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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We studied endothelial-mediated microvascular blood flow in neuropathic diabetic patients to determine the association between endothelial regulation of the microcirculation and the expression of endothelial constitutive nitric oxide synthetase (ecNOS) in the skin. Vasodilation on the dorsal foot in response to heating and iontophoresis of acetylcholine (endothelium-dependent) and sodium nitroprusside (endothelium-independent) were measured using single-point laser Doppler and laser Doppler imaging in diabetic patients with neuropathy (DN), with neuropathy and vascular disease (DI), with Charcot arthropathy (DA), and without complications (D), and in healthy control subjects (C). The response to heat was reduced in the DN (321 [21-629] percentage of increase over the baseline, median [interquartile range]) and DI (225 [122-470]) groups but was preserved in the DA (895 [359-1,229]), D (699 [466-1,029]), and C (810 [440-1,064], P < 0.0001) groups. The endothelial-mediated response to acetylcholine was reduced in the DN (17 [11-25]), DA (22 [2-34]), and DI (13 [2-30]) groups compared with the D (47 [24-58]) and C (44 [31-70], P < 0.001) groups. The non-endothelial-mediated response to sodium nitroprusside was also reduced in the DI (4 [0-18]), DN (17 [9-26]), and DA (21 [11-31]) groups compared with the D (37 [19-41]) and C (44 [26-67], P < 0.0001) groups. There was a significant reduction in vasodilation in the DI group compared with all other groups (P < 0.0001). Full thickness skin biopsies from the dorsum of the foot of 15 DN, 10 DI, and 11 C study subjects were immunostained with antiserum to human ecNOS, the functional endothelial marker GLUT1, and the anatomical endothelial marker von Willebrand factor. The staining intensity of ecNOS was reduced in both diabetic groups. No differences were found among the three groups in the staining intensity of von Willebrand factor and GLUT1. We conclude that the endothelium-dependent and endothelium-independent vasodilations are impaired in diabetic patients predisposed to foot ulceration and that neuropathy is the main factor associated with this abnormality. Reduced expression of ecNOS may be a major contributing factor for endothelial dysfunction. These data provide support for a close association of neuropathy and microcirculation in the pathogenesis of foot ulceration.
Diabetes 1998 Mar
PMID:Endothelial dysfunction and the expression of endothelial nitric oxide synthetase in diabetic neuropathy, vascular disease, and foot ulceration. 951 54

Although diabetes and peripheral neuropathy are perhaps the most important risk factors for neuropathic osteoarthropathy, we hypothesized that peak plantar pressures may also be higher in patients who have this condition. We are unaware of any reports in the medical literature that have specifically addressed this hypothesis. We obtained data from the medical records of 164 diabetic patients who had been managed in a multidisciplinary tertiary-care diabetic foot-specialty clinic. We then divided the patients into four groups: those who had acute Charcot arthropathy, those who had neuropathic ulceration, those who had neuropathy without ulceration, and those who had neither neuropathy nor ulceration. The peak plantar pressures were significantly higher in the patients who had acute Charcot arthropathy and those who had a neuropathic ulcer (p < 0.001 for both) compared with the pressures in those who had no history of arthropathy and those who had neuropathy without ulceration. With the numbers available, we could not detect a significant difference in the peak pressure between the affected and the unaffected foot in the patients who had Charcot arthropathy (mean [and standard deviation], 100+/-8.5 compared with 101+/-9.6 newtons per square centimeter; p > 0.05). However, the mean peak pressure was significantly higher on the ulcerated side than on the contralateral side in the patients who had a neuropathic ulcer (90+/-18.8 compared with 86+/-20.7 newtons per square centimeter; p < 0.02). Although the midfoot was the site of maximum involvement in all patients who had Charcot arthropathy, the peak plantar pressure was on the forefoot, suggesting that the forefoot may function as a lever, forcing collapse in the midfoot.
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PMID:Elevated peak plantar pressures in patients who have Charcot arthropathy. 987 50

Neuropathic osteoarthropathy, i.e., Charcot's joint, has not previously been reported as a sequela of elective foot surgery. The authors present a challenging case of a patient with long-standing diabetes mellitus and peripheral neuropathy who developed neuropathic osteoarthropathy after a Keller arthroplasty for a recalcitrant hallux ulcer. The radiographic findings, diagnostic tests, and histopathology are discussed. Finally, the authors offer suggestions for surgeons contemplating a Keller arthroplasty for patients with peripheral neuropathy.
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PMID:Charcot's joint following Keller arthroplasty. A case report. 954 56

Neuropathic arthropathy or Charcot joint is a disease process that results in progressive destruction of bone and soft tissue secondary to the loss of protective sensation. The disease is most common among patients suffering from diabetes mellitus. Although there is no known definitive cure for the progressive destruction of a Charcot joint, it is possible to slow and in some cases arrest the destruction of the bone and soft tissue. The Charcot joint will be addressed with a review of the literature and use of a new technology as adjunct treatment.
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PMID:Adjunct low intensity ultrasound in Charcot neuroarthropathy. 958 75

