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

Diabetes mellitus is treatable but not curable. Management is complex and involves dietary restrictions and sometimes daily injections. There is also a significant risk of serious complications which, at their worst, may include blindness, gangrene and renal failure. It is not surprising that a combination such as this may have significant psychological implications.
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PMID:Psychological aspects of diabetes. 195 29

Fournier's gangrene is defined classically as a fulminant, rapidly spreading infection of the scrotum that also involves the perineum, penis and abdominal wall. The pathologic findings are described as synergistic gangrene secondary to a polymicrobial flora with a poorly defined portal of entry. We report 3 cases of Fournier's gangrene. Case 1 was a 67 years old who was admitted with the chief complaint of scrotal swelling and necrosis. Case 2 was a 59 years old who was admitted with the problem of scrotal swelling and pain, he had sought other medical help without success, and was then transferred to our hospital. Case 3 was a 62 years old who was admitted with the chief complaint of scrotal swelling and pain for 2 days. These 3 patients were all found to have diabetes mellitus. All 3 patients required aggressive surgical debridement, broad-spectrum antibiotics and adjunctive measures. Blood cultures were usually negative and pus cultures were typically aerobic gram-negative rods and gram-positive cocci and anaerobic bacteria of various types, especially Bacteroids fragilis. Our pus cultures revealed Escherichia coli and Staphylococcus aureus in Case 1, Enterobacter cloacae in Case 2 and E. coli, B. fragilis and Pseudomonas aeruginosa in Case 3. This disease is no longer a disease of young men. After 1945, the average age in 119 reported cases was 51.3 years and the average age of our cases was 62.7 years. Before the era of antibiotics, scrotal gangrene was not a rarity. In these modern times, in spite of seeking medical attention early, patients still developed scrotal gangrene and the mortality rate is high.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Fournier's gangrene: report of 3 cases]. 198 85

Plasma homocyst(e)ine (the sum of free and bound homocysteine, homocystine, and the mixed disulfide homocysteine-cysteine, expressed as homocysteine) levels were determined by high performance liquid chromatography in 214 patients with symptomatic (claudication, rest pain, gangrene, amputation) lower extremity arterial occlusive disease and/or symptomatic (stroke, cerebral transient ischemic attacks) cerebral vascular disease and in 103 control persons. Mean plasma homocyst(e)ine was significantly higher in patients than in controls (14.37 +/- 6.89 nmol/ml vs 10.10 +/- 2.16, p less than 0.05). Thirty-nine percent of patients (83 of 214) had plasma homocyst(e)ine values greater than control mean + 2 standard deviations. Plasma homocyst(e)ine values were contrasted to age, male sex, diabetes, hypertension, smoking, renal failure, and plasma cholesterol. No difference was found in the incidence and/or level of any of these risk factors when patients with normal plasma homocyst(e)ine were compared to those with elevated plasma homocyst(e)ine, both by univariate and multivariate analysis. Patients with elevated plasma homocyst(e)ine were more likely to demonstrate clinical progression of lower extremity disease and of coronary artery disease, but not of cerebral vascular disease than were patients with normal plasma homocyst(e)ine, and the rate of progression was more rapid (p = 0.002). Progression of lower extremity disease as assessed in the vascular laboratory was also more common in patients with elevated plasma homocyst(e)ine (p = 0.01). We conclude that elevated plasma homocyst(e)ine is an independent risk factor for symptomatic lower extremity disease or cerebral vascular disease or both. Symptomatic patients with lower extremity disease and with elevated plasma homocyst(e)ine also appear to have more rapid progression of disease.
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PMID:The association of elevated plasma homocyst(e)ine with progression of symptomatic peripheral arterial disease. 198 84

We studied the efficacy of infrainguinal bypass for limb salvage in patients with end-stage renal disease. The patency of 42 femoropopliteal and femorodistal bypasses, performed for limb salvage in 37 patients with end-stage renal disease, was assessed with Doppler ultrasonography and dye tests. Patency rates and limb salvage were determined by life-table analysis. Average age was 45 years (range, 28 to 61 years); 23 of the 37 were men. Twenty-three patients had diabetes mellitus, and 16 were smokers. Bypass procedures were done in 32 instances while the patients were maintained with chronic hemodialysis and in five instances with peritoneal dialysis; in five instances the patients had had successful renal transplantation. Indications for revascularization included pain at rest, nonhealing ulcer, or distal gangrene. Femoropopliteal bypass was done in 32 limbs; 10 were more distal procedures. Reversed saphenous vein was the conduit in 30 cases; prosthetic material was used in the remainder. Autogenous material was used in all distal bypasses. Four patients required graft revision during the initial hospitalization, but none thereafter. Two patients died within the operative period, nine within 18 months of operation. Nine major operations were required. Three-month cumulative graft patency was achieved in 41 cases and corresponding limb salvage in 33 cases; 18-month patency was achieved in 34 cases and overall limb salvage in 33 cases. Success of limb salvage most closely correlated with preoperative ankle-brachial ratio and level of bypass required.
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PMID:Infrainguinal revascularization for limb salvage in patients with end-stage renal disease. 199 Apr 50

