Impact of magnetic resonance imaging on the management of diabetic foot infections

Article Abstract:

Diabetic patients often develop foot infections; this complication alone accounts for 20 percent of diabetic hospital admissions. It is important that the infection be diagnosed and treatment begun quickly. The abscess or focus of infection must be drained and the dead tissue removed. Inadequate or delayed treatment can result in life-threatening sepsis (body-wide infection), infection ascending up the leg with possible progressive loss of toes, foot, or leg. Many foot infections are obvious, but some patients have definite signs of foot infection but the abscess site cannot be identified. To surgically explore the foot without knowing the site of infection causes unnecessary damage to the foot. Magnetic resonance imaging (MRI) may be useful in diagnosis of these deep-seated infections. MRI is a noninvasive technique of imaging bone and soft-tissue structures without the use of ionizing radiation. It can image many planes of tissue, has increased soft-tissue contrast, and can differentiate cellulitis from actual pockets of abscess and localize sites of infection. Its accuracy is not hindered by the presence of bony structures. A study was undertaken of 18 diabetic patients believed to have foot infection. MRI was part of the initial assessment of 12 patients, and for six patients was part of postoperative evaluation for persistent fever following drainage of known foot abscess. MRI differentiated between abscess, cellulitis and osteomyelitis, permitting selection of the most appropriate treatment. In two patients unsuspected abscess cavities were identified, permitting pinpoint drainage. Evaluation of previous abscess drainage can be performed, thereby avoiding unnecessary reoperation. MRI was found to be a rapid and reliable method of studying the depths of the foot. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Infection, Diagnosis, Magnetic resonance imaging, Foot, Abscess

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Chronic pyelonephritis: the significance of renal renin and the vascular changes in the human kidney

Article Abstract:

Pyelonephritis is a kidney inflammation resulting from bacterial infection which, in both its acute and chronic forms, may be associated with high blood pressure (hypertension). The walls of the renal artery (which delivers blood to the kidney) in pyelonephritis become thicker, with narrowing of the vessel (a cause of hypertension). This can lead to a reduction in the blood supply to the organ which, in turn, affects the juxtaglomerular apparatus (JGA), a group of cells in the kidney critical for the regulation of blood pressure. The JGA produces renin, which causes vasoconstriction (constriction of blood vessels, raising blood pressure). Renin-containing cells (RCCs) are known to be abnormally distributed in some kidney diseases. To learn more about the anatomy of RCCs in pyelonephritis, 18 kidneys that had been surgically removed from patients with that disease were examined. Six of the patients had high blood pressure and 12 had normal blood pressure. Five of the six kidneys from patients with high blood pressure and seven of the 12 kidneys from patients with normal blood pressure had more than the normal number of RCCs, with no differences noted with respect to blood pressure in number or distribution of these cells. No relationships were found between the degree of narrowing and blood pressure or the degree of narrowing and the number of RCCs. Kidney veins were more severely damaged than kidney arteries, and many were blocked by clotted blood. These findings do not support an association between hypertension in pyelonephritis and narrowing of the arteries within the kidney. Extensive damage to kidney veins may impair the blood flow within the organ, leading to the tissue damage characteristic of pyelonephritis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Kidneys, Blood vessels, Kidney, Pyelonephritis, Renin

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Cardiac pathology in the hypertensive diabetic rat. Biventricular damage with right ventricular predominance

Article Abstract:

Rats with high blood pressure and diabetes are now used to study diseases of the heart muscle in which the ventricle (main pumping chamber) is damaged. The degree of damage to heart muscle in hypertensive, diabetic rats was compared to that in healthy rats during the autopsies of rats that died spontaneously and rats that were killed. Rats that died spontaneously had higher systolic blood pressures (pressure in the left ventricle as it pumps oxygenated blood to the body) than those killed deliberately. Body weights were lower and lung weights were higher, and damage and death of ventricular tissue were greater in the spontaneously dying rats. Heart muscle damage was similar in the right (pumps blood to the lungs to be re-oxygenated) and left ventricles, but was several times greater in magnitude in the right ventricle. This damage, combined with major alterations in the ability of the remaining heart muscle to function, may lead to congestive heart failure (the inability of the heart to pump effectively) or to arrhythmia (abnormal rhythms in heartbeat).

Models, Causes of, Congestive heart failure, Arrhythmia, Heart muscle, Myocardium

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