1/97. Subcutaneous nodules caused by pseudomonas aeruginosa without sepsis.pseudomonas aeruginosa infection can cause a wide array of skin manifestations. While some infections are mild, as are the cases with hot tub folliculitis and toe web or nail infection, others are a result of sepsis and can be fatal without prompt treatment. The classic skin finding of P. aeruginosa sepsis is ecthyma gangrenosum, but other signs such as papules, petechiae, and hemorrhagic bullae can also be seen. Suppurative panniculitis can also be caused by P. aeruginosa sepsis and clinically manifests as solitary or multiple subcutaneous nodules. Reports in the literature describe these nodules in the setting of clinical sepsis or with positive blood cultures. We report a case of localized subcutaneous nodules on the leg caused by P. aeruginosa in a patient without sepsis or positive blood cultures. The source of the infection was thought to be from a traumatic inoculation. This raises the possibility that P. aeruginosa can cause subcutaneous nodules from a localized infection, perhaps via lymphangitic spread without the manifestations of sepsis.- - - - - - - - - - ranking = 1keywords = fat (Clic here for more details about this article) |
2/97. mucormycosis, a threatening opportunistic mycotic infection.mucormycosis is a rare and invasive mycotic opportunistic infection, occurring mostly in predisposed patients, mainly diabetics and immunocompromised individuals. The evolution of this fungal infection is frequently fatal unless aggressive treatment is started, or predisposing factors are handled. Our first patient was a known diabetic who had ketoacidotic coma at admission, complicated with pulmonary mucormycosis, and needed surgical resection followed by antimycotic therapy. The second patient did not survive his severe aplastic anemia (with neutropenia) and hemochromatosis (treated with desferrioxamine), complicated with a systemic rhizopus infection, despite treatment with amphotericin b and granulocyte-colony-stimulating factors.- - - - - - - - - - ranking = 1keywords = fat (Clic here for more details about this article) |
3/97. A phase in the psychotherapy of a juvenile onset diabetic patient.The psychotherapy of a juvenile onset diabetic patient, who initially presented with problems of poor diabetic management and depression, is discussed. Pertinent details of the first two years of treatment are presented to show the interrelationship between the medical and psychiatric problems. The patient severely mismanaged her illness around the tenth anniversary of her father's death. The patient's behavior and attitude toward her own illness were associated with guilt relating to the death of her father, also diabetic. During the anniversary period the patient was able to gain insight into the dynamics of her behavior, and from then on, succeeded in adequate management of her diabetes. The events in this case are linked to relevant literature.- - - - - - - - - - ranking = 2keywords = fat (Clic here for more details about this article) |
4/97. enteritis necroticans (pigbel) in a diabetic child.BACKGROUND AND methods: enteritis necroticans (pigbel), an often fatal illness characterized by hemorrhagic, inflammatory, or ischemic necrosis of the jejunum, occurs in developing countries but is rare in developed countries, where its occurrence is confined to adults with chronic illnesses. The causative organism of enteritis necroticans is clostridium perfringens type C, an anaerobic gram-positive bacillus. In December 1998, enteritis necroticans developed in a 12-year-old boy with poorly controlled diabetes mellitus after he consumed pig intestines (chitterlings). He presented with hematemesis, abdominal distention, and severe diabetic ketoacidosis with hypotension. At laparotomy, extensive jejunal necrosis required bowel resection, jejunostomy, and ileostomy. Samples were obtained for histopathological examination. Polymerase-chain-reaction (PCR) assay was performed on paraffin-embedded bowel tissue with primers specific for the cpa and cpb genes, which code for the alpha and beta toxins produced by C. perfringens. RESULTS: Histologic examination of resected bowel tissue showed extensive mucosal necrosis, the formation of pseudomembrane, pneumatosis, and areas of epithelial regeneration that alternated with necrotic segments--findings consistent with a diagnosis of enteritis necroticans. Gram's staining showed large gram-positive bacilli whose features were consistent with those of clostridium species. Through PCR amplification, we detected products of the cpa and cpb genes, which indicated the presence of C. perfringens type C. Assay of ileal tissue obtained during surgery to restore the continuity of the patient's bowel was negative for C. perfringens. CONCLUSIONS: The preparation or consumption of chitterlings by diabetic patients and other chronically ill persons can result in potentially life-threatening infectious complications.- - - - - - - - - - ranking = 1keywords = fat (Clic here for more details about this article) |
