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

A case is herein reported of pneumocystis carinii pneumonia in a 60-year-old female patient with ectopic production of ACTH at a position 2 cm superior to her right clavicle, revealed in an octreotide scan. Her extremely high plasma ACTH and cortisol levels (460 pg/ml and 80 microg/dl, respectively) were markedly decreased with the combined treatment of octreotide (300 microg/d) and ketoconazole (600 mg/d). As her serum cortisol concentration decreased, pneumocystis carinii pneumonia occurred on the third day of treatment. A secondary E. coli infection was superimposed and the patient died of disseminated intravascular coagulation and adult respiratory distress syndrome. This case suggests that primary prophylaxis for pneumocystis carinii infection should be initiated before cortisol lowering therapy, especially when the plasma cortisol concentration is excessively high, and that early adjunctive glucocorticoid therapy can reduce the acute mortality in patients with endogenous Cushing's syndrome and Pneumocystis carinii pneumonia. This case study would also like to point out that plasma ACTH and cortisol levels were decreased effectively by the combination of octreotide and ketoconazole in this instance of ectopic ACTH syndrome.
Exp Clin Endocrinol Diabetes 2000
PMID:Pneumocystis carinii pneumonia associated with a rapid reduction of cortisol level in a patient with ectopic ACTH syndrome treated by octreotide and ketoconazole. 1082 24

Diabetic ketotic acidosis and hyperosmolar hyperglycemic syndrome are regarded as the most serious diabetes complications. Acute renal failure frequently develops simultaneously with the symptoms of multiorgan disfunction and might be a factor indicating the severity of the primary disease. Authors present a case of a 11-year-old boy with acute renal failure due to defective perfusion and disseminated intravascular coagulation as the complications of hyperosmolar hyperglycemic syndrome. This syndrome was the first feature of juvenile diabetes. Intensive treatment of fluid and electrolyte disorders, mechanic ventilation, renal replacement therapy, and close collaboration of trained nephrologist with intensive care unit specialists allowed to cure critical health states and improve the course of diabetes.
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PMID:[Multiorgan dysfunction syndrome complicating hyperosmolar hyperglycemic syndrome as the primary feature of juvenile diabetes]. 1089 58

Data on 1112 tuberculosis patients with various neurological complications who were treated at Moscow Tuberculosis Clinical Hospital No. 7 during 1997-1999 are analyzed. A working classification of neurological complications in tuberculosis, which may be recommended to therapeutists, phthisiologists, and neurologists, is proposed. The leading neurological complications in nonspecific tuberculosis are described. The acute toxic encephalopathy syndrome that is characterized by a combination of impaired consciousness, meningeal syndrome without spinal fluid changes, epileptic seizures, disseminated neurological symptoms, disseminated intravascular coagulation syndrome, and high death rates holds the lead. Mono- and polyneuropathies of predominantly the lower extremities are frequently detectable in tuberculosis. Concomitant alcoholism, diabetes mellitus, and isoniazid treatment make their course poorer. Vascular abnormalities of the nervous system in patients with tuberculosis run much more favourably that in those without it. Mild forms of parkinsonism were observed in 3% of patients with tuberculosis, vascular dementia is detectable rarely (0.2%), strokes run without severe overall cerebral symptoms. The high incidence of neurological diseases in patients with tuberculosis requires that specialized departments of neurology should be set up at the institutes of tuberculosis and at multidisciplinary related hospitals. The tuberculosis curricula for students and postgraduate physicians should envisage additional sections to study diseases of the nervous system in tuberculosis.
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PMID:[Clinical aspects, diagnosis and treatment of neurological complications of tuberculosis]. 1150 28

