statewide Planning and Development in California that identified all hospitalizations for lower-extremity amputations in the state in 1991. Amputation level was defined by ICD-9-CM codes 84.11-84.18 and were categorized as toe, foot, leg, and thigh amputations. RESULTS: The age-adjusted incidence of diabetes-related amputation per 10,000 persons with diabetes in 1991 was 95.25 in African-Americans, 55.98 in non-Hispanic whites, and 44.43 in Hispanics. Hispanics had a higher proportion of amputations (82.7%) associated with diabetes than did African-Americans (61.6%) or non-Hispanic whites (56.8%) (P < 0.001). African-Americans had the highest age-adjusted incidence rate for each level in people with and without diabetes. African-Americans underwent more proximal amputations compared with non-Hispanic whites and Hispanics (P < 0.001). Diabetes-related amputations were 1.72 and 2.17 times more likely in African-Americans compared with non-Hispanic whites and Hispanics, respectively. CONCLUSIONS: Hispanics had proportionally more amputations associated with diabetes than did African-Americans or non-Hispanic whites. A significant excess incidence of both diabetes- and non-diabetes-related amputations and proportionally more proximal amputations were identified in African-Americans compared with Hispanics and non-Hispanic whites. A possible explanation could be the higher prevalence of peripheral vascular disease in African-Americans. Public health initiatives, which have been demonstrated to reduce the incidence of diabetes-related lower-extremity amputations, should be implemented, and additional work should focus on minority groups.

Adult↗
PubMed1996

The development of foot deformities and ulcers after great toe amputation in diabetes.

OBJECTIVE: Our aim was to compare the prevalence and severity of foot deformities and the development of ulcerations in patients after a great toe amputations. RESEARCH DESIGN AND METHODS: We evaluated the presence of deformities of the toes and metatarsophalangeal joints (MTPJs) in patients with a great toe amputation who had an intact unamputated contralateral foot. The contralateral foot served as the patient's own control. We used a binomial test for paired data to compare the presence of deformity and ulcer formation and Fisher's exact test to compare joint flexibility in toes and MTPJs with foot deformities. RESULTS: There were more deformities of the second (P = 0.012) and third (P = 0.002) toes and lesser MTPJs (P < 0.05) and more rigid deformities of the second (P = 0.002) and third (P = 0.016) toes and second MTPJs (P = 0.035) in feet with great toe amputations. New ulcers were more common in feet that had an amputation (P = 0.002). CONCLUSIONS: We concluded that amputation of the great toe contributes to the development of deformities of the second and third toes and lesser MTPJs and new ulcer formation in patients with diabetes. When deformities were present, the second and third toes and second MTPJ were more severe in feet with a great toe amputation.

Amputation, Surgical↗
PubMed1996

Reducing dynamic foot pressures in high-risk diabetic subjects with foot ulcerations. A comparison of treatments.

OBJECTIVE: To compare the effectiveness of total contact casts, commercially available therapeutic shoes, and removable walking casts to reduce mean peak plantar foot pressures at the site of neuropathic ulcerations in diabetic subjects. RESEARCH DESIGN AND METHODS: We compared the reduction in peak plantar pressures at ulcer sites under the great toe (n = 5), first metatarsal (n = 10), and second through fifth metatarsals (n = 10) using six treatments: total contact casts (TCCs), DH Pressure Relief Walkers (DH), Aircast Pneumatic Walkers, Three D Dura-Steppers (3D), CAM Walkers, and P.W. Minor Xtra Depth shoes. A rubber sole canvas oxford was used to establish baseline pressure values. The canvas oxford could be viewed as a worse-case scenario for this patient population. With the EMED Pedar in-shoe pressure measurement system, data for 40 steps were collected for each treatment. We used Tukey's Studentized Range Test for simultaneous multiple comparisons to compare treatments. RESULTS: DH Pressure Relief Walkers reduced plantar pressures significantly better than other commercially available treatments for ulcers under the first metatarsal, second through fifth metatarsals, and great toe (P < 0.05). There was not a significant difference in mean peak plantar pressures between TCCs and DHs at any of the forefoot ulcer sites. CONCLUSIONS: DH Pressure Relief Walkers were as effective as total contact casts to reduce foot pressures at ulcer sites and may be an effective practical addition in the treatment of foot ulcers.

