CIRCULAT The solution for circulatory problems.

Transcription

1 101 Clinical results in treatment of Diabetic Foot Ulcer CIRCULAT The solution for circulatory problems.

2 Scientific Rationale Surrogate laboratory endpoints of dysglycemia have been the targets for treatment of diabetes mellitus (DM) for almost a century, and there have been many pharmaceutical agents developed to reduce FBG and HbA1c. But the development of agents targeting the underlying pathologies of micro- and macrovascular complications in these patients has had considerably less success. Unfortunately, many clinical trials have failed to show healing of diabetic foot ulcers (DFU) often leading to amputation, or to reverse ischemic defects of the myocardium often heralding myocardial ischemia (MI) in many patients with diabetes. Careful protection of feet with stimulation of fibroblasts and/or major improvements in lifestyle (diet/exercise) with reduced platelet aggregation have not met the challenges of DFU and MI. Healing of ischemic tissues in the lower extremities or the myocardium is multifactorial, biologically complex and clinically challenging. The four groups of pathologies and responses which are addressed by CIRCULAT may be referred as follows: A. Vascular - Tone and Flow. Botanical actives in CIRCULAT dilate arterioles directly through stimulating NO/eNOS and by inhibition of ACE, and indirectly by increasing the angiogenic responses of microcirculation. Flow is further improved by reduction in blood viscosity due both to reduction of platelet aggregation and to lowering of plasma lipids. The improvements in flow are manifest in capillary beds by effects on permeability and on vessel fragility. B. Immune - Responsiveness. CIRCULAT induces appropriate responses in several immune functions: 1. The clinical benefit of antiinflammatory agents is generally established; hscrp is a known marker of cardiovascular disease, including in diabetes mellitus; 2. Further studies have shown that reduction in cytokines/interleukins such as IL-2 and IL-6, and in mitogen-stimulated endothelial responses lessen vascular pathologies; 3. Antiinflammatory effects are balanced with immunemodulation (e.g., NF-kappa B) for the best ongoing tissue protection against microbial colonization and to stimulate proliferative responses. C. Metabolic Energy and Enzymes, Diabetes and Lipids. Certain botanicals increase oxidative capabilities, especially in a microenvironment not poisoned by hyperglycemia. Responses to CIRCULAT have been measured in ATP synthesis, in protein phosphylations, in dehydrogenases, and in tricarboxylic acid cycle activity. Some components also improve basic glucose metabolism in the diabetic, improving insulin sensitivity and glucose uptake. Lowering of plasma lipids may be a primary or a secondary effect of CIRCULAT. D. Healing Stimuli and Care. Multiple biological responses are necessary for covering an ulcer. While the supply of oxygen in good capillary flow is sine qua non, a healthy tissue environment includes the right redox levels, stimulation of fibroblasts, normalized glucose metabolism and the right tissue responses of scarring and remodeling. And the complex response can be unsuccessful if the ulcer is not protected, as known in clinical care. 2

3 Diabetic Foot Treatment with CIRCULAT Issued at Phytotherapy Research June 2008 Clinical Outcomes of Diabetic Foot Management with CIRCULAT 3

4 101 examples with photographic evidence of clinic study cases Results of treatment of DFU with CIRCULAT : 88.5% Effectiveness The images shown are not retouched pictures from DFU in real people and may be strong for viewers.

5 Case Study 1 Male patient, 64 years old - 25 years of evolution - After 6 month treatment Dopplers 64 years old male patient, known Diabetes Mellitus Type 2 with 25 years of evolution, which consulted for ulcerative necrotic lesion level right heel that evolved over the past 2 years despite medical treatment, considering the supra-condylar amputation. After 6 months of treatment with CIRCULAT is achieved an optimal tissue regeneration and healing properly, avoiding amputation. It is shown arterio-venous Doppler before start the treatment and after 6 months. 5

6 Case Study 2 Female patient, 61 years old - 12 months of evolution - After 6 month treament Dopplers 61 years old female patient, diagnosed with Diabetes Mellitus Type 2 from the age of 48, which necrotic ulcerative lesions consultation from 12 months of evolution at the level of plantar region, inner side and first finger of his left foot. No improvement despite strict adherence to conventional medical treatment. After 6 months of treatment with CIRCULAT, there was evidence of proper healing and tissue regeneration. It is shown arterio-venous Doppler before start the treatment and after 6 months. 6

7 Case Study 3 Male patient, 58 years old - 6 months of evolution - After 4 month treatment Dopplers 58 years old male patient, known Diabetes Mellitus Type 2, which checked for the presence of extensive necrotic ulcerative lesion-plantar left, indicating surgical amputation. CIRCULAT treatment was started, showing at 4 months of initiation of treatment a successful healing and tissue regeneration, avoiding amputation. It is shown arterio-venous Doppler before start the treatment and after 4 months. 7

8 Case Study 4 Male patient, 56 years old - Years of evolution - After 3 month treatment Dopplers 56 years old male patient, diagnosed with Diabetes Mellitus Type 2, which was discharged against medical advice on hospital medical center in which he indicated surgical amputation due to advanced stage of the extensive necrotic lesion at the level of front-inner-lateral right foot. After months of treatment of 3 months with CIRCULAT, its shown total tissue regeneration and wound healing. It is shown arterio-venous Doppler before start the treatment and after 3 months. 8

9 Case Study 5 Female patient, 59 years old - 7 months of evolution - After 3 month treatment Dopplers 59 years old female patient, Diabetes Mellitus Type 2, who consulted for extensive ulcerative lesion at the level of inside of left foot with exposed tendons and muscle tissue, which had been scheduled for surgical amputation. After 3 months of treatment with CIRCULAT, there was a total tissue regeneration. It is shown arterio-venous Doppler before start the treatment and after 3 months. 9

