And then here is what I saw regarding edema:https://www.google.com/search?site=&tbm=isch&source=hp&biw=1440&bih=741&q=edema+on+legs&oq=edema+on+legs&gs_l=img.3..0j0i24l4
So, in some kinds of edema symptoms there is swelling more but then if you look further there are other signs that are sort of like Diabetes rash. But, the treatments for both are very different. For example, for Edema often Spironolactone is recommended often to reduce swelling when indicated. But, for some types of diabetes it appears that insulin or a complete dietary and exercise change is recommended.
When I asked the above question this is the first response that came up.
 |
 George Liu, DPM, FACFAS Assistant Professor |
CHARCOT VERSUS OSTEOMYELITIS:
Can Diagnostic Imaging Tell Them Apart?
You
receive a call from the hospitalist who consults you on a 59 year old
patient with diabetes and peripheral neuropathy who was admitted for a
red, hot, swollen foot — working diagnosis of cellulitis. Patient
related a history of sudden onset of foot instability and pain with
weightbearing. Radiographs reveal midfoot breakdown with osteolysis and
fragmentation appearing to be charcot arthropathy. However,
complicating the diagnosis is a plantar ulcer which probes deep near
bone. Magnetic resonance imaging was ordered revealing bone marrow
edema to the bones of the tarsometatarsal joints extending to the cuboid
and navicular. An Indium-111 tagged white blood cell (WBC) scan was
ordered showing delayed stage accumulation of WBCs in the midfoot. Now
we are faced with a diagnostic dilemma -- Is it infection or
inflammation? How reliable are diagnostic imaging techniques in
determining the difference between osteomyelitis and Charcot
osteoarthropathy?
|
Though a common survey tool, plain radiographs may not provide distinguishing characteristics separating osteomyelitis from Charcot. In a comparative study by Lipman(1), radiographic evaluation of osteomyelitis in charcot was 75 percent sensitive (i.e. actual positives correctly identified as osteomyelitis), 50 percent specific (i.e. actual negatives correctly identified as not having osteomyelitis) and 58 percent accurate.
MAGNETIC RESONANCE IMAGING
Magnetic
resonance imaging is a useful method to identify inflammation within
the bone, whether from infection, tumor, or fracture. This
inflammation, often characterized by bone marrow edema, is seen as an
increase in signal intensity on a STIR or T2 weighted image.
Distinguishing bone marrow edema from osteomyelitis and Charcot
arthropathy may be challenging as both pathologies exhibit similar
signal characteristics. In a comparative analysis by Lipman(1),
magnetic resonance imaging was 100 percent sensitive; however, only 25
percent specific and 50 percent accurate in detecting osteomyelitis
with concomitant Charcot.
Identifying the patterns and
not only the presence of bone marrow edema may assist in
differentiating between the two entities. Bone marrow in osteomyelitis
and acute Charcot will demonstrate increased signal intensity with T2
and STIR and decreased T1 weighted signal intensity, whereas chronic
Charcot often demonstrates decreased T1 and T2 weighted signal
intensities. Bone marrow edema in osteomyelitis usually involves a
single bone as is often contiguous with an ulcer. In contrast, Charcot
marrow edema distribution is periarticular and subchondral involvement
of multiple bones as seen in Figure 1 (see below). Gross foot
deformity is usually common in Charcot but foot architecture preserved
in osteomyelitis.(5)
|
NUCLEAR IMAGING
Nuclear imaging techniques utilize radiopharmaceutical tracers to measure biologic activity of specific cells reflecting physiologic process within bone.
Nuclear imaging techniques utilize radiopharmaceutical tracers to measure biologic activity of specific cells reflecting physiologic process within bone.
