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

A case of mucormycosis in a 45 year-old woman with uncontrolled diabetes is reported. Following dental extractions, the patient presented with total ophthalmoplegia, chemosis and complete sensory loss of the right fifth cranial nerve. Exophthalmus was not present. Although a fungal infection was suspected, administration of Amphotericin B was avoided because of renal insufficiency. After temporary clinical improvement with high doses of antibiotics, signs of right seventh and eighth cranial nerve paralysis and of thrombosis of the right ophthalmic artery developed. The patient expired after six days. Autopsy disclosed extensive mucormycosis with involvement of the nasal cavity and paranasal sinuses, soft tissues and bones of face and orbit, cranial nerves, meninges and base of the brain, as well as mycotic thrombosis of the right cavernous sinus and the internal carotid, ophthalmic and maxillary arteries. The spread of infection is detailed, and the importance of an early diagnosis is stressed.
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PMID:[Cranial mucormycosis with thrombosis of the sinus cavernosus (author's transl)]. 42 1

Seven patients suffering from maturity on-set diabetes mellitus were given orally 100 mg of 14C-labelled butylbiguanide, specific activity 1.40 or 1.23 muCi/mg, resp. Three days before oral administration, two of the patients had received an i.v. injection of 50 mg butylbiguanide labelled with 120 muCi 14C. The radioactivity in the blood of the patients was followed up during the first 12-h period after administration of the drug. For determination of the radioactivity in the urine aliquots of three 24-h portions were measured. Furthermore, the radioactivity was checked of each individual sample of faeces for the first 72 h after administration. The radioactivity in the exhaled air was also measured. By comparison of the excretion after i.v. and oral application an absorption efficiency of 90% to 92% was calculated. Butylbiguanide is almost exclusively and fast excreted via the kidney. 86.5% of the i.v. administered material was eliminated within 24 h and 88.1% within 3 d in the urine of a person without kidney disease. Elimination through faeces was negligible, 0.2% in a person without kidney disease and 0.7% in a patient with renal insufficiency. The data obtained from the exhaled air show that there is only a negligible break-down of butylbiguanide, if any, to CO2 in man.
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PMID:[Distribution and excretion of 14c-butylbiguanide in man (author's transl)]. 58 7

Fibrinolytic therapy was started 90 min after central retinal occlusion in a 62-year-old male patient, but the retinal function did not recover. Another patient, aged 64 years, with occlusion of a retinal artery branch, had therapy started only 6 hours after the event and showed full recovery as was documented by angiography. General contraindications against fibrinolytic therapy are: hypertension over 200 mm Hg, arteriosclerosis, diabetes with retinal changes, previous cerebral insults, malignancy or ulcer, hepatocirrhosis, recent surgical or angiographic interventions, renal insufficiency, pregnancy, cogenital or acquired abnormal blood coagulation. If these contraindications do not apply, fibrinolytic therapy of central retinal arterial obstruction is recommended provided this therapy can be started not later than 6 hours after the event. Occlusions of the central retinal vein should have fibrinolytic therapy only if there are very few haemorrhages and if the occlusion is not older than 24 hours.
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PMID:[Indications and limitations of fibrinolytic therapy for central artery occlusion (author's transl)]. 62 82

Seven patients had acute oliguric renal failure after intravenous urography (2), celiac arteriography (2), or cardiac angiography (3). Diatrizoate meglumine was the contrast media used in all of the cases. These patients had an average age of 63 years and six were 55 years of age or older. Diabetes mellitus, negative fluid balance before the procedure, underlying renal insufficiency, and hypertension were common, being present in three, four, five, and six of the patients respectively . Anuria or oliguria occurred within 24 hours of the procedure and persisted from 36 to 96 hours (72 hours average). The serum creatinine level rose significantly in all of the patients and reached a peak in two to seven days after the procedure. In six patients, recovery was complete by two to three weeks. The seventh patient experienced only partial recovery. These cases taken together with a mounting number of recent reports suggest that contrast media-induced oliguric renal failure is more common than generally believed. Diabetes mellitus, older age, and underlying renal insufficiency seem to be important predisposing factors.
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PMID:Contrast media-induced oliguric renal failure. 62 32

Twenty-eight patients with total occlusion of the infrarenal aorta have been seen at the UCLA Hospitals in the past 11 years. Claudication was the presenting complaint in all but one patient, with one-third having ischemic rest pain. The average age of these patients was 54 years, and their histories revealed a surprising absence of myocardial infarction, stroke, or diabetes, although 40% had essential hypertension. Heavy tobacco use, however, was characteristic of the entire group. Arteriography proved valuable in identifying and characterizing the vascular abnormalities, but posed problems in technique and interpretation. Significant distal arterial disease was detected radiographically in only 21% of these patients. Operative correction of the aortic occlusion was performed on 26 patients, 18 by aortic bypass grafts and eight by aorto-iliac endarterectomy, with one early postoperative death. Although the thrombus extended to the renal artery origins in 77% of the cases, a well-designed technical approach did not require renal artery occlusion. Using serial creatinine determinations, one case of renal insufficiency was detected which was associated with prolonged postoperative hypotension. Although the extent of distal disease was more severe in those who underwent bypass, symptoms of claudication returned earlier and were more prominent in the endarterectomy group. This recurrence of systems was not favorably altered by sympathectomy performed concomitantly with the initial procedure. Even though this condition seems to pose difficult technical obstacles and has a poor prognosis, infrarenal aortic occlusion can be successfully treated by aortic bypass, with favorable long-term results, if particular attention is paid to elements of the preoperative evaluation and the intraoperative technical requirements peculiar to this relatively uncommon disease entity.
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PMID:Infrarenal aortic occlusion. 64 79

