PubMed Health⌕ Search

Biomedical subjects

L B Harkless

Publications and source records attributed to L B Harkless.

At least 37 records · Page 2Linked to original sources
PubMed1997

Factors associated with pedal ulceration in patients with diabetes mellitus.

Understanding the factors associated with pedal ulceration in patients with diabetes mellitus will increase the successful management of the high-risk diabetic foot and decrease the occurrence of ulcerative events. The authors review the associative factors that have been shown to be involved with pedal ulceration.

Aged↗
PubMed1997

Classification of diabetic foot wounds.

Foot ulcers in persons with diabetes are one of the most common precursors to lower extremity amputation. Appropriate care of the diabetic foot ulceration 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. We describe a clinical classification system for diabetic foot wounds that evaluates wound depth, the presence of infection, and peripheral arterial occlusive disease in every category of the wound assessment. The goal of this system is to improve communication, leading to a less complex, more predictable treatment course, and, ultimately an improved result.

Diabetic Foot↗
PubMed1996

In-hospital mortality and disposition of diabetic amputees in The Netherlands.

The purpose of this study is to identify in-hospital mortality of diabetic amputees and the disposition of survivors in The Netherlands in 1991 and 1992. A database including all hospitalizations in The Netherlands was used. Amputees who died while in the hospital were analysed separately. Survivors were categorized according to different types of discharge: home, nursing home, rehabilitation facility, and other health care facilities. Overall 9.0% of diabetic amputees died while in hospital. The age-adjusted mortality incidence for the diabetic population was 36.3 per 1000 diabetic amputees (95% CI: 18.7-53.9) and 28.2 per 1,000 non-diabetic amputees (95% CI: 20.5-35.9). Non-diabetic amputees with PVD has proportionally more mortality than diabetic amputees with PVD (P < 0.01), diabetic amputees without PVD (P < 0.01), and non-diabetic amputees without PVD (P < 0.001). Using Cox regression analysis age (B(age) = 0.023, RR = 1.024) and the occurrence of multiple amputations during the hospitalization (Bmultiple = 0.325, RR = 1.383) were significant negative predictors for survival. As age and level of amputation increased, more diabetic and non-diabetic amputees were discharged to facilities other than home (P < 0.001).

Age Factors↗
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

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

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

Necrotizing fasciitis.

Necrotizing fasciitis is a rapidly progressing soft-tissue infection characterized by extensive necrosis of subcutaneous fat and fascia. It is frequently accompanied by moderate to severe systemic toxicity and can be fatal without prompt recognition and aggressive surgical treatment. The podiatric physician must be aware of these infections because the extremities are common sites of involvement. Necrotizing, fasciitis must be treated as a medical emergency calling for prompt surgical intervention and high doses of broad-spectrum antibiotics.

Adult↗
PubMed1996

Cellulitis secondary to web space dermatophytosis.

Cellulitis occurring in the lower extremity is encountered frequently and results from a breach of the skin and inoculation of opportunistic bacteria. It has been shown that when web space dermatophytosis is present, changes may occur in normal skin morphology and bacterial flora that can result in severe infection. Knowledge of the pathophysiology of interdigital dermatophytosis allows the clinician to choose the most appropriate empiric antibiotic therapy when treating a secondarily caused cellulitis of the lower extremity.

Aged↗
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

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

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↗
PubMed1994

Neurilemoma. A case report.

In this article, a case report of a patient presenting with "burning pain in the ball of her right foot" is detailed. Topics discussed include the diagnosis, surgical excision, and histopathology.

Aged↗