Thrombomodulin is a glycoprotein that can bind to thrombin and activate protein C, thus mitigating the effects of cytokines produced by inflammatory and immunological processes. The molecule exerts a protective function on endothelial cells. Thrombomodulin is cleaved to its soluble form by neutrophil elastase and by other substances produced during acute and chronic inflammatory responses, immunologic reactions and complement activation. ELISA technique yields normal serum levels of 3.1 +/- 1.3 ng/ml; in males these levels are higher; TM levels also rise during menopause. Other circumstances associated with an increase of serum TM levels are smoking, disseminated intravascular coagulation (DIC), cardiac surgery, atherosclerosis, ARDS, liver cirrhosis, diabetes mellitus, cerebral and myocardial infarction, and multiple sclerosis. Serum levels of TM represent an useful prognostic index, because they are associated with an increase in mortality rate, or however a progression of the underlying pathological condition.
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PMID:Clinical importance of thrombomodulin serum levels. 1155 26

An hemorheological study on whole blood filterability (WBF) was done in eleven patients bearing of sudden deafness, in a continuous way, even before clinical onset. This evaluation is making usually in animal models, but not in humans. Independently of clinical diagnosis of each patient (two cases of diabetes mellitus, one of ulcerative colitis, systemic lupus erythematosus, systemic hypertension, after blood transfusion, sepsis with disseminated intravascular coagulation, upper respiratory ways infection, after surgery, and two healthy individuals), all of them showed a decreased WBF when hearing loss appeared (from 19.97 +/- 1.15 microliters/sec to 16.87 +/- 1.21 microliters/sec). This value normalized at six or seven days from the onset in cases with some kind of hearing recovery (18.83 +/- 1.01 microliters/sec, n = 4), but did not in those with no improvement even at thirty days (17.39 +/- 0.77 microliters/sec, n = 7). There were differences in WBF values of patients with and without hearing recovery in determinations at seven and thirty days from onset. Decrease in WBF accompanies this hearing disorder and confirms the cochlear microcirculation susceptibility to the impairment of blood viscoelastic properties.
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PMID:[Non-interventional study on blood filterability changes in the clinical onset of sensorineural sudden deafness]. 1169 47

A 48-year-old male who had a past history of alcoholic pancreatitis and diabetes mellitus was admitted to our hospital due to chills and vomiting, on August 13, 1998. His body temperature was 38.0 degrees C, and he had the disturbance of consciousness, tachypnea, tachycardia and hepatomegaly with tenderness. Laboratory findings showed highly inflammatory reactions, DIC and hepatorenal dysfunction. Abdominal CT and US revealed multiple liver abscess with portal vein thrombus. Serratia rubidaea was detected in the blood culture. SBT/CPZ and TOB were administered and he recovered. This is a rare case of Serratia rubidaea sepsis. It is also necessary to pay attention to Serratia infections as well as S. marcescens.
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PMID:[Community acquired sepsis by Serratia rubidaea]. 1190 95

A 70-year-old man with poorly controlled diabetes mellitus, and an elevated serum prostatic specific antigen, underwent transrectal prostate biopsy. He received one dose of cefotium before, and three doses of cefotium (1.0 gram every 12 hours intravenously) after prostatic biopsy. He was doing well until postbiopsy day 1, when he developed high fever, dysuria and lower abdominal pain. His perineal area exhibited black-purpish discoloration. On postbiopsy day 3, laboratory data showed leukopenia and DIC. Operative findings during laparotomy on the same day, included malodorous cloudy fluid and tissue edema involving the perivesical space. Intraoperative tissue cultures as well as postoperative cultures of blood and drainage revealed Escherichia coli, serotype O-6. Despite maximal supportive therapy, the patient developed multiorgan failure and died on the tenth postbiopsy day. This patient's history and hospitalization course suggests that transrectal prostatic biopsy induced Fournier's gangrene.
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PMID:[A case report of Fournier's gangrene in a diabetic patient induced by transrectal prostate biopsy (TRPB)]. 1217 43

