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

In a cross-sectional study of Hopi and Navajo Indians with non-insulin-dependent diabetes mellitus, we found vascular complications to be strongly related to the duration of diabetes. In patients with diabetes of at least 10 yr duration, retinopathy was found in 57%, nephropathy in 40%, peripheral neuropathy in 21%, and peripheral vascular disease in 28%. For the Hopi and Navajo, the duration-specific prevalence rates of microvascular disease were very similar to prevalence rates found in many other populations. Thus we question the concept, based on reports in the late 1960s, that the Hopi and Navajo Indians have hyperglycemia as an isolated chemical abnormality unaccompanied by other manifestations of diabetes mellitus.
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PMID:Diabetes mellitus in Hopi and Navajo indians. Prevalence of microvascular complications. 661 18

The diagnosis of diabetic neuroarthropathy of the foot can be difficult. A series of 96 patients (116 extremities) who had diabetes and peripheral neuropathy with bone and joint changes was reviewed. Typically, the patients were middle-aged or older, were taking insulin, and had had diabetes for more than 10 years. Retinopathy, nephropathy, and peripheral vascular disease were often present. There were abnormalities of vibratory sensation (94%) and of the gastrosoleus reflex (88%). The finding of specific radiographic abnormalities assisted but did not reliably differentiate neuropathy from infection. Three patterns of radiographic changes were noted: (1) at the metatarsophalangeal and interphalangeal joints, usually with underlying ulceration; (2) at the tarsometatarsal joints; and (3) in the anterior pillar-medial column of the foot, with talus, talonavicular, navicular, or naviculocuneiform destruction. Ulceration and infection in patients with patterns (2) and (3) were rare. When correlated, the demographic features, mode of presentation, physical signs, specific radiographic abnormalities, and patterns of change were distinctive and allowed the diagnosis of this complication of diabetes to be readily made.
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PMID:Diabetic neuroarthropathy in the foot: patient characteristics and patterns of radiographic change. 661 51

The clinical features and peripheral somatic and autonomic nerve function were studied in 10 diabetic subjects (nine men, one woman; mean age 59 yr, range 41-68 yr; mean duration of diabetes 20 yr, range 8 mo to 33 yr) with generalized small muscle wasting of the hands. Five patients were insulin-dependent and five non-insulin-dependent. Nine had retinopathy (two proliferative, seven background), five nephropathy, two ischemic heart disease, and seven peripheral vascular disease. Nine patients had clinical evidence of sensory peripheral neuropathy and absent reflexes in the lower limbs. Eight patients had distal sensory impairment and/or absent reflexes in the upper limbs. Seven had two or more symptoms of autonomic neuropathy. Nerve conduction measurements in the median, ulnar, and lateral popliteal nerves showed that all patients had moderate to severe polyneuropathy affecting both motor and sensory fibers. Nine had one or more abnormal cardiovascular autonomic function tests. Electromyography of affected muscles in the hands showed changes of chronic partial denervation and collateral reinnervation in all cases.
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PMID:Small muscle wasting of the hands in diabetes mellitus. 683 17

The contribution of organic and psychogenic factors in the aetiopathogenesis of impotence was studied in a large number of diabetic males, to develop an algorithm for its management. We examined 110 consecutive patients who were referred to the Impotence Clinic of the Diabetes Centre. All patients were initially evaluated by a diabetologist and then underwent psychosexual assessment by a specialized psychiatrist. Patients with primarily organic disease were referred to a urologist for further management while those with psychogenic impotence received psychosexual counselling. Peripheral neuropathy was present in 71 (65%) and two or more autonomic tests were abnormal in 22 (20%) patients. Neuropathy was the only cause detected in 29 (27%) patients, the main cause in 22 (20%), and contributing, but not the main factor, in 20 (18%). Psychogenic factors were the only cause detected in 12 (11%) patients, the main cause in 26 (24%) and contributed in 19 (17%). Marital disharmony, medical treatment, and peripheral vascular disease were the main aetiopathogenic factors in the remaining cases. Psychosexual counselling resulted in successful intercourse in 17 (60%) out of the 24 treated patients and papaverine injections in 31 (61%) out of 56 treated patients. It is concluded that although organic factors are mainly responsible for the development of impotence in diabetic males, psychological factors contribute significantly and psychosexual assessment and counselling are essential adjuncts to its management. Treatment with papaverine injections is generally inexpensive and effective to overcome the multifactorial causes of erectile dysfunction in this population. An algorithm which may facilitate the investigation and treatment of impotent diabetic males is proposed.
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PMID:Aetiopathogenesis and management of impotence in diabetic males: four years experience from a combined clinic. 758 14

