Aim To assess the usefulness of monthly thermography and standard foot care to reduce diabetic foot ulcer recurrence. Methods People with diabetes (n = 110), neuropathy and history of >= 1 foot ulcer participated in a single-blind multicentre clinical trial. Feet were imaged with a novel thermal imaging device (Diabetic Foot Ulcer Prevention System). Participants were randomized to intervention (active thermography + standard foot care) or control (blinded thermography + standard foot care) and were followed up monthly until ulcer recurrence or for 12 months. Foot thermograms of participants from the intervention group were assessed for hot spots (areas with temperature >= 2.2 degrees C higher than the corresponding contralateral site) and acted upon as per local standards. Results After 12 months, 62% of participants were ulcer-free in the intervention group and 56% in the control group. The odds ratios of ulcer recurrence (intervention vs control) were 0.82 (95% CI 0.38, 1.8; P = 0.62) and 0.55 (95% CI 0.21, 1.4; P = 0.22) in univariate and multivariate logistic regression analyses, respectively. The hazard ratios for the time to ulcer recurrence (intervention vs control) were 0.84 (95% CI 0.45, 1.6; P = 0.58) and 0.67 (95% CI 0.34, 1.3; P = 0.24) in univariate and multivariate Cox regression analyses, respectively. Conclusions Monthly intervention with thermal imaging did not result in a significant reduction in ulcer recurrence rate or increased ulcer-free survival in this cohort at high risk of foot ulcers. This trial has, however, informed the design of a refined study with longer follow-up and group stratification, further aiming to assess the efficacy of thermography to reduce ulcer recurrence.

Thermal imaging is a useful modality for identifying preulcerative lesions (“hot spots”) in diabetic foot patients. Despite its recognised potential, at present, there is no readily available instrument for routine podiatric assessment of patients at risk. To address this need, a novel thermal imaging system was recently developed. This paper reports the reliability of this device for temperature assessment of healthy feet.

In this paper a description is given of the development, characterisation and first results of a thermal imaging device aimed at significantly reducing the incidence of diabetic foot ulceration (DFU). These devices will be used in three clinical centres and in two preliminary clinical trials. The first will be on healthy volunteers to set a robust baseline for the overall research aims and the second on  >100 patients at high risk of DFU. In the second phase of the project the objective is to demonstrate significant reduction in the incidence of DFU through a comparison of the results of standard care of high risk feet with standard care plus thermal imaging.

In digital imaging, poor contrast between the target and its background can affect the extraction of the object of interest and increase the time used in its analysis. Medical thermal imaging requires the correct interpretation of the thermal values obtained from the region of interest. In this investigation, a subjective and objective comparison of currently available outlining techniques is performed to determine the optimal method. Results indicate that probability-based operators produce the best outcome especially after pre-processing with a noise removal filter. The findings of this study suggest that probability-based edge detection techniques in combination with homomorphic filtering and limited post-processing provide initial estimate delineations of areas. These delineations are of sufficient quality for subsequent automatic or semiautomatic post-processing so that a maximum of the original information inside the regions is preserved without loss or distortion of data.

Medical thermography has become ever more accessible to hospitals, medical research, and clinical centers with the new generation of thermal cameras, which are easier to use and lower in cost. Some diagnostic techniques using thermal cameras are now regarded as standardized, such as the cold challenge test for Raynaud’s phenomenon. The future for medical thermography appears to be improved accuracy, standardization, and establishment as a mainstream medical imaging methodology. Medical thermography standardization, quantitative measurements, image comparison, and multi-center research trials all require thermal cameras to provide a demonstrably traceable, accurate, and reliable temperature output. To this end, the National Physical Laboratory (NPL) has developed a multi-fixed-point source that serves as an in-image calibration system, thereby providing a reliable means for radiometric image validation. An in-field-of-view fixed-point validation system for thermal imaging has successfully been developed, tested, and validated at NPL and has undergone field trials at three clinical centers in the UK. The sources use the phase change plateaux of gallium–zinc eutectic, gallium, and ethylene carbonate. The fixed-point sources have an estimated cavity emissivity of greater than 0.998, a plateau longevity of nominally 3 h at ambient conditions, a stability of 0.1°C, or better, over that period, a repeatability of 0.1°C or better, and an estimated temperature uncertainty of  ±0.4°C (k = 2). In this article, the source specifications and design as well as testing, validation, and field trial results are described in detail.

Bei acht Patienten, die sich im Dauerdialyseprogramm befanden, wurde unmittelbar nach Anschluß an den Hämodialysator eine massive Zunahme von zirkulierenden Thrombozytenaggregaten mit der Methode nach Wu und Hoak gefunden. Die Zahl der Aggregate war noch während der Hämodialyse rückläufig, wobei nach 360 min der Ausgangswert wieder erreicht wurde. Als auslösende Ursache muß die Interaktion der Thrombozyten mit der Membranoberfläche des Dialysators gesehen werden. Antikoagulierung mit Heparin allein ist nicht ausreichend, um eine Mikroaggregatbildung während Hämodialyse zu verhindern.

This study of 20 patients with monoclonal gammopathy (17 patients with multiple myeloma and 3 patients with Waldenström's syndrome) showed a decreased platlet aggregation induced by ADP and collagen, a reduced platlet retention and a prolonged bleeding time in 25% of the cases in comparison with 30 age- and sex-matched healthy controls. Using Wu and Hoak's technique as increased number of reversible platelet aggregates was observed. There was no relationship between the parameters of primary haemostasis and protein analysis. A disturbed mechanism of primary haemostasis is the main factor responsible for the bleeding diathesis in patients with monoclonal gammopathy.

Morphological control of Moncada's bioassay for prostacyclin (PG I2) activity measurement shows that the activity depends not only on endothelium, but in important amounts on subendothelial tissue too. Therefore, it can be concluded that platelet thrombus formation after endothelial cell injury does not depend only on the PG I2-producing ability of the tissue.

Platelet retention was investigated using a standardized technique with a glass pearl column in 18 patients with malignant thyroid disease treated by thyroidectomy before and after high-dose radioiodine treatment (80 or 150 mCi). As compared with the normal controls platelet retention was significantly lower in 13 hypothyroid patients in whom thyroidectomy had been undertaken at least 6 months previously and hormone substitution therapy had been interrupted 3 weeks before the period of investigation. The remaining 5 patients, studied about 18 days following thyroidectomy, were euthyroid and displayed platelet retention values within the lower limits of the normal range except for one patient with markedly reduced values. Thyroid substitution therapy with synthetic preparations induced recovery of platelet retention in both groups examined over a 4 week period, the increase being highly significant in the group of hypothyroid patients. A transient increase in platelet retention was observed 24 hours after a therapeutic dose of radioiodine, and initial values being regained after a further 24-hour period. This phenomenon was found in both, the euthyroid and hypothyroid group, however, it was more pronounced in the latter patients. Our results indicate a dependence of platelet retention on thyroid hormone concentration. The observed transient increase after radioiodine may be due to a radiation effect.