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

Among 3,501 individuals receiving endoscopic examination for the upper digestive tract, 41 were found to have esophageal candidiasis including 17 malignancies, 14 immunological disorders, 4 diabetes mellitus, 7 other underlying diseases and 7 apparently healthy subjects. The diagnosis was made either by brushing of the esophagus or by histological examination of the biopsied specimen. Systemic invasion of fungi was observed mainly in patients with malignancy involving the hematopoietic system, and most of them had been treated by corticosteroids, antibiotics or anticancer agents. Although complications associated with esophageal candidiasis are rare, it is emphasized that those patients with malignancy as well as impared immunity should be carefully examined for esophageal candidiasis, in order to prevent the fungi from developing invasive candidiasis. It should be noted that a few cases of gastric ulcer treated by H2 blocker revealed esophageal candidiasis, suggesting that decrease of gastric acidity might be one of the factors involved in this pathological condition.
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PMID:Esophageal candidiasis. 318 63

An antifungal agent (Flucytosine) was used to treat urinary candidiasis in 9 patients who had an indwelling catheter and developed fungal colony counts greater than 10(4). Among 9 patients with catheter drainage, urologic underlying diseases were benign prostatic hyperplasia in 7 and a neurogenic bladder in one patient all of whom had accompanied diabetes mellitus. Only one patient was supravesically diverted from the upper urinary tract through an indwelling catheter of bilateral ureterocutaneostomy after the removal of a tumorous bladder. All patients had previously received antimicrobials. Isolated strains of Candida were Candida albicans in 6, Candida tropicalis in 2, and Candida parapsilosis in one patient. Out of 9 patients having received daily administration of 1,500 mg Flucytosine for 2 weeks, 7 patients subsequently had no yield of fungal colony after the treatment. Minimum inhibitory concentration (MIC) of this agent was determined at the range of 0.1 to 0.2 microgram/ml in 5 patients with C. albicans and 0.2 microgram/ml in both patients with C. tropicalis. Otherwise, a high MIC of over 100 micrograms/ml indicating resistance to this agent was observed in only 2 patients with C. albicans and C. parapsilosis. Three of the 7 patients had recurrent urinary Candida infection even 2 weeks after the discontinuation of this antifungal therapy despite rapid and excellent eradication of urinary candidiasis. From these results, Flucytosine may be one of the most promising antifungal agent with a low MIC in the treatment of compromised urinary Candida infection and should be occasionally supplemented with a topical instillation of amphotericin B without any serious complication in the prevention of recurrence.
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PMID:[Clinical efficacy of flucytosine on urinary candidiasis]. 321 1

The records of 47 patients with a perinephric abscess diagnosed from 1975 to 1986 at 8 San Francisco Bay Area hospitals were reviewed. The mean age was 51 years. Fifty-five percent were females and 45%, males. The left kidney was affected in 47% of cases, the right kidney in 40%, both in 4%, and a transplanted pelvic kidney in 9%. Fever (55%), chills or diaphoresis (47%), flank pain (40%), abdominal pain (40%), and nausea or vomiting (32%) were the most common presenting symptoms. About half the patients had symptoms for 1 week or less and 12% had no symptoms. Fever was documented before diagnosis in 88% of patients. Abdominal mass (13%) or tenderness (49%), and flank mass (9%) or tenderness (42%) were seen less frequently, and 11% of patients did not have fever, flank, or abdominal findings. The most frequent underlying conditions included previous urologic surgery (45%), previous urinary tract infection (38%), diabetes mellitus (36%), and urinary tract stones (36%). Cultures of perinephric abscesses yielded gram-negative aerobes in 52% of patients, primarily Escherichia coli. Staphylococcus aureus was isolated in 26% of patients and anaerobes in 17%. A single pathogen was isolated in 71% and multiple isolates in 29%. Of interest and great potential therapeutic importance was culture of anaerobes, primarily Bacteroides spp. in 17%, Enterococcus spp. in 7%, and Candida albicans in 7%. Positive blood and urine cultures identified perinephric abscess organisms exactly in 58% and 37% of cases, respectively. Routine laboratory tests such as the white blood cell count and urinalysis were insensitive and non-specific for perinephric abscess. Leukocytosis and anemia at admission were seen in slightly more than half of the patients. For radiologic diagnosis, computerized tomographic scanning was most helpful. Ultrasound and intravenous pyelography were falsely negative in about one-third of cases. Mortality (13%) was low in this series when compared with earlier studies, and probably reflects modern medical care. Six patients (13%) died during hospitalization, 2 of whom had diagnosis of PNA established only at autopsy. Drainage of the perinephric abscess was carried out by open surgical drainage in 64% of patients, percutaneous drainage in 19%, and both in 13%. The initial procedure, whether open surgical drainage or percutaneous catheter drainage, was usually successful. Late complications included nephrocutaneous fistulas in 3 patients and disseminated candidiasis in 1 patient.
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PMID:Perinephric abscess. Modern diagnosis and treatment in 47 cases. 335 13

