Hypercalcaemia during treatment of psoriasis with calcipotriol.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
M J Young
Publications and source records attributed to M J Young.
Differences in peripheral and autonomic nerve function measurements in painful and painless neuropathy. A clinical study.
OBJECTIVE: To examine the differences in peripheral and autonomic nerve function measurements between diabetic patients without neuropathy (group 1, n = 38, mean age 50.9, range 29-71 years), with painless neuropathy (group 2, n = 32, mean age 49.2, range 30-71 years), and with painful neuropathy (group 3, n = 52, mean age 51.5, range 28-73 years). RESEARCH DESIGN AND METHODS: The evaluation of neuropathy was based on clinical symptoms, signs, and quantitative sensory testing, including current perception threshold (CPT) with a neurometer and electrophysiology. RESULTS: The Neuropathy Symptom Score and the Neuropathy Disability Score were higher in patients with painful neuropathy compared with patients with painless neuropathy (6.8 +/- 2.7 vs. 0.5 +/- 0.8 [mean +/- SD], P < 0.0001, and 12.5 +/- 6.2 vs. 8.6 +/- 6.8, P < 0.01, respectively). In contrast, no differences were found in the quantitative sensory testing, including CPT measurements, the electrophysiological measurements, and the autonomic nerve system function tests in the two groups. Significant differences were found in all the above measurements when groups 2 and 3 were compared with diabetic patients without neuropathy (group 1). When all diabetic patients were considered as one group, significant correlations were found between CPT and the other peripheral nerve function assessments. In particular, peroneal nerve motor conduction velocity correlated with CPT at 2 kHz (r = -0.48, P < 0.001) and vibration perception threshold (r = -0.50, P < 0.001). CONCLUSIONS: We conclude that no difference could be found in the function of small and large nerve fibers between painful and painless diabetic neuropathy using conventional tests currently used. The CPT evaluation failed to quantify painful symptoms, but it compared favorably with other quantitative sensory tests in quantifying peripheral neuropathy.
Adult↗
Radiographic abnormalities in the feet of patients with diabetic neuropathy.
OBJECTIVE: To investigate the prevalence of radiographic bone and joint abnormalities in the feet of diabetic patients. RESEARCH DESIGN AND METHODS: In a blinded randomized study, 94 diabetic patients with peripheral neuropathy (54 with a history of foot ulcers) and 43 non-neuropathic patients were drawn at random from the data base of a large university diabetes clinic in the United Kingdom. Fifty nondiabetic age-matched control subjects also were studied. Lateral and dorsi-plantar weight-bearing plain radiographs of the foot and ankle were taken by a single radiographer. Abnormalities in the bones and joints were determined according to a structured reading of the radiographs by a single radiologist. RESULTS: Diabetes per se resulted in no excess of bony abnormality. Diabetic patients with neuropathy had significantly more radiographic abnormalities of the bones and joints than non-neuropathic and age-matched nondiabetic control subjects. However, except for periosteal reaction, this was predominantly caused by an excess of abnormalities in diabetic patients with a history of foot ulceration. Traumatic fractures (most previously unrecognized) were found in 12 (22%) of the 54 neuropathic patients with previous foot ulceration, and 9 (16%) patients who had experienced foot ulcers exhibited characteristic Charcot changes. CONCLUSIONS: These results suggest that bony abnormalities, particularly Charcot changes and traumatic fractures, are more frequent than previously recognized in neuropathic diabetic patients, especially in those with a history of foot ulceration. Early recognition of bony abnormality and appropriate treatment may prevent progression of foot deformity and thereby reduce the morbidity caused by ulceration or reulceration.
Adult↗
The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds. A prospective study.
OBJECTIVE: To assess the ability of vibration perception threshold (VPT) to predict the development of diabetic foot ulceration. RESEARCH DESIGN AND METHODS: A prospective follow-up study of consecutive patients with vibration perception measured by biothesiometry from April 1988 to March 1989. Patients were stratified in various risk groups. RESULTS: Patients with a VPT < 15 V had a cumulative incidence of foot ulceration of 2.9% compared with 19.8% in patients with a VPT > 25 V, odds ratio (OR) 7.99 (3.65-17.5, 95% confidence intervals), P < 0.01. The incidence of ulceration increased with duration of diabetes, but even with this effect removed, the excess of ulceration persisted, OR 6.82 (2.75-16.92), P < 0.01. CONCLUSIONS: VPT is an effective predictor of the risk of foot ulceration in diabetes and therefore could be used to target foot-care education to those patients most likely to benefit and, thereby, possibly improve its effectiveness.
