1/20. Treatment of severe proliferative retinopathy and diabetic maculopathy.Strict blood glucose control, early detection and surveillance of diabetic retinopathy by means of validated screening programmes, and judicious use of laser photocoagulation can greatly reduce the risk of visual loss in diabetes. Some patients however, have aggressive neovascular disease resistant to laser treatment, or present at a late stage with advanced fibroproliferative disease, and may progress rapidly to blindness. In the elderly with Type 2 disease, diabetic maculopathy is more common and requires a different therapeutic approach. The present article describes two diabetic patients and discusses the management of patients with severe proliferative retinopathy or diabetic maculopathy.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/20. Enhanced platelet aggregation, high homocysteine level, and microvascular disease in diabetic muscle infarctions: implications for therapy.Muscle infarction is a rare complication in patients with diabetes mellitus, probably because of the rich vascular supply of this tissue. We describe a patient with type 1 diabetes who had infarction of the muscles in her right thigh. We report, for the first time, that the patient, in addition to an advanced microvascular disease in the muscle, had increased plasma total homocysteine levels and increased platelet aggregation. These pathologies might have a synergistic effect on the development of this rare complication and should be treated aggressively to prevent further episodes.- - - - - - - - - - ranking = 5keywords = vascular disease (Clic here for more details about this article) |
3/20. Sudden hearing loss as a first complication of long-standing Type 1 diabetes mellitus: a case report.The term 'sudden hypoacusis' describes a hearing loss of a rapid onset and unknown origin that can progress to severe deafness. Its pathophysiology is still unknown, the proposed aetiological mechanisms being vascular disease or autoimmune reaction. We present the case of a 19-year-old woman with Type 1 diabetes mellitus who experienced sudden hearing loss on her right side. She had no complications related to diabetes. After being referred to the hospital she was diagnosed with sudden sensorineural right-sided hearing loss accompanied by high frequency tinnitus. After administration of vasoactive drugs, there was partial improvement after 7 days, followed by gradual improvement over the next 4 weeks to 5 months. The tinnitus did not disappear completely. We conclude that hearing organ disturbances can be present in Type 1 diabetes and represent an early complication.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
4/20. Minimal intensity diode laser (810 nanometer) photocoagulation (MIP) for diffuse diabetic macular edema (DDME).BACKGROUND AND OBJECTIVE: To determine the effectiveness of minimal intensity diode laser (810nm) photocoagulation (MIP) for diffuse diabetic macular edema (DDME). methods: patients demonstrating diffuse diabetic macular edema (DDME) were treated with minimal intensity diode 810 laser photocoagulation or modified grid photocoagulation consecutively. patients were seen and reevaluated at regular follow up visits every 3 to 4 months and retreated if residual diffuse diabetic macular edema was still present. Selected patients were tested with Goldmann visual field, pre and post-treatment. Visual improvement, visual loss, visual field, reduction/elimination of macular edema, and a number of treatments were studied. RESULTS: Reduction/elimination of DDME was observed in approximately 74% of eyes with 24 months follow up. The number of treatments per eye ranged from 1 to 5. The presence of cystoid macular edema, initial poor visual acuity, the presence of coexisting macular ischemia, or a history of systemic hypertension did not effect the outcome. patients without a history of systemic vascular disease had a better chance of visual stabilization or improvement compared to those patients with a history of systemic vascular disease. Eighty-eight percent of patients had at least stable visual acuity at the last follow up visit. No post-treatment subjective complaints of increased pericentral scotomas were encountered in this group of patients and post-treatment atrophic scarring was substantially reduced, by using minimal intensity diode laser 810 photocoagulation, compared to eyes previously treated with shorter wavelengths and more visible burns. CONCLUSION: Minimal intensity diode laser 810nm modified grid laser photocoagulation for diffuse diabetic macular edema (DDME) is effective in reducing/eliminating DDME, although resolution of edema may be slightly prolonged and may require 1 or 2 additional treatments compared to eyes previously treated with shorter wavelengths and more visible burns. However, this method appears to be advantageous in that it appears to reduce the objective and subjective effect on the pericentral visual field, as well as substantially reducing the post-treatment atrophic scarring seen in patients treated with shorter wavelength lasers and move visible burns.- - - - - - - - - - ranking = 2keywords = vascular disease (Clic here for more details about this article) |
