Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Almost all diabetic foot infections originate from a foot ulcer. Decreased pain perception and structural deformities such as previous partial foot amputation, Charcot joints, and toe deformity in combination with chronic ischemia lead to a propensity for skin breakdown and subsequent infection. Magnetic resonance (MR) imaging is increasingly performed to evaluate for potential bone infection, but diagnosis of osteomyelitis can be complicated because signal changes from acute Charcot arthropathy, fractures, and postoperative residues may be mistaken for infection. Signal alterations of bone infection may be atypical in sclerosing osteomyelitis and gangrene. Differentiation between osteomyelitis and acute or subacute neuroarthropathy requires careful analysis of the location of bone signal alterations, their distribution, and pattern because qualitative changes are often identical. Presence of secondary signs such as adjacent ulcer, cellulitis, and sinus tract is indicative of osteomyelitis. Differentiation of noninfected neuroarthropathy from infected neuroarthropathy based on MR examinations is difficult. Presence of a sinus tract, disappearance of subchondral cysts, diffuse bone marrow abnormality, and bone erosions are in favor of infection.
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PMID:Differential diagnosis of pedal osteomyelitis and diabetic neuroarthropathy: MR Imaging. 1624 26

This article reviews the published data on the utilization of [(18)F]Fluorodeoxyglucose (FDG) positron emission tomography (PET) and PET/CT imaging in patients with complicated diabetic foot. Three areas have been identified where FDG-PET/CT can have an important role in the clinical decision making process of this disease and could be helpful to the podiatricians if found accurate: (a) Diagnosis of deep soft tissue infection and osteomyelitis (OM), (b) differentiating Charcot arthropathy from OM and (c) evaluating the ischemia/atherogenesis component in a particular case. The main focus of the research initiatives involving PET in the setting of diabetic foot syndrome has been its possible role in the reliable diagnosis or exclusion of OM. The literature on the efficacy of FDG PET in reliably diagnosing or excluding OM in diabetic foot is divided with two groups of results; four studies emphasizing the potential usefulness and two depicting relatively low sensitivity of this modality. The combined PET/CT fusion approach appears better than FDG PET imaging alone owing to superior anatomical localization and thereby better differentiation of soft tissue infection and bone. With the establishment of clinically functioning PET/MRI units, it is essential to conduct further research studies designed to investigate the ability of this modality as the most optimal one-stop shop diagnostic imaging technique for the management of patients with diabetic foot. A relatively less explored area is the role of FDG PET in assessing atherosclerosis in the large vessels of the lower limb that could help in studying the ischemia component and its contribution in the development of diabetic foot. Further research is required in this direction.
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PMID:FDG PET and PET/CT Imaging in Complicated Diabetic Foot. 2715 33

PURPOSE OF THE STUDY The aim of this study was to evaluate the mid-term outcomes of the surgical reconstruction of Charcot Foot Neuroarthropathy in diabetic patients with failed conservative treatment and indicated for a below-knee amputation. MATERIAL AND METHODS In the period from 2010 to 2015 the surgical reconstruction of inactive, chronic Charcot Foot Neuroarthropathy classified as type II and III by Sanders and Frykbeg was performed in 16 patients with failed conservative treatment. All these patients were by the diabetes centres initially indicated for a below-knee amputation. The performed evaluation focused on the clinical outcome (limb preservation, walking in footwear, full weight-bearing capability, the radiographic result (talar-first metatarsal angle, calcaneal inclination - negative, neutral, positive), complications (associated and not associated with the surgery). RESULTS The mean follow-up period was 4.7 years (2.5-7.5 years). From the original group of 16 patients indicated for a below-knee amputation following the failure of conservative treatment, the amputation was performed in one patient only. After the surgical reconstruction 15 patients were able to fully weight-bear when achieving plantigrade foot position, of whom 9 wore regular footwear and 6 customised diabetic footwear. The talar-first metatarsal angle was corrected from the mean 30 degrees (20-45) to the mean 5 degrees (0-10). The calcaneal inclination was corrected from the negative preoperative value in all the cases to neutral in 5 patients and positive in 10 patients. The surgery-associated complications were the following: infectious complications - positive preoperative cultivation in 10 out of 16 patients, secondary healing of the surgical wound in 7 patients, the need of additional ablation of plantar prominence of tarsal skeleton in 2 patients, screw prominence in 2 patients with the need of extraction - all healed without complications. In one case a lower limb amputation was performed due to secondary limb ischemia. The complications not associated with the surgery consisted of a soft tissue injury due to neuropathy. DISCUSSION Conservative treatment remains the basic approach to Charcot foot neuroarthropathy which is often associated with a long-term off-loading of the affected limb on a wheelchair, repeated hospital stays, changes of wound dressing of plantar ulcers. These are stated as the most frequent indications for a major amputation. Nonetheless, even the major amputation is accompanied by complications. The candidate for a reconstruction surgery should be a cooperating, compensated, informed diabetic patient with Charcot foot neuroarthropathy, either instable or stable, but non-plantigrade. It is necessary to diagnose and treat the impairment of leg blood supply and osteomyelitis, and to provide an appropriate rehabilitation. CONCLUSIONS Of the original 16 indications for a lower limb amputation in diabetic patients with Charcot foot neuroarthropathy, only one amputation was performed. Positive mid-term outcomes of surgical reconstruction justify further development of this method, bearing in mind the necessity of careful indication and preoperative preparation of the patient in cooperation with diabetologists. Precise and accurate surgical technique and relevant postoperative care are essential to minimise the potential complications. Key words:Charcot arthropathy, diabetic neuropathy, rocker - bottom foot deformity, foot reconstruction.
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PMID:[Mid-Term Outcomes of Reconstruction of Charcot Foot Neuroarthropathy in Diabetic Patients]. 3084 14