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

The noninvasive diagnosis of osteomyelitis of the foot in diabetic patients with currently available radiologic and radionuclide imaging techniques is often difficult. Recently, 111In-labeled leukocyte scintigraphy has been proposed as an attractive alternative. Accordingly, we retrospectively reviewed 51 111In-labeled leukocyte scans, 49 technetium-99m bone scans, and 49 plain radiographs obtained in 51 adults with diabetes in whom osteomyelitis of the foot was suspected. The sensitivity and specificity of these techniques were evaluated in all patients, as well as in a subgroup of 11 patients with neuroarthropathy. Results with 111In-labeled leukocyte scans were also examined in subsets of patients with soft-tissue ulcers (n = 35) and those receiving antibiotics during investigation (n = 20). Confirmation or exclusion of osteomyelitis was made surgically in 28 patients and clinically in 23. Fourteen patients had osteomyelitis. Bone scans were most sensitive (93%) but least specific (43%); plain radiographs were most specific (83%) but least sensitive (43%). 111In-labeled leukocyte scans were both sensitive (79%) and specific (78%), and remained useful in patients with neuroarthropathy, soft-tissue ulcers, and antibiotic treatment. Poor spatial resolution contributed to the false-negative and false-positive 111In-labeled leukocyte scans, suggesting that this technique should not be interpreted independent of other tests. 111In-labeled leukocyte scans are a valuable diagnostic tool for the diagnosis of pedal osteomyelitis in diabetic patients.
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PMID:Diagnosis of osteomyelitis of the foot in diabetic patients: value of 111In-leukocyte scintigraphy. 187 40

Septic metastatic endophthalmitis from Klebsiella pneumoniae liver abscess, first reported in seven cases treated at the Veterans General Hospital, Taipei, Taiwan, between 1981 and 1985, was seen in six similar cases at the same hospital in the subsequent 2 years. We conducted a retrospective search for factors that might be associated with these complications of pyogenic liver abscess. A total of 23 cases with septic metastatic lesions from pyogenic liver abscess were found between 1981 and 1987, and 164 cases of pyogenic liver abscess without septic metastatic lesions were identified as a comparison group. Klebsiella pneumoniae liver abscess, bacteremia, and the underlying diabetes mellitus were significantly more common in the study group than in the comparison group. Of the 23 patients with septic metastatic lesions, there were 14 cases (60.8%) of endophthalmitis or uveitis, 10 cases (43.4%) of pulmonary abscess and/or emboli, six cases (26.0%) of brain abscess and/or purulent meningitis, five cases (21.7%) of bacteriuria and/or prostate abscess, two cases (8.6%) of osteomyelitis and/or pyogenic arthritis, and one case (4.3%) of psoas abscess.
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PMID:Septic metastatic lesions of pyogenic liver abscess. Their association with Klebsiella pneumoniae bacteremia in diabetic patients. 187 59

The MR appearances of foot problems in patients with diabetes mellitus are illustrated. MR has been found to be effective in the diagnosis of osteomyelitis, the most common indication for imaging the feet of diabetic patients. MR has the ability to image numerous pathologic processes, especially subtle soft-tissue changes, that are not detectable with other imaging methods.
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PMID:Abnormalities of the foot in patients with diabetes mellitus: findings on MR imaging. 189 42

Although Charcot's disease and its association with diabetes have been described many times in the literature, it is still often misdiagnosed and incorrectly treated as osteomyelitis, arthritis, or gout. The best safeguard is a high index of suspicion. A warm, swollen foot in a diabetic patient with long-standing neuropathy without local or systemic signs of infection must be considered Charcot's disease until proven otherwise. The principal treatment is total abstinence from putting weight on the foot until warmth, swelling, and redness subside. Protective weight-bearing methods may then be slowly instituted.
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PMID:Charcot's disease in diabetic patients. Correct diagnosis can prevent progressive deformity. 200 Mar 50

A retrospective review of all patients with vertebral osteomyelitis admitted to all Saskatchewan referral hospitals from 1973 to 1986 was undertaken to determine the incidence and clinical characteristics of the disease. There were 73 patients, an incidence of 5.3 cases/million per year. Erroneous initial diagnoses were common (41%). There was a significantly increased risk in patients older than 60 years. Staphylococcus aureus was the most frequent organism. Mycobacterium tuberculosis was present in 29.5% and was more common in native Indian patients. Surgery was performed in 31% of all patients, and in 50% of those with tuberculous infections. The outcome was excellent in 92% of patients. Diabetes and transurethral resection of the prostate were risk factors for vertebral osteomyelitis.
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PMID:Causes and clinical management of vertebral osteomyelitis in Saskatchewan. 202 98

One hundred consecutive patients with diabetic ulcers were studied in an 8-month-period. There were 58 females. The mean age was 59.9 years. Eighty three patients had non-insulin dependent diabetes mellitus. The mean duration of diabetes mellitus was 11.6 years. The mean duration of the ulcer was 8.5 months. Sixty nine of the ulcers were gangrenous. Over 50% of the ulcers involved the big toes. Neuropathic ulcers were found mainly in the sole of the feet. Roentgenograms showed evidence of osteomyelitis in 44 patients. There were 356 bacterial isolates (340 aerobes and 16 anaerobes) from the ulcers. There were 3.6 infecting organisms per ulcer in gangrenous ulcers, while in neuropathic ulcers, there were 3.4 infecting organisms per ulcer. In both types of ulcer Staphylococcus aureus and Escherichia coli were the commonest infecting organisms each being isolated in 88 of the 100 ulcers studied. In repeat bacterial cultures at 4 weeks there were 116 bacterial isolates. Staphylococcus aureus persisted in 63 ulcers despite therapy, while Escherichia coli persisted in 35. There were no new organisms isolated at repeat cultures and no ulcer was completely sterile. The Staphylococcus aureus was 100% sensitive to Augmentin (Amoxicillin plus clavulinic acid), Clindamycin, Novobiocin, and Amikacin while the gram negative bacilli were sensitive to Cefotaxime, Piperacillin, Amikacin and augmentin, Clindamycin, Chloramphenicol and Lincomycin inhibited the growth of anaerobes to a varying degree.
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PMID:Diabetic ulcers--a clinical and bacteriological study. 207 Jul 56

