RESUMEN
The purpose of the present study was to demonstrate the effect of a delayed diagnosis of Charcot foot on acute care cost and usage. We used International Classification of Disease, Ninth Revision, Clinical Modification codes, and the California Office for Statewide Health Planning and Development 2009 to 2012 public patient discharge files to identify patients with type 2 diabetes mellitus and Charcot foot. The costs and length of stay were compared for those with a diagnosis of Charcot foot on admission compared with those who received a delayed diagnosis of Charcot foot before discharge. Patient demographic data, diagnoses often mistaken for Charcot foot, and procedures often performed for Charcot foot were assessed to determine the potential effect on costs and length of stay in Charcot foot subjects. A delayed Charcot foot diagnosis was associated with 10.8% greater inpatient costs and 12.1% longer length of stay. These patients required greater resource usage owing to the significantly greater number of procedures performed. A significantly greater number of patients underwent lower extremity amputation when the diagnosis was delayed, resulting in a 30.4% increase in costs and 31.6% longer length of stay. A greater rate of diabetic foot ulcers, foot infections, and osteomyelitis was also observed; however, the cost was only affected by osteomyelitis, and the length of stay was not significantly affected. A delayed diagnosis of Charcot foot at admission resulted in significantly increased acute care costs and longer lengths of stay.
Asunto(s)
Artropatía Neurógena/diagnóstico , Artropatía Neurógena/terapia , Diagnóstico Tardío , Pie Diabético/complicaciones , Costos de la Atención en Salud , Recursos en Salud/economía , Adolescente , Adulto , Anciano , Artropatía Neurógena/etiología , Diabetes Mellitus Tipo 2/complicaciones , Utilización de Instalaciones y Servicios/economía , Femenino , Recursos en Salud/estadística & datos numéricos , Hospitalización/economía , Humanos , Masculino , Persona de Mediana Edad , Utilización de Procedimientos y Técnicas/economía , Adulto JovenRESUMEN
A new method of excision of painful plantar lesions in the forefoot was studied in 13 feet (12 patients). Etiology of the lesions was variable, including traumatic and iatrogenic scars. Localized transfer of partially undermined tissue is used to fill a triangular defect created by excising the lesions. The flap is advanced/rotated into place, without gapping or tension. Full sensation is maintained and because of the significant vascular contribution by the proximal plantar subcutaneous plexus, there is little chance of vascular compromise. Problematic scars occurred in only three feet (two patients). Complications included inclusion cysts in two cases, one parakeratotic nodule and an incidental occurrence of verruca in one case. Follow-up average was 25 months. This procedure provides an alternative method for resolving patients' painful plantar lesions.
Asunto(s)
Enfermedades del Pie/cirugía , Antepié Humano/cirugía , Queratodermia Palmoplantar/cirugía , Colgajos Quirúrgicos/métodos , Adolescente , Adulto , Niño , Cicatriz/cirugía , Femenino , Dermatosis del Pie/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neuroma/cirugía , Verrugas/cirugíaRESUMEN
Adult male mice were exposed to either alternating illumination or constant illumination for 70 days. Light and dark pinealocytes were compared as to distribution within the gland and ultrastructure. Quantitative studies with the electron microscope revealed a significant reduction in pinealocyte size and Golgi complex size in constant light treatment, as well as a marked but nonsignificant reduction in the concentration of lipid droplets and irregular vacuoles. Under constant light treatment the cross-sectional area of pinealocyte pericapillary terminals and the number of granulated vesicles per terminal decreased significantly. A greater number of mitochondria appeared swollen, with rarified matrix and reduced numbers of cristae, with constant light treatment. These results provide ultrastructural correlation with the known reduction of pineal weight, protein synthesis and antigonadotrophic activity that is seen with constant light treatment. The marked decrease in concentration of pinealocyte granulated vesicles in constant light treatment gives morphological support to the theory that these vesicles contain antigonadotrophic secretory material.