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Recent work has demonstrated a rolefor TCD monitoring in acute stroke to follow the evolution of the MCA occlusion in realtime (80) and to determine the speed of clot lysis (81). As an example, when performing a bone biopsy ofdiabetic foot osteomyelitis, passing through the ulcer bed with the needle should be avoidedto prevent contamination of the specimen.

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Malignant oti-tis externa is really osteomyelitis of the skull from Pseudomonas in a patientwith diabetes.

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Angiotensin II produced locally in the kidney hasdirect effects on intrarenal vascular beds as well as on saltand water reabsorption (see Ch. Electromyographic and nerve conduction stud-ies are also useful to exclude neuromuscular disorders.Muscle biopsy should be taken from an affected muscle(most often the vastus lateralis) and may demonstratenecrosis of single fibers and endomysial infl ammatoryinfiltrates.

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