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

Forty-five patients (25 male and 20 female) over 12 years of age with cystic fibrosis have been studied clinically, radiologically and physiologically. Their mean age at the first visit was 17 years; they were followed for a mean period of 4 years and attended at least every six months. The first symptom which developed before the age of five in 42 of the 45 patients was respiratory. Thirty-two of the 45 patients had severe lung disease (Group III) at the start of the study of the seven patients died during the study. Cough and sputum were almost universal, 23 had haemoptyses and eight pneumothoraces. Staphylococcus pyogenes, Haemophilus influenzae and Pseudomonas aeruginosa were the common pathogens isolated from sputum and the increasing prevalence of the latter was again confirmed. Acquisition of the mucoid strain of pseudomonas signified poor prognosis. Established infection was never eradicated. Forty-three patients had evidence of pancreatic insufficiency; in all but one patient the symptoms were mild and five patients abandoned dietary restriction and pancreatin without ill effect. Seven patients had symptoms of partial bowel obstruction (meconium ileus equivalent) but only one required surgical relief. The liver was enlarged in seven patients and the spleen was felt in three. Three patients had diabetes mellitus. The influence of cystic fibrosis on growth and development is reported--the growth spurt is late in the majority but growth failure is not confined to those with severe lung infection or malabsorption and in these circumstances remains unexplained. Mean weight was low in relation to height and puberty was delayed in both sexes.
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PMID:Cystic fibrosis in adolescents and adults. 82 Oct 91

Neonatal small left colon syndrome is a cause of functional colon obstruction in newborn infants, with a high association of maternal diabetes. There has been much confusion regarding its relationship to meconium plug syndrome and aganglionosis. Six cases of aganglionosis (2 in infants of diabetic mothers) were encountered in which the radiographic findings were identical to small left colon syndrome, indicating the need for caution in dismissing aganglionosis solely on the basis of a small left colon seen radiographically in a newborn infant with colon obstruction. Small left colon and meconium plug syndrome are overlapping entities in the total spectrum of functional intestinal obstruction in newborn infants.
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PMID:Neonatal small left colon syndrome: its relationship to aganglionosis and meconium plug syndrome. 91 57

Bacterial translocation is defined as the passage of viable bacteria from the gastrointestinal tract to extraintestinal sites, such as the mesenteric lymph node complex, liver, spleen, kidney, and blood. The major mechanisms promoting bacterial translocation in animal models are: (a) disruption of the ecologic equilibrium to allow intestinal bacterial overgrowth, (b) deficiencies in host immune defenses, and (c) increased permeability of the intestinal mucosal barrier. These mechanisms can act in concert to promote synergistically the systemic spread of indigenous translocating bacteria to cause lethal sepsis. Studies are presented of attempts to delineate the mechanisms promoting bacterial translocation utilizing animal models of intestinal bacterial overgrowth, immunosuppression, T-cell deficiencies, solid tumors, leukemia, diabetes, endotoxemia, hemorrhagic shock, thermal injury, bowel obstruction, bile duct ligation, protein malnutrition and parenteral nutrition. Also described are the use of selective antibiotic decontamination or nonspecific macrophage immunomodulators in attempts to reduce bacterial translocation from the gastrointestinal tract.
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PMID:Bacterial translocation from the gastrointestinal tract. 147 1

Percutaneous endoscopic gastrostomy (PEG) has become a commonly performed procedure to provide nutritional support to chronically ill patients. Following a PEG-related death, we retrospectively reviewed our complication rate with that of the published values. In the past 48 months at Madigan Army Medical Center and Eisenhower Army Medical Center, 147 PEGs have been performed. We have had 20 minor complications and 5 major complications, with 2 reported deaths directly related to the procedure. Minor complications included 14 cases of localized cellulitis and 5 cases of prolonged ileus. The major complications included two cases of necrotizing fasciitis (both fatal), two cases of tube extubation within 24 hours, both resulting in surgical gastrostomy, and one bowel obstruction requiring laparotomy. Both patients who developed necrotizing fasciitis had several predisposing factors including diabetes, malnutrition, obesity, and long-term hospitalization. In conclusion, we believe PEG is an extremely valuable procedure which should be utilized with caution in the immunocompromised or morbidly obese patient.
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PMID:Complications of percutaneous endoscopic gastrostomy. 152 71