The inherited susceptibility to autoimmune Addison's disease was found to be strongly associated with human leukocyte antigens (HLA)-DR3 and DR4 alleles. In a study of 45 white patients from the United States with the disease, the relative risks (the number of times that an individual is at risk for Addison's disease if they had a marker, compared to those without such marker) were found to be 6.0, 4.6, and 26.5 for the DR3 allele, the DR4 allele, and for DR3/DR4 heterozygotes, respectively. Frequencies of DR2, DR5, and DR7 in the patients with Addison's disease were significantly decreased in comparison to 265 individuals in the control population. These HLA-DR frequencies in patients with Addison's disease were similar to those for 723 patients with insulin-dependent diabetes (IDD). However, the above HLA-DR associations persisted even when only data from the 37 patients with Addison's disease who did not have IDD were considered. Adrenocortical autoantibodies in 23 patients with IDD who did not have Addison's disease were equally frequent among those with DR4 and DR3 alleles. In contrast, HLA-DR frequencies in 17 patients with type I autoimmune polyglandular syndrome (chronic mucocutaneous moniliasis, hypoparathyroidism, Addison's disease, etc.) were not different from control. We conclude that genetic susceptibility to autoimmune Addison's disease may involve the same HLA-associated genetic determinants as IDD, except when Addison's disease occurs as part of type I autoimmune polyglandular syndrome.
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PMID:Inherited susceptibility to autoimmune Addison's disease is linked to human leukocyte antigens-DR3 and/or DR4, except when associated with type I autoimmune polyglandular syndrome. 348 49

Thirty-two diabetic patients with vaginal candidiasis were treated orally with 400 mg ketoconazole once daily for five days. At the end of the treatment period symptoms had disappeared and cultures for Candida were negative in 18 patients; a total of 28 reported improved symptoms. One month later 15 patients were still negative for Candida and 24 showed improved symptoms. The remaining 8 repeated the course of treatment; 6 became negative while 2 cases remained refractory to treatment. It was concluded that these encouraging results and low relapse rates indicate ketoconazole as a drug of first choice for candidiasis in patients with predisposing conditions such as diabetes.
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PMID:Treatment with ketoconazole in diabetic patients with vaginal candidiasis. 372 May 26

Clinical findings, symptoms and predisposing factors were studied in 43 patients with oesophageal candidiasis, 40 patients with peptic oesophagitis and 40 normal controls. Oesophageal candidiasis was confirmed cytologically. 2.4% of patients who had undergone gastroscopy had oesophageal candidiasis; only three of them had simultaneous candidiasis of the oral cavity. Cardiac failure, oesophageal varices, hiatus hernia and gastric ulcer were common associated disorders. 42% of patients with candidal oesophagitis were symptom-free. Most common symptoms were vomiting, retrosternal and epigastric pain. Peptic oesophagitis was more frequently associated with symptoms. Predisposing factors were present in 88% of cases of oesophageal candidiasis: alcoholism, hepatic cirrhosis, diabetes mellitus, malignant tumours and other wasting diseases. 18 patients had had treatment with cimetidine; they included all 13 patients whose candidiasis was first detected at check endoscopy.
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PMID:[Candidiasis of the esophagus. Prospective study of incidence, type of complaints and predisposing factors]. 373 73

