1/1782. Latent coeliac disease. Personal experience.Latent coeliac disease (L.C.D.) is an extremely rare condition to describe. In this study we analyzed three cases of patients affected by L.C.D.: two of them suffered from insulin-dependent diabetes mellitus (IDDM) and the other one from infantile cerebral palsy and eosinophilic gastroenteritis. We confirm the existence of this form of coeliac disease (C.D.), by means of duodenal biopsy, and stress the importance of an early diagnosis in order to prevent the serious consequences caused by untreated C.D.- - - - - - - - - - ranking = 1keywords = b (Clic here for more details about this article) |
2/1782. Acute torsion of the renal transplant after combined kidney-pancreas transplant.BACKGROUND: Surgical complications after combined kidney and pancreas transplantation are a major source of morbidity and mortality. Complications related to the pancreas occur with greater frequency as compared to renal complications. The occurrence in our practice of two cases of renal infarction resulting from torsion about the vascular pedicle led to our retrospective review of similar vascular complications after combined kidney and pancreas transplantation. methods: charts were reviewed retrospectively, and two patients were identified who experienced torsion about the vascular pedicle of an intra-abdominally placed renal allograft. RESULTS: Two patients who had received combined intraperitoneal kidney and pancreas transplantation presented at 16 and 11 months after transplant, respectively, with abdominal pain and decreased urine output. One patient had radiological documentation of abnormal rotation before the graft loss; unfortunately, the significance of this finding was missed. Diagnosis was made in both patients at laparotomy, where the kidneys were infarcted secondary to torsion of the vascular pedicle. Both patients underwent transplant nephrectomy and subsequently received a successful second cadaveric renal transplant. CONCLUSIONS: The mechanism of this complication is a result of the intra-abdominal placement of the kidney, length of the vascular pedicle, excess ureteral length, and paucity of adhesions secondary to steroid administration. These factors contribute to abnormal mobility of the kidney. Technical modifications such as minimizing excess ureteral length and nephropexy may help to avoid this complication.- - - - - - - - - - ranking = 2.8571428571429keywords = b (Clic here for more details about this article) |
3/1782. insulin dependent diabetes mellitus (IDDM) and autoimmune thyroiditis in a boy with a ring chromosome 18: additional evidence of autoimmunity or IDDM gene(s) on chromosome 18.A 4 year 3 month old boy with insulin dependent diabetes mellitus (IDDM), autoimmune thyroiditis, slight mental retardation, facial dysmorphism, and a de novo ring chromosome 18 (deletion 18q22.3-18qter) is described. This unique association of defects could represent a chance association. Alternatively, the clinical features could be the result of the chromosomal aberration. If so, one could speculate that a gene or genes on chromosome 18 might act as a suppressor or activator of the autoimmune process by itself or in concert with other IDDM loci.- - - - - - - - - - ranking = 2keywords = b (Clic here for more details about this article) |
4/1782. Subacute painful lumbosacral polyradiculoneuropathy in immunocompromised patients.The syndrome of inflammatory subacute lumbosacral polyradiculoneuropathy (SLP) has been reported in acquired immunodeficiency syndrome (AIDS) patients in association with cytomegalovirus infection and is only partially amenable to anti-viral therapy. We report three cases of relatively benign inflammatory painful SLP in two non-AIDS, immunosuppressed patients and one who hiv-seroconversed at the time of clinical presentation. SLP developed: (1) in association with hiv seroconversion; (2) during ECHO virus infection in a patient with common variable immune deficiency; and (3) after a severe systemic infection that induced transient immunosuppression due to Epstein-Barr virus reactivation. This report expands the spectrum of viruses associated with acute and subacute lumbosacral polyradiculoneuropathy and may shed light on its possible pathogenesis.- - - - - - - - - - ranking = 26.753899513604keywords = deficiency, b (Clic here for more details about this article) |
5/1782. travel-related morbidity in travelers with insulin-dependent diabetes mellitus.BACKGROUND: To assess whether there are clinically significant problems in patients with insulin-dependent diabetes mellitus (IDDM) traveling to tropical countries regarding metabolic dysregulations, infectious complications and general health problems. methods: A retrospective, descriptive cohort study by telephone interview of all IDDM patients who had received pretravel health advice at our travel clinic during a 12 month period. Data were collected on IDDM related problems: hypo-/hyperglycemic dysregulation, infectious complications, practical difficulties, exploring risk factors, as well as on general health problems. RESULTS: Of the 19 respondents, 13 (68%) reported any metabolic dysregulation, including all but one respondents with Type 1 diabetes. Fifty-five percent of Type 1 diabetics reported to have dysregulated more often than in the preceding period at home. Critical dysregulations occurred in 2 of the 19 study patients. Only 4 out of 11 (36%) type 1 IDDM patients increased frequency of blood glucose monitoring while traveling. Three travelers reported a febrile illness which resulted in hyperglycemic dysregulation. Five study patients experienced difficulties in the adjustment of their insulin dosage to the unfamiliar circumstances of traveling in the tropics. CONCLUSIONS: Metabolic dysregulation was a clinically significant problem, thus IDDM travelers to tropical destinations probably run extra health risks. fever, easily acquired in the tropics, appeared to be an additional, serious health problem for this study population. As the number of diabetic travelers will increase, more research on the importance of risk factors possibly leading to dysregulation is necessary.- - - - - - - - - - ranking = 4.2857142857143keywords = b (Clic here for more details about this article) |
