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

Management of insulinopenic diabetic individuals centers on administration of insulin by means of multiple injections, a wearable or implantable insulin-infusion pump, or a whole-organ or segmental-pancreas transplant. Preliminary trials indicate that surgical implantation of a hybrid device containing living insulin-secreting tissue may function as a combined glucose sensor and insulin-infusion pump. By means of a chamber composed of a semipermeable membrane shaped into hollow fibers or a box surrounding endocrine tissue, pilot studies have shown that isolated islets of Langerhans, fragments of insulinoma, or a fetal pancreas retains function for days to weeks, as judged by the ability to sustain euglycemic conditions in chemically induced diabetic rats. Lacking clear proof that normalizing blood glucose levels will prevent vascular complications of diabetes in humans, the case for further development of a hybrid (tissue plus fabricated components) device rests mainly on optimistic extrapolation of results attained in the chemically induced diabetic rat and dog. For the minority of diabetic patients who have insulin-dependent diabetes, the benefit afforded by a bionic device establishing internal insulin release regulated by silently sensed blood glucose level is more than enough payoff for the discomfort and surgery involved in its implantation. Further trials of a hybrid artificial pancreas in the dog appear warranted as a logical extension of preliminary studies with this species.
Diabetes Care 1989 Jun
PMID:Toward a hybrid artificial pancreas. 249 44

The present communication reports preliminary findings of haematological investigations carried out on patients attending an oral medicine clinic in the University of Iceland over a two year period. Patients have been referred to this newly-established clinic with candidosis, aphtous ulceration, sore tongues, burning mouth syndrome and other miscellaneous conditions. Many were investigated for underlying causes for their oral disorder. A high proportion of patients (33/45: 73%) referred for haematological investigation had abnormal findings largely related to a deficiency of iron (21/45: 47%). Most of these reported improvement in their oral discomfort after a course of iron tablets. Only two patients had abnormally reduced erythrocyte counts but a further 19 (42%) were found to have sideropaenia. Diabetes was diagnosed in two patients and one previously unknown case of megaloblastic anaemia was also discovered. The results were sufficiently encouraging to warrant continuing the clinic and collection of further data.
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PMID:[Haematological investigation of patients attending an oral medicine clinic in the Dental Faculty, University of Iceland, 1987-1988]. 263 50

LOCAs offer significant advantages in certain situations, but in others their advantages are either absent or unproved. On the basis of current knowledge and practice, there is no legal mandate to use these agents. Clear advantages to the use of LOCAs are (a) decreased pain and discomfort in painful examinations (in this regard, however, they are equivalent to dilute HOCAs in intraarterial digital subtraction angiography), (b) decreased myocardial and generalized hemodynamic effects, and (c) decreased osmotic load, perhaps important in infants or severely dehydrated patients. LOCAs may be helpful in examinations of patients with alteration of the blood-brain barrier (major trauma, tumor, or stroke), prior contrast media reactions, and marked anxiety. However, in the following areas, there are, as yet, no clear answers about the use of LOCAs: (a) reduction of overall mortality, (b) reduction of morbidity in elderly patients, and (c) reduction of the risk of nephrotoxicity in patients either with or without specific risk factors such as diabetes mellitus or renal failure.
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PMID:Guidelines for use of low-osmolality contrast agents. 267 4

Clinical and pathological analysis of 66 cases of fibromatoses are presented. The age range in our series was 1 to 72 years. Superficial fibromatoses occurred predominantly in older patients with a peak incidence in the fifties while deep fibromatoses occurred predominantly in younger patients with a peak incidence in the twenties. Male to female ratio was 1.4 to 1. The abdominal fibromatosis occurred in female while our palmar fibromatosis occurred in male. There were 17 cases (26%) of multiple fibromatoses which occurred most frequently on both palms and had a tendency to symmetric distribution. The latent period between the two fibromatoses in a patient ranged from 1 year to 36 years. Clinical presentations included a palpable nodule or mass; flexure contracture of finger; penile hypertrophy, contracture, or discomfort on erection; and soreness, tenderness, or paresthesia over the tumor. Hydronephrosis may be complicated by intraabdominal fibromatosis. Size of the tumors ranged from 0.5 cm. To 30.0 cm. Three cases were associated with diabetes mellitus, 2 with alcoholics, 1 with liver cirrhosis, 2 with pulmonary tuberculosis, and 3 with hepatocellular carcinoma, cholangiocarcinoma, and mammary papillary carcinoma, respectively. Nine cases (14%) were associated with variable types of trauma, including being hurt by a stick, intramuscular injection in the gluteal region, tying penile shaft with a plastic band, breast massage and hot applying, and operation on abdomen. The superficial fibromatoses seldom recurred after excisional biopsy or fasciectomy while the deep fibromatoses often recurred. The recurrent rate of the deep fibromatoses was 21%. Malignant transformation or spontaneous regression was not found.
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PMID:[The fibromatoses. A clinicopathological study of 66 cases]. 281 66