Millions of women worldwide continue to suffer from vulvovaginal candidiasis, which is second only to anaerobic bacterial vaginosis in the United States. Evidence is presented of an increasing incidence of vulvovaginal candidiasis, the cause of which is unclear, but this increase is probably the result of multiple factors including widespread abuse of antibiotics, possibly oral contraceptives, and most important inadequate vaginal therapy. Some women never experience vulvovaginal candidiasis, others have infrequent episodes, and a third subpopulation have recurrent episodes resulting in considerable morbidity and suffering. Two fundamental questions face investigators: the mechanism whereby asymptomatic colonization converts to symptomatic disease and the elusive explanation for frequent recurrences of vulvovaginal candidiasis. Although several factors have been identified as predisposing to recurrent vulvovaginal candidiasis (pregnancy, oral contraceptives, exogenous hormones, antibiotics, diabetes mellitus, etc.), the majority of women with recurrent vulvovaginal candidiasis do not have recognizable predisposing factors. What has emerged over the last few years is the awareness that different pathogenic mechanisms may be operative in individual patients responsible for a spectrum of clinical manifestations. Understanding the pathogenic mechanisms is essential if we are to progress in treatment. In addition to the study of newer antimycotic agents, new strategies of therapy are required and must be individualized for patients with recurrent vulvovaginal candidiasis.
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PMID:Epidemiology and pathogenesis of recurrent vulvovaginal candidiasis. 389 58

A guest faculty discussed the management of patients with vaginal infections. It was agreed that correct diagnosis is necessary before therapy. Diagnosis can be accomplished by a microscopic examination in 90% of the cases. The cytologic smear is also very important. Specific culture media may be useful for troublesome cases, for instance, blood agar fo Haemophilus vaginalis, Trichocel medium for Trichiomonas vaginalis, Neckerson's medium for candidal species and Thayer-Martin for Neisseria gonorrhoeae. Patient history is important since some infections tend to occur in certain patients such as candidiasis in patients with diabetes mellitus, patients who are pregnant or are taking broad spectrum antibiotics, estrogen or contraceptive pills. The pH of vaginal secretions may also be helpful in making the diagnosis. It was suggested that the term "nonspecific" vaginitis is a misnomer and is used to conceal ignorance. Others felt that such agents as soap, vaginal deodorant spray, and clothing may be causatives. The term "psychogenic leukorrhea" was discussed with varying conclusions. Routine treatment for each form of vaginitis was outlines and treatment for recurrent, persistent trichomoniasis and moniliasis was given. It was agreed that douching will not cure vaginitis but may be useful in removing excessive secretion. It is not recommended for routine hygeine but is acceptable following menstruation or intercourse.
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PMID:Management of patients with vaginal infections. An invitational symposium. 434 29

In their initial radiographic description of esophageal intramural pseudodiverticulosis (EIP) in 1960, Mendl and coworkers suggested that elevated esophageal intraluminal pressure might be etiologically important. Chronic inflammation and moniliasis have also been implicated. A patient is reported with EIP and a primary esophageal motility disorder characterized by esophageal contractions of increased amplitude and duration. Features confusing the interpretation of esophageal motor abnormalities in previously reported cases, such as diabetes mellitus, fungal esophagitis, and stricture formation, were not present in this case.
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PMID:High-amplitude peristaltic contractions in a patient with esophageal intramural pseudodiverticulosis. 641 38

Esophageal motility disturbances are common in diabetics in general and are most prevalent in these with peripheral neuropathy or autonomic neuropathy. The usual findings are a decrease in the amplitude of esophageal contractions in the smooth muscle portion of the body, frequent absence of primary peristalsis, simultaneous or repetitive body contractions, and a decrease in the velocity of peristalsis. Radiographically, this may be manifest as delayed esophageal emptying. These changes do not produce symptoms. Dysphagia and chest pain should be thoroughly evaluated and not ascribed to the diabetes. Candidiasis may be more common in diabetics.
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PMID:Esophageal disorders in diabetes mellitus. 642 49


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