Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0031117 (peripheral neuropathy)
 10,577 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To determine the lower extremity amputation rate and the risk factors for amputation, we analysed the medical records of 147 Turkish diabetic patients who have been referred to the clinic with diabetic foot. Eleven patients (7.5%) had type 1, and 136 patients (92.5%) had type 2 diabetes mellitus. Fifty-four patients (36.7%) have undergone amputation due to diabetic foot. Femoropopliteal by-pass has been performed in 4 patients in the non-amputees group who did not have gangrene. None of the patients in the amputees group has undergone a revascularisation procedure. Considering all lower-extremity amputations in the group studied, 25.9% were transphalangial amputations, 3.7% were transmetatarsal amputations, 7.4% were Syme type amputations, 51.9% were below-knee amputations, and 11.1% were above-knee amputations. In a logistic regression model, age, gender, duration of diabetes, smoking history, hypertension, retinopathy, nephropathy, and peripheral neuropathy were insignificant factors in determining the risk of amputation. In contrast, presence of peripheral vascular disease (odds ratio 4.0, 95% CI 1.17-13.4; p = 0.03), osteomyelitis (odds ratio 3.73, 95% CI 1.08-12.6; p = 0.04) and gangrene (odds ratio 30.8, 95% CI 7.39-121.5; p < 0.0001) were found to be the significant predictors of amputation. The mortality rate due to amputation during hospital stay was 13.2%. These data suggest that lower extremity amputation is a frequently encountered outcome of the hospitalized patients in Turkish diabetic population with diabetic foot which mainly occur due to peripheral vascular disease, osteomyelitis and gangrene. Lack of adequate vascularisation procedures might have contributed to a high percentage of major amputations in the group studied. Population-based studies should be undertaken in order to determine the status of lower extremity amputation as a whole in Turkish diabetic population.
 ...
PMID:Amputation rate in 147 Turkish patients with diabetic foot: the Hacettepe University Hospital experience. 983 6

Peripheral neuropathy is one of the most common long-term complications of Type 2 diabetes. A population-based study in the north of England showed that 42% of Type 2 diabetic patients had clinical evidence of neuropathy. The Diabetes Control and Complications Trial (DCCT) has shown that the incidence of neuropathy in Type 1 diabetes can be reduced by over 50% with intensive therapy and optimal glycaemic control. Hyperglycaemia is believed to be a major aetiological factor in the development of neuropathy in Type 2 diabetes. Neuropathy cannot be diagnosed through history alone; therefore, careful examination of the feet for evidence of sensory loss and an assessment of the circulation must form part of the annual review of each patient. Peripheral somatic and autonomic neuropathy, together with peripheral vascular disease, are major contributing factors to the development of foot ulcers. In addition, abnormalities of foot shape (e.g. claw toes, prominent metatarsal heads) and the presence of plantar callus are signs of foot-ulcer risk. Effective patient education can reduce the incidence of foot ulceration and amputation by over 50%; therefore, all patients with a high risk of foot ulcers should be informed and, if indicated, referred for regular podiatry. The team approach to diabetic foot problems is an effective method of providing treatment for active ulcers. This should be followed by appropriate education, the provision of follow up and if indicated, suitable footwear and hosiery. Key members of the team are the podiatrist, the specialist nurse and the orthotist; medical staff may include the diabetologist and a vascular or orthopaedic surgeon. Thus, the risk of foot ulceration and amputation can be reduced by careful screening and patient education, without the need for expensive equipment.
 ...
PMID:Lowering the risk of neuropathy, foot ulcers and amputations. 986 94

The leading cause of amputation in patients with diabetes is the nonhealing foot wound and its complications. The effects of peripheral neuropathy, peripheral vascular disease, and infection often combine to facilitate ulcer development that can lead to gangrene and amputation. In many instances, foot ulcers and amputation can be prevented. The literature over the past 5 years has included information on the infrared thermometry in the diagnosis of infection and acute Charcot change. Pressure downloading has been facilitated by computerized foot scanning systems and the use of prefabricated pneumatic walkers as an alternative to the contact cast. Local wound care is enforced by repeated sharp debridement. Nonhealing ulcers can benefit from biologicals: platelet-derived growth factors and a human dermal replacement containing viable fibroblasts. The most successful outcomes are achieved when interdisciplinary teams are formed to provide coordinated care. The goal of this article is to provide healthcare professionals with an overview of the risks of neuropathic foot injury and to offer strategies for prevention, protection, and reduction of recurrences of the diabetic foot ulcer.
 ...
PMID:The diabetic neuropathic ulcer: an overview. 1008 72