A 66-year-old man with erysipelas was admitted with complaints of oliguria and massive proteinuria/hematuria. He was diagnosed as having acute poststreptococcal glomerulonephritis(APSGN) due to erysipelas infected by group A streptococcus pyogenes. On admission, his white cell count increased to 31,000, and CRP was 27.3 mg/dl. Serum urea nitrogen and creatinine were increased to 90.1 mg/dl and 4.5 mg/dl, respectively. He had diabetes mellitus(HbA1c 7.9%) and liver dysfunction(total bilirubin 3.5 mg/dl, AST 76 IU, ALT 41 IU) caused by alcoholic liver cirrhosis. Hypocomplementemia was found in addition to ASO 216 U/ml and ASK 10,240 x. After antibiotics treatment was initiated, inflammation of the erysipelas began to improve. Disseminated intravascular coagulation syndrome, probably due to sepsis, occurred on the 5th hospital day. He died of gastrointestinal bleeding on the 18th hospital day. Renal autopsy revealed 37% formation of fibrocellular crescents, and marked mesangiolysis was noted by light microscopy. Granular deposition of C3 and IgG was seen along the capillary walls on immunofluorescence study. Intramembranous deposits were scattered on electron microscopy. This case illustrates a fulminant type of APSGN, which was in part attributed to the presence of diabetes and alcoholic liver cirrhosis. Histological findings of crescent formation and marked mesangiolysis may account for the fulminant clinical course.
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PMID:[A case of fulminant acute poststreptococcal glomerulonephritis showing mesangiolysis and crescent formation preceded by erysipelas]. 1247 94

A 50-year-old woman with a 15-year history of type 2 diabetes mellitus was admitted to our hospital due to high fever and a skin lesion with severe pain, swelling and a sensation of heat in the right thigh. Laboratory examination showed elevated C-reactive protein (CRP), thrombocytopenia, nephrotic syndrome and renal dysfunction. Her blood glucose level had been well controlled. Streptococcus agalactiae was detected in both the skin lesion and blood culture, and pathological examination revealed neutrophil infiltration in the fascia and muscle layer. The patient was diagnosed with necrotizing fasciitis, septic shock and disseminated intravascular coagulation. A combination therapy of antibiotics and surgical debridement resulted in the improvement of symptoms as supported by laboratory findings, and the skin lesion also showed improvement. Although group A streptococcus is well known to be implicated in the pathogenesis of necrotizing fasciitis, only S. agalactiae, belonging to group B streptococcus, was isolated from the tissue and blood cultures in this case. Although this organism is not virulent and rarely causes a necrotizing fasciitis, both the superficial fascial layer and underlying muscle were affected in this case. There have been only a few reports of necrotizing fasciitis due to S. agalactiae in patients with diabetes mellitus. Although the blood glucose level was well controlled in our patient, this disease might be caused by other factors, including diminished sense of touch and pain, abnormality of microcirculation and hypogammaglobulinemia due to nephrotic syndrome.
Diabetes Res Clin Pract 2003 Jun
PMID:Successful treatment of necrotizing fasciitis associated with diabetic nephropathy. 1275 84

Specific features of dilatation tracheostomy (DTS) were studied in 45 patients with hemorrhagic syndrome; 37 of them had thrombocytopenia; 6 patients had thrombocytopenia and disseminated intravascular coagulation (DIC); and 2 patients had congenital coagulopathy. Besides, there were patients, among the examined ones, with hemoblastosis (36), with idiopathic thrombocytopenic purpura (1), with aplastic anemia (1), with HELLP-syndrome (1), with diabetes mellitus (1), with rheumatoid arthritis, with stomach cancer (2) and with hemophilia A (2). Commercial sets were made use of for DTS ("Portex"). DTS can be safely made provided the blood platelets' level is not below 40-50 x 10(9), and the time of bleeding is below 3 min; in hemophilia, the procedure is possible after the administration factor's preparations; and in DIC--after plasma transfusion and after ensuring the normal coagulation. Obturation of lumens of the trachea and bronchi with blood grumes is an often complication in DTS, which makes it necessary to make bronchoscopy immediately after DTS.
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PMID:[Dilatation tracheostomy in patients with hemorrhagic syndrome]. 1291 1


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