1′-Phenyl-6′-thia­cyclo­heptane-1-spiro-2′-perhydro­pyrrolizine-3′-spiro-3′′-indoline-2,2′′-dione

The thia­zolidine ring and the pyrrolidine ring in the title compound, C25H26N2O2S, both adopt an envelope conformation. The seven-membered ring has a twist-chair conformation. The crystal packing is stabilized by inter­molecular N—H⋯O hydrogen bonds

3-(4-Methoxy­phen­yl)-6-(phenyl­sulfon­yl)perhydro-1,3-thiazolo[3′,4′:1,2]pyrrolo[4,5-c]pyrrole

In the title compound, C21H24N2O3S2, the three five-membered rings adopt envelope conformations. The dihedral angle between the two aromatic rings is 68.4 (1)°. C—H⋯O inter­actions link the mol­ecules into a chain and the chains are cross-linked via C—H⋯π inter­actions involving the meth­oxy­phenyl ring

Doppler Based Evaluation of Peripheral Lower Limb Arterial Insufficiency in Diabetic Lower Limb Disease and Its Significance in the Course of Management

INTRODUCTION: Diabetes Mellitus is a common pathological condition of present times mainly because of the impact it has on the quality of life by its acute and long term complications secondary to the involvement of micro and macrovasculature. Diagnosis of PAD in diabetic patients is of paramount clinical significance in order to determine the subset of patients who are at a higher risk of developing ischemic complications and also to timely intervene and treat the symptoms of PAD which if left untreated can lead to limb loss and functional disability. Thus Doppler Scanning, a non-invasive imaging modality can act as a basis for regular followup of the cases at the risk of arterial disease and early intervention to salvage the limb if vascular insufficiency is detected at an early stage. AIMS AND OBJECTIVES: 1. To determine the incidence of lower limb arterial insufficiency in diabetic patients presenting with ulcer, cellulitis, gangrene. 2. To establish PAD as an important risk factor in development of lower limb diseases in diabetics. MATERIALS AND METHODS: Randomly selected 100 diabetic patients admitted in our general surgery ward with either numbness of foot, ulcer, cellulitis, gangrene or any other symptoms suspicious of vascular insufficiency. Study period : 2 years. Study design : Longitudinal observation study. Sample : 100 cases. RESULTS: Patients with long standing diabetes with poor glycemic control had severe form of clinical presentation and Doppler findings warranting atleast minor amputation. Out of 100 patients, 18 of them had no vascular involvement at all. Remaining 82 patients had some form of peripheral arterial involvement. Patients who had severe form of PAD (luminal stenosis / more proximal involvement) had presented with severe disease (ulcer and gangrene). Patients who were diagnosed with PAD and intervened with drugs and surgical methods improved well and limb salvage was made possible for them. CONCLUSION: From this study, it is evident that PAD is an important risk factor in diabetic lower limb disease and early diagnosis using simple noninvasive method like Doppler can significantly improve the outcomes by early intervention and thereby preventing amputations and improving limb salvages

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Not AvailableTHE PAPER SUGGESTS THAT BITUMEN SPRAY WITH 3mm THICK LINING WAS A BETTER SEALANT FOR REDUCING SEEPAGE LOSS BUT WAS SUBJECTED TO SEASONAL INFLUENCE OF CLIMATE, RAINFALL AND API WERE THE MAIN FACTORS INFLUENCING THE SEEPAGE LOSS. PREDICTING EQUATION HAS BEEN FITTED TO THIS EFFECT.Not Availabl