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Some people who are diagnosed with diabetes haven’t experienced any diabetes symptoms — their diabetes was diagnosed from the results of a simple blood test. If you begin to notice any one of the above mentioned symptoms please contact your primary care physician. Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 All About Heart Rate (Pulse) 4 What are the Symptoms of High Blood Pressure?
This site complies with the HONcode standard for trustworthy health information: verify here. Of the 26 million people who have diabetes, an estimated 7 million have no idea that they have the disease, according to the American Diabetes Association.
A recent study in “The Journal of the American Dental Association” found that one in five cases of total tooth loss in the United States can be linked to diabetes. Regardless of your health status, the ADA recommends everyone practice good oral health habits by brushing twice a day for two minutes with fluoride toothpaste, flossing daily, eating a healthy diet and visiting your dentist regularly.
The not-for-profit ADA is the nation's largest dental association, representing 157,000 dentist members. This picture of a 78-year-old man’s scalp, left parietal area, shows a rounded, raised 1-cm in diameter lesion with central crusted ulceration that had been present for 1 to 2 months.
Diabetes, the lifestyle disease, can be cured with the help of certain positive changes in the dietary regime, proper exercise routine and a healthier lifestyle. If the patient is taking insulin or other prescription drugs, it is important to take herbal remedies under the supervision and as per the recommendations of the doctor. The insulin content present in the roots of Burdock helps in preventing the blood sugar levels from going out of control.
The hypoglycemic and hypoallergenic properties of Carob, help in preventing the blood sugar levels from going out of control. The starch and sugar content present in dandelion roots can be easily assimilated in the blood stream by the diabetic patients and is usually incorporated in the diet to keep the blood sugar levels under control. The medicinal properties of fenugreek plant and its seeds make it an important herb for the treatment of the signs and symptoms of diabetic patients. Garlic has several hypoglycemic properties and is administered to diabetic patients in the raw and powdered form. The extract of goat’s rue has been used since the medieval times for its effect on blood sugar levels. The rising numbers of patients being diagnosed for Diabetes Type 2 symptom has increased the importance of the tract of gurmar leaves. The problems connected with obesity and diabetes can be corrected with the help of the water soluble fibers and pectin found in prickly pear cacti.
According to recent studies, the extract of stevia contains hypoglycemic activities and can be used for lowering the blood sugar levels in diabetic patients. Along with the above, there are many more varieties of herbs and medicinal plants which help in keeping the blood sugar levels under control.
Science, Technology and Medicine open access publisher.Publish, read and share novel research. Colles’ fascia completely envelops the scrotum and penis, continuiting cephalad to the level of the clavicles. Adinolfi MF, Voros DC, Moustouskas NM, Hardin WD, Nichols RL.Severe systemic sepsis resulting from neglected perineal infections. Adams JR Jr, Mata JA, Venable DD, Culkin DJ, Bocchini JA Jr.Fournier’s gangrene in children. Baskin LS, Carroll PR, Cattolica EV, McAnninch JW.Necrotising soft tissue infections of the perineum and genitalia.
Tests and DiagnosisThe above discussed causes along with other specific conditions of the person could lead to a realistic primary diagnosis of CVI.
To understand the causes of CVI better, let us first understand the function of blood circulation in our body. Yet, for over a decade, as I've sat at my computer working, my lower legs have swollen, and left me with very ugly brown specked splotches - the skin has never broken but they have been swollen to twice their normal size. Now, it's been so very long happening that the original splotches are now a dark brown, and today, the new ones are bright red and are excruciatingly painful - as if I had some kind of bone cancer, tho I know I do not.
Besides, they ended right below my knees, and above the knee, you can clearly see the marks where they had st```````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````opped. I literally CRY when I walk since every step is painful, to my ankes as well as to the 'broken golf balls'I 'feel' underboth feet I awalk.and no amount of narcotics helps,neither do all the newer rugs that are non-narcotic and the newer dual reuptake inibitors, such as Cymbalta.
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Since your kidneys must remove the excess glucose from your blood, it ends up in your urine, which can cause more frequent urination with more volume.
