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

A conservative approach to foot problems is especially useful in patients with diabetes, rheumatoid arthritis, diminished circulatory changes, and those who are too debilitated for surgical treatment. If one will start with either the medial heel wedge or the anterior heel correction, some response should be evident within 4 to 6 weeks. If the response after a trial period of approximately two to three months for a heel wedge or another two to three months for the anterior heel doesn't relieve pain, then perhaps some other problem might now become easier to localize, i.e. Morton's toe syndrome, hallux valgus, soft or hard corns, or hammertoe deformities. When the anterior heel is prescribed many foot problems other than metatarsalgia will stop being symptomatic and surgery treatment can be bypassed. A physician must know about the supply of shoes in the community and, if necessary, instigate a better inventory of available shoes. In addition, it is necessary to establish good rapport with the shoe repair man so that he will not intrude in your patient rapport or alter your directions. Patients also need advice about losing weight. Frequently a loss of 15 or 20 pounds will change a patient's complaint from one of extremely discomforting daily weight-bearing to a tolerance of a fair amount of walking and at least a reduction of the complaints to a more endurable and functional level. One can't expect the shoe correction to do everything for everyone. The anterior heel isn't the whole solution to the complicated problem but it helps to have patients begin to see results in more comfort in their shoe wear.
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PMID:The anterior heel for metatarsalgia in the adult foot. 85 20

In a prospective, randomized study a comparison was made of the results of primary below-knee amputation for ischaemic gangrene carried out by two methods: In 47 cases by the transverse technique with a long posterior musculo-cutaneous flap and in 41 cases by the sagittal technique using equally large medial and lateral musculo-cutaneous flaps--in both instances followed by 2 weeks in a half-open plaster cast with extended knee. The sex ratio and age distribution were the same in both groups. Minor differences in the vascular condition between the groups, assessed by the duration of rest pain, pulsation findings, extent of gangrene, and frequency of diabetes, wholly or partially equalized each other. The course of healing was the same in both groups, primary healing being attained in 38 per cent and 41 per cent, respectively (0.70 less than P less than 0.80). There was also no difference between the results as regards limb fitting, ambulation, occupational, or social status. It is concluded that the choice between the two methods can be based merely upon surgical skill and the ischaemic changes in the lower leg.
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PMID:Below-knee amputation for ischaemic gangrene. Prospective, randomized comparison of a transverse and a sagittal operative technique. 92 Jan 24

A review of 132 consecutive patients 65 years of age and older who had a myocardial infarction showed that two-thirds of them experienced pain at onset. Pain was the only symptom leading to bedside diagnosis in one-fourth of the patients. Pain at onset combined with sudden or increased dyspnea was present in one-fifth of the patients and pain associated with other symptoms in one-sixth. Dyspnea unaccompanied by pain heralded onset of infarction in one-fifth of the patients, and in almost 7 percent, onset was marked only by other symptoms. Cerebral symptoms dominated onset in one-tenth of the patients. Preexisting coronary heart disease, hypertension, or diabetes was not predictive of painless infarction. To avoid pitfalls and facilitate bedside diagnosis of infarction, physicians should be aware of the different clinical presentations of painless infarction in the aged, which occurred in over one-third of the patients in this cohort. They also should suspect the possibility of myocardial infarction in any patient in whom symptoms are not clear, even when they are mild and unobtrusive. Questioning of the elderly patient, his family, or others around him as early as possible after the onset of an acute attack is likely to elicit a history of pain, which may lead to the correct diagnosis.
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PMID:The initial manifestations of acute myocardinal infarction. 93 23

A peculiar involvement of the interphalangeal joints of both hands with palmar flexion of the fingers has been observed in 11 insulin-treated, nonrheumatoid, juvenile diabetics. The onset of diabetes occurred between 1 and 12 years of age. Painless deformities of the fingers with progressive stiffness and impaired extension started 4 to 10 years later. One patient complained of articular pain and swelling. X-ray and circulatory changes were absent or minimal. Prepubertal patients showed delayed puberty and stunted growth, adult patients had normal sexual development. Rheumatic or rheumatoid signs were absent. Electromyography showed minor abnormalities of the motor units, normal or subnormal motor nerve conduction velocity, increased median nerve terminal latency, in the absence of muscular atrophy or thickening of palmar tendons. Vibratory sensitivity was impaired in 1 subject. Juvenile cheiroarthropathy is associated with: a) early onset and poor control of diabetes; b) stunted growth; c) hepatomegaly; d) delayed puberty; e) long standing administration of insulin. The articular changes are distinct from previously known forms of "diabetic hand", such as atrophic neuropathy, osteoarthropathy, Dupuytren's contracture, carpal tunnel syndrome.
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PMID:Juvenile diabetic cheiroarthropathy. 97 70

A case report is presented of a 38-year-old alcoholic welfare patient. Drainage of a pancreatic abscess, which had to be repeated, pyloromyotomy, cholecystectomy and sphincterotomy were undertaken in 1972 at another hospital. He was admitted on the present occasion because of weight loss, severe attacks of pain and diabetes. At operation multiple necrotic areas were found in the pancreas, with many stones in the parenchymatous tissue and in the main pancreatic duct and one large stone close to the pailla acting like a valve. Sub-total duodenopancreatectomy, resection of the pyloric region of the stomach, retrocolic hepaticojejunostomy and gastroenteroanastomosis was performed. The postoperative recovery took place without complications. 5 days after discharge the patient died in a hypoglycaemic coma at another hospital. He had administered 400 U. insulin to himself whilst in a drunken state. A short description is given of the aetiology and pathogenesis of calcifying pancreatitis. The choice of the surgical technique depends on the operative findings and the aim of therapy. Attention is called to the increase in late mortality in patients with pancreatectomy who do not abstain from alcohol.
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PMID:[Fatal outcome of a case with calcifying alcoholic pancreatitis (author's transl)]. 97 84

