1/7. Diabetic neuropathy masquerading as glossodynia.BACKGROUND: Diabetic neuropathy, or DN, occurs in approximately 50 percent of patients who have type 2 diabetes mellitus, or DM. Oral burning and symptoms consistent with glossodynia (burning mouth syndrome) may occur secondary to DN. CASE DESCRIPTION: A 54-year-old woman reported to a university dental clinic with a chief complaint of oral burning. No clinical signs were evident. Her medical history was positive for type 2 DM. The initial diagnosis was glossodynia, and she was evaluated with relevant blood studies, which indicated that her diabetes was not well-controlled. The patient was referred back to her physician, and her symptoms abated once her diabetic condition was under control. CLINICAL IMPLICATIONS: It is important to consider DN within the differential diagnoses of patients who have symptoms consistent with glossodynia but have no clinical signs. dentists are invaluable in ascertaining underlying systemic disease considerations in patients with oral symptomatology. Cooperation between dentists and physicians often is helpful and necessary in caring for patients who have uncontrolled type 2 DM and oral symptoms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Profiles in patient safety: when an error occurs.Medical error is now clearly established as one of the most significant problems facing the American health care system. Anecdotal evidence, studies of human cognition, and analysis of high-reliability organizations all predict that despite excellent training, human error is unavoidable. When an error occurs and is recognized, providers have a duty to disclose the error. Yet disclosure of error to patients, families, and hospital colleagues is a difficult and/or threatening process for most physicians. A more thorough understanding of the ethical and social contract between physicians and their patients as well as the professional milieu surrounding an error may improve the likelihood of its disclosure. Key among these is the identification of institutional factors that support disclosure and recognize error as an unavoidable part of the practice of medicine. Using a case-based format, this article focuses on the communication of error with patients, families, and colleagues and grounds error disclosure in the cultural milieu of medial ethics.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. Charcot foot osteoarthropathy in diabetes mellitus.Charcot joint, a destructive bone and joint disorder of the foot, is becoming more common in long-term diabetic patients. The combination of diabetic neuropathy and painless trauma causes dislocation and collapse of the tarsal joints. The resulting soft tissue and osseous pathology easily mimics an infective episode. This report presents a review of the clinical identification, diagnosis, and treatment of this unusual diabetic complication, plus a review of three cases. Also, the pathogenesis of Charcot joint is explained in describing why surgery can be a viable treatment alternative in these patients, after careful evaluation. It is also necessary that physicians inspect the feet of their diabetic patients to rule out quiescent beginnings of Charcot joints. Referral to a podiatrist is recommended for long-term management of the Charcot foot.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/7. diabetic foot amputations. Part I: Digital.Foot lesions in diabetic patients with sensory deficiencies are ignored or not noted by the patients, therefore, leading to major infections of the soft tissue and/or bone. This can be quite devastating with subsequent loss of limb and life-threatening if the extent of the problem is not recognized and prompt treatment initiated. If an amputation is necessary, it should be performed at the lowest level possible. Part I of this series of articles, concerning diabetic foot amputations, will review the pathogenesis, indications, objective vascular criteria, basic surgical principles and complications of diabetic foot amputations. case reports with various digital amputation procedures and their postoperative care will also be presented in detail. A team approach should be used in the treatment of diabetic foot disorders. The podiatrist, along with admitting internist, leads a team of other specialists including: radiologist, vascular surgeon, infectious disease physicians and plastic surgeon, depending on the progression of foot pathology.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/7. lower extremity burns related to sensory loss in diabetes mellitus.A chart review of 37 hospitalized patients with diabetes mellitus who received burn therapy showed that ten (27 percent) had preventable lower-extremity burns related to sensory loss. Most of these ten burns occurred from heat applied for self-care of diabetes, namely, from hot tap water, a hot moist compress, or a heating pad. These ten patients, compared with the other 27 diabetic burn patients, were more likely to be men younger than 45 years old, to have insulin-dependent diabetes, and to have been burned during self-treatment. These findings underscore the importance of injury-prevention educational efforts by physicians in cautioning their diabetic patients, especially those with lower-extremity sensory losses, about potential burns from heat applied to the lower extremities for self-care.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/7. spinal stenosis. A common cause of podiatric symptoms.spinal stenosis, involving pressure on either the central spinal cord or nerve root exiting the spinal canal, can cause a variety of symptoms in the lower extremities. A classic symptom is that of neurogenic claudication, involving leg pain and weakness brought on by walking. The pain is relieved by sitting or lying down, not by standing and resting as would be seen in arterial insufficiency-induced claudication. Other symptoms of spinal stenosis can involve paresthesia, weakness or cramping in one or both extremities, rest pain, or burning pain, and are commonly misdiagnosed as peripheral neuropathy, especially in patients with diabetes. Symptoms are often chronic, frequently missed, or misdiagnosed in the medical community, and may cause severe disability or reduction in the quality of life. spinal stenosis is in some patients the unidentified cause of failure of treatment of foot and leg pain. Podiatric physicians, who focus on the patient's lower extremities, are in a unique position to be able to identify spinal stenosis and facilitate appropriate treatment. The authors provide current information regarding symptoms of spinal stenosis, a guide to diagnosis including the anatomical etiologies, and a basic understanding of treatment.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
7/7. Limb threatening neuropathic complications from ankle fractures in patients with diabetes.Although less common than neuropathic (Charcot) deformities in feet, ankle deformities can occur and produce significant limb threatening complications after injury in patients with longstanding diabetes. A series of six such complications, including one that resulted in amputation and several near amputations, are presented. The authors' primary purpose is to alert or remind physicians and orthopaedic surgeons of the often unanticipated but significant complications of these rare and seemingly mild ankle injuries. A secondary purpose is to point out that complications may be avoided or mitigated with early stabilization and possibly with treatment of bone resorbing, inflammatory processes characteristic of neuroarthropathies.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |