A novel approach to the management of the diabetic foot: metatarsal excision in the treatment of osteomyelitis.

OBJECTIVE: To describe the procedure and outcomes of metatarsal excision in seven patients treated for osteomyelitis in the diabetic foot. RESULTS: Average age was 60.6 (48-83) years. The mean length of hospital stay was 33.5 (3-50) days (excluding one patient who died from hospital acquired pneumonia). All remaining patients had negative wound cultures after a mean 7.4 (0-20) days of antibiotic treatment after procedure and were discharged from hospital 16.9 (2-48) days after surgery. Two patients developed wound infections after discharge. Pre-operative levels of mobility were achieved within a mean of 12.6 days (range 2-40). CONCLUSIONS: In diabetic patients, metatarsal excision may be better than transmetatarsal amputation.

Outbreaks of clinical mastitis caused by Trichosporon beigelii in dairy herds.

Trichosporon beigelii is widely distributed in nature and is classically associated with white piedra, a mycosis that may involve the hair of the human body. Intramammary infections caused by T beigelii may be fatal in cows; the prevalence in affected dairy herds may be high. Affected cows may have hyperthermia, swelling of the udder, and substantially decreased milk production or agalactia. Intramammary infections caused by yeast, including T beigelii, may also be associated with high bacterial counts in bulk-tank milk.

The role of simple non-invasive testing in infra-inguinal vein graft surveillance.

A prospective vein graft screening programme was established in order to improve graft patency in the period 1-12 months after operation. Patient assessment consisted of ankle:brachial pressure index (ABPI) measurement before and after exercise, and Duplex scanning. Thirty-nine grafts have been followed up, with 19 stenoses detected in 18 grafts (46%) using Duplex. Of these 18 grafts, six had a serial fall in resting ABPI, median 0.14 (range 0.11-0.33), and nine had a post-exercise ABPI fall, median 0.19 (range 0.13-0.4). The remaining three had a normal ABPI but were unable to exercise. Fifteen grafts have been treated, 12 by percutaneous transluminal angioplasty (PTA), and three by surgery. One stenosis treated with PTA recurred within 3 months and was repaired with a vein patch. Since screening was implemented no grafts in the programme have occluded. This study indicates that simple ABPI measurements can be used to screen "at risk" grafts for evaluation with Duplex scanning, without jeopardising graft patency.

The natural history of small abdominal aortic aneurysms: an ultrasound study.

A retrospective study was undertaken to assess whether, using serial ultrasound examinations, the behaviour of small abdominal aortic aneurysms could be predicted. The average increase in size was found to be 0.3 cm/year. The pattern of increase in size was not affected by age, sex or the presence of hypertension. A proposed course of management of patients with small aneurysms is suggested, particularly if they have other significant medical problems.

Variations in gas flow of laparoscopic insufflators.

Maintenance of an adequate pneumoperitoneum is important in laparoscopy, yet little is known about the functioning of laparoscopic insufflators except for the manufacturer's description of the specifications. Frequent failure to maintain an established pneumoperitoneum with the insufflator switched to its automatic mode prompted evaluation of the volume of gas delivered per unit of time by machines in active use. Limited standardization was found between machines in regard to the gas flow mediated by the automatic flow control. In this mode, the insufflator did not adequately compensate for changes in resistance to flow. Disparity of response among flow control devices and interinstrument variations suggest the need to test and calibrate each unit separately for clinical use.