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

Infection with Coxsackie B viruses has been linked to insulin-dependent diabetes mellitus. Nine of 14 serum samples (64%) taken from children at the onset of diabetes were positive for enterovirus RNA by PCR. All of the children were under age six, and five were under age three. By contrast, enterovirus sequences were detected in only two of 45 serum samples from appropriate comparison children (4%). Sequences from six of the positive patients showed strong homology with Coxsackie B3 and B4 viruses, and there were some common patterns among the sequences from infected diabetic children. This is evidence for a role for enteroviruses in childhood diabetes.
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PMID:Coxsackie B virus infection and onset of childhood diabetes. 765 Oct 48

Diagnostic criteria for allergic fungal sinusitis have not been established, and clinical information consists primarily of isolated case reports. We proposed five diagnostic criteria for allergic fungal sinusitis including: (1) the demonstration of the characteristic eosinophil-rich allergic mucin visually or histopathologically, (2) a positive fungal stain or culture from the sinus at surgery, and (3) the absence of immunodeficiency or diabetes. With these criteria, seven patients in our metropolitan area with allergic fungal sinusitis were identified in a short period. Initial symptoms in our seven patients reflected those in 99 case reports in that two children were first seen with proptosis, one child and three adults with nasal congestion, and one adult with symptoms of chronic sinusitis. All had pansinusitis as shown on x-ray films. Six patients were atopic, five had nasal polyposis, and five had Curvularia species cultured from the sinuses. Infections with Bipolaris species, asthma, and chronic sinusitis were less common in our patients than in those previously reported. Recurrent symptoms and additional surgery sometimes resulted when the diagnosis was delayed by failure to obtain silver stains for fungus on surgical material sent for histopathologic review. Sinus tomography showed that the fungal material in the sinuses was of high density, which distinguished it from polyps or bacterial exudate. Bony compression, erosion, and rupture of the sinus walls were common. Results of IgE levels, precipitin determinations, and eosinophil counts were variable in both our patients and those in the literature. On the basis of our review, we believe that the simple diagnostic criteria proposed are appropriate for both research and clinical purposes.
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PMID:Diagnostic criteria for allergic fungal sinusitis. 762 60

From 1974 to 1990, 336 Bacteroides isolates were obtained from 312 specimens from 274 patients. They comprised 180 (54%) B. fragilis isolates, 55 (16%) B. theta-iotaomicron, 36 (11%) B. vulgatus, 34 (10%) B. distasonis, 21 (6%) B. ovatus and 10 (3%) B. uniformis. Infections in 253 (92%) patients were polymicrobial, but in 21 (8%) children, a Bacteroides sp. was isolated in pure culture. Most Bacteroides isolates were from peritoneal fluid (114), abscesses (110), wound infections (20), blood cultures (10) and from patients with pneumonia (14) or chronic otitis media (8). Predisposing conditions were present in 145 (53%) children; these were previous surgery (46), trauma (28), malignancy (21), prematurity (19), immunodeficiency (18), steroid therapy (12) foreign body (10), diabetes (9) and sickle cell disease (7). The micro-organisms isolated most commonly mixed with Bacteroides spp. were anaerobic cocci (221), Escherichia coli (122), Fusobacterium spp. (38) and Clostridium spp. (30). All patients received antimicrobial therapy in conjunction with surgical drainage or correction of pathology in 197 (72%) cases. All but 12 (5%) patients recovered. These data illustrate the importance of Bacteroides spp. in infections in children.
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PMID:Bacteroides infections in children. 762 59

Complications associated with vascular accesses account for approximately 30% of hospital admissions for chronic hemodialysis patients. Long-term patency of access was evaluated in 76 patients, without diabetes mellitus, who had been on dialysis for at least 3 years and 41 patients, with diabetes mellitus, who had been on dialysis for over 2 years. Fistulas functioned longer than grafts (58 vs. 22 months, p < 0.01, in nondiabetics and 70 vs 22 months, p < 0.01, in patients with diabetes). Declotting or revision of restored graft function for short periods of time (< 6-10 months) and subsequent declotting was ineffective. Infections were uncommon in grafts (1 per 13.5 years of dialysis) and in fistulas (1 in 200 years of dialysis).
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PMID:Long-term survival of vascular accesses in a large chronic hemodialysis population. 775 53

We reviewed 50 patients with genitourinary fungal infections between 1982 and 1992. Infections were classified as simple--localized to the bladder and complex--demonstrated evidence of upper tract and/or systemic infection. Predisposing factors of fungal infections, including diabetes mellitus, prolonged Foley catheter drainage and corticosteroid use, were not significantly different. The incidence of obstructive uropathy (88% versus 20%), malnutrition (88% versus 48%), neoplasia (56% versus 16%), renal failure (24% versus 8%) and prolonged antibiotic use (60% versus 32%) were significantly greater in patients with complex infections. The incidence of fungemia in patients with complex infections was 81% with an associated mortality rate of 36%. Of the patients with complex infections 56% required urological intervention. Given the high incidence of obstructive uropathy with complex fungal infections, upper tract imaging is essential.
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PMID:Predisposing factors of systemic fungal infections of the genitourinary tract. 777 14

