Cases reported "Diabetes Mellitus, Type 1"

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1/929. 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.
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ranking = 1
keywords = vascular complication
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2/929. 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.
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ranking = 1150.6171049962
keywords = diabetic
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3/929. hypothermia--a sign of hypoglycemia.

    hypothermia may occur in association with hypoglycemia, and indeed may be the only sign. Two cases are presented. In one, the patient presented with hypoglycemic encephalopathy. In the insulin dependent diabetic, the condition is life-threatening. Subnormal temperature is a clue to hypoglycemia in the alcoholic. The mechanism of hypothermia has been extensively studied, but remains unclear.
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ranking = 575.3085524981
keywords = diabetic
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4/929. T-cell insulitis found in anti-GAD65 diabetes with residual beta-cell function. A case report.

    CASE history: We recently encountered a 65-year-old anti-GAD diabetic woman with residual beta-cell function who was proved to have T-cell insulitis. The proportion of CD4 and CD8 cells varied among individual islets, although CD4 cells tended to be the predominant T-cell type in the islets examined. All of the islets examined still contained insulin, suggesting that beta-cell mass may have been preserved. DISCUSSION: It is well known that lymphocytic infiltration of pancreatic islets, a condition referred to as "insulitis," is seen in acute-onset type 1 diabetes at autopsy and in biopsy specimens. However, there have been no proven cases of insulitis in type 1 diabetes with residual beta-cell function. We believe that this is the first type 1 diabetic patient with residual beta-cell function who was proven to have T-cell insulitis. This novel evidence will contribute to the proper classification and treatment of diabetes and to a better understanding of the pathophysiology of type 1 diabetes.
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ranking = 1150.6171049962
keywords = diabetic
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5/929. vitrectomy for cystoid macular oedema with attached posterior hyaloid membrane in patients with diabetes.

    AIM: To report the success of vitrectomy in eliminating cystoid macular oedema and improving vision in three eyes of two patients with diabetic cystoid macular oedema. In all of the eyes there was no ophthalmoscopic evidence of traction from a posterior hyaloid membrane or from proliferative tissue. methods: Pars plana vitrectomy was performed on three eyes of two patients with diabetic cystoid macular oedema who did not show traction upon examination with a slit lamp biomicroscope and a scanning laser ophthalmoscope. RESULTS: Cystoid changes disappeared 1, 3, and 5 days, postoperatively, and diffuse macular oedema resolved within 2 weeks. The visual acuity was improved and maintained. CONCLUSION: vitrectomy can be effective in some patients with diabetic cystoid macular oedema even in patients who lack evidence of traction by ophthalmoscopy.
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ranking = 1725.9256574943
keywords = diabetic
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6/929. A man with a mysterious hypogammaglobulinaemia and skin rash.

    We have observed a 26-year-old diabetic male who had been treated with carbamazepine because of seizures. After two months of treatment, he developed a severe illness with skin rash, fever, hepatomegaly and hypogammaglobulinaemia. Since hypogammaglobulinaemia is a rare side effect of carbamazepine treatment, a stop order was given for carbamazepine. The abnormalities (skin, fever, hypogammaglobulinaemia) remained until it appeared that the patient had secretly continued taking the drug. When drug administration was stopped the skin abnormalities improved and serum immunoglobulin levels became normal. The etiology of this transient carbamazepine-induced hypogammaglobulinaemia is unknown.
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ranking = 575.3085524981
keywords = diabetic
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7/929. Recognizing factitious hypoglycemia in the family practice setting.

    BACKGROUND: Factitious hypoglycemia is a deliberate attempt to induce a low serum glucose level using either insulin or oral hypoglycemic agents. Sulfonylurea-induced hypoglycemia is more common than incidents of insulin abuse, and hypoglycemia caused by these oral agents is biochemically indistinguishable from insulinoma. methods: We describe a case of factitious hypoglycemia resulting from insulin abuse in an adult diabetic patient, review the essentials of glucose homeostasis, and describe diagnostic tests that allow a differential diagnosis. RESULTS AND CONCLUSION: Factitious hypoglycemia is associated with a higher incidence of suicide, depression, and personality disorders. Insulin-induced hypoglycemia can be detected by an insulin to c-peptide ratio that is greater than 1.0. In the absence of proof to the contrary, insulinoma should be considered the cause of hypoglycemia until another diagnosis is established. The generally poor prognosis for patients with factitious hypoglycemia underscores the importance of early recognition of factitious disorders.
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ranking = 575.3085524981
keywords = diabetic
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8/929. The use of iliac bone flap as a penile stiffener in a diabetic patient with erectile dysfunction.

    A diabetic man with erectile dysfunction in whom two previous attempts at penile prosthesis implantation had failed was treated by using an iliac bone flap as a penile stiffener. The patient had satisfactory sexual function with his penis; it retained its size and stiffness during the 1-year follow-up period. We recommend this method for use in patients in whom multiple earlier attempts at penile prosthesis implantation were unsuccessful.
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ranking = 2876.5427624905
keywords = diabetic
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9/929. The management of hypertension in a diabetic pregnancy.

    pregnancy in a woman with Type 1 diabetes poses several clinical challenges. In addition to meticulous glycaemic control, careful attention must be paid to the management of developing and pre-existing diabetic complications which may progress in severity during pregnancy. pregnancy-induced hypertension is more common in women with diabetes and especially in those with diabetes of long duration. Diabetic renal disease is associated with hypertension which often deteriorates during pregnancy. The management of hypertension is difficult because of limited therapeutic options and the need to consider the implications for the developing fetus as well as the mother. This case report details the clinical management of a young woman with Type 1 diabetes whose pregnancy was complicated by the development of hypertension.
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ranking = 2876.5427624905
keywords = diabetic
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10/929. Effects of blood glucose levels on performance in activities of daily living: a case example of a diabetic man with an acquired brain injury.

    Dysfunctional blood glucose regulation and sequelae of acquired brain injury (ABI) can affect behavioural training in brain injury rehabilitation. The relationship is examined between blood glucose levels and performance in three activities of daily living (ADL) skills (showering, toileting, and dressing) in a 21-year-old male with ABI and Type I diabetes mellitus. Multiple daily glucometer readings were obtained both pre- and post-treatment. Skills training involved graduated prompting and reinforcement to develop independence in ADLs. Assessment and teaching occurred initially in hospital, and then was presented at home. Results show a strong negative relationship between daily fluctuations in blood glucose levels and performance; no relationship was found between daily mean levels and performance. Implications for treatment approaches for diabetic individuals with ABI are discussed.
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ranking = 2876.5427624905
keywords = diabetic
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