scholarly journals The implementation of percutaneous bone biopsies in the outpatient setting and how it has changed our practice in charcot foot patients with deep neuropathic ulcers

2018 ◽  
Vol 55 ◽  
pp. S77
Author(s):  
M. Raad ◽  
E. Massa ◽  
A. Vris ◽  
M. Bates ◽  
V. Kavarthapu
Keyword(s):  
Outpatient Setting ◽  
Charcot Foot ◽  
Bone Biopsies ◽  
Neuropathic Ulcers

scholarly journals Primary Results of Bone Biopsies in Outpatients with Neuropathic Ulcers

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000 ◽  
Author(s):  
Alexandros Vris ◽  
Edward Massa ◽  
Raju Ahluwalia ◽  
Venu Kavarthapu
Keyword(s):  
Antibiotic Treatment ◽  
Bone Biopsy ◽  
Outpatient Setting ◽  
Limiting Factor ◽  
Anatomical Landmarks ◽  
Intact Skin ◽  
University Of Texas ◽  
Bone Biopsies ◽  
Foot Disease ◽  
Protective Sensation

Category: Diabetes Introduction/Purpose: Patients with Charcot foot disease often develop ulcers that probe to bone due to progressive deformity and loss of protective sensation. Infection of the ulcers and the underlying bone is common. In order to diagnose and treat osteomyelitis, especially in cases where reconstruction is planned, the pathogen must be isolated. The need for bone debridement and the duration of antibiotic treatment depends on the presence of bone infection. Percutaneous bone biopsies through intact skin is the gold standard for acquisition of samples for cultures. The presence of neuropathy negates the need for anaesthesia and renders biopsies possible in the outpatient setting. In our study we compare the results of bone biopsies with wound swabs and document the safety of the technique in clinic. Methods: Thirty five patients were included in the study. Inclusion criteria were the presence of neuropathy and foot ulcers with exposed bone (Grade 3 University of Texas wound classification). Samples were obtained by three different doctors with aseptic technique through intact skin and sent for cultures. The area of the bone where the sample was taken from was defined by the location of the ulcer, the available imaging and anatomical landmarks. Complications such as bleeding and entry point infection and delayed healing were documented. Superficial ulcer swabs were also obtained for comparison. Results: In 37 patients 2 procedures were abandoned due to pain; otherwise no complications during or after the biopsy were recorded and the procedure duration was 4 minutes at most. There was bacterial growth in 40% of bone biopsy samples, compared to 65.7% of superficial swabs. Cultures were polymicrobial in 35.7% of positive biopsies and 82.6% of positive ulcer swabs. Concordance between bone biopsy and swab results was seen in 16/35 (45.7%) of samples. In 7 patients both tests were negative and in 9 both positive. 7/9 of samples that were positive with both methods grew the same organism. Conclusion: Our study showed that there is poor concordance of the results of the two tests. Wound swabs have high rates of polymicrobial cultures; in comparision bone biopsies are more reliable in confirming a specific microbial organism and dictating the need for and type of antibiotic. Targeted antibiotics can thus be safely used, potentially reducing the complications and the cost of broad-spectrum antibiotic treatment. The technique of needle bone biopsy is easy, safe and reproducible, and pain is not a limiting factor for in outpatients with neuropathy.

scholarly journals Short-term outcomes of treatment of active stage of Charcot foot in outpatient setting

2020 ◽  
Vol 23 (4) ◽  
pp. 316-323
Author(s):  
Anastasia G. Demina ◽  
Vadim B. Bregovskiy ◽  
Irina A. Karpova
Keyword(s):  
Treatment Group ◽  
Treatment Options ◽  
Outpatient Setting ◽  
Healing Time ◽  
Acute Stage ◽  
High Rate ◽  
Charcot Foot ◽  
Charcot Arthropathy ◽  
Active Stage ◽  
Foot Lesions

Background: Treatment options in patients with an acute Charcot foot is not well standardized and still challenging.Aims: To evaluate the results of the non-operative treatment of patients with active stage of diabetic charcot arthropathy in outpatient foot clinic and to identify factors influenced on treatment results.Materials and methods: Medical files of 141 patients with unilateral ulcer-free active charcot arthropathy were reviewed. 78 patients agreed for treatment (total contact cast or walker), 63 patients refused of treatment (follow-up only). The time of resolution of the acute stage, severity of final deformities and foot-related complications were evaluated. Refusers were asked about the cause of their decision.Results: Mean delay of the diagnosis was 3,2±2,8 months. Main causes of the refuse were: mistrust to doctor - 38%, problems with employment - 33%, home/family problems - 18%, medical reasons - 11%. Median healing times (months) in the treatment group vs controls: 9 (6 - 19) 15 (13 - 25) (p=0,001) and progression of the initial deformity: 14% and 35%, respectively (p=0,01). Foot-related complications: 17,5% in the treatment group and in 55,6% of controls (including 6 amputations) (p=0,001). Frequency of breaking the cast/walker - 32%/16,6%. Foot lesions due to cast/walker: 13,6%/41,7% (p<0,01). Median healing times (months) with walkers - 13 (11 - 19), with casts - 9 (6 - 15) months (р=0,02). The use of crutches shortened healing time.Conclusions: The significant delay of diagnosis was revealed. The refuse rate in our cohort was high and main causes of the refuse were social and psychological. Neglect of treatment leads to high frequency and severity of foot-related complications. We noticed high rate of breaking of walkers and casts and device-related foot lesions. Total contact casts were more effective and safe compared with walkers.

