Surgical Treatment of Peripheral Neuropathy

2005 ◽  
Vol 95 (5) ◽  
pp. 451-454 ◽  
Author(s):  
Juan M. V. Valdivia ◽  
A. Lee Dellon ◽  
Martin E. Weinand ◽  
Christopher T. Maloney
Keyword(s):  
Lower Extremity ◽  
Peripheral Nerves ◽  
Tibial Nerve ◽  
Diabetic Patients ◽  
Analog Scale ◽  
Postoperative Results ◽  
Patients With Diabetes ◽  
A Prospective Study ◽  
Balance Problems

Since 1992 it has been reported that patients with diabetes mellitus recover sensibility and obtain relief of pain from neuropathy symptoms by decompression of lower-extremity peripheral nerves. None of these reports included a series with more than 36 diabetic patients with lower-extremity nerves decompressed, and only recently has a single report appeared of the results of this approach in patients with nondiabetic neuropathy. No previous report has described a change in balance related to restoration of sensibility. A prospective study was conducted of 100 consecutive patients (60 with diabetes and 40 with idiopathic neuropathy) operated on by a single surgeon, other than the originator of this approach, and with the postoperative results reviewed by someone other than these two surgeons. Each patient had neurolysis of the peroneal nerve at the knee and the dorsum of the foot, and the tibial nerve released in the four medial ankle tunnels. After at least 1 year of follow-up, 87% of patients with preoperative numbness reported improved sensation, 92% with preoperative balance problems reported improved balance, and 86% whose pain level was 5 or greater on a visual analog scale from 0 (no pain) to 10 (the most severe pain) before surgery reported an improvement in pain. Decompression of compressed lower-extremity nerves improves sensation and decreases pain, and should be recommended for patients with neuropathy who have failed to improve with traditional medical treatment. (J Am Podiatr Med Assoc 95(5): 451–454, 2005)

Elevated BNP and High Brachial Pulse Pressure in Patients with Diabetes

2021 ◽  
Author(s):  
Jean-Guillaume Dillinger ◽  
Charlotte Patin ◽  
Philippe Bonnin ◽  
Tiphaine Vidal-Trecan ◽  
Elise Paven ◽  
...  
Keyword(s):  
High Risk ◽  
Pulse Pressure ◽  
Daily Practice ◽  
Diabetic Patients ◽  
Brachial Blood Pressure ◽  
Patients With Diabetes ◽  
History Of ◽  
A Prospective Study

Abstract Background Heart failure (HF) is frequent in patients with diabetes mellitus (DM), and early detection improves prognosis. We investigated whether analysis of brachial blood pressure (BP) in daily practice can identify patients with DM and high risk for subsequent HF, as defined by brain natriuretic peptide (BNP) > 50 pg/ml. Methods 3,367 Outpatients with DM without a history of cardiovascular disease were enrolled in a prospective study. Results Age (mean±SD) was 56±14 years, 57% were male, 78% had type 2 DM and HbA1C was 7.4%±1.4%. A history of hypertension was recorded in 43% of patients and uncontrolled BP was observed in 13%. BNP concentration (mean±SD) was 21±21 ng/L and 9% of patients had high risk of incident HF. Brachial pulse pressure (PP) was the best BP parameter associated with high risk of incident HF compared to diastolic, systolic or mean BP (area under the ROC curve: 0.70, 0.65, 0.57 and 0.57 respectively). A multivariate analysis demonstrated that elevated PP was independently associated with high risk of incident HF (odds ratio [95%CI]: 2.1 [1.5–2.8] for PP ≥65mmHg). Study of central aortic BP and pulse wave velocity on 117 patients demonstrated that high risk of incident HF was associated with increased arterial stiffness and subendocardial ischemia. After a mean follow-up of 811days, elevated PP was associated with increased all-cause mortality (hazard ratio [95%CI]: 1.7 [1.1–2.8]). Conclusions Brachial PP is powerful and independent “easy to record” BP parameter associated with high risk of incident HF in diabetic patients.

