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This disease complex afflicts 22% of all Americans and increases with age with 40% meeting these criteria at age 60. If you hit your thumb with a hammer, the resulting swelling and inflammation is obvious, painful, and short lived. Inflammation is the life-saving component of your immune system that helps fend off bacteria, viruses, fungi, and other microbial invaders.
Medical schools don’t teach much about the inflammatory effects of food, toxic chemicals, orEMF so the medical profession has been slow to appreciate the extent of the problem. Their work has stimulated research into microbes as possible reasons for other chronic inflammatory conditions, such as Crohn’s disease, ulcerative colitis, rheumatoid arthritis and atherosclerosis, the Nobel assembly said in its citation. Chronic inflammation has a damaging effect on arteries, which can lead to high cholesterol, heart attacks and strokes.
Chronic inflammation depresses the immune system and helps promote the formation of cancerous tumors.
Consider what our great-grandmother had to eat; she lived in a time when chronic inflammation and chronic diseases were not rampant. Transition away from inflammatory foods like sugar, refined carbs (pasta, chips, crackers, cookies), and store-bought milk. Pathology leading to amputation - Physiopedia, universal access to physiotherapy knowledge.
Worldwide prevalence estimates of amputation are difficult to obtain, mainly because amputation receives very little attention and resources in countries where survival is low[1]. Peripheral Vascular Disease is also known or referred to as Peripheral Artery Disease or lower extremity occlusive disease. The peripheral vascular system consists of the veins and arteries beyond or distal to the chest and abdomen supplying the arms, hands, legs and feet. Atherosclerosis, which is the process of Peripheral Arterial Disease (PAD), affects several arterial beds including the coronary and peripheral circulation[5].
Diabetes is also another condition that has an effect on the pathology that may lead to lower limb amputation.
Diabetes Mellitus (Type 2)  Diabetes mellitus is also present in almost half of all cases, and people with diabetes mellitus have a 10 times higher risk of amputation[6]. Patients who suffer from Diabetes Mellitus are at a high risk of developing ulcers and associated complications.[9] Studies indicate that diabetic patients have up to a 25% lifetime risk of developing a foot ulcer[10].
Neuropathy in diabetic individuals affects the motor, sensory and autonomic components of the the nervous system.
In the case of peripheral circulation where the the arteries of the lower limbs are affected, pain and tissue damage develop which may eventually lead to amputation in some cases. Peripheral arterial disease is one contributing factor to ischaemia involving the lower limbs. Tissue viability is affected not only by internal factors such as PAD or Diabetes Melllitus but also by external stimuli such as smoking. Lower limb amputation can also occur due to systemic infections such as bacterial infections.
Learn about the shoulder in this month's Physiopedia Plus learn topic with 5 chapters from textbooks such as Magee's Orthopedic Physical Assessment, 2014 & Donatelli's Physical therapy of the shoulder 2012.
In somewhat more modern times, Joseph Jones, an army physician in the American Civil War, detailed 2642 incidents of what he called ‘hospital gangrene’ which had a recorded death rate of 50%. Necrotizing fasciitis around the genitalia was first recorded by a researcher named Baurienne in 1764 and is called Fournier’s gangrene after Jean Alfred Fournier who presented five cases for lectures in 1883. The general public may know necrotizing fasciitis as ‘flesh-eating bacteria’ and ‘killer bug’, phrases often used by reporters and news people. Necrotizing fasciitis can occur in any part of the body but it is most common in the truncal region, genitals, legs, and other extremities. Most research shows that necrotizing fasciitis occurs as a result of minor trauma or surgery to the affected area. Necrotizing fasciitis can occur in any age group but is more common in men associated with an underlying condition. Disproportionate pain combined in the infected is the leading symptom along with deep redness and swelling. Researchers believe that antibiotic therapy should be continued until there is no further need for surgical removal of dead skin and the patient has stabilized. Surgical debridement (removal of dead tissue) is critical in fighting necrotizing fasciitis and is essential to stop the progression of the disease.
The patient should be taken to surgery immediately and surgeons should make incisions into the flesh and remove all non-viable tissue. Further surgical exploration may be considered after 24-48 hours, to examine the wound and to ensure the infection has stopped. Amputation is necessary in some cases of necrotizing fasciitis when muscle groups are dead, resulting in the loss of use of extremities. Following surgery, normal wound healing may be difficult in patients with necrotizing fasciitis due to the nature of the disease and any underlying conditions. There are several new technologies to support people recovering from the wounds from necrotizing fasciitis including life-like covers that disguise scar tissue and areas of reduced flesh and muscle mass.
