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

Vitreous haemorrhage is a serious complication of proliferative diabetic retinopathy: it provides evidence of the severity of at proliferative retinopathy at stake and precludes laser photocoagulation. In some cases of moderate vitreous haemorrhage, panretinal photocoagulation remains possible especially using longer wavelengths such as krypton red; cryotherapy under ophthalmoscopic control may be an alternative to panretinal photocoagulation. Development of pars plana vitrectomy, however, has been the main break the rough in the management of severe vitreous haemorrhage. Pars plana vitrectomy was first reserved to massive, long-standing vitreous haemorrhage; improvements in instrumentation and techniques, as well as observations of the favourable effect of vitrectomy on the progression of proliferative retinopathy led to enlarged indications for pars plana vitrectomy. Beyond severity and duration of visual loss, main arguments for pars plana vitrectomy are bilaterality, lack of previous panretinal photocoagulation, iris neovascularization, Type 1 diabetes, and severity of fibrovascular proliferation.
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PMID:[Vitreous hemorrhage: attitudes in therapy, vitrectomy]. 805 23

Our perspective is that the concepts of glucose toxicity and glucose desensitization should be differentiated because they carry very different connotations. The term glucose desensitization most properly refers to a pharmacological event involving a temporary, readily induced, physiological and reversible state of cellular refractoriness because of repeated or prolonged exposure to high concentrations of glucose. The term glucose toxicity should be reserved for nonphysiological, irreversible alterations in cellular function caused by chronic exposure to high glucose concentrations. With regard to the pancreatic islet beta-cell, the mechanism of action for glucose desensitization seems most likely to be expressed at the level of the insulin exocytotic apparatus or insulin stores within the beta-cell, whereas the mechanism of action for glucose toxicity may be at the level of insulin gene transcription. This differentiation raises the possibility that exposure of patients to chronic hyperglycemia may cause glucose toxic effects on the process of insulin gene transcription and/or expression that are irreversible. If so, this may contribute to so-called secondary drug failure and, in any event, reemphasizes the need to intensify therapeutic efforts to better regulate glycemia in type II diabetes.
Diabetes 1994 Sep
PMID:Differentiating glucose toxicity from glucose desensitization: a new message from the insulin gene. 807 Jun 7

The "campus" represents a good instrument to improve the independence of the child and adolescent with diabetes. What are the expectation of children taking part in it? For them, will it be a vacation or a period of hospitalization? To evaluate these aspects we have studied, in addition to the theoretical and practical knowledge, the emotional life of 53 young diabetics (31 males and 22 females, age 8.1-15.7 years, duration of disease 2 months 10 years, and HbA1c 6.5-12.6%). We observed that 80% of the patients improved the injection technique; we also found an increase of correct answers (from 60% to 73%, x = 3.8, p < 0.05) to a list of questions on different aspects of diabetes asked at the beginning and at the end of the campus. From the drawings collected at the end of the stay, we observed that 78% of the children lived the experience in a playful way, 11% in a medical and 11% in a educational way. It must be pointed out that the children who perceived the educational aspect of the stay were older than the others (11.5 +/- 2 vs. 13.9 +/- 1; p < 0.05). Consequently, we believe that educational programs on diabetes, like the "campus", should be reserved to children older than 12 years of age.
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PMID:[Some clinical, psycho-emotional and cognitive aspects in insulin- dependent diabetic young patients at the end of educative camps]. 809 Jan 42

Plasma glucose determinations continue to be at the heart of the proper diagnosis and monitoring of diabetes mellitus, the post-prandial values in particular being of decisive importance for the diagnosis. Laboratory diagnostic investigations going beyond this (e.g. the oral glucose tolerance test) are reserved for special indications. In contrast, the determination of microalbuminuria is of increasing importance for deciding on the next therapeutic steps. Prerequisites for successful treatment are patient instruction, treatment of the metabolic disorder including diet and physical exercise, and self-monitoring by the patient. Of fundamental importance for treatment is the diet, with calorie reduction in type 2 diabetics, most of whom are obese.
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PMID:[Management of diabetes in general practice--current requirements. 1: Diagnosis, pathophysiology and overall therapeutic concept]. 820 May 96