10 Case Study 6 Female patient, 49 years old - 1 year of evolution - After 2 month treatment Doppler1 Doppler 2 49 years old female patient, diagnosed with Diabetes Mellitus Type 2 and peripheral obstructive arteriopathy of lower limbs, which consulted for ulcerative lesion of 1 inch by 5/8 inch at the top left foot, about 1 year of evolution, without response to conventional medical treatment. After 2 months of treatment with CIRCULAT, the injury was healed completely. It is shown arterio-venous Doppler before start the treatment and after 2 months. 10

11 Case Study 7 Female patient, 65 years old - 15 days of evolution - After 9 month treatment Dopplers 65 years old female patient, diagnosed with type 2 diabetes mellitus, with a history of surgical amputation of the left leg, which query having graduated from hospital against medical advice, by denial of new amputation due to extensive necrotic lesion located in third through his right leg. After 9 months of treatment with CIRCULAT, there is a successful regeneration and tissue healing, thus avoiding amputation. 11

12 Case Study 8 Female patient, 67 years old - 2 years of evolution - After 7 month treatment Doppler 1 Doppler2 67 years old female patient, diagnosed with Diabetes Mellitus Type 2, which checked for the presence of extensive ulcerative lesion on internal plantar region of left foot, 2 years of evolution. After 7 months of treatment with CIRCULAT, there was a successful tissue regeneration with a significant increase in blood flow Doppler images. It is shown arterio-venous Doppler before start the treatment and after 7 months. 12

13 Case Study 9 Male patient, 44 years old - 1 month of evolution - After 9 month treatment Doppler 1 Doppler 2 44 years old male patient, diagnosed with Diabetes Mellitus Type 1 during 20 years, who consulted for the presence of extensive and deep ulcerative lesions at the level of internal plantar region of left foot. After 9 months of treatment with CIRCULAT, there was evidence of adequate regeneration of damaged tissue and a significant increase in blood flow Doppler images of control. It is shown arteriovenous Doppler before start the treatment and after 9 months. 13

14 Case Study 10 Male patient 67 years old - 1 year of evolution - After 2 month treatment 67 years old male patient with the diagnosis of venous insufficiency of lower limbs, which checked for the presence of varicose ulcers of 1 year of evolution at the level of the left internal ankle region. After 2 months of treatment with CIRCULAT, ulcerative lesions were healed successfully. 14

15 Case Study 11 Male patient, 62 years old After 1 month treatment Dopplers 62 years old male patient, with Diabetes Mellitus Type 2, which consulted by the presence of extensive and deep ulcerative lesion at the level of external lateral left foot, with approach of surgical amputation. After just 1 month of treatment with CIRCULAT, the lesion had adequate regeneration and healing, which is explained by the restoration of blood flow documented by Doppler images of control. It is shown arterio-venous Doppler before start the treatment and after 1 month. 15

16 Case Study 12 Male patient, 46 years old - 4 month of evolution - After 2 month treatment Dopplers 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 16

17 Case Study 13 Female patient, 69 years old After 4 month treatment Female 69 years old patient, diagnosed with diabetes mellitus type 2 with 15 years of evolution following a treatment with Oral Hypo Glycemic and antibiotics. Patient presents extensive gangrene in the left foot stump (basal portion) bearing a three month development. Patient enters treatment with CIRCULAT, and after four months, the local circulatory system is restored and total scarring of the wound is achieved. Prevention of limb amputation is accomplished. 17

18 Case Study 14 Female patient, 59 years old - 7 month evolution - After 3 month treatment Female 59 years old diabetes mellitus type 2 patient (aggravated by diabetic neuropathy) with amputation a history of all phalanges in the left foot presenting extensive fetid ulcerous injury in that member, with irregular borders and 7 month evolution. Patient had various interventions and is resistant to conventional treatment and was being scheduled for member s amputation. A complete recuperation and regeneration of the left foot was observed after three months of treatment with CIRCULAT, surgical cures and antibiotics. 18

19 Case Study 15 Male patient, 47 years old After 4 month treatment Male 47 years old diabetes mellitus type 2 with a 10 year old evolution. Arrives at consultation for an extensive ulcer in the external face of the right heel; with a deep -approximately 5 cm diameter- peri-ulcerous erythema, clean borders and three month old development. The wound has not reacted to conventional treatment. Patient was treated with CIRCULAT during four months and a satisfactory evolution of the scarring was completed. 19

20 Case Study 16 Female patient, 55 years old After 1 month treatment Female 55 years old patient diagnosed diabetes mellitus with a 10 year evolution. Comes to consultation for a three month evolution of a plantar injury in the right foot with a 1 x 1.5 cm and a 3 x 2 cm in diameter ulcer lesion in the infra malleolar and lateral region of the same foot with clean depth scarce granulation tissue and regular borders. In one month treatment with CIRCULAT, a total remission in the ulcerous injuries, as well as metabolic control and improvement in life quality is obtained. 20

21 Case Study 17 Male patient, 73 years old After 4 month treatment Male 73 years old patient, with a 4 year diabetes mellitus type 2 evolution. Treated with Oral Hypo Glycemic. Arriving at consultation because of two infected ulcers in the right foot s plantar and dorsal regions respectively. A total scarring of the ulcerous lesions can be observed after four months of treatment with CIRCULAT. 21

22 Case Study 18 Male patient, 61 years old After 2 month treatment 61 years old patient with diagnosed diabetes mellitus type 2 with an eight years evolution presenting two ulcers of 1 and 2 cm respectively in the right foot dorsal region with one month development. Both ulcers are cured after a two month CIRCULAT treatment. 22

23 Case Study 19 Male patient, 68 years old After treatment 68 years old patient with long development uncontrolled diabetes mellitus type 2. Presenting ulcerous lesion in the inter-digital space between toes one and three of the right foot and peri-lesional inflammation. The patient had a previous amputation of the second toe. CIRCULAT and antibiotic treatment were provided according to the anti-biogram sensibility pattern and daily cures were administered. Evolution was satisfactory preventing amputation. 23