5/20. argon green (514 nm) versus krypton red (647 nm) modified grid laser photocoagulation for diffuse diabetic macular edema.Between 1984 and 1988, 225 eyes of 132 patients were entered in a prospective, randomized clinical trial to determine if any significant differences exist between treatment with argon green (514 nm) and krypton red (647 nm) modified grid laser photocoagulation for patients with diffuse diabetic maculopathy with or without cystoid macular edema. At the 12- and 24-month follow-up visits, no statistically significant difference was found between the two groups with respect to all of the following: reduction or elimination of macular edema, improvement in visual acuity, worsening of visual acuity, number of treatments per eye, and effect on the visual field. At the 12-month follow-up visit, none of the following factors statistically affected the visual outcome in either of the two groups: a history of systemic hypertension, systemic vascular disease, cystoid macular edema, or initial poor visual acuity.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
6/20. Clinical and etiological heterogeneity of idiopathic diabetes mellitus. The banting memorial lecture.We have presented and reviewed evidence for the heterogeneous nature of diabetes mellitus in terms of genetics, environmental factors, insulin responses to glucose and vascular disease. We have reviewed evidence for heterogeneity between juvenile-onset diabetes (JOD) and maturity-onset diabetes (MOD) and maturity-onset diabetes of young (MODY) and for heterogeneity within groups of JOD and MOD and MODY patients. Although much remains to be learned, a beginning has been made and suggests that primary diabetes mellitus is not a single specific disease but a syndrome comprised of a variety of diseases all characterized by hyperglycemia and tissue changes that result from heterogeneous etiologic and pathogenetic factors. Future classifications of primary diabetes mellitus will undoubtedly be lengthy, as are for other diseases and syndromes also caused by a variety of etiologic and pathogenetic mechanisms.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
7/20. Use of injectable collagen to treat chronic diabetic foot ulcers.A significant portion of the population suffer from diabetic foot ulcers. While conservative treatment is often successful, many diabetic patients with accompanying peripheral vascular disease and neuropathy are under constant medical care for chronic, recurring foot ulcers. A new injectable biomaterial, Keragen Implant, was evaluated on two patients with bilateral diabetic ulcers. The implanted lesions healed completely during the months following treatment. Control lesions treated by conventional means remained open and ulcerated.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
8/20. Rapid development of nephrotic syndrome, hypertension, and hemolytic anemia early in pregnancy in patients with IDDM.In recent years, the prognosis for a successful pregnancy has greatly improved for women with insulin-dependent diabetes mellitus (IDDM) who are under good glycemic control and free of complications such as vascular disease and nephropathy. We report the rapid development of severe nephrotic syndrome, malignant hypertension, and microangiopathic hemolytic anemia during the first trimester of pregnancy in a 29-yr-old woman with IDDM of 18 yr duration. Our patient had no pregestational history of retinopathy or hypertension and only minimal proteinuria. Significant improvement in blood glucose levels had been achieved over the 6 mo before conception. kidney biopsy performed before the termination of pregnancy at 10 wk gestation revealed diabetic nephropathy. No other etiology for her renal disease could be found. An arteriole was noted to have entrapped red blood cell fragments and platelet thrombi, revealing the probable source of her hemolytic process. By 8 wk postpartum, her nephrotic syndrome and hemolysis had completely resolved. At 3 mo postgestation, the patient's hypertension was still present but less severe. Her serum creatinine has continued to decrease toward normal. This is the first report of a woman with IDDM in White's classification C who developed a toxemia-like syndrome during the first trimester of pregnancy, attributable to the underlying diabetic state.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
9/20. Hypoglycemic hemiplegia: two cases and a clinical review.Hypoglycemic hemiplegia mimics cerebrovascular disease. Two patients are reported who experienced multiple attacks of transient hemiplegia associated with hypoglycemia and who were initially diagnosed as having transient ischemic attacks. In both, angiography was normal and the attacks resolved with reduction of insulin dose. Recognition of hypoglycemia as the cause of transient hemiplegia is important, often obviating the need for cerebrovascular evaluation.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
10/20. Three cases of vascular problems in the human stria vascularis.The histopathological findings of a study of temporal bones are reported. Each patient suffered from one of the following systemic vascular diseases: leukemia, hypertension, and diabetes mellitus. In each temporal bone, a differing strial pathology was observed: leukemic infiltration, dilatated strial vessels, and microaneurismata. Microvascular changes as seen in this study could make the human inner ear more vulnerable to inner ear traumata.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
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