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Query: UMLS:C0031117 (peripheral neuropathy)
 10,577 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Over 700 cases of anaerobic osteomyelitis have been reported in the literature. Nonetheless, most reviews of osteomyelitis have paid little attention to the potential role of anaerobes in bone infections. There have, as yet, been no prospective studies of osteomyelitis utlizing optimal anaerobic transport and culture techniques. In a retrospective study of osteomyelitis at Wadsworth VA Hospital from 1973--1975, 39 percent of 58 patients with osteomyelitis had an infection involving anaerobes. Anaerobes were isolated from 81 percent of 27 patients whose specimens were cultured anaerobically. Anaerobes were isolated from nine of ten samples of bone. Anaerobic bacteria were part of a mixed flora involving facultative bacteria in all but two cases. All of the patients with anaerobic infection had non-hematogenous osteomyelitis. Non-hematogenous disease comprises 80--90 percent of the osteomyelitis seen in adults. Our experience at Wadsworth VA Hospital and a review of the literature lead us to believe that anaerobes play a much larger role in osteomyelitis than has been appreciated previously. Infections of the calvarium, mastoid, mandible, maxilla and the extremities are most likely to involve anaerobes. Predisposing conditions include paranasal sinusitis, otitis media, periodontal disease, trauma, peripheral vascular disease, peripheral neuropathy and/or chronic osteomyelitis. The presence of a foul odor is a valuable clinical clue to the presence of anaerobes. Bacteroides, fusobacteria and anaerobic cocci have been reported with almost equal frequency from anaerobic bone infections. While Bacteroides fragilis is the most common anaerobe isolated in infections of other organ systems, it does not appear to be a common pathogen in anaerobic bone infections. The role of anaerobes in osteomyelitis is not yet resolved. They have been isolated in pure culture from infected bone, and under those circumstances are clearly pathogenic. Anaerobes are found more frequently as part of a mixed flora with facultative streptococci, gram-negative bacilli, and less often with S. aureus. In this setting it is unclear which organism or organisms are the primary invaders, or whether there is a synergistic mechanism of infection. The reliability of sinus drainage cultures also remains to be determined. Our retrospective study suggests that certain anaerobes isolated from sinus drainage are not present in infected bone. Cultures of bone or an abscess adjacent to bone would be expected to give more reliable data. The majority of anaerobes other than B. fragilis are susceptible to levels of penicillin achievable with parenteral administration of the antibiotic. Anaerobic pathogens should be sought in the situations noted above. We feel that parenteral penicillin should be part of the initial antibiotic regimen in patients with suspected or documented anaerobic bone infection...
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PMID:Bone infections involving anaerobic bacteria. 20 46

Diabetes mellitus and arteriosclerotic vascular disease have been found to be the predisposing factors of osteomyelitis associated with peripheral vascular disease (10). A diabetic person is more susceptible to osteomyelitis because of the microangiopathy, peripheral neuropathy and decreased resistance to infection. In diabetes mellitus there can be microangiopathy which results from the proliferation of the endothelium of the intima and thickening of the basement membrane. This further contributes to a sluggish blood flow. In the patient with arteriosclerotic vascular disease, the lumens of the arterioles and arterioles are compromised by the atheromatous plaques. The anatomic structure of the blood supply to bone along with the pathologic membrane thickening, allows for slowing of blood. This slowing of blood flow causes micro-thrombi and enhances bacterial growth. In diabetes mellitus it has been shown that there is a decreased immunologic response which, along with the above, contributes to the sheltering and proliferation of bacteria in the small bones of the foot.
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PMID:Osteomyelitis associated with peripheral vascular disease secondary to diabetes mellitus. 103 Jul 28

Diabetic midfoot ulcers are caused by bone and joint disruption that occur as a consequence of progressive peripheral neuropathy associated with this disease. This results in osseus deformities and areas of high pressure on the plantar surface of the midfoot, which cause the ulcers. These lesions are difficult to heal and frequently lead to amputation. In a series of 348 patients, 40 developed 54 midfoot ulcers. Limb preservation was achieved in 33 (61%). Wound closure was achieved in 32 (60%). The amputation rate was highest (83%) in the 10 of 12 patients with peripheral vascular disease. Successful therapy for limb preservation most often included an operation combining resection of underlying osseus deformities with debridement of affected soft tissues.
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PMID:Management of diabetic midfoot ulcers. 163 84

