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

Infections of the lower extremities in patients with diabetes mellitus have been attributed to Staphylococcus aureus and other facultatively anaerobic bacteria. However, a review of 30 consecutive diabetics who required surgery for lower-extremity infections revealed that 17 had mixed infections due to both obligate and facultative anaerobes; only six had infections due to S. aureus. Mixed infections often had characteristics of anaerobic suppuration and responded poorly to therapy. Patients with mixed infections required more operations than did those with staphylococcal infections, and their surgical wounds healed more slowly. Seven patients had infections with mixed enteric bacteria (neither anaerobes nor S. aureus), and their response to therapy was intermediate between that of the patients with mixed anaerobic infections and those with staphylococcal infections. Nine additional patients with mixed anaerobic infections were treated with cefoxitin; three required amputations at a level above the ankle, but six patients improved and required only limited surgery that preserved foot function. Bacteroides fragilis was the anaerobe isolated most often. Cefoxitin (less than or equal to 20 micrograms/ml) inhibited all of the anaerobes isolated from the nine patients and 97% of an additional 135 consecutive clinical isolates of B. fragilis; 98% of 54 strains of Bacteroides oralis and all of 34 strains of Bacteroides melaninogenicus were also inhibited. These in vitro results and the results of our clinical study show that cefoxitin is a promising antibiotic for therapy of foot infections due to a mixed flora of anaerobes in diabetics.
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PMID:The fetid foot: lower-extremity infections in patients with diabetes mellitus. 31 25

Indications, selection of donor and recipient, medical and surgical management and complications, problems of organ procurement. Renal transplantation has become routine therapy. Organs are predominantly obtained from cadavers, transplantations from living donors are rarely indicated. Advances in preservation methods have improved organ quality and prolonged storage time. Selection of the most suitable recipient is based on histocompatibility matching. Blood transfusions before transplantation seem to improve the results. Recognition of a rejection crisis is primarily based on clinical symptoms. Persistent rejection calls for prompt explantation and the patient has to return to dialysis. Infections, serum-hepatitis and gastro-intestinal bleeding are the most common complications. Late complicatons are diabetes mellitus, cirrhosis of the liver, osteopathy, recurring glomerulonephritis, and, rarely, malignomas. Transplantation frequency in the Federal Republic of Germany could be increased by more awareness of physicians and a better knowledge of the general public about the need for cadaver donors.
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PMID:[Kidney transplantation from a nephrological-urological viewpoint--results and problems. 2. Diagnosis and therapy after transplantation, complications, long-term results]. 33 52

There is reported about a case of vulvitis, which was resistant to usual forms of therapy. Infections as such of Candida or of Trichomonas as well as diabetes could be excluded. But there could be proved an incidence of Ancylostoma duodenale, which is nowadays more often to be observed. Adequate therapy was successful.
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PMID:[Vulvitis due to ancylostoma duodenale (author's transl)]. 96 93

A large end stage renal failure population treated by chronic ambulatory peritoneal dialysis (CAPD) was examined for rates of infection, CAPD modality failure and patient survival (N = 347). Nearly half were considered high risk for survival for reasons of age (39% older than 60 years), diabetes mellitus (33%), hemodialysis access failure (10%), poor cardiopulmonary reserve (16%) or technical challenges (30% had morbid obesity, history of abdominal aortic aneurysm repair or multiple abdominal surgeries). Hence, CAPD was often initiated by default rather than choice in the 347 patients studied (mean age: 51 +/- 17 years). Infections greatly outnumbered technical failures as grounds for cessation of CAPD. Over 5521 patient-months, 51% of patients developed infection with peritonitis predominating (80%) when compared to exit site infections (20%). The frequency of infections was 1.9 mean episodes per patient; however, 55% of these patients had only one episode of peritonitis. A rate of 0.75 infections per patient per year was seen with an average interval of 16 months between infections. Technique and patient survival rates at 4 years were 50% and 61% respectively. High risk status does not preclude successful CAPD and should not preclude its implementation.
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PMID:Single center success with a high risk peritoneal dialysis population. 136 61

Homologous transfusions are immunosuppressive and associated with a higher risk of postoperative infection. In this retrospective analysis, we studied 238 consecutive patients who underwent first-time coronary operations by a single surgeon in 1988 to 1989 and collected clinical and laboratory data relevant to postoperative infections including pulmonary, urinary, and wound sites. Culture-proved postoperative infections occurred in 16 of the 238 patients (6.7%), with only 3 (1.3%) being deep sternal wound infections. Seven of 16 (44%) of the infections were away from the wound sites, suggesting that nonsurgical variables contributed to at least some infections. Factors significantly associated with an increased risk of postoperative infection by univariate analysis included female sex, diabetes mellitus, and transfusion dose. Infections occurred in 3.9% of patients receiving up to 2 units of red cells and whole blood, 6.9% receiving 3 to 5 units, and 22% of those receiving 6 units or more. Multiple linear and logistic regression analysis showed that transfusion dose was the most significant predictor of infection, days of fever, days of antibiotic therapy, and length of hospital stay. Homologous transfusion is associated (in a dose-dependent fashion) with a threefold to eightfold increased risk of postoperative infection in patients undergoing coronary artery operations. This increased risk of infection may be due to transfusion-induced immunosuppression of the patient.
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PMID:Homologous blood transfusion as a risk factor for postoperative infection after coronary artery bypass graft operations. 140 68