Phlegmasia cerulea dolens (PCD) is an uncommon, severe form of lower extremity deep venous thrombosis characterized by extremity swelling, cyanosis, and pain. Progression of the thrombotic process may result in extremity gangrene, amputation, and death. The relative value of specific therapeutic regimens in the treatment of this disease remains uncertain. Twelve patients, 9 females and 3 males, with PCD were treated during a 10-year period. Eighteen lower extremities were involved. Pre-existing conditions included malignancy (eight), postoperative state (four), diabetes (three), previous deep venous thrombosis (three), and hypercoagulation (two). Venous gangrene was present in four patients. All patients were treated initially with bedrest, fluid resuscitation, extremity elevation, and systemic high-dose heparin therapy. Five patients had complete resolution with this regimen alone. One patient required cessation of heparin therapy due to heparin-induced thrombocytopenia and developed gangrenous toes. Two patients whose condition failed to respond to heparin therapy underwent catheter-based delivery of urokinase with marked clinical improvement. Four patients, two with venous gangrene, died, three of whom had disseminated malignant disease. A significant percentage of patients with PCD will respond to extremity elevation, fluid resuscitation, and aggressive systemic anticoagulation therapy. Thrombolytic therapy selectively administered is beneficial in patients whose disease fails to respond promptly. Venous thrombectomy should be reserved for patients with contraindications to thrombolysis.
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PMID:Advances in the treatment of phlegmasia cerulea dolens. 835 17

In the United States diabetes in now the principle cause of end-stage renal disease. For diabetic patients undergoing cadaveric kidney transplantation, a combined kidney-pancreas (KP) transplant is often recommended because this option is perceived to carry no additional risk. However, most transplant centres have restricted KP transplantation to patients with few diabetic complications and no coronary artery disease. We compared survival rates after KP transplantation with those after kidney transplantation alone in clinically similar though non-randomised patient groups. In 173 consecutive diabetic renal transplant candidates, 3-year patient survival in 54 KP recipients was 68%, versus 90% in 46 patients who received a cadaveric kidney alone (p = 0.01). The remaining patients had a living-related-donor kidney transplant, either alone (65) or followed 4-20 months later by a pancreas transplant (8), with survival similar to that with a cadaveric kidney. Independent variables associated with early death were age, history of congestive heart failure, and pancreas transplantation. A serious complication of pancreas transplantation was infection, or which 14 of 54 recipients required pancreatectomy; KP recipients had a higher death rate from infection in the first 12 months (p = 0.034). In view of the excess mortality associated with KP transplantation, we suggest that the combined operation should be reserved for young patients with no history of congestive heart failure, or for patients in whom hyperglycaemia is life-threatening. A randomised trial is needed to compare the long-term outcomes of these procedures.
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PMID:Mortality of cadaveric kidney transplantation versus combined kidney-pancreas transplantation in diabetic patients. 862 51

Diabetes mellitus and rheumatoid arthritis often affect the foot. Indeed in either of these, the foot is commonly the initial site of symptoms. Early diagnosis appropriate treatment can prevent or at least slow the progression of the disease in the foot. Extra depth shoes and moulded inserts are the keystone of non operative treatment. Surgery is indicated when the deformity is severe. Surgery does have good results in rheumatoid arthritis but in diabetes mellitus it is usually reserved as a salvage procedure.
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PMID:Feet and systemic disease. 868 10