After looking at over 75,000 people for genes associated with body fat, the researchers found evidence linking a gene called IRS1 to lower levels of body fat. There are also many people who take the time to work out regularly and are relatively fit but are still overweight or have the same pot belly.
Tom Griesel adds, “Focus first and foremost on optimal health.  Having a truly lean body with ideal body composition, eliminating all excess subcutaneous and visceral fat is the key.
Want an easy to "copy & paste" version of this free content for your website or newsletter? The number of Americans with the Metabolic Syndrome increases with lack of physical exercise, smoking, high carbohydrate diets and certain genetic factors. And this is certainly justified because the Metabolic Syndrome doubles the risks of cardiovascular disease and produces a fivefold increased risk of developing type 2 diabetes. Your immune system sends white blood cells and other hormone-like substances to help start the healing process. Without inflammation we would be sitting ducks in a very hostile world, with no way to repair the damage constantly inflicted on us. The stimulus might come from an army of free radicals launched every day when we eat foods made with processed vegetable oils – French fries, fried food, non-fat dried milk, powdered coffee creamer, most salad dressings, crackers, cookies, chips, and a plethora of other processed and convenience foods. Now you can see why suppressing cholesterol production is not a good way to address the problem. A substantial body of evidence supports the conclusion that chronic inflammation can predispose an individual to cancer as demonstrated by the association between chronic inflammatory bowel diseases and the increased risk of colon carcinoma. The inflammation in a joint can eat away at cartilage and you’ve got a serious case of arthritis. One anti-inflammatory compound in food that has been studied extensively is curcumin, the yellow pigment in the curry spice turmeric. If you snack on wild blueberries and goji berries, you are snacking on foods high in antioxidants.
Commercial dairy cows are fed an unnatural diet of grain that produces excessive omega-6 fats.
In the 1940′s, researchers thought they found a strong correlation between cancer and the consumption of fat, and fat became demonized.
It affects the peripheral vascular system, mostly the arteries, and is a manifestation of systemic atherosclerosis and atherothrombotic conditions which may include stenotic, occlusive and aneurysmal disease[4]. It may be referred to as hardening of the arteries where there is generalised degeneration of the elastic tissue and muscles composing the arterial system. It is characterised by chronic compensatory hyperglycaemia that results from progressive insulin resistance especially in muscle tissue together with insufficient pancreatic secretion of insulin to aid glucose uptake in tissues [7]. Peripheral neuropathy and ischaemia from Peripheral vascular disease are two contributing factors to the development of foot ulcers. Autonomic neuropathy causes the reduction in sweat and oil gland function with the foot loosing its natural ability to moisturise the overlying skin. Patients suffering from peripheral arterial disease present with pain referred to as Intermittent Claudication. The latter is one of the causal factors when amputation of the affected lower limb may be considered. Smoking is considered to be another or an added risk factor for lower limb amputation due to its effect on the circulation and potential for healing. Previously healthy individuals when affected by such infections are at a risk of amputation of limbs not only as a treatment of choice but also as a life saving measure.
In order to facilitate scientific communication the International Organization for Standardization (ISO) developed a system of accurate classification.
2005, Major lower limb amputations in the elderly observed over ten years: the role of diabetes and peripheral arterial disease. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Older age is a factor in susceptibility to necrotizing fasciitis, but the estimated age at which occurrences becomes more frequent is between 60 and 65 years of age.


As the infection progresses, the skin goes from a red purple color to dusky blue, and other colors as the infection and necrosis continues to destroy skin cells. The combination of clindamycin and cefuroxime should be administered, and have recently been accepted as the common treatment for patients in the hospital. The non-viable tissue should be removed leaving a wide band of viable tis-sue to reduce the risk of recurrence. A former practice of ‘sparing of muscle’, is now replaced by the concept of removal of all non-viable tissue, including muscle if necessary. Hemorrhage is not uncommon after removing dead tissue; therefore whole blood and clotting products should be available before surgery. If necrotizing fasciitis affects the genital area then a temporary colostomy should be considered to reduce stress on the patient. The wound could take several months to heal, and would heal through granulation and scar tissue formation. Just sign up for a free membership here and you'll see the HTML version at the end of each article! Additionally, it is associated with obstructive sleep apnea, gout, chronic kidney disease and many other medical problems. An estimated 80 percent of visits to doctor’s offices are for issues relating to chronic disease. Robin Warren turned medical dogma on its head by proving that bacteria – not stress – caused ulcers.
