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

The most important side effects of oral contraceptives (OCs) and their incidence, together with advice and monitoring of the patient at risk, are pointed out. There is a mild increase in blood pressure in longterm contraceptive use caused by increased angiotensinogen production by the liver. It is significant only for women with a history of familial hypertension, diabetes mellitus, or pre-eclampsia. Smoking increases this risk. Urinary tract infections are 25-50% more frequent in pill users. Glucose tolerance is slightly decreased. Contraceptives' diabetogenic effect is higher in women with hereditary tendency for diabetes, latent diabetes, and/or obesity. They are contraindicated in latent diabetes. Findings are contradictory in their effects on cholesterol and triglyceride serum level, but the pill is contraindicated in lipid metabolism disorders. There is an increased incidence in cholecystitis and cholelithiasis in pill-users (70-80 additional cases/100,000 user years). Liver diseases, intrahepatic cholestasis, occur rarely and benign liver tumors have not conclusively been proved to be caused by the pill. A variety of laboratory findings have been related to contraceptive use and drug interactions occur with barbiturates, rifampicin, hydantoin, and phenylbutazone. Blood coagulation is increased, partially by increased production of various blood coagulation factors; but more importantly, by a decreased synthesis of antithrombin III, a natural protective mechanism against intravascular coagulation. This increases thrombosis risk. Risk doubles with simultaneous cigarette smoking. Various epidemiological studies indicate a 5-10 fold increase in thromboembolism and thrombophlebitis, deep vein thrombosis, and pulmonary embolism. There is a correlation between contraceptive use and cerebrovascular disorders and myocardial infarction. This risk increases with age and years of pill use. The pill is contraindicated with symptoms of thrombophlebitis and thromboembolism, sickle cell anemia, proposed surgery, and longterm immobilization. Overall risk factors are not too high. Recommendations for rational pill use related to age are given and further contraindications are mentioned.
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PMID:[Adverse effects of oral contraceptives]. 55 52

A case of successful treatment by vitrectomy and lensectomy of early-stage endogenous endophthalmitis caused by Enterococcus faecalis was reported. The case was a 50-year-old man with poorly controlled diabetes. Following T-tube drainage for a necrotic cholecystitis operation, he developed iridocyclitis in both eyes as well as fever. At the time of his first visit to our clinic, his right eye had already lost light perception. His left eye had visual acuity recognizing hand movement, marked uveitis, complicated cataract, and dense vitreous opacity. As gram-positive cocci were isolated from the aspirated vitreous, lensectomy and vitrectomy under irrigation with antibiotics were conducted. After the administration of systemic postoperative antibiotics and human immunoglobulin, the patient showed remarkable improvement in the state of his ocular fundus. By 60 days after the surgery, the visual acuity of his left eye recovered to 0.2. Endogenous Enterococcus faecalis endophthalmitis has rarely been reported in Japan. The diagnosis and treatment of this disease with reference to the above findings were discussed.
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PMID:A case of endogenous Enterococcus faecalis endophthalmitis. 151 69

Gangrenous cholecystitis, a disease more common in older patients and diabetics, may be complicated by perforation, pericholecystic abscess, and fistula. Intestinal obstruction has rarely been reported as a complication and only in cases involving perforation or acute, nongangrenous cholecystitis. A retrospective review of hospital records between 1961 and 1989 identified 126 patients with gangrenous cholecystitis, five of whom came to the hospital with intestinal obstruction. Three were cases of paralytic ileus and two of simple mechanical obstruction without perforation. The latter group may represent the first such cases reported. Gallbladder perforation occurred in two patients and cholelithiasis was found in three. The mean age of the total patient cohort was 70.6 years; patients were predominantly male and black. Hypertension and diabetes were common concomitant diseases. Patients commonly came to the hospital with nausea and vomiting, increasing abdominal girth, and obstipation. A leukocytosis on admission was more common than fever or hyperbilirubinemia. The clinical presentation of intestinal obstruction and the lack of objective data specific for gangrenous cholecystitis made a preoperative diagnosis impossible. Thus, a high index of suspicion should increase diagnostic accuracy. The incidence of intestinal obstruction (at presentation) in cases of gangrenous gallbladders was 4 per cent. Morbidity and mortality are reduced with early operation.
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PMID:Gangrenous cholecystitis: five patients with intestinal obstruction. 162 8

