1/599. Emergence of vancomycin resistance in Staphylococcus aureus. Glycopeptide-Intermediate Staphylococcus aureus Working Group.BACKGROUND: Since the emergence of methicillin-resistant staphylococcus aureus, the glycopeptide vancomycin has been the only uniformly effective treatment for staphylococcal infections. In 1997, two infections due to S. aureus with reduced susceptibility to vancomycin were identified in the united states. methods: We investigated the two patients with infections due to S. aureus with intermediate resistance to glycopeptides, as defined by a minimal inhibitory concentration of vancomycin of 8 to 16 microg per milliliter. To assess the carriage and transmission of these strains of S. aureus, we cultured samples from the patients and their contacts and evaluated the isolates. RESULTS: The first patient was a 59-year-old man in michigan with diabetes mellitus and chronic renal failure. peritonitis due to S. aureus with intermediate resistance to glycopeptides developed after 18 weeks of vancomycin treatment for recurrent methicillin-resistant S. aureus peritonitis associated with dialysis. The removal of the peritoneal catheter plus treatment with rifampin and trimethoprim-sulfamethoxazole eradicated the infection. The second patient was a 66-year-old man with diabetes in new jersey. A bloodstream infection due to S. aureus with intermediate resistance to glycopeptides developed after 18 weeks of vancomycin treatment for recurrent methicillin-resistant S. aureus bacteremia. This infection was eradicated with vancomycin, gentamicin, and rifampin. Both patients died. The glycopeptide-intermediate S. aureus isolates differed by two bands on pulsed-field gel electrophoresis. On electron microscopy, the isolates from the infected patients had thicker extracellular matrixes than control methicillin-resistant S. aureus isolates. No carriage was documented among 177 contacts of the two patients. CONCLUSIONS: The emergence of S. aureus with intermediate resistance to glycopeptides emphasizes the importance of the prudent use of antibiotics, the laboratory capacity to identify resistant strains, and the use of infection-control precautions to prevent transmission.- - - - - - - - - - ranking = 1keywords = diabetes, diabetes mellitus, mellitus (Clic here for more details about this article) |
2/599. Vertebral osteomyelitis in insulin-dependent diabetics.Vertebral osteomyelitis continues to be a diagnostically and therapeutically challenging disease with a relatively high incidence in diabetics. The clinical features, investigations and treatment of 7 insulin-dependent diabetics with vertebral osteomyelitis are presented and possible aetiological factors in this group are discussed.- - - - - - - - - - ranking = 0.0045194063756616keywords = insulin-dependent (Clic here for more details about this article) |
3/599. Coexistence of primary endocrine deficiencies: a unique case of male hypergonadism associated with hypoparathyroidism, hypoadrenocorticism, and hypothyroidism.The unique combination of male hypogonadism with hypoparathyroidism, hypoadrenalism, hypothyroidism, diabetes mellitus, and alopecia totalis has been documented in a male patient who has been followed over the past 28 years. In this patient, first seen at the age of six for hypoparathyroidism alone, repeated clinical and laboratory endocrine evaluation detected the sequential development of the additional endocrine deficiencies. The presence of abnormal serum antibodies is consistent with an atuoimmune pathogenesis of this syndrome.- - - - - - - - - - ranking = 0.64771647729187keywords = diabetes, diabetes mellitus, mellitus (Clic here for more details about this article) |
4/599. adult Leigh syndrome with mitochondrial dna mutation at 8993.adult onset Leigh syndrome with a nucleotide (nt) 8993 mutation in mitochondrial (mt) dna is reported. A 43-year-old woman with a 6-year-history of insulin-resistant diabetes mellitus developed muscular weakness, intractable nausea and vomiting, and anemia. These were followed vertigo, blindness, and deafness with nystagmus. magnetic resonance imaging (MRI) revealed abnormal high intensities in the bilateral medial regions of the thalamus and periaqueductal gray matters. autopsy disclosed well-demarcated necrotizing lesions with prominent capillaries in the areas detected by MRI, which were sufficiently diagnostic for Leigh syndrome. MtDNA analysis performed on DNAs extracted from formalin-fixed tissues including liver, heart, brain, muscle, kidney and pancreas showed a T-->G mutation at nt 8993. This is the first case of adult Leigh syndrome demonstrating on mtDNA mutations.- - - - - - - - - - ranking = 0.64771647729187keywords = diabetes, diabetes mellitus, mellitus (Clic here for more details about this article) |
5/599. blood brain barrier destruction in hyperglycemic chorea in a patient with poorly controlled diabetes.A case of hemichorea in a patient with poorly controlled diabetes is reported. T1-weighted magnetic resonance imaging (MRI) showed an unusual homogeneous high-intensity area in the corpus striatum. Of interest in the case was the fact that the globus pallidus, which was enhanced with gadolinium at the onset of hemichorea, showed homogeneous high-intensity on a subsequent T1-weighted image. This indicated that blood brain barrier destruction preceded the signal intensity change in the basal ganglia. As far as the authors could determine, this is the first reported case showing such enhancement during the course of diabetic hemichorea.- - - - - - - - - - ranking = 1.7614176135406keywords = diabetes (Clic here for more details about this article) |