Vasomotion, the spontaneous rhythmic contraction exhibited by small arteries and arterioles is dysregulated in patients with diabetic neuropathy. We examined the relationship between Charcot arthropathy and vasomotion at the dorsum of the foot. We studied nine diabetic patients with clinically diagnosed neuropathy and Charcot arthropathy in 13 feet (n=13), twelve subjects with diabetic neuropathy and no Charcot deformity (n=12), and 11 healthy controls (n=11). Following neuropathy assessment, blood flow was measured by laser Doppler flowmetry with local skin warming. Fast Fourier transformation was performed to provide an index of vasomotion. Subjects with Charcot osteoarthropathy had more severe somatic neuropathy and higher circulating levels of serum calcium (9.8+/-0.1 versus 9.3+/-0.1 mg/dL). Raising local temperature increased skin blood flow and vasomotion in both control subjects and Charcot subjects, but not in diabetic patients with neuropathy alone (p < 0.05 for blood flow, p < 0.02 for vasomotion). Patterns of peripheral vasomotion and blood flow which are clearly disordered in diabetic neuropathy are intact in patients with a Charcot osteoarthropathy, despite a more severe sensory nerve impairment. These findings suggest that the loss of peripheral blood flow and vasomotion often seen in diabetic neuropathy may actually be protective against Charcot arthropathy by preventing bone resorption. It remains unclear then whether the Charcot arthropathy is a direct result of a failure to decrease blood flow to bone, or is the manifestation of some other pathology.
J Diabetes Complications
PMID:Normal blood flow response and vasomotion in the diabetic Charcot foot. 961 70

Foot deformity and lower extremity dysfunction are debilitating complications of diabetes mellitus which often lead to significant permanent disability. Acute diabetic neuroarthropathy (Charcot arthropathy) directly leads to foot deformity, subsequent lower-extremity complications and may lead to lower-extremity amputation, if not identified and managed appropriately. The purpose of this study is to report the healing times of acute-onset neuropathic arthropathies (fractures, joint subluxations or dislocations) in individuals with diabetes mellitus by foot location using the ambulatory method of total-contact casting (TCC). In addition, the identification of critical subject characteristic which influence healing outcomes were determined. The results indicate all (100%) of the acute (Charcot) fractures, subluxations, or dislocations healed in an average of 86+/-45 days. Acute Charcot arthropathies of the ankle, hindfoot, or midfoot take longer to heal by TCC than arthropathies localized to the forefoot. Adherence to partial weight bearing with assistive devices during casting and early institution of cast immobilization are critical factors associated with shorter healing times using TCC. Physicians, rehabilitation specialists and third-party payers should be aware of the length of time required to heal acute Charcot foot arthropathies at all locations of the foot using TCC.
J Diabetes Complications
PMID:Acute Charcot arthropathy in patients with diabetes mellitus: healing times by foot location. 974 46

It is well accepted that Charcot arthropathy is most frequently encountered in the diabetic population. Also well known is the association between diabetes and osteoporosis, even in the absence of overt renal dysfunction. Is it plausible that Charcot arthropathy is a late sequela of osteoporosis in diabetic patients, and if so, can the osteoporosis be treated early, leading to a decrease in the ultimate prevalence of Charcot arthropathy? The objective of this paper is to concisely review the literature detailing the course of Charcot neuroarthropathy and to investigate the links between Charcot arthropathy and osteoporosis among diabetic patients.
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PMID:Is Charcot arthropathy a late sequela of osteoporosis in patients with diabetes mellitus? 979 77

Charcot's arthropathy of the right wrist in a 55-year-old patient with diabetes is reported. Neurogenic arthropathy rarely affects non-weightbearing joints such as those of the hand and wrist; the foot, ankle, and knee most commonly are affected. When crutches are used by patients with diabetes who have Charcot's arthropathy, orthotics and platform crutches can help to relieve pressure induced by weight transfer to the wrist during ambulation.
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PMID:Diabetic Charcot's arthropathy of the wrist. Case report and literature review. 991 8

Neuropathic arthropathy is a chronic, progressive degenerative disorder affecting one or more peripheral or vertebral articulations, which develops as the result of a disturbance in the normal sensory (pain or proprioceptive) innervation of joints. Diabetes, syphilis, and syringomelia are the most commonly associated clinical entities. When neuropathic arthropathy is suspected, careful clinical evaluation should be performed to identify an underlying neurologic disorder. Patient education, joint protection, and early recognition of fractures are the most important general management principles. Surgery can be considered in cases of advanced joint destruction when there is significant disability.
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PMID:Neuropathic Arthropathy: Review of Current Knowledge. 1079 44

The diabetic Charcot foot is a major limb-threatening complication of long-term diabetes mellitus and neuropathy. Although first described over 100 years ago, we are still lacking definitive studies regarding its prevalence in this population, precise etiology, or most effective treatments. Trauma in the presence of peripheral sensory neuropathy and abundant arterial perfusion seem to be the primary causal factors leading to this severe foot deformity. Misdiagnosis or delayed diagnosis of osteoarthropathy allows the destructive phase of this disorder to continue with resultant further destruction of the foot architecture. The authors discuss the natural history of this entity as well as potential treatment options and recommendations. Through a better understanding of the underlying pathogenesis, Charcot arthropathy can be more effectively managed and thereby limit the development of severe deformity, ulceration, infection and limb loss.
Diabetes Metab Res Rev
PMID:Management of the diabetic Charcot foot. 1105 91


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