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

Three cases of pancreatic microcystic adenoma (PMA) are presented. These tumors comprise less than 1% of all pancreatic tumors in a large series, and exhibit a benign course, in contrast to mucinous cystadenomas, which have a definite malignant potential. The cases here presented are middle and advanced aged women who complained of epigastric discomfort and mild weight loss. Two of them also had a palpable epigastric mass and one of them diabetes mellitus. They were treated surgically with total excision of the tumor. During surgery and thereafter no evidence of spreading beyond the pancreas was found. CT scan shows a characteristic image of PMA, which may then be confirmed by a percutaneous biopsy. If the patient is asymptomatic or a poor surgical risk, it is reasonable to rely on this evidence and follow the patient rather than operate.
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PMID:Microcystic adenoma of the pancreas. 356 33

Characteristics, and the occurrence of other diseases, and complications related to diabetes mellitus of 91 consecutive diabetic patients who underwent vitreous surgery in 1979-1985 were examined. The mean age of the patients was 40 years (median 37, range 19-74), and the mean duration of diabetes 23 years (range 5-44). All, but one, had insulin therapy. Abnormalities in the cardiovascular and/or renal function were found in 89 of the 91 patients (98%). Signs of cardiovascular disease were observed in 58 patients (64%): 42% had elevated blood pressure (greater than or equal to 150/100 mmHg), 46% were on antihypertensive therapy, 14% had a history or signs of ischaemic heart disease, 12% had been digitalized, 7% had a history of cerebral ischaemia, and 8% had had surgery for gangrene of the lower limb. Signs of nephropathy were recorded in 64 patients (70%); 6 of them were on dialysis therapy, and two had received a kidney transplant. Symptoms possibly related to autonomic neuropathy e.g. postural hypotension, urinary tract symptoms, and gastric discomfort were found in 27%. Nine patients (10%) had some kind of thyroid disease, and two of them signs of multiple autoimmune endocrinopathy. The percentage surviving decreased from 96% at one year to 80% after 5 years of follow-up.
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PMID:Characteristics and survival of diabetic patients undergoing vitreous surgery. 360 10

In a randomized double-blind study we evaluated the effects on cervical ripening and labor induction of 0.5 mg PGE2 in gel given intracervically and 2.0 mg PGE2 given as a vaginal suppository. All patients were at term with unfavorable cervical scores. The indications for induction were toxemia, diabetes mellitus, Rh-immunization, or intrauterine growth retardation. Significantly better results for both cervical priming and labor induction were obtained after intracervical PGE2-gel application than after treatment with placebo or vaginal suppositories. Eleven out of 19 patients (58%) were delivered within 24 h after intracervical PGE2-gel compared to two out of 19 patients given placebo (p less than 0.01). In patients not delivered 24 h after the start of treatment, the mean cervical score had changed from 3.7 to 6.0 (p less than 0.05) after PGE2-gel application compared to a change from 3.9 to 4.3 after placebo treatment (n.s.). The outcome after treatment with PGE2 suppositories did not differ significantly from that with placebo treatment. In a subsequent study 25 patients were given 0.5 mg PGE2-gel intracervically. The results were consistent with those obtained in patients receiving PGE2-gel intracervically in the double-blind study. Few side effects were noted. No patient complained of gastro-intestinal discomfort but increased myometrial activity was observed in two patients; one after placebo and the other after active intracervical PGE2-gel treatment. The hyperactivity was readily countered with the beta 2-agonist, terbutaline. All infants were born in good condition with Apgar scores of 7 or more within 5 min. At pediatric examinations at 1 week and at 6 months of age all children seemed healthy.
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PMID:Intracervical versus intravaginal PGE2 for induction of labor at term in patients with an unfavorable cervix. 386 Nov 38

