1/89. Hereditary pancreatitis and mutation of the trypsinogen gene.Hereditary pancreatitis is a rare form of chronic recurrent pancreatitis. A family, in which 11 members had chronic pancreatitis, five had diabetes, and two had pancreatic cancer, was studied, and hereditary pancreatitis was diagnosed in all patients by demonstrating the mutation in exon 3 of the cationic trypsinogen gene (R117H). The clinical implications of genotypic analysis in hereditary pancreatitis are discussed.- - - - - - - - - - ranking = 1keywords = diabetes (Clic here for more details about this article) |
2/89. Therapeutic plasma exchange in patients with chylomicronemia syndrome complicated by acute pancreatitis.Chylomicronemia syndrome (CMS) is a rare disorder characterized by the presence of chylomicrons in the fasting state causing a milky appearance of plasma, eruptive xanthomas, and hepatosplenomegaly; an acute and potentially life threatening complication is severe acute pancreatitis. The underlying defects are inborn errors of metabolism such as deficiencies of lipoprotein lipase (LPL) or apoprotein C-II (apo C-II) as well as familial hypertriglyceridemia. Moreover, CMS can be precipitated when mild hypertriglyceridemia is exacerbated by additional factors such diabetes mellitus, ethanol abuse, or pregnancy. The purpose of the present study was to retrospectively analyze the results of therapeutic plasma exchange (TPE) in 5 patients transferred to our hospital for severe acute pancreatitis due to chylomicronemia syndrome. In a total of 7 TPE sessions, on average 3,286 /- 247 ml of plasma (i.e., about 1 patient plasma volume) were treated per session. Triglyceride (TG) levels were decreased from 4,972 /- 2,469 mg/dl on admission to 1,614 /- 1,276 mg/dl (-70%) after the TPE sessions, and a further decrease was achieved by conservative treatment. Part of the TG reducing effect of the treatment was probably due to heparin induced lipolysis. Acute pancreatitis was resolved in all cases, and 1 pregnant patient delivered without problems at term. In summary, 1 or 2 TPE sessions sufficed to substantially decrease the bulk of triglycerides in acutely exacerbated chylomicronemia syndrome causing a rapid resolution of acute severe pancreatitis.- - - - - - - - - - ranking = 3.6398640513269keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
3/89. Elevated serum creatine kinase activity in a patient with acute pancreatitis.A 62-year-old man presented with a five-day history of a 'flu-like' illness, epigastric pain and a state of increasing confusion. His serum values for amylase and glucose were grossly elevated, as was the creatine kinase (CK) activity, being 23 times above the upper limit of normal. CK-MB was less than 5% of his total CK activity. There was no past history of diabetes or recent history of intramuscular injections or injury. A diagnosis of acute pancreatitis complicated by hyperosmolar non-ketotic (HONK) diabetic pre-coma was made. The patient was treated with intravenous fluids, insulin and subcutaneous heparin. Normal values for serum amylase and CK activity were recorded with convalescence. This case indicates a possible association of a rise in total CK activity with acute pancreatitis complicated by HONK diabetic pre-coma. This observation was made in the absence of clinically evident muscle pathology.- - - - - - - - - - ranking = 1keywords = diabetes (Clic here for more details about this article) |
4/89. Fibrocalculous pancreatic diabetes in a child: case report.A case of fibrocalculous pancreatic diabetes in a 12-year old boy is described. A medline literature search back to 1966 revealed that no cases had been reported from East africa. We reviewed the literature and suggest that the condition is probably under-reported.- - - - - - - - - - ranking = 5keywords = diabetes (Clic here for more details about this article) |
5/89. Maternally inherited diabetes and deafness (MIDD): unusual occult exocrine pancreatic manifestation in an affected German family.The mitochondrial (mt) 3243 dna mutation is an underlying cause of maternally inherited diabetes and deafness (MIDD) syndrome and the syndrome of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS). We report an affected German MIDD pedigree with maternal lineage over three generations. The index patient, her mother, her maternal aunt and her maternal grandmother all suffered from diabetes and premature hearing loss and were positive on testing for the mt 3243 dna mutation. The 27-year-old index patient had a history of grand mal seizures. As sequela of abdominal ultrasound and confirmed by magnetic resonance cholangio-pancreaticography, she was diagnosed with chronic pancreatitis with pancreatic calcifications and pancreatic duct dilation, although she was completely asymptomatic and with no signs of steatorrhoea. She did not have gallstones and the common bile duct was normal. A possible etiopathogenic pathway for pancreatitis could be a suppressive effect of the mt 3243 mutation on the oxidative phosphorylation in affected mitochondria. Although pancreatitis and pancreatic dysfunction in association with the mt 3243 mutation, especially in patients with comorbidity of MELAS and diabetes, has previously been described as a rare manifestation, this case is specific because of the discrepancy of advanced morphological pancreatic alterations and complete lack of pancreatogenic symptoms.- - - - - - - - - - ranking = 7keywords = diabetes (Clic here for more details about this article) |
