Charcot Arthropathy of the Diabetic Foot. Current Concepts and Review of 36 Cases

2002 ◽  
Vol 91 (2) ◽  
pp. 195-201 ◽  
Author(s):  
T.-K. Pakarinen ◽  
H.-J. Laine ◽  
S. E. Honkonen ◽  
J. Peltonen ◽  
H. Oksala ◽  
...  
Keyword(s):  
Recent Literature ◽  
Diagnostic Delay ◽  
Patient Records ◽  
Charcot Foot ◽  
Charcot Arthropathy ◽  
Triple Arthrodesis ◽  
Charcot Neuroarthropathy ◽  
Cast Immobilisation ◽  
Tibiocalcaneal Arthrodesis ◽  
Time Period

Background and Aims: The incidence of diabetic Charcot neuroarthropathy has increased. The purpose here was to study the current diagnostics and treatment of the Charcot foot. Materials and Methods: During a time period from 1994 to 2000, a total of 36 feet were diagnosed as cases of diabetic Charcot neuroarthropathies. A retrospective analysis of patient records and radiographs was undertaken. A review of the recent literature is presented. Results: 29 cases were diagnosed in the dissolution stage, 2 in coalascence, and 5 in the resolution stage. The diagnostic delay averaged 29 weeks. Treatment with cast immobilisation ranged from 4 to 37 weeks (mean 11 weeks). A total of 14 surgical procedures were carried out on 10 patients: six exostectomies, four midfoot arthrodeses, one triple arthrodesis, one tibiocalcaneal arthrodesis and two below-knee amputations. radiological fusion was achieved in two thirds of the attempted arthrodeses. Conclusions: A physician should always consider the Charcot neuroarthropathy when a diabetic patient has an inflamed foot. In the absence of fever, elevated CRP or ESR, infection is a highly unlikely diagnosis, and a Charcot process should primarily be considered. The initial treatment of an inflamed Charcot foot consists in sufficiently long non-weightbearing with a cast, which should start immediately after the diagnosis. The prerequisites of successful reconstructive surgery are correct timing, adequate fixation and a long postoperative non-weightbearing period. In the resolution stage most Charcot foot patients need custom-molded footwear.

scholarly journals The Role of Bone Scintigraphy with SPECT/CT in the Characterization and Early Diagnosis of Stage 0 Charcot Neuroarthropathy

2020 ◽  
Vol 9 (12) ◽  
pp. 4123
Author(s):  
Raju Ahluwalia ◽  
Ahmad Bilal ◽  
Nina Petrova ◽  
Krishna Boddhu ◽  
Chris Manu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Early Diagnosis ◽  
Bone Scintigraphy ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Charcot Foot ◽  
Bone Pathology ◽  
Charcot Neuroarthropathy ◽  
Focal Uptake ◽  
Stage 1

We describe the use of Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) in the investigation and diagnosis of Charcot neuroarthropathy (CN) in patients with a hot swollen foot but normal radiographs and clinical suspicion of CN, usually termed Stage 0. This was a retrospective cohort review of 46 diabetes patients who underwent 3 phase bone scintigraphy with “High Resolution” SPECT/CT. The imaging demonstrated that Stage 0 Charcot foot has a distinct bone pathology, which can be classified into three groups: (1) fractures on Computed Tomography (CT) with accompanying focal uptake of tracer on SPECT, (2) bony abnormalities apart from fracture on CT with focal uptake of tracer on SPECT, and (3) normal CT but focal bony uptake of tracer on SPECT. The CT component of SPECT/CT detected bony fractures in 59% of patients. Early treatment with below knee cast and follow-up for 24 months showed only 4 patients who developed Stage 1 Eichenholtz Charcot foot. Our findings support the use of 3 phase bone scintigraphy with SPECT/CT in the characterization and early diagnosis of CN. Stage 0 Charcot foot has a distinct bone pathology which requires urgent treatment to prevent progression to Stage 1 Eichenholtz Charcot foot. If SPECT/CT is unavailable, CT alone will detect bone fracture in 59% patients.

scholarly journals An unusual presentation of acute onset Charcot arthropathy

2020 ◽  
Vol 2020 (5) ◽  
Author(s):  
Ammar Al-Najjar ◽  
Julien Al Shakarchi ◽  
Melwyn Pereira ◽  
Richard Downing
Keyword(s):  
Rare Complication ◽  
Major Amputation ◽  
Acute Onset ◽  
Lower Limbs ◽  
Charcot Foot ◽  
Charcot Arthropathy ◽  
Plantar Aspect ◽  
Patients With Diabetes ◽  
Fracture Dislocations ◽  
High Index Of Suspicion

