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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Assuming >/= 75 years old as the age limit to define dialysis in the elderly, the incidence in this group of patients is progressively increasing in most dialysis units, with an annual growth of 8 to 16%, and represents 20 to 33% of the overall population being affected. The prevalence of the elderly dialysis group is also high, 14 to 20%, in the main literature casistics. Vascular nephropathies, 13 to 50%, represent the major cause of end-stage renal disease, followed by diabetes, 11 to 37%. First year survival rate is an acceptable 52 to 82%, whereas the fifth year value is on average 20 %, also due to the high baseline mortality in these patients. The death causes are mainly cardiac related and represent 45% of the overall mortality. The main prognostic factors are frequency and severity of comorbid factors, in addition to nutritional indexes that are particularly important in this age group. Dialysis dose and treatment time are not related to mortality. Haemodialysis and peritoneal dialysis complement each other to allow the best results. The survival rate, however, is usually better with haemodialysis, especially in old diabetic patients and after some years of treatment. Vascular access, intradialytic hypotension, cardiopathy, intestinal bleeding and amyloidotic arthropathy represent the more critical aspects of dialysis in the elderly, while the quality of life is sometimes unexpectedly good.
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PMID:[Dialysis in the elderly]. 1250 66

Hereditary hemochromatosis is classically inherited as a recessive trait but is genetically heterogeneous. Mutations in the HFE and the TFR2 genes account for about 80% of patients and a third locus on chromosome 1q is responsible for juvenile hemochromatosis. We describe here the clinical and biological characteristics of autosomal dominant form of iron overload due to the N144H mutation of the SLC11A3 gene. Clinical signs of iron overload in patients include joint pains, cardiomyopathies, liver fibrosis and hormonal disorders including diabetes mellitus. The main and most common clinical symptoms in this family were joint complaints and early signs of arthrosis. Serum ferritin levels in iron overloaded subjects varied from 31 to 2179 ng/ml and the transferrin saturation from 13 to 88.6%. The iron overload is moderate compared to patients with type 1 hemochromatosis but the deferoxamine test was normal in all patients. The disease in this family segregated as a dominant trait. None of the patients was homozygous or compound heterozygous for any known mutation in the HFE or TFR2 genes. The disease in this family represents a non-classical form of iron overload caused by the N144H mutation in the SLC11A3 gene. The reports of other distinct mutations in SLC11A3 suggest that this gene may be of interest for further etiologic research.
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PMID:Dominant hemochromatosis due to N144H mutation of SLC11A3: clinical and biological characteristics. 1254 33

In this retrospective study data of 257 patients (11- 6 years; 52 % male, 48 % female) admitted during the last three years for treatment of sudden unilateral hearing loss are statistically evaluated. No correlation with coexisting disease like hypertension, coronary heart disease, hypercholesteremia, arthropathy of the cervical spine, diabetes, thyroid disorders or nicotine abuse were evident. In 194 patients (75 %) total remission was achieved after rheological therapy. Patients additionally treated with steroids had a significant better outcome. Younger patients had higher remission rates. The best prognosis was found for patients with hearing loss in the lower frequency range. There were no differences in remission rates for patients with preexisting sensorineural hearing loss or chronic otitis media. Also patients suffering from recurrent episodes of sudden hearing loss had a similar outcome also.
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PMID:[Epidemiological data of patients with sudden hearing loss -- a retrospective study over a period of three years]. 1254 57

