RESUMEN

OBJECTIVE: The aim was to compare three ulcer classification systems as predictors of the outcome of diabetic foot ulcers: the Wagner, the University of Texas (UT) and the size (area, depth), sepsis, arteriopathy, denervation system (S(AD)SAD) systems in a specialist clinic in Brazil. METHODS: Ulcer area, depth, appearance, infection and associated ischaemia and neuropathy were recorded in a consecutive series of 94 subjects. A novel score, the S(AD)SAD score, was derived from the sum of individual items of the S(AD)SAD system, and was evaluated. Follow-up was for at least 6 months. The primary outcome measure was the incidence of healing. RESULTS: Mean age was 57.6 years; 57 (60.6%) were male. Forty-eight ulcers (51.1%) healed without surgery; 11 (12.2%) subjects underwent minor amputation. Significant differences in terms of healing were observed for depth (P=0.002), infection (P=0.006) and denervation (P=0.002) using the S(AD)SAD system, for UT grade (P=0.002) and stage (P=0.032) and for Wagner grades (P=0.002). Ulcers with an S(AD)SAD score of or=10 (P<0.001). CONCLUSIONS: All three systems predicted ulcer outcome. The S(AD)SAD score of ulcer severity could represent a useful addition to routine clinical practice. The association between outcome and ulcer depth confirms earlier reports. The association with infection was stronger than that reported from the centres in Europe or North America. The very strong association with neuropathy has only previously been observed in Tanzania. Studies designed to compare the outcome in different countries should adopt systems of classification, which are valid for the populations studied.

Asunto(s)

Pie Diabético/clasificación , Pie Diabético/patología , Índice de Severidad de la Enfermedad , Cicatrización de Heridas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Pie Diabético/cirugía , Neuropatías Diabéticas/diagnóstico , Femenino , Humanos , Infecciones/diagnóstico , Isquemia/diagnóstico , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Necrosis , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sepsis/diagnóstico

RESUMEN

OBJETIVOS: Avaliar os fatores associados com persistência ou recorrência do hipertireoidismo após tratamento com131 I. METODOLOGIA: Análise retrospectiva de prontuários de todos os pacientes com hipertireoidismo tratados com dose fixa de 400MBq de131 I em um centro especializado (1992 a 1997). Dos 104 pacientes tratados nesse período, seis tinham bócio multinodular e um adenoma tóxico; 96 estavam usando tionamidas que foram descontinuadas 7 dias antes da administraçäo do iodo. RESULTADOS: Progressäo precoce para hipotireoidismo ocorreu em mediana de 88 dias (22-214) em 60 pacientes (57,7 por cento). Persistência ou recorrência do hipertireoidismo ocorreu em 13 pacientes (12,5 por cento) e foram relacionadas positivamente com a idade (p<0,007), embora näo relacionadas com o diagnóstico. Houve maior prevalência de doença persistente nos pacientes tratados com propiltiouracil previamente ao radioiodo do que naqueles tratados com carbimazol (35 por cento vs. 8 por cento; p<0,006). CONCLUSÕES: O efeito bloqueador das tionamidas na captaçäo do radioiodo parece ser mais prolongado em idosos. O efeito radioprotetor do propiltiouracil parece ser mais duradouro que o do carbimazol.

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Hipertiroidismo , Radioisótopos de Yodo/uso terapéutico , Recurrencia , Estudios Retrospectivos