Intramuscular Nerve and Neuromuscular Junction Alteration In Extraocular Muscles of Diabetic Mice

1985 ◽  
Vol 43 ◽  
pp. 682-683
Author(s):  
Bruce R. Pachter
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Nerves ◽  
Sudden Onset ◽  
Extraocular Muscles ◽  
Diabetic Patients ◽  
Oculomotor Palsy ◽  
Third Nerve Palsy ◽  
Patients With Diabetes ◽  
Intramuscular Nerve ◽  
Oculomotor Nerves

Diabetes mellitus is one of the commonest causes of neuropathy. Diabetic neuropathy is a heterogeneous group of neuropathic disorders to which patients with diabetes mellitus are susceptible; more than one kind of neuropathy can frequently occur in the same individual. Abnormalities are also known to occur in nearly every anatomic subdivision of the eye in diabetic patients. Oculomotor palsy appears to be common in diabetes mellitus for their occurrence in isolation to suggest diabetes. Nerves to the external ocular muscles are most commonly affected, particularly the oculomotor or third cranial nerve. The third nerve palsy of diabetes is characteristic, being of sudden onset, accompanied by orbital and retro-orbital pain, often associated with complete involvement of the external ocular muscles innervated by the nerve. While the human and experimental animal literature is replete with studies on the peripheral nerves in diabetes mellitus, there is but a paucity of reported studies dealing with the oculomotor nerves and their associated extraocular muscles (EOMs).

Abstract 13242: Insulin Treated Patients With Diabetes Derive Reduction in Mortality From Cardiac Resynchronization Therapy - Results From the Madit-Crt in Trial Experience

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Barbara Szepietowska ◽  
Valentina Kutyifa ◽  
Martin H Ruwald ◽  
Scott D Solomon ◽  
Anne-Christine H Ruwald ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Risk Reduction ◽  
Insulin Treatment ◽  
Cardiac Resynchronization ◽  
Reverse Remodeling ◽  
Diabetic Patients ◽  
Resynchronization Therapy ◽  
All Cause Mortality ◽  
Patients With Diabetes

Methods: We aimed to analyze the risk for death and HF and the effect of CRT on HF/death in diabetic patients with or without insulin treatment compared to none diabetic population. The study comprised 1278 patients with left bundle branch block in the MADIT-CRT trial with an average follow-up of 3.3y. We used time dependent survival analysis and Cox proportional hazards regression method. Results: In ICD arm patients with diabetes receiving insulin treatment had 2.4-fold higher risk of all-cause mortality (p=0.008), and 2.2-fold higher risk of HF (p<0.001) when compared to non diabetic patients, and 2.8-fold higher risk of death (p=0.01), and 1.6-fold higher risk of HF (p=0.06) when compared to patients with diabetes not treated with insulin. Treatment with CRT-D was associated with a significant 75% risk reduction in all-cause mortality (hazard ratio [HR ] 0.25; 95% confidence interval [CI]: 0.08-0.77; p=0.016) in patients with diabetes receiving insulin. Noteworthy, during the 3-year follow-up, reduction in all-cause mortality was not observed in patients not treated with insulin or in patients with no diabetes (interaction p-value=0.038). Significant risk reduction in HF and in HF/death after CRT treatment was observed across all three investigated groups. There were not significant differences in left ventricular reverse remodeling after CRT-D among diabetic patients with or without insulin treatment compared to the nondiabetic population. Conclusions: Patients with insulin treated diabetes derive significant reduction in mortality and heart failure after implantation of cardiac resynchronization therapy. Patients with diabetes and no insulin and patient without diabetes benefit from CRT by reduction of HF events.

