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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report the case of a 59-year-old diabetic woman with emphysematous pyelonephritis. The patient presented with nausea, vomiting, and right flank pain of three days duration. The diagnosis was established by a plain abdominal radiograph in the emergency department. Aggressive rehydration, control of diabetes, broad-spectrum antibiotic therapy, and early right nephrectomy resulted in rapid clinical improvement. Emphysematous pyelonephritis is rare and often fatal. Survival depends on early diagnosis and aggressive combined medical and surgical management.
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PMID:Emphysematous pyelonephritis: an emergency indication for the plain abdominal radiograph. 328 24

Recent trends in amputation surgery favor amputation at the most distal level to preserve the patient's ability to walk. This paper reports the results of sixty-four amputations performed at the level of the middle of the foot in fifty-eight patients. All were performed in patients with peripheral vascular disease who had a diagnosis of either gangrene or resistant, nonhealing ulcers. Forty-three patients (74 per cent) had diabetes. Nutritional evaluation of the patient was used to improve the potential for healing. In the initial forty-six patients, a retrospective review of the serum albumin level, the blood total-lymphocyte count, and the Doppler ischemic index was performed. A prospective study was performed in the final twelve patients, in whom a minimum level in each of these three factors was required before the distal amputation was done. The healing rate for all sixty-four amputations was 81 per cent. When all three factors were above the minimum level, the healing rate was increased to 92.2 per cent. When one or two of the factors was below the minimum level, the rate of healing decreased to 38.5 per cent. Aggressive distal amputation can be performed with a high rate of success when the factors influencing the decision on the amputation level include non-invasive vascular testing and nutritional evaluation.
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PMID:Amputations at the middle level of the foot. A retrospective and prospective review. 374 44

To examine the effects of the altered metabolic and hormonal state of diabetes mellitus on rodent social behavior, male Swiss Webster mice made diabetic with streptozotocin were tested in a resident-intruder encounter. Isolated diabetic and control mice were introduced as intruders into the home cages of aggression-trained resident mice. The encounters were videotaped and analyzed for frequencies and durations of agonistic behavior. Diabetic mice responded to the aggression of resident mice with significantly less investigation and aggression and significantly more static defense and escape behaviors than did control mice. Resident mice responded to less aggressive diabetic mice with more aggression and social investigation. Plasma corticosterone levels were significantly higher in diabetic mice compared to controls and positively correlated with submissive behavior in diabetic mice. These findings indicate that social behavior is altered in male diabetic mice and support the hypothesis that elevated pituitary-adrenal cortical activity and/or metabolic changes affect behavior in male diabetic mice.
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PMID:Agonistic behavior patterns in mice with streptozotocin-induced diabetes mellitus. 378 8

In most of the cases, once a given endocrine gland is involved, the corresponding specific autoantibody may be detected; for example, anti-islet cell antibodies are produced within the first few years, after onset of symptoms in insulin-dependent diabetes (DID). Accompanying autoantibodies are quite frequently found in the patient himself. In Schmidt's syndrome (thyroid and adrenal glands are involved and associated to IDD in 30% of the cases) thyroid microsomal antibodies are found in 38% of the cases, thyroglobulin antibodies in 11% of the cases, islet-cell antibodies in 7% of the cases and steroid cell antibodies in 17% of the cases. Associations are also possible in patient family members. Aberrant expression of HLA-DR molecules at the membrane of follicular thyroid cells (as of any other endocrine gland), following a viral aggression, could well account for the endocrinopathy combinations, but alternative mechanisms should be discussed.
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PMID:[Autoimmune polyendocrinopathies. Pathogenic hypotheses]. 382 97

EMC virus-induced diabetes in mice may be a model of human type I diabetes. It is postulated that auto-immune reaction plays a role in beta cell destruction after viral aggression. The use of anti-viral (interferon) or immunosuppressive drugs (Cyclosporin A) could contribute to an understanding of the pathogenesis of diabetes in this model. Early or late administration of cyclosporin A increased mortality and frequency of diabetes in female mice and did not influence these parameters in males despite a reduction of pancreatic inflammatory lesions. Interferon administered at the time of virus inoculation diminished mortality in both sexes and frequency of diabetes in males. These results are against an autoimmune pathogenesis for diabetes in this model and suggest that the virus plays the major role in beta cell damage.
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PMID:Assessment of viral and immune factors in EMC virus-induced diabetes: effects of cyclosporin A and interferon. 618 14

Overt diabetic nephropathy is a well-established clinical picture characterized by macroproteinuria and irreversible decline of glomerular function. The first phase of renal involvement has been widely investigated in the last decade in the hope to individuate early lesions. Five stages of glomerular damage have been identified by morphological abnormalities and clinical tests. Although renal hypertrophy, hyperfiltration, and microalbuminuria are present in all diabetics at onset, subsequent evolution shows different patterns: some patients may present no further progression, while others show a rapid and irreversible decline of kidney function. This suggests that other factors, i.e., risk factors, may play important roles in the renal involvement in diabetics. The predictive role of microalbuminuria and of hyperfiltration was investigated, and, so far, only an albumin excretion rate above 30 micrograms/min had been proved to be associated with a decline of renal function. Actually no practical hints can be given to prevent the disease apart from persistent strict glycometabolic control during the course of diabetes. Antihypertensive treatment can slow glomerular damage when overt diabetic nephropathy and hypertension are present. Aggressive treatment in the early phases of renal involvement might change the natural history of the disease.
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PMID:Etiology, diagnosis, and prevention of renal involvement in insulin-dependent diabetes mellitus. 640 Apr 50