Low dose estrogen tablets, containing less than 50 mcg of ethinyl estradiol, were formulated because of the recognized dose response relationship with the steroid content of the tablet and side effects. These new oral contraceptives (OCs) are as effective as the older high-dose OCs, and available evidence reports fewer side effects. This discussion reviews pharmacology of these new OCs, the mechanism of action, contraindications, side effects, and problems with the low-dose estrogen OC. Ethinyl estradiol is the only estrogen used in the low-dose combination OC. There are several synthetic progestins: norethindrone, norethindrone acetate, norgestrel, levonorgestrel, and ethynodiol diacetate. These progestins have different potencies so the pharmacologic activity cannot be accurately predicted based on the amount present in the tablet. The synthetic steroids in OCs are absorbed in the small intestine, metabolized in the liver, excreted in the bile and feces with a half-life of 24 hours. The low-dose estrogen combination preparation is taken 3 out of every 4 weeks. Its contraceptive effect is primarily a result of hypothalamic mediated gonadotropin suppression with subsequent inhibition of ovulation. Contraindications to taking the low-dose OC are the same as for the higher dose OC: thromboembolic or cardiovascular disease, estrogen dependent neoplasia, markedly impaired liver function, undiagnosed genital bleeding, congenital hyperlipidemia, pregnancy, and women over age 30 who smoke. Relative contraindications include hypertension, diabetes mellitus, migraine headaches, uterine myomas, and epilepsy. The often quoted 2-5-fold increased incidence of thromboembolic disease, myocardial infarction, and stroke is based on large epidemiologic studies involving patients taking the older higher dose OCs. Current data from patients taking the newer low-dose medication demonstrate minimal if any increased incidence of these problems in young women who do not smoke. The low-dose estrogen OCs have minimal effect on lipid levels. Early reports of patients using the low-dose OC have shown little if any increased incidence of hypertension. The low-dose contraceptives have little effect on glucose tolerance, and there is no evidence to show an increased incidence of overt diabetes in OC users. There is no evidence that use of the combination OC causes an increase in cancer of the cervix, uterus, or ovaries. Clinical complaints of nausea, breast discomfort, chloasma, weight changes, and depression are reduced with the low-dose estrogen preparation. Hypomenorrhea while taking the OC occasionally occurs because the lower dose of estrogen is insufficient to stimulate the endometrial growth in face of the predominant progestin-atrophy effect.
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PMID:Oral contraceptives in 1984. 649 Mar 38

Observations have been made on nine cases of painful diabetic neuropathy of acute onset. All cases were male and all were associated with and preceded by precipitous and severe weight loss. The pain was of a continuous burning quality and experienced mainly in the legs, especially distally. Contact discomfort of the skin was often a troublesome feature, but sensory loss was mild or absent, and reflex loss or depression not invariable. There were no accompanying motor signs. Depression and impotence were constant features. The weight loss responded to adequate control of the diabetes with insulin and was followed by improvement in the neuropathy. The severe manifestations subsided in all cases within 10 months, and in most cases within 6 months, and later resolved completely in all except one. No recurrences were observed after follow-up periods of up to 6 years. Abnormalities of nerve conduction were mild or even lacking. Sural nerve biopsies from three cases taken in the acute stage showed evidence of active degeneration of myelinated nerve fibres of all diameters and also degeneration of unmyelinated axons. There was a mild degree of demyelination. It is concluded that acute painful diabetic neuropathy is a distinct syndrome, occurring in insulin or noninsulin dependent patients of any duration, and unrelated to other diabetic complications. It is separable from other types of painful diabetic sensory polyneuropathy that have been described.
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PMID:The natural history of acute painful neuropathy in diabetes mellitus. 687 82

Octreotide is an effective therapeutic option in controlling secretory diarrhea of varied etiology. However, marked patient-to-patient differences in the antidiarrheal effects necessitate titration of octreotide dose in individual patients to achieve optimal symptom control. A consensus development panel established guidelines for octreotide dose titration in patients with secretory diarrhea. Overall, the panel recommended an aggressive approach in selecting the initial octreotide dose and in making subsequent dose escalations in patients with secretory diarrhea due to gastrointestinal tumors (eg, carcinoids, VIPomas), AIDS, dumping syndrome, short bowel syndrome, radiotherapy, or chemotherapy. To avoid hypoglycemia in patients with diabetes mellitus-associated secretory diarrhea, the panel recommended a low initial octreotide dose and a conservative titration regimen with close monitoring a blood glucose levels. The end point of therapy should focus on a reduction in diarrhea (frequency of bowel movements or stool volume) rather than normalization of hormonal profile. Overall, octreotide is well tolerated; principal side effects are transient injection site pain and gastrointestinal discomfort. For many patients with secretory diarrhea, octreotide therapy is expected to improve the overall health and quality of life and in the long run will lessen health care costs.
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PMID:Consensus statement: octreotide dose titration in secretory diarrhea. Diarrhea Management Consensus Development Panel. 762 70

The DCCT study confirmed the importance of optimizing insulin therapy to reduce the microvascular risks of diabetes mellitus. Optimization requires improving the methods already in use. Recent results must be used to improve patient motivation. Control of blood glucose levels must include improving the frequency and/or the quality of follow-up (pluridisciplinary consultations). Follow-up must be improved, taking advantage of the recent developments such as rapid glycosylated haemoglobin assay and computerized glucose meters. Of course, improvement in blood glucose must aim at normal levels, accepting the increased risk of hypoglycaemia. The insulin-tool itself must be improved on the basis of recent developments including ultra-rapid analogues and external and implantable insulin pumps. Finally, a major challenge is to develop these improvements without increasing too greatly the patient's short-term costs and without causing further discomfort.
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PMID:[Current methods for optimal insulin therapy]. 774 19

