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

Retinopathy associated with sickle-C and sickle cell disease is well described. Sickle trait and haemoglobin C trait are generally considered benign conditions, with infrequent systemic manifestations. Rare cases of retinopathy in sickle trait, in the presence of contributory factors, exist and we recently reported three such patients. The occurrence of retinopathy in haemoglobin C trait is even less well documented. Haemoglobin C does not cause red blood cell sickling but is known to decrease erythrocyte plasticity and increase blood viscosity. We report three cases in which haemoglobin C trait was associated with significant peripheral vascular occlusion and seafan formation (confirmed by fluorescein angiography) similar to that seen in sickle retinopathy. Two patients had coexistent systemic disease (hypertension and diabetes mellitus). Vitreous haemorrhage was the presenting feature in two patients. It is evident that haemoglobin C trait may be associated with sight-threatening complications.
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PMID:Retinopathy in haemoglobin C trait. 937 5

We recorded pattern electroretinograms and visual evoked potentials in a group of selected patients with unilateral uncomplicated branch retinal vein occlusion. To document the effects of preexisting risk factors, patients were divided into three groups: diabetes mellitus, hypertension with hyperlipidemia and no systemic disease. The transient and steady-state pattern electroretinogram and visual evoked potential amplitudes were significantly reduced and visual evoked potential peak times were delayed relative to the fellow eyes and age-matched normal subjects. There was a second amplitude reduction relative to the other patient groups in both the affected and fellow eyes of the diabetes mellitus group, which was indicative of an additive effect of diabetes mellitus.
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PMID:Pattern-reversal electroretinograms and visual evoked potentials in branch retinal vein occlusion. 881 95

The objects of the study were to determine: (1) whether United Kingdom ophthalmologists who used argon lasers had the elevation of colour-contrast thresholds previously discovered and (2) whether other users of argon lasers showed any unusual loss of colour vision. A total of 1072 UK ophthalmologists filled in a questionnaire about their professional use of lasers, the length of time spent operating, and their out-of-doors activities. Their colour vision was then tested by a new sensitive system, and if any abnormality was detected, a clinical eye examination was performed. The results were as follows: (1) Colour vision testing was shown to be reliable. Any self-selection bias was excluded. Test-retest variability was small. Normal results did not change during the survey. (2) A number of men with high red-green thresholds were discovered. Some were aware of their congenital insensitivity. The frequency of all such defects was less than the known incidence of congenital colour deficiency in the male population. (3) Additionally a number of high tritan (blue-yellow) thresholds were encountered, some associated with reported diabetes and hypertension. In other cases of this type, undetected or unacknowledged systemic disease may be present. (4) After making allowance for all these incidental causes of loss of colour vision, and for the effect of age on colour vision (which is very small) only four of the sample were > 2 SD above normal. (5) However, the average blue-yellow thresholds of ophthalmologists were slightly and highly significantly raised compared with normal, in the first year of the survey. During the second and third years, the mean thresholds declined to normal. Similar but less significant findings were found for protan thresholds. It is concluded that the enhanced safety precautions recently introduced are associated with a recovery of colour vision in this population, demonstrating that any changes to individuals were reversible. Colour vision screening has proved able to detect mild ocular abnormalities due to systemic and congenital disease.
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PMID:Does occupational exposure to argon laser radiation decrease colour contrast sensitivity in UK ophthalmologists? 884 35

Diabetes mellitus is a systemic disease with profound effects on oral health and periodontal wound healing. Uncontrolled diabetes adversely affects surgical wound healing and is often associated with abnormal proliferation of fibroblasts, excessive angiogenesis and poor bone regeneration. Human gingival fibroblasts and periodontal ligament cells from both diabetics and non-diabetics were evaluated for growth responses following culture in 20 mM glucose, a concentration compatible with blood glucose levels in uncontrolled diabetics. Gingival fibroblasts derived from 9 non-diabetic patients and 3 insulin-dependent diabetics either proliferated or showed little change of growth in elevated glucose. Enhanced proliferation was observed following 1 wk of culture in glucose. Growth of periodontal ligament cells from 5 non-diabetic patients was inhibited by 20 mM glucose. Fibroblasts that were markedly growth stimulated were probed for expression of basic fibroblast growth factor (bFGF) using a reverse-transcribed polymerase chain reaction (RT-PCR). Results indicate that fibroblasts exhibiting the greatest increase in growth in response to high glucose also exhibited increased expression of bFGF. No changes were observed in mRNA expression for platelet-derived growth factor-AA, platelet-derived growth factor-BB, insulin-like growth factor and transforming growth factor-beta 1. Mitogenic effects induced by the cytosol of fibroblasts exhibiting increases of growth in 20 mM glucose were abrogated by neutralizing antibodies to bFGF. In addition, some periodontal ligament cells that were growth inhibited by high glucose had reduced expression of bFGF. These data suggest that bFGF may play a role in the abnormal wound healing associated with periodontal surgery of uncontrolled diabetics.
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PMID:Glucose modulates growth of gingival fibroblasts and periodontal ligament cells: correlation with expression of basic fibroblast growth factor. 897 57

