Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The value of the vascular examination cannot be over-estimated. Symptoms of vascular disease present in the foot and lower extremity may actually be manifestations of severe life-threatening disease. Symptoms, their location, and the frequency and quality of the patient's pain often provide valuable clues for the clinician's diagnosis. Central nervous system symptoms, ocular disturbances, cardiac symptoms, impotence, or constitutional disturbances may all indicate systemic arterial disease. Risk factors for this disease include smoking, hypertension, hyperlipidemia, genetic predisposition, diabetes, emotional stress, and physical inactivity. Those factors attributable to hypercoagulability and venous disease are birth control pill use, estrogen chemotherapy, obesity, prolonged immobilization, paralysis, previous thrombotic episodes, venous stasis disease, and varicose veins. An accurate bilateral assessment of blood pressure, pulses, and capillary perfusion is of critical importance. Careful inspection of the extremity for trophic changes, skin color, texture, temperature, edema, ulceration, atrophy, or paresis, will provide clues of vasculopathy. A relatively accurate assessment of circulatory status may be obtained without the use of exotic instruments. Simple tests such as the elevation and dependency tests, capillary bed return test, venous filling time test, along with blood pressure, pulse, and possibly oscillometry data are valuable in arterial evaluation. Such venous tests as inspection, percussion, Homan's sign, Trendelenburg, and Perthes' tourniquet are useful in the determination of the presence of venous disease. Fortunately, over the past few years tremendous advances have been made in the technology of the vascular laboratory. If symptoms are discovered during the vascular history and physical examination, the complete noninvasive study will provide impressive data to quantitate and specifically establish the diagnosis.
 ...
PMID:The vascular history and physical examination. 173 54

BACKGROUND Diabetic myonecrosis is an uncommon complication of long-standing poorly controlled diabetes mellitus. It presents as acute non-traumatic swelling and pain of the lower extremity, which can mimic deep vein thrombosis (DVT). The clinical course is usually self-limiting and patients respond well to supportive medical therapy. CASE REPORT A 54-year-old male with past medical history of poorly controlled diabetes mellitus type II, hyperlipidemia, gastroesophageal reflux disease (GERD), and remote history of DVT presented to our emergency department with 2-week history of progressively worsening left calf pain and swelling. On physical examination, the patient had increased warmth, edema, erythema, and tenderness in the left calf, with positive Homan's sign. A lower-extremity venous Doppler was negative for DVT. His creatinine phosphokinase (CPK) level was normal, but hemoglobin A1C was 11.0%, reflective of poor glycemic control. Magnetic resonance imaging (MRI) of the left calf revealed a focus of non-enhancement in the gastrocnemius muscle along with increased enhancement of the rest of the muscle, suggestive of diabetic myonecrosis. CONCLUSIONS Diabetic myonecrosis is a rare complication of long-standing diabetes mellitus that can often mimic DVT. Diagnosis can be made on an MRI, and treatment involves strict glycemic control along with antiplatelet therapy and non-steroidal anti-inflammatories (NSAIDs).
 ...
PMID:Diabetic Myonecrosis: A Rare Complication of Diabetes Mellitus Mimicking Deep Vein Thrombosis. 2807 44