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

Group B streptococcal bacteremia outside the perinatal setting is not commonly emphasized. This report reviews all episodes of group B streptococcal bacteremia during a four and a half year period in a large community teaching hospital. Fourteen episodes occurred in neonates, four in parturient women, and 28 in other adults. Bacteremic adults were usually elderly with an average age of 68 years. Group B streptococcal bacteremia occurred in adults with various underlying diseases, including diabetes mellitus, liver disease, peripheral vascular disease, and hematologic disease, and in those receiving long-term steroid therapy. Infections causing group B streptococcal bacteremia in adults included decubitus ulcers, pneumonia, endocarditis, cellulitis, arthritis, osteomyelitis, and meningitis. Thirteen of 28 episodes of group B streptococcal bacteremia in adults were hospital-acquired. Overall mortality in adults was 70 percent. Group B streptococcal bacteremia in adults outside of the perinatal setting is associated with significant underlying diseases and has a high mortality.
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PMID:Group B streptococcal bacteremia in a community teaching hospital. 388 11

Diabetes mellitus is defined as an hereditary chronic metabolic disease due to an absolute or relative shortage of insulin. There are various types to be differentiated, among others, (I) the insulin-dependent and mostly juvenile type, and (II) the insulin-independent type, which mainly appears in later life. We discuss three main groups of cutaneous diseases. Infections of the skin and underlying tissue predominantly occur along with an acutely disturbed metabolic situation. The late diabetic syndrome includes macroangiopathy (arteriosclerosis) and microangiopathy (rubeosis, necrobiotic granulomas, diabetic skin spots, epidermolysis bullosa diabetica, gangrene). Owing to failure of sensible, motor, or autonomous fibers, diabetic neuropathy may lead to various symptoms - in the extreme case, to neuropathic malum perforans. The diabetic foot represents a collection of various diabetic complications in both early and late stages.
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PMID:[Diabetes mellitus and skin diseases]. 639 Oct 4

The patient with diabetes represents to the surgeon a particular challenge in the management of acute abdominal problems. In addition to their ongoing and potential metabolic problems, diabetics have specific difficulty in their ability to handle infections and heal wounds. The present report reviews the general principles in the peri-operative management of diabetics and discusses the implications in the diabetic of several specific clinical problems. In view of the known accelerated atherosclerosis associated with diabetes, the risks of anesthesia and surgery must be assessed in the context of the coronary, cerebral, visceral, and peripheral vascular status. Infections in diabetics (potential or established) must be treated aggressively and promptly. Acidosis in the diabetic with abdominal pain must be considered both a metabolic problem and a possible secondary manifestation of an intra-abdominal process. In view of these challenges, the need for careful, anticipatory management of the diabetic patient facing major abdominal surgery is clear.
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PMID:Diabetes and abdominal surgery: the mutual risks. 642 50

Between 1967 and 1978 41 patients were transplanted at an age of 60 years or more. The patient survival was approximately 50% at two years. Most of the dead patients died with functioning grafts. Infections and cardiovascular complications dominated as causes of death. Main complications were cardiovascular diseases, infections, musculosceletal diseases and diabetes. During the last three years results have improved and we will continue to offer kidney transplantation to elderly patients in terminal renal failure.
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PMID:Kidney transplantation in patients 60 years and older. 701 26

Infections of the head and neck were identified in 12 (9%) of 128 consecutive patients undergoing renal transplantation. The infections included sinusitis, otitis media, dental abscess, Ludwig's angina, parotitis, and nasal abscess. A significant correlation was found between the development of infection and juvenile-onset diabetes but not with previous splenectomy. None of the infections occurred during treatment of rejection episodes with corticosteroids. The clinical presentations and microbiologic agents causing the infections were similar to those found in nonimmunosuppressed patients.
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PMID:Head and neck infection after renal transplantation. 704 19

Dystrophic vulvar conditions are found to increase with age and to predominate in postmenopausal women. The differentiation of this entity from infectious lesions and from precancerous conditions by clinical examination is extremely difficult. Therefore, diagnostic procedures are necessary which supplement local inspection and palpation. Photography is useful for documentation and follow-up control and colposcopy is suited for examination of lesions exhibiting erythroplakia, but not for leukoplakia which is much more frequent. Exfoliative cytology occupies a key position in vulvar diagnosis, since negative findings almost rule out a precancerous process, so long as the criteria of malignancy are sufficiently extended to include all abnormalities of the horny cells. Infections frequently cause equivocal cytological findings which disappear after appropriate treatment. Such infections can be diagnosed by phase contrast cytology, cultures, or serological tests. In many cases, further investigation will reveal diabetes mellitus or other metabolic disorders (internal consultant), urinary incontinence (urological consultant), allergic dermatoses (dermatological consultant) or psychoneurotic disease (neurologic consultant). Positive cytological findings always prompt biopsy; but equivocal and negative findings will also lead to histologic examination, if repeated control reveals constancy or exacerbation of a lesion in spite of the use of different diagnostic and therapeutic procedures. Vital staining with the toluidine blue method (so-called Collins test) is well suited for marking para- or dyskeratotic skin areas which then can be removed by surgery.
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PMID:[Diagnosis of vulvar diseases. 2. Discussion and conclusions for practice]. 707 77