Abstract Charcot arthropathy is a progressive condition primarily affecting the lower limbs in patients with diabetes mellitus. It is a rare complication of diabetic neuropathy and if left untreated can lead to severe limb destruction necessitating major amputation. Here, we report the case of a 41-year-old female who presented with rapidly progressive Charcot foot over a 10-day period, necessitating open reduction and internal fixation of Lisfranc-type fracture dislocations. Her presentation with a rapidly progressing red, swollen foot with a blister on the plantar aspect prompted initial treatment on the basis of a diabetic foot infection. The report will therefore serve as a useful reminder to maintain a high index of suspicion for Charcot foot, which may present in an atypical manner.

scholarly journals Drift-corrected trends and periodic variations in MIPAS IMK/IAA ozone measurements

2014 ◽  
Vol 14 (5) ◽  
pp. 2571-2589 ◽  
Author(s):  
E. Eckert ◽  
T. von Clarmann ◽  
M. Kiefer ◽  
G. P. Stiller ◽  
S. Lossow ◽  
...  
Keyword(s):  
Atmospheric Chemistry ◽  
Recent Literature ◽  
Michelson Interferometer ◽  
Quasi Biennial Oscillation ◽  
Significance Level ◽  
Tropical Tropopause ◽  
Time Period ◽  
Ozone Trends ◽  
Institute Of Technology ◽  
Good Agreement

Abstract. Drifts, trends and periodic variations were calculated from monthly zonally averaged ozone profiles. The ozone profiles were derived from level-1b data of the Michelson Interferometer for Passive Atmospheric Sounding (MIPAS) by means of the scientific level-2 processor run by the Karlsruhe Institute of Technology (KIT), Institute for Meteorology and Climate Research (IMK). All trend and drift analyses were performed using a multilinear parametric trend model which includes a linear term, several harmonics with period lengths from 3 to 24 months and the quasi-biennial oscillation (QBO). Drifts at 2-sigma significance level were mainly negative for ozone relative to Aura MLS and Odin OSIRIS and negative or near zero for most of the comparisons to lidar measurements. Lidar stations used here include those at Hohenpeissenberg (47.8° N, 11.0° E), Lauder (45.0° S, 169.7° E), Mauna Loa (19.5° N, 155.6° W), Observatoire Haute Provence (43.9° N, 5.7° E) and Table Mountain (34.4° N, 117.7° W). Drifts against the Atmospheric Chemistry Experiment Fourier Transform Spectrometer (ACE-FTS) were found to be mostly insignificant. The assessed MIPAS ozone trends cover the time period of July 2002 to April 2012 and range from −0.56 ppmv decade−1 to +0.48 ppmv decade−1 (−0.52 ppmv decade−1 to +0.47 ppmv decade−1 when displayed on pressure coordinates) depending on altitude/pressure and latitude. From the empirical drift analyses we conclude that the real ozone trends might be slightly more positive/less negative than those calculated from the MIPAS data, by conceding the possibility of MIPAS having a very small (approximately within −0.3 ppmv decade−1) negative drift for ozone. This leads to drift-corrected trends of −0.41 ppmv decade−1 to +0.55 ppmv decade−1 (−0.38 ppmv decade−1 to +0.53 ppmv decade−1 when displayed on pressure coordinates) for the time period covered by MIPAS Envisat measurements, with very few negative and large areas of positive trends at mid-latitudes for both hemispheres around and above 30 km (~10 hPa). Negative trends are found in the tropics around 25 and 35 km (~25 and 5 hPa), while an area of positive trends is located right above the tropical tropopause. These findings are in good agreement with the recent literature. Differences of the trends compared with the recent literature could be explained by a possible shift of the subtropical mixing barriers. Results for the altitude–latitude distribution of amplitudes of the quasi-biennial, annual and the semi-annual oscillation are overall in very good agreement with recent findings.

