Cases reported "Diabetes Mellitus, Type 1"

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11/50. Successful treatment of candida albicans osteomyelitis of the spine with fluconazole and surgical debridement: case report.

    A 65-year old diabetic male presented with progressive bone destruction of thoracic spine (T-11&12) with cord compression. candida albicans was isolated from aspirated materials pre-and intra-operative. Two weeks of fluconazole was given prior to surgical debridement, and fixation of the lesion. C. albicans isolated pre-and 2-weeks after fluconazole treatment were dna-typed using AP-PCR. MIC was 2-4 mg/l in all isolates tested. The pre-and post treatment isolates had two dna patterns, indicating the existence of two different strains. Surgical treatment was necessary for patient recovery.
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keywords = bone
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12/50. Complete remission of pure white cell aplasia associated with thymoma, autoimmune thyroiditis and type 1 diabetes.

    Pure white cell aplasia (PWCA) is a rare disorder of unknown origin, often associated with thymoma, characterized by selective neutropenia or pure agranulocytosis, and absence of granulocyte precursors in the bone marrow, but with normal erythroblasts and megakaryocytes. We report a case of PWCA associated with thymoma. Unusual findings in this case report included simultaneous presence of autoimmune thyroiditis, type 1 diabetes, anti-striated muscle antibodies, and the presence in the peripheral blood of CD8 T cells that expressed a homogeneous naive phenotype. Neutrophil count became normal on immunosuppressive therapy after thymectomy.
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ranking = 1
keywords = bone
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13/50. Identification of prevotella in pedal osteomyelitis of a diabetic patient.

    osteomyelitis in a diabetic patient with a nonhealing foot ulcer, multiple medical conditions, and recurrent hospitalization for antibiotic therapy was found to be associated with gram-negative bacteria prevotella melanginoganica and prevotella melaninoganica hemagglutinating variant. Those organisms were identified due to the morphologically distinct features in electron microscopy and sequencing of the genes after polymerase chain reaction amplification from the pathological material. The bacteria invaded the bone and resided in osteocyte, osteoblast, and endothelial cells. The bacteria are usually associated with periodontal plaques, causing inflammation and destruction of gingival tissue and resorption of the alveolar bone. This is the first ultrastructural and molecular study of a diabetic bone lesion with anaerobic bacterial infection.
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keywords = bone
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14/50. macrophages, T cell receptor usage, and endothelial cell activation in the pancreas at the onset of insulin-dependent diabetes mellitus.

    Current knowledge of the phenotype of mononuclear cells accumulating in pancreatic islets in insulin-dependent diabetes (IDDM) and factors determining their homing into the pancreas is limited. Therefore, a pancreas obtained at the onset of IDDM was studied in detail. Cryostat sections were stained for mononuclear cell types, T cell receptor subtypes, and adhesion molecules of vascular endothelium and studied by immunofluorescence microscopy, and peripheral blood mononuclear cells were phenotyped using flow cytometry. monocytes/macrophages (lysozyme- or CD 14-reactive cells) were identified among other mononuclear cell types in islet infiltrates. V beta 8-positive T cells were overrepresented, but T cells with other V beta s studied (V beta 5, V beta 5.1, V beta 6, V beta 12) were also found. The vascular endothelium of the islets and many small vessels nearby islets strongly expressed intercellular adhesion molecule-1, whereas vascular cell adhesion molecule-1 and e-selectin were totally absent. We conclude: (a) that increased expression of intercellular adhesion molecule-1 on vascular endothelium may increase endothelial adhesion of mononuclear cells and enhance their accumulation in the pancreas during diabetic insulitis; (b) that T cells with certain T cell receptors can be enriched in infiltrated pancreatic islets; and (c) that macrophages and antigen-specific CD 8-positive T cells are involved in pancreatic beta cell destruction at the onset of IDDM.
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ranking = 159.34775992444
keywords = macrophage
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15/50. interferon-gamma and colony-stimulating factors as adjuvant therapy for refractory fungal infections in children.

    A human immunodeficiency virus-infected boy with scedosporium apiospermum otomastoiditis and a girl with diabetes mellitus and Mucor sinusitis and orbital cellulitis had life-threatening disease progression despite antifungal treatment. interferon-gamma and granulocyte-macrophage or granulocyte colony-stimulating factor were added, with good functional outcome in both children. Adjunctive therapy with interferon-gamma, granulocyte-macrophage colony-stimulating factor and granulocyte colony-stimulating factor can be considered for refractory invasive fungal infections.
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ranking = 159.34775992444
keywords = macrophage
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16/50. Slowly progressive type 1 diabetes mellitus associated with vitiligo vulgaris, chronic thyroiditis, and pernicious anemia.