Recently, we are hearing that statins’ best asset may be their anti-inflammatory properties. In Rheumatoid Arthritis, the inflammation is systemic, eating away at the entire body, an autoimmune disorder. If arthritis runs in your family, then you very possibly have a genetic weak link in that regard and you are likely prone to arthritis. Greg Cole, professor of medicine and neurology at UCLA, has found that small doses reduce TNF-alpha and IL-1.
Wheat today is also high in glutamine, an amino acid that has an inflammatory effect on the body. If you are allergic to dairy, as many are, that allergic reaction feeds chronic inflammation. Supermarket beef generally comes from cattle fed an unnatural diet of grain, meaning unwanted residues of hormones, steroids, antibiotics – and meat that is acid.
They provide the building blocks for cell membranes and a variety of hormones and hormone-like substances which we need. Dozens of studies have shown that the omega-3s can help prevent heart attacks and sudden cardiac death by preventing arrhythmias, making blood less likely to clot in arteries, improving the balance of good and bad cholesterol and limiting inflammation. Peripheral Vascular Disease is the most common cause of limb loss overall[2], with the rate of dysvascular amputation being nearly 8 times greater than the rate of trauma related amputations, the second leading cause of limb loss[3].
This tissue is replaced by fibrous tissue and the elastic vessels become harder with stretching of collagen and calcium depositing in the walls of the arteries causing them to become hard and tortuous. Diabetes Mellitus usually has an insidious onset and presents as persistent hyperglycaemia.
Once a foot ulcer develops there is a high risk of wound progression that may lead to complications and amputation. The innervation of the intrinsic muscles of the foot is affected and damage leads to an imbalance between the flexors and extensors of the affected foot and therefore causing anatomic deformities. The skin becomes dry and susceptible to tears or breaks with subsequent development of infection. Neuropathy (with alterations in motor, sensation, and autonomic functions) plays the central role and causes ulcerations due to trauma or excessive pressure in a deformed foot without protective sensibility. It has a detrimental effect on wound healing due to the local and systemic processes that nicotine has[15]. Infections include: Meningococcal Meningitis, Staphylococcus and MRSA infections and Necrotizing Fascitis.
Whereas no other treatment but surgery is currently available for chondrosarcomas, osteosarcomas show an approximately 50–80% response rate to adjuvant chemotherapy. The mentioned classification is constructed on an anatomical bases due to a failure of formation. A ‘dull murky dishwater fluid’ may be found in the wound, which is a characteristic of necrotizing fasciitis. Your physician is your best advisor when addressing the ravages of the Metabolic Syndrome, the treatment of which consume about 20 percent of all healthcare costs.
The pair proved the bacterium Helicobacter pylori causes inflammation, then ulcers.Some 20 years after their discovery, and having endured a storm of criticism from the medical establishment, the pair was awarded the Nobel Prize for Medicine. Immune cells are dispatched to fight the inflammation, and then cholesterol is laid down over the wound like a Band-Aid.
Inflammation of kidneys is known as nephritis and may cause kidney failure or high blood pressure. For someone else, the genetic weak link may make them prone to cancer or Crohn’s Disease. Some of the best foods for vitamin C: guava, bell peppers, oranges, grapefruit, strawberries, pineapple, kohlrabi, papayas, lemons, broccoli, kale, brussels sprouts, kidney beans, kiwi, cantaloupe, cauliflower, red cabbage, mangos, and mustard greens. Today’s diets contain a large amount of salad dressings and processed foods made with vegetable oils, and these provide an overdose of omega-6 fatty acids. On analysing causal pathways for diabetic lower-limb amputation foot ulcers preceded around 84% of amputations[11]. Such deformities include the toes being pulled up into a hammer toe or claw foot flexion deformity. Minor trauma is also a contributing factor to ulcers that may eventually lead to amputation. Once the protective layer of skin is broken, deep tissues are exposed to bacterial colonization. It is the first method of choice for arterial stenosis and occlusion, and for venous incompetence[14]. Nicotine being a vasconstrictor reduces the blood flow to the skin and thus causes tissue ischaemia together with an impairment in the healing process. Examples of traumatic injuries include: compound fractures, blood vessel rupture, severe burns, blast injuries, stab or gunshot wound, compression injuries and cold trauma[16]. Surgical removal of these tumours is currently mostly performed with limb salvage, but amputation may be required in some cases. A Review of Pathophysiology, Classification, and Treatment of Foot Ulcers in Diabetic Patients.
