1/6. One pair must last a lifetime. Case studies of foot care in diabetes.Neuropathy is the second most important of the four major 'traffic light' warnings for future foot problems (vascular, neuropathy, structural, self care). Peripheral neuropathy is a significant clinical problem in 20% of patients with diabetes. Painful neuropathy can disrupt patients lives but simple effective interventions are available. Painless neuropathy is often not perceived to be a problem by the patient or their doctor but puts the foot at risk from trauma (physical, chemical and thermal). patients with neuropathy need systematic reassessment of self and professional diabetes care, and education about footwear and foot care. A podiatrist can be invaluable in prescribing appropriate footwear and orthotics to distribute foot pressure and in educating patients about self care. patients with the 'double whammy' of neuropathy and vascular disease are at extreme risk of limb threatening problems and should have a regular monitoring program by themselves (or their carers) and their professionals as well as an 'action plan' to detect and deal with problems early.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/6. Using hyaluronic acid derivatives and cultured autologous fibroblasts and keratinocytes in a lower limb wound in a patient with diabetes: a case report.patients with diabetes have an impaired wound healing process that contributes to the pathophysiology that may lead to amputation. In this case study, an extensive (103.49 cm2) full-thickness cutaneous wound with exposure of a necrotic Achilles' tendon in a patient with diabetes, neuropathy, and infrapopliteal vascular disease of the lower limbs was healed using a two-stage autologous skin substitute technique. The scaffolds on which the autologous fibroblasts and keratinocytes were grown comprised an ester derivative of hyaluronic acid. Two applications of the cultured autologous fibroblasts and one of the cultured autologous keratinocytes were placed on the wound at 7-day intervals. The ulcer healed completely 60 days following the first fibroblast graft application. After 16 months of follow-up, no recurrence was noted and the patient can walk without ancillary support. This novel tissue engineering technique is a promising treatment for wound healing.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
3/6. Phrenic neuropathy in association with diabetes.We report the case of a 51-year-old man who presented with breathlessness on exertion and orthopnoea in association with Type 2 diabetes mellitus. Investigation showed bilateral diaphragmatic paralysis due to phrenic neuropathy. There was no evidence of neuropathy or microvascular disease elsewhere. Phrenic neuropathy may be an important, albeit rare, complication of diabetes and diaphragmatic function should be considered in any patient with unexplained breathlessness and orthopnoea.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
4/6. Case-of-the-month: perineuritis presenting as mononeuritis multiplex.Perineuritis unassociated with other significant pathological changes is a rare finding. A patient is described with mild, non-insulin dependent diabetes mellitus who presented with the clinical picture of mononeuritis multiplex, and in whom perineuritis but no occlusive vascular disease was found on sural nerve biopsy. Treatment with prednisone and plasma exchange resulted in some improvement. We conclude that the focal perineuritis, rather than the diabetes, was responsible for the clinical picture mimicking mononeuritis multiplex. In conjunction with previous reports, this suggests that perineuritis may be a treatable neuropathy.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
5/6. Asymptomatic myocardial ischemia in diabetic patients.The recent recognition of the prevalence of asymptomatic ST-segment depression in patients with coronary artery disease demonstrates the poor sensitivity of using angina as a sign of myocardial ischemia. Possibly the greatest application of ambulatory ST-segment monitoring for the detection of asymptomatic ischemia is in diabetic patients. coronary artery disease represents the ultimate cause of death in more than half of such patients and usually manifests itself prematurely at an advanced stage. The long-held clinical belief that infarction may be silent, or less painful, in patients with diabetes is supported by several retrospective studies (32 to 42 percent of diabetic patients lack angina at infarction, compared with only 6 to 15 percent of nondiabetic patients). Explanations for this observation have been remarkably deficient in the literature. One group has shown that in diabetic patients with painless infarction, the autonomic nerve fibers of the heart display typical lesions of autonomic neuropathy that may affect afferent sensory impulse transmission compared with those in several matched control groups. Except for a recent report from italy, there are no data on the prevalence of asymptomatic ischemia in diabetic patients. There are obvious reasons to address this issue more comprehensively: first, given the high incidence of painless myocardial infarction, the frequency of asymptomatic ischemia may be very high; second, because the ability to evaluate patients with standard treadmill testing is limited in patients with peripheral vascular disease and diabetic neuropathy, ambulatory monitoring may be used on a more widespread basis; and third, given the higher than average incidences of sudden death and left ventricular dysfunction in diabetic patients compared with nondiabetic patients, ambulatory monitoring may represent a method of assessing the role of episodic ischemia in explaining these other cardiac events.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
6/6. Diabetic neuroarthropathy in the foot: patient characteristics and patterns of radiographic change.The diagnosis of diabetic neuroarthropathy of the foot can be difficult. A series of 96 patients (116 extremities) who had diabetes and peripheral neuropathy with bone and joint changes was reviewed. Typically, the patients were middle-aged or older, were taking insulin, and had had diabetes for more than 10 years. Retinopathy, nephropathy, and peripheral vascular disease were often present. There were abnormalities of vibratory sensation (94%) and of the gastrosoleus reflex (88%). The finding of specific radiographic abnormalities assisted but did not reliably differentiate neuropathy from infection. Three patterns of radiographic changes were noted: (1) at the metatarsophalangeal and interphalangeal joints, usually with underlying ulceration; (2) at the tarsometatarsal joints; and (3) in the anterior pillar-medial column of the foot, with talus, talonavicular, navicular, or naviculocuneiform destruction. Ulceration and infection in patients with patterns (2) and (3) were rare. When correlated, the demographic features, mode of presentation, physical signs, specific radiographic abnormalities, and patterns of change were distinctive and allowed the diagnosis of this complication of diabetes to be readily made.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |