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

In an open, prospective, multicenter trial the clinical efficacy of imipenem/cilastatin sodium (IPM/CS) for the treatment of 14 cases with aspiration pneumonia was investigated. The mean age was 75.4 years old. Diseases of central nervous system were present in 11 cases, cardiovascular diseases, pulmonary diseases and diabetes mellitus in 2 cases each respectively. Seven cases were community-acquired and another seven were hospital-acquired. Six cases were moderate and 8 cases were severe. Causative organisms were determined in 9 cases (64.3%), multiple causative organisms were isolated in 3 cases. Isolated organisms were Staphylococcus aureus (4), Pseudomonas aeruginosa (3), Klebsiella pneumoniae (3), Escherichia coli (1), Acinetobacter calcoaceticus (1). Detection of anaerobes was not attempted. Clinical effects of IPM/CS were excellent in 3, good in 8, fair in 2, poor in 1, the efficacy rate was thus 78.6%. P. aeruginosa was isolated from 2 out of 3 cases in which therapy with IPM/CS failed. Monotherapy with IPM/CS appears to be highly effective for cases of aspiration pneumonia, but the disease due to IPM-resistant P. aeruginosa is an exception.
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PMID:[Clinical evaluation of therapy for aspiration pneumonia with imipenem/cilastatin sodium]. 211 7

Invasive external otitis occurs almost exclusively in patients with longstanding diabetes. Except for occasional cases, the etiologic agent has been Pseudomonas aeruginosa. We report a case caused by Aspergillus species in a diabetic patient with acute leukemia. Persistent infection was documented by culture and histology after a course of intravenous amphotericin B (total dose, 2 g). Clinical resolution occurred in association with a 3-month course of oral itraconazole. Four previously reported cases of invasive aspergillus otitis are reviewed.
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PMID:Invasive external otitis caused by Aspergillus. 218 97

We have experienced a case of Fournier's gangrene which progressed rapidly after prostatic massage. The patient was a 70-year-old man who had poorly controlled diabetes mellitus, hemorrhoid, urethral stricture and benign prostatic hyperplasia. He visited an urologist complaining of pollakisuria and miction pain. Under the diagnosis of prostatitis, prostatic massage was performed. From that night, he developed a high grade fever. Simultaneously, redness, swelling and pain of the scrotum progressed rapidly, and 11 days later, he was admitted to our hospital. An X-ray examination revealed subcutaneous gas formation in the scrotum. Immediately, incision and drainage with extensive debridement of necrotic tissue were performed combined with chemotherapy using broad spectrum antibiotics and insulin therapy. About 3 months later, the gangrene and the wound were healed with granulation and scarring. Cultures of the pus and the necrotic tissue from the scrotum were positive for Bacteroides fragilis and several aerobes including Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterococcus and Staphylococcus epidermidis. The case proved to be non-clostridial gas gangrene.
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PMID:[A case of Fournier's gangrene: was it triggered by prostatic massage?]. 223 20

There has been an increased incidence of melioidosis in Singapore. The disease affects mainly males, older patients and a disproportionately higher number of Indians and Malays. Possible predisposing illness include diabetes mellitus. Most patients are bacteraemic. Mortality rate is 72% for bacteraemic patients, as compared to 32% for non-bacteraemic patients. Local strains of Pseudomonas pseudomallei have been consistently sensitive to ceftazidime, chloramphenicol and piperacillin, and nearly always sensitive to tetracycline.
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PMID:Melioidosis: epidemiology and antibiogram of cases in Singapore. 225 29

Soft tissue infections in compromised patients are frequently caused by Gram-negative organisms and particularly by Pseudomonas aeruginosa. These pathogens are effectively eradicated by pefloxacin as well as by ceftazidime. The effectiveness and safety of these two agents were compared in a prospective randomized study in 67 patients with soft tissue infections. Underlying conditions included malignant diseases, diabetes mellitus and chronic renal failure. The infections included: post operative infection, septic foot, soft tissue abscess and cellulitis. Thirty-three patients were treated with intravenous ceftazidime for a mean duration of ten days. More than half the 34 patients given pefloxacin were treated only orally for a mean period of 13 days. The clinical and bacteriological outcomes were similar in both groups. There was clinical cure or improvement in 26 pefloxacin cases and in 23 ceftazidime cases, failure in six pefloxacin cases and in seven ceftazidime and relapse in two pefloxacin and in three ceftazidime patients. The bacteriological responses were eradication in 23 pefloxacin cases and in 22 ceftazidime cases, persistence in five pefloxacin cases and in six ceftazidime cases, relapse in one pefloxacin case and in none of the ceftazidime group, reinfection in four pefloxacin cases and in three ceftazidime cases and there was one unassessed patient in the pefloxacin group and two in the ceftazidime group. Nausea and vomiting occurred in three patients and elevation of liver enzymes in another patient; all side effects were observed only in the pefloxacin treated patients. These results suggest that oral pefloxacin could offer an alternative to intravenous ceftazidime in half the compromised patients with tissue infections. However, adverse reactions due to pefloxacin administration should be watched for during such therapy.
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PMID:Pefloxacin versus ceftazidime in therapy of soft tissue infections in compromised patients. 225 49