Adolescent↗
Dilatation of the colon complicating acute self-limited colitis.
Colonic dilatation has been reported as an occasional complication of infectious colitis in single case reports and short series, but no large series has been published. We analysed 19 cases of self-limited colitis complicated by colonic dilatation, with infective agents identified in 14, admitted to a Regional Infectious Diseases Unit. Colonic dilatation, defined as a minimum transverse colonic diameter of 7 cm on plain abdominal X-ray, was associated with approximately 1% of cases of notifiable diarrhoea requiring hospital admission. The clinical course was associated with pyrexia (in 90%), tachycardia (in 90%), hypoalbuminaemia (in 100%), anaemia (in 84%) and reactive thrombocytosis (in 63%). There was a history of antidiarrhoeal agents or opiate analgesia in eighteen patients (95%). Intensive medical management, consisting of intravenous antibiotics, steroids, supplementary nutrition and withdrawal of anti-motility agents, resulted in resolution in 17 patients. Two patients required subtotal colectomy for perforation of the transverse colon, but neither developed severe peritonitis, and both subsequently underwent reversal of ileostomy. With early recognition and close observation of colonic dilatation in patients with acute diarrhoea, most cases can be successfully managed conservatively with preservation of the colon. Surgical intervention should be considered in patients with progressive colonic dilatation despite intensive medical management. There were no clinically useful parameters distinguishing self-limited colitis from inflammatory bowel disease acutely, so initial management should cover both possibilities.
Acute Disease↗
Complications of internal fixation of tibial plateau fractures.
All cases of displaced tibial plateau fractures treated by open reduction and internal fixation at two university hospitals over a 3-year period were retrospectively reviewed. There were 47 fractures in 45 patients. Rigid fixation to allow early motion was the goal in all cases. There were 3 AO type I (wedge) fractures, 20 AO type III (wedge/depression) fractures, and 24 AO type IV (comminuted/bicondylar) fractures. Cases were classified into three groups depending on the amount of hardware used to obtain fixation (a single buttress plate, group 1; a buttress plate and interfragmentary lag screws, group 2; or medial and lateral buttress plates with or without lag screws, group 3). In group 1, there were 20 fractures and no instances of deep-wound infection or postoperative ankylosis. In group 2, infection occurred in 6 of 19 fractures (32%), all of which also developed significant ankylosis including 1 patient who underwent arthrodesis. In group 3, 7 of 8 (87.5%) knees became infected, and the patients experienced other devastating complications, including ankylosis (n = 3), arthrodesis (n = 2), knee disarticulation (n = 1), and above-knee amputation (n = 1). Patients whose knees became infected underwent an average of five subsequent surgical procedures. These results suggest that patients with comminuted tibial plateau fractures requiring either two buttress plates or a single plate with additional interfragmentary lag screws would probably be better managed by either non-operative treatment or limited internal fixation.
Adult↗
The effectiveness of ovarian cancer screening. A decision analysis model.
OBJECTIVE: To estimate the effectiveness of ovarian cancer screening with CA 125 and transvaginal sonography. DESIGN: Decision analysis was used to examine the no-screen compared with the screen strategy. SETTING: Estimates of cancer incidence, survival, and life expectancy were derived from population-based data and clinical series. SUBJECTS: A cohort of 40-year-old women of all races and residing in the United States. INTERVENTIONS: A one-time screening intervention. The criterion standard for diagnosis of ovarian cancer was evaluation with exploratory laparotomy. MAIN OUTCOME MEASURE: Average years of life expectancy gained by women in the screened group. RESULTS: Screening for ovarian cancer with a combination of CA 125 and transvaginal sonography increases the average life expectancy in the population by less than 1 day. CONCLUSIONS: Given the limited effect on overall life expectancy, it is unlikely that mass screening for ovarian cancer with CA 125 and transvaginal sonography would be an effective health policy.
