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

A young woman was diagnosed with systemic lupus erythematosus at the age of 7 years and incurred an acute myocardial infarction at the age of 17 years. Her risk factors for coronary artery disease include hypertension, hypercholesterolemia, a relatively long disease duration, a fairly active disease as evidenced by the history of nephrotic syndrome and other organ system involvement, and a long history of prednisone use. It is difficult to determine the etiology of this patient's acute myocardial infarction without coronary artery histopathology, but aspects of her presentation (a history of virulent systemic lupus erythematosus, and the angiographic findings of ectasia and aneurysm) suggest that coronary arteritis was the etiology of her accelerated coronary artery disease and subsequent myocardial infarction. Acute myocardial infarction is an uncommon occurrence in premenopausal women less than 30 years old.35 These patients are typically found to have an associated systemic disease such as diabetes mellitus or familial hypercholesterolemia. Systemic lupus erythematosus is a less common systemic disease associated with premature coronary artery disease. Mechanisms of acute coronary syndromes in these patients include accelerated atherosclerosis, active coronary vasculitis, and/or vasospasm with superimposed thrombosis.
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PMID:Acute myocardial infarction in a young woman with systemic lupus erythematosus. 954 9

Paracrine effect of transforming growth factor-beta1 (TGF-beta1) on autoimmune insulitis and diabetes was studied by transgenic production of the active form of porcine TGF-beta1 (pTGF-beta1) in pancreatic islet (islet) alpha cells in nonobese diabetic (NOD) mice under the control of rat glucagon promoter (RGP) (NOD-RGP-TGF-beta1). None of 27 NOD-RGP-TGF- beta1 mice developed diabetes by 45 wk of age, in contrast to 40 and 71% in male and female nontransgenic mice, respectively. None of the NOD-RGP-TGF-beta1 mice developed diabetes after cyclophosphamide (CY) administration. Adoptive transfer of splenocytes of NOD-RGP-TGF-beta1 mice to neonatal NOD mice did not transfer diabetes after CY administration. Adoptive transfer of three types of diabetogenic lymphocytes to NOD-RGP-TGF-beta1 and nontransgenic mice after CY administration led to the lower incidence of diabetes in NOD-RGP-TGF-beta1 mice versus that in nontransgenic mice: 29 vs. 77% for diabetogenic splenocytes, 25 vs. 75% for islet beta cell-specific Th1 clone cells, and 0 vs. 50% for islet beta cell-specific CD8(+) clone cells, respectively. Based on these, it is concluded that autoimmune diabetes in NOD mice is not a systemic disease and it can be completely prevented by the paracrine TGF-beta1 in the islet compartment through protection against CD4(+) and CD8(+) effector lymphocytes.
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PMID:Abrogation of autoimmune diabetes in nonobese diabetic mice and protection against effector lymphocytes by transgenic paracrine TGF-beta1. 969 Oct 86