6/89. epidural abscess after epidural catheter for pain release during pancreatitis.BACKGROUND: Despite knowledge about compromised host defence in the course of diabetes mellitus and pancreatitis, epidural analgesia (EA) is recommended for pain management during pancreatitis. CASE REPORT: We present the case of a diabetic patient with pancreatitis who developed an epidural abscess after 3 days with an epidural catheter. Natural killer and T-helper cell counts were distinctively reduced in the absence of hiv serology. Furthermore, a synthesis failure of the liver was observed and evidenced by low cholinesterase, low whole protein fraction and low antithrombin iii in the peripheral blood. CONCLUSION: We suggest that the combination of pancreatitis, diabetes and compromised immunity might be a contraindication to epidural analgesia.- - - - - - - - - - ranking = 4.6398640513269keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
7/89. Simultaneous onset of type 1 diabetes mellitus and painless thyroiditis following acute pancreatitis.A 24-year-old female suffered from acute pancreatitis, followed by simultaneous onset of painless goiter, elevation of thyroid hormones and diabetic ketoacidosis. Two months later, her insulin secreting function was severely decreased and positive for anti-GAD and anti-islet cell antibodies, whereas the serum glucagon level was normal, suggesting an autoimmune-related destruction specifically of beta cells. In addition, the initial hyperthyroid state was followed by a hypothyroid phase which later recovered to an euthyroid state, suggesting an initial destruction of thyroid cells. Because anti-thyroidal antibodies were positive, it is likely that the thyroidal destruction was also autoimmune-related. This case implies common pathogenic mechanisms in the autoimmunity related destruction of beta cells and thyroid cells.- - - - - - - - - - ranking = 14.559456205307keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
8/89. Olanzapine-induced diabetic ketoacidosis.OBJECTIVE: To report the case of a patient taking olanzapine who developed diabetic ketoacidosis (DKA). CASE SUMMARY: A 46-year-old African American woman with no previous history of diabetes mellitus was admitted to the hospital and subsequently diagnosed with DKA and acute pancreatitis. The patient had been taking olanzapine, valproic acid, carbamazepine, hydrochlorothiazide/triamterene, and conjugated estrogens prior to admission. Olanzapine was the last medication added to the regimen. In addition to clinicians treating the DKA with appropriate interventions, olanzapine (due to possible association with hyperglycemia and DKA) as well as valproic acid (due to possible association with pancreatitis) were discontinued from the medication regimen. The patient was discharged home and her most recent glycosylated hemoglobin and fasting glucose concentrations have been within the normal range. DISCUSSION: Atypical antipsychotics, such as olanzapine, have been associated with hyperglycemia and possibly DKA. We believe that this occurred in our patient who had no previous history of diabetes mellitus. Possible mechanisms of action and potential confounding variables are discussed. CONCLUSIONS: Clinicians should monitor blood glucose concentrations periodically in patients taking olanzapine, especially in those patients with risk factors for diabetes mellitus.- - - - - - - - - - ranking = 10.919592153981keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
9/89. Diabetic hypertriglyceridemia-induced acute pancreatitis masquerading as biliary pancreatitis.diabetes mellitus has a profound effect on plasma lipid metabolism especially triglycerides. One complication of hypertriglyceridemia is acute pancreatitis. Here, we report a case of diabetic hypertriglyceridemia-induced recurrent acute pancreatitis that masquerades as biliary pancreatitis. Institution of insulin therapy caused a resolution of the hypertriglyceridemia and a cessation of the episodes of acute pancreatitis.- - - - - - - - - - ranking = 0.48129362208822keywords = mellitus (Clic here for more details about this article) |
10/89. Tropical pancreatitis.Tropical pancreatitis is an uncommon cause of acute, and often chronic, relapsing pancreatitis. patients present with abdominal pain, weight loss, pancreatic calcifications, and glucose intolerance or diabetes mellitus. Etiologies include a protein-calorie malnourished state, a variety of exogenous food toxins, pancreatic duct anomalies, and a possible genetic predisposition. Chronic cyanide exposure from the diet may contribute to this disease, seen often in india, asia, and africa. The pancreatic duct of these patients often is markedly dilated, and may contain stones, with or without strictures. The risk of ductal carcinoma with this disease is accentuated. Treatment may be frustrating, and may include pancreatic enzymes, duct manipulations at endoscopic retrograde cholangiopancreatography, octreotide, celiac axis blocks for pain control, or surgery via drainage and/or resection.- - - - - - - - - - ranking = 3.6398640513269keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
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