Incidence and Predictive Factors for Amputations Derived From Charcot's Neuroarthropathy in Persons With Diabetes

2021 ◽  
pp. 153473462110258
Author(s):  
Mariana A. Bandeira ◽  
Alexandre L. G. dos Santos ◽  
Kevin Woo ◽  
Mônica A. Gamba ◽  
Vera L. C. de Gouveia Santos
Keyword(s):  
Peripheral Neuropathy ◽  
Acute Phase ◽  
Predictive Factors ◽  
Cumulative Incidence ◽  
Arterial Disease ◽  
Lower Limbs ◽  
Categorical Variables ◽  
Exact Test ◽  
Amputation Level ◽  
Peripheral Arterial

Charcot's neuroarthropathy (CN) is the progressive destruction of the bones and joints of the feet, as a consequence of severe peripheral neuropathy, which predisposes patients to amputations. The purpose of this study was to measure the cumulative incidence of amputations resulting from CN and risk factors among amputated people with diabetes mellitus (DM). This was an epidemiological, observational, and retrospective study of 114 patients with DM who had an amputation involving the lower limbs. Data were collected from 2 specialized outpatient clinics between 2015 and 2019, including socio-demographic and clinical variables (cause of amputation: CN, peripheral arterial disease [PAD], infected ulcers, fracture, osteomyelitis, and others; body mass index [BMI]; 1 or 2 DM, time since DM diagnosis, insulin treatment, glycated hemoglobin; creatinine; smoking and drinking; systemic arterial hypertension, diabetic retinopathy, diabetic kidney disease, diabetic peripheral neuropathy, acute myocardial infarction, PAD, and stroke; characteristics of amputation [level and laterality], in addition to the specific variables related to CN [time of amputation in relation to the diagnosis of CN, diagnosis of CN in the acute phase, and treatment implemented in the acute phase]). We compared socio-demographic and clinical characteristics, including types of amputation, between patients with and without CN. Statistical analyses were performed using the 2 sample t-test or Wilcoxon–Mann–Whitney test, for quantitative variables, and the Pearson's χ2 test or Fisher's exact test for categorical variables. The investigation of the possible association of predictive factors for a CN amputation was carried out through logistic regression. The amputation caused by CN was present in 27 patients with a cumulative incidence of 23.7% in 5 years. There was a statistically significant association between BMI and the occurrence of CN (odds ratio: 1.083; 95% confidence interval: 1.001–1.173; P = .048); higher values of BMI were associated with a higher occurrence of amputations secondary from CN.

scholarly journals What Is Currently the Role of TcPO2 in the Choice of the Amputation Level of Lower Limbs? A Comprehensive Review

2021 ◽  
Vol 10 (7) ◽  
pp. 1413
Author(s):  
Judith Catella ◽  
Anne Long ◽  
Lucia Mazzolai
Keyword(s):  
Arterial Disease ◽  
Major Amputation ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Quality Of Data ◽  
Amputation Level ◽  
Increased Risk ◽  
Transcutaneous Oximetry ◽  
Peripheral Arterial

Some patients still require major amputation for lower extremity peripheral arterial disease treatment. The purpose of pre-operative amputation level selection is to determine the most distal amputation site with the highest healing probability without re-amputation. Transcutaneous oximetry (TcPO2) can detect viable tissue with the highest probability of healing. Several factors affect the accuracy of TcPO2; nevertheless, surgeons rely on TcPO2 values to determine the optimal amputation level. Background about the development of TcPO2, methods of measurement, consequences of lower limb amputation level, and the place of TcPO2 in the choice of the amputation level are reviewed herein. Most of the retrospective studies indicated that calf TcPO2 values greater than 40 mmHg were associated with a high percentage of successful wound healing after below-knee-amputation, whereas values lower than 20 mmHg indicated an increased risk of unsuccessful healing. However, a consensus on the precise cut-off value of TcPO2 necessary to assure healing is missing. Ways of improvement for TcPO2 performance applied to the optimization of the amputation-level are reported herein. Further prospective data are needed to better approach a TcPO2 value that will promise an acceptable risk of re-amputation. Standardized TcPO2 measurement is crucial to ensure quality of data.