Advantages and disadvantages of the various therapies for stable angina are considered with particular attention to quality of life. Advantages of coronary artery bypass surgery (CABS), apart from the question of survival, include less angina, less activity limitation, and less need for drugs than with medical treatment. However, data from the Coronary Artery Surgery Study (CASS) and others show that there is no difference between medical and surgical therapy in return to work and in need for subsequent hospitalization. In CABS patients, there is also predictable return of angina, substantial late vein graft occlusion, and possibly increased progression of native coronary artery disease in grafted vessels. Percutaneous transluminal coronary angioplasty (PTCA) has advantages similar to those of CABS, with very low initial mortality and major complication rates, minimal discomfort, very short disability period, and moderate cost. Its major disadvantages are a high short-term reocclusion rate and uncertain long-term outcome. Beta blockers provide good control of angina, have additional antihypertensive and antiarrhythmic effects, and may be beneficial in preventing sudden cardiac (arrhythmic) death and limiting myocardial infarct size, should these events supervene in the patient with angina. Disadvantages of beta blockers involve the occasional major side effects, including potential exacerbation of bronchospasm, peripheral vascular disease (PVD), diabetes, congestive heart failure and bradyarrhythmia, and frequent "nuisance" side effects. Calcium blockers control both exercise and rest angina and pose no problem in patients with bronchoconstriction, PVD, or diabetes. Disadvantages include need for frequent dosage, cost, and side effects. Long-acting nitrates have few major side effects and usually transient minor side effects, with little effect on quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Ischemic heart disease: a patient-specific therapeutic approach with emphasis on quality of life considerations. 288 39

Complications of the gastrointestinal tract in patients with diabetes mellitus can cause marked discomfort and may modify the ability of the patient to maintain normal glucostasis. In an attempt to elucidate some of the factors causing gastrointestinal dysfunction in experimental diabetes we examined the responses of jejunal smooth muscle in streptozotocin-induced diabetes in rats to some of the neurotransmitters and autocoids found in the enteric nervous system. Jejunal tissues from 4- to 5-week diabetic rats were examined for their responses to neurokinin (NK) A, NKB, substance P (SP), bradykinin, neurotensin, bethanechol, isoproterenol and phenylephrine. The affinities for all these agonists, except for SP which increased slightly with diabetes, were the same in both control and diabetic tissues. NKA was the most potent neurokinin and elicited the largest contractile responses from jejunal tissues of both control and diabetic animals. The contractile response to NKA, but not that to NKB or SP, was increased in the jejunum from diabetic animals. Part of this increased responsiveness was antagonized by atropine. The contractile effects of the cholinergic agonist, bethanechol, were not altered by the diabetic state. Decreased relaxation responses in the jejunum from diabetic animals were observed for bradykinin, neurotensin and isoproterenol, but not for phenylephrine. These results suggest that the myogenic actions of several agonists are modified in experimental diabetes.
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PMID:Modified smooth muscle responses of jejunum in streptozotocin-diabetic rats. 290 44

Insulin-dependent diabetes mellitus was induced in the pig by pancreatectomy or by administration of intravenous streptozotocin (150 mg/kg). High post-operative morbidity and mortality in the pancreatectomised animals made this method of inducing diabetes unsuitable for animals to be used in long term studies. By contrast, the good clinical state of animals after streptozotocin and the permanence of their diabetes indicated that these animals were suitable for long term studies such as those involving transplantation of pancreatic islet tissue. Techniques designed to facilitate the assessment and management of these animals included placement of an indwelling jugular venous catheter to enable blood samples to be obtained for metabolic studies, denervation of an area on the flank of the animal to enable insulin administration with minimum discomfort and denervation of an ear to enable blood samples to be obtained from the animal for glucose estimation in long term studies.
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PMID:Induction and management of diabetes mellitus in the pig. 295 29