Various foot structures are thought to influence forefoot plantar pressures during walking. High peak plantar pressures (PPP) during walking in people with diabetes mellitus (DM) and peripheral neuropathy (PN) can cause skin breakdown. The question addressed by this study is "What are the primary forefoot structural factors that predict regional PPP during walking in groups of people with and without DM and PN?" Twenty people with DM and PN (mean age 55+/-9 years, 6 female, 14 male, BMI=33+/-8) and 20 people without DM, matched for gender, age, and BMI were tested. Measures of foot structure were taken from three-dimensional images constructed from spiral X-ray computed tomography. Peak plantar pressure data were recorded during walking. Hierarchical multiple regression analysis was used to predict regional PPP at the great toe and five metatarsal heads from selected structural and walking variables. Metatarsal phalangeal joint angle (hammer toe deformity) was the most important variable predicting pressure, accounting for 19-45% of the PPP variance at five of the six locations in the DM group. Soft tissue thickness, hallux valgus, and forefoot arthropathy were the most important predictors of PPP in the control group. Combinations of structural and walking variables accounted for 47-71% of the variance in the DM group and 52-83% of the variance of PPP during walking in the control group. These structural variables, especially hammer toe deformity, should be considered in attempts to develop strategies to reduce excessive forefoot PPP that may contribute to skin breakdown or other injury.
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PMID:Forefoot structural predictors of plantar pressures during walking in people with diabetes and peripheral neuropathy. 1275 10

The hip arthrosis is a degenerative joint disease occurring mainly in the elderly patients, a recently growing population. Rational measures are needed to better carry out the surgical procedures and to reduce cost for the health system, since almost two thirds of the costs are due to the admission period. Therefore, a global, multidisciplinary assistance program for total hip arthroplasty (THAAP), including ambulatory appointments and programmed home care by a nursing team, was established to guide patients and their relatives for the procedure. This is a pilot study for a randomized prospective clinical trial to assess the feasibility of the THAAP and to determine the protocol adherence by the medical and nurse team. Secondarily, it attempts to determine the impact of the program on admission period, patient functional autonomy and postoperative events, as well as to assess the feasibility of the programmed nursing home-care. A total of 22 patients (8 males, 12 females) with mean (SD) age of 59.45 (16.87) ranging from 21 to 86 years were included in the study. They were divided into two groups according whether they were (group 1, n = 10) or were not (group 2, n = 10) included in the THAAP. The main comorbidity for both groups were SAH (2 vs. 1), diabetes (1 vs. 0) and alcohol consumption (1 vs. 0), respectively. Mean (SD) postoperative (p.o.) period was significantly reduced (p = 0.0055) in group 1; 5.2 (0.4) as compared to group 2; 7.5 (2.3). Adherence to the THAAP was 90% and 100% for doctors and nurses, respectively. Seven out of nine patients in group 1 were bed-seated on the second POD, two were seated on the third POD and none were bed-ridden. All of them were able to walk with crutches a day later. All patients in group 2 left bed on the fourth POD. In conclusion, the present protocol demonstrated to be feasible, team adherence was adequate and resulted in a reduced admission period. The progress of the program shall determine its efficacy and the feasibility of programmed nursing home care.
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PMID:[Preliminary evaluation of a treatment protocol for total hip arthroplasty]. 1293 51

Diabetic neuroarthropathy was observed in four patients; these are the first cases of this nature reported in the Canadian medical literature. The criteria for this diagnosis included: (1) long-standing diabetes; (2) arthropathy, most frequently involving the foot, which shows deformity, shortening and ulceration without evidence of infection or peripheral circulatory failure; (3) abolition or diminution of pain on weight-bearing; (4) diabetic peripheral neuropathy with impaired sense of position or vibration and weak or absent deep tendon reflexes. Radiographic findings were similar to those in patients with Charcot's arthropathy from any cause.Tabes dorsalis, leprosy, syringomyelia, myelodysplasia and the arthropathies of corticosteroid therapy were ruled out in these cases. In addition to conventional medical therapy the patients were treated by means of walking-casts for several months.Diabetic neuroarthropathy is probably more common than the medical literature would indicate. Diminished sensation in the lower limbs in diabetics of long standing appears to be the major factor contributing to this disorder.
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PMID:DIABETIC NEUROARTHROPATHY: REPORT OF FOUR CASES. 1419 8