When you lose an increased amount of fluid through frequent urination, you may become dehydrated and thirsty. Since your body is unable to use your blood glucose effectively, it begins to break down your energy stores such as fat, which can result in weight loss or a failure to gain weight in growing children. Feeling tired is a common diabetes symptom because your body cannot convert the glucose in your blood into usable energy. Along with hunger and fatigue, it is not uncommon to feel irritable when you have diabetes. Hope is an innovative and federally-qualified community health center offering comprehensive medical, dental, pharmacy and clinical research.
These ulcers first appeared after a motor vehicle accident in which the patient saw her fianc die. With those figures in mind, the American Dental Association (ADA) recommends that regular health care checkups may help to identify potential signs of diabetes. That, along with a longer healing process, makes them more susceptible to developing gum disease and developing a more severe form of the disease. The premier source of oral health information, the ADA has advocated for the public's health and promoted the art and science of dentistry since 1859.
The diagnosis was infiltrating well-differentiated to moderately differentiated squamous cell carcinoma. The patient was saved time and many days of travel elsewhere for radiation treatment, if that had been his choice. Patients in the initial stages of diabetic conditions can get a lot of help from their kitchen and simple herbal remedies as well. It is important to note that these botanical remedies can be taken along with the medicines if there are no visible side effects. They are very effective in treating diabetes and the extract of heir root is generally prescribed for best results. It has plenty of advantages over chocolate and is recommended for the treatment of diabetes. Garlic is found to initiate the production and release of insulin from the beta cells in the pancreas and this helps in bringing down the blood sugar levels by a significant extent.
It is being used by herbal experts even in the modern time for the treatment and control of diabetes. Very effective in keeping the blood sugar levels under control, gurmar is recommended worldwide for its hypoglycemic properties. They are very effective in the regulation of blood sugar as well and are administered to diabetic patients across the world.
Fournier’s gangrene: Historic (1764-1978) versus contemporary (1979-1988) differences in etiology and clinical importance.


Chronic venous insufficiency is a medical condition where veins, mainly in the lower part of a leg, are incapable of pumping blood back efficiently.
From ankle to knee, they feel as hard as baseball bats and if I accidently hit them upon anything, the pain is what I would imagine lightening would be like if it struck ! Your body is unable to use the glucose you have and is trying to tell you it needs more fuel. Since then, she has tried selective serotonin reuptake inhibitors, various mouthwashes, special toothpastes, nystatin, doxycycline, and "swish and spit" corticosteroids. Oxypentifylline in the management of recurrent aphthous oral ulcers: an open clinical trial.
A randomized, double-blind, placebo-controlled trial of pentoxifylline for the treatment of recurrent aphthous stomatitis. The ADA's state-of-the-art research facilities develop and test dental products and materials that have advanced the practice of dentistry and made the patient experience more positive.
In certain cases, its seeds are soaked in water overnight and eaten before breakfast for best results.
Understanding the tendency of necrotizing fasciitis to spread along fascial planes and the fascial anatomy, one can see how a process that initiates in the perineum can spread to the abdominal wall, the flank, and even the chest wall.4. Such incompetent perforating veins result in lack of enough blood transmission back to the heart. Conservative therapies include measures like use of compression pumps, compression stockings, lymphatic massage therapy, and medicines that deal with blood pressure. The ADA Seal of Acceptance long has been a valuable and respected guide to consumer dental care products. Skin and superficial fasciaBecause Fournier’s gangrene is predominantly an infectious process of the superficial and deep fascial planes, appreciating the anatomic relationship of the skin and subcutaneous structures of the perineum and abdominal wall is vital.The skin cephalad to the inguinal ligament is backed by Camper’s fascia, which is a layer of fat-containing tissue of varying thickness and the superficial vessels to the skin that run through it. Onwuchekwa, Fournier’s gangrene of the penis associated with adenocarcinoma of the rectum and diabetes mellitus. Another similar medical condition, Chronic Cerebrospinal Venous Insufficiency occurs when veins from the central nervous system fail to perform the objective of circulation of the blood.