24 Case Study 20 Male patient, 68 years old After 1 month treatment 68 years old male patient diagnosed with DM type 2, with a period of 12 years of evolution. Patient shows a posterior traumatism on the left foot. The 3 cm by 2 cm diameter lesion is very painful and is associated with purulent secretion. Patient was attended by a General Practitioner which indicated local as well as antibiotics treatment. Since no results were obtained the patient visits looking for a second opinion and receives a one month treatment with CIRCULAT. The injury was completely healed and closed. Patient s glycemia levels were normalized. 24

25 Case Study 21 Male patient, 46 years old After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 25

26 Case Study 22 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 26

27 Case Study 23 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 27

28 Case Study 24 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 28

29 Case Study 25 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 29

30 Case Study 26 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 30

31 Case Study 27 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 31

32 Case Study 28 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 32

33 Case Study 29 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 33

34 Case Study 30 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 34

35 Case Study 31 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 35

36 Case Study 32 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 36

37 Case Study 33 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 37

38 Case Study 34 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 38

39 Case Study 35 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 39

40 Case Study 36 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 40

41 Case Study 37 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 41

42 Case Study 38 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 42

43 Case Study 39 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 43

44 Case Study 40 Male patient, 46 years old - 4 month evolution - After 2 month treatment 46 years old male patient, diagnosed with Type 1 diabetes, which checked for the presence of ulcerative-necrotic lesion at the first right toe, with indication of surgical amputation. After 2 months of treatment with CIRCULAT, a high total healing and regeneration of the affected tissue, with a significant increase in blood flow to the Doppler control. It is shown arterio-venous Doppler before start the treatment and after 2 months. 44

45 Case Study 41 Male patient, 59 years old After 4 month treatment 59 years old patient diagnosed diabetes mellitus 2 and a 10 year evolution. Presents necrotic ulcer in the inter-digital space between the 3rd and 4th toes, cyanosis in the extreme distal space of 1rst, 2nd and 3rd toes of the right foot; as well as an ulcer on the plantar region of the same foot. The patient arrives for a treatment. He follows a four month treatment with CIRCULAT. The total scarring and recuperation of the affected member is obtained. 45

46 Case Study 42 Male patient, 61 years old After 3½ month treatment Male 61 years old hypertensive patient diagnosed DMT2 with 15 years of evolution. Come for consultation because he was advised the amputation of the left lower limb. He evidenced a 5 x 2 diameter ulcer with necrotic borders, cold epidermis, edema and periulcerous erythema in the stump were the first toe had been amputated. The interdigital spaces showed small ulcerations and scant yellow secretions. Also present was phlyctena in the foot s dorsal area with a sullied surrounding. In the external lateral area of the same foot between the third and half of the foot a very painful -for examination- necrotic area. After a little over three and a half moths of treatment with CIRCULAT and antibiotics an excellent clinical evolution -with wound closure- is clearly observable. 46

47 Case Study 43 Female patient, 29 years old After 7 month treatment Female 29 years old patient diagnosed with Diabetes Mellitus Type 2 with a 9 years evolution. Since the diagnosis patient has been regularly treated with hypoglycemiants for metabolic correction. Patient presents necrosis in the 2nd toe of the right foot and an extensive ulcer with abundant purulent secretion in the dorsal region of the same foot without medical treatment. Patient was referred to the local hospital were a supracondylar amputation was scheduled. A disarticulation of the second toe is carried out followed by a seven month treatment with antibiotics, CIRCULAT and daily cures. The amputation of the foot is prevented and glycemia levels are stabilized. 47

48 Case Study 44 Male patient, 69 years old After 3½ month treatment Male 69 years old patient with a two years diabetes mellitus type 2 diagnostic in regular treatment with hypoglycemiants and a 22 day hospitalization period at a local hospital due to a necrosis of the 1st and 5th toe of the right foot were they were amputated. However, after the operation an infection at the stump level ensued which resisted conventional treatment and a supracondylar amputation of the leg was advised. After three and half months of treatment with CIRCULAT, antibiotics and daily cures the patient responded satisfactorily to the therapy. The scarring of the affected area was attained and the amputation was avoided. 48

49 Case Study 45 Male patient, 45 years old After 2 month treatment 45 years old male patient with diabetes mellitus type 2 and a 2~3 year old evolution. Patient prescribed with hypoglycemiants however condition still was uncontrolled presenting one month old cellulites in the right foot which does not react with antibiotic therapy. Attends to a Medical Center looking for a second opinion where CIRCULAT and a new scheme of antibiotics are prescribed. After barely- a two month treatment the clinical status is resolved and glycemia values are normalized. 49

50 Case Study 46 Male patient, 65 years old After 1 year treatment Male 65 years old patient, diagnosed with Diabetes Mellitus type 2 with 3 years of evolution aggravated by a peripheral neuropathy. Patient has an extensive painful necrotic ulcer with abundant yellowish, fetid secretion were the first toe had been previously amputated and comprising all the plantar region of the left foot preventing walk. The diagnosis at the local hospital was the amputation of the left foot. The ulcer culture reveals Pseudomona aeruginosa. After a year s treatment with CIRCULAT, antibiotics and daily cures the patient shows an excellent progress and a clinical evolution towards total scarring of the injury with the preservation of his member. 50

51 Case Study 47 Female patient, 39 years old After 1 month treatment Female 39 years old patient diagnosed with diabetes mellitus type 2, two weeks earlier. Patient is on treatment with hypoglycemiants and presenting a controlled hypertension. Patient has a cyanosis on the second toe of the left leg with intense pain and which inhibits walk. Patient diagnosed for amputation. The operation is prevented with a one month treatment of CIRCULAT 51