The foot care behaviors of patients with diabetes were assessed by medical history, and their feet were examined for peripheral neuropathy, peripheral vascular disease, foot ulcers, and deformities. The sample consisted of 136 patients (14 with insulin-dependent diabetes and 122 with non-insulin-dependent diabetes). Mean age was 61 years and mean duration of diabetes was 13 years. Peripheral vascular disease was found in 25% of the patients, peripheral neuropathy in 33%, and 13% had both peripheral vascular disease and peripheral neuropathy. Potentially unsafe nail and foot care practices were identified, suggesting that routine diabetes care may not provide sufficient foot care education and follow-up for all patients. A screening algorithm was developed to provide guidelines for individualizing foot care education and referral of patients with diabetic foot disease. The recommendations included annual diabetes foot care assessments and education for those at low risk for foot amputation, intensive foot care education and more frequent follow-up for individuals with peripheral neuropathy or peripheral vascular disease, and referral to a foot care specialty clinic for individuals with peripheral neuropathy and peripheral vascular disease, or foot ulcers.
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PMID:Foot care assessment in patients with diabetes: a screening algorithm for patient education and referral. 783 4

During the past 3 years six episodes of ischemic monomelic neuropathy (IMN) have been identified in five patients as a complication of upper extremity dialysis grafts. All patients had long-standing insulin-dependent diabetes, peripheral neuropathy, and brachial artery graft origins, whereas 60% had peripheral vascular disease. Five episodes occurred immediately after graft placement, whereas one was due to a graft-related thromboembolus. Diagnostic delay was common with initial findings attributed to anesthesia, positioning, or surgical trauma. Electrophysiologic studies showed underlying diabetic neuropathy with severe multifocal neuropathy distal to the grafts. Digital pressure indices were reduced but there was no critical ischemia. In three cases ischemia was completely corrected with improvement in one. One patient had proximal balloon angioplasty with no improvement and of the two untreated patients, one improved slightly. Ischemic monomelic neuropathy is a rare but disabling complication of dialysis access in diabetic uremic patients. Its occurrence is unpredictable and diagnostic delay is common. Correction of ischemia is indicated but usually does not improve the neuropathy. Prevention requires further research to more accurately characterize the patients at risk.
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PMID:Ischemic monomelic neuropathy: an under-recognized complication of hemodialysis access. 786 97

Of 147 diabetic patients with end-stage renal disease who were treated in our CAPD program between 1978 and 1991, 6 men and 1 woman (5 had type II and 2 type I diabetes) with a mean age of 54 (range 21-70) years have been on CAPD for more than five years (mean: 76 mos, range: 65-109 mos) and on peritoneal dialysis (IPD+CAPD) for an average of 85 (range: 67-118) mos. They had a variety of comorbid conditions at the start of CAPD: Retinopathy (5/7), blindness (3/7), hypertension (5/7), peripheral neuropathy (7/7), peripheral vascular disease (3/7), congestive heart failure (3/7), myocardial infarction (1/7), ischemic heart disease (2/7). Two were smokers and five over the age of 65. Peritonitis rate was 1 episode/11.4 pt mos, exit-site infection 1/76.4 pt mos and average hospitalization rate 32.8 days/patient/year. Hypertension was well-controlled with discontinuation of all medications; after initiation of CAPD two of them remained without medications throughout the study but in the rest, medications had to be restarted. As assessed by HbA1c, blood glucose control improved with IP administration of insulin. Residual renal function progressively decreased. None of them developed severe hyperparathyroidism. Peripheral neuropathy remained stable in four and deteriorated in two. Total protein, albumin, cholesterol and triglycerides decreased during the last two years indicating a degree of malnutrition. Our experience with these seven patients suggests that diabetic patients, even the aged and those with many comorbid conditions and complications, can survive for long periods on CAPD.
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PMID:Long-term continuous ambulatory peritoneal dialysis in diabetics. 792 68