scholarly journals Influence of Patient Setting and Dedicated Limb Salvage Efforts on Outcomes in Charcot-Related Foot Ulcer

2019 ◽  
Vol 18 (4) ◽  
pp. 362-366 ◽  
Author(s):  
Brian M. Schmidt ◽  
Crystal M. Holmes
Keyword(s):  
Diabetes Mellitus ◽  
Limb Salvage ◽  
Patient Outcomes ◽  
Foot Ulcer ◽  
Outpatient Setting ◽  
Inpatient Setting ◽  
Charcot Foot ◽  
Specialist Care ◽  
Charcot Neuroarthropathy ◽  
Patients With Diabetes

Charcot neuroarthropathy is a devastating consequence of diabetes mellitus and peripheral neuropathy. Because of its rarity, the condition is often misdiagnosed or poorly managed. When misadventure occurs, patients with Charcot neuroarthropathy can suffer ulceration, infection, amputation, and death. When patients have Charcot-related foot ulcers, the risks are amplified. Utilizing advanced electronic medical record analysis, a 30-month investigation was undertaken to determine if patients with diabetes mellitus and a concomitant diagnosis of Charcot-related foot ulcer were at greater risk of complications because of location setting of initial treatment for their condition. Charcot foot–related ulcers that are diagnosed in the outpatient setting had established foot specialist care. The outpatient management of the condition lead to a significant reduction in the amount of admissions to a higher acuity setting. However, patient outcomes did not vary once established and dedicated limb salvage efforts were employed. In this large contemporary population managed in a tertiary health system, patients with Charcot-related foot ulcer had negative outcomes when they were initially treated in an inpatient setting and had a significantly greater likelihood of readmission as compared with individuals who had established focused limb salvage care.

scholarly journals AB234. 28. Primary results of bone biopsies in outpatients with neuropathic ulcers—comparison with wound swabs and superficial tissue samples

2018 ◽  
Vol 2 ◽  
pp. AB234-AB234
Author(s):  
Marjan Raad ◽  
Alex Vris ◽  
Edward Massa ◽  
Maureen Bates ◽  
Venu Kavarthapu ◽  
...  
Keyword(s):  
Tissue Samples ◽  
Bone Biopsies ◽  
Superficial Tissue ◽  
Neuropathic Ulcers

Lingual Strengthening: Success in an Outpatient Setting

2015 ◽  
Vol 24 (2) ◽  
pp. 71-74
Author(s):  
Ali Meier
Keyword(s):  
Oropharyngeal Dysphagia ◽  
Patient Discharge ◽  
Outpatient Setting ◽  
Oral Performance ◽  
Exercise Protocol ◽  
Anterior Position ◽  
Tongue Position ◽  
Bolus Propulsion ◽  
Posterior Position

In the last decade or more, dysphagia research has investigated the effect of lingual strengthening on oropharyngeal dysphagia with promising results. Much of this research has utilized strengthening devices such as the Iowa Oral Performance Instrument (IOPI) or the Madison Oral Strengthening Therapeutic (MOST) Device. Patients are often given a device to use, and are able to complete an exercise protocol daily or multiple times per day. This case study was completed to determine the effectiveness of using the IOPI in an outpatient clinic where therapy was conducted two to three times per week. The patient was seen post tongue resection due to oropharyngeal cancer. From initiation of IOPI use to patient discharge, the patient demonstrated a 71% increase in lingual strength at the anterior position, a 61% increase at the posterior position, and a 314% increase at the base of tongue position. His diet advanced from NPO to general based on gains in lingual strength and bolus propulsion.

Abstract #1142: Improving Diabetes Management By Residents in an Outpatient Setting

2017 ◽  
Vol 23 ◽  
pp. 312-313
Author(s):  
Jahnavi Sagi ◽  
Lavanya Vuppu ◽  
Medha Joshi
Keyword(s):  
Diabetes Management ◽  
Outpatient Setting

Tonsillar Inflammation, a Rare Cause of Bradycardia and Hypotension

2018 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Streptococcus Pyogenes ◽  
Fusobacterium Necrophorum ◽  
Outpatient Setting ◽  
Peritonsillar Abscess ◽  
The Other ◽  
Streptococcus Group ◽  
Other Hand ◽  
Group A

Tonsillitis is a frequently encountered pathology in the outpatient setting, usually caused by viruses [1]. When bacterial, the most common causatory microbe is streptococcus group A [1]. Tonsillar and peritonsillar abscess (PTA) on the other hand are never viral, and are usually caused by streptococcus pyogenes, Streptococcus melleri, fusobacterium necrophorum and staphylococci [1,2]. The overall incidence of PTA is suggested to be 37/100,000 patients, with the highest incidence between ages 14-21 at 124/100,000 [3].

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