52 Case Study 48 Female patient, 34 years old After treatment 34 years old female patient with diabetes type 1 and a long standing evolution (15 years). Patient treated with insulin and hypoglycemiants, however presents complications due to diabetic neuropathy and presenting 2 necrotic ulcerous injuries in the plantar region of the left foot concomitant with signs of phlogosis which extend over the first and second toe of the same foot and a three month evolution. After barely one month of treatment with CIRCULAT the patient has an 80% scarring with an important reduction in edema as well as trophic changes which allow the patient to walk, improving his quality of life. 52

53 Case Study 49 Male patient, 67 years old After 19 month treatment 67 years old diabetic and hypertensive treated patient with cerebrovascular accident sequels. Patient has high glycemia levels (250 mg/dl.) and for two years bears an ulcer in the left plantar region which extends over most of the foot presenting thick borders, an abundant quantity of fetid, purulent secretion concurrent with heat and bright red coloring. Patient had surgical treatment with a resultant walking limitation. The patient is treated with CIRCULAT and antibiotics for 19 months. The patient has an almost complete scarring as well as controlled glycemia values. Patient walks on his own conditions. 53

54 Case Study 50 Male patient, 56 years old After 2 month treatment 56 years old female patient with diabetes mellitus type 2 and an 11 years evolution controlled with hypoglycemiants. Patient attends consultation due to a phlegmonous toe -on the right foot- with a one month evolution. She shows no improvement after a one month treatment with conventional/orthodox medicine. However, after two months of treatment with CIRCULAT the patient presents a complete scarring and cure of the injury. 54

55 Case Study 51 Male patient, 72 years old After treatment Female 72 years old patient, with a 20 years diabetes evolution. Hypertensive in treatment with hypoglycemiants but not having achieved control of the condition. Since one month earlier she presents a necrotic ulcer in the 4th toe of the right foot at the anterior and posterior distal faces of the distal phalange. The ulcer presents irregular borders and purulent secretion. Also, the patient presents another ulcer in the 5th toe -of the same foot- in lateral face at the distal phalange level with amputation risks. The patient follows a treatment with CIRCULAT achieving the reduction of the ulcerous lesions and the control of the glycemia. The member is preserved and the quality of life is improved significantly 55

56 Case Study 52 Male patient, 60 years old After 2 month treatment Male 60 years old patient with diabetes mellitus type 2 and hypertensive condition for approx. 25 years. Patient treated with hypoglycemiants. Patient attends consultation because of a 15 day development of a necrotic ulcer in the 5th toe of the right leg of approx. 2 x 2 cm in diameter. Injury is concurrent with fetid secretion, important edema and moderate pain. Patient is diagnosed for amputation and decides to attend for a second opinion. After two months of treatment with CIRCULAT and antibiotics there is an important improvement in the injury and the amputation is prevented. 56

57 Case Study 53 Female patient, 40 years old - 12 years evolution - After 6 month treatment Female 40 years old patient with diabetes mellitus type 2 and a 12 year condition evolution; complicated by a diabetic neuropathy which was treated with hypoglycemiants. However the patient presents a hyperglycemic condition and as well as an edema -of two months evolution- in the left foot as well as three small - very edematous- ulcerous injuries in the dorsal region of the left foot. The patient commences a 6 month treatment with CIRCULAT and presents a very positive clinical response: ulcerous lesions closure, lessening of edema and normalization of glycemia values. 57

58 Case Study 54 Male patient, 58 years old After treatment Male 58 years old patient diagnosed with diabetes mellitus type 2 with an 18 year old evolution and treated with hypoglycemiants. His condition is aggravated by an uncontrolled weeks evolution albeit a conventional pharmaceuticals treatmentof an infected diabetic ulcer at the base of the right foot s first toe as well as another ulcer at the 2nd metatarsal in the plantar region of the same foot; and high glycemia values. A treatment based on CIRCULAT and antibiotics obtains the complete scarring of the ulcers as well as normalization of glycemia values. 58

59 Case Study 55 Male patient, 78 years old - 4 month evolution - After 2 month treatment Male 76 years old patient with diabetes mellitus type 2 with a 15 year evolution and hypoglycemiant treatment. Patient refers to have a three month evolution leading to his present condition when after the amputation of the 3rd toe of the left leg a deep abscess with purulent secretion, signs of phlogosis and intense pain in the region of the stump is diagnosed with the need of amputation. The lesion in the left foot is scarred after 2 months of treatment with CIRCULAT and antibiotics. The amputation of the affected member is prevented.. 59

60 Case Study 56 Female patient, 59 years old After 1 month treatment Female 59 years old patient with diabetes mellitus type 2 with a five year evolution. Patient was administered hypoglycemiants which did not control glycemia levels. Also, patient, presented a 1 x 1 cm diameter ulcer in the of anterior face of the 3rd toe of the left foot with a two month evolution which was treated with conventional medicine without success. Scarring of the wound was obtained after a one month treatment with CIRCULAT. Levels of glycemia were normalized as well. 60

61 Case Study 57 Male patient, 57 years old After 15 days treatment Male 67 years old patient with a 30 year evolution of diabetes mellitus type 2. Prior to his arrival at the Centro Medico Adaptógeno (CMA) the patient refers to have a wound (blister type) evolution in the first toe of the left foot caused by an uncomfortable shoe with purulent secretion and signs of phlogosis as well as high level counts of glycemia. Since he saw no results with conventional medicine he decided to seek treatment at a second opinion. After 15 days of treatment with CIRCULAT and antibiotics the glycemia levels descended significantly and the wound improved considerably 61

62 Case Study 58 Female patient, 49 years old - 1 month evolution - Female 49 years old patient with diabetes mellitus type 2 with a six year evolution. Glycemia under control with hypoglycemiants. Patient presents a 10 x 10 cm diameter ulcerous wound with irregular borders, fetid necrosis area, important edema and signs of phlogosis in the middle third of the left foot dorsal region. Patient had a one month evolution and was treated with conventional medicine without any improvement. The diagnosis was amputation. After two months of treatment with CIRCULAT, and antibiotics a total closure of the wound and normalization of glycemia was obtained. The prevention of the amputation and a better quality of life were additional results. 62