The musculoskeletal complications of diabetes mellitus (DM), which are the most common endocrine arthropathy, have been generally ignored and poorly treated compared with other complications such as neuropathy, retinopathy and nephropathy. Like other quality of life issues, the musculoskeletal disability of DM has not been investigated effectively. The incidence of diabetic foot has decreased thanks to excellent foot care, but the hand is still an important target for diabetic complications. The aim of this study was to investigate early diabetic musculoskeletal complications on the basis of a collaborative multidisciplinary study design. For this purpose 78 patients (mean age 57.8 +/- 11.9 years, 55 women and 23 men) who had type II DM for 15 years maximally and 37 non-diabetic controls (mean age: 55.7 +/- 11.5, 27 women and 10 men) were randomly selected for inclusion in the study. All patients were evaluated by the Rheumatology, Orthopedic Rehabilitation and Hand Rehabilitation Divisions. Dupuytren's disease was present in 17 (21.8%) of 78 diabetic subjects as the most frequent and statistically significant complication of the musculoskeletal system. In correlation and logistic regression analysis, only retinopathy was significantly associated with duration of diabetes and diabetic foot. Long-term prospective randomised controlled trials on the effects of exercise in preventing musculoskeletal complications and disability in diabetics are needed.
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PMID:The musculoskeletal complications seen in type II diabetics: predominance of hand involvement. 1450 17

Vascular surgeons are frequently asked to evaluate diabetic patients with foot problems. While most of these patients present with diabetic foot ulcerations, there is a significant number of patients who have a concomitant Charcot arthropathy. Charcot neuropathic arthropathy, also know as Charcot joint disease (CJD), is a progressive, degenerative arthropathy associated with various types of neuropathic diseases; however, diabetes mellitus is the leading cause of CJD today. CJD targets the joints of the foot, leading to structural foot deformities and a threatened limb. Unfortunately, early signs of the disease are subtle and often go unrecognized until severe structural deformities have occurred. At this stage, the risk of developing pedal ulcerations, osteomyelitis, and a threatened limb has increased significantly. Early detection and immediate treatment of CJD is paramount in preventing the devastating deformities. The purpose of this article is to present a detailed overview of CJD in patients with diabetes mellitus and discuss the pathogenesis, clinical presentation, detection modalities, and various treatment modalities.
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PMID:Charcot joint disease in diabetes mellitus. 1450 61

Diabetic neuropathic osteo-arthropathy (DNOAP; Charcot's foot) is a dramatic complication of diabetic polyneuropathy. The diabetic foot is the most neglected long-term sequela of diabetes mellitus, and this is especially true for DNOAP. The increasing number of diabetics presenting in the foot ambulance with DNOAP demonstrates this general lack of knowledge and indicates that this complication is more frequent than hitherto assumed. In view of this dilemma, the pathogenesis, diagnosis and therapy of DNOAP are reviewed. Special emphasis is given to the differentiation between the neuropathic and neuroischemic foot as well as between acute DNOAP and bacterial infection. Therapy of DNOAP is predominantly conservative. The indication for surgery should be restricted to serious deformities of the foot, instability of joints, imminent skin perforation caused by fracture-induced dislocation of bones, and recurrent ulcers caused by prominent bones. Surgery comprises ulcer excision, ablation of bony prominences, as well as orthopedic surgery for the reconstruction of the foot skeleton.
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PMID:[Diabetic neuropathic osteoarthropathy (Charcot foot)]. 1453 41

Neuropathic arthropathy is a chronic, progressive joint degeneration with bone fragmentation, ligamentous instability, and dislocation. Diabetes is the leading cause of neuropathic arthropathy. Conventional radiography is the most commonly used imaging modality for diagnosing neuropathic arthropathy. The disease is mostly the hypertrophic type and is manifested by sclerosis of the bone, fragmentation, joint destruction, swelling, large joint effusion, and large osteophyte formation. Computed tomography, magnetic resonance imaging and radionucleide scintigraphy are helpful for diagnosing the disease and may help in distinguishing neuropathic arthropathy from septic arthritis and osteomyelitis.
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PMID:Imaging of neuropathic arthropathy. 1459 63


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