Unchecked inflammation in the pancreas can cause both pancreatitis, a potentially fatal disease, and type 1 diabetes, in which the pancreatic islet cells that produce insulin are destroyed. As the level of AGEs buildup, cells start to signal the production of inflammatory cytokines.
The trachea (windpipe) conducts inhaled air into the lungs through its tubular branches, called bronchi. Foot ulcers are considered to be reasonably common and they not only affect the patient's funtional status and well being but can also identify individuals who may be at a higher risk of amputation. These will cause abnormal bony prominences and pressure points, such as on the tops of the toes or under the metatarsal heads, which may eventually lead to skin breakdown and ulceration. Individuals suffering from peripheral vascular disease and diabetic peripheral neuropathy experience a loss of sensation that may exacerbate the development of ulcers.
Infection is facilitated by DM-related immunological deficits, especially in terms of neutrophils, and rapidly progresses to the deep tissues. In individuals suffering from PAD the blood flow in the lower limbs is reduced due to processes causing stenosis.
Ultrasonic imaging is non-invasive and can provide clinical information about the site and severity of narrowing of arterial vessels or of any blockages of main vessels. Nicotine also promotes an increase in the level of platelet adhesiveness which in result raises the risk of thrombotic microvascular occlusion leading to further tissue ischaemia[15].
In cases of traumatic injury amputation of the limb is considered either as a life saving procedure or where the limb is so severely injured that reconstruction will be less functional than amputation.
In addition, the tumours have a risk of local recurrences adversely affecting the prognosis compared to the primary tumour".[17]. Transverse Deficiencies resemble an amputation residual limb, where the limb has developed normally to a particular level beyond which no skeletal elements are present. Inflammation of the small airways that transport air to the lungs may cause an asthma attack or chronic bronchitis. While drugs usually block a single target molecule and reduce its activity dramatically, he says, natural anti-inflammatories gently tweak a broader range of inflammatory compounds. The bronchi then divide into smaller and smaller branches (bronchioles), finally becoming microscopic.The bronchioles eventually end in clusters of microscopic air sacs called alveoli.
In peripheral arterial disease there is build up of fatty deposits in the walls of the arterial system. Many times diabetic individuals are unable to detect trauma to an affected area such as the foot. Blood circulation is usually sufficient when one is at rest, however when one starts walking and the demands are greater the blood supply is not sufficient to the lower limb muscles causing cramps and pain.


Where multiple stenoses are present such imaging can determine which stenosis is causing more restriction to blood flow[14]. In the case of trauma limb amputation can also take place months or years after the actual trauma when reconstructive procedures or healing hava failed. These fatty deposits, also known as atheromas, cause a reduction in the lumen of the arteries.
In diabetic individuals the hyperglycaemic-induced metabolic abnormalities cause a conversion of intracellular glucose to sorbitol and fructose.
This may result in injury with wounds either going unnoticed or progressively worsen when the affected area is exposed to repetitive pressure or forces such as shear forces during ambulation[12][11]. Thus such pain gets worse with greater demands example: when walking uphill and improves or is relieved after a short rest[13]. Carbon dioxide, a waste product of metabolism, travels from the blood to the alveoli, where it can be exhaled. The reduction in the lumen causes stenosis and restricts the blood flow and supply to the particular area affected. The accumulation of these sugars cause a reduction in the synthesis of products required for normal nerve conduction and function. Poor healing of such wounds, due to compromised circulation, will eventually lead to amputation of the involved limb. Between the alveoli is a thin layer of cells called the interstitium, which contains blood vessels and cells that help support the alveoli.The lungs are covered by a thin tissue layer called the pleura. The chemical conversion of glucose will also increase the oxidative stress on nerve cells and lead to further ischaemia and thus causing further nerve cell injury and death. The skin surface is located at the top of the image whilst markers on the right indicate depth in cms.
A small amount of fluid between these two layers acts as a lubricant allowing the lungs to slide smoothly as they expand and contract with each breath.Lung conditionsChronic obstructive pulmonary disease (COPD). The fragile walls between the lungs' air sacs (alveoli) are damaged, trapping air in the lungs and making breathing difficult.Chronic bronchitis. The lungs' airways (bronchi) become inflamed and can spasm, causing shortness of breath and wheezing.
Allergies, viral infections or air pollution often trigger asthma symptoms.Acute bronchitis.
The interstitium (walls between air sacs) become scarred, making the lungs stiff and causing shortness of breath.Sarcoidosis (Boeck’s disease).
Tiny areas of inflammation can affect all organs in the body, with the lungs involved most of the time.