Lower extremity ulcers cause significant morbidity and mortality in patients with diabetes. The primary factors that contribute to the development of this type of ulcer are peripheral neuropathy and peripheral vascular disease, which are often accompanied by infection. Lower extremity diabetic ulcers are chronic and difficult to treat, in part due to underlying pathologic conditions in individuals with diabetes that can contribute to impaired wound healing. This article reports the author's experience with treatment of chronic lower extremity ulcers of mixed etiologies with recombinant human platelet-derived growth factor--BB [rhPDGF-BB, REGRANEX (becaplermin) Gel 0.01%] in a patient with multiple risk factors including long-standing insulin-dependent type 2 diabetes.
 ...
PMID:Use of topical recombinant human platelet-derived growth factor-BB (becaplermin) in healing of chronic mixed arteriovenous lower extremity diabetic ulcers. 1055 55

Twelve cases of feet burns sustained because of standing or walking barefoot on the street following the "Friday Mass" were included in a prospective study. All injuries occurred during the summer months when the ground temperature is estimated to be in the range of 50-60 C. There were 2 children and 10 adults. Eight out of the 10 adults were diabetics with significant peripheral neuropathy. Non-diabetic patients with intact sensibility of the feet developed second degree burns that mainly involved the anterior part of the soles. On the other hand. diabetic patients with peripheral neuropathy developed deep burns that involved the entire weight-bearing area of the sole. Furthermore, in one diabetic patient with superimposed significant peripheral vascular disease this burn injury induced toe pulp necrosis. Treatment and prevention of these burns are discussed.
 ...
PMID:The "Friday Mass" burns of the feet in Saudi Arabia. 1063 Mar 27

Foot ulcers are a major cause of disability, morbidity, and mortality in people with diabetes. The three major etiological factors for diabetic foot ulcers are peripheral neuropathy, peripheral vascular disease, and infection. Tight control of blood glucose and proper foot care are essential for prevention of foot ulcers and lower extremity amputations. Treatment of lower extremity diabetic ulcers typically includes surgical debridement of the wound and appropriate oral or intravenous antibiotics. Becaplermin gel, a prescription, recombinant wound-healing therapy, may be used to promote healing of diabetic foot ulcers in select patients. Pharmacists can make a significant contribution to the prevention of diabetic foot ulcers and lower extremity amputations.
 ...
PMID:Lower extremity management in patients with diabetes. 1102 63

This study examined the association between urinary markers of early diabetic nephropathy and non-renal diabetic complications in 946 patients with type 2 diabetes mellitus. The association with hypertension was also studied. Data on macrovascular complications (ischaemic heart disease, stroke, peripheral vascular disease) and microvascular complications (retinopathy, peripheral neuropathy) were obtained from case records and clinical examination. Urine samples collected were analysed for albumin, beta(2)-microglobulin, retinol-binding protein (RBP), and N-acetyl-beta-D-glucosaminidase (NAG). Results showed that urinary albumin, RBP and beta(2)-microglobulin levels were higher in patients with macro- and/or microvascular complications, compared to those without. NAG levels were higher only in patients with both types of complications. A higher proportion of patients with complications had abnormally raised urinary protein and enzyme levels, compared to those without. Patients with associated hypertension had higher urinary levels of albumin and beta(2)-microglobulin, regardless of whether complications were present or not. RBP excretion was, however, markedly higher only in patients with microvascular complications, whereas hypertension did not influence NAG excretion. Urine albumin and RBP excretion were predictive of microvascular, as well as both macrovascular and microvascular complications, whereas NAG excretion was predictive of macro- and microvascular complications. These findings could mean that increased urinary protein and enzyme excretion were associated with more severe disease in these patients.
 ...
PMID:Urinary protein excretion in Type 2 diabetes with complications. 1111 88