Surgical methods include Linton procedures, Varicose Vein Stripping, and Sub-fascial Endoscopic Perforator Vein surgery.
The monthly The Journal of the American Dental Association (JADA) is the ADA's flagship publication and the best-read scientific journal in dentistry. Green, Fournier’s gangrene in a man who was HIV-positive with a high CD4 count: an unusual presentation of a complex recto-scrotal fistula. However surgical methods are referred to only in case of refractory ulcer and other such direct discomforts. Failure of such veins can be pinpointed to various reasons such as blockage (called as Stasis), damage or plain absence of such veins. Are there any other treatments?----- Garrick Olsen, MDHastings, Minn Current evidence suggests that the etiology of aphthous stomatitis involves an immune dysfunction.
In the perineum, Scarpa’s fascia blends into Colles’ fascia (superficial perineal fascia), and continuous with Dartos fascia of the penis and scrotum.Several important anatomic relationships should be considered.
New surgical methods are being experimented which revolve around valve repair and valve transposition but are yet to be put into practice.The FDA approved Maggot debridement has been long ignored by the medical faculty but is supposed to be an effective way of curbing CVI although not the most sophisticated one (due to its creepy procedure involving leeches). A potential space between the Scarpa’s fascia and the deep fascia of the anterior wall (external abdominal oblique) allows for the extension of a perineal infection into the anterior abdominal wall.
Pearl, Causes, presentation and survival of fifty-seven patients with necrotizing fasciitis of the male genitalia.
Sheikh, The spectrum of presentation and management of Fournier’s gangrene-an experience of 73 cases. Yildiz, Fournier’s gangrene: risk assessment and enzymatic debridement with lyophilized collagenase application.
Topical products reduce the intensity of the pain by physical (covering of the ulcer) or chemical (cautery) means.Other treatments decrease symptoms and hasten healing. Superiorly, Scarpa’s and Camper’s fasciae coalesce and attach to the clavicles, ultimately limiting the cephalad extension of an infection that may have originated in the perineum. Neuropathy does NOT leave brown splotches on the skin, followed by deep red ones, with cream-clored or whitish centers What do you call a doctor with a GPA of 2.0? Colles’s fascia is attached to the pubic arch and the base of the perineal membrane, and it is continuous with the superficial Dartos fascia of the scrotal wall. I worse compression hose for several years but they became too painful to get and off, so I quite wearing them.
The perineal membrane is also known as the inferior fascia of the urogenital diaphragm and, together with Colles’ fascia, defines the superficial perineal space.This space contains the membranous urethra, bulbar urethra, and bulbourethral glands.
For recalcitrant major aphthae, some experts advocate treatment with other types of systemic immune modulators, such as corticosteroids, azathioprine, or thalidomide. Infectious disease of the male urethra, bulbourethral glands, perineal structures, or rectum can drain into the superficial perineal space and can extend into the scrotum or into the anterior abdominal wall up to the level of the clavicles.5. Blood supplyBranches from the inferior epigastric and deep circumflex iliac arteries supply the lower aspect of the anterior abdominal wall.
With the exception of the internal pudendal artery, each of these vessels travels within Camper’s fascia and can therefore become thrombosed in the pathogenesis of Fournier gangrene.
In the male, the testis receives its blood supply primarily from the testicular artery, a branch of the abdominal aorta. This explains the sparing of the testis in Fournier’s gangrene.Thrombosis jeopardizes the viability of the skin of the scrotum and perineum. Often, the posterior aspect of the scrotal wall supplied by the internal pudendal artery remains viable and can be used in the reconstruction following resolution of the infection.6.
Penis and scrotum The contents of the scrotum, namely the testes, epididymides and cord structures, are invested by several fascial layers distinct from the Dartos fascia of the scrotal wall.
The most superficial layer of the testis and cord is the external spermatic fascia, which is continuous with the external oblique aponeurosis of the superficial inguinal ring. The next deeper layer is the internal spermatic fascia, which is continuous with the transversalis fascia.
