11/101. Intragastric balloon for morbid obesity causing chronic gastric dilatation.We describe the radiographic findings observed in a morbidly obese and diabetic patient with an intragastric air-filled balloon introduced as a therapeutic measure to reduce food intake. The balloon was associated with chronic gastric dilatation and had to be removed 3 months after insertion. However, together with diet and behavioural therapy, it proved effective in reducing body weight and ameliorating glycaemic control. Although rarely used, intragastric balloons for the treatment of morbid obesity are still encountered in radiological practice. Radiologists must be able to recognize them and to understand their complications.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
12/101. Partial calcanectomy in the treatment of chronic heel ulceration.Chronic decubitus ulceration of the heels is a common condition encountered by podiatric physicians, especially in diabetic patients. Very often these ulcerations can progress to osteomyelitis of the calcaneus. Many times, this in turn leads to a below-the-knee amputation. A partial calcanectomy is a viable alternative to below-the-knee amputation. A more functional limb both mechanically and cosmetically is achieved, and the morbidity and mortality associated with the calcanectomy is less than with a below-the-knee amputation. A brief overview of the history and outcomes associated with this procedure is outlined and a case utilizing a partial calcanectomy is presented.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
13/101. Invasive mucormycosis in benign gastric ulcer.Fungal elements are frequently noted overlying the base of chronic peptic ulcers of the stomach and it has been suggested that the fungi enhance the degree of necrosis and that these cases have protracted disease and deeper ulcers with more perforations. It has also been postulated that the number of fungal elements might be increased in the stomach of patients who are receiving potent medications such as H2-receptor antagonists to reduce gastric acidity, but there have not been adequate control studies, and the deleterious effects from the presence of the fungi in these cases have not been substantiated. We present a very rare case of invasive mucormycosis (phycomycosis) occurring in the base of a chronic gastric ulcer in a 55 years old diabetic male. This case was clinically and radiologically been mistaken for a gastric carcinoma. In addition, the ulcer was complicated by perforation and fungal septicemia with subsequent fatal outcome. The clinical, radiological and histopathological features are described together with a literature review of other reported fungal gastric ulcers.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
14/101. Opioids in non-cancer pain: a life-time sentence?There is continuing reluctance to prescribe strong opioids for the management of chronic non-cancer pain due to concerns about side-effects, physical tolerance, withdrawal and addiction. Randomized controlled trials have now provided evidence for the efficacy of opioids against both nociceptive and neuropathic pain. However, there is considerable variability in response rates, possibly depending on the type of pain, the type of opioid and its route of administration, the time to follow-up, compliance and the development of tolerance. Five patients were selected with nociceptive or neuropathic pain in whom other pharmacological or physical therapies had failed to provide satisfactory pain relief. They received transdermal fentanyl (starting dose 25 microg/h) for at least 6 weeks. Transdermal fentanyl dosage was titrated upwards as required. Transdermal fentanyl provided adequate pain relief in patients with nociceptive pain (diabetic ulcer, osteoporotic vertebral fracture, ankylosing spondylitis) or neuropathic pain with a nociceptive component (radicular pain due to disc protrusion, herpetic neuralgia). The duration of treatment ranged from 6 weeks to 6 months for four cases. In the case of ankylosing spondylitis, treatment was carried out for 2 years, stopped and then restarted successfully. There were no withdrawal effects or addictive behaviour on treatment cessation, regardless of duration of the treatment. In conclusion, strong opioids may provide prolonged effective pain relief in selected patients with nociceptive and neuropathic non-cancer pain. Transdermal fentanyl treatment can often be temporary and can easily be stopped following adequate pain relief without withdrawal effects or any evidence of addictive behaviour.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
15/101. metformin as a cause of late-onset chronic diarrhea.metformin is an effective and commonly administered drug for controlling plasma glucose concentrations in patients with type 2 diabetes mellitus. Gastrointestinal adverse effects such as abdominal pain, nausea, dyspepsia, anorexia, and diarrhea are common and widely accepted when occurring at the start of metformin therapy. diarrhea occurring long after the dosage titration period is much less well recognized. Our patient began to experience nausea, abdominal cramping, and explosive watery diarrhea that occasionally caused incontinence after several years of stable metformin therapy A trial of metformin discontinuation resolved all gastrointestinal symptoms. A review of the literature revealed two reports that suggest diarrhea occurring long after the start of metformin therapy is relatively common, based on surveys of patients with diabetes. metformin-induced diarrhea is differentiated from diabetic diarrhea, which is clinically similar, except diabetic diarrhea is rare in patients with type 2 diabetes. patients with type 2 diabetes who are taking metformin and experience diarrhea deserve a drug-free interval before undergoing expensive and uncomfortable diagnostic tests, even when the dosage has been stable over a long period.- - - - - - - - - - ranking = 2keywords = diabetic (Clic here for more details about this article) |
16/101. Hemorrhagic Descemet's membrane detachment as a complication of deep sclerectomy: a case report.PURPOSE: To report a case that developed hemorrhagic Descemet's membrane detachment after deep sclerectomy. PATIENT AND methods: Case report. A 63-year-old diabetic patient suffering from uncontrolled chronic open-angle glaucoma with full medication, underwent an uneventful deep sclerectomy operation combined with intraoperative mitomycin-C. RESULTS: On the second postoperative day, a hemorrhagic Descemet's membrane detachment (HDDM) was observed. The hemorrhage showed rapid absorption rate during the first two weeks along with reduction of the HDDM. After this period of time the rate of blood absorption was decreased. The Descemet's membrane reattached completely six months after surgery without any intervention but a paracentral corneal scar was present. The bleb was not functionally impaired during the whole postoperative period, and intraocular pressure remained stable at the level between 12 and 15 mmHg without medication. CONCLUSION: Hemorrhagic Descemet's membrane detachment should be considered as a potential complication of deep sclerectomy.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