Mid-term follow-up of patients with hindfoot arthrodesis with retrograde compression intramedullary nail in Charcot neuroarthropathy of the hindfoot

2018 ◽  
Vol 100-B (2) ◽  
pp. 190-196 ◽  
Author(s):  
M. Chraim ◽  
S. Krenn ◽  
H. M. Alrabai ◽  
H-J. Trnka ◽  
P. Bock
Keyword(s):  
Limb Salvage ◽  
Case Series ◽  
Foot And Ankle ◽  
Charcot Arthropathy ◽  
Charcot Neuroarthropathy ◽  
Additional Surgery ◽  
Functional Scores ◽  
Compression Nail ◽  
Hindfoot Arthrodesis

Aims Hindfoot arthrodesis with retrograde intramedullary nailing has been described as a surgical strategy to reconstruct deformities of the ankle and hindfoot in patients with Charcot arthropathy. This study presents case series of Charcot arthropathy patients treated with two different retrograde intramedullary straight compression nails in order to reconstruct the hindfoot and assess the results over a mid-term follow-up. Patients and Methods We performed a retrospective analysis of 18 consecutive patients and 19 operated feet with Charcot arthropathy who underwent a hindfoot arthrodesis using a retrograde intramedullary compression nail. Patients were ten men and eight women with a mean age of 63.43 years (38.5 to 79.8). We report the rate of limb salvage, complications requiring additional surgery, and fusion rate in both groups. The mean duration of follow-up was 46.36 months (37 to 70). Results The limb salvage rate was 16 of 19 limbs. Three patients had to undergo below-knee amputation due to persistent infection followed by osteomyelitis resistant to parenteral antibiotic therapy and repeated debridement. Complications including infection, hardware removal, nonunion, and persistent ulcers requiring further intervention were also observed. Postoperative functional scores revealed significant improvement compared with preoperative scores on American Orthopaedic Foot and Ankle Society (AOFAS) – Hindfoot scale, Foot Function Index (FFI), visual analogue scale (VAS), and Foot and Ankle Outcome Score (FAOS). Conclusion The use of retrograde intramedullary compression nail results in good rates of limb salvage when used for hindfoot reconstruction in patients with Charcot arthropathy. Cite this article: Bone Joint J 2018;100-B:190–6.

scholarly journals Novel Pathologic-Scoring for Charcot Arthropathy with Intraneural Observations

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0025
Author(s):  
Jesse King ◽  
Ben Murie ◽  
Julie Fanburg-Smith ◽  
Chris Stauch ◽  
Kempland Walley ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Staging System ◽  
Skeletal Muscle Atrophy ◽  
Charcot Arthropathy ◽  
Charcot Neuroarthropathy ◽  
Lower Limb Surgery ◽  
Bone Fragments ◽  
American Society ◽  
Medial Hypertrophy ◽  
Large Bone

Category: Diabetes, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Charcot arthropathy is a destructive joint disorder in patients with longstanding neuropathy, commonly related to Type II diabetes (T2DM). The diagnosis is historically classified via the radiologic Eichenholtz staging system (E-score). The purpose of this study is to examine histopathologic features and develop a correlative pathologic score for Charcot neuroarthropathy. Methods: Patients undergoing lower limb surgery with a clinical diagnosis of midfoot-ankle Charcot neuroarthropathy were included for study. Clinical data, radiology, E-score (1-3), and surgical pathology specimens were reviewed to evaluate skin, adipose, vessel, skeletal muscle, nerve, bone, and bone fragments embedded in synovium. Charcot pathology-score 1 (P-score, CPSI) = large bone fragments (> half 40x hpf objective) without host histiocytic response. CPSII = mixed large and small bone fragments with/without host histiocytic response, CPSIII = small to minute spicules to almost complete resorption/absence of bone fragments with histiocytic/fibrosis-reactive response, were scored by the authors in a blinded fashion. Results: Forty-two patients (32 males and 10 females) were included in analyses with a mean age of 59.9 years (median age: 60, range 28-83). Clinical risk factors for Charcot included T2DM and longstanding neuropathy. Elevated HbA1C, E-Score, preoperative American Society of Anesthesia score, and Charlson comorbidity index were predictors of amputation. Majority of pathologic specimens examined had superficial ischemic ulceration, dermal fibrosis, cellulitis, medial hypertrophy, atherosclerosis, skeletal muscle atrophy, and nerve hypertrophy with intraneural edema and perineural fibrosis. Osteomyelitis was present in >70%. P-scores CPSI = 6%, CPSII = 44%, CPSIII = 50% correlate with E-scores in 98% of cases without interobserver variability. Minor difference from E-score to P-score (2%) was due to sampling. Novel neuropathy change includes observation of intraneural vasculopathy (arteriolosclerosis) in evaluable nerves. Conclusion: CPS is reliable and reproducible and can be performed with adequate synovial sampling. Charcot progresses from large bone fragments in synovium to mixed size with histiocytic response, and final small/resorbed fragments with marked host response/fibrosis. Intraneural vasculopathy likely plays a role in Charcot. Charcot pathology-score (P-score) strongly correlates with clinicoradiologic Eichenholtz-score (E-score).

