Diabetic patients without signs of peripheral disease or neuropathy had significantly lower TcPo(2) values compared with age- and sex-matched nondiabetic patients. The influence of the examiner on the variance in TcPo(2) measurements was relatively small. We advocate the use of TcPo(2) measurement in diabetic patients to detect subclinical microvascular impairment as an additional tool to assess peripheral vascular disease.
ease. For example, it was previously reported that the reactivity of diabetic patients to local heating is impaired, 2 and it should be kept in mind that TcPO 2 is measured at 43°C and then automatically corrected to 37°C.Second, the standard deviations (SD) of TcPO 2 are similar in the two groups: 11 to 12 mm Hg at the chest and 9 mm Hg at the foot. Then the differences between means found between diabetic and nondiabetic subjects are roughly 0.50 SD at the chest and 0.66 SD at the foot level. For an equal cost of false-positive and false-negative tests, mathematically the optimal cutoff point for the discrimination of the two clinical situations would be half way between the two means (according to the authors' results, 55 mm Hg at the chest and 53 mm Hg at the foot). In a Gaussian distribution, only 20% and 26% of a population are in the interval mean Ϯ 0.25 SD and mean Ϯ 0.33 SD, respectively. 3 Then if TcPO 2 should be used as a tool to assess vascular disease or dysfunction, the sensitivity and specificity of TcPO 2 would both be 60% and 63% at the chest and foot level, respectively. Assuming that the prevalence of diabetes in the population is Ͻ10% in Europe, 4 the positive predictive values of a chest TcPO 2 Ͻ55 mm Hg and a foot TcPO 2 Ͻ53 mm Hg to detect a diabetic vascular disease or dysfunction in the population would be Ͻ12% and 15%, respectively.Third, as underlined by the authors, TcPO 2 is primarily used as a key point for the diagnosis of critical limb ischemia, amputation level determination, and wound healing evaluation. Thus, there are two major issues resulting from this article. The first issue is to define whether the difference in chest TcPO 2 can be found in a population of patients referred for critical limb ischemia. The second issue is that in diabetes, a number of factors, including neuropathy, may induce foot lesions independently from the presence of arterial disease. Thus, contrary to the chest TcPO 2 and due to a higher prevalence of foot lesions unrelated to vascular disease, the foot TcPO 2 in diabetic patients with suspected foot ulcer or critical limb ischemia could on the average be higher than in nondiabetic subjects.Thereby, although the difference between the two groups is significant, we think that the discriminative power of the sole resting value for TcPO 2 is insufficient to be useful in clinical practice as an additional diagnostic tool to assess subclinical peripheral vascular disease of diabetic origin.
The study is about ampullar ectopic pregnancy following ipsilateral partial isthmic salpingectomy. An ectopic pregnancy is any pregnancy outside of the uterine cavity. Pregnancies in the fallopian tube account for 97 % of all ectopic pregnancies. Fifty-five percent of these pregnancies occur in the ampulla, 25 % in the isthmus, 17 % in the fimbriae, and 3 % of the pregnancy is situated in the abdominal cavity, ovary, or uterine cervix. Diagnosing an ectopic pregnancy can be difficult; however, the widespread availability of pregnancy tests and the present high-resolution ultrasound possibilities have resulted in earlier diagnosis and have thus reduced the chance of massive intraabdominal bleeding and hypovolemic shock at presentation. We present a rare case of a recurrent ectopic pregnancy, occuring in the distal remnant of the ampulla of the fallopian tube, after a previous partial ipsilateral salpingectomy. This case shows that a strict adherence to the Dutch guideline would probably have led to an earlier detection.
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