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

The tactics of early operations for acute cholecystitis in patients with diabetes mellitus gives substantially better results of surgery. In the recent years the incidence of complications in this group of patients has been 20.3%, lethality--6.3%. Control of the carbohydrate metabolism must be made at short terms. It is the operation in combination with the rational insulin therapy which gives the correction of the carbohydrate metabolism.
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PMID:[Surgical treatment of acute cholecystitis in patients with diabetes mellitus]. 345 54

A case of acalculous cholecystitis in a 65-year-old man with underlying diabetes mellitus, hypertension, and peripheral arteriosclerosis is presented here. His case remained diagnostically puzzling for some time until symptoms and signs became more severe and very suggestive of acute cholecystitis. The clinical impression was then supported by an abnormal radioisotope biliary scan. The scan has fairly good sensitivity in detecting this condition but may not be totally dependable. Acalculous cholecystitis is an unusual but serious variant of a common disorder in which treatable gallbladder disease may masquerade as a less treatable liver malady. A common denominator among this disorder's many etiologies may be impairment of the gallbladder microcirculation in the presence of one or more conditions that lower the gallbladder's resistance to bacterial invasion. Prompt detection and treatment are desirable to reduce morbidity and mortality. However, early diagnosis is not always possible, because the clinical picture often is unclear, clear, gallstones are absent, and laboratory test results may be normal or equivocal. As in the case reported here, the vague clinical picture may dictate following a patient until the illness reaches an intensity acute enough to permit identification. The greatest aid to earlier diagnosis for the physician faced with circumstances similar to those described here is to think of cholecystitis and then to give strong weight to that clinical suspicion. At times, a recommendation for cholecystectomy may have to be made mainly on clinical judgment.
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PMID:Cholecystitis occurring without stones. 351 45

Prophylactic cholecystectomy has been recommended in patients who have diabetes and silent gallstones because of the reports of increased mortality resulting from acute cholecystitis in such patients. To assess recent mortality rates, we reviewed the course of acute cholecystitis in patients hospitalized between 1960 and 1981 at one hospital. Death occurred in 3 of 46 patients with diabetes and in 7 of 263 patients without the disease (p = 0.55). The age-adjusted estimate of the relative risk for death was 2.2 (95% confidence interval, 0.5 to 9.4) for diabetic compared with nondiabetic patients. All 3 diabetic patients who died had been diagnosed as having diabetes within 5 years of death, and only one had been taking insulin. Patients who had elevated blood urea nitrogen levels (greater than 20 mg/dL) were found to have an increased mortality rate when compared with patients with normal levels (27% compared with 2%; p less than 0.001). Results were similar for the outcome of serious complications. These results suggest the need for reconsideration of the recommendation for prophylactic cholecystectomy in diabetic patients with silent gallstones.
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PMID:Outcome of acute cholecystitis in patients with diabetes mellitus. 357 69

The course of the disease analyzed in 104 patients has shown the correlation between severity of acute cholecystitis and the degree of diabetes mellitus, i. e. the "syndrome of mutual aggravation". The active- temporizing tactics is recommended. The data obtained show the timely operation with a radical removal of the inflammation focus in combination with an adequate correction of carbohydrate metabolism by high doses of insulin to be a successful method of treatment of acute cholecystitis in patients with diabetes mellitus.
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PMID:[Surgical treatment of acute cholecystitis in diabetics]. 637 97

We evaluated 935 patients for risk factors of cholecystectomy. Factors assessed included reason for cholecystectomy, preoperative laboratory values, sex, age, weight, presence of associated disease, and pathologic findings. Evaluation revealed an overall significant complication rate of 10.50% and a mortality of 1.07%. Risk factors were age over 60 years, hypertension, atherosclerotic cardiovascular disease with prior heart failure, and acute cholecystitis. Incidental cholecystectomy was associated with an increased risk due to concomitant associated disease. Patients with obesity and uncomplicated diabetes had the same risk as the general population.
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PMID:Risk factors for cholecystectomy: analysis of 935 patients. 661 88