Diabetes in nonobese diabetic (NOD) mice is a T cell-dependent autoimmune disease. The destructive activities of autoreactive T cells have been shown to be tightly regulated by effector molecules. In particular, T helper (Th) 1 cytokines have been linked to diabetes pathogenesis, whereas Th2 cytokines and the cells that release them have been postulated to be protective from disease. To test this hypothesis, we generated transgenic NOD mice that express interleukin (IL) 4 in their pancreatic beta cells under the control of the human insulin promoter. We found that transgenic NOD-IL-4 mice, both females and males, were completely protected from insulitis and diabetes. Induction of functional tolerance to islet antigens in these mice was indicated by their inability to reject syngeneic pancreatic islets and the failure of diabetogenic spleen cells to induce diabetes in transgenic NOD-IL-4 recipients. Interestingly, however, islet expression of IL-4 was incapable of preventing islet rejection in overtly diabetic NOD recipient mice. These results demonstrate that the Th2 cytokine IL-4 can prevent the development of autoimmunity and destructive autoreactivity in the NOD mouse. Its ability to regulate the disease process in the periphery also indicates that autoimmune diabetes in NOD mice is not a systemic disease, and it can be modulated from the islet compartment.
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PMID:Pancreatic expression of interleukin-4 abrogates insulitis and autoimmune diabetes in nonobese diabetic (NOD) mice. 906 26

The charts of 319 consecutive patients who underwent total laryngectomy at the Cancer Institute Hospital from 1971 to 1994 were reviewed in order to clarify the relationship between pharyngo-cutaneous fistula formation and age, the dose of pre-operative radiation and radical neck dissection, as well as the need for subsequent surgical repair. The patients did not need to undergo reconstruction by flaps at the time of laryngectomy. Radiation sources were limited to X ray radiotherapy and Cobalt 60. Of the 319 patients 204 (63.9%) underwent neck dissection. Both radical neck dissection and modified radical neck dissection were classified as neck dissection. The chi-square test was used to construct a table of the three parameters age, dose of radiation and neck dissection. With respect to age, the incidence of fistula formation was 13.4% (16 patients of 119) in patients at the age of 59 and below, 5.9% (7/118) in those from 60 to 69, and 8.5% (7/82) in those at 70 years and above. Our analysis reveals that the age at the time of surgery is not a predisposing factor for fistula formation in the three age groups (59 and below, between 60 and 69, and 70 and above). Similarly the need for subsequent surgical repair is also not age-related. With respect to radiation, the incidence of fistula formation was 8.0% (4/50) for patients who received radiotherapy less than 20 Gy, 6.3% (2/32) in those who received between 20 and 40 Gy, 2.6% (2/77) in those who received between 40 and 60 Gy, 13.2% (20/152) in those who received between 60 and 80 Gy and 25.0% (2/8) in those who received over 80 Gy. When the preoperative dose of radiation was divided into three classes, that is, less than 40 Gy, 40 to 60 Gy and over 60 Gy, we observed that the incidence of fistula formation increased significantly in the patients who received over 60 Gy. Surgical repair was also indicated more frequently for those patients who received over 60 Gy than for those who received less than 60 Gy. With respect to neck dissection, the incidence of fistula formation was 12.2% (14/115) for the patients who did not undergo neck dissection or those who underwent only lymphadenectomy, 7.8% (9/115) for the patients who underwent unilateral neck dissection, and 7.9% (7/89) for those who underwent bilateral neck dissection. These data reveal that neck dissection, whether unilateral or bilateral, dose not increase the incidence of fistula formation, nor the need for subsequent surgical repair. Fistulae were present in 30 patients (9.4%) for 24 years, and 14 of these 30 patients did not need subsequent surgery. In these 30 patients with fistulae, we did not find patients with systemic disease such as diabetes mellitus prior to the surgery. When the period of 24 years was divided into 4 periods, the incidence of fistula formation was 19.0% (from 1971 to 1976), 6.9% (from 1977 to 1982), 10.3% (from 1983 to 1989) and 2.6% (from 1989 to 1994), that of the latest period was the lowest with gradual improvement. The average dose of preoperative radiation was 57.7 Gy (from 1971 to 1976), 50.8 Gy (from 1977 to 1982), 39.6 Gy (from 1982 to 1988) and 45.7 Gy (from 1989 to 1994) and reduction in dose of radiation seemed to be one of the reasons for the lower frequency of fistula. Several surgeons performed the operations for different patients, but the procedure of laryngectomy was recently directed by an experienced surgeon. The study also indicates that the risk of fistula formation is reduced not only by the dose of radiation but also by improved surgical skill.
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PMID:[Pharyngo-cutaneous fistula after total laryngectomy]. 907 Nov 21