The aim of this study was to review the current situation of penile prostheses in the treatment of erectile dysfunction and to analyze the indications, degree of acceptability and complications in our experience. From 1987 to 1993, 35 implants were inserted in men suffering from impotence due to different etiologies. The mean age was 54 years and the mean duration of erectile dysfunction was 37 months. Diabetes, vascular disease and pelvic surgery were the most common pathologies recorded. We utilized the penoscrotal approach in 97.14% of the cases and implanted the following prostheses: 12 Hydroflex, 7 Uniflate 1000, 6 Acuform, 4 Mark II, 3 Dynaflex and 3 Alpha 1. The mean follow-up was 38 months. Infection of the prosthesis by Staph. epidermidis was observed in 5.71% of the cases. This infectious complication required removal of the prosthesis. Two patients with a Uniflate prosthesis complained of mechanical failure. Eighty percent of the patients and 74.28% of their partners were satisfied with the results. When asked if they would undergo another operation again if it were necessary, 71.42% answered "yes". Penile prostheses have withstood the test of time and continue to be an effective and valid therapeutic alternative in impotent men. Although the complication rate is low, adequate information must be provided to the patient and partner in order to enhance the results.
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PMID:[Penile prosthetic implant in the treatment of impotence: our experience]. 780 74

Infection is one of the most common complications in diabetes mellitus (DM). The neutrophil plays an important role in the anti-infection mechanism. A comparative study on phagocytosis of P. Aeruginosa by human neutrophils in diabetic patients and healthy volunteers was carried out by means of the monolayer of neutrophils and ultrastructural observation in electronic microscopy. The results showed that the rates of phagocytosis, index of phagocytosis and rates of microbe lysis in DM group were much lower than those in normal controls (P < 0.01). The ultrastructure of neutrophils in diabetic patients became apparently abnormal during the process of neutrophil phagocytosis. The results demonstrated that the impairment in phagocytosis of neutrophils may be one of the causes of severe and repeated infection in diabetics.
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PMID:[Study on phagocytosis of human neutrophils in diabetics]. 780 88

In elderly patients, even those with a typical venous (stasis) ulcer, coexisting conditions like peripheral arterial insufficiency and diabetes are very common. Therefore, all elderly patients with leg ulcers should have a complete medical assessment. The mainstay of treatment for venous ulcers is compression therapy, exercise and leg elevation at rest. Long term treatment with double bandages (zinc paste bandages and elastic compression), changed once weekly, is the recommended standard treatment in the elderly. Hydrocolloid dressings are also suitable for long term treatment in clean ulcers, and should be changed once or twice weekly and combined with compression. Sloughy, exudating ulcers might need redressing daily with a desloughing agent for a short period of time. The risk of sensitising patients with chronic leg ulcers is high and few topical preparations, with low antigenicity, should be used. Infection and ulcerated skin cancers should be ruled out in nonhealing ulcers if the patient complies with compression therapy. After healing, the patient should be advised to continue compression therapy with stockings to prevent recurrences. New noninvasive techniques for investigation of venous insufficiency can select patients suitable for venous surgery, but many elderly patients are not interested in surgery or have other ailments that prevent surgery.
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PMID:Optimal treatment of venous (stasis) ulcers in elderly patients. 783 86

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

The quest for an ideal vascular graft began in the early 1950s and continues at a steady pace. The perfect graft has yet to be designed. As a result, patients with vascular prostheses may suffer complications that range from minor to catastrophic. The emergency physician may be faced with the initial presentation of patients with these vascular graft complications. If he or she is not familiar with these possibilities, then the resulting morbidity and mortality could be devastating. Probably the most unnerving complication involving the failure of vascular prostheses is that of the aortoenteric fistula. Instantaneous decisions and interventions must be made when a patient presents in this state of pre-exsanguination. Massive GI bleeding is at one end of the spectrum with other less-severe GI complications involving aortoenteric erosions and small bowel obstructions due to graft migration at the other end of the spectrum. Infection of a vascular prosthesis is a complication much feared by vascular surgeons. A spectrum of presentation also exists here whereby a patient may present with an obvious draining wound or with subtle complaints of fever, weakness, and a minimally elevated white blood cell count. The function of the emergency physician is critical here but only if he or she is able to suggest the possibility of graft infection to the admitting physician. Fortunately, thrombosis of a vascular graft is an infrequent complication that may occur at any time postoperatively, although the frequency decreases with time. There are many different causes of graft occlusion of which the emergency physician should be aware. If the cause of the thrombosis is known, then the secondary vascular reconstruction can be optimized. The dialysis population has grown rapidly over the past two decades and as a result so have complications of renal dialysis grafts. Because the dialysis population now includes large numbers of older subjects as well as those with systemic diseases such as diabetes and HIV, recognition and prompt aggressive management of clinical complications is of paramount importance.
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PMID:Vascular prostheses. 806 92


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