Casts, Surgical↗
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

Review of the effect of fixation on complication rate in the base wedge osteotomy.

The complications of elevation and shortening in the oblique closing base wedge osteotomy of the first metatarsal fixated with either a single AO screw or two 0.062 Kirschner wires were compared. Thirty-three consecutive oblique closing base wedge osteotomies of the first metatarsal bone are evaluated. With the exception of fixation, which is examined as an independent variable, the patients are managed identically with respect to osteotomy technique and postoperative care. The Reese osteotomy guide is used to normalize osteotomy configuration. The authors found no difference in elevation or shortening when comparing an AO screw with 0.062 Kirschner wire fixation. When other variables are controlled, fixation type does not lead to a statistical difference in elevation or shortening.

Adult↗
PubMed1995

The costs of diabetes-related lower extremity amputations in the Netherlands.

Diabetes mellitus is a common problem in the Netherlands and in the rest of the world. A complication seen in association with diabetes is peripheral neuropathy which can lead to lower extremity amputation. The purpose of this study is to identify the duration of hospital stay and the direct costs associated with diabetes-related lower extremity amputations in the Netherlands in 1992. Total direct costs included costs associated with hospital stay and the average procedure specific costs (surgeons' fees, anaesthetists' fees, and operating room fees) for the specific level of amputation. In the Netherlands in 1992, 1575 hospitalizations for 1810 diabetes-related lower extremity amputations occurred. The total number of days in the hospital for the diabetic population was 65,778 days with a mean of 41.8 days per hospitalization. Mean costs associated with diabetes-related hospitalizations for amputation were pounds 10,531 (Dfl. 28,433) per hospitalization. Persons who underwent multiple amputations during their hospitalization stayed in the hospital longer and the costs associated with these hospitalizations were higher when compared to hospitalization with a single amputation. An increase in length of stay and costs with increasing age and higher level of amputation was identified.

Amputation, Surgical↗
PubMed1995

Increased foot pressures after great toe amputation in diabetes.

OBJECTIVE: To compare peak pressures on the sole of the foot in non-insulin-dependent diabetic patients with isolated, unilateral amputations of the great toe and first metatarsal with the patients' contralateral, intact foot. RESEARCH DESIGN AND METHODS: Eleven patients with a unilateral great toe and partial first metatarsal amputation of at least 6 months duration were evaluated with the F-Scan in-shoe pressure measurement system. Patients were studied in the same brand and style of footwear--a thin, rubber-soled, canvas boat shoe. We compared mean peak plantar foot pressures under the first metatarsal, lesser metatarsals, lesser toes, and heel in feet with and without a great toe amputation using the Wilcoxon's matched pairs signed-rank test. RESULTS: Peak foot pressures were significantly higher under the first metatarsal head (P = 0.046), lesser metatarsal heads (P < 0.001), and toes (P < 0.001) in feet with a great toe amputation compared with the contralateral foot without an amputation. Pressure under the heel was higher on the contralateral foot (P < 0.01). CONCLUSIONS: After a great toe amputation, pressure distribution of the foot is significantly altered. Because preamputation risk factors such as peripheral neuropathy, foot deformity, and limited joint mobility for many of these patients remain unchanged, an increase in foot pressures contributes to an increased risk of reulceration and reamputation in these patients.

Adult↗
PubMed1995

Infected puncture wounds in diabetic and nondiabetic adults.

OBJECTIVE: To evaluate bone and soft tissue pathogens resulting from puncture wounds among diabetic and nondiabetic adults. RESEARCH DESIGN AND METHODS: We used a case-control design to compare bacterial pathogens in diabetic and nondiabetic subjects with foot infections precipitated by puncture injuries. We used ICD-9-CM code E920.8 to identify 77 diabetic and 69 nondiabetic patients admitted to the hospital for infected puncture wounds. We identified surgical bone and soft tissue cultures and number and type of organisms per culture. RESULTS: Nondiabetic subjects had significantly less osteomyelitis (13 vs. 35%, P < 0.01) than diabetic subjects and were infected by fewer organisms. Pseudomonas was the most common cause of osteomyelitis among nondiabetic subjects (P < 0.001). Staphylococcus aureus was more common in diabetic bone (P < 0.001) and soft tissue (P < 0.001) infections. Polymicrobial osteomyelitis was more common in diabetic subjects. There was a longer delay until diabetic subjects received medical treatment compared with nondiabetic subjects (8.7 vs. 5.3 days, P < 0.002). Diabetic subjects were more likely to have neuropathy (P < 0.001) and to have sustained their injuries while barefoot (P < 0.006). CONCLUSIONS: Puncture wounds in diabetic subjects were commonly associated with polymicrobial infections. Pseudomonas was the most common cause of nondiabetic osteomyelitis. These results have implications for differential emergent and chronic treatment of puncture wounds in diabetic versus nondiabetic subjects.

