Trial of a Trivial Quantitative Heat-Pain Stimulus for Detecting Severe Loss of Nociception.

Background: Loss of nociception (LON) at the feet of persons with diabetes mellitus develops gradually over years and remains asymptomatic until the first painless diabetic foot ulceration (DFU). Severe LON with pain insensitivity can be diagnosed with a mechanical (pinprick) pain stimulus of 512-mN force. A comparable "suprathreshold" heat-pain stimulus may have the same potential.

A Novel Diagnostic Test for End-Stage Sensory Failure Associated With Diabetic Foot Ulceration: Proof-of-Principle Study.

Background: Diabetic foot ulceration (DFU) affects only a subgroup of patients with diabetic neuropathy, that is, those with pain-insensitivity due to end-stage sensory failure. Pain perception failure develops insidiously and remains asymptomatic until first DFU. As loss of pain perception is clinically significant, timely detection is mandatory.

Follow up of MRI bone marrow edema in the treated diabetic Charcot foot - a review of patient charts.

: Ill-defined areas of water-like signal on bone magnetic resonance imaging (MRI), characterized as bone marrow edema or edema-equivalent signal-changes (EESC), is a hallmark of active-stage pedal neuro-osteoarthropathy (Charcot foot) in painless diabetic neuropathy, and is accompanied by local soft-tissue edema and hyperthermia. The longitudinal effects on EESC of treating the foot in a walking cast were elucidated by reviewing consecutive cases of a diabetic foot clinic. : Retrospective observational study, chart review : Cases with active-stage Charcot foot were considered, in whom written reports on baseline and follow-up MRI studies were available for assessment.

Conventional deep pressure algometry is not suitable for clinical assessment of nociception in painless diabetic neuropathy.

Background: In diabetic persons with painless neuropathic foot ulceration, foot skin was found to be insensate to noxious pinprick stimulation (stimulation area less than 0.05 mm), while compression of deep subcutaneous foot tissues by Algometer II (stimulation area 1 cm) could evoke a deep dull aching. To elucidate this discrepancy, the Algometer II stimulation technique was critically reviewed by varying probe sizes and anatomical sites in the same study population 3 years later.

Nociception at the diabetic foot, an uncharted territory.

The diabetic foot is characterised by painless foot ulceration and/or arthropathy; it is a typical complication of painless diabetic neuropathy. Neuropathy depletes the foot skin of intraepidermal nerve fibre endings of the afferent A-delta and C-fibres, which are mostly nociceptors and excitable by noxious stimuli only. However, some of them are cold or warm receptors whose functions in diabetic neuropathy have frequently been reported.

Effect of painless diabetic neuropathy on pressure pain hypersensitivity (hyperalgesia) after acute foot trauma.

Introduction And Objective: Acute injury transiently lowers local mechanical pain thresholds at a limb. To elucidate the impact of painless (diabetic) neuropathy on this post-traumatic hyperalgesia, pressure pain perception thresholds after a skeletal foot trauma were studied in consecutive persons without and with neuropathy (i.e.

Insulin-induced localized lipoatrophy preceded by shingles (herpes zoster): a case report.

Introduction: Localized involutional lipoatrophy of subcutaneous adipose tissue may develop due to subcutaneous injection of pharmaceutical preparations. The pathogenesis of this adverse drug reaction is unknown. The progression of localized involutional lipoatrophy ceases and occasionally it resolves after withdrawing the inducing agent.

Is the Eichenholtz classification still valid for the diabetic Charcot foot?

In his 1966 monograph "Charcot joints", Sidney N. Eichenholtz (1909-2000) described "three well defined stages … in the course and development of a Charcot joint", based on plain X-rays of 68 patients. Since then, medical imaging has advanced very much: computed tomography and magnetic resonance imaging (MRI) scans exceed plain X-ray by far in detecting foot fractures and other injuries.

The acute diabetic Charcot foot managed on the basis of magnetic resonance imaging--a review of 71 cases.

Background: Acute Charcot foot (ACF) is a skeletal breakdown associated with inflammatory swelling of a foot in patients with pain insensitivity, such as diabetic neuropathy. In ACF stage 0, skeletal pathology (e.g.

Pressure pain perception in the diabetic Charcot foot: facts and hypotheses.

Background: Reduced traumatic and posttraumatic (nociceptive) pain is a key feature of diabetic neuropathy. Underlying condition is a gradual degeneration of endings of pain nerves (A-delta fibers and C-fibers), which operate as receivers of noxious stimuli (nociceptors). Hence, the absence of A-delta fiber mediated sharp pain ("first" pain), and of C-fiber mediated dull pain ("second" pain).