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

Patterns of mortality among members of the Seneca Nation of Indians between January 1, 1955, and December 31, 1984, were investigated. The study cohort consisted of all members of the Seneca Nation residing in New York State who were listed in the tribal rolls as of January 1, 1955 (n = 3,262). Deaths among cohort members were identified through a computer match against New York State vital records files. Sex-specific standardized mortality ratios (SMRs) were calculated on the basis of mortality patterns exhibited by the general population of New York State, exclusive of New York City. Seneca Nation males demonstrated an excess of deaths from all causes (SMR = 124), while all-cause mortality among Seneca Nation females did not differ from that expected (SMR = 106). Both males and females exhibited excess mortality from infectious diseases, diabetes mellitus, cirrhosis of the liver, and accidents and injuries. Excess mortality was also noted among males for deaths due to atherosclerosis and hernia/intestinal obstruction and among females for deaths due to pneumonia, chronic nephritis, and homicide. Both sexes exhibited a deficit of deaths due to malignant neoplasms and circulatory diseases. Findings from this study will be useful to those responsible for the planning and implementation of health care programs among the Seneca Nation of Indians and other Native American groups.
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PMID:Mortality in a northeastern Native American cohort, 1955-1984. 292 27

Between 1973 and 1983, 43 patients with histologically proven unresectable pancreatic carcinoma were irradiated in the UCLA Department of Radiation Oncology. Ten patients received irradiation alone and 33 were nonrandomly assigned to receive chemotherapy in addition to irradiation. Of those patients receiving chemotherapy, 30 were given 5-fluorouracil and three were given a combination of agents. Forty-one of the 43 patients have died with a median survival of 7 months. Actuarial survival at 1 and 2 years was 24% and 3%. Local control was achieved in three of 43 patients. Two patients are alive with no evidence of disease at 11 and 30 months. The median survivals with and without chemotherapy were 9.5 and 4 months, respectively (p = 0.06). Survival dependent on nodal status, surgical bypass, primary site, and dose are also reported. No significant differences were found. Acute complications were noted in 23 patients but were a reason for discontinuing therapy in none. Late complications were noted in nine patients. Six patients with an upper gastrointestinal hemorrhage or a small bowel obstruction all had local recurrence. There were two patients with posttreatment diabetes mellitus and one with pancreatitis. The limits of conventional therapy for unresectable pancreatic cancer have been reached. Creative sequencing of induction combination chemotherapy, newer radiation modalities, and maintenance chemotherapy are required if systemic and local progression of this lethal disease is to be eliminated.
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PMID:Results in the management of locally unresectable pancreatic carcinoma. 348 45

Twenty-six patients, mean age 20.5 years (range 11-33 years) at last assessment or death, attended an adult cystic fibrosis clinic between 1975 and 1983. Twenty-one presented in infancy, and 5 later (3-17 years). Most morbidity was due to recurrent respiratory infection and 5 of the 7 deaths were from respiratory failure. Cor pulmonale occurred in 4 patients, pneumothorax in 3 and severe haemoptysis necessitating lobectomy in 2. Declining spirometric values and persistent isolation of Pseudomonas aeruginosa from sputum samples were associated with a poor prognosis. Minor gastrointestinal symptoms were common (19 patients). Four patients developed intestinal obstruction. Six patients had abnormal liver function tests and one patient died from hepatic cirrhosis. Diabetes was diagnosed in 3 patients and 9 patients experienced joint pains. The prognosis and quality of life for patients with cystic fibrosis appear to be improving, and all but 2 of the patients attending the clinic are at school, university or are employed.
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PMID:Cystic fibrosis--a review of 26 adolescent and adult patients. 393 89

