An imbalance of regeneration and destruction of the extracellular matrix due to a plethora of chemo- and cytokines, elevated matrix metalloproteinases, bacterial contamination and repetitive painless tissue damage can lead the chronicity of a wound, especially in diabetic foot ulcers (DFU). Along general lines, wound healing and cancer development are similar. Therefore chronic wounds prepare a breeding ground for cancer development. Several characteristics such as increase in size, verrucous everted margins and contact bleeding are suspicious for malignant growth in a chronic wound. While previously the term Marjolin’s ulcer was attributed to a malignant tumor in (burn) scars, it is nowadays used for every malignant tumor in chronic wounds. Furthermore, chronic ulcers in diabetic feet are susceptible for malignant transformation. We describe two cases of squamous cell carcinoma in patients with DFU—a 71 year-old woman and a 67 year old man. Both received total tumor excision and split-skin grafts with good short-time results.
The diabetic foot syndrome (DFS) is the most important cause for non-traumatic
major amputation in adult individuals and actually one of the most frightening
events in diabetics’ life. Despite the often protracted treatment of
infected DFS at the end patients are often confronted with amputation. We
investigated 352 individuals with infected DFS in two age separated-groups.
Older individuals presented with significant worse renal function and lower
HbA1c on day of admittance. Most detected ulcers involved the plantar sides of
the metatarsal heads (MTH) and the toes. We saw an age-dependent translocation
of foot ulcers from plantar and hindfoot to the forefoot and toes. In average
every third wound provoked amputation, in the majority (94%) minor
amputations, only 1.9% major amputations occurred. Lesions of the
5th toe or its MTH and interdigital or interphalangeal joint
ulcers led to amputation in more than 60%. Worse renal function and WBC
above 11 tsd/µl were linked with higher amputation risk. But in
particular current scoring systems like SINBAD or Wagner-Armstrong scale and
thus finally clinician’s assessment of the wound situation gave a
substantial hint for subsequent amputation – regardless of age.
Cognitive decline and falls in the elderly are common and are often accepted as natural and inevitable by relatives and health care professionals, but frequently there are specific and treatable diseases that should be revealed. In our case, cerebral amyloid angiopathy-related inflammation (CAA-RI) was causative for neuro-psychiatric symptoms and worsening of gait in a 71 year-old man with recurrent falls and decline of gait and cognition. Cerebral amyloidangiopathy (CAA) is an important cause of cerebrovascular disorders in the elderly, characterized by leukoencephalopathy combined with lobar or small cortical hemorrhage due to amyloid deposition in cortical and leptomeningeal vessels. In several conditions, amyloid deposition can provoke inflammation or edema that lead to -normally reversible- encephalopathy. CAA-RI is then characterized by subacute neurobehavioral symptoms, headache, seizures or stroke-like signs. The first therapeutic option after confirming the diagnosis is treatment with glucocorticoids. Despite treatment with prednisolone, our patient could not regain his unrestricted mobility and self-help competence. Our report aims to sharpen awareness for CAA and its inflammatory form (CAA-RI) in healthcare professionals involved in medical care of the elderly and provide a short summary of this disease.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.