Technetium99 Methylene
Diphosphonate (MDP) labels hydroxyapetite which is used to measure bone
turnover. Though highly sensitive, this method may not differentiate
between bone reparative activity due to infection versus trauma.(3)
For osteomyelitis alone, Technetium-99 MDP bone scans were only 67 percent positive in patients with positive bone cultures.(4)
Indium-111 labeled leukocytes primarily localize in neutrophil mediated inflammatory processes such as those found in bacterial infections of bone marrow. This method is believed to improve diagnostic value for infections as leukocytes, theoretically, do not accumulate in areas of increase bone turnover in absence of infection. A combined Technetium-99 MDP with Indium-111 bone scan, also referred to as a “dual bone scan”, was 50 percent sensitive (i.e. actual positives correctly identified as osteomyelitis), 100 percent specific (i.e. actual negatives correctly identified as not having osteomyelitis) and 81% percent accurate for the diagnosis of osteomyelitis. For osteomyelitis with charcot, sensitivities and specificities were the same and therefore distinguishing osteomyelitis from a concomitant charcot process was not improved. Attributing to this lack of variation, leukocytes were found to accumulate in bone during the acute and reparative stages of the charcot process creating difficulty distinguishing between this reparative process versus infection.(3)
Radiopharmaceutical bone marrow imaging techniques has been shown to have diagnostic value in identifying osteomyelitis from charcot arthropathy. Technetium 99m sulfur colloid, also known as “bone marrow imaging”, is used to image areas of reticuloendothelial cells commonly found in the liver, spleen and bone marrow. Both white blood cells and sulfur colloid accumulate in bone marrow. In the case of bone infection, marrow elements infarct reducing the accumulation of the sulfur colloid radiopharmaceutical. In contrast, Indium-111 labeled leukocytes will gather in areas of infection. Therefore, dual scan imaging with Technetium-99m sulfur colloid in combination with Indium-111 labeled leukocytes may be useful on the basis that white blood cells accumulate in areas of infection where sulfur colloid does not. With this combined imaging technique, a relative presence of sulfur colloid and labeled leukocytes is referred to as “spatially congruent” and is low probability for osteomyelitis. In images with absent uptake of sulfur colloid but relative collection of labeled leukocytes, image is referred to as “spatially incongruent” – consistent with osteomyelitis as shown in Figure 2 (see below). Accuracy of this method ranges from 88 to 98 percent.(2)
For osteomyelitis alone, Technetium-99 MDP bone scans were only 67 percent positive in patients with positive bone cultures.(4)
Indium-111 labeled leukocytes primarily localize in neutrophil mediated inflammatory processes such as those found in bacterial infections of bone marrow. This method is believed to improve diagnostic value for infections as leukocytes, theoretically, do not accumulate in areas of increase bone turnover in absence of infection. A combined Technetium-99 MDP with Indium-111 bone scan, also referred to as a “dual bone scan”, was 50 percent sensitive (i.e. actual positives correctly identified as osteomyelitis), 100 percent specific (i.e. actual negatives correctly identified as not having osteomyelitis) and 81% percent accurate for the diagnosis of osteomyelitis. For osteomyelitis with charcot, sensitivities and specificities were the same and therefore distinguishing osteomyelitis from a concomitant charcot process was not improved. Attributing to this lack of variation, leukocytes were found to accumulate in bone during the acute and reparative stages of the charcot process creating difficulty distinguishing between this reparative process versus infection.(3)
Radiopharmaceutical bone marrow imaging techniques has been shown to have diagnostic value in identifying osteomyelitis from charcot arthropathy. Technetium 99m sulfur colloid, also known as “bone marrow imaging”, is used to image areas of reticuloendothelial cells commonly found in the liver, spleen and bone marrow. Both white blood cells and sulfur colloid accumulate in bone marrow. In the case of bone infection, marrow elements infarct reducing the accumulation of the sulfur colloid radiopharmaceutical. In contrast, Indium-111 labeled leukocytes will gather in areas of infection. Therefore, dual scan imaging with Technetium-99m sulfur colloid in combination with Indium-111 labeled leukocytes may be useful on the basis that white blood cells accumulate in areas of infection where sulfur colloid does not. With this combined imaging technique, a relative presence of sulfur colloid and labeled leukocytes is referred to as “spatially congruent” and is low probability for osteomyelitis. In images with absent uptake of sulfur colloid but relative collection of labeled leukocytes, image is referred to as “spatially incongruent” – consistent with osteomyelitis as shown in Figure 2 (see below). Accuracy of this method ranges from 88 to 98 percent.(2)
|
1. Radiographs alone may not provide
adequate accuracy to distinguish osteomyelitis and Charcot arthropathy.
2. Pattern of bone marrow edema between osteomyelitis and Charcot on MRI may help differentiate the two conditions unless both conditions exist at the same time. 3. Indium-111 tagged WBC scan may present with false positives as WBCs can accumulate in during the acute and reparative phases of the Charcot process. 4. Technetium-99m Sulfur Colloid bone marrow imaging in concert with Indium-111 labeled WBCs can greatly improve qualitative differentiation between bone marrow infection versus inflammation. 5. Imaging should be correlated with clinical findings to improve diagnostic differentiation between osteomyelitis and Charcot. |
REFERENCES
1. Lipman, B. T. et al.: Detection of osteomyelitis in the neuropathic foot: nuclear medicine, MRI and conventional radiography. Clin Nucl Med, 23(2): 77-82, 1998.2. Palestro, C. J.; Mehta, H. H.; Patel, M.; Freeman, S. J.; Harrington, W. N.; Tomas, M. B.; and Marwin, S. E.: Marrow versus infection in the Charcot joint: indium-111 leukocyte and technetium-99m sulfur colloid scintigraphy. J Nucl Med, 39(2): 346-50, 1998.