The Buck fascia covers the erectile bodies of the penis, the corpora cavernosa, and the anterior urethra. The Buck fascia fuses to the dense tunica albuginea of the corpora cavernosa, deep in the pelvis. These fascial layers do not become involved with an infection of the superficial perineal space and can limit the depth of tissue destruction in a necrotizing infection of the genitalia. AetiologyAlthough originally described as idiopathic gangrene of the genitalia, Fournier gangrene has an identifiable cause in approximately 95% of cases. The necrotizing process commonly originates from an infection in the anorectum, urogenital tract, or skin of the genitalia 10. Urethral instrumentation, prosthetic penile implants, superficial soft-tissue injuries, intramuscular injections, genital piercings, steroid enemas (used for the treatment of radiation proctitis), blunt thoracic trauma, and penile self-injection with cocaine have been reported in the literature as causative factors.In women, septic abortions, vulva or Bartholin gland abscesses, hysterectomy, and episiotomy are documented sources of sepsis.
Escherichia coli is the predominant aerobe, and Bacteroides species the predominant anaerobe.
Other common microflora includes Proteus, Staphylococcus, Enterococcus, aerobic and anaerobic Streptococcus, Pseudomonas, Klebsiella, and Clostridium. Incidence of methicillin-resistant Staphylococcus aureus (MRSA) may be increasing 7.Any condition that leads to depressed cellular immunity may predispose a patient to the development of Fournier gangrene. A photomicrograph may show the presence of ulcerated epidermis and the presence of thrombosed blood vessel Figure 2.Ulcerated epidermis and dermis with thrombosed blood vessel and bacterial colonies Infection represents an imbalance between host immunity and the virulence of the causative microorganisms. The compromised immunity provides a favourable environment to initiate the infection, and the virulence of the microorganism promotes the rapid spread of the disease.


Microorganism virulence results from the production of toxins or enzymes that create an environment conducive to rapid microbial multiplication 11. In a 1924 series of Chinese men with necrotizing infections, Meleney reported that streptococcal species were the predominant organisms recovered from cultures 12.
Subsequent clinical series however stress the polymicrobial nature of most cases of necrotizing infection including Fournier’s gangrene 13,14.Presently, recovering only streptococcal spp is unusual 15. For example, one microorganism might produce the enzymes necessary to cause coagulation of the nutrient vessels.
The resultant tissue hypoxia allows growth of facultative anaerobes and microaerophilic organisms. Knowledge of this provides the surgeon with a clinical marker of the extent of tissue affectation. Severe or fulminant Fournier’s gangrene can spread from the fascial envelopment of the genitalia throughout the perineum, along the trunk, occasionally, into the thighs and very rarely, to the chest.9. Clinical presentationA thorough review of systems, including history of diabetes, alcohol abuse, cancer, colorectal or urogenital disease or surgery, steroid use, sexual history, and HIV status is important. Fournier’s gangrene usually begins with an insidious onset of pruritus and discomfort of the external genitalia. Swelling and erythema of the region follow pain, and a patient may complain of systemic symptoms such as fever or chills.
Crepitus may be present, but its absence does not exclude the presence of Clostridium species or other gas-producing organisms. InvestigationsThe diagnosis of Fournier’s gangrene is clinical and includes the history and physical examination findings, especially the anatomical involvement in the external genitalia and perineum. Urinalysis and blood sugar measurements give evidence of metabolic derangements such as diabetes mellitus.
Considering that FG is a urological emergency, treatment should not be delayed for these investigative tools. Other investigations are essential to identify co-morbid factors as well as causative factors.
Appropriate bacteriological evaluation of pus from the gangrene, full blood count, renal and hepatic function studies are essential. Diagnostic investigations, which may also help to determine Figure 4.Fournier’s gangrene of scrotum following orchidectomy for prostate cancer.
The hallmark in all imaging modalities is the demonstration of air in the soft tissue planes 17. Histopathology assessment has been reported by authors but describes pathological consequences of the disease.
Marjolin’s ulcer has been reported to arise from the scar of a FG many years after successful treatment 18,19.