Survival, cardiovascular morbidity, and reinterventions after elective endovascular aortic aneurysm repair in patients with and without diabetes: A nationwide propensity-adjusted analysis

2019 ◽  
Vol 24 (6) ◽  
pp. 539-546 ◽  
Author(s):  
Soumia Taimour ◽  
Tarik Avdic ◽  
Stefan Franzén ◽  
Moncef Zarrouk ◽  
Stefan Acosta ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Endovascular Aneurysm Repair ◽  
Total Mortality ◽  
Epidemiological Data ◽  
Diabetic Patients ◽  
Protective Effects ◽  
Adjusted Analysis ◽  
Patients With Diabetes ◽  
Aneurysm Repair

Epidemiological data indicate decreased risk for development and growth of abdominal aortic aneurysm (AAA) among patients with diabetes mellitus (DM). On the other hand, DM adds to increased cardiovascular (CV) morbidity and mortality. In a nationwide observational cohort study of patients registered in the Swedish Vascular Register and the Swedish National Diabetes Register, we evaluated potential effects of DM on total mortality, CV morbidity, and the need for reintervention after elective endovascular aneurysm repair (EVAR) for AAA. We compared 748 patients with and 2630 without DM with propensity score-adjusted analysis, during a median 4.22 years of follow-up for patients with DM, and 4.05 years for those without. In adjusted analysis, diabetic patients showed higher rates of acute myocardial infarction (AMI) during follow-up (relative risk (RR) 1.44, 95% CI 1.06–1.95; p = 0.02), but lower need for reintervention (RR 0.12, CI 0.02–0.91; p = 0.04). There were no differences in total (RR 0.88, CI 0.74–1.05; p = 0.15) or CV (RR 1.58, CI 0.87–2.86; p = 0.13) mortality, or stroke (RR 0.95, CI 0.68–1.32; p = 0.75) during follow-up. In conclusion, patients with DM had higher rates of AMI and lower need for reintervention after elective EVAR than those without DM, whereas neither total nor CV mortality differed between groups. The putative protective effects of DM towards further AAA enlargement and late sac rupture may help explain the lower need for reintervention and absence of excess mortality.

Antiplatelet Agents In Diabetic Lower Extremity Vascular Disease. A Va Cooperative Study

1981 ◽  
Vol 46 (01) ◽  
pp. 091-091
Author(s):  
J Colwell
Keyword(s):  
Lower Extremity ◽  
Vascular Disease ◽  
Collaborative Study ◽  
Antiplatelet Agents ◽  
Vascular Complication ◽  
Smoking History ◽  
Diabetic Patients ◽  
Vascular Events ◽  
Diabetic Vascular Disease

Peripheral vascular disease is a devastating complication of diabetes mellitus. Post-operative vascular death rates are 10% or more following amputation for gangrene in diabetic patients, and three year mortality approaches 30%. An additional 20-30% of patients require subsequent amputation for diabetic gangrene. In view of these statistics, and because of the postulated role of the blood platelet in diabetic vascular disease, a collaborative study on antiplatelet agents was begun in 10 VA medical centers in 1977. In a double-blinded study, aspirin (325 mg tid) plus dipyridamole (75 mg tid) or placebos are given to adult diabetic males who had suffered a recent amputation for diabetic lower extremity vascular disease. End points are major vascular events after at least 3 years of follow-up.Recruitment of 231 subjects was completed by May, 1980. Baseline characteristics are well matched in both groups. Mean age is 59.6 years, duration of diabetes 12.7 years, smoking history 33.3 pack years, and treatment with insulin 68%. Previous myocardial infarction, congestive heart failure, and/or cerebrovascular disease is present in 17-18% and retinopathy is present in 40% at entry. About 43% have more than one vascular complication at baseline.Mean duration of follow-up is now 18 months. Major vascular events in separate patients are: 40 amputations, 31 deaths, 5 myocardial infarctions. Numerous less serious vascular events have also occurred, as have multiple events in single patients. Therapy has been stopped in 17% of patients, but rarely due to drug side effects. Compliance with therapy has been good.We conclude that this study will provide important new information on the natural history of lower extremity vascular disease in diabetes. It will also provide definitive data about the efficacy of antiplatelet agents in diabetic vascular disease.