Acute renal failure following angiography with contrast agents is known to occur, but the circumstances and frequency of its occurrence are not well described. A retrospective review of consecutive angiographic procedures performed over a six month interval revealed a 12 per cent incidence of renal failure following angiography. The degree of failure was severe in approximately 30 per cent of these cases and was associated with a significant mortality even though renal function usually recovered. The occurrence of renal failure was associated with the presence of renal insufficiency, impaired liver function, diabetes mellitus, hypoalbuminemia and proteinuria at the time of angiography to a statistically significant level. Furthermore, combinations of these factors, particularly preexisting combined renal insufficiency and impaired liver function, were associated with an increased incidence of acute renal failure. It is concluded that angiography poses a significant hazard to patients with underlying medical problems, particularly those involving the excretory routes of the contrast agent.
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PMID:Renal failure following major angiography. 68 98

Thirty-two patients with advanced chronic renal insufficiency due to juvenile onset diabetes mellitus were submitted to dialytic treatment, 16 with intermittent haemodialysis and 16 with peritoneal dialysis. Both groups were similar with respect to onset of diabetes, course of renal insufficiency, as well as start and duration of dialysis treatment (382 and 389 patient months respectively). Patients on haemodialysis showed a more rapid progress of retinopathy and neuropathy, whereas the control of hypertension proved to be more difficult with peritoneal dialysis. A reduced peritoneal dialysance of urea, demonstrated in patients with diabetic nephropathy, could be improved by dipyridamole administration, whereas this drug showed no effect on the dialysances of urea and inulin in patients with chronic renal insufficiency of non-diabetic origin. There were no differences between the survival rates of the two groups which were substantially lower than in non-diabetic dialysis patients.
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PMID:Haemo- and peritoneal dialysis treatment of patients with diabetic nephropathy--a comparative study. 74 Jun 64

Eighteen diabetic patients with lactic acidosis (L.A.) were analyzed for possible causal factors, metabolic changes, and efficacy of treatment. An antecedent phenformin therapy was performed in fifteen cases and was associated with renal insufficiency in ten cases and liver disease in eight cases. Tissular anoxia of primary hemodynamic or respiratory origin was absent in all cases. The severe metabolic acidosis (pH m.93 +/- 0,03; HCO3-= 6 +/- 1 MM; PaCO2 = 18 +/- 2 MM. Hg) and hyperlactatemia (14.2 +/- 0.3 mM) were associated with high lactate/pyruvate ration (70 +/- 22). High alanine levels (up to 4.6 mM) were measured in some of these patients. High beta-hydroxybutrate levels were sometimes measured (up to 7.6 mM), and substantial amounts of acetoacetate were also detected in twelve cases. Glucagon level was always increased (1,050 +/- 240 pg./ml.), and insulin/glucagon ratio was low. Cortisol (49 +/- 10 mug./100 ml.) and HGH (10.8 +/- 0.6 ng./ml.) were also elevated. Increased plasma levels of phenformin were measured in five L.A. diabetic subjects (50 +/- 5 mug./ml.) by comparison with other phenformin-treated diabetic subjects. The specificity of the assay was investigated, and phenformin metabolites were characterized by thin-layer chromatography. Por the treatment of L.A., adjunction of dialysis and furosemide improved the efficacy of early and massive sodium bicarbonate infusion. It is suggested that accumulation of phenformin via renal insufficiency plays a determinant role in causing L.A. through an impairment of lactate metabolism in the liver. An accelerated epuration of the drug may be helpful in therapy of L.A. Phenformin treatment should be avoided in case of renal and/or liver insufficiency.
Diabetes 1975 Sep
PMID:Phenformin-induced lactic acidosis in diabetic patients. 80 37

From 1969 to 1974 on 38 diabetic patients with terminal renal insufficiency 1,500 haemodialyses were carried out. Out of them 21 were or are in the prolonged programme of dialysis. The average duration of diabetes up to the terminal renal insufficiency was 20 years. The survival time under dialysis between 50 to 616 days was on the average nearly 248 days. The waste of substances normally contained in the urine and the normalisation of changes of minerals under dialysis is to be compared with that one in non-diabetics. The conduction of the diabetic metabolism in advanced diabetic nephropathy is independent on the form of therapy chosen difficult and undergoes strong variations. For this practical recommendations are given. Dependent on the beginning of the dialysis in 8 cases we succeeded in a temporarily limited full rehabilitation, 5 patients were partially rehabilitated and in 8 patients the general condition could be improved by the treatment without successful rehabilitation. The main complications, which were also dominating causes of death, were seen from the side of the system of coronary circulation. Mediascleroses of the arterial walls partly of a high degree allow the supposition that in these cases additionally a secondary hyperparathyroidism was in question.
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PMID:[Immunological studies on the pancreas]. 81 74

The term diabetic nephropathy includes the Kimmelstiel-Wilson intercapillary glumerulosclerosis (1936), arterio-arteriolosclerotic changes and pyelonephritis. In principle, diabetic nephropathy becomes more frequent with increasing duration of diabetes mellituus. Pyelonephritis is 4 to 5 times more frequent in diabetics than in the general population. Elderly overweight women are particularly at risk. - Only the nodular intercapillary glomerulosclerosis and not the diffuse or exudative form is specific for diabetes mellitus. It is found in 20-40% of all diabetics who have had the disease for 10-15 years. Whether the microangiopathy is typical of diabetes mellitus remains to be seen. Due to the intense cardiovascular changes, possible disorders of brain and liver function and infection, the prognosis of renal insufficiency is considerably worse in diabetics than in non-diabetics.
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PMID:[Diabetic nephropathy (author's transl)]. 81 41


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