Safety of 60-day l-arginine supplementation of patients with peripheral arterial disease of lower limbs

2015 ◽  
Vol 67 ◽  
pp. 16
Author(s):  
Natasza Balcer-Dymel ◽  
Katarzyna Korzeniowska ◽  
Artur Cieślewicz ◽  
Anna Jabłecka
Keyword(s):  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Lower Limbs ◽  
Peripheral Arterial ◽  
Arginine Supplementation

scholarly journals FAKTOR-FAKTOR YANG MEMENGARUHI NEUROPATI PERIFER TERKAIT HIV DI MANADO

2018 ◽  
Vol 35 (3) ◽  
Author(s):  
Deivy Cirayow ◽  
Arthur Hendrik Philips Mawuntu ◽  
Herlyani Khosama
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Neuropathy ◽  
Influencing Factors ◽  
Categorical Variables ◽  
Fisher Exact Test ◽  
Hiv Dementia ◽  
Chi Square ◽  
Exact Test ◽  
International Hiv Dementia Scale ◽  
Hiv Aids

FACTORS THAT INFLUENCE HIV ASSOCIATED PERIPHERAL NEUROPATHY IN MANADOABSTRACTIntroduction: There are  several sociodemographic and clinical factors that influence the development of HIV associated peripheral  neuropathy (HIV-PN). Manado has different sociodemographic and clinical characteristics  from other regions. However, the percentage of HIV-PN and its influencing factors are unknown.Aims: To know the percentage of HIV-PN and factors that influence this disorder in Manado.Methods: A crosssectional study conducted in HIV/AIDS clinic R.D. Kandou hospital Manado between November2016–January 2017. Neuropathy evaluation was performed using brief peripheral neuropathy screening (BPNS), neuropathic pain diagnostic questionnaire (DN4), and electroneurography. A Chi-square or Fisher exact test was done to analyze categorical variables, independent T or Mann-Whitney test was done for numerical variables, and linear regression was done in multivariate analysis.Results: 50 subjects were included, most were male (70%), and the mean age was 32.98 (±9.726) years, with HIV- NP percentage was 46%. Age >30 years old, low hemoglobin count, CD4, and low international  HIV dementia scale (IHDS) significantly associated with HIV-NP. Working subjects were 13.6 times more likely to have HIV-PN.Discussion: HIV-PN prevalence was relatively high, influenced by age >30 years old an low hemoglobin, CD4, andIHDS. As a factor, working was escalating the likelihood of NP-HIV by 13.9 times.Keywords: HIV/AIDS, influencing factors, peripheral neuropathyABSTRAKPendahuluan: Neuropati perifer terkait human immunodeficiency virus/HIV (NP-HIV) dapat dipengaruhi oleh beberapa faktor klinis dan sosiodemografis. Manado mempunyai karakteristik yang berbeda dengan daerah lain, namun belum diketahui persentase NP-HIV dan faktor-faktor yang memengaruhinya.Tujuan: Mengetahui persentase NP-HIV dan faktor-faktor yang memengaruhinya di Manado.Metode: Penelitian potong lintang terhadap pasien HIV/AIDS di poliklinik HIV/AIDS RSUP Prof. dr. R.D. Kandou, Manado, pada November 2016–Januari 2017.  Evaluasi neuropati dilakukan menggunakan brief peripheral  neuropathy screening (BPNS), neuropathic pain diagnostic questionnaire (DN4), dan elektroneurografi. Digunakan uji Chi-square atau Fisher exact untuk menganalisis variabel kategorik, uji T independen atau Mann-Whitney untuk variabel numerik, dan regresi linear untuk analisis multivariat.Hasil: Didapatkan 50 subjek yang memenuhi kriteria penelitian dengan mayoritas laki-laki (70%), rerata usia32,98±9,726 tahun, dan mengalami NP-HIV sebanyak 46%. Usia >30 tahun, kadar hemoglobin, jumlah CD4, dan skor international  HIV dementia scale (IHDS) yang rendah berhubungan secara bermakna dengan adanya NP-HIV. Adapun subjek yang bekerja berisiko 13,6 kali lebih besar mengalami NP-HIV.Diskusi: Didapatkan prevalensi NP-HIV yang cukup tinggi dengan dipengaruhi oleh usia >30 tahun serta kadar hemoglobin, CD4, dan skor IHDS yang rendah. Faktor bekerja juga meningkatkan kecenderungan 13,9 kali mengalami NP terkait HIV.Kata kunci: Faktor-faktor yang memengaruhi, HIV/AIDS, neuropati perifer

Oral sirolimus for prevention of recurrent infrainguinal arterial obstructions after surgical and endovascular revascularizations

VASA ◽  
2008 ◽  
Vol 37 (3) ◽  
pp. 285-288 ◽  
Author(s):  
Keo ◽  
Do ◽  
Husmann ◽  
Baumgartner
Keyword(s):  
Arterial Disease ◽  
Lower Limbs ◽  
Rest Pain ◽  
Short Term ◽  
The Third ◽  
Neointimal Proliferation ◽  
Arterial Lesions ◽  
Peripheral Arterial ◽  
Case Basis

