διαβητολόγοι 2016

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Diabetes Mellitus Epidemic

15 % (life-time risk). 4-10 % . : 2.5 %.Palumbo et al, NIH, 1984 International Consensus on the diabetic foot, 1999 Moss et al, Arch Intern Med, 1992Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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: 5 - 24 / 100.000 / 6 - 8 / 1000 / 85 %

International Consensus on the diabetic foot, 1999Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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35.000 . . .Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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50000 85% Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

- Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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62% 25% 13% Edmonds, The foot in Diabetes, 1987 3-4 . Matsuda, Diabetes Res Clin Pract, 1994Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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N (>80%)

Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

Am J Med. 1999;107(2B):17S26S AGEs PGI2 Schwann Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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Boulton AJM, Malik RA, Diabetic neuropathy, Med Clin N Am 1998Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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Semmes-Weinstein 10-g 10- Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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() > 25 Volt 4- 10 < 13Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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Zick R et al, Klinikarzt 2003 Papanas N et al, Exp Clin Endocrinol Diabetes 2005.

Neuropad ( ) 2 Neuropad 86% 67%Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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(%) The WHO Multinational Study

The WHO Diabetes Drafting Group, Diabetologia 1985

Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

31Das Ziel der WHO multinational Studie fr die Gefsskrankheiten bei Diabetikern war die Abschtzung der Prvalenz der mikro- und makrovaskulre diabetischen Komplikationen. 6695 diabetische Mnner und Frauen, im Alter von 35 bis 54 Jahre, aus 14 nationale gruppen nahmen in dieser Untersuchung teil.Die Diagnose der koronaren Hertzkrankheit wurde auf der Grundlage des Rose-Fragebogens und/oder EKG Vernderungen. Die Diagnose einer PAVK wurde auf der Grundlage des Rose-Fragebogens ber Claudicatio intermittens und/oder einer Amputation. In der Tabelle ist die Prvalenz der diabetischen Makroangiopathie bei Mnnern und Frauen. Die Prvalenz der makrovaskulren Erkrangungen war abhngig von dem Alter, der Blutdruck und dem BMI bei beiden Geschlechten und nur bei Mnnern von der Diabetesdauer und dem Cholesterinspiegel.

Advanced Glycosylation End Products (AGEs) , AGEs M Brownlee et al, N Engl J Med 1988 Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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120130

ABI = = 1.08130120

BI: >0.9 50% Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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CT MRI ( . , Stent ) M ( 94% 100% ) ( 36 - 73% 58-78% ) , Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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From Levin and Pfeifer, The Uncomplicated Guide to Diabetes Complications, 2002 Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

43Hallux valgus deformities are more common in persons with diabetes and result in high pressure points from shoe gear at the distal end of the proximal phalanx.

[PATRICK AND TED: FROM SAME REFERENCE, NO PERMISSION]

Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

44This patient has a marked Hallux valgus deformity and early hammer-toe deformities from diabetic motor neuropathy. Note the areas of persistent erythema over pressure points on the first MTP joint and on the dorsums of the proximal phalanges. This patient requires a modification of shoe gear to relieve pressure and prevent callus and ulcer formation.

From Levin and Pfeifer, The Uncomplicated Guide to Diabetes Complications, 2002

Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

45Diabetic motor neuropathy leads to atrophy of the intrinsic musculature of the foot with consequent dorsiflexion of the proximal phalanx to form a hammer toe. Dorsiflexion of the middle phalanx and a flexion contracture of the distal phalanx convert the hammer toe into a claw toe. Note the increasingly prominent metatarsal heads with these two deformities. These deformities result in areas of high pressure and subsequent callus formation over the metatarsal head and the tip of the toe when walking, and over the distal end of the proximal phalanx from shoe gear.

[PATRICK AND TED: I DO NOT HAVE PERMISSION TO USE THIS DIAGRAM IN A MONOGRAPH THAT IS FOR SALE, AND I DOUBT IT WILL BE GRANTED BY THE AMERICAN DIABETES ASSOCIATION. DO YOU HAVE ARTISTS TO DRAW A SIMILAR PICTURE?]

Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

48This patient has much more severe hammer and claw-toe deformities. There are areas of persistent erythema on the dorsum of the fourth and fifth toes. However, the consequences of the ill-fitting shoe gear have now progressed to marked callus formation at the peak of the hammer toe deformities on the dorsum of the second and third toes.

Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital (shunts)

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Diabetic Foot Clinic, 4th Dep. Of Internal Med, Evangelismos Hospital

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