5/97. Fatal anaphylactic reaction to protamine after femoropopliteal by-pass surgery.BACKGROUND AND AIMS: Administration of protamine might cause serious complications especially in patients treated preoperatively with NPH insulin. MATERIAL AND methods: A case report. RESULTS AND CONCLUSION: Administration of protamine sulphate caused fatal anaphylactic reaction to a diabetic patient undergoing femoropopliteal by-pass surgery. Care should be taken when administering protamine to a patient treated preoperatively with NPH insulin and the possibility of an anaphylactid reaction to protamine have to be kept in mind.- - - - - - - - - - ranking = 1keywords = fat (Clic here for more details about this article) |
6/97. insulin resistance caused by massive degradation of subcutaneous insulin.Severe resistance to subcutaneous insulin but sensitivity to intravenous insulin persisted for 15 months in a 17-year-old diabetic girl. Heat-labile insulin-degrading activity was present in the patient's ketotic sera and in the 100,000 g fraction (soluble fraction) of adipose tissue. serum-degrading activity was not inhibited by N-ethylmaleimide. The soluble fraction also degraded glucagon and B chain but not growth hormone or myoglobin. It was inhibited by incubation with the patient's nonketotic sera, normal sera, or Trasylol. glutathione-insulin-transhydrogenase (GIT) activity was 66% of normal. The biopsy of adipose tissue at remission showed a normal level of insulin- and glucagon-degrading activity. The activity was eluted from Sephadex G200 as a single peak and had properties consistent with those of the insulin-specific protease (ISP). The increased degrading activity present during insulin resistance had properties not shared with ISP, suggesting the presence of an uncharacterized protease.- - - - - - - - - - ranking = 47.382428521614keywords = adipose (Clic here for more details about this article) |
7/97. pulmonary edema associated with hyperbaric oxygen therapy.We report three cases of pulmonary edema associated with hyperbaric oxygen therapy, including one fatality. All three patients had cardiac disease and reduced left ventricular (LV) ejection fractions (EFs). Two patients had diabetes, and one patient had severe aortic stenosis. Hyperbaric oxygen therapy may contribute to pulmonary edema by increasing LV afterload, increasing LV filling pressures, increasing oxidative myocardial stress, decreasing LV compliance by oxygen radical-mediated reduction in nitric oxide, altering cardiac output between the right and left hearts, inducing bradycardia with concomitant LV dysfunction, increasing pulmonary capillary permeability, or by causing pulmonary oxygen toxicity. We advise caution in the use of hyperbaric oxygen therapy in patients with heart failure or in patients with reduced cardiac EFs.- - - - - - - - - - ranking = 1keywords = fat (Clic here for more details about this article) |
8/97. Presacral myelolipoma in a patient with colon carcinoma.myelolipoma is an uncommon benign tumor, composed of an admixture of adipose tissue and hematopoietic cells, usually discovered within the adrenal glands. Extra-adrenal myelolipomas are rare and approximately half of the reported cases were presacral. We report a case of an asymptomatic presacral myelolipoma measuring 9x8x7 cm, incidentally found in a 71-year-old woman with a stenosing colon cancer. ultrasonography, computed tomography and magnetic resonance imaging of the presacral mass evidenced a well circumscribed tumor with heterogeneous features due to a nonuniform composition. Surgical excision of the mass was performed.- - - - - - - - - - ranking = 23.691214260807keywords = adipose (Clic here for more details about this article) |
9/97. Contraindication of magnesium sulfate in a pregnancy complicated with late-onset diabetes mellitus and sensory deafness due to mitochondrial myopathy.A primipara affected by late-onset diabetes and sensory deafness because of mitochondrial myopathy was hospitalized for threatened preterm delivery. magnesium sulfate was started for tocolysis, resulting in general muscle damage, although the mitochondrial myopathy did not deteriorate during pregnancy. magnesium sulfate may be contraindicated in pregnancy with mitochondrial myopathy.- - - - - - - - - - ranking = 6keywords = fat (Clic here for more details about this article) |
10/97. anorexia nervosa, diabetes mellitus, brain atrophy, and fatty liver.An increased number of diabetes mellitus cases followed by the development of anorexia nervosa have been reported. In this report, the opposite has been observed in the case of a patient with anorexia nervosa who later developed insulin-dependent diabetes mellitus, associated with brain atrophy and fatty liver. The patient was treated with insulin, amitriptylene, and behavior modification. Significant improvement was noted on this regimen.- - - - - - - - - - ranking = 5keywords = fat (Clic here for more details about this article) |
| | Next -> |