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

A 72-year-old Japanese male developed disseminated herpes zoster and could not easily walk due to right drop foot and pain. He soon developed numbness and pain on the left side of his face, and noticed difficulty closing his left eye. The left angle of his mouth dropped. The patient was diagnosed as having a double mononeuropathy (a left facial nerve paresis and a right peroneal nerve paresis) following disseminated herpes zoster. Given that the patient was elderly and had diabetes mellitus, the patient appeared to be an immunocompromised host. We also describe other rare complications of herpes zoster from the published work.
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PMID:Isolated double herpes zoster paresis involving the left facial nerve and the right peroneal nerve following disseminated herpes zoster. 1740 47

Drastic increase in diabetic patients poses serious problems in the care of neuropathy so that there needs to explore the pathogenesis and to establish the effective treatment. Recent clinical and basic studies revealed characteristic pathophysiology of diabetic neuropathy and some clue to the direction of the treatment. The pathology of diabetic neuropathy is characterized by progressive nerve fiber loss that gives rise to positive and negative clinical signs and symptoms such as pain, paresthesia and loss of sensation. The nerve fiber loss takes the form of pan-modal pattern with proximo-distal gradient. Endoneurial microangiopathic change is also a constant feature of peripheral nerve pathology and negatively correlates with nerve fiber density. The vascular change and distal nerve fiber loss of small caliber, in particular, at the site of epidermis, commence even in subjects with impaired glucose tolerance and precede loss of nerve fibers in the nerve trunk of lower extremities. Pathogenetic mechanisms underlying the progressive nerve fiber loss seem to be multifactorial, including polyol pathway, glycation, reactive oxygen species, and altered protein kinase C activity. Clinical trials based on this background confirmed that fundamental treatment is in fact beneficial for the prevention and halting of this intractable disorder.
Diabetes Res Clin Pract 2007 Sep
PMID:Pathology and pathogenetic mechanisms of diabetic neuropathy: correlation with clinical signs and symptoms. 1746 77

Carpal tunnel syndrome is an entrapment neuropathy where the median nerve is compressed inside of the carpal canal. Causes of this syndrome include repetitive strain, wrist fracture, rheumatoid arthritis, space-occupying lesion, dialysis-related amyloidosis, diabetes mellitus, and in addition, cases with no apparent cause. Similar symptoms such as numbness, sensory disturbance of the median nerve distribution area and weakness of thenar muscles also occur in patients who suffer from cervical diseases. In cases where the patient suffers from both carpal tunnel syndrome and cervical disease, the patient's complaints may not disappear if treatment is only performed for one of them. Therefore, accurate diagnosis of the cause of the symptoms, using electrophysiological test results and/or carpal canal pressure measurement results is essential to the successful treatment of such patients. The purpose of operative treatments for carpal tunnel syndrome is to decompress the median nerve. A variety of operative treatment techniques, i.e., standard open procedure, minimum incision open procedure, one-portal or two-portal endoscopic procedures, etc., are used. Every procedure has different conditions such as equipment used, operative hand positions, location and size of skin incisions, blind ways or no blind ways, approaches to target tissues, tourniquet usage and others. I developed the world's first endoscopic operative procedure for carpal tunnel syndrome using the Universal Subcutaneous Endoscope (USE) system in 1986 and I have operated on over 7,300 hands during these last 20 years. My technique has been proven by pre- and postoperative carpal canal pressure and intraneural median nerve pressure measurement results as an evidence-based medicine. Before an operative method is chosen, the most important thing to consider is whether or not it will safely and completely achieve the purpose as evidence-based medicine with minimal invasion of the patient.
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PMID:[Operative treatment for carpal tunnel syndrome]. 1804

Diabetic neuropathy is related to plantar ulceration through a variety of factors of which increased plantar pressures and loss of protective sensation are the most important. Loss of sensation in the lower limbs is also related to postural instability and an increased risk of falling. Ankle and foot proprioception play an important role in postural control and this sensory function is also affected by neuropathy. It is conceivable that footwear, orthotics, casts and braces used for treatment or prevention of plantar ulceration through offloading of the injured or at-risk foot area can exacerbate the postural instability and risk of falling. This has, however, received very limited attention in the literature. There are studies that have demonstrated that footwear adjustments can influence balance and stability in healthy, elderly subjects. The adjustments made to footwear for the diabetic foot are generally more dramatic and, therefore, are expected to have a greater influence on postural stability. Furthermore, casts and braces tend to deviate even more from normal footwear. This may seriously interfere with normal gait and posture and, therefore, stability. So far the evidence suggests that patients wearing such devices demonstrate markedly reduced activity levels. This reduced activity could add to the effect of offloading. This could also be interpreted to indicate problems with stability. This presentation will review the different types of offloading interventions frequently used for ulcer treatment and prevention and will consider the mechanical effect of these interventions on stability.
Diabetes Metab Res Rev
PMID:Footwear for the neuropathic patient: offloading and stability. 1835 82