The purpose of this study is to report our experience with the Vacuum Assisted Closure (VAC) negative pressure technique in patients with non-healing wounds of the foot, ankle, and lower limb. We retrospectively reviewed 17 patients with non-healing wounds of the lower extremity who underwent treatment using the Vacuum Assisted Closure (VAC) device. Thirteen of 17 (76%) had diabetes mellitus, nine of whom were insulin-dependent, and 10 of whom had associated peripheral neuropathy. Eight of 17 (47%) had severe peripheral vascular disease. All had failed previous management with serial wound debridements and dressing changes; 15 of 17 (88%) had previously completed at least one course of oral antibiotics. Thirteen of 17 (76%) had previously undergone operative irrigation and debridement of the wounds; six of 17 (35%) had previously undergone revascularization procedures of the involved extremity. Five of 17 (29%) had wounds necessitating an amputation procedure prior to the present treatment; seven of 17 (41%) had failed treatment with local growth factors prior to the present treatment. Average length of treatment with the VAC device was 8.2 weeks. Fourteen of 17 (82%) wounds successfully healed; four underwent split-thickness skin grafting for wound closure; four were briefly treated with local growth factors; six were treated with only dressing changes following VAC treatment. Three of 17 (18%) wounds failed VAC treatment; all three patients had diabetes and had wounds located in the midfoot or forefoot; two of three had severe peripheral vascular disease. Our results indicate that the Vacuum Assisted Closure negative pressure technique is emerging as an acceptable option for wound care of the lower extremity. Not all patients are candidates for such treatment; those patients with severe peripheral vascular disease or smaller forefoot wounds may be best treated by other modalities. Larger wounds seem to be better suited for skin grafting or two-stage primary closure.
 ...
PMID:Experience with the vacuum assisted closure negative pressure technique in the treatment of non-healing diabetic and dysvascular wounds. 1239 40

This article outlines the three main factors that cause foot problems in people with diabetes: peripheral neuropathy, peripheral vascular disease and infection. It describes how these problems are classified and how nurses can use their skills in assessment and education to improve outcomes for these patients.
 ...
PMID:Foot care in patients with diabetes. 1265 68

Abnormal bone metabolism is a recognized complication of end-stage renal disease, but fracture risk following renal transplantation has not been well quantified. We followed the 86 Olmsted County, Minnesota, residents who underwent initial renal transplantation in 1965-1995 for 911 person-years (median, 10.6 years per subject) in a retrospective cohort study. Fractures, and possible risk factors, were assessed through review of each subject's complete community medical records. Altogether, 117 fractures were observed during follow-up extending to 33 years. The cumulative incidence of any fracture at 15 years was 60% versus 20% expected ( P<0.001). There was a significantly increased risk of fractures generally [standardized incidence ratio (SIR), 4.8; 95% CI, 3.6-6.4] and vertebral (SIR, 23.1; 95% CI, 12.3-39.6) and foot fractures (SIR, 8.4; 95% CI, 5.1-12.9) especially. Age at first transplantation, renal failure due to diabetes, pancreas transplantation, peripheral neuropathy, peripheral vascular disease and blindness were all associated with overall fracture risk. In a multivariate analysis, however, only age and diabetic nephropathy were independent predictors of fracture risk generally, while higher activity status was protective. Diabetes was the only independent predictor of lower limb fractures, whereas age and osteoporosis history predicted vertebral fractures. Cumulative corticosteroid dosage was not associated with increased fracture risk in this analysis. Despite the fact that our patients had few risk factors for preexisting bone disease attendant to postmenopausal osteoporosis, prior corticosteroid use or renal osteodystrophy, these data indicate that renal transplantation is associated with a significant increase in fracture risk among unselected patients in the community. Diabetic patients, particularly, experience excess lower limb fractures. Patients and their care providers should be aware of this elevated fracture risk, which continues long-term.
 ...
PMID:Long-term fracture risk following renal transplantation: a population-based study. 1466


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>