Long-term follow-up in diabetic Charcot feet with spontaneous onset

CEL. Ocena odległych wyników leczenia artropatii Charcota u chorych ze stopą cukrzycową. MATERIAŁ I METODY. Badanie przeprowadzono retrospektywnie. Obserwowano 115 pacjentów (140 stóp), 107 osób z ostrą deformacją Charcota i 8 z deformacją przewlekłą, przez okres średnio 48 miesięcy (zakres 6–114). Rutynowe postępowanie w przypadkach nagłych polegało na odciążeniu za pomocą kul ortopedycznych oraz zabezpieczeniu stopy butem terapeutycznym do czasu normalizacji temperatury stopy, a następnie na stopniowym dociążaniu w bucie wykonywanym na zamówienie lub w zmodyfikowanym obuwiu typowym. WYNIKI. Częstość występowania stopy Charcota wynosi 0,3% w przebadanej populacji chorych na cukrzycę. Około połowa pacjentów pracowała zawodowo. Poważniejsze powikłania, wymagające interwencji chirurga, wystąpiły u 5 pacjentów (4%): artrodezę z powodu niestabilności nieprawidłowo ustawionych kostek stwierdzono u 3 pacjentów (u 1 — obustronną), a rozległe amputacje konieczne były u 2 pacjentów z powodu niestabilności kostek oraz owrzodzeń spowodowanych nieprawidłowym rozkładem ciśnienia na stopie. Łagodniejsze powikłania odnotowano u 43% chorych: nowe przypadki artropatii u 41 osób (36%) lub owrzodzenie stopy — u 43 (37%), a takie, które wymagały ograniczonej interwencji chirurgicznej — u 11 pacjentów (9%). Zmiany te nie ustąpiły jedynie u 2 chorych; 1 pacjent zmarł przed wyleczeniem złamania Charcota i 1 przed zagojeniem się owrzodzenia. Żaden z chorych nie utracił zdolności samodzielnego poruszania się. WNIOSKI. Przeprowadzenie poważnych zabiegów chirurgicznych było konieczne tylko u 4% chorych z deformacją Charcota w obrębie kostek. Łagodniejsze powikłania odnotowano u prawie połowy pacjentów. Profilaktyka i leczenie stóp są konieczne do końca życia chorego na artropatię Charcota.OBJECTIVE. To assess the long-term results after Charcot breakdown with spontaneous onset in diabetic feet. RESEARCH DESIGN AND METHODS. This study was retrospective. A total of 115 patients (140 feet), 107 with acute deformity and 8 with chronic Charcot deformity, were followed for a median of 48 months (range 6–114). The routine treatment for acute cases was a weight-off regimen with crutches and foot protection with therapeutic shoes until skin temperature had normalized followed by increased weightbearing and the use of bespoke shoes or modification of conventional shoes. RESULTS. The incidence of Charcot deformity was 0.3%/ /year in the diabetic population investigated. About half of the patients were active in their jobs. Major complications were encountered in 5 (4%) of the patients that required surgical intervention: arthrodesis for unstable malaligned ankles in 3 subjects (1 bilaterally) and major amputation in 2 subjects for unstable ankle and pressure sores. Minor complications were recorded in 43% of subjects: new attacks of Charcot breakdown in 41 patients (36%) and/or foot ulceration in 43 patients (37%) that required minor surgical procedures for 11 patients. All healed except in 2 patients: 1 patient died before the Charcot fractures had healed, and 1 patient died with an unhealed ulcer. No patient lost the ability to walk independently. CONCLUSIONS. Major surgical procedures in only 4% were particularly related to patients with Charcot deformities in the ankle. Minor complications were recorded in about half of the patients. Lifelong foot care is required for diabetic patients with Charcot feet

Quasiparticle structure and coherent propagation in the t−Jz−J⊥t-J_{z}-J_{\perp} model

Numerical studies, from variational calculation to exact diagonalization, all indicate that the quasiparticle generated by introducing one hole into a two-dimensional quantum antiferromagnet has the same nature as a string state in the $t-J_{z}$ model. Based on this observation, we attempt to visualize the quasiparticle formation and subsequent coherent propagation at low energy by studying the generalized $t-J_{z}-J_{\perp}$ model in which we first diagonalize the $t-J_{z}$ model and then perform a {\em degenerate} perturbation in $J_{\perp}$. We construct the quasiparticle state and derive an effective Hamiltonian describing the coherent propagation of the quasiparticle and its interaction with the spin wave excitations in the presence of the N\'{e}el order. We expect that qualitative properties of the quasiparticle remain intact when analytically continuing $J_{\perp}$ from the anisotropic $J_{\perp} < J_{z}$ to the isotropic $J_{\perp} = J_{z}$ limit, despite the fact that the spin wave excitations change from gapful to gapless. Extrapolating to $J_{\perp}=J_{z}$, our quasiparticle dispersion and spectral weight compare well with the exact numerical results for small clusters.Comment: Revised with minor changes and references updated. To appear in Phys. Rev. B., Jan. 1996. 10 pages, The complete PostScript file including figures can be obtained via ftp at ftp://serval.berkeley.edu/tjzjp.ps . It is also posted in the WEB site of Niels Bohr Institute at http://roemer.fys.ku.dk/recent.ht

Hair as an indicator of the body content of polonium in humans: Preliminary results from study of five male volunteers

The radionuclide (210)Po is of importance from a radiation protection view and has properties that cause special problems when attempting to determine the body content in humans. Estimates have traditionally been made from either urine and/or fecal samples, which require a time-consuming radiochemical preparation before alpha spectrometric determination. In order to find a more simple and less labor intensive method hair has been used as a bioindicator and investigated in this study. The relationship between intake and excretion in hair has been estimated in five volunteers who ingested radioactive polonium ((209)Po as a bio-tracer for (210)Po) in well determined quantities. Four of the volunteers were given 5-10 Bq (209)Po in a single intake (acute intake) and one volunteer has ingested a daily intake of 58.7 mBq (209)Po for a period of 180 d. Human hair was found to reflect the daily clearance of ingested polonium peaking at 0.001-0.01% d(-1) of the ingested amount, thereafter decreasing mono-exponentially, corresponding to a biological half-time of 10-20 days. For the case of protracted intake a mono-exponential build-up was observed with a half-time of 40 ± 5 d. In addition, after cessation of intake, a short-term component (74%) with a biological half-time of 16 ± 4 d, and a long-term component (26%) with a half-time of 93 ± 53 d were observed. It is concluded that hair can be used to detect not only the amount of ingested polonium but also whether the intake was protracted or acute