Diagnosis of pedal osteomyelitis in diabetic patients using current scintigraphic techniques

Article Abstract:

Foot problems are common to diabetic patients, and they can be complicated by the presence of osteomyelitis (OM), inflammation of the bone marrow. Three-phase bone scintigraphy (TPBS), a radionuclide bone imaging technique using radioactive technetium 99m, has been the method of choice for providing images of arterial blood flow, blood pool activity and uptake of the bone tracer in the feet of diabetic patients. Use of TPBS alone, however, does not permit the accurate diagnosis of OM, particularly in diabetic patients, who often suffer from many other diseases that may appear similar to OM on TPBS images. Researchers evaluated indium 111-labeled white blood cell scintigraphy (WBCS) in a trial of 77 diabetic patients suspected of having foot OM. The sensitivity of WBCS was compared with TPBS and standard X-ray imaging of the feet. Using WBCS, researchers were able to identify OM in 100 percent of the 19 patients with confirmed OM. This result, however, must be tempered by the fact that all 19 patients were symptomatic and, therefore, had a high degree of likelihood of active OM disease. Overall, WBCS was better able to localize the site of infection than was TPBS. Results of this study suggest that WBCS is better able to differentiate between OM and other foot problems in diabetics than is TPBS. Furthermore, WBCS is more accurate in the site- identification of OM infections than are other imaging techniques, such as X-ray imaging and TPBS. X-ray imaging remains well suited for localizing the disease with a great degree of precision and detail. X-ray images can confirm destruction of bones, and provide important information that is of use in surgical planning. Researchers state that WBCS and X-ray foot images are the most accurate imaging modalities for diagnosis of pedal OM in diabetics.

Usage, PET imaging, Positron emission tomography, Radiography, Medical, Medical radiography, Diagnostic imaging, Foot

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Diagnosis of hematogenous pyogenic vertebral osteomyelitis by magnetic resonance imaging

Article Abstract:

Hematogenous pyogenic vertebral osteomyelitis is an infectious process in which bacteria form abscesses within the bones of the spine, as the result of spread through the bloodstream. Making a diagnosis of vertebral osteomyelitis has often been difficult in the past, due to the somewhat vague symptom complex of back or neck pain, occasional leg weakness, and in about half of the patients, fever. Traditional X-rays are not able to make the diagnosis easily, as the abnormalities seen on some plain spine X-rays or CT scans often do not appear until the patient has been ill for several weeks. Nuclear imaging studies, such as bone scans and gallium scans to locate abscesses, are nonspecific, and the same abnormalities seen in vertebral osteomyelitis will be found in arthritis and healing fractures. Magnetic resonance imaging (MRI) is a technology that utilizes powerful magnetic fields to produce clear images of internal structures with far greater detail than most of the older imaging techniques. Twenty-seven patients with vertebral osteomyelitis underwent various imaging studies during the course of their illnesses. Routine spine X-rays made the diagnosis in only 48 percent of the patients, CT scans in 65 percent, bone scans in 71 percent, and gallium scans in 86 percent. MRI made the diagnosis in all 27 patients. MRI offered other advantages over the conventional techniques, such as greater accuracy in detecting spread to tissues surrounding the spine, and easier localization of the site of infection for purposes of performing a biopsy. MRI should be the initial imaging technique in patients in whom vertebral osteomyelitis is suspected, because of its earlier and greater accuracy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Magnetic resonance imaging, Vertebrae

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Diabetic diarrhea: pathophysiology, diagnosis, and management

Article Abstract:

Idiopathic diarrhea, or diarrhea of unknown cause, is a common problem in diabetes mellitus; it often occurs in patients with poorly-controlled, insulin-dependent diabetes and accompanying neuropathy or nerve disease affecting the peripheral and autonomic nervous system. The peripheral nervous system controls muscles and organ activity, whereas the autonomic nervous system specifically modulates involuntary body functions, such as heart rate, breathing, and excretion. Diabetes-related diarrhea may be associated with steatorrhea, the formation of fatty stools. The diarrhea may occur intermittently, followed by normal bowel movements or constipation. It is painless, can occur during the day or night, and may be accompanied by fecal incontinence (loss of control over defecation). The possible mechanisms that may cause diabetes-related diarrhea include: autonomic neuropathy or disease of the autonomic nervous system, which regulates defecation; overgrowth of bacteria; and impaired function of the pancreas, a gland that secretes digestive enzymes. In order to differentiate idiopathic diarrhea from other causes of diarrhea, the patient must undergo appropriate clinical assessment. Diabetes-related diarrhea may be difficult to treat, although antibiotics that eliminate bacterial overgrowth, antidiarrheal agents, the drug clonidine, and forms of the hormone somatostatin, which prevents the release of various other hormones, have been shown to be effective. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Physiological aspects, Diarrhea, Diabetic neuropathies

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