Brachial plexus injury has often occurred secondary to malposition of the patient during general anesthesia. We have experienced median nerve injury following laparoscopic sigmoidectomy. A 61-year-old man with diabetes and hypertension received laparoscopic sigmoidectomy under general and epidural anesthesia. Tracheal intubation was easy without excessive retroflextion of his neck after anesthesia induction with fentanyl, propofol, and vecuronium. Both his upper arms were abducted to 80 degrees and his elbows were extended on a padded arm board. The shoulder braces were placed over both his acromioclavicular joints. His head remained in neutral position. Anesthesia was maintained with air, oxygen, sevoflurane, fentanyl, and vecuronium using mepivacaine via epidural catheter. During surgical procedures, he was in a combined lithotomy and head down position at maximum of 20 degrees. The operative table was tilted to the right at maximum of 20 degrees. The operation was finished successfully in 2 hours and 40 minutes without a special event. Postoperatively, he complained of numbness of the first, second, and third digits, and the radial side of fourth digit in his right hand. The redness on both his shoulders was observed. Muscle weakness and motor disturbance were not observed. Orthopedic surgeon diagnosed him as right median nerve injury. His symptoms improved gradually by physical training and disappeared one week after the operation. We suspect that his right median nerve injury was caused by compression and stretching of the brachial plexus in head down position, right lateral tilt table, use of shoulder brace, laparoscopy, abduction of the upper arm, and extension of the elbow. In laparoscopic operation in head down position, we should avoid using the shoulder brace to minimize the risk of brachial plexus injury. The arms should be approximated to the sides as nearly as possible and the elbows should be gently flexed to unload the median nerve and relieve tension on the brachial plexus.
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PMID:[Right median nerve injury following laparoscopic sigmoidectomy]. 1854 9

The study was designed to investigate effect of alpha-lipoic acid (alphaLA) and mexidol on clinical manifestations of diabetic neuropathy (DN) and the associated changes of the affective status in patients with diabetes mellitus at early stages of diabetic foot syndrome (DFS). Integral indicator of clinical symptoms of distal symmetric sensorimotor polyneuropathy (according to the neuropathic signs and symptoms scale) significantly decreased within 14 days after the onset of the treatment with alphaLA (600 mg/day) and mexidol (300 mg/day). Antineuropathic effect of alphaLA was associated with a rise in the left ventricular ejection fraction. Mexidol reduced the severity of DN-related depression and was more efficacious than alphaLA in terms of beneficial effect on spasms and paresthesia (pricking and burning sensation, numbness) in distal segments of the lower extremities. The above clinical effects of alphaLA and mexidol were unrelated to changes of glycemia, lipidemia amd lipid peroxidation.
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PMID:[Effect of alpha-lipoic acid and mexidol on neuro- and the affective status in patients at early stages of diabetic foot syndrome]. 1906 61

The improvement in processor performance through continuous breakthroughs in transistor technology has resulted in the proliferation of lightweight embedded systems. Advances in wireless technology and embedded systems have enabled remote healthcare and telemedicine. Continuous and real-time monitoring can discretely analyze how a patient's lifestyle affects his/her physiological conditions and if additional symptoms occur under various stimuli. Diabetes is one of most difficult challenges facing the healthcare industry today. One of the primary afflictions of diabetic patients is peripheral neuropathy (loss of sensation in the foot). As a direct result of this condition, the likelihood of ulcer increases which in many cases leads to to amputation. We have developed a wireless electronic orthotics composed of lightweight embedded systems and non-invasive sensors which can be used by diabetic patients suffering from peripheral neuropathy. Our proposed system monitors feet motion and pressure distribution beneath the feet in real-time and classifies the state of the patient. The proposed system detects the conditions that could potentially cause a foot ulcer. This system enables a continuous feedback mechanism for instance in case of an undesired behavior or condition a preemptive message wirelessly to the patient and the patient's caregiver.
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PMID:Electronic orthotics shoe: preventing ulceration in diabetic patients. 1916 69