    A 81-year-old woman was diagnosed as having diabetes mellitus (DM) at 58 years of age. She started insulin therapy the following year, but her blood sugar levels were poorly controlled. At the age of 75, she tested positive for the anti-GAD antibody (7.8 U/ml) and was diagnosed as having slowly progressive type 1 DM (SPIDDM), as well as vitiligo vulgaris. At 78 years of age, chronic thyroiditis was diagnosed after positive tests for anti-thyroid peroxidase antibody and anti-thyroglobulin antibody. At the age of 81, general fatigue and jaundice appeared concomitantly with severe anemia, with Hb levels at 5.2 g/dl. Low serum vitamin B12 levels and the finding of erythroblastic hyperplasia with megaloblasts in bone marrow led to the diagnosis of pernicious anemia. anemia was alleviated by intramuscular injections of vitamin B12. The patient developed chronic thyroiditis, vitiligo vulgaris, and pernicious anemia concomitantly with SPIDDM, and was diagnosed as having polyglandular autoimmune syndrome type III. attention should be paid to these potentially associated autoimmune diseases in daily practice during the follow-up of SPIDDM patients.
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ranking = 1
keywords = bone
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17/50. Rhinocerebral mucormycosis complicated by internal carotid artery thrombosis in a pediatric patient with type 1 diabetes mellitus: a case report and review of the literature.

    OBJECTIVE: To illustrate that rapid diagnosis and aggressive treatment of rhinocerebral mucormycosis with internal carotid artery occlusion in a pediatric patient can prevent mortality and significant morbidity. research DESIGNS AND methods: Rhinocerebral mucormycosis infrequently occurs in the pediatric population, and when it involves thrombosis of an internal carotid artery, it has been almost uniformly fatal. We present an 8-yr-old girl with type 1 diabetes mellitus who has survived such an infection for 2 yr, and who has minimal residual morbidity. We believe she is the youngest patient to survive rhinocerebral mucormycosis complicated by internal carotid artery and cavernous sinus thromboses. She has survived with an intensive regimen including aggressive surgical debridement, amphotericin b, rigorous glucose control, hyperbaric oxygen therapy, interferon-gamma, posaconazole (an experimental antifungal), and granulocyte-macrophage colony-stimulating factor. CONCLUSIONS: This article illustrates the importance of prompt recognition and aggressive treatment of fungal infection in patients with diabetes. Additionally, it emphasizes that such treatment can have an excellent outcome, and mortality and significant morbidity can be avoided. Finally, we provide a review of the literature regarding mucormycosis infections and treatment options.
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ranking = 79.673879962218
keywords = macrophage
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18/50. Direct evidence of attempted beta cell regeneration in an 89-year-old patient with recent-onset type 1 diabetes.

    AIMS/HYPOTHESIS: We investigated whether there was evidence of attempted beta cell regeneration in the pancreas obtained from a patient with recent-onset type 1 diabetes, and if so by what mechanism this occurred. SUBJECTS, MATERIALS AND methods: We examined pancreas tissue from a lean 89-year-old patient (BMI 18.0 kg/m(2)) with recent-onset type 1 diabetes who had had a distal pancreatectomy to remove a low-grade pancreatic intraepithelial neoplasia. RESULTS: In the tumour-free tissue, the fractional beta cell area was 0.54 /-0.2% of pancreas area (about one-third of that in non-diabetic humans). CD3-positive T lymphocytes and macrophages had infiltrated the majority of the islets. Subclassification of the T cell population revealed a predominance of CD8-positive cells over CD4-positive cells. Beta cell apoptosis (terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labelling [TUNEL] staining) was greatly increased, consistent with ongoing immune-mediated beta cell destruction. There was also a marked increase (more than approximately 100-fold) in the frequency of beta cell replication (0.69 /-0.15% Ki67-positive beta cells) in all blocks examined. CONCLUSIONS/INTERPRETATION: The present report provides direct evidence of attempted beta cell regeneration through the mechanism of beta cell replication in a case of newly diagnosed type 1 diabetes, and affirms that beta cell apoptosis is an important mechanism for beta cell loss in type 1 diabetes.
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ranking = 79.673879962218
keywords = macrophage
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19/50. Diabetic Charcot joint mimicking acute osteomyelitis in radiography and three-phase radionuclide bone imaging study.

    Three phase radionuclide bone imaging procedures are used to differentiate cellulitis and osteomyelitis. Acute cellulitis is shown only as increased radioactivity in the blood flow and blood pool images; a persistent area of high activity in a delayed image is usually diagnosed as acute osteomyelitis. We present a patient with Charcot's joint secondary to diabetes mellitus whose three-phase bone imaging as well as radiographic studies revealed a consistent picture of acute osteomyelitis. In the appropriate clinical setting, Charcot's joint, along with several other etiologies (including bone tumors, leukemia, trauma, recent surgery, Paget's disease, and malunion of fracture), should be included in the differential diagnosis.
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ranking = 7
keywords = bone
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20/50. osteomyelitis of the foot in diabetic patients: evaluation with magnetic resonance imaging.

    Magnetic resonance (MR) imaging examination was performed with a 1.5-Tesla superconducting magnet on a diabetic patient's right foot that had extensive deformities due to previous surgery, infection, and neuropathy. The purpose of the examination was to help identify areas of active infection in preparation for surgical debridement. This manuscript reviews current concepts on the use of radionucleotide scanning and computed tomography (CT) as compared to MR imaging when used to assist in the diagnosis of osteomyelitis in the diabetic foot. MR imaging was found to be useful in identifying areas of active bone infection in the presence of underlying osseous pathology when radiographic images and radionucleotide scans were unreliable.
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ranking = 1
keywords = bone
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