Between February 1989 and June 1994 193 cases of acute community acquired pneumonia (PAC) which were of intermediate or great severity were admitted to two hospitals in the South West of France. These patients were explored using bronchofibroscopy (FB) with a protected brush (BP) and alveolar microlavage (MLBA) and quantitative cultures were performed, also there were other specimens taken in a regular fashion. The percentage of positive examinations was 60% for brushings (BP), 59% for MLBA and 21% for blood cultures and 16% for serological tests. An aetiology was determined in 137 cases (70.9%). The organisms recovered were Streptococcus pneumoniae (49.6%), gram negative bacilli (17.4%), Haemophilus influenzae (11.7%), Mycoplasma pneumoniae (4.4%), Mycobacterium tuberculosis (4.4%), Staphylococcus aureus (3.6%), Chlamydia pneumoniae (2.2%), Legionella pneumophila (0.7%), and various 5.8%. The overall mortality was 15% despite immediate antibiotics based on the likely organism in 88% of cases. The study of prognostic factors confirmed the Fine score system (determined a posteriori) which constitutes a useful and practical index determining the management of PAC. On the other hand the role of bacteriological documentation in improving the vital prognosis remains to be confirmed. If bronchofibroscopy has appeared to us as a safe and useful means of investigation, the management of these disease remains to specified. We suggest that its use is reserved for subjects with life threatening disease (a Fine score equal to or greater than 3) or for those patients who are likely to have unusual germs: failure of previous antibiotics, diabetes, malnourishment, cancer, airflow obstruction and inhalation.
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PMID:[Acute community-acquired pneumonia of moderate and grave severity investigated by bronchoscopy. Analysis of 193 cases hospitalized in a general hospital]. 871 Dec 37

The purpose was 1) To assess the prevalence of abdominal aortic aneurysms (AAA) in elderly males with atherosclerosis and 2) to evaluate the value of physical exam (PE) by a vascular surgeon in detecting AAA. A total of ninety-six males older than 55 years referred to vascular surgery clinic with atherosclerotic disease were screened prospectively with PE by a vascular surgeon, followed by ultrasonography (US). Atherosclerosis was documented by ankle brachial index and duplex US. Patients who had recently undergone a vascular procedure, aortography, laparotomy, abdominal computed tomography, or US were excluded. Mean age was 67 years. Patients were 67 per cent Caucasian, 32 per cent black, and 1 per cent Hispanic. Presenting complaints were related to claudication (83%), carotid disease (19%), both (3%), and subclavian stenosis (1%). Patient characteristics included cigarette smoking (85%), hypertension (67%), cardiac disease (51%), diabetes (45%), stroke (18%), and chronic obstructive pulmonary disease (8%). One (1%) 3.7 cm AAA was detected by US. Sensitivity of PE was 100 per cent and specificity 92 per cent. Twenty-two (23%) patients were too obese for us to feel the aortic pulse. Screening cost was $14,250. The prevalence of AAA in this population is very low. AAA screening should be reserved for patients with a positive PE or who are too obese for the examiner to feel the aortic pulse.
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PMID:Abdominal aortic aneurysm screening in elderly males with atherosclerosis: the value of physical exam. 881 72

Necrotizing external otitis is a life-threatening condition that still causes therapeutic problems. A retrospective analysis of 22 patients who were all treated with a short standard course of aminoglycoside and beta-lactam antibiotic with through local debridement was carried out; 50% (11/22) had diabetes mellitus, and all had a positive culture of Pseudomonas aeruginosa. The frequency of recurrence was 14% (3/22), and 95% (21/22) were eventually cured. The treatment course lasted 17 days on average. Side effects caused by the drug treatment were seen in 14% (3/22), but they were mild and transient consisting of a reversible increase of the serum creatinine level. It was concluded that the treatment was short, efficient, safe, and as successful as treatment with quinolones or third-generation cephalosporins which has been reported during the past years. In our opinion, therefore, these drugs should be reserved for cases of treatment failure, development of resistance, or side effects.
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PMID:Necrotizing external otitis: aminoglycoside and beta-lactam antibiotic treatment combined with surgical treatment. 922 36


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