No data are currently available on the role of oral sirolimus in the prevention of recurrent stenosis in the periphery. We report the effects of oral sirolimus in the prevention of recurrent infrainguinal obstructions in patients with complex peripheral arterial disease. Three patients with ischemic rest pain of the lower limbs and repeated short-term need for surgical and/or endovascular revascularization: 9 times within 12 months, 7 times within 15 months, 11 times within 26 months, respectively. Oral sirolimus on a case by case basis, resulted in less frequent restenosis and longer intervention-free intervals: three re-interventions within 37 months in the first patient, one balloon angioplasty within 17 months in the second, and three re-interventions within 21 months in the third patient, respectively. Side effects, in particular dyspepsia and diarrhoea, were mild and tolerable. To our knowledge, this is the first report to show that oral sirolimus was successfully administered in patients with recurrent excessive neointimal proliferation after revascularization of peripheral arterial lesions lowering the necessity of re-intervention and hence prolonging intervention-free intervals.

scholarly journals Peripheral vascular disease – a new vascular disease associated with normal tension glaucoma: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Ali Nowrouzi ◽  
Javier Benitez-del-Castillo ◽  
Sepideh Kafi-abasabadi ◽  
Mario Rodriguez-Calzadilla ◽  
Antonio Diaz-Ramos ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Vascular Disease ◽  
Normal Tension Glaucoma ◽  
Arterial Disease ◽  
Lower Limbs ◽  
Vascular Abnormality ◽  
Vascular Abnormalities ◽  
Peripheral Arterial ◽  
The Right ◽  
First Time

Abstract Introduction Normal-tension glaucoma is known as a multifactorial optic neuropathy. A number of lines of evidence suggested that vascular factors played a significant role in the development of normal-tension glaucoma. The mechanisms underlying the abnormal ocular blood flow in normal-tension glaucoma are still not clear. Peripheral vascular disease seems to be associated with glaucoma populations independent of other cardiovascular risk factors. We found this presentation, for the first time, to our knowledge, as another probable vascular abnormality related to our patient with normal-tension glaucoma, although it is necessary to confirm its pathological effect in future studies. Case presentation Our patient was a 48-year-old Spanish man without any personal and family history of interest except for circulatory problems of the lower limbs with repetitive ulcers at the frontal and lateral aspects of his legs. His chief complaint was vision loss when he came to consult us. In exploration, his best corrected visual acuity was 20/20 in both eyes; initial intraocular pressure in the right eye was 14–16 mmHg and in the left eye was 16–18 mmHg, with a mild sclerosis of the lens in slit-lamp examination. No inflammation or pigmented lesion was detected in the anterior chamber. Open angle confirmed by Goldman four quadrants gonioscopy. Funduscopic examination revealed a vertical cup disc ratio of 0.6 in the right eye and 0.8 in the left eye. The patient’s neuroretinal rim was normal in the right eye, and superior thinning in the left eye was determined. Examination of the patient’s visual field showed inferior mild probable nasal scotoma in the right eye and an inferior deep arcuate scotoma defect in the left eye. His optical coherence tomography examination revealed thinning of the peripapillary nerve fiber layer thickness in the left eye and superior loss of macular retinal ganglion cells in the left eye. Normal intraocular pressure values were measured on the intraocular pressure curve without treatment (maximum value, 18–20 mmHg), discarding higher intraocular pressures measured out of office. Ultrasonic pachymetry measured 515/520 μm, and normal intraocular pressure measured with a PASCAL tonometer ruled out probable corneal biomechanical underestimations. The patient’s polysomnography study was normal and excluded sleep apnea syndrome. The patient’s serial mean blood pressure was normal, especially in the lower limbs (mean value, 125/70 mmHg), ruling out the possibility of systemic hypotension. Thyroidal and coagulation abnormalities, autoimmune disease, and inflammatory disease were excluded. Normal immunologic study and normal vascular biopsy were observed, as well as normal brain magnetic resonance imaging and a normal carotid vascular study. The primary diagnosis was moderate medium peripheral arterial disease in the lower limbs, which was confirmed by echography after ruling out other probable vascular abnormalities related to normal-tension glaucoma. Conclusion After ruling out other systemic diseases and vascular abnormalities related to normal-tension glaucoma, we found peripheral arterial disease as a probable vascular abnormality related to normal-tension glaucoma in our patient. To our knowledge, this is the first time such a case has been reported. Thus, further research is needed to determine the relevance of these results to the general population.

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