Pressure pain perception at the injured foot: the impact of diabetic neuropathy.

Background: At feet with painless diabetic neuropathy (PDN) and a healed fracture (quiescent Charcot-foot), cutaneous pressure pain perception threshold (CPPPT) is elevated beyond the range of measurement, whereas deep pressure pain perception threshold (DPPPT) may be normal. It is unknown, how these thresholds behave under the conditions of a foot injury. We therefore measured CPPPT and DPPPT in the vicinity of a unilateral active foot injury.

The diagnostic value of measuring pressure pain perception in patients with diabetes mellitus.

Question Under Study: Repetitive skin trauma and reduced pressure pain sensation are necessary components of plantar ulcer risk in patients with diabetic neuropathy. The diagnostic value of measuring pressure nociception to detect ulcer risk is, however, unknown. Instead, measuring the vibration perception threshold (VPT) by 64 Hz graduated Rydel-Seiffer tuning fork has become standard clinical practice to screen for neuropathy and ulcer proneness.

Pressure pain thresholds at the diabetic Charcot-foot: an exploratory study.

Objective: Painless mechanical trauma is believed to induce neuroosteoarthropathy at the neuropathic foot in diabetes (diabetic Charcot-foot). To investigate pressure nociception at the diabetic foot, we measured the pain perception thresholds for deep pressure (DPPPT, using Algometer II®) and cutaneous pressure (CPPPT, using calibrated monofilaments).

Methods: In 24 diabetic patients with painless neuropathy (11 with a chronic, inactive Charcot-foot and a history of foot ulcer, and 13 control patients who never had an ulcer), and in 20 healthy subjects, CPPPT (at palmar and plantar digital skinfolds) and DPPPT (over musculus abductor pollicis, musculus hallucis longus, and over metacarpophalangeal and metatarsophalangeal joints) was measured.

Relapsing insulin-induced lipoatrophy, cured by prolonged low-dose oral prednisone: a case report.

Introduction: Circumscript, progressing lipoatrophy at the insulin injection sites is an unexplained, however rare condition in diabetes mellitus.

Case Presentation: We report a case of severe localised lipoatrophy developing during insulin pump-treatment (continuous subcutaneous insulin infusion) with the insulin analogue lispro (Humalog®) in a woman with type-1 diabetes mellitus. After 11 months of progressing lipoatrophy at two spots on the abdomen, low-dose prednisone (5-10 mg) p.

Differences in bioactivity between human insulin and insulin analogues approved for therapeutic use- compilation of reports from the past 20 years.

In order to provide comprehensive information on the differences in bioactivity between human insulin and insulin analogues, published in vitro comparisons of human insulin and the rapid acting analogues insulin lispro (Humalog®), insulin aspart ( NovoRapid®), insulin glulisine (Apidra®), and the slow acting analogues insulin glargine (Lantus®), and insulin detemir (Levemir®) were gathered from the past 20 years (except for receptor binding studies). A total of 50 reports were retrieved, with great heterogeneity among study methodology. However, various differences in bioactivity compared to human insulin were obvious (e.

Meeting report: 3rd international workshop on insulin & cancer heidelberg, Germany, october 30-31, 2010.

The 3rd International Workshop on Insulin & Cancer was held on October 30-31, 2010 at the German Cancer Research Centre in Heidelberg/Germany. The topics followed-up the discussions of the previous workshops: possible differences in mitogenicity between natural insulin and genetically engineered insulin derivatives (insulin analogues), as shown by laboratory studies and epidemiologic studies alike; molecular studies on the links between metabolic and mitogenic effects of insulin, and of hyperinsulinaemia in particular; epidemiologic evidence of interferences between insulin and other hormones, particularly sex hormones, and obesity-associated cancer; the involvement of inflammatory cytokines produced by fat tissue in obesity-associated cancer; aspects of drug-design (binding drugs to albumin) and, last but not least, detection and investigation of circulating cancer cells.

Sudeck's disease stage 1, or diabetic Charcot's foot stage 0? Case report and assessment of the diagnostic value of MRI.

Background: The diagnosis of Sudeck's syndrome stage 1 (nowadays termed complex regional pain syndrome I, abbreviated CRPS I) is based on clinical features, namely swelling and pain in a limb. Plain X-ray may be normal. In the absence of pain sensitivity, e.