63 Case Study 59 Male patient, 61 years old - 20 years evolution - After 2 month treatment Male 51 years old diabetic -with a 20 plus years of evolution- and hypertensive patient, with diabetic neuropathy under hypoglycemiant treatment. Patient attends consultation due to a one and a half year old evolution of ulcerated wounds in the dorsal region of the left foot. These have worsened in the last 15 days before attending at the Medical Center. The patient presented purulent and fetid secretion, erythema and edema as well as high levels of glycemia. Two months after his treatment with CIRCULAT and antibiotics the clinical history of the patient reflects a noticeable progress in scarring as well as the improvement of the phlogosis and glycemia values. 63

64 Case Study 60 Female patient, 69 years old After 1½ month treatment Female 69 years old patient with a 15 year old evolution. Treated with hypoglycemiants. Patient presents a complication due to diabetic neuropathy indicated by a necrotic 2nd toe on the right foot with a nine month evolution. She is advised of amputation. Patient also has elevated glycemia levels. After a one and a half treatment with CIRCULAT and antibiotics there is a 100% wound healing, glycemia normalization and quality of life improvement. Finally the member was saved form amputation. 64

65 Case Study 61 Male patient, 54years old - After 15 days treatment 54 years old male patient with an 8 year old diabetes mellitus type 2 evolution; under hypoglycemiants treatment and presenting an infected ulcerous wound (one month progression) of 2 x 2 cm in diameter in the interdigital space between the 4th and 5th toes of the right foot without any improvement with conventional medicine. The patient is placed under treatment with CIRCULAT and antibiotics during 15 days. His clinical record shows a remarkable progress in the scarring process and healing of the wound. 65

66 Case Study 62 Male patient, 70 years old After 15 days treatment 70 years old male patient with a long standing -diabetes mellitus type 2- condition. Patient is following a hypoglycemiant treatment. However his clinical history shows a complication due to a diabetic neuropathy and high uncontrolled glycemia levels. The patient refers an ulcerous pruriginous wound (with signs of phlogosis) in the second toe -of the right foot- with a two year progression. The wound has been treated by various doctors without any healing progress. After barely 15 days of treatment with CIRCULAT and antibiotics a total closure of the wound was obtained. Also, glycemia levels were normalized. 66

67 Case Study 63 Female patient, 71 years old After 2 month treatment 71 years old male patient with a 20 year old diabetes mellitus type 2 evolution under hypoglycemiant treatment. Case complicated with diabetic neuropathy. Patient presents a one month ulcerous wound development of approximately 4 x 1 cm in diameter -with purulent secretion which does not yield to antibiotic treatment- in the upper third of the dorsal left foot face. Patient also has uncontrolled hypoglycemia levels. After a two month combined treatment with antibiotics and CIRCULAT an evident scarring of the wound and the normalization of hypoglycemia is evident. 67

68 Case Study 64 Female patient, 24 years old - 1 month evolution - After 2 month treatment Female 24 years old patient with diabetes type I with a ten year evolution under insulin and hypoglycemiant treatment. Patient shows a one month old progression of an ulcerous wound with regular borders and periulcerous edema in the dorsal face of the left foot with no signs of healing even though a conventional treatment was provided. Patient has high glycemia levels at the time of consultation. After two months of treatment with a combined CIRCULAT and antibiotic cure the patient presents an excellent clinical response with the total closure of the wound, absence of edema and glycemia level normalization. 68

69 Case Study 65 Male patient, 51 years old After 3 month treatment Male 51 years old patient diagnosed with diabetes mellitus type 2 with decompensation of glycemia level. After being burned the patient was affected by a bleb in the 1st toe of the right foot which kept increasing in size became infected and would not recede even though a conventional treatment was followed for a month. The suggested diagnosis for his wound was amputation. However, the patient seeks a second opinion at a Medical Center. He is submitted to a three month treatment with CIRCULAT and an antibiotic scheme. The result was a good clinical response in the wound, as well as reaching control over his glycemia. 69

70 Case Study 66 Male patient, 57 years old After 2 month treatment Male 57 years old patient with diabetes mellitus type 2 with decompensation of glycemia levels. Patient also presents an ulcerous wound in the first toe of the right foot with irregular borders and purulent secretion with a four month long development. The conventional diagnostic was the amputation of the toe. Patient is submitted to a combined CIRCULAT, and antibiotic treatment reaching a good clinical response in two months. The glycemia levels are also normalized.. 70

71 Case Study 67 Female patient, 69 years old After 3 month treatment Female 69 years old patient with diabetes mellitus type 2 with a 12 year evolution receiving an ineffective hypoglycemiant treatment. Patient is affected by a year old evolution open wound (without secretion) with irregular borders -painful to touchin the left foot; concurrent with walking and support difficulty, swelling and pain. Patient is submitted to a three month treatment with CIRCULAT, were he states as picture shows- the cure of the injury. Glycemia levels are also normalized. 71

72 Case Study 68 Male patient, 32 years old After treatment 32 years old male patient with diabetes type 1 with years long progression; and under insulin and hypoglycemiants treatment. At the moment of consultation patient refers elevated hypoglycemia values as well as ulcers in the 1st, 2nd, 3rd and 4th toes of the right foot, with unhealthy violet coloring and foot amputation indications by the specialist. Patient undertakes a three month treatment with CIRCULAT, attaining excellent results and closure of all wounds, reduction of edemas and signs of phlogosis; and amputation prevention. Glycemia levels are normalized as well. 72

73 Case Study 69 Male patient, 59 years old After 1½ month treatment Male 59 years old patient; with a 7 year old diabetes mellitus type 2 evolution. Patient presents two -15 days evolution- ulcerous wounds at the base of the 4th toe (right foot). Patient has high glycemia values at consultation. Patient subjected to a one and a half month treatment with CIRCULAT ; after which the wounds are completely scarred and glycemia levels are normalized. Patient refers a great increase in his quality of life. 73

74 Case Study 70 Male patient, 51 years old After 2 month treatment Male 51 years old patient diagnosed with type 2 diabetes and a 3 year old evolution. Patient has glycemia level decompensation as well as ulcerous injury in the upper third section of his external dorsal right foot face. Injury has irregular borders and purulent secretion and a two month long progress. Conventional medical doctor recommends amputation. But at the consultation at second opinion, a protocol consisting of CIRCULAT and an antibiotic scheme is advised. The patient undertakes the treatment for two months were the clinical response is positive in healing the wound and attaining normal glycemia levels 74

75 Case Study 71 Male patient, 54 years old After 1 month treatment Male 54 years old patient with a five year evolution of diabetes mellitus type 2. Patient presents decompensation in glycemia levels. Also, an ulcerous lesion in the superior third of the dorsal right foot face of approx. 2x1 cm in diameter, indurated borders and purulent secretion with a four month evolution. Patient receives a one month treatment with CIRCULAT and antibiotic scheme. Patient presents a good clinical response including total lesion scarring and normalization of glycemia levels. 75

76 Case Study 72 Female patient, 59 years old After 22 days treatment Female 59 years old patient who has a 10 year old diabetes mellitus type 2 evolution, treated with hypoglycemiants yet presenting glycemia decompensation. Arrives to consultation due to the presence of ulcerous purulent (with signs of phlogosis) in the interdigital region of the 1st and 2nd left foot toes and a 6 month evolution period. Patient has difficulties in walking. With just 22 days of CIRCULAT treatment a considerable clinical improvement is appreciated by the closure of the injury as well as the compensation of glycemia levels and the patient s increase in quality of life. 76

77 Case Study 73 Male patient, 56 years old After 2½ month treatment Male 56 years old patient with diabetes mellitus type 2 and a 20 year old evolution of this condition. Complications due to peripheral vascular disease and three completely necrotic wounds in the internal face of the right foot which according to the previous doctor warranted amputation. At the moment of consultation patient also has glycemia levels decompensation. After only two and a half months of treatment with CIRCULAT the patient refers the scarring of wounds (approx. 95%; as evidenced by the documented photographs herein); normalization of glycemia levels and a better quality of life. 77

78 Case Study 74 Female patient, 45 years old After 4 month treatment 46 years old female patient with a 10 year old DM type 2 evolution with hypoglycemiant treatment; referring at consultation a two week old change in the first toe of the right foot. The injury consists in a deforming (pencil shaped) ulcerated hyperkeratosis with non fetid thin watery form with an amputation risk of the first toe and eventually the foot. Patient presents a remarkable improvement without requiring surgery; and obtaining an improvement in the quality of life, after a four month treatment with CIRCULAT and antibiotics. 78

79 Case Study 75 Feale patient, 45 years old - 3 month evolution - After treatment Female 45 years old patient with diabetes mellitus type 2 under hypoglycemiant treatment for two years. Patient at consultation refers to a decompensation in glycemia levels. Examination reveals an extensive necrotic ulcer in the left foot (inferior third of member) which patient indicates has a three month evolution. The patient is submitted to a six month CIRCULAT treatment; were a very positive clinical evolution is evidenced including the closure of the wound, normalization of glycemia levels and quality of life increase. 79

80 Case Study 76 Male patient, 74 years old After 4 month treatment Male 74 years old patient with a 30 year old diabetes mellitus type 2 evolution; under treatment with oral hypoglycemiants. After an injury with a splinter in the right foot an ulcer develops (4 month evolution) and progresses in extent and depth. Reaching; by the time of consultation an approx. 10x8 cm diameter, fetid, indurated borders, at the heel level compromising the muscle and subcutaneous cellular tissue; resistant to any type of treatment. The patient is advised to seek amputation of foot. After four month treatment with CIRCULAT and antibiotics a good evolution of the injury can be perceived and the amputation of the member is prevented. 80

81 Case Study 77 Female patient, 55 years old - 4 month evolution - After 6 month treatment Female 55 years old patient with a long standing diabetes mellitus type 2 conditions as well as hypoglycemiant therapy. Patient refers to have a two year old injury evolution determined by an extensive gangrene which embraces the dorsal side of the left foot resistant to conventional treatment warranting amputation of the left lower member. Patient receives a six month treatment with CIRCULAT and the injury responds satisfactorily and amputation is avoided and acquiring a quality of life increase. 81

82 Case Study 78 Female patient, 74 years old After 10 month treatment Female 74 years old patient with long standing diabetes mellitus type 1 development (hypertensive and glycemia conditions present); being treated with insulin and hypoglycemiants. Attends consultation, due to the presence ( years of evolution) of an approx. 4x4 cm in diameter fetid necrotic ulcer with green secretion; localized in the plantar region of the right foot. Ulcer is concurrent with intense pain, inability to walk and multiple treatments without improvement. Patient is subjected to treatment with CIRCULAT (10 months). An improvement is evidenced -in the ulcerous lesion- which allowed the patient to walk and carry out the normal daily routines. 82

83 Case Study 79 Female patient, 42 years old After 1 month treatment Female 42 years old patient with diabetes type 2 with a two year old evolution; under hypoglycemiant treatment. Patient refers a ulcerous injury of approx. 2x2 cm in diameter with purulent secretion between the 1st and 2nd toe of the left foot and months development.patient has high glycemia values at the time of first consultation. In barely one month with CIRCULAT and antibiotics therapy the total closure of the ulcer can be appreciated and glycemia values are normalized/controlled. 83