In a survey of outpatients at the Denver Veterans Affairs Medical Center for common leg symptoms--515 questionnaires returned in a 3-week period--56% reported nocturnal leg cramps, 29% reported the restless leg syndrome, and 49% reported symptoms of peripheral neuropathy. Only 33% of patients had no symptoms relating to their legs. Patients often did not report these symptoms to their physician but were more likely to do so if the symptoms were frequent. Conditions especially related to leg symptoms were hypertension, peripheral vascular disease, coronary artery disease, cerebrovascular disease, kidney disease, and hypokalemia. Most patients did not receive effective therapy for these symptoms.
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PMID:Leg symptoms in outpatient veterans. 153 89

Ulceration of the foot is a major cause of morbidity in patients with diabetes, and its treatment has become a significant part of general surgical practice. It is, therefore, important to develop an efficient and effective approach to the care of this complication. We established a clinic dedicated to the care and prevention of foot ulcers in diabetic patients and since its inception in 1985, 343 patients have been seen. We provide regular prophylactic care and education to patients without ulcers, as well as treating those with ulcers. To assess the effectiveness of the clinic, we compared two groups of patients. Group 1 contained those who had ulcers while attending our prophylactic care program. Group 2 comprised those who were referred to us with lesions already present. There were 21 patients in group 1 and 150 in group 2. There were no statistical differences between the two groups with respect to age, sex, type and duration of diabetes, smoking history, prevalence of peripheral neuropathy, peripheral vascular disease, renal impairment and retinopathy. The sites and sizes of lesions were also no different between the groups. In spite of these similarities, however, patients in group 1 had a significantly better prognosis than those in group 2. The over-all number of lesions per patient was lower (1.52 +/- 0.98, compared with 2.06 +/- 1.33, p less than 0.05), the mean time required for lesions to heal was shorter (111.9 +/- 80.5 days compared with 160.5 +/- 151.3 days, p less than 0.05). The major amputation rate was lower and fewer patients required partial foot amputation. Prior to the opening of the clinic, the mean length of inpatient treatment was 30 days. This now has been reduced to 12.9 +/- 12.8 days. We conclude that the improved prognosis for those in group 1 can be attributed to the earlier detection and treatment of both potential and actual foot lesions. These results support the contention that the establishment of a dedicated diabetic foot care clinic and regular patient review can reduce the morbidity associated with diabetic foot ulceration.
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PMID:Meticulous attention to foot care improves the prognosis in diabetic ulceration of the foot. 172 50

An open cross-sectional study of elderly (age greater than 65 yr) patients with insulin-requiring diabetes mellitus (n = 57) was undertaken to audit safety of self-management. Levels of knowledge and management skills of hypoglycaemia, hyperglycaemia, and foot care were determined. The prevalence of hypoglycaemia, visual impairment, and at-risk feet and the ability to perform practical procedures (insulin injection and self-monitoring) were assessed. Drawing up insulin and self-injection was correct in 84% and 76% of patients, but 53% of self-monitored urine or blood tests were performed incorrectly. Twenty-six per cent experienced hypoglycaemia at least monthly and 25% had been seen at the hospital with hypoglycaemia in the last year. Eighteen per cent did not know what action to take with hypoglycaemia. Forty-six per cent did not know any hyperglycaemic symptoms or signs. Prompted with symptoms, 35% still did not know what to do and 21% would take inappropriate action when self-monitored tests read high. Fifty-one per cent had impaired vision, 61% peripheral neuropathy and 24% peripheral vascular disease, with the result that 78% had at-risk feet. Fifteen percent inspected or washed their feet infrequently, 40% walked barefoot occasionally, and 47% would take potentially dangerous action in the event of foot injury. This study demonstrates serious deficiencies in the basic education and management skills in our elderly insulin-requiring diabetic population that could result in morbidity and mortality. Greater effort and vigilance by health care professionals must be directed towards this group.
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PMID:A community-based study of diabetes-related skills and knowledge in elderly people with insulin-requiring diabetes. 183 72

