To quantify corneal ultrastructure using laser scanning in vivo confocal microscopy (IVCM) in pat... more To quantify corneal ultrastructure using laser scanning in vivo confocal microscopy (IVCM) in patients with keratoconus and control subjects. Unscarred corneas of 78 keratoconic subjects without a history of contact lens use and 36 age-matched control subjects were evaluated with slit-lamp examination (SLE), corneal topography and laser scanning IVCM. One eye was randomly chosen for analysis. Anterior and posterior stromal keratocyte, endothelial cell and basal epithelial cell densities and sub-basal nerve structure were evaluated. IVCM qualitatively demonstrated enlarged basal epithelial cells, structural changes in sub-basal and stromal nerve fibers, abnormal stromal keratocytes and keratocyte nuclei, and pleomorphism and enlargement of endothelial cells. Compared with control subjects, significant reductions in basal epithelial cell density (5817±306 cells/mm(2) vs 4802±508 cells/mm(2), P<0.001), anterior stromal keratocyte density (800±111 cells/mm(2) vs 555±115 cells/mm(2), ...
Page 1. Management of Painful Diabetic Neuropathy Patrick G. Jensen and Jennifer R. Larson Univer... more Page 1. Management of Painful Diabetic Neuropathy Patrick G. Jensen and Jennifer R. Larson University of Iowa Hospital and Clinics, Department of Pharmaceutical Care, Iowa City, Iowa, USA Contents Abstract . . . . . ...
This Practice Point commentary discusses the results of a study that employed thermal threshold t... more This Practice Point commentary discusses the results of a study that employed thermal threshold testing and quantification of intraepidermal nerve fiber (IENF) density in patients with diabetes who had normal electrophysiology findings. The study showed that a significant proportion of these patients had abnormalities in small-fiber function, as quantified by thermal thresholds, and structure, as quantified by IENF density. Interestingly, patients who showed symptoms of diabetic neuropathy had reduced IENF densities but no difference in thermal thresholds compared with diabetic patients lacking these symptoms. This study highlights the importance of establishing which tests should be used to detect the earliest nerve damage in diabetic neuropathy, and which tests should be used as end points in clinical trials relating to this condition.
Pitceathly, RDS and Tavakoli, M and Marshall, A and Roberts, ME and Gow, D and Efron, N and Malik... more Pitceathly, RDS and Tavakoli, M and Marshall, A and Roberts, ME and Gow, D and Efron, N and Malik, RA (2008) Corneal confocal microscopy to diagnose idiopathic small fibre neuropathy. In: JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY.(pp. 342-342). BMJ PUBLISHING GROUP
As of March 2016, we continue to advocate the diagnosis of diabetic neuropathy using a simple foo... more As of March 2016, we continue to advocate the diagnosis of diabetic neuropathy using a simple foot examination or monofilament, which identifies only those with severe neuropathy and hence risk of foot ulceration. Given the fact that the 5-year mortality rate of diabetic patients with foot ulceration is worse than that of most common cancers, surely we should be identifying patients at an earlier stage of neuropathy to prevent its progression to a stage with such a high mortality? Of course, we lament that there is no licensed treatment for diabetic neuropathy. Who is to blame? As researchers and carers, we have a duty of care to our patients with diabetic neuropathy. So, we have to look forward not backwards, and move away from our firmly entrenched views on the design and conduct of clinical trials for diabetic neuropathy. Relevant organizations such as Neurodiab, the American Diabetes Association and the Peripheral Nerve Society have to acknowledge that they cannot continue to en...
To quantify corneal ultrastructure using laser scanning in vivo confocal microscopy (IVCM) in pat... more To quantify corneal ultrastructure using laser scanning in vivo confocal microscopy (IVCM) in patients with keratoconus and control subjects. Unscarred corneas of 78 keratoconic subjects without a history of contact lens use and 36 age-matched control subjects were evaluated with slit-lamp examination (SLE), corneal topography and laser scanning IVCM. One eye was randomly chosen for analysis. Anterior and posterior stromal keratocyte, endothelial cell and basal epithelial cell densities and sub-basal nerve structure were evaluated. IVCM qualitatively demonstrated enlarged basal epithelial cells, structural changes in sub-basal and stromal nerve fibers, abnormal stromal keratocytes and keratocyte nuclei, and pleomorphism and enlargement of endothelial cells. Compared with control subjects, significant reductions in basal epithelial cell density (5817±306 cells/mm(2) vs 4802±508 cells/mm(2), P<0.001), anterior stromal keratocyte density (800±111 cells/mm(2) vs 555±115 cells/mm(2), ...
Page 1. Management of Painful Diabetic Neuropathy Patrick G. Jensen and Jennifer R. Larson Univer... more Page 1. Management of Painful Diabetic Neuropathy Patrick G. Jensen and Jennifer R. Larson University of Iowa Hospital and Clinics, Department of Pharmaceutical Care, Iowa City, Iowa, USA Contents Abstract . . . . . ...
This Practice Point commentary discusses the results of a study that employed thermal threshold t... more This Practice Point commentary discusses the results of a study that employed thermal threshold testing and quantification of intraepidermal nerve fiber (IENF) density in patients with diabetes who had normal electrophysiology findings. The study showed that a significant proportion of these patients had abnormalities in small-fiber function, as quantified by thermal thresholds, and structure, as quantified by IENF density. Interestingly, patients who showed symptoms of diabetic neuropathy had reduced IENF densities but no difference in thermal thresholds compared with diabetic patients lacking these symptoms. This study highlights the importance of establishing which tests should be used to detect the earliest nerve damage in diabetic neuropathy, and which tests should be used as end points in clinical trials relating to this condition.
Pitceathly, RDS and Tavakoli, M and Marshall, A and Roberts, ME and Gow, D and Efron, N and Malik... more Pitceathly, RDS and Tavakoli, M and Marshall, A and Roberts, ME and Gow, D and Efron, N and Malik, RA (2008) Corneal confocal microscopy to diagnose idiopathic small fibre neuropathy. In: JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY.(pp. 342-342). BMJ PUBLISHING GROUP
As of March 2016, we continue to advocate the diagnosis of diabetic neuropathy using a simple foo... more As of March 2016, we continue to advocate the diagnosis of diabetic neuropathy using a simple foot examination or monofilament, which identifies only those with severe neuropathy and hence risk of foot ulceration. Given the fact that the 5-year mortality rate of diabetic patients with foot ulceration is worse than that of most common cancers, surely we should be identifying patients at an earlier stage of neuropathy to prevent its progression to a stage with such a high mortality? Of course, we lament that there is no licensed treatment for diabetic neuropathy. Who is to blame? As researchers and carers, we have a duty of care to our patients with diabetic neuropathy. So, we have to look forward not backwards, and move away from our firmly entrenched views on the design and conduct of clinical trials for diabetic neuropathy. Relevant organizations such as Neurodiab, the American Diabetes Association and the Peripheral Nerve Society have to acknowledge that they cannot continue to en...
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