Diabetes mellitus is a systemic disease that affects more than 12 million people in the United States and represents a risk factor for periodontitis with odds ratios of 2.1 to 3.0. New data support the concept that in diabetes-associated periodontitis, the altered host inflammatory response plays a critical role. We have recently examined the gingival crevicular fluid (GCF) mediator level, monocytic secretion, and clinical presentation of 39 insulin-dependent diabetes mellitus (IDDM) patients and 64 non-diabetic patients with various degrees of periodontal health and disease. First, we found that there was an unexpected high level of GCF mediators among the IDDM subjects, even in the gingivitis and mild periodontitis patients. Furthermore, the GCF and monocytic mediator responses were obviously bimodal in distribution with respect to periodontal status. Gingivitis patients and mild periodontitis patients represented one low response group, and the moderate and severe periodontitis subjects the high response group. Accordingly, these 4 periodontal subgroups were pooled to form 2 main groups for analyses--group A (AAP Types I-II) and group B (AAP Types III-IV). Diabetics had significantly higher GCF levels of both PGE2 and IL-1 beta when compared to non-diabetic controls with similar periodontal status. Within the diabetic group, the GCF levels of these inflammatory mediators were almost 2-fold higher in group B subjects when compared to diabetics from group A. Among diabetics, GCF TNF-alpha levels were only marginally detectable and no significant difference was found between group A and group B patients. Insulin-dependent diabetic patients with gingivitis or mild periodontitis (group A) and moderate to severe periodontitis (group B) have abnormal monocytic inflammatory secretion in response to LPS challenge from Porphyromonas gingivalis (P. gingivalis) as compared to non-diabetic periodontal patients. Data suggest that the diabetic state results in a significantly upregulated monocytic secretion of PGE2 (4.2-fold), IL-1 beta (4.4-fold), and TNF-alpha (4.6-fold) when compared to non-diabetic controls. Within diabetics, LPS dose-response curves demonstrated that monocytes from group B patients secreted approximately 3 times more PGE2 and 6.2 times more TNF-alpha than those from group A; however, there was no significant difference in monocytic IL-1 beta secretion between the 2 diabetic groups. This upregulated monocytic trait is thought to exist independently of the presence of severe periodontal disease since, in non-diabetic patients with adult periodontitis, Gram-negative bacterial infections alone are not sufficient to elicit a systemic hyperresponsive monocytic trait. Between group A and group B diabetics, there was no significant difference in metabolic control as expressed by mean level of glycosylated hemoglobin (HbA1c). In conclusion, our data suggest that diabetic patients have exaggerated inflammatory responses when compared to non-diabetic controls. Furthermore, within diabetics, individuals with moderate to severe periodontitis (group B) have significantly elevated monocytic secretion of PGE2 and TNF-alpha upon LPS challenge and significantly higher GCF levels of PGE2 and IL-1 beta when compared to patients with gingivitis or mild periodontal disease (group A). Thus, we suggest that insulin-dependent diabetes mellitus is a significant risk factor for more severe periodontal disease because, as compared to non-diabetics, diabetic subjects react with an abnormally high degree of inflammation to an equivalent bacterial burden.
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PMID:PGE2, IL-1 beta, and TNF-alpha responses in diabetics as modifiers of periodontal disease expression. 972 89

Orthostatic hypotension is frequently related to severe insufficiency of the autonomic nervous system associated with neuropathy or systemic disease like diabetes. Inversely, pre-syncopal orthostatic symptoms associated with mild drop in orthostatic blood pressure is quite often a reason to seek medical care, but is relatively unrecognized in the literature. Recently a syndrome of mild orthostatic intolerance has been defined, and seem to be quite common among young subjects, characterized by frequent orthostatic presyncopal symptoms associated with orthostatic tachycardia and high plasma catecholamines levels. In the paper, we will review different causes of orthostatic hypotension, and mention some physiopathological mechanisms linked to renal sodium handling. In particular, alterations in renal proximal segmental handling of sodium might generate and play a pathophysiological role in maintenance of the orthostatic hypotension. Finally, we will evoke some therapeutical aspects.
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PMID:[Does constitutional hypotension exist?]. 1006 35

Dental procedures may lead to a transient bacteraemia lasting for up to 30 minutes. Of the numerous cases of total hip arthroplasty (THA) reported which have been infected from haematogenous sources, dental procedures have been involved only infrequently. We reviewed the records of 2973 patients after THA. Of the late infections identified in 52 patients, three (6%) were strongly associated with a dental procedure. Infection was diagnosed by culture from the affected joint; Streptococcus viridans was identified in two cases and Peptostreptococcus in one. One patient had diabetes mellitus and another rheumatoid arthritis, both conditions predisposing to infection. The dental operations all lasted for more than 45 minutes and no patient received perioperative antibiotics. Infection of a THA after dental procedures is more common than has been previously suspected. Patients with systemic disease, or who are undergoing extensive procedures, should be considered for prophylactic antibiotic treatment.
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PMID:Infections associated with dental procedures in total hip arthroplasty. 1075 49

