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This brief review of abdominal emergencies is by no means encyclopedic. Indeed, it simply reflects the multiplicity of problems that can occur and suggests the need for a high index of suspicion and an optimistic attitude toward their solution. In addition, the surgeon must keep in mind the fact that cancer patients may also suffer acute abdominal distress from extra-abdominal causes such as pneumonia, myocardial infarction, diabetes mellitus, and hematologic abnormalities such as porphyria or sickle cell anemia. Inflammatory bowel disease, pelvic inflammatory disease, acute hepatitis or other similar problems more commonly seen in general hospital populations may also develop. Consultations for an acute condition of the abdomen in patients receiving marrow-suppressing chemotherapy are challenging problems and repeated examination every few hours is required to detect subtle changes. Hypovolemia, sepsis, confusion and unexplained metabolic acidosis may be the only criteria for surgical exploration. An unnecessary operation in a leukopenic and thrombocytopenic patient is indeed risky, but failure to drain an occult abscess or resect a perforated segment of bowel is always lethal. An additional consideration is the likelihood of response to further treatment of the underlying disease. Unless further effective therapy is unavailable, pessimism is unwarranted.
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PMID:Abdominal emergencies. 31 58

A 72-years old man was severely injured when a lorry rolled back and pinned him down, causing contusion of the chest, fractures of ribs 3-10 on the right and haemothorax. Treatment of the chest injuries was by drainage and by positive end-expiratory pressure ventilation because of the development of severe pneumonia with wet lung. Persistent renal insufficiency, a gastro-intestinal haemorrhage and diabetes also required treatment. The patient developed septic endomyocarditis as a late complication, possibly attributable to the central venous catheter. All pulmonary and extrapulmonary injuries and complications could be set right during the patient's 4-months' stay in the intensive care unit.
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PMID:[A case of extremely severe chest injury with fracture of several ribs (author's transl)]. 37 48

Our experience with 101 consecutive T.H.A.'s in 91 patients was examined in an attempt to identify preoperative risk factors for postoperative medical complications, especially pulmonary embolism and thrombophlebitis. Six per cent of patients developed postoperative clinical thrombophlebitis, and 8% a pulmonary embolism. Advancing age and previous venous thrombosis served as predictors for pulmonary embolism and thrombophlebitis, respectively (p less than 0.01), but obesity, venous varicosities, diabetes mellitus, cigarette smoking, previous pulmonary embolism, and length of surgery did not, for either. Fifty per cent of the patients with preoperative abnormal kidney function developed some form of medical complication postoperatively, a significant increase in risk (p less than 0.05) over patients with normal kidney function. We were unable to identify an increase in postoperative atelectasis or pneumonia associated with smoking or obesity in these patients. No consistent decrease in post-operative medical morbidity could be assigned to preoperative medical consultations, suggesting that we have not yet identified all significant risk factors. A thorough preoperative preparation and improvement in intra- and postoperative techniques and management may account for differences found in this study from traditionally held risk factors.
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PMID:Risk factor assessment in 101 total hip arthroplasties: a medical perspective. 47 24

In a 22-year followup of 3686 San Francisco longshoremen, the roles of physical activity, cigarette smoking habit, and systolic blood pressure level were evaluated independently in relation to risk of death from a broad range of diseases. Smoking pattern and blood pressure status were established in 1951 and job activity was assessed annually during the followup period. Lower levels of energy expenditure predicted increased risk of fatal heart attack and perhaps of stroke. Heavy cigarette smoking predicted increased risk of death from heart attack, cancer, chronic obstructive respiratory disease, and pneumonia. Higher levels of systolic blood pressure were associated with death from all cardiovascular diseases, diabetes mellitus, and cirrhosis. Tacit to these findings: sedentary living takes its toll largely through heart disease and stroke; the toxicity of cigarette smoking is associated with a broader range of diseases, including heart attack, cancer, and respiratory disease; and higher level of blood pressure related to an even broader range of cardiovascular disease than either of the other characteristics studied.
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PMID:Energy expenditure, cigarette smoking, and blood pressure level as related to death from specific diseases. 68 71

Serious infections in adults due to group B streptococci have been infrequently reported. We describe 24 such patients. Bacteremic pyelonephritis, pneumonitis and endometritis were the most common clinical syndromes observed. Group B streptococci infections tended to occur in patients with underlying illnesses, particularly genitourinary disorders and diabetes mellitus. Mortality was surprisingly low (8 per cent). Type III was the serotype most commonly isolated, and there was no significant correlation of different serotypes with specific organ-system involvement. Group B streptococcal isolates from these patients were uniformly sensitive to penicillin, ampicillin, cephalothin, chloramphenicol, erythromycin and clindamycin; all were highly resistant to kanamycin. Eighty-seven per cent were resistant to tetracycline. Although consistently sensitive to penicillin, the minimal inhibitory concentrations were significantly higher for group B than group A streptococci (p less than 0.0005).
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PMID:Serious infections in adults due to group B streptococci. Clinical and serotypic characterization. 78 13