6/1782. cyclosporine disposition and long-term renal function in a 500-pound kidney transplant recipient.Patient size has been suggested as a risk factor in kidney transplantation. We have followed a recipient of a cadaver kidney who became massively obese (232 kg, 511 lbs) 5 years posttransplantation. He has maintained stable renal function with no rejection episodes and at 5 years has a measured serum creatinine of 2.2 mg/dL, creatinine clearance 42 mL/min, and urinary protein excretion of 320 mg/24h. Both oral and intravenous cyclosporine (Sandimmune) pharmacokinetic studies were done on a steady-state dose of 150 mg, which represents 0.65 mg/kg per dose. The patient exhibited very high bioavailability, F = 95%, and an oral elimination T1/2 of over 21 hours. These data confirm that stable cyclosporine delivery in very obese recipients can be sustained by dosing normalized to the ideal body weight and trough level monitoring.- - - - - - - - - - ranking = 1.8571428571429keywords = b (Clic here for more details about this article) |
7/1782. Acute renal failure from multiple myeloma precipitated by ACE inhibitors.Renal failure in multiple myeloma can be precipitated during hemodynamic perturbances of renal blood flow, as seen secondary to volume depletion, radiocontrast dye, and nonsteroidal anti-inflammatory agents. We report two cases of acute renal failure that developed suddenly after initiation of angiotensin-converting enzyme (ACE) inhibitor, both with biopsy-proven cast nephropathy. ACE inhibitors may contribute to the intratubular light chain cast formation and acute "myeloma kidney" in susceptible patients.- - - - - - - - - - ranking = 2.5714285714286keywords = b (Clic here for more details about this article) |
8/1782. Use of computed tomography and plantar pressure measurement for management of neuropathic ulcers in patients with diabetes.BACKGROUND AND PURPOSE: Total contact casting is effective at healing neuropathic ulcers, but patients have a high rate (30%-57%) of ulcer recurrence when they resume walking without the cast. The purposes of this case report are to describe how data from plantar pressure measurement and spiral x-ray computed tomography (SXCT) were used to help manage a patient with recurrent plantar ulcers and to discuss potential future benefits of this technology. CASE DESCRIPTION: The patient was a 62-year-old man with type 1 diabetes mellitus (DM) of 34 years' duration, peripheral neuropathy, and a recurrent plantar ulcer. Although total contact casting or relieving weight bearing with crutches apparently allowed the ulcer to heal, the ulcer recurred 3 times in an 18-month period. Spiral x-ray computed tomography and simultaneous pressure measurement were conducted to better understand the mechanism of his ulceration. OUTCOMES: The patient had a severe bony deformity that coincided with the location of highest plantar pressures (886 kPa). The results of the SXCT and pressure measurement convinced the patient to wear his prescribed footwear always, even when getting up in the middle of the night. The ulcer healed in 6 weeks, and the patient resumed his work, which required standing and walking for 8 to 10 hours a day. DISCUSSION: Following intervention, the patient's recurrent ulcer healed and remained healed for several months. Future benefits of these methods may include the ability to define how structural changes of the foot relate to increased plantar pressures and to help design and fabricate optimal orthoses.- - - - - - - - - - ranking = 2.1428571428571keywords = b (Clic here for more details about this article) |
9/1782. Thrombotic risk in thalassemic patients.Hemostatic parameters of 495 beta-thalassemic patients (421 with thalassemia major and 74 with thalassemia intermedia) were analyzed, to assess their association with the described thrombophilic condition and to verify the role of additional risk factors (e.g. persistent postsplenectomy thrombocytosis, insulin dependent diabetes mellitus, estrogen-progestin treatment and atrial fibrillation). The prevalence of thromboembolic accidents was 5.2% and in four patients (15.3%) inherited or acquired predisposing defects were recognized. The incidence of thromboembolic events and the associated relative risk due to hemocoagulative abnormalities in these patients are discussed.- - - - - - - - - - ranking = 2.1428571428571keywords = b (Clic here for more details about this article) |
10/1782. Pancreatic graft survival after arterial thrombosis in simultaneous renal-pancreatic transplantation.Vascular thrombosis following pancreas transplantation is one of the main causes of early graft loss. Successful thrombectomy after pancreatic graft thrombosis has not been reported yet. A patient with arterial graft thrombosis in whom the graft survived after thrombectomy is described. Different varieties of pancreatic graft thrombosis are discussed.- - - - - - - - - - ranking = 1.7142857142857keywords = b (Clic here for more details about this article) |
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