The characteristics and outcome of 68 newly diagnosed Type 2 diabetic patients who presented with clinically evident peripheral neuropathy were compared with matched controls who had no neuropathy at diagnosis. All subjects (34 male) whose median age was 68 (range 47-89) yr were identified from a computerized diabetes register and presented in 1982-1990. The groups were compared at diagnosis for haemoglobin A1, body mass index, blood pressure, smoking, and alcohol consumption, and for co-existent coronary and peripheral vascular disease. Mortality and morbidity were recorded to March 1991. Significantly more patients with neuropathy had co-existent peripheral vascular disease: 24(35%) compared to 6(9%) controls (p = 0.0021). Twenty (30%) of those with neuropathy and no controls had retinopathy at diagnosis, which was sight-threatening in 10. Seven (10%) with neuropathy but no controls presented with foot ulcers, one requiring limited amputation. Two more patients with neuropathy and one control subsequently developed foot ulcers resulting in one or more amputation in each group. Twenty-one (31%) of those with neuropathy and 14 (21%) controls died (p = 0.2109). In conclusion more diabetic patients with clinically evident peripheral neuropathy at diagnosis have peripheral vascular disease than matched patients without neuropathy. It is likely that macrovascular disease either exacerbates or causes the neuropathy in this group of patients. They are at high risk of developing foot ulceration and high priority should be given to foot care in planning their management.
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PMID:Peripheral neuropathy as a presenting feature of type 2 diabetes: a case-controlled study. 808 15

The prevalence of peripheral neuropathy, peripheral vascular disease, and foot ulceration in Type 2 diabetic patients in the community were determined in a community-based study. Eight hundred and eleven subjects (404 male, 407 female, mean age 65.4 (range 34-90) years, diabetes duration 7.4 (0-50) years) from 37 general practices in three UK cities were studied. Neuropathy was diagnosed clinically using modified neuropathy disability scores which were ascertained using structured interviews and clinical examinations by one observer in each city. Peripheral vascular disease was diagnosed if a history of revascularization was present or > or = 2 foot pulses were absent. History of current or previous foot ulceration was recorded. The prevalence of neuropathy was 41.6% (95% confidence limits 38.3-44.9%) and the prevalence of PVD, 11% (9.1-13.7%). Forty-eight percent of neuropathic patients reported significant neuropathic symptoms. Forty-three patients (5.3% (3.8-6.8%)) had current or past foot ulcers; 20 of these were pure neuropathic ulcers, 13 neuroischaemic, 5 pure vascular, and 5 were unclassified. Multiple logistic regression showed history of amputation, neuropathy disability score, and peripheral vascular disease to be significantly associated with foot ulceration after adjusting for age and diabetes duration. A substantial proportion of Type 2 diabetic patients, often elderly patients who do not attend hospitals, suffered from peripheral neuropathy and peripheral vascular disease. These patients are at risk of foot ulceration and may benefit from preventive footcare.
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PMID:The prevalence of foot ulceration and its correlates in type 2 diabetic patients: a population-based study. 808 27

Diabetic foot disease results from two common pathologies: peripheral vascular disease and diabetic neuropathy. If these pathologies are not identified, ulceration may occur in the foot. Ulcers can lead to infection and finally amputation. This article discusses the components of the physical exam, current treatment for both pathologies, and client education. Because the two pathologies are similar in presentation, it is important for clinicians to distinguish between the two pathologies. Careful attention to the feet during the physical exam and assessment for symptoms can help distinguish the two pathologies. There are new treatments available for peripheral vascular disease to improve the client's circulation. Treatment of peripheral neuropathy is usually palliative, but can improve the client's quality of life. Through early identification and treatment of peripheral vascular disease and diabetic neuropathy, clients with diabetes can avoid ulceration. Client education is central to the treatment plan.
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PMID:Preventing diabetic foot disease. 823 44


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