Melioidosis, a severe, often fatal disease caused by infection with Pseudomonas pseudomallei, has been thought to be a rare endemic disease relatively limited to the areas 20 degrees on either side of the equator. However, an increasing number of people travelling to these areas are reportedly suffering from this disease. It is timely to review this disease for doctors who are unfamiliar with this disease. P. pseudomallei, first discovered by Whitmore and Krishnaswami in 1912, is a gram-negative aerobic rod, motile due to polar flagella, isolated from soil and natural waters in endemic areas, and presumably transmitted to human beings through skin abrasion, ingestion and inhalation. Associated underlying conditions must be searched for, such as diabetes mellitus and chronic renal failure. Clinical classification ranges from disseminated septicemic melioidosis, the most serious form, to subclinical melioidosis, the least serious form. Disseminated septicemic type is associated with high fever, multiple organ lesions with septic shock and high fatality rate within a few days after symptoms develop. This type of infection requires prompt institution of antimicrobial therapy as well as surgical intervention such as drainage. Antimicrobial agents should be carefully selected according to the susceptibility results of the isolates. During the suspected stage, ceftazidime is a drug of choice. Subclinical melioidosis associated with positive serologic test alone should be closely followed up against the potential reactivation of dormant infection with P. pseudomallei. We must certainly be aware of melioidosis and diagnose melioidosis as early as possible by completing the initial routine diagnostic procedures to febrile patients.
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PMID:[Infection with Pseudomonas pseudomallei]. 227 64

Nine cases of Fournier's gangrene diagnosed between 1982 and 1989 are reported. All were males with a mean age of 76 (47-82 years). Seven had a history of alcoholism and one had non insulin-dependent diabetes. Six patients also had an anal fistula which may have been the starting point of the infection. The causal agents were two anaerobes (Clostridium perfringens and Bacteroides fragilis) two gram-negatives (Morganella morgagni and Pseudomonas aeruginosa) and one, an unidentified gram-positive. In three patients a mixed intestinal flora was isolated and in another no germs were found. All were treated with broad-spectrum antibiotics and surgery. Seven patients survived and two died.
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PMID:[Fournier's disease: a report of 9 cases]. 227 37

Malignant external otitis (MEO) is a disease of the external auditive channel (EAC) due to Pseudomonas aeruginosa which usually involves individuals with diabetes mellitus. It may result in the invasion of the cranial base with cranial neuropathy and a high mortality rate despite therapy. We report the clinical features, diagnostic procedures, evolution and therapy of 8 patients with MEO, seven of which had cranial neuropathy. All patients have diabetes except one who had acquired immunodeficiency syndrome. All had otalgia, otorrhea and headache lasting for several months. Six patients had homolateral (as related to the MEO) facial palsy. One patient with bilateral MEO developed bilateral facial palsy and lesion of the cranial nerves VI (unilaterally) and IX through XII (bilaterally). In all patients P. aeruginosa was cultured from the EAC exudate scintigraphy with 99Tc showed uptake at medium ear and mastoid level in all 8 patients, suggesting a possible osteomyelitis. Scintigraphy with 67Ga was positive in the 6 cases where it was carried out, showing uptake in the soft tissues of the cranial base. Computed tomography was carried out in 6 patients, and it was useful to define the anatomical extent of the disease. The patients received different therapeutic schedules, particularly the combination of a betalactamic and aminoglucoside antibiotics. Follow up was characterized by common recurrences, and one patient died. The importance of early diagnosis and treatment to prevent the extension and recurrence of MEO are discussed. Cranial neuropathy is considered as a poor prognostic finding.
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PMID:[Otitis externa maligna and cranial neuropathy]. 228 52

We hypothesized that the forcible introduction of water containing Pseudomonas aeruginosa into the ear canal of a susceptible host (an elderly diabetic with cutaneous hypoperfusion secondary to microangiopathy) was the inciting factor in the development of malignant external otitis. Tap water irrigation of the ears by a physician preceded the onset of symptoms in 61.5% (8/13) of cases of malignant external otitis. Two control subjects with known diabetes mellitus were matched for each patient by sex and age. Both groups were questioned on the nature and degree of aural water exposure, as well as history of ear disease. There were no significant differences between 13 patients and 26 control subjects for presence of ear disease (hearing loss, chronic infection, prior operations), swimming, showering, bathing, frequency of ear cleaning, or method of ear cleaning (washcloth, cotton applicator). Patients with malignant external otitis had a statistically significant higher incidence of aural irrigation with tap water when compared with control subjects. We suggest that a substantial number of cases of malignant external otitis may be iatrogenic.
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PMID:Aural irrigation with water: a potential pathogenic mechanism for inducing malignant external otitis? 230 65

While fifty years ago 20 p. 100 of cystic fibrosis patients only reached the age of one year, more than 50 p. 100 of the patients now live more than twenty years. The clinical manifestations of cystic fibrosis are more diverse in adults than in children, so that the diagnosis might concern several specialties. In actual fact, only 3 to 7 p. 100 of cystic fibroses are diagnosed after thirteen to sixteen years, and in half the cases the symptoms had been present before the age of one year. In adults, the respiratory manifestations of cystic fibrosis are predominant, whereas the gastrointestinal manifestations tend to be blurred. Radiography of the chest shows interstitial lesions (opacities, cystic images, disorders of ventilation), principally located in the right side and the apex. The most common functional defect is an obstructive syndrome corresponding to a gradual involvement of the peripheral airways. A number of complications may develop, including recurrent Pseudomonas infection of the lung, pneumothorax, heart failure, malnutrition, liver cirrhosis, episodes of intestinal occlusion, etc. The longer life span of these patients raises the problems of diabetes with its vascular complications, infertility or pregnancy, social and professional insertion, and so forth. The prognosis of cystic fibrosis in adults depends on the date the diagnosis was made, on the therapeutic follow-up and on the creation of specialized centres. The control of Pseudomonas infections and the development of lung transplantation are the main advances to be expected.
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PMID:[Cystic fibrosis in adults]. 236 14


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