Diagnostic criteria for allergic fungal sinusitis have not been established, and clinical information consists primarily of isolated case reports. We proposed five diagnostic criteria for allergic fungal sinusitis including: (1) the demonstration of the characteristic eosinophil-rich allergic mucin visually or histopathologically, (2) a positive fungal stain or culture from the sinus at surgery, and (3) the absence of immunodeficiency or diabetes. With these criteria, seven patients in our metropolitan area with allergic fungal sinusitis were identified in a short period. Initial symptoms in our seven patients reflected those in 99 case reports in that two children were first seen with proptosis, one child and three adults with nasal congestion, and one adult with symptoms of chronic sinusitis. All had pansinusitis as shown on x-ray films. Six patients were atopic, five had nasal polyposis, and five had Curvularia species cultured from the sinuses. Infections with Bipolaris species, asthma, and chronic sinusitis were less common in our patients than in those previously reported. Recurrent symptoms and additional surgery sometimes resulted when the diagnosis was delayed by failure to obtain silver stains for fungus on surgical material sent for histopathologic review. Sinus tomography showed that the fungal material in the sinuses was of high density, which distinguished it from polyps or bacterial exudate. Bony compression, erosion, and rupture of the sinus walls were common. Results of IgE levels, precipitin determinations, and eosinophil counts were variable in both our patients and those in the literature. On the basis of our review, we believe that the simple diagnostic criteria proposed are appropriate for both research and clinical purposes.
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PMID:Diagnostic criteria for allergic fungal sinusitis. 762 60

From 1974 to 1990, 336 Bacteroides isolates were obtained from 312 specimens from 274 patients. They comprised 180 (54%) B. fragilis isolates, 55 (16%) B. theta-iotaomicron, 36 (11%) B. vulgatus, 34 (10%) B. distasonis, 21 (6%) B. ovatus and 10 (3%) B. uniformis. Infections in 253 (92%) patients were polymicrobial, but in 21 (8%) children, a Bacteroides sp. was isolated in pure culture. Most Bacteroides isolates were from peritoneal fluid (114), abscesses (110), wound infections (20), blood cultures (10) and from patients with pneumonia (14) or chronic otitis media (8). Predisposing conditions were present in 145 (53%) children; these were previous surgery (46), trauma (28), malignancy (21), prematurity (19), immunodeficiency (18), steroid therapy (12) foreign body (10), diabetes (9) and sickle cell disease (7). The micro-organisms isolated most commonly mixed with Bacteroides spp. were anaerobic cocci (221), Escherichia coli (122), Fusobacterium spp. (38) and Clostridium spp. (30). All patients received antimicrobial therapy in conjunction with surgical drainage or correction of pathology in 197 (72%) cases. All but 12 (5%) patients recovered. These data illustrate the importance of Bacteroides spp. in infections in children.
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PMID:Bacteroides infections in children. 762 59

Complications associated with vascular accesses account for approximately 30% of hospital admissions for chronic hemodialysis patients. Long-term patency of access was evaluated in 76 patients, without diabetes mellitus, who had been on dialysis for at least 3 years and 41 patients, with diabetes mellitus, who had been on dialysis for over 2 years. Fistulas functioned longer than grafts (58 vs. 22 months, p < 0.01, in nondiabetics and 70 vs 22 months, p < 0.01, in patients with diabetes). Declotting or revision of restored graft function for short periods of time (< 6-10 months) and subsequent declotting was ineffective. Infections were uncommon in grafts (1 per 13.5 years of dialysis) and in fistulas (1 in 200 years of dialysis).
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PMID:Long-term survival of vascular accesses in a large chronic hemodialysis population. 775 53

We reviewed 50 patients with genitourinary fungal infections between 1982 and 1992. Infections were classified as simple--localized to the bladder and complex--demonstrated evidence of upper tract and/or systemic infection. Predisposing factors of fungal infections, including diabetes mellitus, prolonged Foley catheter drainage and corticosteroid use, were not significantly different. The incidence of obstructive uropathy (88% versus 20%), malnutrition (88% versus 48%), neoplasia (56% versus 16%), renal failure (24% versus 8%) and prolonged antibiotic use (60% versus 32%) were significantly greater in patients with complex infections. The incidence of fungemia in patients with complex infections was 81% with an associated mortality rate of 36%. Of the patients with complex infections 56% required urological intervention. Given the high incidence of obstructive uropathy with complex fungal infections, upper tract imaging is essential.
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PMID:Predisposing factors of systemic fungal infections of the genitourinary tract. 777 14


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