A 66-year-old woman with a history of non insulin-dependent diabetes mellitus, hypertension, and hypothyroidism presented with a painless orbital apex syndrome without any sign of orbital cellulitis or acute systemic disease. Her blood glucose was mildly elevated, but there was no diabetic ketoacidosis. Neuroimaging revealed only mild sinus disease. Transnasal sphenoidal mucosal biopsy showed an inflammatory mass with cellular atypia on frozen sections, suggesting squamous cell carcinoma. However, review of the permanent sections showed broad, nonseptate hyphae consistent with mucormycosis. The patient was treated with a 3-month course of intravenous amphotericin B and no further surgery. Examination 3 months after presentation revealed complete resolution of her ocular motility deficits and partial resolution of her optic neuropathy. Mucormycosis should be suspected in any case of orbital apex syndrome, especially in the diabetic patient.
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PMID:Painless orbital apex syndrome from mucormycosis. 930 30

Since oral isotretinoin (Roaccutane/Accutane) is the only therapy to address all major acne causes, it remains the most effective antiacne therapy available. Due to this unique efficacy and its potential side effects that are predictable and can be managed easily and effectively, it is widely used also in acne patients suffering from serious systemic diseases. As the primary mechanism of action of oral isotretinoin is suppression of sebaceous gland activity, mucocutaneous side effects such as dry lips, nasal passages and eyes are predictable. Pretreatment counseling and concomitant use of moisturizing agents usually manage these side effects effectively; in unusual cases of particularly poor tolerability, dose adjustments suffice. Severe side effects are rare, the most common being aches and pains requiring no therapy, aspirin or paracetamol. As with other retinoids, reliable contraception is mandatory for women of childbearing potential. Acne patients with serious concomitant systemic disease, such as insulin-dependent diabetes, epilepsy or spina bifida, transplant patients, patients with renal failure, multiple sclerosis motor neuron disease and other can also safe be treated with a standard cumulative dose of 120 mg/kg per treatment course.
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PMID:How safe is oral isotretinoin? 931 Jul 42

Total knee arthroplasties are at risk for hematogenous seeding secondary to procedures that create a transient bacteremia. To define the risk of infection associated with dental surgery, a retrospective review of the records of 3490 patients treated with total knee arthroplasty by the authors between 1982 and 1993 was performed. Sixty-two total knee arthroplasties with late infections (greater than 6 months after their procedure) were identified, and of these, seven infections were associated strongly with a dental procedure temporally and bacteriologically. These seven cases represented 11% of the identified infections or 0.2% of the total knee arthroplasty procedures performed during this period. In addition, among 12 patients referred for infected total knee arthroplasties from outside institutions, two infections were associated with a dental procedure. Five of the nine (56%) patients had systemic risk factors that predisposed them to infection, including diabetes and rheumatoid arthritis. All dental procedures were extensive in nature (average, 115 minutes; range, 75-205 minutes). Eight of the patients received no antibiotic prophylaxis. One patient had only one preoperative dose. Infections associated with dental procedures may be more common than previously suspected. Eight of these patients had no prophylactic antibiotics, and one had inadequate coverage. The authors think that patients with a total knee arthroplasty who have systemic disease that compromises host defense mechanisms against infections and who undergo extensive dental procedures should receive prophylactic antibiotics. A first generation cephalosporin, given 1 hour preoperatively and 8 hours postoperatively would provide the best prophylaxis against the organisms identified in this study.
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PMID:Total knee arthroplasty infections associated with dental procedures. 975 87

Proper patient selection and careful technique will always be the marks of quality implant dentistry providers. The implications for therapy, of existing systemic disease or systemic therapies have been described in this article. All health care delivery provided by dental practitioners must take into account, always and foremost, the patient. Careful patient evaluation is critical. Patients' physicians may not fully appreciate the physiologic ramifications of the complex and sometimes lengthy appointments required in performing implant procedures. The final decisions regarding the prescription of therapy rest with the dentist. Through increased knowledge of the pathophysiology of diabetes mellitus, disorders of bone metabolism, radiotherapy, and chemotherapy, improved patient selection and perioperative management can benefit the dental implant team.
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PMID:Implants in the medically challenged patient. 942 68


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