Emphysematous cholecystitis is a rare variant of acute cholecystitis, most frequently seen in elderly, debilitated, or diabetic patients. This report documents the development of fulminant sepsis due to acalculous cholecystitis after endoscopic retrograde cholangiopancreatogram (ERCP) in an otherwise healthy patient with suspected malignant obstructive jaundice. Three other cases of acute cholecystitis have been reported in the literature after ERCP. Although not proven to prevent infectious complications during ERCP, strong consideration should be given to prophylactic antibiotics in patients with suspected malignant obstruction and/or coexistent medical illness, eg, diabetes. When attempts at decompression of the obstructed biliary system by endoscopy fail, decompression by percutaneous or surgical routes should be considered in a timely fashion.
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PMID:Emphysematous cholecystitis after ERCP. 805 Mar 24

The authors analyse the results of surgical treatment in 105 elderly and old-aged patients who were admitted to the clinic for acute cholecystitis and concomitant diabetes mellitus of various severity. The results of clinical, biochemical, morphological, and cytochemical (salkaline phosphatase of neutrophilic leukocytes, HCT test, myeloperoxidase) studies revealed "the syndrome of mutual aggravation" of the pathological process. The authors conclude that an early (during the first 3 days after the onset of the disease and the severity of the "syndrome of mutual aggravation") operative intervention must be undertaken on this category of patients.
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PMID:[Surgical methods in acute cholecystitis in old and elderly patients with diabetes mellitus]. 817 72

The analysis of 664 cases operated upon for acute cholecystitis as well as a review of the literature indicate the dramatic increase in the age of patients presenting with this complication. Other obvious changes: increasing rate of diabetes mellitus and acalculous cholecystitis. The development of preoperative and operative sonography has contributed greatly to the safety of surgery for acute cholecystitis. The majority of patients classified as having low risks should, at the present state of our knowledge, undergo early and definitive surgery. This approach has shown to be the most beneficial from both the medical and economic standpoint. High risk patients as well as patients refusing surgery are optimally treated by sonar-guided percutaneous transhepatic cholecystostomy. Among the recent changes observed over the last 5 years, a marked decrease in septic complications as well as in the length of hospital stay was noted. Both changes improve the cost-benefit ratio of early surgery in this condition.
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PMID:State of the art in the diagnosis and management of acute cholecystitis. 844 56

The management of gallstones in diabetic patients has traditionally been considered problematic. Autopsy findings and uncontrolled studies have documented a higher prevalence of cholelithiasis in diabetics, and early reports showed dramatically increased perioperative morbidity and mortality for treatment of diabetics with acute cholecystitis. As a result, some authorities have recommended prophylactic cholecystectomy for diabetic patients with asymptomatic gallstones, which is in contrast to recommendations for nondiabetics. More recent investigators have shown comparable rates of operative morbidity and mortality for biliary surgery in diabetics when compared with the general population. Recent studies have questioned whether diabetes is an independent risk factor for gallstone formation. Decision analyses using these new data have shown that prophylactic cholecystectomy is not of clear benefit and should not be routinely recommended for diabetics with asymptomatic gallstones. We believe that available data, although limited, indicate that asymptomatic patients with diabetes do not benefit from screening for gallstones and that cholecystectomy should only be performed in cases of symptomatic cholelithiasis, as is the case in the general population.
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PMID:Management of gallstones in diabetic patients. 848 Oct 73

The increase of acute acalculous cholecystitis (AAC) in out-patients produces the review of clinic files of 810 cases of cholecystectomy because of acute cholecystitis; 27 were acalculous (3.3%). AAC was predominant in female sex (20/27) in which the mean age was 37 years. In twelve patients (44%) the cholecystitis was associated with diabetes and hypertension. The clinical manifestations were similar to patients with cholelithiasis and preoperative diagnosis was made in only 33% by ultrasonography. The surgical findings were: Edematous gallbladder without stones, wall thickness and necrosis, as well as perivesicular adherences. In all patients the treatment was immediate cholecystectomy, with morbidity of 14.4% and no mortality. AAC is not only present in critically ill patients, but also is present in patients not hospitalized, and immediate cholecystectomy is the treatment of choice.
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PMID:[Acute non-calculous cholecystitis in non-hospitalized patients]. 894 99


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