84 Case Study 80 Female patient, 63 years old After 1 month treatment Female 63 years old patient presenting a 13 year diabetes mellitus type 2 evolution; and receiving hypoglycemiant treatment. Patient presents complication due to diabetic neuropathy and ulcerous injury in the anterior face of the 3rd toe of the right foot. The patient is advised a hypo caloric diet as well as CIRCULAT treatment; progressively improving the injury in one month; obtaining total scarring; complete mobility as well as quality of life improvement. 84

85 Case Study 81 Female patient, 64 years old After 15 days treatment Female 64 years old patient with Diabetes Type 2 and a 10 year old evolution; treatment with hypoglycemiants. Hypertensive with diabetic neuropathy complication, decompensated glycemia levels. Presents an white periulcerous lesion of 1x1 cm diameter which impedes walking. Patient was treated for 15 days with CIRCULAT attaining total wound closure as well as recuperating her walking capability and improving her quality of life. 85

86 Case Study 82 Male patient, 68 years old After 4 month treatment 86 years old diabetic hypertensive patient with having received for 5 years treatment with oral hypoglycemiants. Patient informs that his present situation has been evolving for a year when an ulcerous necrotic wound started to develop. The lesion -situated in the second toe of the right foot- has secretion (low level), and shows a reduction in the dorsalis pedis artery pulse. The consulted physician recommends amputation. Patient assist to the doctor and him puts the patient on CIRCULAT, treatment for four months. The improvement is complete and the patient attains glycemic normalization and a better quality of life. 86

87 Case Study 83 Female patient, 62 years old After 2 month treatment Female 62 years old diabetes type 2 patient, with a 20 year old evolution. Patient treated with insulin and hypoglycemiants. Patient has complications due to diabetic neuropathy, decompensated glycemia and a one year old developing ulcerous wound (2x2 diameter) in the plantar region of the left foot that does not improve with conventional treatment. Patient is subject of a two month treatment with CIRCULAT and a complete scarring of the wound can be observed. The glycemia values are also under control and the patient refers a better quality of life. 87

88 Case Study 84 Male patient, 67 years old After 4 month treatment Male 57 years old patient with a 22 year old diagnosed diabetes type 1. Patient under insulin and OHG. Complication of clinical story due to diabetic neuropathy. Patient refers a 15 year old ulcerous wound in the external border of the left foot s 1st toe (1 cm in diameter, necrotic base, signs of inflammation, scarce fetid secretion). No improvement with conventional treatments. Wound impedes mobilization. Patient is treated for 4 months with CIRCULAT and antibiotics returning to work as well as his daily routines which improve his quality of life. 88

89 Case Study 85 Male patient, 84 years old - 20 years evolution - After treatment Diabetic -type 2-84 year old patient, with a 20 years evolution. Patient treated with insulin and hypoglycemiants. Attends consultation due to a an ulcerous left foot plantar wound of 12x10 cm in diameter. Wound has scarce, yellow, fetid secretion and a two month evolution requiring hospitalization. Patient abandons health care center against the physicians advice which had scheduled the member s amputation. Patient receives a combined CIRCULAT and antibiotic therapy. The patient s evolution is satisfactory attaining a total closure of the wound, normalization of glycemia levels and amputation prevention. 89

90 Case Study 86 Female patient, 63 years old - 2 month evolution - After 1 month treatment Female 63 years old patient, with a 20 year old diabetes type 2 evolution, complicated by a peripheral neuropathy, high glycemia values and hypertension. Patient attends consultation due to a two month evolution of a 2 x 2 diameter, nonpainful ulcerous wound, with a granular background, serous secretion, round thick borders in the plantar region of the right foot. Patient undertakes a one month treatment with CIRCULAT and the ulcer is observed to be in remission. 90

91 Case Study 87 Female patient, 63 years old After 2 month treatment Female 63 years old with a 22 year old evolution of diabetes type 2; glycemia under control with oral hypoglycemiants. Patient had previously suffered the amputation of the 2nd and 5th toe of the right foot. Presently the patient presents an infected ulcer in the first toe of the right foot with six months of torpid evolution and resistance to conventional therapy. Patient advised for member amputation surgery. After a two month treatment with antibiotics and CIRCULAT, the patient s wound is completely scarred, avoiding amputation and significantly increasing the quality of life. 91

92 Case Study 88 Female patient, 28 years old After 2 month treatment 28 years old female patient with diabetes type 1, since she was 14 years old. The condition worsened with diabetic neuropathy. Patient receiving insulin and OHG (Oral Hypoglycemiants). Attends consultation due to a two month development of ulcer (4x4 cm diameter) which has a scarce, fetid, yellow secretion, resistant to hospital s treatment. Amputation is advised to the patient, and this last decides to leave the institution. Patient receives a combined antibiotic and CIRCULAT, therapy during two months. The lesion evolves satisfactorily and the scarring and glycemia control evolution is satisfactory. 92

93 Case Study 89 Male patient, 43 years old - 5 years of evolution - After 1 month treatment 43 years old patient bearing diabetes type 2 with a 5 year old evolution. Treated with OHG. Patient shows cellulites in the 2nd toe of the right foot with a great edema, hyperemia, and hardening of the dorsal part of the foot (three month old evolution). Glycemia decompensation is also observed. After a one month treatment with antibiotics and CIRCULAT an improvement in the disease is observed with the total wound closure and the normalization of glycemia values. 93

94 Case Study 90 Female patient 77 years old After 5 month treatment Female 77 years old patient with a 20 year old diabetes type 2 evolution. Controlled with OHG. Patient is hypertensive and presents since the previous two months (approx.) an infected ulcerous injury with irregular borders very little fibrin and abundant granulated tissue (concurrent with intense pain) in the internal face of the inferior left member. Patient receives a combined five month CIRCULAT, and antibiotic treatment. The scarring of the wound is observed as well as the maintenance of glycemia under normal levels. 94