We reported a case of successful treatment of early-stage metastatic endophthalmitis caused by Enterococcus faecalis with vitrectomy and lensectomy. The case was a 50-year-old male with poorly controlled diabetes. Following T-tube drainage for a necrotic cholecystitis operation, he developed iridocyclitis in both eyes as well as fever. At the time of his first visit to our clinic, his right eye had already lost light perception. His left eye had visual acuity recognizing of hand movement, marked uveitis, complicated cataract, and dense vitreous opacity. As gram positive cocci were isolated from the aspirated vitreous, we conducted lensectomy and vitrectomy under irrigation of antibiotics. With systemic postoperative antibiotics and human immunoglobulin, the patient showed remarkable improvement in his ocular fundus. By 60 days after the operation, the visual acuity of his left eye recovered to 4/20. Metastatic Enterococcus faecalis endophthalmitis has almost nerve been reported in Japan. The diagnosis and treatment of this disease with a reference to the above findings were discussed.
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PMID:[A case of metastatic Enterococcus faecalis endophthalmitis]. 191 Feb 53

To evaluate the likelihood that patients can be discharged from the hospital the day after open cholecystectomy, a prospective study of 500 consecutive patients undergoing cholecystectomy was undertaken. The study group included patients with associated acute and gangrenous cholecystitis, biliary pancreatitis and choledocholithiasis as well as those with diabetes, hypertension and obesity. Approximately one-fourth of the total group were discharged within 24 hours and over one-half in 48 hours. There was a significant correlation between advancing age and increasing length of stay. Almost one-half of the patients less than 35 years of age without acute or complicated disease were discharged within 24 hours, more than 80 per cent within 48 hours, and the mean length of postoperative stay (MLS) for these patients was 1.9 days. The presence of choledocholithiasis and fever greater than 101 degrees F. increased MLS, while acute cholecystitis, hyperamylasemia and leukocytosis did not. Early discharge from the hospital after open cholecystectomy, even in sick patients, is safe and cost-effective.
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PMID:Twenty-four hour hospitalization after cholecystectomy. 194 86

This review of the literature is designed to identify the state of our knowledge about the ileal, colonic and biliary damage arising in diabetes mellitus. The approach is primarily clinical with the emphasis on the major symptoms involved: diarrhea, constipation and anal sphincter incontinence. The most common symptom, found in 20% of diabetics with neurological disease, is constipation. While the peculiar features of diabetic diarrhea have been well described, there is considerable controversy over its pathogenesis. As for sphincter dysfunction, manometric examinations will already reveal the autonomic neuropathy involved in the early asymptomatic phase. There is considerable debate over the possible involvement of the gallbladder in diabetes mellitus. Some believe that the autonomic neuropathy is involved in the pathogenesis of the lithiasis and helps to mask the pain in cholecystitis as well.
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PMID:[Diabetic enteropathy]. 219 94

Patients with non-insulin dependent diabetes mellitus have an increased incidence of coronary artery disease which may, in part, be associated with abnormalities in plasma lipids. In a double-blind, parallel, randomized study, lovastatin and gemfibrozil were compared in 102 diabetic patients with primary hypercholesterolemia; two-thirds of the patients were treated with oral hypoglycemic agents and one-third received diet therapy alone for their diabetes. Mean pretreatment total and low-density lipoprotein (LDL) cholesterol values were 273 and 193 mg/dl, respectively. Lovastatin significantly reduced total, LDL and very low density lipoprotein cholesterol (20, 26 and 28%, respectively) and raised high-density lipoprotein (HDL) cholesterol (14%). Gemfibrozil significantly reduced triglycerides and very low density lipoprotein cholesterol (36 and 41%, respectively) and, to a lesser extent, total cholesterol (9%); it also increased HDL cholesterol (21%). Lovastatin therapy was not associated with a significant change in triglycerides, and gemfibrozil did not significantly lower LDL cholesterol. The decrease in the ratio of total to HDL cholesterol tended to be greater with lovastatin than with gemfibrozil (26.5 and 20.4%, respectively; p = 0.053). Changes in lipid profiles with both agents were of a degree similar to those reported in nondiabetic patients. Neither agent had a clinically important effect on fasting glucose or hemoglobin A1c. Both drugs were well tolerated with the exception of 2 patients treated with gemfibrozil who developed symptoms of cholecystitis.
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PMID:Comparison of the effects of lovastatin and gemfibrozil on lipids and glucose control in non-insulin-dependent diabetes mellitus. 220 32