The effects of two potent vasodilating drugs, captopril (C) (25 mg tid), nicardipine (N) (20 mg tid), and placebo (P) were evaluated and compared, in 10 men (mean age of sixty-five years) with intermittent claudication from moderate to severe multilevel chronic occlusive arterial disease (COAD) of the lower extremity, by use of the Doppler ultrasonic method, at rest and after Carter's exercise test. All the examined subjects were normotensive, without diabetes or cardiopathy; all have been smokers. The eight-week total protocol consisted of an initial two-week placebo run-in period followed by two active drug phases and a two-week placebo phase, according to a double-blind, randomized, crossover design. At the end of each two-week period, ankle-arm index (AAI) and, following exercise, onset of lower extremity discomfort time (ODT), duration of exercise (ET), decrease of ankle systolic pressure after test (APD), and recovery time (RT) were determined. Moreover, at rest, just after exercise, and after recovery, simultaneous common femoral artery velocity waves were recorded and analyzed by a quantitative approach to detect the peripheral vasomotor adjustments. None of the patients required the withdrawal of the active treatments. Compared with P, C significantly reduced APD and RT, and N reduced RT and AAI; furthermore N caused a significant decrease in ODT, whereas C showed a trend, although not statistically significant, to increase ODT. Neither active therapy modified ET. These results suggest that C and N have different short-term effects on peripheral circulation in COAD. During exercise, C induces hemodynamic improvement in the ischemic lower extremity probably by inhibition of the sympathetic system and consequent reduction in collateral vessel vasoconstriction.
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PMID:Assessment of captopril and nicardipine effects on chronic occlusive arterial disease of the lower extremity using Doppler ultrasound. 305 83

To determine the factors related to discontinuation of continuous subcutaneous insulin-infusion (CSII) therapy in patients with insulin-dependent diabetes mellitus, we analyzed clinical data from a group of 177 patients followed for up to 5 yr. Fifty-one (29%) of the patients made a decision to terminate CSII during the study. Of the clinical characteristics present before the onset of treatment with an insulin pump, the most important variable to predict a future decision to terminate CSII was pregnancy, followed by female gender. In addition, there was a greater percentage of smokers, single or divorced patients, and patients with a history of treatment for mental illness in the dropout group, although none of these differences was statistically significant. There was no correlation between discontinuation of CSII and age, duration of diabetes, or prepump concentrations of HbA1c. Events occurring during CSII were also analyzed for predictive value. Patients who discontinued CSII had a higher incidence of ketoacidosis and a lower incidence of hypoglycemic coma while using a pump. The most common reason reported by patients for terminating CSII therapy, cited by 24 (47%) of the 51, was discomfort, irritation, or infection at the infusion site.
Diabetes Care 1988 Jan
PMID:Factors related to discontinuation of continuous subcutaneous insulin-infusion therapy. 312 87

Continuous subcutaneous insulin infusion (CSII) of 6 months duration was compared with 6 months of multiple insulin injections (MII) using a pen injector (NovoPen) in a prospective cross-over study with 20 young insulin dependent diabetics by evaluating metabolic control, insulin requirements and patient acceptability. Following both intensified regimens (CSII/MII) serum fructosamine declined significantly from 4.1 +/- 0.7 to 3.4 +/- 0.5 mmol/l and 3.6 +/- 0.7 mmol/l respectively (normal range: 2.2 +/- 0.2 mmol/l). When comparing CSII and MII no significant differences could be demonstrated in mean blood glucose (MBG), fasting plasma ketone bodies, fasting plasma free fatty acids (FFA), fasting plasma human growth hormone (HGH), fasting plasma glucagon or serum fructosamine. Mean insulin requirement was 11.4% higher during MII and glucose instability--demonstrated by the M-values and by the frequency of blood glucose values below 4 mmol/l--was significantly (p less than 0.02) higher during the MII treatment. All of the patients reported a better well-being on both treatment regimens and none of them wanted to go back to conventional therapy (CT). In conclusion, on a long-term basis both regimens result in identical metabolic control, but due to physical discomfort during pump treatment, the insulin pen injector was preferred by the majority (80%) of the patients.
Diabetes Res 1987 Nov
PMID:Multiple insulin injections using a pen injector versus insulin pump treatment in young diabetic patients. 332 20


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