Pyelonephritis emphysematous (PE) is a life threatening renal infection which is observed practically exclusively as a serious complication of diabetes mellitus. 95% of the 73 cases which have been reviewed were found in diabetic patients. The symptomatology resembles that of severe acute pyelonephritis but the disease differs from this in that, in PE, emphysema develops in the actual renal parenchyma and/or in the perirenal tissues. The most important single factor in the etiology appears to be ischaemia of the tissues which are employed as growth media for the microorganisms involved. Infections with E. coli, Klebsiella pneumoniae, Aerobacter and Proteus are the most commonly found. Isolated cases with Candida and Cryptococcus neoformans have been observed. The mortality in untreated cases of PE is 100%. With medical treatment alone, the mortality decreases to 73% while, when combined medical and surgical intervention is employed, the mortality can be reduced to 30%.
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PMID:[Emphysematous pyelonephritis. A serious complication of diabetes mellitus]. 163 68

We address the question of whether or not age and comorbidity are related to intra- and postoperative complications after a transurethral resection. The data are derived from a retrospective, population-based study conducted in Hagen, Germany, which included all patients with an initial prostatectomy for benign prostatic hyperplasia (N = 621) during the five-year period 1984-1988. Seventy-seven percent of the patients had at least one of the following preoperative risk factors: heart disease, hypertension, smoking, chronic obstructive lung disease, and diabetes. There was no intraoperative death. The risk of intraoperative circulatory complications was found to be related to age only for patients without a history of heart diseases or hypertension. The incidence of major complications was 3.1 percent and was significantly higher in the oldest age group. Three patients (0.54%) died postoperatively in the hospital. Infections were the most frequent postoperative complications. The relationship of age and overall postoperative complications was not statistically significant either for patients with (p = 0.121) or without any comorbidity (p = 0.651). Based on this study it seems reasonable to conclude that age is not a clinically relevant risk factor for perioperative complications in patients who have a transurethral resection for benign prostatic hyperplasia.
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PMID:Comorbidities and perioperative complications among patients with surgically treated benign prostatic hyperplasia. 171 58

Infections due to Salmonella serotype enteritidis have increased markedly in the northeastern United States. Due to the potential severity of these infections, host risk factors for infection were determined in the largest nosocomial S. enteritidis outbreak to have occurred in the United States. In a case-control study, patients in a New York City hospital who developed infection after exposure to an S. enteritidis-contaminated meal were more likely to be medication-dependent diabetics than were those who did not develop infection (17/75 vs. 7/80, Mantel-Haenszel adjusted odds ratio = 3.1, 95% confidence interval = 1.1, 8.6). Proposed mechanisms for diabetes as a risk factor for infection include decreased gastric acidity in diabetic patients and an autonomic neuropathy of the small bowel that reduces intestinal motility and prolongs gastrointestinal transit time.
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PMID:Diabetes mellitus--a newly described risk factor for infection from Salmonella enteritidis. 186 41

Infections of the chest and abdominal wall are rare but potentially fatal disorders that can occur spontaneously or in association with diabetes mellitus, immunosuppression, or trauma. The condition (either in the form of necrotizing fasciitis and/or pyomyositis) is difficult to diagnose clinically because of poor localizing signs. Prognosis depends on early recognition, extent of disease, and type of causative organism. Pathologically, the infections can manifest as cellulitis, abscess, and/or granulation tissue formation. To determine the value of MR imaging in the assessment of these infections, we compared the findings of MR with those of CT, sonography, scintigraphy, and plain radiography in 13 patients with proved thoracic and/or abdominal wall infection. The imaging findings were correlated with microbiological, pathologic, and/or surgical data. The isolated pathogens were Staphylococcus aureus (n = 6), Klebsiella pneumoniae (n = 1), Mycobacterium tuberculosis (n = 4), and Streptomyces somaliensis (n = 2). In 10 of 13 patients, MR imaging and CT were comparable and proved accurate in detecting the nature and extent of the inflammatory process. In seven of the patients, CT also was useful in guiding percutaneous biopsy and/or partial drainage procedures. Coronal and sagittal MR images were helpful for planning surgery. Rib osteomyelitis was missed with both techniques in one patient; in two other patients who did not have CT, MR imaging missed osteomyelitis of the ribs, the spinous process of a vertebral body, and the iliac bone. Sonography underestimated the extent of the disease in all 13 patients, but detected fluid collections in six. Findings on scintigraphy and plain radiography were the least contributory to the diagnosis and treatment of these patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:MR imaging of thoracic and abdominal wall infections: comparison with other imaging procedures. 213 43

Infections with Coxsackie viruses (especially Coxsackie B4) are thought to be involved in the pathogenesis of diabetes. Many interdependent variables determine the outcome of an infection with a Coxsackie virus, one of them being the tropism of the virus for a specific tissue. The extent to which Beta cell tropic variants of Coxsackie B4 virus occur naturally was assessed. Human isolates of this virus were tested in an in vitro system in which elevated insulin release from infected islets incubated at a non-stimulatory (2 mmol/l) glucose concentration appears to be related to viral attack. Using this technique, 8/24 isolates tested, impaired secretory function in mouse islets. Some strains of Coxsackie B4 virus, therefore, will directly infect mouse islets in vitro leading to changes in islet cell function. In conclusion, these findings confirm that variants of Coxsackie B4 virus with the potential to damage Beta cells occur quite frequently in the natural population. In certain circumstances the damage they inflict on Beta cells may cause destruction of these cells, or precipitate overt diabetes.
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PMID:Coxsackie B4 viruses with the potential to damage beta cells of the islets are present in clinical isolates. 216 44


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