Adult↗
PubMed1995

1995 William J. Stickel Silver Award. Structural analysis of absorbable pin and screw fixation in first metatarsal osteotomies.

The structural characteristics of 4.0-mm stainless steel screws compared with 4.0-mm poly-L-lactic acid absorbable screws and 2.0-mm stainless steel Steinmann pins compared with 2.0-mm poly-L-lactic acid absorbable pins in oblique closing base wedge osteotomies of the first metatarsal were evaluated. The authors performed oblique closing base wedge using an osteotomy guide in six matched pairs of fresh frozen first metatarsal bones. Fixation was achieved with either a 4.0-mm stainless steel screw or poly-L-lactic acid absorbable screw. An additional five pairs of matched specimens were used to compare 2.0-mm stainless steel and poly-L-lactic acid absorbable pins with the same approach. Specimens were loaded to failure with the Bionix Material Testing System at a constant rate of 0.166 mm/sec. A Student's t-test for paired samples was used with a 95% confidence interval to measure differences in ultimate load, ultimate displacement, and structural stiffness. There was not a significant difference in any of the parameters evaluated in the 4.0-mm poly-L-lactic acid absorbable versus stainless steel screw comparison (P > 0.05). Stainless steel 2.0-mm pins had significantly greater structural stiffness (P = 0.032) and less ultimate displacement (P = 0.021) than their poly-L-lactic acid absorbable counterparts. There was not a significant difference in ultimate load in poly-L-lactic acid absorbable and stainless steel pins (P = 0.59).

Awards and Prizes↗
PubMed1993

1993 William J. Stickel Gold Award. Stability of absorbable fixation in basilar first metatarsal osteotomies.

The purpose of this study was to compare the structural characteristics of 2.0-mm polyglycolic acid pins and 2.0-mm Steinmann pins in oblique closing base wedge osteotomies of the first metatarsal bone commonly used to correct metatarsus primus varus. Six pairs of fresh frozen cadaveric first metatarsal bones were osteotomized, fixated with either absorbable or stainless steel 2.0-mm pins, cemented in a specimen-holding jig, and tested with the Bionix Material Testing System. There was no significant difference in the mean ultimate force, ultimate displacement, or structural stiffness when comparing 2.0-mm polyglycolic acid pins and Steinmann pins in this model. The structural characteristics of 2.0-mm absorbable pins were the same as stainless steel pins at the time of initial placement in the oblique closing base wedge osteotomy of the first metatarsal.

Absorption↗
PubMed1991

Hallux hammer toe secondary to pseudomonas osteomyelitis.

The authors present two cases of resultant hallux hammer toe secondary to the definitive treatment of hallux sesamoidal osteomyelitis. Pseudomonas osteomyelitis developed in both cases following puncture wounds to the first metatarsophalangeal joint complex. The authors also review the literature on pseudomonas osteomyelitis secondary to puncture wounds and the development of hallux hammer toe after removal of the involved sesamoid bones.

Adolescent↗
PubMed1990

Puncture wounds and foreign body reactions.

Puncture wounds present a clinical dilemma when considering the amount of intervention. Through a logical and thorough history and physical examination a wound score is reached. This scoring system allows for a more objective approach to treatment. Although by no means perfect, wound score will help the clinician in decision making for this difficult clinical problem. Guidelines for the total score are as follows: 1. If the total score is between 1 and 4, treatment is local cleansing and observation. 2. If the total score is between 5 and 8, local cleansing, incision and drainage, and exploration for foreign body is performed with placement of drain. Oral antibiotic regimen is up to local standards of care. 3. If the total score is 9 or more, incision and drainage are mandatory, and wound lavage, intravenous antibiotics, hospitalization, and immobilization are indicated.