scholarly journals DIABETES MELLITUS MODIFYING FACTORS;

2014 ◽  
Vol 21 (06) ◽  
pp. 1185-1190
Author(s):  
Safirah Maheen ◽  
Haroon-ur- Rashid ◽  
Khan Mohammad Baber ◽  
Hafeez ullah Khan ◽  
Ambreen Malik Uttra ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Sampling Method ◽  
Diabetic Patients ◽  
Dietary Recommendations ◽  
Modifying Factors ◽  
Convenience Sampling ◽  
Healthy Activity ◽  
A Prospective Study ◽  
Structured Questionnaire

Objective: Diabetes mellitus is wide spread non transmissible disease but its prevalence is increasing everyday so this study was conducted with an aim to investigate the factors that are modifying diabetes mellitus among patients at DHQ (District Head Quarter) Hospital Sargodha. Methodology: A prospective study was carried out by well-trained pharmacists in DHQ Sargodha, Pakistan to assess the factors modifying diabetes mellitus. Data was collected from 110 patients randomly by using convenience sampling method. A well structured questionnaire was designed to collect information from patients and entire procedure was conducted with the permission of concerned authorities of Hospital management. The factors that are considered in present study are medication, treatment, patient physician interaction and society attitude towards diabetic patients which are helpful in halting the progression of diabetes and prevention of co morbidities. Results: The results of study disclose that 74.5% diabetic patients felt better after treatment whereas 56% diabetic patients were satisfied with the information provided by physician to them but still 70% patients were suffering from co morbidities. The survey indicated that 62.7% patients said that exercise proved to be healthy activity in improving diabetes. However 59% diabetic patients were following a proper diet plan which was helpful in modifying their diabetes. Conclusions: The diabetic patients must be informed about importance of regular follow-up in averting long-standing complications. Patients should be guided about importance of dietary recommendations, exercise and strict metabolic control, that can holdup or avert the series of complications allied with diabetes.

scholarly journals The effect of diabetes mellitus on evolution and outcome of tuberculosis in a prospective study

2021 ◽  
Vol 64 (5) ◽  
pp. 16-20
Author(s):  
Alina Malic ◽  
◽  
Evelina Lesnic ◽  
Keyword(s):  
Diabetes Mellitus ◽  
Prospective Study ◽  
Treatment Effectiveness ◽  
Similar Rate ◽  
Control Group ◽  
Diabetic Patients ◽  
A Prospective Study ◽  
Prospective Longitudinal ◽  
The Impact

Background: In the Republic of Moldova almost 5% of the cases with tuberculosis are diagnosed annually among diabetic patients. The aim of this study was to assess the impact of diabetes mellitus on the evolution and anti-tuberculosis treatment effectiveness in a prospective study. Material and methods: A prospective, longitudinal and case-control study, which included a total number of 252 patients diagnosed with pulmonary tuberculosis and distributed in a study group, consisting of 93 patients diagnosed with diabetes mellitus and a control group, consisting of 159 patients without glycemic disorders, was performed. Results: This study identified that one half of the group with diabetes was detected by active screening and one third received anti-tuberculous treatment before actual episode. A similar rate of diabetic and non-diabetic patients was microbiologically positive, as well confirmed with drug-resistance. The anti-tuberculous treatment effectiveness was lower in diabetic patients, the death rate and the low treatment outcome (lost to follow-up and failed) were higher than in non-diabetic patients. The main causes of unfavorable evolution were: glycemic disorders (hyperglycemia), diabetes complications and the history of the anti-tuberculous treatment in the anamnesis. Conclusions: The individualized approach and a tight follow-up should be performed regularly in all patients with glycemic disorders and tuberculosis for the improvement of the disease outcome.

scholarly journals Long-term glycemic variability and risk of stroke in patients with diabetes: a meta-analysis