95 Case Study 91 Male patient, 68 years old - 2 years of evolution - After treatment Male 68 years old patient suffering uncontrolled diabetes type 2 with years of development. Patient attends local hospital and a result of an infected ulcerous lesion in the right foot as well as trophic changes in the plantar region of the same member. Patient is advised to get an amputation. Patient seeks a second advice. He is placed under treatment with CIRCULAT, antibiotics (according to antibiogram sensitivity test) and daily cures. The scarring of the lesion is obtained and the amputation of the right limb prevented. 95

96 Case Study 92 Male patient, 64 years old After 8 month treatment 64 years old diabetes type 2 patient with a 20 year old plus evolution. Treated with OHG. Patient attends hospital for the presence of an extensive ulcer which occupies the lower half of the plantar region in the right foot and with calcaneous exposure. Conventional treatment is incapable of redressing the injury and offers the amputation option. Patient seeks assistance. Decompensated glycemia is observed at the moment of consultation. Patient receives a local daily cure combined with antibiotics and CIRCULAT during eight months. The amputation is prevented and a 100% recuperation of the wound is attained. 96

97 Case Study 93 Female patient 67 years old After 15 days treatment Female 67 years old patient with a long standing diabetes type 2, with complications such as peripheral neuropathy and previous amputation of the left foot s 1st toe. Patient attends with ulcerous lesion in the left foot s 4th toe (one week evolution) and glycemia decompensation. Patient undertakes a 15 day treatment with CIRCULAT that: prevents the amputation of the member, compensation of glycemia values and increase patient s quality of life. 97

98 Case Study 94 Male patient, 46 years old - 4 months of evolution - After 9 month treatment Female 59 years old patient with diabetes type 2, and 15 year evolution, under OHG treatment. Attends consultation, due to 2 fetid necrotic ulcers, (14 months of evolution) which occupy a great part of the right foot dorsal region and resistant to previous treatments. Thus, the patient was advised to seek member s amputation. At the moment of consultation, the patient also has glycemia decompensation. After 9 months of treatment with CIRCULAT and antibiotics both lesions are observed to be improving as well as scarring. The amputation of the member is prevented 98

99 Case Study 95 Male patient, 64 years old After 12 month treatment 64 years old patient, with diabetes type 2, and a long period ( years ) of evolution. Patient is under treatment with insulin/ohg and arrives at consultation with a four year evolution of a 4x4 cm fetid, necrosed ulcer with exposed tendons in the plantar region of the right foot. Patient has been under various treatments without results and is incapable of walking. After 12 months of treatment with CIRCULAT a total scarring of the ulcerous wound is observed, allowing the patient carry on with his daily routine. 99

100 Case Study 96 Male patient, 66 years old After treatment This case is a 65 years old male patient diagnosed with a non-controlled diabetes type 2 and a long period of evolution. Patient shows a four month evolution of trophic changes, signs of cyanosis and infection of the right foot s dorsal region which is resistant to conventional treatment. After treatment with CIRCULAT, daily cures and antibiotics, according to antibiogram sensitivity results, the patient follows an evidenced improvement in under two months. 100

101 Case Study 97 Male patient, 60 years old - 15 years of evolution - After 9 month treatment 60 years old patient diagnosed with diabetes type 2 (with a 15 year old evolution) under OHG treatment. Patient presents an extensive ulcer covering the half of the inferior external and plantar region of the left foot (with calcaneous exposure) and a one year evolution with no response with conventional treatment. At the time of consultation the patient has decompensated glycemia levels. Patient is subjected to local daily cures, antibiotics and CIRCULAT treatment during nine months. A 100% clinical recovery is attained and the limb s amputation is prevented.. 101

102 Case Study 98 Male patient, 46 years old - 4 month of evolution - After 15 days treatment Male 60 years old patient diagnosed with diabetes type 2 and a long development (28 years according to the patient). The illness is complicated by a non-controlled peripheral neuropathy, earlier (1997) amputation of the lower left limb and four year dated right foot paresthesia. Patient attends consultation due to a 2x2 callous surrounded lesion with yellow secretion in the plantar region of the right foot. Capillary glycemia is carried out with (289 mg/dl). After 15 days of treatment with CIRCULAT there is marked improvement in the lesion, improvement in the foot s sensitivity and a reduction in paresthesia. Glycemia stands at 143 mg/dl. 102

103 Case Study 99 Male patient, 53 years old After 4 month treatment Male 53 years old patient, with a 20 year old diagnosed diabetes type 1. Patient undergoing insulin and OHG treatment. Case is complicated by diabetic neuropathy and a three month old ulcerative lesion development in the interdigital space between the 4th and 5th toe resistant to conventional treatment. Glycemia decompensation detected at consultation. After a four month treatment with CIRCULAT, tissue regeneration is observed as well as complete scarring of wound. Glycemia levels are normalized. 103

104 Case Study 100 Female patient, 81 years old After 6 month treatment Female 81 years old patient with a twenty five year evolution of diabetes type 2. Hypertensive patient, controlled with OHG and enalapril (angiotensin converting enzyme or ACE). Patient has previous history of lower left limb amputation dating two years back. At consultation patient presents an extensive necrotic ulcer in the back of the foot (Aquiles heel) due to a traumatism which has been growing in crescendo -for one year- resisting conventional treatment. After a six month treatment with CIRCULAT an excellent evolution is to be noted as well as a significant reduction of the lesion and an important improvement in quality of life. 104

105 Case Study 101 Male patient, 66 years old After treatment Male 66 years old patient with a 15 year old diabetes type 2 diagnosis. Hypertensive and decompensated glycemia levels. Patient attends consultations with various specialists due to a necrotic ulcerated wound in the 4th toe of the right foot; without clinical improvement and foot amputation diagnosis by doctors. Patient were placed under CIRCULAT, treatment. A positive clinical response is evidenced by the scarring of the ulcerous lesion. Amputation is prevented and quality of life is better. 105