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The tarsal tunnel is composed of the posterior border of the medial malleoulus, the posterior aspect of the talus and the medial aspect of the calcaneus. The medial calcaneal nerve emerges from the posterior aspect of the posterior tibial nerve in 75% of cases and from the lateral plantar nerve in the remaining 25%. Finally, the medial calcaneal nerve ends as a single terminal branch in 79% of cases and in numerous terminal branches in the remaining 21%. To describe the anatomical variants of the posterior tibial nerve and its terminal branches. To describe the steps for tarsal tunnel release. To describe Baxter nerve release. The anatomical variants of the posterior tibial nerve and its terminal branches within the tarsal tunnel were studied. Then the Lam technique was performed; it consists of: 1) opening of the laciniate ligament, 2) opening of the fascia over the abductor hallucis muscle, 3) exoneurolysis of the posterior tibial nerve and its terminal branches, identifying the emergence and pathway of the medial calcaneal branch, the lateral plantar nerve and its Baxter nerve branch and the medial plantar nerve. Baxter nerve was found in 100% of cases. In 100% of cases in our series the nerve going to the abductor digiti minimi muscle of the foot was found; 87.5% of cases had two terminal branches. The dissections proved that a crucial step was the release of the distal tarsal tunnel.

Nursing was qualified to carry out an in depth study on the effects diabetes has on feet by means of an educational intervention complemented by a pre- and post-intervention transversal study 268 primary care center nurses who deal with diabetics in 34 basic health areas participated in this study This project was sponsored by SALUD, the Aragon Health service, in 2000 and it lasted two years. This study was presented at the XI FEAED (Spanish Federation of Associations of Educators in Diabetes) Congress which took place in Valencia in 2004.

The care of combatants with lesions caused by frostbite during the battle of Teruel, which was fought in extreme weather conditions and in temperatures as low as twenty degrees below zero, was the period of greatest medical activity and the highest rates of occupation in the military hospitals of Navarre during the civil war of 1936-1939. From November 1937 to March 1938, 375 cases of frostbite were registered in the provincial establishments, amongst which there was a predominance of cases of dry gangrene partially affecting the lower extremity, which was popularly known as "Teruel feet". Some of the medical staff, conscious of the exceptional nature of the casuistry, registered statistics, clinical cases and personal impressions of the evolution of the lesions and the effectiveness of the treatments. In treating this affectation they employed medicines, surgical techniques and novel therapeutic procedures that were not widely used in the medical milieu of the time. However, the limited duration of the problem, the inconclusive results of the treatments and the differing opinions on their effectiveness -questions that are considered in this article- restricted the subsequent medical repercussion of the experiences of frostbite developed during the wartime period in Teruel.

Objective: To review the literature on vascular complications of diabetic foot with special interest in ulcerative lesions and their prevention and treatment., Materials: Representative papers were selected through a computer MEDLINE search from 1980 to 2001., Results: In diabetes mellitus, physiologic and biochemical mechanisms that regulate coordinated behavior between blood circulation and vessel wall are damaged, both in small and large vessels. Vascular alterations observed in patients with diabetes result in peripheral vascular disease with special characteristics in these patients that produce a greater tendency in diabetic than non-diabetic patients for chronic ulcerative lesions of foot and lesser capacity for healing. These lesions frequently result in amputation of the lower limb. Nevertheless efforts made for preventing and healing ulcerative complications, results are unsatisfactory., Conclusions: It is necessary to research new methods for preventing and healing vascular complications of diabetic foot with special attention to improving damaged physiologic and biochemical mechanisms in diabetes mellitus.

One case of gas gangrene by Clostridium septicum associated to colon cancer is herein presented. Spontaneous gas gangrene is often associated with neoplasms among which hematologic and colon neoplasms are the most frequent. The present case has also peculiarity that the colon cancer had developed from a familiar adenomatous polyposis syndrome.

We describe the case of a 70-years-old woman with ischemic-hemorrhagic lesions in the cutaneous surface of both feet and analytical data of disseminated intravascular coagulation, in which the studies conducted were negative except for the presence of cryofibrinogen in plasma. We also review the clinical manifestations and the diseases associated to cryofibrinogenemia previously described in the literature.

