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

We studied the changes in peripheral lymphocyte subsets, mitogen responsiveness, natural killer (NK) cell activity, and interleukin-2 (IL-2) production in patients with or without diabetes receiving coronary artery bypass surgery. Group I (GI): 9 diabetic patients comprising three on oral diabetics during therapy, two on insulin therapy, and four on alimentary therapy. Group II (GII): 12 non-diabetic patients (borderline diabetics excluded). age, amount of blood transfusion, number of grafts, aortic cross-clamp time (ACC), cardio-pulmonary bypass time (CPB), and operative time (OP) did not significantly differ between the groups. Lymphocyte subsets were measured using monoclonal antibodies and IL-2 production was measured by radio-immuno assay using IL-2 labeled with I125. All variables were measured the day before, the day after, 3 days after and 7 days after the operation. The number of lymphocytes and their subsets (CD3+, CD+, CD8+, 4/8 ratio, IL-2R+) did not significantly differ between the groups, but in GI patients, the number of OKIa1 positive lymphocytes were significantly lower than in GII the day before and 7 days after the operation. II-2 production on the day after the operation was significantly (p < 0.05) reduced from the preoperative level in both groups. On 3 days, there was a significant difference (p < 0.05) between the two groups: IL-2 production in GI (3.1 +/- 2.6 U) was remarkably lower than in GII (6.6 +/- 4.0 U). IL-2 production in GII was significantly correlated to the number of CD4 positive lymphocytes, but this was not true in GI. Mitogen responsiveness to stimulation with PHA was not significantly different between the groups. NK cell activity on the first postoperative day was significantly reduced (p < 0.01) in the both groups, but there was no difference between the groups. The % change in IL-2 production (%IL-2) in GII on 3 days after the operation was significantly correlated to the amount of blood transfusion (r = -0.7, p = 0.0077) but that in GI was not. %IL-2 was not significantly correlated to ACC, CPB, OP, or age in both groups. This study clearly showed that diabetics who underwent coronary artery bypass surgery suffered depression of cellular immunity, in particular, IL-2 production, which might be a key factor in cellular immunity. It showed a decrease in helper T lymphocyte function after surgery, implying postoperative immunodeficiency in diabetics.
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PMID:[Reduction in cellular immunity in diabetics receiving coronary artery bypass grafting]. 779 3

680 Peptostreptococcus sp. (Ps) were recovered from 598 (34%) of 1,750 specimens obtained from 554 patients. They included 103 Ps asaccharolyticus, 74 Ps magnus, 56 Ps prevotii, 51 Ps micros, 46 Ps anaerobius, 11 Ps morbilorum, and 10 Ps saccharolyticus. Most infections were polymicrobial (in 553 instances or 92%) but in 45 (8%), Ps were recovered in pure culture. Most Ps were isolated from abscesses (237), ears (104), peritoneal fluid (95), lung infections (66), bone (30) and sinuses (24). Predisposing conditions were present in 224 (40%) children. These were previous surgery (54), immunodeficiency (43), malignancy (35), trauma (34), diabetes (23), prematurity (22), steroid therapy (19), foreign body (10) and sickle-cell anemia (7). The organisms most commonly isolated with Ps were Bacteroides sp. (276, including 190 B. fragilis group), Prevotella sp. (159), Fusobacterium sp. (122), Escherichia coli (114), and Staphylococcus aureus (97). Antimicrobial therapy was administered to all but 14 patients. Surgical drainage or correction of pathology was performed in 307 (56%) patients. 10 patients (2%) died of their infection. These data illustrate the importance of Ps and suggests their enhancing potentials in infection in children.
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PMID:Peptostreptococcal infection in children. 785 47