186 patients with periarthritis of the shoulder have been studied. The sex ratio was female:male, 1-52:1. The peak age of onset was 54-59 years in both sexes. Over 40% of the patients were referred to the clinic after 6 months had elapsed from the time of onset of the disease. The right shoulder was more frequently involved than the left, particularly in the men. One shoulder only was affected in 75% of patients. There was frequently a previous history of 'rheumatism' before the episode of periarthritis. In one-third of the women 'nonspecific rheumatism' had occurred. Cervicobrachial pain and a previous episode of shoulder pain had occurred more often in the women. There were a number of associated diseases, ischaemic heart disease, thyroid disease among women, diabetes among women, hemiplegia, pulmonary tuberculosis, chronic bronchitis, and epilepsy. Acute trauma was rarely a precipitating factor. Manual workers were more frequently seen than sedentary workers in the sample, and there were more in the sample than in the general population of Leeds. The general psychological background was no different from a control group. The Maudsley Personality Inventory gave no different results among patients with periarthritis of the shoulder than among a control group and among the general population. It is suggested that there is no evidence in this study for a 'periarthritic personality'. It is suggested that the cause of periarthritis of the shoulder is likely to be related to chronic trauma occurring in an age range when changes in connective tissue are occurring. Certain associated diseases may predispose the patient to this disorder.
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PMID:Periarthritis of the shoulder. I. Aetiological considerations with particular reference to personality factors. 98 1

Of one hundred and forty-nine patients (101 male and 48 female) 4-67 years of age, 117 were alcoholics and underwent pancreatectomy because of episodic or continuous abdominal pain or complications or chronic pancreatitis. Nineteen patients underwent pancreaticoduodenectomy, seventy-seven 80-95% distal resection, anf fifty-three 40-80% distal pancreatic resection. There were 3 operative death and 30 late deaths 6 months to 11 years post pancreatectomy. Twenty-one patients were lost to followup, 1 to 11 years post pancreatectomy. Ninety-five patients are known to be alive, 4 of whom are institutionalized. Indications for pancreatectomy in addition to abdominal pain include recurrent or multiple pseudocysts, failure to relieve pain after decompression of a pseudocyst, pseudoaneurysm of the visceral arteries associated with a pseudocyst, recurrent attacks of pancreatitis unrelived by non-resective operations, duodenal stenosis and left side portal hypertension. The choice between pancreaticoduodenectomy or distal resection of 40-80% or 80-95% of the pancreas should be based on the principle site of inflammation whether proximal or distal in the gland, the size of the common bile duct, the ability to rule out carcinoma, and the anticipated deficits in exocrine and endocrine function. The risk of diabetes is very significant after 80-95% distal resection and of steatorrhea after pancreaticoduodenectomy. When the disease process can be encompassed by 40-80% distal pancreatectomy this is the procedure of choice.
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PMID:Pancreatectomy for chronic pancreatitis. 101 87

A 29-year-old white man with growth-onset diabetes developed fulminant endophthalmitis after vitreous lavage. The only significant symptom was severe pain 36 hours after surgery. The endophthalmitis rapidly became more severe. Despite systemic antibiotics, therapeutic vitrectomy and lensectomy, followed by the intraocular injection of antibiotics 48 hours postoperatively, the eye was lost.
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PMID:Endophthalmitis after vitrectomy. 108 74

The Tokelau Island Migrant Study has shown no important differences between those who subsequently left their home islands to migrate to New Zealand and those who remained, in key anthropometric and biochemical variables already reported. This comparison is now extended to various common diseases and conditions, and again no major difference emerges. The Tokelauans are compared with other Polynesians and shown to have less diabetes, hypertension, effort pain, chronic bronchitis and varicose veins than New Zealand Maoris, while resembling some Cook Island groups. Changes in prevalences of some conditions following migration are postulated.
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PMID:The Tokelau Island migrant study: prevalence of various conditions before migration. 108 34

Studies were undertaken in 40 patients with chronic pancreatitis six months to seven and a half years (mean 25 months) after operation, results being compared with pre-operative findings. Measurements included: exercise capacity, absence of pain, body weight, endocrine (36) and exocrine (25) pancreatic function. Almost all patients returned to full or only slightly impaired activity, were free of pain or had less pain and weight increase. Exocrine pancreatic function (secretin-pancreozymin test and faecal fat) was noted in 11 of 25 patients. In another 11 pre-operative progression was arrested. But endocrine function improved in only three of 36 and worsened in 13 (manifestation of subclinical diabetes in eight, worse glucose tolerance in five). The results justify a more active surgical approach in the treatment of chronic pancreatitis in order to save the patients from an often long and painful "burning out" of the disease on purely conservative treatment. Furthermore, exocrine pancreatic function, at least, is maintained or improved.
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PMID:[Results of operative treatment of chronic pancreatitis, especially exocrine and endocrine functions (author's transl)]. 112 91


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