Between June of 1987 and August 1988 we evaluated 31 diabetic patients hospitalized for severe foot infections to determine the etiologic agents, the value of the bacteriologic samples obtained, the benefits of conservative surgery and variable predictors of a major amputation. Sixteen patients suffered from necrosis, 16 osteomyelitis, 14 ulcers, 5 cellulitis, and/or abscesses and 22 had vascular compromise. Samples were taken from these infections excluding necrotic material. We isolate 76 microorganisms (2.4/pt), 57% Gram-positive cocci (predominantly S. aureus and enterococci), and 43% Gram-negative bacilli. Anaerobes were not isolated probably secondary to the exclusion of necrotic samples. There was high incidence of skin and soft tissue sampling (79%) bone (13/16) and surgical curettage (11/11). In 9 patients the correlation of soft tissue sampling and bone sampling was assessed with a positive correlation with respect to Gram-positive cocci. Twenty-one patients required conservative surgeries of the foot (9 underwent revascularization), 67% of which avoided a mayor amputation. However no significant variables predictive of a major amputation were detected in this study. In summary, the conservative surgery allowed to 2 out of 3 patients to preserve the foot.

Thirty diabetic patients submitted to a major amputation were tested by humo-celullar assays (retarded hypersensibility assays). Reactive patients were subdivided into two groups: one group was treated postoperatively with antibiotics, and the other group was not treated. Both groups were homogeneous in age, hemoglobin concentrations, hematocrit, total proteins, glucemy and history of sepsis or leukocytosis. Five patients treated with antibiotics (33.3%) presented sepsis, one patient was reamputated and one patient died. Between the not treated patients, only three presented sepsis (20%) without any other complications. Authors conclude that the development of sepsis in reactive, diabetic, amputated patients is independent of antibiotic treatment.

Ergotism is a rare disorder, generally caused by iatrogenia after the administration of drugs containing ergotamine derivates. Two cases of ischemic incidents at the extremities caused by a chronic intoxication with ergotamine tartrate, after its prolonged administration in therapeutical doses as a treatment for hemicrany, are reported. A short bibliographic review about semiology and therapeutic possibilities of such toxic pathology has been made.

Authors explain their experiences on the study and further clinical application of peripheral venous biopsy (dorsal food vein) as a systematic diagnose method for phlebopatic patients. Results from these experience seem to support the availability of this method to select patients candidates for an autologous venous graft in Cardiovascular Surgery. Peripheral venous biopsy, such as for the dorsal food vein, allows to individualize the possible injuries at the saphenous wall, previously its use for autologous graft; and it avoids the preliminary sample taking for biopsy. By this method, the requirement of an intraoperatory biopsy is also avoided and an eventual by-pass or substitution are better programmed.

An extensive summary on the results of treatment of diabetic patients with necessity of urgent treatment for ischemic or infectious complications is presented. Such frequent events often need an active treatment for infection, followed in some cases by a large debridement or minor amputations. Adequate treatment may avoid a major amputation. Revascularization surgery may play a opportune role and it depends on clinical criterion.

This study was made in order to assess the percentage of patients who underwent a by-pass (by saphenous vein) "in situ" on the foot arteries, as an alternative to the amputation for cases of severe ischaemia on the foot. The medium and short-term survival associated to the revascularized limb was also analyzed. Sixteen patients underwent this surgical procedure, 8 of them (50%) lost their limb within the following seven days to the revascularization; one patient lost their limb at the first year and 43.7% of patients maintain the viability of their limbs 3 years latter. This surgical procedure was made by microsurgery using a Carl Zeica amplification optic lens 2,3 X and a OFMI microscope with an amplification lens 40 X.

Prospective study of 11 patients with lower limbs traumatisms, affecting vessels under Hunter canal. The results of surgical treatment (no prosthesis) are analyzed. In all cases there was bony and/o articular lesion.

A case of acute pityriasis lichenoides associated with a distal ischemia and a similar evolution is reported. The vasculitic cause is demonstrated by angyologic exploration. The gross vascular afectation other than dermal vessels is suggested.

Hematocrit was measured every 8 hours in the bloods of 20 shocked infants and in 10 healthy cases. Samples of blood were taken at the same time from the external jugular vein and following puncture on the heel. Whereas the difference of both measurements was 5.3% as an average in healthy cases, in patients it was of 25.7%. At the end of eight hours of treatment, there was still a difference of 28.8% in patients who finally died, but it dropped tp 8.8% in those who survived.