Aan het Nederlands lijkt best wat te knutselen

2020 ◽  
Vol 25 (2) ◽  
pp. 387-395
Author(s):  
Marten van der Meulen ◽  
Nicoline van der Sijs
Keyword(s):  
Case Studies ◽  
Empirical Research ◽  
Recent Literature ◽  
Large Body ◽  
New Methods ◽  
Time Period ◽  
New Findings ◽  
Linguistic Level

Abstract The influence of prescriptivism on DutchWeerman (2003) unequivocally rejected the possibility for language to be malleable. At the time, there was little empirical research to challenge or support this claim. Over the last two decades, however, a fairly large body of research has delved into this issue. In light of this, we review some of Weerman’s views, and discuss new findings of the recent literature, both for Dutch and other languages. We show how new methods and insights have led to a re-evaluation of the effects of prescriptivism. We furthermore argue that, rather than categorically dismissing effects of prescriptivism, researchers should focus on case studies with different parameters, including linguistic level, prohibition strength and time period.

The Relative Influence of European Writers on Late Eighteenth-Century American Political Thought

1984 ◽  
Vol 78 (1) ◽  
pp. 189-197 ◽  
Author(s):  
Donald S. Lutz
Keyword(s):  
Eighteenth Century ◽  
Political Thought ◽  
Recent Literature ◽  
Citation Count ◽  
Relative Influence ◽  
Future Research ◽  
American Political Thought ◽  
Late Eighteenth Century ◽  
Time Period ◽  
Surrogate Measure

Drawing upon a comprehensive list of political writings by Americans published between 1760 and 1805, the study uses a citation count drawn from these 916 items as a surrogate measure of the relative influence of European writers upon American political thought during the era. Contrary to the general tendencies in the recent literature, the results here indicate that there was no one European writer, or one tradition of writers, that dominated American political thought. There is evidence for moving beyond the Whig-Enlightenment dichotomy as the basis for textual analysis, and for expanding the set of individual European authors considered to have had an important effect on American thinking. Montesquieu, Blackstone, and Hume are most in need of upgrading in this regard. The patterns of influence apparently varied over the time period from 1760 to 1805, and future research on the relative influence of European thinkers must be more sensitive to this possibility.

scholarly journals Post-surgical Pyoderma Gangrenosum: A Retrospective Analysis of four Clinical Cases

2019 ◽  
pp. 37-40
Author(s):  
Kirsi Isoherranen
Keyword(s):  
Treatment Outcomes ◽  
Retrospective Analysis ◽  
Pyoderma Gangrenosum ◽  
Diagnostic Delay ◽  
Special Focus ◽  
Inflammatory Disorder ◽  
Patient Records ◽  
Clinical Cases

Pyoderma gangrenosum is a rare neutrophilic, inflammatory disorder. A recent study from Finland has analysed patient records with postsurgical pyoderma gangrenosum with special focus on the diagnostic delay and treatment outcomes.

Paradoxes of Dual Nationality: Geopolitical Constraints on Multiple Citizenship in the Iranian Diaspora

2019 ◽  
Vol 73 (4) ◽  
pp. 531-554
Author(s):  
Amy Malek
Keyword(s):  
Recent Literature ◽  
Costs And Benefits ◽  
Dual Citizenship ◽  
Time Period ◽  
Dual Nationality ◽  
The Impact ◽  
Iranian Diaspora

Despite suggestions that multiple citizenships offer enhanced access to security, mobility, and rights, dual nationals of countries like Iran may instead experience greater insecurity, immobility, and disruption of rights. This article offers a brief overview of recent literature and controversies surrounding dual citizenship and then focuses on the Iranian case, demonstrating the limits of dual citizenship as felt by diasporic Iranians. The winds of geopolitical change may affect which nation's dual citizens will be targeted in a given time period, but the impact of geopolitical constraints must be considered in any explanations of the costs and benefits of dual citizenship.

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