17/101. Chronic thrombotic microangiopathy associated with antineoplastic therapy with minimal hematologic effects.OBJECTIVE: To describe 6 patients who developed progressive renal failure and renal thrombotic microangiopathy (TM) not accompanied by the characteristic hematologic disturbances of TM syndromes. patients AND methods: Portions of renal biopsy specimens from each patient were examined by light and electron microscopy for histopathologic evidence of TM. Antecedent clinical events, laboratory evidence of hemolysis and thrombocytopenia, and clinical outcome were documented. medical records were reviewed and clinical data, including laboratory values, treatment, and outcome, were recorded. RESULTS: In each case, a slowly progressive uremia evolved after radiation and/or chemotherapy without laboratory evidence of acute hemolysis or thrombocytopenia. Renal biopsy specimens in all cases showed TM and tubulointerstitial scarring, suggesting both acute and chronic renal injury. Two of the 6 patients underwent plasma exchange therapy without improvement of renal function. Three patients treated with angiotensin-converting enzyme inhibitors for coexisting systemic hypertension remained stable or had mild improvement in renal function. CONCLUSIONS: A small subset of patients treated for malignancy developed slowly evolving uremia associated with renal TM without marked hematologic abnormalities. In the absence of thrombocytopenia and other typical laboratory findings, the diagnosis of renal TM may be overlooked.- - - - - - - - - - ranking = 1.5802328876109keywords = microangiopathy (Clic here for more details about this article) |
18/101. diabetes mellitus and its chronic complications.diabetes mellitus is a major cause of morbidity and mortality, and it is a major risk factor for early onset of coronary heart disease. Complications of diabetes are retinopathy, nephropathy, and peripheral neuropathy. Currently, treatment involves diet modification, weight reduction, exercise, oral medications, and insulin. In recent years, important advances have been made into the pathogenesis of diabetes that affect the cardiovascular, renal, and nervous systems; vision; and the lower extremities, especially the feet. The progression of diabetic retinopathy and nephropathy can be slowed or prevented with tight glucose and blood pressure control. Neuropathy remains a major problem causing significant impairment. Ongoing clinical trials and testing of various medications to determine their effectiveness in treating the complications of diabetes have met with some success, but there still is much to learn about this disease.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
19/101. depression and chronic diabetic foot disability. A case report of suicide.Evidence at the scene of death and the postmortem examination led the pathologist to conclude suicide by intentional insulin overdose. The examination was conducted one day after the patient's death. The amount of insulin injected is not known, but levels of insulin in the vitreous gel were extremely high. While glucose and insulin are more stable in vitreous than in postmortem blood, the longer the delay between death and sample collection, the greater the uncertainty of the exact concentrations of substances at the time of death [42]. patients with diabetes may have at their disposal the resources to end their lives; misuse of insulin and suicide by insulin overdose are presumably underreported events. Not only do diabetics have insulin available, but they may also have narcotics, tricyclic antidepressants or other drugs that are toxic at high doses. Even in the absence of depression, all patients with diabetes face multiple emotional issues related to the diagnosis and course of the disease. Diabetes often requires significant lifestyle changes, such as diet and physical activity, upon its diagnosis. patients face the possibility of long-term, possibly debilitating, complications: vision loss, sexual dysfunction, and amputation. Any podiatrist who treats a large number of diabetic patients will encounter the situation of a patient at risk of losing a limb. A patient may consciously or unconsciously view amputation as punishment; limb loss interferes physically with bodily function and has extensive emotional consequences as well. It is important for patients to be involved with a healthcare team (including primary care physician, nurse educator, ophthalmologist, and podiatrist) that provides support throughout their lives [3]. As learned early on in podiatry school, podiatric physicians don't treat feet; they treat patients who have foot problems. It is as important to know when to refer a patient to the primary care physician or a psychiatrist for mental health complaints as it is to know when to refer a patient to an orthopedic surgeon for hip pain or to an ophthalmologist for vision problems. We do not propose that this patient's diabetic foot disease was the direct cause of his depression and suicide; however, the prevalence of depression in the general population and its even higher rates in patients with chronic medical illness require awareness of these problems by all members of the medical profession.- - - - - - - - - - ranking = 7keywords = diabetic (Clic here for more details about this article) |
20/101. Remission of chronic thrombotic thrombocytopenic purpura after treatment with cyclophosphamide and rituximab.BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) in adults is usually caused by autoantibody inhibitors of ADAMTS13. Treatment with plasma exchange is often effective but does not address the underlying autoimmune process. OBJECTIVE: To report the efficacy of intensive immunosuppressive therapy in refractory TTP. DESIGN: Case report. SETTING: University medical center. PATIENT: 42-year-old woman with chronic relapsing TTP. INTERVENTION: immunosuppression therapy with rituximab and cyclophosphamide. MEASUREMENTS: ADAMTS13 activity and inhibitors and hematologic variables for TTP. RESULTS: For 19 months, the patient had relapsing thrombotic microangiopathy despite plasma exchange; splenectomy; and therapy with vincristine, prednisone, and cyclosporine. ADAMTS13 activity was low, and tests detected an IgG inhibitor that recognized the metalloprotease domain of recombinant ADAMTS13. After treatment with rituximab and cyclophosphamide, the disease remitted, ADAMTS13 levels normalized, and the inhibitor was undetectable. The patient has required no treatment for 13 months. CONCLUSION: Intensive immunosuppressive therapy can lead to sustained clinical remission in patients with refractory autoimmune TTP.- - - - - - - - - - ranking = 0.31604657752218keywords = microangiopathy (Clic here for more details about this article) |
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