Xanthogranulomatous cholecystitis (XGC) is an uncommon lesion which may form a tumor-like mass in inflamed gallbladders. In a review of 44 cases there were 40 associated with gallstones which had been incarcerated in the neck of the gallbladder, 10 with past histories of abdominal surgeries, 15 with diabetes mellitus, three with carcinomas in the neck of the gallbladder and four with carcinomas in the other organs. Radiologically the differential diagnosis of gallbladder cancer and XGC was difficult in several cases. Thirty five cases of XGC have been diagnosed as chronic cholecystitis and 7 have been mistaken for feature of XGC in the contrast enhancement CT that is, detection of an intramural low density mass with continuously enhanced internal membraneous layer of the gallbladder wall. In view of the clinico-pathological findings of XGC, the lesions appear to result from intramural extravasation of bile and subsequent xanthogranulomatous reaction under obstructive conditions in the neck of the gallbladder. We conclude that XGC is not an uncommon special type of cholecystitis but an accompanied lesion sometimes seen in a kind of cholecystitis.
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PMID:[Clinico-pathological study of xanthogranulomatous cholecystitis]. 223 54

Findings from studies showing an increased incidence of gallstones in diabetic patients do not control for other variables, such as obesity. There is no proof that diabetic patients have more gallstones. Gallstones do not cause diabetes mellitus. The principal gallbladder pathologic feature in diabetic patients is a functional deficit of uncertain etiologic factors, creating a large, flaccid, poorly emptying organ. Bile acid and lipid composition are usually increased in diabetic patients. Cholecystitis seems to be a more serious disease in diabetic patients, with worse infectious sequelae and more rapid disease progression. This conclusion has not been examined statistically. Even with modern care, the complication rate for operations upon the biliary tract in patients with diabetes is increased. Those with diabetes are generally older than other patients requiring cholecystectomy. Systemic changes of aging partly explain increased morbidity and mortality. Diabetic patients with symptomatic gallbladder disease usually require operation. Risk of cholecystectomy in diabetic patients is similar to that in nondiabetics. Prophylactic cholecystectomy for diabetic patients with "silent" gallstones was formerly recommended because of an apparent high risk of cholecystitis. Until the natural history of gallstones in those with diabetes has been defined, such patients should be considered in danger of serious illness. The risk of acute cholecystitis in diabetic patients with stones is probably significant enough to warrant the performance of early cholecystectomy.
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PMID:Gallstones, cholecystitis and diabetes. 224 90

We have reviewed data pertinent to three tumor syndromes that derive from overproduction of three GEP peptide hormones. The clinical syndrome of somatostatin excess remains well defined with diabetes, diarrhea, steatorrhea being predominant features. With the availability of assays and increasing awareness, more cases are being diagnosed in the intestine and these differ somewhat in their presentation with cholecystitis, GI bleeding, or a mass as the cardinal features. An unusual association with MEN II pheochromacytoma and neurofibromatosis is emerging. PPomas remain enigmatic. Although diarrhea is a feature, these tumors are usually silent and present with hypatomegally, abdominal pain, and jaundice because of the large size and malignant nature. Neurotensinomas remain rare and truly difficult to separate from the symptom complex produced by VIP excess. Edema, hypotension, cyanosis and flushing should alert one to the possibility of a neurotensin-secreting tumor.
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PMID:Somatostatinomas, PPomas, neurotensinomas. 282 62


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