Το διαβητικό πόδι: Κλινικοεργαστηριακή μελέτη

Diabetic foot, a serious complication of longstanding diabetes melitus, is a poorly understood clinical entity, caused by macroangiopathy, neuropathy, usually complicated by infection. The difficulty in indentifying the predominant underlying disorder is the most important reason of poor therapeutic response. This work was undertaken to contribute in the elucidation of the pathogenetic mechanisms of the condition. The investigation of a diabetic patient with this complication includes careful clinical evaluation supported by methods like ultrasound, skin photophlethysmography, and transcutaneous oxygen tensiometry. These methods have a wide application as they are ease to use, have a high degree of reproducibility und can be applied several times on the same patient with low cost. Transcutaneous oxygen tensiometry has the advantage to monitor simultaneously a metabolic index and the microcirculation. The measurement is not influenced by the calcified medial arterial layer and can detect lesions distally to the ankles. This study included 113 patients, 61 men and 52 women, aged 40-70, divided in 4 groups: group A, included 27 healthy controls, mean age 59,5 years, group B, 29 non-diabetic patients with atherosclerotic peripheral angiopathy, mean age 60,4 and group C, 57 diabetic patients. The latter group was divided in two sub-groups, C₁ with 30 patients with various symptoms of the legs, mean age 57,0, and C₂ with 27 patients without symptoms, mean age 46,9 years. The selection of the patients was based on clinical criteria. The group were comparable in terms of severity of diabetes, whereas angiopathy was of the same stage. Measurements were done in both legs of the 113 patients and therefore 226 values are analysed. All patients were investigated by a standardized protocol: ultrasound was used in studying the ankle-arm index, photoplethysmography in studying the finger-arm index, and transcutaneous oxygen tensiometry for estimation of TcPΟ₂ and TcPΟ₂ index. The latter method was applied in various positions of the limb (supine, standing, elevated, sitting). Statistical evaluation of TcPΟ₂ values was done by monodirectional analysis in horizontal and vertical comparison and if the difference was significant, t-test method was applied. TcPΟ₂ values were correlated with other parameters. By analysing the results the following conclusions can be drawn: Comparing the TcPΟ₂ values in the 4 supine positions, no significant difference was elicited and therefore were considered to be a "single" position in the elaboration of the results. Comparing the TcPΟ₂ values in supine, standing, elevated, sitting position, significant differences were found for all positions in every group, except the position sitting-standing in atherosclerotic and the non-symptomatic diabetics. Significant differences were also elicited in TcPΟ₂ values in supine and elevated position between normals and patients with peripheral angiopathy, diabetics or not. More significant differences were found in elevated position, the diabetics being more affected than the atherosclerotics. No difference was found between TcPΟ₂, values of normals and asymptomatic diabetics. The statistical significant differences drawn out by the comparison of TcPΟ₂, index values between normals and patients with peripheral angiopathy or not, are not superior from the corresponding absolute values of TcPΟ₂. Correlation of absolute TcPΟ₂, values and index TcPΟ₂ with ankle-arm and finger-arm index and the flow, is not satisfactory. Our results lead to the conclusion that transcutaneous oxygen tensiometry is a reliable method for the assessment of peripheral angiopathy in diabetic patients and non-diabetics, especially the diabetic foot. The selection of changing the spatial position of the limb is advantageous over the other techniques used by other investigators. Transcutaneous oxygen tensiometry can be applied widely in the everyday clinical practice and can contribute to the proper management of diabetic foot as well as the early diagnosis of preclinical lesions.

Grantor dc:publisher

Aristotle University Of Thessaloniki (AUTH)

Year dc:date

1990

Authors dc:creator

• Sbarouni, Eftihia
• Σμπαρούνη, Ευτυχία

• Ιατρική και Επιστήμες Υγείας
• Κλινική Ιατρική
• Medical and Health Sciences
• Clinical Medicine

Language dc:language

gre

Identifier

10.12681/eadd/1452

OAI identifier oai:identifier

oai:10442/1452