The clinical features of 101 Melanesian patients with Staphylococcus aureus bacteraemia observed during two 2-year periods (1977-1979 and 1985-1987) in a university teaching hospital in Papua New Guinea are reviewed. The age of the patients ranged from 12 to 70 years. There were 69 males and 32 females. Diabetes mellitus, found in 15 patients, was the most common predisposing factor. Most of the patients (87%) had community-acquired infection. Soft-tissue infection, pneumonia, arthritis, osteomyelitis, intravenous-site thrombophlebitis, cerebral abscess, endocarditis and cavernous sinus thrombosis were among the clinical entities observed. Soft tissues and lungs were the most common sites of primary and secondary foci of infection, respectively. All but 1 of the 101 blood isolates were resistant to penicillin G and none was resistant to methicillin. The overall case fatality rate was 24%. These data demonstrate that staphylococcal bacteraemia in adult Papua New Guineans is mostly community acquired and has a high mortality. Skin and soft tissues are the major primary foci of infection leading to staphylococcal bacteraemia.
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PMID:The clinical spectrum of staphylococcal bacteraemia: a review of 101 Melanesian patients from Papua New Guinea. 208 Jun 75

Infections of the chest and abdominal wall are rare but potentially fatal disorders that can occur spontaneously or in association with diabetes mellitus, immunosuppression, or trauma. The condition (either in the form of necrotizing fasciitis and/or pyomyositis) is difficult to diagnose clinically because of poor localizing signs. Prognosis depends on early recognition, extent of disease, and type of causative organism. Pathologically, the infections can manifest as cellulitis, abscess, and/or granulation tissue formation. To determine the value of MR imaging in the assessment of these infections, we compared the findings of MR with those of CT, sonography, scintigraphy, and plain radiography in 13 patients with proved thoracic and/or abdominal wall infection. The imaging findings were correlated with microbiological, pathologic, and/or surgical data. The isolated pathogens were Staphylococcus aureus (n = 6), Klebsiella pneumoniae (n = 1), Mycobacterium tuberculosis (n = 4), and Streptomyces somaliensis (n = 2). In 10 of 13 patients, MR imaging and CT were comparable and proved accurate in detecting the nature and extent of the inflammatory process. In seven of the patients, CT also was useful in guiding percutaneous biopsy and/or partial drainage procedures. Coronal and sagittal MR images were helpful for planning surgery. Rib osteomyelitis was missed with both techniques in one patient; in two other patients who did not have CT, MR imaging missed osteomyelitis of the ribs, the spinous process of a vertebral body, and the iliac bone. Sonography underestimated the extent of the disease in all 13 patients, but detected fluid collections in six. Findings on scintigraphy and plain radiography were the least contributory to the diagnosis and treatment of these patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:MR imaging of thoracic and abdominal wall infections: comparison with other imaging procedures. 213 43

An elderly male with a history of diabetes mellitus and a recent dental procedure presented to the emergency department with acute lumbosacral pain and low grade fever. Computerized tomography (CT scan) and magnetic resonance imaging (MRI) yielded a presumptive diagnosis of pyogenic vertebral osteomyelitis. A diagnosis of viridans Streptococcus vertebral osteomyelitis was confirmed by gallium scanning and blood culture. The literature has emphasized the occurrence of pyogenic vertebral osteomyelitis as a chronic process. A review suggests that viridans Streptococci, although an uncommon cause of this disorder, is usually associated with back pain of more acute onset. It is therefore recommended that pyogenic vertebral osteomyelitis be considered in any patient presenting to the emergency department with the acute onset of lower back pain, fever, leukocytosis and an elevated erythrocyte sedimentation rate.
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PMID:Streptococcus viridans osteomyelitis with endocarditis presenting as acute onset lower back pain. 214 6

Malignant external otitis (MEO) is a disease of the external auditive channel (EAC) due to Pseudomonas aeruginosa which usually involves individuals with diabetes mellitus. It may result in the invasion of the cranial base with cranial neuropathy and a high mortality rate despite therapy. We report the clinical features, diagnostic procedures, evolution and therapy of 8 patients with MEO, seven of which had cranial neuropathy. All patients have diabetes except one who had acquired immunodeficiency syndrome. All had otalgia, otorrhea and headache lasting for several months. Six patients had homolateral (as related to the MEO) facial palsy. One patient with bilateral MEO developed bilateral facial palsy and lesion of the cranial nerves VI (unilaterally) and IX through XII (bilaterally). In all patients P. aeruginosa was cultured from the EAC exudate scintigraphy with 99Tc showed uptake at medium ear and mastoid level in all 8 patients, suggesting a possible osteomyelitis. Scintigraphy with 67Ga was positive in the 6 cases where it was carried out, showing uptake in the soft tissues of the cranial base. Computed tomography was carried out in 6 patients, and it was useful to define the anatomical extent of the disease. The patients received different therapeutic schedules, particularly the combination of a betalactamic and aminoglucoside antibiotics. Follow up was characterized by common recurrences, and one patient died. The importance of early diagnosis and treatment to prevent the extension and recurrence of MEO are discussed. Cranial neuropathy is considered as a poor prognostic finding.
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PMID:[Otitis externa maligna and cranial neuropathy]. 228 52


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