Adult↗
The diabetic foot: aetiopathogenesis and management.
Explore the source record for details and available documents.
Diabetic Angiopathies↗
A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population.
A cross-sectional multicentre study of randomly selected diabetic patients was performed using a standardised questionnaire and examination, to establish the prevalence of peripheral neuropathy in patients attending 118 hospital diabetes clinics in the UK. Vibration perception threshold was performed in two centres to compare with the clinical scoring systems. A total of 6487 diabetic patients were studied. 53.9% male, median age 59 years (range 18-90 years). 37.4% Type 1 (insulin-dependent) diabetes mellitus, with a median duration of diabetes 8 years (0-62 years). The overall prevalence of neuropathy was 28.5% (27.4-29.6%) (95% confidence interval) in this population. The prevalence in Type 1 diabetic patients was 22.7% (21.0-24.4%) and in Type 2 (non-insulin-dependent) diabetic patients it was 32.1% (30.6-33.6%). The prevalence of diabetic peripheral neuropathy increased with age, from 5% (3.1-6.9%) in the 20-29 year age group to 44.2% (41.1-47.3%) in the 70-79 year age group. Neuropathy was associated with duration of diabetes, and was present in 20.8% (19.1-22.5%) of patients with diabetes duration less than 5 years and in 36.8% (34.9-38.7%) of those with diabetes duration greater than 10 years. Mean vibration perception threshold measured at the great toe was 21.1 +/- 13.5 SD volts and correlated with the neuropathy disability score, r = 0.8 p < 0.001. In conclusion, diabetic peripheral neuropathy is a common complication associated with diabetes. It increases with both age and duration of diabetes, until it is present in more than 50% of Type 2 diabetic patients aged over 60 years.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Medial arterial calcification in the feet of diabetic patients and matched non-diabetic control subjects.
The prevalence and distribution of medial arterial calcification was assessed in the feet of four subject groups; 54 neuropathic diabetic patients with previous foot ulceration (U), median age 60.5 (50.5-67 interquartile range) years, duration of diabetes 19.5 (9.9-29.9) years; 40 neuropathic diabetic patients without a foot ulcer history (N), age 68 (62-73) years, duration of diabetes 14.0 (8.0-28.0) years; 43 non-neuropathic diabetic patients (NN), age 60.5 (52-68.5) years, duration of diabetes 14.0 (8.0-28.0) years and 50 non-diabetic control subjects, age 62.5 (53.7-70) years. A single radiologist graded medial arterial calcification as absent, mild or severe, at the ankle, hind-foot, mid-foot, metatarsals and toes on standardised plain lateral and antero-posterior foot radiographs taken by a single radiographer. Diabetes history, vibration perception threshold, ankle systolic pressure and serum creatinine were also assessed. Medial arterial calcification was significantly greater (total score 18 [3-31]) in neuropathic diabetic patients with previous ulceration (U vs N p < 0.01, U vs NN p < 0.001). Non-neuropathic diabetic patients did not have significantly higher arterial calcification scores than age-matched non-diabetic control subjects. Medial arterial calcification correlated with vibration perception threshold (r = 0.35), duration of diabetes (r = 0.32) and serum creatinine (r = 0.41), (all p < 0.01). Logistic regression models showed vibration perception and duration of diabetes to predict the probability of any calcification. Serum creatinine level was added to predict severe calcification.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Patient preferences for novel therapy: an N-of-1 trial of garlic in the treatment for hypertension.
The authors used the N-of-1 clinical trial methodology to obtain insights about a patient's preference for garlic for the management of his hypertension. The 61-year-old man received garlic, 500 mg by mouth three times a day (3 weeks), or identical placebo (3 weeks) in three treatment pairs. While the patient was taking garlic the mean systolic blood pressure decreased by 2 mm Hg (95% confidence interval 0.4 to 4.7, p < 0.05), and the diastolic blood pressure decreased by 2.4 mm Hg (95% confidence interval 0.4 to 4, p < 0.025). The treatment effect of garlic was small, but the patient believed continuing garlic for the management of his hypertension was justified.
Blood Pressure↗
Variation in physicians' decision-making thresholds in management of a sexually transmitted disease.