In the Tri-State Leukemia Survey, the history of diseases in 605 adult male leukemia cases 15 years and older and in 668 adult male population controls was examined. These diseases occurred at least 1 year before leukemia was diagnosed. The data were based on respondents' answers that the disease was diagnosed by a physician; the respondent was either the subject or his spouse. Of 30 diseases studied, 7 showed an excess among the patients with leukemia: infectious hepatitis, eczema, psoriasis, diabetes, arthritis and rheumatism, heart disease, and ankylosing spondylitis. Mumps had a lower reported occurrence among the cases, whereas pneumonia was less frequent in acute lymphatic cases than in population controls. Three diseases occurred significantly less in controls than in persons with specific histologic types of leukemia. Our data revealed a more frequent history of herpes zoster (shingles) in chronic lymphatic leukemia, more hives in acute chronic myeloid cases, and meningitis in acute myeloid leukemia. When we only considered the patients' responses, more of them admitted having had acne than did our controls. The remaining diseases--childhood viral diseases, infectious mononucleosis, smallpox, typhoid fever, dysentery, scarlet fever, tuberculosis, asthma, hay fever, and goiter did not occur more frequently in cases than in controls. The findings were consistent with evidence from previous laboratory and clinical studies. The increased occurrence of infectious hepatitis in our case series is consistent with the findings of other studies showing an increased frequency of Australia antigen in patients with hepatitis, leukemia, and Down's syndrome.
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PMID:Epidemiology of diseases in adult males with leukemia. 99 1

In a retrospective computerized study of 451 Austin Moore arthroplasties (211 for acute hip fractures and 240 for hip reconstruction), the operative and general complications were correlated with the historical, preoperative, operative, and early and late postoperative factors usually thought to influence the results. Wound complications were significantly associated with diabetes and fracture, obesity and fracture, and procedures lasting two hours or more. General complications showing significant associations were: death or pneumonia with fractures, phlebitis with obesity, and myocardial infarction with fracture. Factors not significantly associated with complications included age, previous hip surgery, time of day of the operation, surgical approach, wound irrigation, use of drains, postoperative anticoagulation, and reaming of the acetabulum.
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PMID:Complications of Austin Moore arthroplasty. Their incidence and relationship to potential predisposing factors. 107 27

This study was based on a survey of the death certificates of Pu-Li Town in Taiwan, issued over the past 20 years from 1966 to 1985. Age-adjusted mortality trends as well as cause-specific mortality trends were analyzed and compared with nationwide Taiwan data. As a whole, Pu-Li had a higher age-adjusted mortality than that of the overall Taiwan area. This finding may result from a higher mortality from tuberculosis in Pu-Li. Based on these data, the five leading causes of death in Pu-Li were cerebro-vascular disease, accident, heart disease, cancer and tuberculosis. Hypertension and diabetes were the 5th and 6th leading causes of death in 1985 and ranked 12th and 13th, respectively, in 1966. This data point out the increasing importance of hypertension and diabetes rates in Pu-Li. Tuberculosis and pneumonia had been controlled, ranking from the 1st and 3rd in 1966 to the 10th and 12th, respectively, in 1985. Suicide, cancer, and accident were usually coded as the single cause of death without other co-existent causes of death noted, so that there was in most instances not much difference between analyses based on the underlying cause of death and multiple causes of death. However, this was not true for hypertension and diabetes. If multiple causes of death were analyzed, only 34.5% of hypertension and 66% of diabetes were coded as the underlying cause of death. 37.2% of cerebro-vascular diseases co-existed with hypertension, and 20.3% of diabetes co-existed with hypertension.
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PMID:Mortality trends in the past 20 years in Pu-Li, Taiwan. 132 83

Two recent cases of cervical necrotizing soft-tissue infection are herein presented. Case 1. A 52-year-old man with uncontrolled diabetes was hospitalized because of an erythematous swelling of the left side of his neck and high grade fever. Fetid yellowish pus exuded from the left parotid area. The swelling extended from the left temporal area to the left supraclavicular fossa, with necrosis of the parotid gland, sternocleidomastoid, masseter and a portion of the strap muscles. Wound cultures revealed Staphylococcus aureus and alpha-hemolytic streptococcus. No anaerobic bacteria were detected. Treatment consisted of intravenous administration of antibiotics, control of diabetes with insulin, and debridement of the necrotic tissue, which left an epidermal defect in the initially swollen area. Transfer of a forearm free flap was done after the growth of healthy granulation tissue over the affected area. Case 2. A 55-year-old woman with rheumatoid arthritis was transferred to our hospital after tracheotomy performed in another hospital because of dyspnea due to severe crepitant swelling of her cheeks and submandibular areas bilaterally, and her left temporal area. A copious amount of fetid pus exuded from the incisions made in the left temporal area, left cheek, and right submandibular area. There were bilateral diffuse rales. Culturing the pus revealed alpha-hemolytic streptococci, while MRSA and Pseudomonas aeruginosa were detected from cultures of sputum. No anaerobic bacteria were found. After intravenous administration of antibiotics, infected wounds and pneumonia were ameliorated, and necrotic subcutaneous tissue and fascia were debrided. The patient was discharged with a residual depression in her left cheek and a scar on her left temporal area.
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PMID:[A report of two cases of cervical necrotizing soft-tissue infection]. 140 20

Eight documented cases of pulmonary zygomycosis were analyzed retrospectively with regard to radiographic and clinical features. Predisposing factors were diabetes mellitus in six cases, lymphoblastic lymphoma in one case, and surgery to correct a tracheoesophageal fistula in one case. Two of the patients with diabetes had also undergone renal transplantation for diabetic nephropathy and were immunosuppressed. The more usual radiographic findings of pulmonary zygomycosis represent a spectrum that comprises a normal chest radiograph, a lung abscess, subacute or chronic pneumonia that often evolves into a lung abscess, and rapidly progressive fatal pneumonia. Awareness of the various presentations of pulmonary zygomycosis is important because early diagnosis and appropriate therapy clearly have been shown to improve the survival rate of these patients. Zygomycosis should be included in the differential diagnosis when patients with diabetes mellitus, patients with leukemia or lymphoma, or immunocompromised patients present with or develop perplexing pulmonary abnormalities.
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PMID:Pulmonary zygomycosis: a radiographic and clinical spectrum. 140 48


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