2022 ◽  
Vol 14 (1) ◽  
Author(s):  
Xiaoli Ren ◽  
Zhiyun Wang ◽  
Congfang Guo
Keyword(s):  
Standard Deviation ◽  
Coefficient Of Variation ◽  
Meta Analysis ◽  
Glycemic Variability ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Follow Up Studies ◽  
Patients With Diabetes

Abstract Objectives Long-term glycemic variability has been related to increased risk of vascular complication in patients with diabetes. However, the association between parameters of long-term glycemic variability and risk of stroke remains not fully determined. We performed a meta-analysis to systematically evaluate the above association. Methods Medline, Embase, and Web of Science databases were searched for longitudinal follow-up studies comparing the incidence of stroke in diabetic patients with higher or lower long-term glycemic variability. A random-effect model incorporating the potential heterogeneity among the included studies were used to pool the results. Results Seven follow-up studies with 725,784 diabetic patients were included, and 98% of them were with type 2 diabetes mellitus (T2DM). The mean follow-up duration was 7.7 years. Pooled results showed that compared to those with lowest category of glycemic variability, diabetic patients with the highest patients had significantly increased risk of stroke, as evidenced by glycemic variability analyzed by fasting plasma glucose coefficient of variation (FPG-CV: risk ratio [RR] = 1.24, 95% confidence interval [CI] 1.11 to 1.39, P < 0.001; I2 = 53%), standard deviation of FPG (FPG-SD: RR = 1.16, 95% CI 1.02 to 1.31, P = 0.02; I2 = 74%), HbA1c coefficient of variation (HbA1c-CV: RR = 1.88, 95% CI 1.61 to 2.19 P < 0.001; I2 = 0%), and standard deviation of HbA1c (HbA1c-SD: RR = 1.73, 95% CI 1.49 to 2.00, P < 0.001; I2 = 0%). Conclusions Long-term glycemic variability is associated with higher risk of stroke in T2DM patients.

scholarly journals Metformin Attenuates Osteoporosis in Diabetic Patients with Carcinoma in Situ: A Nationwide, Retrospective, Matched-Cohort Study in Taiwan

2020 ◽  
Vol 9 (9) ◽  
pp. 2839 ◽  
Author(s):  
Chieh-Hua Lu ◽  
Chi-Hsiang Chung ◽  
Feng-Chih Kuo ◽  
Kuan-Chan Chen ◽  
Chia-Hao Chang ◽  
...  
Keyword(s):  
Carcinoma In Situ ◽  
Diabetic Patients ◽  
Research Database ◽  
Proportional Hazard ◽  
Metformin Therapy ◽  
Cox Proportional Hazard ◽  
Metformin Group ◽  
Patients With Diabetes

Patients with diabetes are at increased risk of cancer development and osteoporosis. Metformin is an effective agent for diabetes management. Epidemiological studies have identified an association between metformin use and cancer prevention. This article outlines the potential for metformin to attenuate the rate of osteoporosis in diabetic patients with carcinoma in situ (CIS). From the National Health Insurance Research Database of Taiwan, 7827 patients with diabetes with CIS who were receiving metformin therapy were selected, along with 23,481 patients as 1:3 sex-, age- and index year-matched controls, who were not receiving metformin therapy. A Cox proportional hazard analysis was used to compare the rate of osteoporosis during an average of 15-year follow-up. Of the subjects who were enrolled, 801 (2.56%) had osteoporosis, including 168 from the metformin group (2.15%) and 633 from the without metformin group (2.70%). The metformin group presented a lower rate of osteoporosis at the end of follow-up (p = 0.009). The Cox proportional hazard regression analysis revealed a lower rate of osteoporosis for the metformin group (adjusted hazard ratio of 0.820; 95% confidence interval = 0.691–0.972, p = 0.022). Diabetic patients with CIS under metformin therapy presented lower osteoporosis rate than those who were not receiving metformin therapy.

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