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

The alleviation of neuropathic pain cannot be satisfactorily achieved by treatment with opioids. There is much evidence to indicate that the active site of morphine for inducing effective analgesia is in the raphe magnus nucleus, where serotonin (5-HT, 5-hydroxytryptamine) acts as a primary transmitter. Therefore, we developed the hypothesis that 5-HT released in the raphe magnus nucleus could be related to the effectiveness of morphine in two mice models of neuropathic pain, diabetic (DM)-induced neuropathy and sciatic nerve ligation (SL). Two weeks after a single administration of streptozotocin, or 10 days after sciatic nerve ligation, mice were subcutaneously (s.c.) injected with morphine at 3, 5 and 10 mg/kg. The antinociceptive effect of morphine was estimated in the tail-pinch test; 5-HT content was measured after induction of neuropathic pain by microdialysis followed by high-performance liquid chromatography with electrochemical detection (HPLC-ECD). Morphine produced as insufficient antinociceptive effect in SL mice at all doses compared with that in sham-operated mice, while in DM mice, morphine given s.c. at 5 and 10 mg/kg produced antinociceptive effects compared with those in non-diabetic mice, but not at 3 mg/kg. The 5-HT content of dialysates, expressed as AUC for 75 min, in SL and DM mice was less than that in control mice. However, morphine given s.c. at 5 mg/kg did not significantly affect 5-HT levels in both mice models compared to their controls. These results suggest that the decrease in 5-HT levels in the raphe magnus nucleus may be related to attenuation of the analgesic effect of morphine caused by the abnormal pain state found in diabetes and partial peripheral nerve injury.
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PMID:Decrease in serotonin concentration in raphe magnus nucleus and attenuation of morphine analgesia in two mice models of neuropathic pain. 1474 6

To determine the safety of same-day discharge for patients who undergo combined nasal and palatal surgery for obstructive sleep apnea syndrome, we undertook a retrospective review and analysis of 2 groups of patients (total, 86 patients) who underwent such surgery. The patients with obstructive sleep apnea syndrome who underwent combined nasal and palatal surgery were considered for same-day discharge if they fulfilled the following postoperative criteria: sustained O2 saturation of 94% or greater on room air while asleep, no history of cardiopulmonary disease or diabetes mellitus, adequate oral analgesia and oral intake, hemostasis, and normal vital signs. Twenty-three patients met these criteria and were assigned to group 1. The remaining 63 patients were admitted overnight for monitoring and were assigned to group 2. The data collected included patient demographics, respiratory disturbance index, lowest O2 saturation, body mass index, and postoperative complications. The mean age, respiratory disturbance index, lowest O2 saturation, and body mass index for group 1 were 45.9 years, 36 events per hour, 84.9%, and 28.7 kg/m2, respectively. For group 2, the results were 48 years, 36.5 events per hour, 82%, and 32.5 kg/m2. There were no postoperative complications in group 1, and 3 in group 2. There were no incidents of airway compromise or cardiopulmonary events in the immediate postoperative period in either group. There were no readmissions for either group. We conclude that same-day discharge for patients who have undergone combined nasal and palatal surgery for obstructive sleep apnea syndrome is relatively safe in selected cases in which significant comorbid diseases are not present. These selected cases would have constituted a minority of the patients studied.
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PMID:Same-day discharge for selected patients undergoing combined nasal and palatal surgery for obstructive sleep apnea. 1499 68

Galanin peptide in primary sensory neurons may confer analgesia following injury. Its presence in regenerative axon sprouts where pain may be initiated has not been examined. We examined very early outgrowth of peptidergic axon sprouts after sciatic nerve crush in mice with experimental streptozotocin-induced diabetes. Diabetic mice had a retarded wave of outgrowing galanin axons, but those expressing calcitonin gene-related peptide grew normally. Diabetic mice also developed early, then persistent excessive autotomy behaviour, an index of pain behaviour in complete nerve lesions. Diabetes is associated with variations in the early outgrowth of peptide-containing axons. A relative delay in galanin axon outgrowth could contribute to heightened neuropathic pain in diabetes.
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PMID:Heightened pain and delayed regeneration of galanin axons in diabetic mice. 1507 19