Foot Injuries↗
PubMed1988

The efficacy of laser surgery for verruca plantaris: report of a study.

Many therapeutic modalities are available to eradicate plantar verrucae. Lately, lasers have gained a great deal of notoriety in the treatment of verrucae. In this study, we chose to evaluate the success of using one laser treatment for full eradication of verrucae. The results indicated that the greatest success rate occurred with solitary lesions. Other studies of methods of verrucae treatment yielded similar results to those of the laser, with cryotherapy achieving the highest success rate. However, the higher rate was based on an average of two treatments, whereas this study obtained similar results with just one. The laser also has the advantages of minimal postoperative pain, minimal healing time, and less damage to perilesional tissue. These advantages make the laser a viable option in the treatment of verrucae plantaris.

Evaluation Studies as Topic↗
PubMedDate not supplied

The impact of diabetes-related lower-extremity amputations in The Netherlands.

The purpose of this study is to identify the incidence of diabetes-related lower-extremity amputations in the Netherlands. We used discharge records from SIG Health Care Information for every hospitalization for a lower-extremity amputation in all hospitals in the Netherlands in 1992. Age- and gender-specific population figures and diagnosed cases of diabetes were obtained from the Central Bureau of Statistics. Age- and gender-adjusted amputation incidences were identified at four different levels (toe, foot, leg, and thigh). Multiple amputations were analyzed by the highest level. Of all lower-extremity amputations, 1,575 (47%) were in persons with diabetes mellitus. Age- and gender-adjusted lower-extremity amputation rates per 10,000 persons with diabetes by level were the following: toe 12.39, foot 2.42, leg 7.82, thigh 2.54, and total 25.17. People with diabetes were 20.3 times more likely to experience a lower-extremity amputation than people without diabetes. Males were at a significantly higher risk of experiencing an amputation than females. There was a significant increase in the age-specific incidence of amputations as age increased. The most common amputation procedure performed was the toe amputation. There was a significant increase in thigh amputations as age increased, indicating that as people get older they suffer higher levels of amputations. Although the incidence of lower-extremity amputations was lower than previous reports, they still have a serious impact on the health-care system in the Netherlands.

Adult↗
PubMedDate not supplied

Lower extremity manifestations of Vibrio vulnificus infection.

Vibrio vulnificus is a potentially lethal marine bacterium that has not been previously described in podiatric literature. A review of the microorganism's characteristics, susceptible patient population, and lower extremity manifestations of infection is presented. V. vulnificus is found as part of the normal flora of the Gulf of Mexico, Atlantic, and Pacific coastal waters and is often isolated from the filter feeding shellfish of these regions. Its pathogenicity is generally reserved for the immunocompromised host, and is specifically related to disease states which exhibit high serum iron levels. V. vulnificus infections present in two distinct clinical syndromes: primary sepsis secondary to raw oyster ingestion, or localized infection from wound exposure to V. vulnificus-inhabited salt water. Both syndromes demonstrate characteristic skin lesions of the trunk and extremities that present as hemorrhagic bullae and progress to necrotic ulcerations. Although V. vulnificus infection is rare, its extreme virulence in patients suffering from a chronic disease process and its manifestation of characteristic lower-extremity lesions require the podiatric physician to be able to recognize and treat such a condition.

Combined Modality Therapy↗
PubMedDate not supplied

Microbiology of osteomyelitis in diabetic foot infections.

The objective of this report is to describe the bacterial pathogens in diabetic patients with osteomyelitis due to neuropathic foot ulcerations. The authors reviewed the records of 36 diabetic patients with osteomyelitis of the foot due to neuropathic ulceration. Intraoperative deep soft tissue and bone specimens were obtained from each patient. The mean age of patients was 56.7 years, and the mean duration of diabetes was 14.9 years. Streptococcus species (61%) and Staphylococcus aureus (47%) were the most common organisms identified. Gram-negative aerobes were found in 18 cultures (50%). Only five patients' cultures (14%) were identified with anaerobic pathogens. The average number of pathogens per patient was 2.25. The most common bacterial pathogens in bone infections in diabetics were Streptococcus species and Staphylococcus aureus. Anaerobes were uncommon.

Adult↗