OBJECTIVE: To gain insight into the variation in physicians' clinical decisions and further understand the factors that influence physicians' thresholds for testing and treating. DESIGN: Written clinical scenarios were mailed to two groups of physicians who were asked to provide probability estimates of syphilis, how these estimates might change with new information, and when a diagnostic test would be ordered or treatment begun. A model was then used to calculate the probabilities at which physicians ordered tests or initiated treatment. PARTICIPANTS: Group 1 comprised 126 board-certified internists from metropolitan Philadelphia responding from a sample of 360 such physicians randomly selected from a directory. Group 2 consisted of 31 experts in sexually transmitted disease responding from a sample of 50 experts selected by the authors. MEASUREMENTS AND MAIN RESULTS: Experts were willing to obtain a serologic screening test at a lower likelihood of syphilis (0.013%) than were internists (0.034%), and they were willing to obtain a lumbar puncture at a lower likelihood of neurosyphilis (0.165%) than were internists (0.393%). The difference in the groups' thresholds to begin neurosyphilis treatment was not significant. A multivariate model showed that group differences were created by individual characteristics (years in practice, subspecialty board certification, and full-time nonacademic practice) that were associated with higher thresholds for serologic screening. CONCLUSIONS: There are differences in the diagnostic testing practices for syphilis between national experts and internists. Although status in one of these groups alone did not predict the threshold for obtaining syphilis tests, certain individual characteristics were predictive. Examination of physician characteristics helps to explain the variation observed in their practice patterns, and determination of physicians' thresholds aids in analyzing these variations.
Clinical Laboratory Techniques↗
A perturbation analysis of depth perception from combinations of texture and motion cues.
We examined how depth information from two different cue types (object motion and texture gradient) is integrated into a single estimate in human vision. Two critical assumptions of a recent model of depth cue combination (termed modified weak fusion) were tested. The first assumption is that the overall depth estimate is a weighted linear combination of the estimates derived from the individual cues, after initial processing needed to bring them to a common format. The second assumption is that the weight assigned to a cue reflects the apparent reliability of that cue in a particular scene. By this account, the depth combination rule is linear and dynamic, changing in a predictable fashion in response to the particular scene and viewing conditions. A novel procedure was used to measure the weights assigned to the texture and motion cues across experimental conditions. This procedure uses a type of perturbation analysis. The results are consistent with the weighted linear combination rule. In addition, when either cue is corrupted by added noise, the weighted linear combination rule shifts in favor of the uncontaminated cue.
Cues↗
A comparison of the neurothesiometer and biothesiometer for measuring vibration perception in diabetic patients.
The Neurothesiometer is a new device designed to replace the Biothesiometer in screening for diabetic peripheral neuropathy by measuring vibration perception threshold (VPT). It was compared with the Biothesiometer in 85 diabetic patients, mean age 61 (range 21-82) years and mean duration of diabetes 12 (1-26) years, attending routine diabetes and foot screening clinics. VPT correlated with age and duration of diabetes (r = 0.46 and r = 0.42, respectively P < 0.01), with both devices. The Biothesiometer VPT was 29.9 +/- 15.2 V (mean +/- S.D.) compared with 26.2 +/- 13.4 V with the Neurothesiometer (P = NS) and there was a close correlation between the two devices r = 0.93 P < 0.001. The within patient coefficient of variation was 8.6% for the Biothesiometer and 8.1% for the Neurothesiometer. The Neurothesiometer gives results that are in close agreement with the Biothesiometer and has a good coefficient of variation in routine clinical use. It is a self contained, battery operated device, which, although more expensive than its predecessor, is well suited to diabetes screening programmes and would be particularly useful to epidemiological surveys in the community.
Adult↗
Alternative medicine: potential dangers for the diabetic foot.
Two patients with non-insulin-dependent diabetes mellitus and previously undiagnosed peripheral neuropathy consulted separate practitioners in alternative medicine with symptoms of painful cold feet. They both received the traditional Chinese therapy of moxibustion and subsequently developed painless ulceration at the sites of treatment on the feet and legs. These cases re-emphasize the dangers of trauma to the neuropathic limb in patients with diabetes.
Adult↗
Painful neuropathy and foot ulceration in diabetic patients.