Fluid builds up in the normally tiny space between the lung and the inside of the chest wall (the pleural space). Inflammation of the lining of the lung (pleura), which often causes pain when breathing in. Autoimmune conditions, infections or a pulmonary embolism may cause pleurisy.Bronchiectasis. The airways (bronchi) become inflamed and expand abnormally, usually after repeated infections. Coughing, with large amounts of mucus, is the main symptom of bronchiectasis.Lymphangioleiomyomatosis (LAM). A rare condition in which cysts form throughout the lungs, causing breathing problems similar to emphysema.
The excess mucus causes repeated episodes of bronchitis and pneumonia throughout life.Interstitial lung disease. A collection of conditions in which the interstitium (lining between the air sacs) becomes diseased.
Fibrosis (scarring) of the interstitium eventually results, if the process can't be stopped.Lung cancer. A slowly progressive disease that affects the lungs caused by the bacteria Mycobacterium tuberculosis.
Chronic cough, fever, weight loss and night sweats are common symptoms of tuberculosis.Acute respiratory distress syndrome (ARDS). Life support with mechanical ventilation is usually needed to survive until the lungs recover.Fungal pneumonia. Pneumonia caused by a type of fungus such as Coccidioides orHistoplasma capsulatum, both types of fungi are found in soil and can affect travellers to the USA where Coccidioides is found in the southwest, and Histoplasmosis in the eastern and central regions. Most people experience no symptoms or a flu-like illness with complete recovery.Hypersensitivity pneumonitis (allergic alveolitis). Usually this occurs in farmers or others who work with dried, dusty plant material.Influenza (flu). An infection by one or more flu viruses causes fever, body aches and coughing lasting a week or more. Influenza can progress to life-threatening pneumonia, especially in older people with medical problems.Mesothelioma. A rare form of cancer that forms from the cells lining various organs of the body with the lungs being the most common. Mesothelioma tends to emerge several decades after asbestos exposure.Pertussis (whooping cough). A highly contagious infection of the airways (bronchi) by Bordetella pertussis, causing persistent cough. Many conditions can lead to high blood pressure in the arteries leading from the heart to the lungs. If no cause can be identified, the condition is called idiopathic pulmonary arterial hypertension.Pulmonary embolism. A blood clot (usually from a vein in the leg) may break off and travel to the heart, which pumps the clot (embolus) into the lungs.
Sudden shortness of breath is the most common symptom of a pulmonary embolism.Severe acute respiratory syndrome (SARS).
A severe pneumonia caused by a specific virus first discovered in Asia in 2002.Pneumothorax. Air in the chest; it occurs when air enters the area around the lung (the pleural space) abnormally. A CT scan uses X-rays and a computer to make detailed pictures of the lungs and nearby structures.Pulmonary function tests (PFTs). Lung capacity, the ability to exhale forcefully and the ability to transfer air between the lungs and blood are usually tested.Spirometry. Culturing mucus coughed up from the lungs can sometimes identify the organism responsible for a pneumonia or bronchitis.Sputum cytology.
Viewing sputum under a microscope for abnormal cells can help diagnose lung cancer and other conditions.Lung biopsy.
Examining the biopsied tissue under a microscope can help diagnose lung conditions.Flexible bronchoscopy. An endoscope (flexible tube with a lighted camera on its end) is passed through the nose or mouth into the airways (bronchi). Rigid bronchoscopy is often more effective than flexible bronchoscopy, but it requires general anaesthesia.Magnetic resonance imaging (MRI scan). An MRI scanner uses radio waves in a magnetic field to create high-resolution images of structures inside the chest.Lung treatmentsThoracotomy.
Thoracotomy may be done to treat some serious lung conditions or to obtain a lung biopsy.Video-assisted thorascopic surgery (VATS). Less-invasive chest wall surgery using an endoscope (flexible tube with a camera on its end).
A tube is inserted through an incision in the chest wall in order to drain fluid or air from around the lung.Pleurocentesis. When used soon after flu symptoms start, antiviral medicines can reduce the severity of influenza. This can reduce wheezing and shortness of breath in people with asthma or COPD.Corticosteriods. Steroids can also be used to treat less common lung conditions caused by inflammation.Mechanical ventilation.
People with severe attacks of lung disease may require a machine called a ventilator to assist breathing.
The ventilator pumps in air through a tube inserted into the mouth or the neck.Continuous positive airway pressure (CPAP). It is used at night to treat sleep apnoea, but it is also helpful for some people with COPD.Lung transplant. Severe COPD, pulmonary hypertension and pulmonary fibrosis are sometimes treated with lung transplant.Lung resection.



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