Diabetic neuropathic pain is one of the most commonly encountered neuropathic pain syndromes. However, the treatment of diabetic neuropathic pain is challenging because of partial effectiveness of currently available pain relievers. It is well known that diabetic animals are less sensitive to the analgesic effect of morphine, and opioids are found to be ineffective in the treatment of diabetic neuropathic pain. Cannabinoids are promising drugs and they share a similar pharmacological properties with opioids. It has been reported that cannabinoid analgesia remained intact and to be effective in some models of nerve injury. Thus, we investigated antinociceptive efficacy and the effects of cannabinoids on behavioral sign of diabetic neuropathic pain in diabetic mice by using WIN 55, 212-2, a cannabinoid receptor agonist. Diabetes was induced by streptozotocin (STZ) (200mg/kg) and animals were tested between 45 and 60 days after onset of diabetes. Antinociception was assessed using the radiant tail-flick test. Mechanical and thermal sensitivities were measured by Von Frey filaments and hot-plate test, respectively. Tactile allodynia, but not thermal hyperalgesia developed in diabetic mice. Systemic WIN 55, 212-2 (1, 5 and 10mg/kg) produced a dose-dependent antinociception both in diabetic and control mice. WIN 55, 212-2-induced antinociception were found to be similar in diabetic mice when compared to controls suggesting efficacy of cannabinoid antinociception was not diminished in diabetic mice. WIN 55, 212-2 also produced a dose-dependent antiallodynic effect in diabetic mice. This study suggests that cannabinoids have a potential beneficial effect on experimental diabetic neuropathic pain.
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PMID:Cannabinoids blocks tactile allodynia in diabetic mice without attenuation of its antinociceptive effect. 1534 39

It has been known that acupuncture has various effects such as analgesia, promotion of homeostasis, improvements in brain circulation, and rectification of internal disorders. Neuropeptide Y (NPY), a 36-amino-acid peptide, is known to increase appetite. In the present study, the effect of acupuncture stimulation at Zusanli (St.36) on NPY expression in the Streptozotocin (STZ)-induced diabetic rats was investigated via immunohistochemistry. Increased NPY expression was detected in both the Arcuate nucleus (ARN) and the Paraventricular nucleus (PVN) of the Hypothalamus in rats with in STZ-induced diabetes. Needling on Zusanli resulted in decreased NPY levels in both the ARN and PVN of diabetic rats. The present study shows that acupuncture suppressed NPY expression in the ARN and PVN of the Hypothalamus in STZ-induced diabetic rats, suggesting the possibility that acupuncture treatment is effective in curbing the hyperphagia of diabetes.
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PMID:Acupuncture decreases neuropeptide Y expression in the hypothalamus of rats with Streptozotocin-induced diabetes. 1538 90

Diabetic muscle infarction (DMI) is a largely unfamiliar disease. It affects mainly patients around 40 years of age with long-standing diabetes and concomitant end-organ complications. The symptoms represent a classic pattern of a musculoskeletal disease with muscle pain without trauma, swelling, and functional impairment. Although its short-term prognosis is good, with improvement of the symptoms over weeks or months under analgesia and rest, a high recurrence rate of up to 60% can be observed. Additionaly, the long-term survival of patients after DMI is reduced mostly due to major vascular complications. Since many diabetic patients are in orthopedic care for musculoskeletal disorders, the orthopedic surgeon should be aware of this disease to avoid unnecessary invasive diagnostic procedures and initiate suitable therapy. Furthermore, a better knowledge of the disease could lead to definite conclusions regarding its real incidence and aid in establishing new therapeutic measures for prophylaxis and better long-term survival.
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PMID:[Diabetic muscle infarction-an orthopedic disease pattern?]. 1565 99

