Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hyperosmolar nonketotic coma is characterized by hyperglycemia, hyperosmolarity and dehydration in the absence of ketoacidosis. Two cases of hyperosmolar nonketotic coma, in which both the patients recovered, were presented. One of the cases was a 59-year-old female who had suffered from a metastatic brain tumor. After removal of the tumor, the patient's condition improved for a period. This was followed by a period of frequent vomiting, subsequently followed by coma. The laboratory data showed the absence of ketoacidosis in the blood sugar measured at 672 mg/dl and serum osmolarity at 343.1 mOsm./kg. The other case was a 74-year-old female who was admitted to the clinic because of cerebral thrombosis. Her caloric in-take was restricted and insulin was administered because of a mild diabetes mellitus which occured after admission. Then she entered a hyperosmolar non-ketotic coma. The laboratory data revealed blood sugar to be 1068 mg/dl and serum osmolarity to be 418 mOsm./kg. Immediately after large amounts of intravenous drip infusion and insulin were administerd, she recovered from the syndrome. The clinical observations and the pathogenesis of this syndrome were discussed.
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PMID:[Two cases of nonketotic hyperosmolar coma in neurosurgery (author's transl)]. 91 16

We evaluated the hospital records of 412 patients with isolated or combined ocular nerve palsies in a retrospective study. Palsies of the oculomotor nerve (n = 172) and of the abducens nerve (n = 165) were more frequent than those of the trochlear nerve (n = 25). Combined ocular nerve palsies (n = 50) were generally combinations of the 3rd and 6th cranial nerves (n = 21) or pareses of all three ocular nerves (n = 17). 165 ocular nerve palsies were due to vascular causes: in 135 of these cases diabetes mellitus and hypertension were present. The oculomotor nerve was most frequently affected; in 63% there was no involvement of the pupil. In inflammatory disease and brain tumor the abducens nerve was most frequently affected, with aneurysm of the oculomotor nerve. The origin of ophthalmoplegia was unclear in 73 patients. Ocular nerve paralysis was most common with tumors, aneurysm, and vascular processes and in 206 cases was only partial. Pain was associated with tumor, trauma and aneurysm. In trochlear nerve palsies concomitant pain was much less frequent than in palsies of the other two ocular nerves. The clinical course was followed for 3 weeks in 352 patients; in 191 patients there was a complete regression of the pareses and in 59 only a partial recovery. The most favorable prognosis was with inflammatory and vascular lesions; in the latter the outcome was improved by the administration of non-steroidal anti-inflammatory drugs.
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PMID:Isolated and combined pareses of cranial nerves III, IV and VI. A retrospective study of 412 patients. 186 22

Superior oblique palsy is thought to be the most frequent cause of acquired vertical diplopia. It is often the result of blunt head trauma but may also be caused by brain tumor, meningitis, diabetes, lesions of the cavernous sinus, and superior orbital fissure as well as arteriosclerosis. The characteristics frequently include a small vertical strabismus in primary gaze, ipsilateral inferior oblique overaction with an increased hypertropia to the contralateral side, a "V" pattern, excyclotorsion, and a positive Bielschowsky head tilt test to the ipsilateral side. In a typical case, it is not difficult to make the proper diagnosis. Several patients will be described whose superior oblique palsy was marked by an association with another motility disturbance.
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PMID:Think superior oblique palsy. 374 90

Primary CNS malignancies are responsible for approximately 12,000 deaths annually in the United States. There has been little change in the outcome for adults with malignant brain tumors over the past few decades, despite improvements in surgical techniques and advances in radiation therapy. These tumors are uniformly fatal one to two years after diagnosis. The morbidity and mortality of this disease arise from the effects of a locally invasive, non-metastasizing lesion. The patients may suffer from seizures, paralysis, incoordination, aphasia, confusion, memory loss, sensory deficits or visual loss, depending on the regions of the brain affected. In addition, they usually require large doses of corticosteroids early and late in their illness, and may experience disabling side effects of this treatment, such as edema, proximal myopathy, diabetes, fungal infections or deep vein thrombosis. Few patients in the older age group are able to work after the diagnosis. Most of the patients are incapable of self-care for several months before death. The localized transfer of new genes into cancer cells potentially permits the expression of proteins with specific biologic functions that may provide a means to alter the biology of tumor growth through a variety of mechanisms including increasing tumor immunogenicity, inducing the local expression of toxic agents, and sensitization of tumors to chemotherapeutic agents. Gene therapy with the transfer of the drug susceptibility gene Herpes virus thymidine kinase (HSV-TK) has shown promise in a number of animal models, including CNS tumors. This study will evaluate the use of adenovirus-mediated transfer of the HSV-TK gene into primary human brain tumors followed by systemic treatment with ganciclovir. The goals of this phase I study are to evaluate the overall safety and efficacy of this treatment and to gain insight into the parameters that may limit the general applicability of this approach. In this phase I study, patients with recurrent gliomas will receive stereotactic-guided injections of the virus into the brain tumor, followed by intravenous ganciclovir for 14 days. Patients eligible to undergo a palliative debulking procedure will receive the same treatment followed by resection on day 7. At the time of resection a second dose of virus will be administered intra-operatively into the residual, unresectable portion of the tumor, and intravenous ganciclovir will be continued for additional 14 days. Tissue removed at the time of resection will be analyzed for evidence of adenovirus infection, thymidine kinase expression and signs of inflammation. The size and metabolic activity of all tumors will be followed by volumetric MRI scans and Position Emission Tomography Scans, respectively. Patients will be enrolled in groups of three, with each group receiving successively larger doses of adenovirus. This study will quantify the toxicity of this therapy, and provide evidence as to the duration of transgene expression and virus induced inflammation.
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PMID:Treatment of advanced CNS malignancies with the recombinant adenovirus H5.010RSVTK: a phase I trial. 884 6