3. Seabold, J. E.; Flickinger, F. W.; Kao, S. C.; Gleason, T. J.; Kahn, D.; Nepola, J. V.; and Marsh, J. L.: Indium-111-leukocyte/technetium-99m-MDP bone and magnetic resonance imaging: difficulty of diagnosing osteomyelitis in patients with neuropathic osteoarthropathy. J Nucl Med, 31(5): 549-56, 1990.
4. Shults, D. W.; Hunter, G. C.; McIntyre, K. E.; Parent, F. N.; Piotrowski, J. J.; and Bernhard, V. M.: Value of radiographs and bone scans in determining the need for therapy in diabetic patients with foot ulcers. Am J Surg, 158(6): 525-9; discussion 529-30, 1989.
5. Tan, P. L., and Teh, J.: MRI of the diabetic foot: differentiation of infection from neuropathic change. Br J Radiol, 80(959): 939-48, 2007.
end quote from:
http://presentdiabetes.com/ezines/index.php?action=viewPublication&nopopout=true&confirmOff=true&SearchText=&id=269&keepThis=true&TB_iframe
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WHAT IS DIABETIC RASH
There are a number of rashes caused by the symptoms of diabetes that can occur with uneven. A couple of rash can be itchy and red as that of an allergic reaction. Others will simply darken the skin in small spots on the body. There is also a type of result that will lead to more bumps on the skin, the ability to have itching. No matter what type of person has a rash as a result of diabetes is a sure way to cope. Early diagnosis is important because it can reduce your risk of developing full blown version of the disease. Although diabetes is often genetic, there are many preventive measures you can take early to assess its impact on your life to reduce.
SYMPTOMS OF DIABETES RASH
Before a person learns they have diabetes, they begin to certain symptoms of the disease to have. One of these signs appear a result that is either a darkening of the skin or even a raised area. A skilled physician can offer a patient as a precursor to diabetes. This result may be a way to learn about diabetes before it has a chance to grow and stop. However, a rash develops diabetes after the disease has too. There are several eruptions that can be caused by diabetes, each result has its own symptoms. Some diabetics red rash and itching, including allergic reactions. result, where the dark color of the skin and appear as tiny spots on the body treatment of diaper diabetes maintain a healthy diet which keeps sugar levels at an appropriate level where people with diabetes to help prevent rashes and delete it.
TREATMENT OF DIABETES RASH
Rash ointments and creams feature also works for most skin rashes. Of course, in some cases a rash may be caused by diabetic injecting insulin. If a person sees an eruption in the area they get their chance soon after the shot is administered, they should consult their doctor immediately. Rash should always be discussed with a doctor during the events in case they might be caused by something other than diabetes. A good diet with the ability to keep blood glucose levels on a constant supply will help diabetics to prevent and eliminate the rash.
.DIABETES RASH ON LEG
Diabetic neuropathy - unrestrained diabetes can harm your nerves. If you have injured nerves in the legs and feet, you would not feel heat, cold or pain. This be deficient in of feeling is called diabetic neuropathy. If you do not experience a cut or stinging sensation on the foot because of neuropathy, the cut could get worse and become infected. • Peripheral vascular disease - Diabetes also affects blood flow. Without good circulation, it takes longer for a wound or cut to heal. Bad movement in the arms and legs is called peripheral vascular disease. (The word "peripheral" means "far from a central point and the word “vascular”refers to blood vessels. Peripheral vascular ailment is a situation that the arteries of the heart.) If you have an illness that does not heal because poor movement, you run the risk of rising gangrene, which is tissue death due to be short of of blood. To avert the extend of gangrene, the doctor of a toe, foot, or part of leg removed. This method is called amputation. Diabetes is the most general cause of leg amputations non-traumatic. Each year, over 56,000 people with diabetes have amputations. However, research indicates that more than half of these amputations can be prohibited with proper foot care.
end quote from:
http://www.selfgrowth.com/articles/what-is-diabetic-rash
And then since often this is a later in life event what if you have both events coinciding? You better have someone who could separate the events in some kind of useful manner like a doctor who can give you a prescription for medicines or diets or whatever or insulin or it could get quite serious if you just don't deal with it in some constructive way I think.
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