Critical limb ischemia secondary to chronic peripheral occlusive disease is common in chronically dialysed patients, with an incidence rate of 25-30%. Atherosclerotic lesions are more frequent in the infrainguinal arteries and long infrapopliteal occlusions often occur. Due to diabetes, hypertension and ischemic cardiopathy, the surgical prognosis is very poor in these patients; medical treatment should always be attempted associated with analgesia, without an excessive delay in surgical therapy if needed. Both spinal stimulation and lumbar simpaticectomy often fail; open and endovascular surgery are the best options before major amputation, which has a high incidence in this patient subgroup. Between 2000 and 2003, 23 chronically dialysed patients underwent surgery. Nine open and 13 endovascular procedures were performed, associated with four immediate and five late minor amputations. Despite an immediate mortality rate of 8.6%, we obtained immediate patency and limb salvage in all cases. In a medium follow-up of 25 months (range 3-36), five thromboses were found in subinguinal procedures; not one in iliac procedures. The five patients underwent major amputation. Another two patients underwent amputation despite arterious patency. Seven patients died due to cardiovascular diseases during the follow-up. Our experience confirms that the association between POAD and dialysis is a prediction factor for medium-term death and that the surgical risk is highly increased. It is important to select patients undergoing surgical treatment to check for the lowest invasivity.
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PMID:[Peripheral arteriopathy in ESRD dialysed patients: when and how to intervene]. 1578 8

A 65-year-old patient with ischemic heart disease and severe diabetes mellitus underwent minimally invasive direct coronary artery bypass grafting under general combined with epidural anesthesia. Paraplegia developed after surgery and the diagnosis of anterior spinal artery syndrome was made based on the patient's neurological condition and magnetic resonance imaging findings. Paraplegia following epidural anesthesia is a rare but recognized complication and this complication should be taken into account, especially in patients at risk, when considering epidural analgesia techniques in the minimally invasive cardiac surgery.
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PMID:Anterior spinal artery syndrome after minimally invasive direct coronary artery bypass grafting under general combined epidural anesthesia. 1587 63

There is no branch of medicine in which nutritional considerations do not play some part. Overnutrition, undernutrition or unbalanced nutrition are the major causes of ill health in the world. Conversely, illness causes important nutritional and metabolic problems. The spectrum from lack to excess of nutrients is seamless as a clinical and scientific discipline, the two extremes being linked by the Barker effect by which intrauterine malnutrition and low birth weight predispose to obesity, diabetes and CVD in later life. However, the teaching of nutrition in medical and nursing schools remains sparse. Nutritional care cannot be practised satisfactorily in isolation from other aspects of management, since factors such as drugs, surgery and fluid and electrolyte balance affect nutritional status. Nutritional treatment may also have adverse or beneficial effects according to the composition, amount and mode of delivery of the diet and the clinical context in which it is given. Any benefits of nutritional support may also be negated by shortcomings in other aspects of treatment and must therefore be fully integrated into overall care. One example of this approach is the enhanced recovery after a surgery protocol incorporating immediate pre-operative carbohydrate and early post-operative oral intake with strict attention to zero fluid balance, epidural analgesia and early mobilisation. Other examples include the deleterious effect on surgical outcome of salt and water overload or hyperglycaemia, either of which may negate the benefits of nutritional support. There is a need, therefore, to integrate clinical nutrition more closely, not just into medical and surgical practice, but also into the organisation of health services in the hospital and the community, and into the training of doctors and nurses. Societies originally devoted to parenteral and enteral nutrition need to widen their scope to embrace wider aspects of clinical nutrition.
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PMID:Integrated nutrition. 1604 63

Diabetic muscle infarction of the peroneus brevis is a rare complication of diabetes mellitus. It often presents with an acute leg pain without any obvious signs. Due to poor awareness of this condition, it is often misdiagnosed and results in anxiety of the patient and unnecessary investigations. It is ominous as it usually indicates vascular disease of the end organs. We report a case where the patient presented to several physicians for leg pain without any other clinical signs. The diagnosis was suspected on ultrasound and confirmed with biopsy. The symptoms improved dramatically after excision. Although most literature suggests conservative treatment by non-weight bearing and analgesia, the recovery period can last for more than 6 weeks, with a recurrence rate of 50%. We feel that there is a role for excision biopsy of the lesion for both diagnosis and treatment. In this case, symptoms improved remarkably and the patient was able to ambulate without pain 2 days after the operation without needing any analgesia.
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PMID:Diabetic muscle infarction of the peroneus brevis: a case report. 1636


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