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Biomedical subjects

G M Caputo

Publications and source records attributed to G M Caputo.

At least 19 recordsLinked to original sources
PubMed1999

Elevated plantar pressure and ulceration in diabetic patients after panmetatarsal head resection: two case reports.

Panmetatarsal head resection (variously called forefoot arthroplasty, forefoot resection arthroplasty, the Hoffman procedure, and the Fowler procedure) was developed for the relief of pain and deformity in rheumatoid arthritis. Although there are successful retrospective series reported in the literature, such an approach is not supported by carefully designed controlled trials. This procedure has also been advocated by some for the relief of plantar pressure in diabetic patients who are at risk for plantar ulceration. The efficacy of the procedure in this context is not supported by existing pressure measurements on rheumatoid arthritis patients in the literature, which has tended to show that although pain relief is obtained, the procedure results in elevation of forefoot pressure. Case reports are described of two patients (three feet) with sensory neuropathy who presented to our clinic 1 to 2 years after panmetatarsal head resections had been performed. Peak plantar pressures in these feet during first step gait were above the 99th percentile and outside the measuring range of the device used (EMED SF platform; NOVEL Electronics Inc., St. Paul, MN). Both patients had also experienced plantar ulcers subsequent to the surgery. Combining the information on patients with rheumatoid arthritis (RA) with that from our two case studies, we conclude that panmetatarsal head resection does not necessarily eliminate focal regions of elevated plantar pressure.

Aged↗
PubMed1998

The non-healing diabetic foot wound: fact or fiction?

Wounds on the feet of diabetic patients are often labeled as "non-healing." This article discusses the basis for and the dangers of such a classification. The evidence suggests that if the foot has an adequate vascular supply and no significant infection, a plantar wound that does not heal is the result of poor treatment and/or poor compliance. Wounds that do not heal despite optimal treatment and compliance are extremely rare and need to be referred to the appropriate specialist for care.

Diabetic Foot↗
PubMed1998

The Charcot foot in diabetes: six key points.

The Charcot foot commonly goes unrecognized, particularly in the acute phase, until severe complications occur. Early recognition and diagnosis, immediate immobilization and a lifelong program of preventive care can minimize the morbidity associated with this potentially devastating complication of diabetic neuropathy. If unrecognized or improperly managed, the Charcot foot can have disastrous consequences, including amputation. The acute Charcot foot is usually painless and may mimic cellulitis or deep venous thrombosis. Although the initial radiograph may be normal, making diagnosis difficult, immediate detection and immobilization of the foot are essential in the management of the Charcot foot. A lifelong program of patient education, protective footwear and routine foot care is required to prevent complications such as foot ulceration.

Acute Disease↗
PubMed1997

The total contact cast: a method for treating neuropathic diabetic ulcers.

Plantar ulcers that do not heal in patients with diabetes and peripheral sensory neuropathy have been shown to be precursors of lower extremity amputation. The total contact cast is considered by many authorities to be the most effective technique for healing of wounds in the neuropathic extremity, yet it still is not widely used in clinical practice. Use of the total contact cast allows mobilization and results in diminished edema and decreased pressure over the ulcerated area. Complete healing usually occurs in eight weeks or less. Total contact casting with careful follow-up should be considered as a useful modality for healing plantar ulcers in diabetic patients with neuropathy of the extremities.

Adult↗
PubMed1997

Foot infections in patients with diabetes.

The combination of sensory neuropathy, ischemia and direct adverse effect on host defense mechanisms makes patients with diabetes vulnerable to foot infections. A high degree of clinical suspicion and vigilance is necessary for early diagnosis of soft tissue infections and their differentiation from noninfected ulcers. Diagnosis and assessment depend primarily on clinical history and physical examination, although radiographs, scans and laboratory tests may also provide useful clinical data. The ability to detect bone in the base of an ulcer with a blunt sterile probe may be particularly useful in assisting the recognition of osteomyelitis. Most non-limb-threatening infections are caused by Gram-positive cocci, but more serious infections are often polymicrobial. Effective treatment is based on a comprehensive strategy of wound care, avoidance of weight bearing, optimal metabolic control, appropriate antibiotic use and, possibly, surgical intervention.

Diabetic Foot↗
PubMed1994

Assessment and management of foot disease in patients with diabetes.

Limb- or life-threatening complications in patients with diabetes can be prevented with an integrated, multidisciplinary approach. Most patients seen in clinical practice are in the early stages of the disease process. Glycemic control retards the progression of neuropathy, which is the most important risk factor for ulceration. Early detection of the loss of protective sensation and implementation of strategies to prevent ulceration will reduce the rates of limb-threatening complications. Clinicians should routinely examine the feet of diabetic patients. Education in foot care, proper footwear, and close follow-up are required to prevent or promptly detect neuropathic injury. If ulceration occurs, removal of pressure from the site of the ulcer and careful management of the wound will allow healing in most cases. The failure to heal despite these measures should prompt a search for associated arterial insufficiency. If infection is present, appropriate antimicrobial therapy combined with immediate surgical intervention, including revascularization when necessary, will increase the chances of saving the limb. With this comprehensive approach, it is possible to achieve the goal of a 40 percent decrease in amputation rates among diabetic patients by the year 2000.

