PubMed · 11022282
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A Seavers. 2000. Docking dispute.. https://pubmed.ncbi.nlm.nih.gov/11022282/
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We report the case of an ethnic Asian patient who attended the renal transplant follow-up clinic complaining of pain in the right great toe. He had undergone transplantation nine months earlier and was maintained on triple immunosuppression. Initially, a clinical diagnosis of gout was made and the patient treated with analgesia. Two weeks later he remained symptomatic and developed a discharging sinus on his toe. A plain X-ray revealed a lytic lesion with minimal periosteal reaction. Aspiration of his first right metatarsal phalangeal joint was performed and fungal hyphae were observed in the fluid. Subsequently, despite surgical debridement and treatment with Itraconozaole amputation of the toe was required. Microbiological analysis revealed the organism to be Madurella grisea,which was resistant to both Itraconazole and Amphotericin B. He has remained well since amputation. We believe this to be the first case of Madurella infection to be described in a transplant patient.
This review discusses some of the significant studies and events from the 61st American Diabetes Association's Scientific Symposium. Many of the issues raised at the meeting will form building blocks for future research into offloading, footwear, wound classification, wound healing, tissue engineering, and psychological aspects of therapy and prevention.
The clinical screening of diabetic patients at risk for foot ulcer should be regularly performed by all physicians and health professionals in charge of these patients. In addition, the high risk patient should be also educated to detect high risk foot lesions. This step represents the first strategy in order to prevent this too frequent complication of diabetes mellitus. The amputation which represents the most dramatic evolution of foot ulcer, has profound psychosocial, economic and functional effects on diabetic patients. For these reasons a global strategy should be developed in order to reduce the incidence of diabetic foot ulcer. A systematic follow-up strategy in high risk patients is highly recommended. The patient education is one of the most important step for the success of this strategy.