The aim of the present work was to study clinical course of depression in patients (pts) with diabetes mellitus (DM) and non-proliferative retinopathy (NPR). In total, 250 pts with DM were included into the study, and more separated into 2 groups (Gr): Gr.1 (n=115)--pts with DMT1 and DMT2 without NPR; mean ABP - SBP < or = 130 mmHg/DBP < or = 85 mmHg. Fundus photography grade 10/10. Gr.2 (n=135)--was subdivided in Gr.2a (n=43), pts with DMT1; fundus photography grade from > or = 20/10 to < or = 47/47; mean ABP - SBP < or = 130 mmHg/DBP < or = 85 mmHg; Gr.2b (n=92) pts with DMT2 fundus photography grade from > or = 20/10 to < or = 47/47, mean ABP - SBP < or = 160 mmHg/DBP < or = 90 mmHg. To assess depression severity a 12-question Screening Questionnaire was used, results were compared to Beck's and Hamilton's Depression and Sheehan's Anxiety Scales. According to Sheehan's Scale pts with DMT1 most often complained of profuse sweating (66+/-16%), while in DMT2 more often itching and numbness in different parts of the body (72+/-11%) were registered. According to the Beck's scale the most frequent and acute symptoms were: depressed mood, sadness (100-10%), disappointment about their future (78+/-14%), inferiority feeling (90+/-10%), irritation (89+/-11%), feeling of being unlucky (75+/-15%), decreased working ability (78+/-14%). DMT1 was characterized by light while DMT2 by moderate depression. Thus, depression is one of the most severe DM complications; it has negative effect both on pts compliance and quality of his/her life. When DM is complicated by NPR depression takes the most sever form (psychopathologic symptoms are observed in 85.9% of cases).
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PMID:[Psychopathologic peculiarities in patients with diabetes mellitus and non-proliferative retinopathy]. 1920 20

A 59-year-old Japanese woman developed numbness below the level of the lower chest (day 1). She showed mild paraparesis and mild sensory disturbance below the level of Th8. Anti-HTLV-1, antinuclear, and anti-SS-A antibodies were negative. The cerebrospinal fluid yielded 10 lymphocytes/microl and IgG index 0.46. MRI demonstrated a centrally located hyperintense spinal cord lesion at the level of Th4-6, but there were no lesions in the brain. Weakness improved after two courses of intravenous infusion of methylprednisolone 1000 mg. On day 67, she developed paraplegia, urinary retention, a Th4 sensory level, and loss of position sense in the lower limbs. EDSS score was 8.0. MRI demonstrated a cord lesion extending from C6 through Th10 levels. Serum anti-aquaporin 4 (AQP4) antibody was positive. After immunoadsorption plasmapheresis, strength improved. Visual evoked potential was delayed in the right eye. This case represents a high-risk syndrome of neuromyelitis optica. As the patient had diabetes, ocular hypertension, and a high risk of osteoporosis, she was started on ciclosporin in addition to a tapering dose of glucocorti-cold. The patient has remained relapse free for more than one year and serum anti-AQP4 antibody became negative. This case suggests possible beneficial effects of cyclosporin in preventing attacks of myelitis with anti-AQP4 seropositivity.
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PMID:[Relapsing transverse myelitis with anti-aquaporin 4 seropositivity: possible beneficial effects of ciclosporin]. 1922 97

A 72-year-old woman, ASA physical status II, weighing 47 kg, with uterine cancer was scheduled for semiradical hysterectomy. She had uncontrolled diabetes mellitus with FBS 123 mg x dl(-1) and HbA1c 7.0%. After an epidural catheter had been placed at the L1-2 level, general anesthesia was induced with propofol 100 mg, fentanyl 50 microg and vecuronium 5 mg. The trachea was intubated, and ventilation was controlled. Anesthesia was maintained with 1.5% sevoflurane in 30% oxygen and epidural anesthesia. Systolic blood pressure was maintained between 80-120 mmHg throughout the operation and the total blood loss was 1260 g. Continuous epidural anesthesia was started 1 hour before the end of operation using 0.2% ropivacaine and 3.7 microg x ml(-1) fentanyl at 5 ml x hr(-1). She awoke in the operating room and her trachea was extubated. After awaking from anesthesia, she complained of weakness and numbness in the both lower extremities. We considered these as an influence of epidurally administered 5 ml of 0.5% ropivacaine 30 min before the end of surgery. However, 2 hours later, she complained of right lower leg pain. We removed the epidural catheter, considering the possibility of the epidural catheter tip stimulating nerve root. However, next morning, the frontal part of her right lower leg turned reddish and swollen, and the pain appeared with the pulse of dorsalis pedis artery hardly palpable. Taken together these symptoms and the elevation of creatine kinase to 20000 IU x l(-1), we diagnosed as a compartment syndrome. In the evening of the postoperative one day, emergent fasciotomy was performed under local anesthesia. She was discharged with full recovery of her right leg function, and a well healed fasciotomy scar. Magnetic resonance angiography (MRA) on the 10th postoperative day demonstrated the obstruction of the right superficial femoral artery and anterior tibial artery. Emergent fasciotomy is the recommended treatment for severe compartment syndrome. Early recognition, diagnosis, and surgical intervention averted potential neural and functional impairment in this patient.
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PMID:[Compartment syndrome in the left lower leg following semiradical hysterectomy under general anesthesia combined with epidural anesthesia]. 1936 20


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