OBJECTIVE: To examine the prevalence of painful symptoms in neuropathic patients with or without foot ulceration. It has been suggested that there are two clinical presentations of sensory diabetic neuropathy with little overlap: painful (acute or chronic) and painless with recurrent foot ulceration. RESEARCH DESIGN AND METHODS: We examined three groups of diabetic patients matched for age and duration of diabetes--24 without neuropathy on clinical grounds (mean age 56.1 yr [range 38-76 yr], diabetes duration 12.6 yr [0.4-40 yr]), 30 with neuropathy (mean age 55.3 yr [range 21-73 yr], diabetes duration 17.3 yr [range 0.2-61 yr]), and 40 with neuropathic foot ulceration (mean age 58.1 yr [range 41-72 yr], diabetes duration 18.5 yr [range 1-46 yr])--and compared them with 20 healthy subjects (mean age 50 yr [range 37-69 yr]). For evaluation of neuropathy, the neuropathy symptom score, neuropathy disability score, and vibration perception threshold were measured. RESULTS: No difference existed between the neuropathic and foot ulcer groups in the neuropathy symptom score (4.2 +/- 3.9 [mean +/- SD] vs. 2.5 +/- 2.1, NS) and neuropathy disability score (15.1 +/- 5.7 vs. 16.8 +/- 6.1, NS), but the vibration perception threshold was lower in the neuropathic group (30.1 +/- 13.4 vs. 40.5 +/- 13.8 V, P < 0.001). Painful symptoms (neuropathy symptom score > 3), either in the past or during the time the study was conducted, had been experienced by none of the control subjects, 7 (29%) of the nonneuropathic group, 18 (60%) of the neuropathic group, and 17 (43%) of the foot ulcer group (NS for the last two groups), and were present at the time of examination in 13 (43%) of the neuropathic group and in 13 (33%) of the foot ulcer group (NS in all groups). Duration of symptoms was < 12 mo in 12 (40%) neuropathic and 15 (38%) foot ulcer patients (NS). CONCLUSIONS: We conclude that painful symptoms are frequent in diabetic neuropathy, irrespective of the presence or absence of foot ulceration and that these symptoms can occur at any stage of the disease. These results suggest that there is a spectrum of neuropathic syndromes from the painful to the patients with foot ulceration, and that much overlap exists.
Adult↗
Role of experimental socks in the care of the high-risk diabetic foot. A multicenter patient evaluation study. American Group for the Study of Experimental Hosiery in the Diabetic Foot.
OBJECTIVE: To assess the acceptability of specially designed socks to provide satisfactory pressure relief in the insensitive, high-risk, diabetic foot. We have conducted a longitudinal multicenter patient evaluation study to assess the acceptability of such hosiery in neuropathic diabetic patients. RESEARCH DESIGN AND METHODS: A group of 86 neuropathic diabetic patients (69 males, 14 with type I diabetes) with a mean age of 63 yr (range 34-85 yr), and a diabetes duration of 16 yr (range 1-45 yr) participated in the study. Peripheral vascular disease was present in 28 (33%) patients, previous foot ulceration in 39 (44%) patients, and active ulceration was present in 11 (13%) patients. All patients were provided with three pairs of specially designed socks and 80 patients with extra-depth shoes. Evaluation and foot examination were performed at 3 and 6 mo. RESULTS: Socks were worn for a mean of 6 days/wk (range 1-7 days/wk). Patient satisfaction evaluated at both visits was good or very good in 85%, average in 12%, and poor in 3% of patients. Ten ulcers healed during this period, and seven new ulcers occurred. Intention to continue wearing the socks, most or all of the time, was expressed by 84% of patients. CONCLUSIONS: We conclude that the experimental socks have a high level of patient satisfaction when worn with suitable shoes, and may be an acceptable and inexpensive addition to existing methods of protecting the high-risk insensitive diabetic foot.
Adult↗
The use of alginates in the management of exudating, infected wounds: case studies.
The purpose of this article is to illustrate the use of alginate wound packing on difficult-to-manage wounds. Three case studies are presented with 18 photographs that illustrate the various stages of healing. All wounds were infected, malodorous, and heavily exudative when treatment was initiated.
Adult↗