6/599. Thermal biofeedback for claudication in diabetes: a literature review and case study.temperature biofeedback (TBFB) is designed to alter cutaneous temperature in treated extremities by providing information corresponding to minor temperature fluctuations in the context of therapeutic structure and reinforcement. Toe TBFB may improve vascular flow and walking tolerance in patients with peripheral vascular disease. This case study documents improved walking in a diabetes patient with lower extremity complications, and suggests TBFB might increase lower extremity temperature and blood flow volume pulse in uncomplicated diabetes. ankle-brachial index (ABI) and walking function were assessed in a 60-year-old woman with type 2 diabetes and intermittent claudication, before and after five sessions of TBFB applied to the ventral surface of the great toe. Toe temperature increased during feedback phases but not during baseline phases. Improvements were seen in ankle-brachial index, walking distance, walking speed, and stair climbing. This case indicates the need for extended and controlled study of TBFB for improved vascular and ambulatory function in diabetic claudication.- - - - - - - - - - ranking = 2.4659846589569keywords = diabetes (Clic here for more details about this article) |
7/599. Acquired reactive perforating collagenosis associated with diabetes mellitus: eight cases that meet Faver's criteria.Reactive perforating collagenosis (RPC) is characterized by umbilicated papules with a central adherent keratotic plug. Histologically, this condition shows transepidermal elimination of altered dermal collagen bundles into a cup-shaped epidermal depression. The present paper describes eight patients with associated diabetes mellitus who meet the diagnostic criteria for the acquired form of RPC (ARPC). Although half of these patients underwent dialysis, the lesions did not tend to develop after dialysis. pruritus and the Koebner phenomenon were common, and histologically a microvasculopathy was noted in the dermis of all patients. We speculate that this disease is triggered by a cutaneous response to superficial trauma. Furthermore, this response acts synergistically with vasculopathy in the dermis, primarily in the case of diabetes mellitus. A secondary sign of ARPC may be degenerated collagen fibres as a result of transepidermal elimination.- - - - - - - - - - ranking = 3.8862988637512keywords = diabetes, diabetes mellitus, mellitus (Clic here for more details about this article) |
8/599. Alternating Bell's palsy associated with diabetes mellitus. A report of four cases.Four diabetic patients are presented with alternating facial palsy. The term alternating is meant to imply facial nerve paralysis, the onset of which occurs at different points in time on both sides of the face. Clinical findings are presented and a short review of the literature is summarized. The authors conclude that alternating facial palsy is often associated with diabetes mellitus. Alternating facial palsy is an infrequent finding. This is in marked contrast to the unilateral form. Approximately every 13 minutes someone in the united states incurs idiopathic facial paralysis or Bell's palsy (20 persons per 100,000 per year). It is apparent that the majority of unilateral facial palsies fall into the idiopathic category. The alternating form of facial paralysis, however, appears to be an unusual finding in a symptom complex of several diseases which will be discussed. It is the diagnostic significance of this alternating facial paralysis and its occasional association with diabetes mellitus that prompts this report.- - - - - - - - - - ranking = 3.8862988637512keywords = diabetes, diabetes mellitus, mellitus (Clic here for more details about this article) |
9/599. Septic shock due to helicobacter fennelliae in a non-human immunodeficiency virus-infected heterosexual patient.helicobacter fennelliae (formerly campylobacter fennelliae) has been reported to cause bacteremia in homosexual men with or without human immunodeficiency virus (hiv) infection. We report here a 48-year-old, non-hiv-infected, heterosexual man with diabetes mellitus and cirrhosis of the liver who developed bacteremia and septic shock due to H. fennelliae. The patient was treated successfully initially with intravenous ampicillin-sulbactam and ceftazidime, followed by ampicillin-sulbactam only. These agents were active in vitro against the isolate by E-test results. To our knowledge, this is the first documented case of septic shock due to H. fennelliae in a non-hiv-infected, heterosexual, immunocompromised patient.- - - - - - - - - - ranking = 0.64771647729187keywords = diabetes, diabetes mellitus, mellitus (Clic here for more details about this article) |
10/599. insulin resistance in patients with depression and its changes in the clinical course of depression: a report on three cases using the minimal model analysis.It has been reported that depression and diabetes mellitus often occur together, and insulin resistance has been observed in patients with depression. For further understanding of the relationship of depression to insulin resistance, three patients with depression were given the oral glucose tolerance test (OGTT) and the frequently sampled intravenous glucose tolerance test (FSIGT) with minimal model analysis before and after antidepressant treatment. Depressive patients showed decreased glucose tolerance, enhanced insulin secretion, and diminished insulin sensitively during OGTT and FSIGT. These abnormalities were resolved after their recovery from depression without changes in body weight or diet.- - - - - - - - - - ranking = 0.64771647729187keywords = diabetes, diabetes mellitus, mellitus (Clic here for more details about this article) |
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