Anti-Bacterial Agents↗
PubMed1994

Clostridium difficile infection: a common clinical problem for the general internist.

Considering the current wide use of antimicrobial agents, the general internist is commonly faced with the patient at risk for diarrhea due to C. difficile. The diagnosis should be considered for any patient with diarrhea who has received any type of antibiotic therapy in the preceding 4-6 weeks. Symptoms may range from a minor bout of diarrhea to fulminant and fatal colitis. Diagnosis usually requires demonstration of the toxin in stool; culture of the organism and fiberoptic endoscopy may play an adjunctive role in selected clinical settings. The ultimate goal in the treatment for C. difficile infection is to repopulate the normal colonic flora in the most efficacious manner. Minimally symptomatic patients may respond to discontinuing the offending antimicrobial agent or using nonspecific binding agents. Oral vancomycin continues to be the "gold standard" for specific treatment, while metronidazole therapy is considered the first-line agent for individuals with milder infection. Oral bacitracin shows promise, though large studies are lacking. Patients with multiple relapses of C. difficile diarrhea can be treated with prolonged courses of vancomycin or a combination of vancomycin and rifampin. Intensive care unit patients who are NPO have few therapeutic options besides intravenous administration of metronidazole and oral administration of vancomycin via clamped nasogastric tube. Preventive efforts are directed at cautious use of antibiotics and the use of vinyl gloves when caring for patients with known infection.

Clostridioides difficile↗
PubMed1994

Physician beliefs, attitudes, and approaches toward Lyme disease in an endemic area.

To assess the beliefs and practice habits regarding Lyme disease among practitioners, questionnaires were sent to physicians in a seven-county Lyme-endemic region. One hundred twenty-four evaluable responses were returned from 53 family physicians, 39 pediatricians, 27 internists, and five subspecialists who diagnosed three to four cases of Lyme disease per year, on average. The majority presented with erythema migrans (EM) or other early symptoms, although arthritis was the presenting sign in 16%. The enzyme-linked immunosorbent assay (ELISA) was the most frequently ordered diagnostic test, but 45% of respondents did not specify which test when ordering Lyme serology. The majority would use amoxicillin or doxycycline to treat EM in children or adults, respectively. Nearly all would use ceftriaxone for meningitis, and half would use it to treat Lyme arthritis or Bell's palsy. Physicians differed markedly in the duration of therapy they would prescribe. Eighty-three percent would treat a patient for possible Lyme disease with antibiotics (many intravenously), even in the absence of EM or positive serology. Thirty-five percent of practitioners prescribed antibiotics for deer-tick bites. Our survey documents significant variation in approaches to Lyme disease among primary-care physicians and suggests the need for well-designed clinical trials, continuing basic research, and physician education.

Adult↗
PubMed1993

Antibiotic prophylaxis: update on common clinical uses.

Cefazolin remains the drug of choice for prophylaxis during surgery. Cefoxitin or cefotetan may be used when both aerobic and anaerobic infections are a concern. Antibiotics are not necessary in most patients with prosthetic joints who are undergoing dental procedures. Oral antibiotic regimens using amoxicillin, erythromycin or clindamycin are now recommended for the prevention of bacterial endocarditis, even in patients at high risk. Most patients with tick bites do not need antibiotics for the prevention of Lyme disease. Human and animal bites require thorough cleaning, care in suturing, proper immunoprophylaxis against rabies and tetanus and, in most circumstances, prophylactic antibiotic therapy.

Animals↗
PubMed1993

Infections due to penicillin-resistant pneumococci. Clinical, epidemiologic, and microbiologic features.

Pneumococcal infection remains a common cause of serious morbidity and mortality throughout the world. Until recently, clinical isolates of pneumococci that were penicillin resistant were rare. However, 4% to 5% of the clinical isolates in the United States were recently found to be either intermediately resistant or highly resistant to penicillin. Clinicians in every field of medicine must therefore be better informed regarding penicillin-resistant pneumococcal infections to minimize their attendant morbidity and mortality and increase compliance with preventive measures. We reviewed the molecular, genetic, and epidemiologic aspects of penicillin-resistant pneumococcal infections, with emphasis on their microbiologic and clinical features.

Adult↗
PubMed1993

Infections due to antibiotic-resistant gram-positive cocci.

Gram-positive cocci are becoming increasingly resistant to traditionally used antimicrobial agents. Staphylococcus aureus, coagulase-negative staphylococci, the enterococcus, and Streptococcus pneumoniae are the most commonly encountered of such pathogens in clinical practice. Clinicians should be keenly aware of the usual types of infections that are caused by these organisms and the importance of documenting susceptibilities of infecting strains. The basic mechanisms of resistance should be familiar to clinicians so that an inappropriate empiric regimen will not be selected (e.g., addition of a beta-lactamase inhibitor for penicillin-resistant pneumococci). Vancomycin remains the agent of choice, sometimes in combination with gentamicin and/or rifampin, for most cases of infection due to these resistant gram-positive organisms. Last, increased efforts toward prevention, such as strict adherence to infection control measures, selective use of broad-spectrum antibiotics, and increased use of pneumococcal vaccine, may be useful to help stem the rising tide of infections due to resistant gram-positive cocci.

Anti-Bacterial Agents↗