Cystic fibrosis is the most common fatal inherited disease of Caucasians. At present, cystic fibrosis accounts for most cases of chronic progressive pulmonary disease and for many other clinical features in the first three decades of life. Thus, it is a challenge to both pediatricians and internists, particularly chest physicians. The diagnosis is based on the triad of chronic obstructive pulmonary disease, pancreatic insufficiency, and increased levels of electrolytes in the sweat. The cardinal test for confirmation of the diagnosis is the "sweat test," which is an excellent discriminant for cystic fibrosis, even in adults. Ancillary features of cystic fibrosis may be of diagnostic assistance (eg, nasal polyposis, Pseudomonas aeruginosa in sputum, azoospermia, and others). Treatment of the pulmonary disease must be emphasized. Choice of antibiotics should be based on the results of sputum culture, but P aeruginosa is the most common pathogen. Removal of secretions by regular postural drainage and percussion is an integral part of the program. Pneumothorax, massive hemoptysis, cor pulmonale, and other complications may be encountered. Sinusitis is almost universal, and nasal polyposis is frequently present. Pancreatic insufficiency occurs in over 80 percent of the patients with cystic fibrosis and may result in intestinal malabsorption. Massive salt loss through the sweat in hot weather, a distinctive type of biliary cirrhosis without jaundice, gallbladder abnormalities, cholelithiasis, and diabetes mellitus also may be found. Of special importance are intestinal obstructive complications (meconium ileus in newborn infants with cystic fibrosis and intestinal obstruction due to fecal accumulation or intussusception in adults). Azoospermia is present in 95 percent of men and there is reduced fertility in women; however, pregnancy does occur in cystic fibrosis. This chronic and ultimately fatal disease produces a predictable set of psychosocial complications.
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PMID:Diagnosis and treatment of cystic fibrosis. An update. 637 70

Canine pancreata obtained at total pancreatectomy were cannulated via the ducts and perfused with collagenase to prepare a tissue suspension that was isografted into the spleen (preparation congruent to 2 h, mean graft vol = 10 +/- 1 ml containing 24% of the B-cell mass/pancreas). In 13 dogs the tissue was implanted by reflux into terminal splenic veins: two died postoperatively, and in two the intrasplenic vein wall was inadvertently punctured during cannulation. In the remaining nine, mean fasting blood glucose (BG) was less than or equal to 150 mg/dl initially; one was killed at 2 wk (distemper) and one at 6 wk (sepsis, diabetes), and one died at 9 wk (intestinal obstruction). Mean BG was 94 +/- 4 mg/dl at 1 mo and remained in this range until the dogs were killed at 5 mo (91 +/- 13 mg/dl). During glucose-tolerance testing 1 wk preimplantation and 1 mo and 2-3 mo postimplant, mean values were: K (decline in glucose concentration, %/min), 3.4 +/- 0.2, 1.4 +/- 0.1, and 1.5 +/- 0.1; peak insulin (microU/ml), 50 +/- 5, 12 +/- 1, and 11 +/- 2; fasting serum glucagon (pg/ml), 33 +/- 3, 59 +/- 12, and 53 +/- 9, with no change in the glucagon response. Histologically, the spleens contained prominent islets. In five other dogs, the tissue was injected into the splenic pulp: mean BG rose to greater than or equal to 250 mg/dl at 2 wk (compared with initial series, P less than 0.001) and remained elevated until death at 6 wk, when histologic examination of the spleens showed severe fibrosis and no islets. Apancreatic controls (N = 4) survived 10 +/- 3 days; BG was 343 +/- 11 mg/dl terminally. We conclude that this modified method for collagenase perfusion of a single large-mammal pancreas via the ducts provides sufficient viable islets to induce prolonged normoglycemia (5 mo) and preserve the response to glucose challenge. Reflux of pancreatic fragments into splenic veins appears more efficient than intrapulp implantation.
Diabetes 1983 May
PMID:Normoglycemia after reflux of islet-containing pancreatic fragments into the splenic vascular bed in dogs. 640 80


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