NEW ORIENTATIONS CONCERNING THE PROFILAXY TREATMENT AND RECOVERY OF THE <>
Dr. Eugenia Dumitrescu (Clinic Calimanesti, Calimanesti - Romania) Mariana Trana, Dorin Danciu, Rodica Ilie
The <> is a cronical complication which raise several medical problems also in Vilcea district. In Calimanesti we are often confronted with patients having digestive or renal affections and also diabetes and a peripherical cronical ischemie syndrome, who are coming from all over the country.
With these patients we have been using the following means of treatment.
1. the diet - to all the patients we have been using food weighing keeping in view the tolerance to the carbon hydrates.
2. crenotherapy with sulphur and alkaline waters - source Caciulata, acting hipoglicemiant effect and increasing the tolerance at glucose of the patients.
3. the sulphur bathes with concentrations of 100-150 mg % at 36℃ lasting 15-20 min for daily applications.
4. transversal or longitudinal galvanic ionization with novocain, vitamins, heparine on the ischemical zone.
5. kinetotherapy - as a method of exercise walking on special routes placed on the bank of the river (about 2 km).
The analyses of the results after such a treatment of these patients conclude:
1. in diabetes disease the treatment by sulphur waters has proved the importance but it should be used gradually, with care, keeping with particularides of the patients and the associated diseases.
2. the using of balneotherapy, physiotherapy, kinctotherapy together with antidiabetis drugs and diet can prevent the occurring of cronical complications caused by diabetes.
DIABETIC GANGRENE - THE INFLUENCE UPON THE QUALITY OF LIFE
Chizuko Yokota, Chieko Bannai, Yasushi Kawakami, Yukichi Okuda, Kamejiro Yamashita (University of Tsukuba, Tsukuba, Japan)
In diabetic patients, foot is a focal point of neurologic, arterial and infectious complications. The risk of gangrene is much higher in diabetics than in non-diabetics. Neuropathic gangrene in diabetic foot frequently worsens unconsciously and stealthily, because the diabetic foot is insensible to pain or heat stimuli. It can also induce regional cellulitis or even general complications such as sepsis. Diabetic gangrene is a common medical problem with socio-economic impact. However, there have been few reports into how this effects quality of life (QOL) in the diabetics. Hence, we investigated retrospectively whether diabetic gangrene restricts QOL in diabetic patients. During the past 9 years, 29 patients (male/female; 20/9) were admitted to the hospital 48 times, 3 males and 2 females were admitted repeatedly. They had had diabetes for more than 10 years. The age of the onset of gangrene was 54.3±13.8 years old. Their diabetic control was poor. All of the patients had diabetic retinopathy, nephropathy, and especially advanced neuropathy. Because of lack of pain sensation, the gangrene with cellulitis or osteomyelitis had curiously little influence on their daily life. Ninety percent of the diabetic gangrene improved with conservative therapy, but other 10 % needed forefoot amputation (toe or toe + single metatarsal head). Even after first toe amputation, the patients suffered from postural instability. Thus, rehabilitation therapy improving postural stability is necessary to maintain the patients' QOL. As the diabetic patient tends to neglect to recognize the seriousness of his condition, his insensibility to pain can often result in a lack of care in the patient himself. On his eventual visit to the hospital, we frequently find his foot is severely wounded. We should educate the families of diabetic patients to encourage in taking responsibility for the sufferer and to act promptly on his behalf.