An exceptional case of Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) arising from the meninges in a 60-year-old Japanese man is presented. Computerized tomographic scans and magnetic resonance images demonstrated well-circumscribed tumorous lesions that were homogeneously enhanced with contrast medium. Systemic examination revealed no abnormalities except for a cervical lymphadenopathy and diabetes mellitus. Microscopic examination of the resected specimens showed proliferated histiocytosis and infiltration of plasma cells and lymphocytes. The histology was characterized by the presence of histiocytes demonstrating lymphophagocytosis and immunoreactivity for S-100 protein staining. Immunohistochemical studies and electron microscopy were useful in confirming the diagnosis. The clinical and histopathological features of this disease are discussed.
Brain Tumor Pathol 1998
PMID:Sinus histiocytosis with massive lymphadenopathy: a case of multiple dural involvement. 1032 41

This is a retrospective study of 378 consecutive stroke patients who were referred between June 1994 and June 1997 for videofluorographic study of oropharyngeal swallow. Patients who had radiation therapy, brain tumor, brain surgery, head and/or spinal cord trauma, oral-pharyngeal disease or surgery, or other neurologic diseases in addition to the stroke were excluded from the study. Patients were assigned to two groups: one with pneumonia and one without pneumonia. One hundred one patients were included in the pneumonia group, and 277 patients were included in the nonpneumonia group. Within the pneumonia group, patients were assigned to an acute pneumonia group (pneumonia within 6 months poststroke) and a chronic pneumonia group (pneumonia more than 6 months poststroke). Variables examined in the study included patients' medical history and the findings from the videofluorographic studies. Pearson chi-square analysis was used to identify those variables that were significantly different between the pneumonia and nonpneumonia patient groups and between the acute and chronic pneumonia groups. Results showed that stroke patients who developed pneumonia had a significantly higher incidence of multiple-location and unspecified lesion strokes, chronic airway disease in their medical history, and aspiration during the videofluorographic studies when compared with patients who did not develop pneumonia. Within the pneumonia group, the acute pneumonia group was found to have a significantly higher incidence of hypertension and diabetes in their medical history and a significantly higher incidence of aspiration and reduced laryngeal elevation during the videofluorographic studies. Between 48% and 55% of all stroke patients in the study aspirated. Patients who suffered multiple strokes, brainstem stroke, or subcortical stroke had the greatest frequency of aspiration.
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PMID:Pneumonia in stroke patients: a retrospective study. 1172 Apr 7

Much has been learned over the last two decades regarding the management of growth hormone (GH) deficiency (GHD) in children and adolescents. However, significant divergence and debate continue to exist on the ideal approach to the management of GHD. Despite active controversy, several paradigms have recently emerged which should guide the treatment of GHD patients as we head into the new millennium. The primary objectives of GH therapy remain the normalization of height in childhood and the attainment of normal adult height, but the recognition of the metabolic roles of GH define additional therapeutic benefits. A daily subcutaneous injection of recombinant human GH in a dose range of 25-50 microg/kg/day has been established as the mainstay of therapy. Alternative modes of treatment including GH-releasing hormone (GHRH), GH secretagogues and depot GH have been developed, but evaluation of their clinical utility remains incomplete. Careful monitoring and follow-up of pediatric GHD patients by a pediatric endocrinologist are essential. Accurate determination of height velocity and interval height increases (expressed as the change in height z score) continue to be the most important parameters in monitoring the response to treatment. Monitoring serum insulin-like growth factor (IGF)-I and IGF-binding protein-3 has gained utility in the assurance of compliance and safety, but does not always correlate well with the growth response. A clear role for a biochemical as well as an auxological monitoring approach has nonetheless been established. The comparison of attained growth response to that which has been calculated by various modeling approaches is also becoming a valuable monitoring tool. Significant side effects of GH therapy are quite rare and are easily identified and addressed during close follow-up. Despite previous concerns, it now appears that in the absence of additional risk factors there is no evidence that long-term recipients of GH are at any increased risk of developing diabetes, slipped capital femoral epiphysis, brain tumor recurrence or leukemia. Although GHD may or may not persist into adult life, adult GHD diagnostic criteria and the importance of GH therapy in adult GHD patients have recently been established. Therefore, the pediatric endocrinologist now has a crucial role in guiding the transition to adult GHD management in collaboration with the adult endocrinologist. In the years to come, with the continued investigation and collaborationof experts from around the world, the approach to GH treatment will undoubtedly continue to evolve and improve.
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PMID:New paradigms for growth hormone therapy in children. 1097 Nov 1