Necrotizing fasciitis is an uncommon and severe soft tissue infection characterized by cutaneous gangrene, suppurative fasciitis, and vascular thrombosis. The disease is usually preceded by trauma in patients that have systemic problems, most commonly diabetes and alcoholism. Streptococcus pyogenes and Staphylococcus aureus are the most frequent bacterial etiologies; however, combinations of numerous facultative and anaerobic organisms have also been isolated. Involvement of the face and periocular region is rare. A case is presented here, as well as a review of the clinical features of 15 other patients previously described, in whom eyelid necrosis due to periorbital necrotizing fasciitis developed. Early surgical debridement and drainage of necrotic tissues and appropriate parenteral antibiotics are the mainstay of therapy. The mortality rate in patients with periorbital spread was 12.5%, with the prognosis known to be adversely affected by delay in diagnosis and treatment and/or extension of infection from the face to the neck. Reconstruction of the eyelids with skin grafts was necessary in most cases to avoid such complications as cicatricial lid retraction, lid malpositions, and lagophthalmos.
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PMID:Eyelid necrosis and periorbital necrotizing fasciitis. Report of a case and review of the literature. 202 41

Peripheral neuropathy, infection, and peripheral vascular disease can produce serious problems in diabetic patients, particularly in the lower limbs. Ulceration of the foot may progress to gangrene and ultimately necessitate amputation. Distal symmetric polyneuropathy causes sensory loss. Such loss in patients with peripheral vascular disease creates a high risk for foot ulcers, which are vulnerable to infection. Treatment includes relief of neuropathic pain and antibiotic therapy for infection. Pentoxifylline (Trental) improves microvascular flow and appears to be effective against peripheral vascular disease. Aldose reductase inhibitors are being investigated as therapy for diabetic neuropathy. Prevention is the mainstay of management in these patients. Patient education is essential to help maintain health and prevent the potential adverse effects of diabetes.
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PMID:Lower limb problems in diabetic patients. What are the causes? What are the remedies? 203 95

Ten cases of penoscrotal gangrene seen in our department over the last 8 years are presented. In 80% of patients causative factors of the gangrenous process were demonstrated and were equally distributed between urology and colorectal pathologies. The most commonly associated pathology was diabetes mellitus affecting up to 50% of our patients. Two or more germs were isolated from the necrotic-purulent material for cultures, mainly E. coli (90%) and Proteus mirabilis (50%) as aerobic organisms, and Bacteroides fragilis (40%) in the anaerobic group. Despite emergency surgical therapy and high doses of broad spectrum antibiotics, mortality in our series was about 20%.
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PMID:[Penoscrotal gangrene: our series of cases]. 205 40

Our experience with 91 operated cases in 84 patients (47 men, 37 women) relates essentially to arterial diseases resulting from overloading and diabetic arteriopathy. Diagnosis of critical ischemia is easy in clinical conditions, but it is advisable to rely on universally recognized hemodynamic standards to define this condition. Ankle pressure should be less than 400 mmHg and the Doppler trace flat or barely perceptible. Patients in our series had a mean ankle pressure of 32.4 mmHg. Local examination can determine the extent of gangrene, whereas general examination detects numerous, often associated defects diabetes, coronary artery disease, rhythm disorders, arterial hypertension, etc. As far as possible, these defects are to be corrected before surgery. X-ray examination (M. Kasbarian) is frequently done in conjunction with conventional aorto-arteriography and digital angiography. The later technique allows arteries to be visualized which are not seen with the conventional technique. The x-ray examination will indicate whether revascularization is feasible, although it cannot show whether it will be efficient. In our series, opacification of the plantar arches was predictive neither of success nor failure. But do tests exist which can predict the success of a revascularization attempt? It would be necessary to be able to estimate ankle pressure after the operation, and several methods have tried to do this. TcPO2 would seem to be a good examination. The possibilities of nuclear magnetic resonance are being studied, and the results thus far are promising. Preoperative explorations are carried out in a different situation. Arteriography performed in the operating room is a simple act which can reveal a usable downstream bed not indicated in preoperative X-rays, although it provides no hemodynamic data. Measurement of peripheral resistances would appear to be a very good predictive examination. Flow measurements by infusion or electronic flowmeter also seem to be predictive for bypass results. Unfortunately, these measurements are at present not widely performed and the critical threshold is assessed differently. Given the difficulty of correctly estimating the value of these numerous methods, many surgeons, ourselves included, have chosen to revascularize patients whenever the upstream bed as evaluated by X-ray indicates the presence of at least one viable artery.
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PMID:[Procedures in critical ischemia of the legs in non-emergency situations]. 219 80

Cardiovascular diseases are the major cause of morbidity and mortality in the diabetic patient. The acceleration of atherogenesis occurs in all types of diabetes and culminates in such fatal complications as myocardial infarction, stroke and gangrene. Subjects with non-insulin-dependent diabetes mellitus exhibit a 3-4 times higher rate of cardiovascular mortality than non-diabetic persons. Since it was not possible to explain the excess risk by the traditional cardiovascular risk factors, various hypothesis have been put forward. These include certain aspects of blood pressure elevation, lipid changes, hyperinsulinemia, abnormal hemostasis, and impaired kidney function.
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PMID:Epidemiology and risk factors of macrovascular disease in diabetes mellitus. 220 34

A novel and simple treatment for healing of infected diabetic foot ulcers in uncontrolled diabetes mellitus patients was devised. The preparations which involve aqueous extracts from the skin of the Arabian Gulf catfish are enriched with different fractions from the same source and with catfish lipids. Eight patients with non-healing foot ulcers and two with wet gangrene were treated. It was found that the ulcers were completely healed. The gangrenic feet noticeably improved in 48 h. The treatment resulted in natural debridation of the necrotic tissues. The ulcer site was invaded by angiogenesis and granulation tissues. Sensation returned to the otherwise neuropathic extremity. The rate of growth of new tissues was proportional to the amount of healing material applied, and its effect ceased shortly after the interruption of the treatment. No. atrophy of the skin lesions was noted and no side-effects were detected.
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PMID:Diabetic ulcer healing preparations from the skin of the Arabian Gulf catfish (Arius bilineatus Val.): a novel and effective treatment. 221 Sep 69


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