Some data suggest that sorbitol intake may be responsible for diarrhea in diabetic patients. One hundred thirteen hydrogen breath tests were performed in type II diabetics (72) and normal controls (41) after oral loads of sorbitol ranging from 2.5 to 20 g in iso-osmolar solutions to assess the role of malabsorption of this compound in the genesis of abdominal symptoms. The prevalence of sorbitol malabsorption and abdominal symptoms, peak (Cmax H2) and total (Ctot H2) hydrogen production, and mouth to cecum transit time (MCTT) did not differ in type II diabetics and controls. Malabsorption was observed more frequently with the highest doses of sorbitol (10% of patients at a dose of 2.5 g and approximately 75% at 20 g). Symptoms, usually consisting of mild discomfort and abdominal distension, were observed only after sorbitol loads of 10 and 20 g in 27.2% of the diabetics and in 36.3% of the controls. Diarrhea was present in three subjects (two diabetics and one control) only at a dose of 20 g. These data indicate that it is highly unlikely for sorbitol to play a role in inducing diabetes diarrhea. A moderate (up to 10 g) sorbitol intake is not contraindicated in type II diabetics.
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PMID:Sorbitol malabsorption and nonspecific abdominal symptoms in type II diabetes. 778 66

We studied the prevalence of sleep disturbances in 184 persons with diabetes, and 99 controls matched for age and sex. Sleep disorders were more common in diabetics (33.7% vs. 8.2% in controls; P < 0.01). Patients with sleep disturbances were younger than those with normal sleep, and had onset of diabetes at a younger age. There was a significant association of sleep disturbances with the presence of cough, dyspnea, nocturnal cramps, paresthesia and burning of soles. Sleep disturbances may be due to physical discomfort, psychosocial factors, fluctuations in metabolic control and perhaps also hypoinsulinemia. Quality of life is affected and coping with the disease is made difficult by sleep disorders. Thus, physicians caring for persons with diabetes must be able to recognize, diagnose and manage sleep disturbances in their patients, when they occur.
Diabetes Res Clin Pract 1994 Apr
PMID:Prevalence of sleep disturbances in diabetes mellitus. 792 79

Although the new nonionic contrast agents are safer than ionic agents, renal insufficiency and even death still occur occasionally. Therefore, we have explored the use of carbon dioxide (CO2) as an alternative angiographic contrast agent used in combination with digital subtraction angiography. Clinical observations have been made in over 800 patients. The images obtained are of equivalent diagnostic quality compared with those using conventional iodinated contrast agents. Recent advances in imaging, including "stacking," provide images comparable with iodinated contrast. Very small vessels, equivalent to third-order branches of the renal artery, can be imaged satisfactorily with CO2. Occasional studies with CO2 yield information not apparent with iodinated contrast agents, including excellent visualization of arteriovenous shunts, collateral circulations, malignant tumors, and minute amounts of arterial bleeding. Many of the advantages and disadvantages of CO2 derive from its special physical and chemical properties. The advantages include no allergic potentiation and no renal metabolism of CO2, because CO2 is cleared by the lungs and does not recirculate. Other advantages include delivery by very small catheters because of the low viscosity of CO2, minimal discomfort on injection, and very low cost. However, the low-density and compressibility of CO2 poses some special problems. Imaging requires digital subtraction angiography with electronic enhancement and injections require an experienced investigator and, ideally, a dedicated CO2 injector. The dedicated CO2 injector provides calculated, controlled dosing and rates for injection, while excluding the possibility of air contamination. The buoyancy of CO2 inhibits good filling of dependent vessels. Accordingly, CO2 does not normally produce good nephrographic images, although proximal renal arteries are normally shown clearly. Experimental studies in dogs, whose renal arteries have been injected repeatedly with very large doses of CO2, demonstrate only transient changes in renal blood flow and no endothelial cell damage. However, these studies also showed clearly that renal ischemia can occur due to a "vapor lock" phenomenon if the kidney is positioned vertically above the injection site, and recurrent injections are given without time for absorption of the arterially delivered CO2 boluses. Uncontrolled studies in over 800 patients have confirmed that CO2 likely has a very low renal toxicity. At the University of Florida, CO2 is the radiologic contrast agent of choice in patients with renal insufficiency, especially those with diabetes mellitus, and in those with pre-existing allergy to iodinated contrast agents. Further controlled clinical studies are required to define the true clinical utility and safety of CO2 compared with conventional radiologic contrast agents.
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PMID:CO2 digital angiography: a safer contrast agent for renal vascular imaging? 794 29


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