Necrotizing fasciitis and progressive bacterial synergistic gangrene are two infrequently reported diseases in the gynecologic literature. The author reports 2 cases highlighting the many similarities and some important differences between these clinical entities. Diabetes mellitus and arteriosclerosis predispose women to both diseases. Aggressive antibacterial and surgical treatment is imperative.
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PMID:Necrotizing fasciitis and progressive bacterial synergistic gangrene of the vulva. 684 37

This study examined the psychological adjustment of children with diabetes and their siblings. Data were collected for 41 diabetic children and their siblings between ages 6 and 11 yr who were followed in a large pediatric practice. The diabetic group was matched with 35 control children who were followed for routine pediatric care and their siblings. Diabetic families and the controls did not differ on divorce rate or level of marital adjustment. Behavior problems were measured through the use of the Achenbach Behavior Checklist for both sexes separately at the 6-11- and 12-16-yr-old age levels. Diabetic boys, aged 6-11 yr, were higher than nondiabetic boys on internalizing and externalizing symptom scales, particularly on measures of schizoid tendencies, obsessive compulsive symptoms, hyperactivity, and aggression. Neither female patients, male siblings, nor female siblings in the 6-11-yr-old age group differed from controls on emotional adjustment. Among the 12-16-yr-old males, diabetic patients were higher on internalizing symptoms than male siblings and their controls. Male siblings tended to be lower than diabetic patients and controls on school performance. Social class differences may have contributed to the differences at the 12-16-yr age levels. Female subjects in the 12-16-yr-old group did not differ on measures of adjustment. Level of control was unrelated to patients' or siblings' adjustment, but behavioral symptoms tended to increase for male diabetic patients with length of illness, and tended to decrease for male siblings. Results are interpreted according to social class effects and sex differences.
Diabetes Care
PMID:Parental perceptions of the psychological adjustment of children with diabetes and their siblings. 718 12

Two groups of 64 diabetic and 30 carefully selected and matched non-diabetic control children 4-17 years old were studied with regard to psychological and social adaptation. Four sets of psycho-social methods were used: (a) psychiatric assessment of the mental state, (b) evaluation of the social situation, (c) measurement of the intellectual capacity, and (d) a Rorschach test. A base-line study was done within 5 months after the onset of diabetes and a follow-up 3 years later with the same methods. The mental state was assessed with regard to 18 variables, and the Rorschach test utilized 12 variables. There were no significance differences as to mental state between diabetics and non-diabetics neither at base-line nor at follow-up. Within each group, however, the diabetics showed an increase with regard to symptoms of aggression while the non-diabetics showed a decrease in such symptoms. Diabetics with high or low glucosuria levels did not differ in this respect. When summarizing mental deviations from average in the two groups the diabetics showed more deviations both at base-line and at follow-up, and a tendency towards higher degrees of mental activity, emotional ability and social contact. In the Rorschach test the diabetics showed a higher level of anxiety concerning their own health than the non-diabetics, but there was a decrease in this variable over the 3-year period. However, in an attempt to summarize the degree of mental disturbance, as estimated in the Rorschach test, no significant differences were found between diabetics and non-diabetics. Nor were any significant differences found between the groups with regard to social problems or intellectual capacity. It is concluded that the few abnormal patterns of raction that were observed may well be explained by the traumatic experience of the onset of a serious chronic disorder such as diabetes, and that a relatively strict care given to diabetic children does not seem to disturb their own or their parents' coping ability or psycho-social adjustment. The strictness might even have a supportive effect.
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PMID:Personality changes and social adjustment during the first three years of diabetes in children. 724 26

The pathophysiology, microbiology, and treatment of diabetic foot infections are reviewed. Patients with diabetes mellitus are at risk for developing infections of the lower extremity because of physiological and anatomical changes. The treatment must be aggressive to prevent systemic complications and recurrence. A combination of pathogens is likely to be found at the site of infection, including gram-negative and gram-positive aerobes as well as anaerobes. If preventive and nonpharmacologic treatment methods are not successful, systemic antimicrobial therapy is indicated. The appropriate agent for empirical therapy is chosen on the basis of the patient's medical history and clinical status with consideration to cost and administration issues. Until a specific organism is identified, a single broad-spectrum agent is administered. The duration of i.v. therapy and appropriate role for oral administration is based upon clinical response. Home infusion therapy is an option for medically stable patients. A single, broad-spectrum, i.v. antimicrobial is usually the best choice for empirical treatment of diabetic foot infection. The regimen is then tailored on the basis of the clinical response and culture and susceptibility test results. Aggressive pharmacologic and nonpharmacologic treatment is needed to avoid possible gangrene and loss of limb.
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PMID:Systemic antimicrobial treatment of foot infections in diabetic patients. 856 19


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