Antiglomerular basement membrane (anti-GBM) disease is characterized by a linear deposition of immunoglobulins along the glomerular basement membrane. A 67-year-old man with a recently discovered monoclonal gammopathy of unknown significance (MGUS) presented with microscopic hematuria, nephrotic-range proteinuria, and rapidly deteriorating renal function after a pneumonia. Renal histology showed a crescentic glomerulonephritis; immunohistology showed intense linear staining of the GBM with immunoglobulin A (IgA) and moderate linear staining with kappa and lambda light chains. Screening for systemic disease, including diabetes mellitus, lupus erythematodes disseminatus, cryoglobulinemia, was negative. Serological tests for detection of anti-GBM antibodies were positive for IgA class and negative for IgG. Further examination indicated a bronchial carcinoma T2N2M0. This clinical report adds new information to the spectrum of anti-GBM disease and suggests that neoplasia may be associated with unusual exposure of and/or immune response to epitopes in the GBM.
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PMID:IgA antiglomerular basement membrane disease associated with bronchial carcinoma and monoclonal gammopathy. 1007 3

Recurrence of chronic subdural hematoma after burr-hole craniostomy and closed system drainage is not uncommon. We sought to identify risk factors for recurrence. In 121 patients, various factors including age, initial neurologic status, hematoma thickness, computed tomographic density of the hematoma, midline shift, multiplicity, systemic disease, and drainage volume were compared retrospectively between nonrecurring cases and recurring cases. Recurrence was noted in 10 cases (8.3%). In recurring cases, the drainage volume was significantly larger than in nonrecurring cases, and the recurrence rate increased in proportion to drainage volume. Other factors significantly influencing recurrence were hematoma thickness and associated diabetes mellitus. Drainage contents mainly derived from either exudate within the subdural membrane or cerebrospinal fluid leakage. Entry of cerebrospinal fluid into the hematoma cavity or continuing leakage of serum components through opened endothelial gap junctions are considered to be major causes of increased drainage volume, leading in turn to recurrence of the hematoma.
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PMID:Recurrence factors for chronic subdural hematomas after burr-hole craniostomy and closed system drainage. 1031 36

Borreliosis is a systemic disease proceeding chronically, in stages and with dermatological, rheumatological and cardiological manifestations. In international terminology the name Lyme borreliosis is most commonly used. Recently the number of the incidents of this disease has increased in Poland as well, particularly among those employed in forests located in endemic regions, which has been confirmed in publications. In this article we present an unusual case of the coexistence of Borrelia burgdorferi infection with cervical medulla injury resulting from discopathy observed in a 65-year-old patient, who additionally suffered from arterial hypertension and diabetes.
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PMID:[Cervical cord damage caused by discopathy coexistent with borreliosis (diagnostic difficulties)]. 1061 7

Atherosclerosis of the carotid bifurcation is an observable sign of systemic disease driven by key risk factors and resulting in an epidemic of stroke, myocardial infarction, and vascular death worldwide. Aggressive integrative preventive interventions of controlling hypertension, hyperlipidemia, diabetes mellitus, smoking, systemic inflammation/infarction, depression, and hyperhomocyst(e)imia are needed in the medical management of these high-risk patients. Surgical indications for asymptomatic surgery may be recalled through the acronym CAROTID, which emphasizes knowledge of risk benefit to a particular patient, adequate disclosure, and physician--patient equipoise.
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PMID:Indications for treatment of asymptomatic carotid stenosis. 1073 43

Establishing the diagnosis of small-bowel malignancy is sometimes an extremely difficult challenge owing to its non-specific symptoms. The mainstay of treatment is early recognition, diagnosis and surgical resection. The prognosis depends primarily on the degree of spread and stage at presentation. We present two cases with initially obscure presentations of a small-bowel tumour. One was a jejunal adenocarcinoma, but an initial upper gastrointestinal and small-bowel series did not disclose the lesion; the other was a primary ileal lymphoma, first thought to be diabetes mellitus gastroparesis. Therefore, a negative small-bowel series or presentation of a systemic disease-associated intestinal pseudo-obstruction or gastroparesis does not exclude the possibility of a small-bowel malignancy, if the clinical symptoms are not alleviated after prokinetic medications. The clinicians should further pursue the possibility of an obstructing lesion.
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PMID:Pseudogastroparesis as a presentation of small-bowel malignancy. 1075 Jun 57


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