The annual number of renal transplantations performed in Taiwan is strictly limited by the availability of donor organs. One way to expand the donor pool is the use of non-heart-beating (NHB) donors. This study evaluated the potential number of NHB kidney-donors in Taiwan using a retrospective death chart review from a regional hospital in patients who died between January 1 and December 31, 1999. Exclusion criteria were extremities of age, systemic infection, malignancies other than primary brain tumor, uncontrolled diabetes mellitus, hypertension, kidney disease, or deaths with incomplete records. Detailed biomedical data of potential donors were collected. Of the 840 in-hospital deaths, 258 were in patients aged 3 to 65 years. Among these patients, 52 (6%) did not meet any exclusion criteria and were classified as potential kidney donors. Of these 52 patients, eight (1%) were classified as very suitable donors, defined as no diabetes mellitus, no hypertension, good renal function (serum creatinine < 1.3 mg/dL), age less than 50 years, and death in the intensive care unit or emergency service. Twenty-five of the remaining 44 sub-optimal potential donors who did not meet the criteria of very suitable were classified as having high potential to be donors by a combined scoring system (sum score = 5-6). The results suggest that there is a considerable number of potential NHB kidney-donors in Taiwan. Programs to advocate use of NHB kidney donors and education of the public and transplant professionals might significantly increase the number of kidneys available for transplantation in Taiwan.
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PMID:Potential pool of non-heart-beating kidney donors in Taiwan: chart review in a regional hospital. 1218 53

We conducted a case-control study to evaluate the preclinical association between epilepsy, diabetes, and stroke and primary adult brain tumors. We first identified all 1,501 low-grade glioma, 4,587 high-grade glioma (HGG), and 4,193 meningioma cases reported to the Swedish Cancer Registry from 1987 to 1999. Next, controls (137,485) were randomly selected from the continuously updated Swedish Population Registry and matched to cases diagnosed that year on age and sex. Finally, cases and controls were linked to the Swedish Hospital Discharge Registry (1969-1999). We found that > or =8 years before HGG diagnosis (or control reference year) there was an elevated risk of HGG among people discharged with epilepsy [odds ratio (OR), 3.01; 95% confidence interval (95% CI), 1.73-5.22]. Two to 3 years before HGG diagnosis, this risk increased (OR, 5.33; 95% CI, 3.58-7.93) and was especially strong among people ages <55 years (OR, 13.49; 95% CI, 6.99-25.94). During this 2- to 3-year prediagnostic period, we also found an increased risk of HGG among people discharged with meningitis (OR, 3.02; 95% CI, 1.06-8.59) or viral encephalitis (OR, 12.64; 95% CI, 2.24-71.24). Results are similar for glioblastoma multiforme, low-grade glioma, and meningioma. In contrast, risk of HGG among people discharged with diabetes or stroke does not increase until year of brain tumor diagnosis. The occurrence of excess epilepsy > or =8 years before HGG diagnosis suggests a relatively long preclinical phase, but excess diabetes or stroke appear late in HGG development.
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PMID:Prior hospitalization for epilepsy, diabetes, and stroke and subsequent glioma and meningioma risk. 1576 44

Cerebral microbleed (CMB) on gradient-echo T2*-weighted MR imaging (T2*-w MR imaging) is associated with microangiopathy. Number of CMBs and new appeared CMBs are markers for stroke recurrence and the performance state. After CMB was reviewed in this manuscript, criterion for CMB is proposed as below. (1) Only microbleed associated with microangiopathies related to primary intracerebral hemorrhage or lacunar infarction is diagnosed as CMB. (2) A low intensity (round or oval shape, <7 mm in diameter) on T2*-w MR imaging defined as a CMB. Exception: (A) Micro-bleedings associated with trauma (cerebral concussion), brain tumor, cavernous angioma, or moyamoya disease are excluded. (B) Calcifications or vascular flow voids were excluded by CT or other MR imagings. Reference: (C) CMB is rarely correlated to a focal neurological sign. (D) CMB is associated with risk factors including hypertension, diabetes mellitus, or high age. CMB is very rare in patients less than 40 years old.
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PMID:[Clinical significance of cerebral microbleed and its diagnostic criteria]. 1766 50


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