The great majority of diabetic patients have diabetic foot symptoms. Significant recent advances in reconstructive surgery, as well as improvements in the management of both diabetes mellitus and peripheral vascular disease, make these patients eligible for plastic and reconstructive surgery. Many diabetic patients who would previously have had below-the-knee amputations are now having their complex foot wounds reconstructed. In addition to the metabolic consequences of the disease and the increased susceptibility to infection and wound healing complications, infrapopliteal arterial occlusive disease, peripheral neuropathy, and hemorrheologic changes are addressed in this article.
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PMID:Foot reconstruction in diabetes mellitus and peripheral vascular insufficiency. 188 57

The syndrome of immersion foot is being seen with increasing frequency among the homeless population. It represents the effects of injury by water absorption in the stratum corneum of the skin of the feet. The taxonomy of this disorder is confusing and the many colorful pseudonyms should probably be dropped in favor of a simple classification based on the temperature of the water and the duration of exposure. When uncomplicated by infection or ischemic injury, immersion foot will quickly resolve with conservative measures only. More complicated cases may require antibiotics and surgical treatment. This syndrome may be exacerbated by disturbances of cognition, peripheral neuropathy, peripheral vascular disease, or the use of tobacco or vasoconstrictor drugs such as cocaine. A major contributing factor seems to be lack of shelter in the homeless population. Attention to foot care problems among the homeless and education concerning preventive measures are incumbent on physicians who care for the indigent.
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PMID:Immersion foot. A problem of the homeless in the 1990s. 201 66

Peripheral neuropathy, infection, and peripheral vascular disease can produce serious problems in diabetic patients, particularly in the lower limbs. Ulceration of the foot may progress to gangrene and ultimately necessitate amputation. Distal symmetric polyneuropathy causes sensory loss. Such loss in patients with peripheral vascular disease creates a high risk for foot ulcers, which are vulnerable to infection. Treatment includes relief of neuropathic pain and antibiotic therapy for infection. Pentoxifylline (Trental) improves microvascular flow and appears to be effective against peripheral vascular disease. Aldose reductase inhibitors are being investigated as therapy for diabetic neuropathy. Prevention is the mainstay of management in these patients. Patient education is essential to help maintain health and prevent the potential adverse effects of diabetes.
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PMID:Lower limb problems in diabetic patients. What are the causes? What are the remedies? 203 95

The prevalence of various diabetic complications, their association with each other and with many risk factors, has been assessed in 2,337 newly diagnosed Type 2 diabetic patients. The patients entered into the UK Prospective Diabetes Study were aged between 25 and 65 (mean age 52 yr) and 33% had either an abnormal ECG or retinopathy. Different macrovascular complications such as strokes, heart attacks or abnormal ECG, and peripheral vascular disease showed little association one with another, and each was associated predominantly with different risk factors, e.g., strokes with hypertension, heart attacks with hypertriglyceridaemia and peripheral vascular disease with smoking and a low HDL cholesterol. Retinopathy was associated with reduced vibration perception but not with other complications. Reduced vibration perception and absent reflexes were associated with absent foot pulses and ischaemic skin changes, raising the possibility of a macrovascular, as well as microvascular, contribution to peripheral neuropathy. Microalbuminuria was associated with hypertension, which might be a factor predisposing to renal microvascular disease or be a consequence of it. Microalbuminuria was also associated with an abnormal ECG. Retinopathy, with exudates and or haemorrhages rather than just microaneurysms, was associated with hyperglycaemia. The occurrence of a particular complication in a diabetic patient is probably dependent on a combination of specific risk factors, many of which are related to, and probably affected by, potentially avoidable factors such as hyperglycaemia, obesity, smoking and hypertension.
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PMID:UK Prospective Diabetes Study 6. Complications in newly diagnosed type 2 diabetic patients and their association with different clinical and biochemical risk factors. 209 90


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