Follow up and biopsy when indicated are necessary.Some investigations are necessary to identify the source of sepsis in FG. Immediate treatment following diagnosis or suspicion includes resuscitative measures such as rehydration, blood transfusion, electrolyte replacements, multiple therapy antimicrobial agents, Oxygen and adequate analgesia 21.
Triple antimicrobial therapy is started empirically to cover aerobes and anaerobes as well as gram-negative and gram-positive organisms pending the result of microbial microscopy, culture and sensitivity from pus and or blood specimens. The organisms invariably cultured from FG include staphylococci and streptococci, coliforms, pseudomonas, bacteroides and clostridia 22. Penicillin is used to cover streptococci while metronidazole is given against anaerobes such as bacteroides. Honey inhibits bacterial growth due to its low pH, high viscosity, the hygroscopic effect and presence of inhibine and anti-oxidants 29.Hyperbaric oxygen (HBO) was used in the erroneous belief that the crepitus in FG was of clostridial aetiology 30. The efficacy of hyperbaric oxygen is applicable in clostridial and nonclostridial infections 30,31. HBO increases the oxygen tension in tissues to a level that is inhibitory and lethal to anaerobic bacteria, while limiting necrosis and enhancing demarcation of gangrene 30-33. However in a review of 42 patients with FG and in whom half were given HBO and another half not given, there was a higher mortality among the HBO patients 34.
This had been observed 10 years earlier 35.Adequate nutrition is an essential part of treatment of FG.
In one study, the authors concluded that diabetes control was an important prognostic measure 36.Surgical treatment is the cornerstone of the treatment of FG. A mortality of 100% has been recorded in patients with necrotizing fascitis treated without surgery 24,37,38. This may be repeated as necrosis is observed.Orchidectomy may be required for testicular gangrene, a rare complication of FG.
It has also been done when there was not enough scrotum to house the testis.Reconstruction may be required to restore function and cosmetic appearance. Procedures that have been carried out vary from secondary closure of well granulated wound to flap procedures to create a neo-scrotum. ComplicationsAn uncomplicated Fournier’s gangrene is one which is localized and resolves with the basic treatments of debridement, dressings and antimicrobial agents. Complicated FG may require urgent and vigorous resuscitation in the intensive care unit and reconstructive procedures. Specific complications include auto-amputation of the penis 20, fatal overwhelming sepsis, tetanus 40 and Marjolin’s ulcer long after the wound has healed 41.
The testis may become gangrenous from FG in which sepsis has originated from the retroperitoneal space or the abdomen 42,43.
Treatment outcomeAlthough more patients survive from FG than die from it, the mortality in FG remains high ranging from 3 to 45% 28,47.
In a review of 1726 cases from 1950 to 1999 worldwide, reported in the English literature, the mortality rate was 16 per cent 6. In a subsequent unpublished study of 3297 cases of FG from 1950 to 2007, the mortality rate rose to 21.1%.
It was paradoxically observed in both studies the mortality was higher in the advanced countries of America, Canada and Europe than in the underdeveloped countries.
Factors associated with high mortality include an anorectal source, advanced age, diabetes mellitus, extensive disease (involving abdominal wall or thighs), shock or sepsis at presentation, renal failure, and hepatic dysfunction 5. Death usually results from systemic illnesses, such as sepsis, coagulopathy, diabetic ketoacidosis, acute renal failure or multiple organ failure.14. Early presentation in good functional status together with adequate and prompt treatment lead to a good outcome. Co-morbid factors include older age, poorly controlled diabetes mellitus 24,48, and colorectal source of infection.
However, if there has been lower limb or abdominal wall involvement there is a noticeable increase in mortality rate.There have been efforts to assess the risk of death in the disease. A severity index above 9 indicates a 75% mortality probability while under 9 indicates a 78% survival probability 50.Other efforts to assess the risk of death in the disease have been reported 46,51. Villanueva Saenz et al 2002 52 employed APACHE II and found that patients with scores of 20 or more had a higher mortality than those with a lower score.



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