A survey of the isolation of Clostridium spp. from 1543 specimens sent to anaerobic microbiology laboratories revealed 113 isolates from 107 specimens (7.0% of all specimens) from 96 children. The isolates comprised 43 (38%) unidentified Clostridium spp., 37 (33%) C. perfringens, 13 (12%) C. ramosum, five (4%) C. innocuum, six (5%) C. botulinum, three (3%) C. difficile, two (2%) C. butyricum, and one isolate each of C. bifermentans, C. clostridiiforme, C. limosum and C. paraputrificum. Most clostridial isolates were from abscesses (38), peritonitis (26), bacteraemia (10), and chronic otitis media (7). Predisposing or underlying conditions were present in 31 (32%) cases. These were immunodeficiency (12), malignancy (9), diabetes (7), trauma (7), presence of a foreign body (6) and previous surgery (6). The clostridia were the only bacterial isolates in 14 (15%) cases; 82 (85%) cases had mixed infection. The species most commonly isolated with clostridia were anaerobic cocci (57); Bacteroides spp. (B. fragilis group) (50), Escherichia coli (22), pigmented Prevotella or Porphyromonas spp. (18) and Fusobacterium spp. (10). Most Bacteroides and Escherichia coli isolates with clostridia were from abdominal infections and skin and soft tissue infections adjacent to the rectal area; most pigmented Prevotella and Porphyromonas isolates were from oropharyngeal, pulmonary, and head and neck sites. Antimicrobial therapy was given to all patients, in conjunction with surgical drainage in 34 (35%). Only two patients died. These data illustrate the importance of Clostridium spp. in paediatric infections.
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PMID:Clostridial infection in children. 786 51

Polymicrobial peritonitis is a relatively uncommon, but potentially serious complication that develops in continuous ambulatory peritoneal dialysis (CAPD) patients. Its cause and optimal management remain controversial. The authors reviewed the frequency and natural history of polymicrobial peritonitis in 432 CAPD patients. Of 1,405 episodes of peritonitis, 80 were polymicrobial (6%). Patients with polymicrobial peritonitis were similar to all CAPD patients in age, gender, race, and underlying renal disease. Diabetes mellitus, human immunodeficiency virus (HIV) status, and clinically apparent gastrointestinal disease did not predisposes patients to polymicrobial peritonitis. Thirty days after the polymicrobial peritonitis, 64 patients remained on CAPD (80%), and at 180 days 48 patients continued CAPD. Prior exit-site infections were present in 12 patients (14%) with polymicrobial peritonitis. Only 22% of patients required catheter removal to treat the infection. We conclude that polymicrobial peritonitis accounts for 6% of the total episodes of peritonitis; diabetes, HIV infection, and underlying gastrointestinal disease are not more prevalent in patients with multiorganism infections. Most patients continue CAPD therapy at 30 and 180 days after the episode of polymicrobial peritonitis.
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PMID:Outcome of polymicrobial peritonitis in continuous ambulatory peritoneal dialysis patients. 787 25

An understanding of the inflammatory and immune response is necessary to recognize conditions that alter these responses. Because normal inflammatory and immune responses are necessary for postoperative healing, the nurse needs to recognize patients at high risk for complications in the postoperative period. The first line of defense, comprised of anatomical barriers such as the skin and mucous membranes, is easily disrupted by instrumentation such as the surgeon's scalpel or any insertion of a tube, such as a central line. This provides easy access to multitudes of pathogens in the surgical patient. The second line of defense, the nonspecific inflammatory response, assists in the elimination of pathogens and the repair of damaged tissues. The cells crucial to the nonspecific inflammatory response may be impaired by drugs such as prednisone or by certain disease states, such as diabetes. The third line of defense, the specific immune response, uses the lymphocytes as effector cells. Patients with impaired immune systems, such as cancer patients, human immunodeficiency virus-positive patients, and severely malnourished patients, are at high risk for problems with postoperative healing because of their impaired immune status. High levels of anxiety and stress can also impair the ability to fight pathogens and to repair damaged tissues. Adequate preoperative teaching programs are beneficial in reducing the stress response and therefore are important in promoting the healing process.
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PMID:Immunology simplified. 789 25

Infections remain a serious hazard for the diabetic patient. Good metabolic control is a major factor in limiting the development and spread of infections and, most importantly, the development of diabetic complications which predispose to infections. In some patients recurrent infections can pose a problem, particularly if there is evidence of secondary immunodeficiency. In these patients adjuvant therapies, including Biological Responses Modifiers (BRMS) should be considered. Several factors could predispose diabetic patients to infections. These factors include: genetic susceptibility to infection; altered cellular and humoral immune defense mechanisms; local factors including poor blood supply and nerve damage, and alterations in metabolism associated with diabetes. In the context of a diabetic patient all or some of these factors may operate. The purpose of this review is to assess the relative contribution of these potential mechanisms in leading to infection in patients with diabetes.
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PMID:Infections and diabetes: mechanisms and prospects for prevention. 789 57

We performed limiting dilution culture of T cells from a patient affected by primary immunodeficiency as a result of complete lack of adenosine deaminase (ADA) activity and also affected by insulin-dependent diabetes mellitus (type I diabetes). Despite the occurrence of immunodeficiency, we were able to raise and grow T cell clones derived from this patient in long-term culture. These T cells displayed ADA enzymatic activity and produced interleukin-2 after engagement of their T cell receptor (TCR)/CD3 complex. We analyzed the TCR repertoire of such clones by nucleotide sequencing of TCR beta chains. The results show that the T cell clones express different V beta but similar J regions. However, the CDR3 regions which are implicated in antigen recognition were found to be heterogeneous.
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PMID:Long-term culture and T cell receptor analysis of T cell clones isolated from a patient with adenosine deaminase deficiency and type I diabetes. 795 66

Three hundred eighty-six isolates of Propionibacterium sp. were recovered from 2,003 specimens studied for the identification of anaerobic bacteria in children during a 15-year period. Three hundred forty-three (89%) of these were Propionibacterium acnes. A total of 50 (13%) Propionibacterium isolates identified from 45 patients were considered to cause infection. Clinically significant infections caused by Propionibacterium sp. were associated with bacteremia in 10 children; ear infection in eight; abscesses in seven; adenitis and central nervous system infection in five each; burns in four; wounds in three; tumors and bone in two each; and cysts, eye, sinus, and mastoid in one each. Predisposing or underlying conditions were present in 33 children (73%). These included the presence of a foreign body (17), immunodeficiency (six), malignancy (five), diabetes (five), previous surgery (four), and steroid therapy (two). Antimicrobial therapy was given to 41 (91%) children. Surgical drainage was concomitantly performed in 22 (49%). Four patients died. This study highlights the importance of Propionibacterium sp. as an unusual, but potentially important, pathogen in children.
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PMID:Infection caused by Propionibacterium in children. 795 90

A ten-year retrospective review of 23 cases of documented spinal epidural abscess in the cervical spine was undertaken to define the clinical features and establish current diagnostic and therapeutic criteria. Diagnosis was made by magnetic resonance imaging or myelography. Risk factors included intravenous drug abuse, diabetes mellitus, previous trauma, and a positive serologic test for the human immunodeficiency virus. A bacterial agent was isolated in 21 cases (91%). Neurologic deficits were present in 20 of the cases (87%) at the time of diagnosis. Erythrocyte sedimentation rate was elevated in all patients in whom it was measured. All patients were treated with appropriate antibiotics, usually for 6 to 8 weeks. Twenty-one patients underwent operative procedures using percutaneous aspiration (1 patient), the anterior approach (14 patients) or the posterior approach (4 patients), or a combination of the two approaches (2 patients). Four of ten patients who initially had less than antigravity strength were eventually ambulatory and continent; in each case, operative decompression was performed within 36 hours of initial consultation. Three patients who had no initial neurologic deficits remained intact.
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PMID:Epidural abscess in the cervical spine. 796 30

Immune status of 48 patients with noninsulin-dependent diabetes mellitus (NIDDM) was studied by the cytotoxic test with monoclonal antibodies. The majority of NIDDM patients were found to develop secondary immunodeficiency of the relative hyposuppressor type, the degree of immune shifts augmenting with the disease duration and as they acquire insulin dependence.
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PMID:[Immune status of patients with non-insulin-dependent diabetes mellitus]. 797 17


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