Cases reported "Diabetic Angiopathies"

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11/74. Diabetic thigh muscle infarction in association with antiphospholipid antibodies.

    BACKGROUND: Diabetic muscle infarction (DMI) is a rare complication of type 1 diabetes mellitus. DMI has a stereotyped clinical presentation and characteristic, though nonspecific, magnetic resonance imaging (MRI) and histologic findings. The etiology, however, remains controversial. OBJECTIVES: To present the first reported cases of DMI in association with positive antiphospholipid (aPL) antibody titers and to discuss the etiologic and pathogenic significance of the association between type 1 diabetes and aPL antibodies. methods: Descriptive case reports of 2 patients with DMI and positive aPL antibodies and a review of the relevant literature. RESULTS: Our 2 patients with DMI are female type-1 diabetics with end-organ microvascular complications who presented with an abrupt, painful swelling or mass of the thigh musculature. The diagnosis of DMI was based on the clinical picture and the findings on T2-weighted MRI and histologic evaluation. The first patient had a long history of known aPL antibodies in the setting of systemic lupus erythematosus. The second patient was only determined to be aPL positive after her recurrent episodes of DMI. The first patient was treated with anticoagulation and corticosteroids with relatively rapid resolution of symptoms. The second patient was treated with local debridement and supportive care with a resulting course of prolonged symptoms and recurrences. There are no controlled trials of the treatment of DMI. In the literature there is evidence for an increased prevalence of aPL antibodies in type 1 diabetic patients. The pathogenesis of DMI is poorly understood, but the hypercoagulable state often associated with aPL antibodies may play an important role. CONCLUSIONS/RELEVANCE: aPL antibodies may be involved in the pathogenesis of diabetic muscle infarction and could serve as an important target of therapeutic intervention, namely with anticoagulation.
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keywords = diabetes
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12/74. Endothelial dysfunction in type 2 diabetes mellitus subjects with peripheral artery disease.

    We strived to characterize the endothelial function status in type 2 diabetic patients with peripheral artery disease which was detected by ankle-brachial index by utilizing high frequency ultrasounds. Predictors of endothelial dysfunction were investigated. We chose 23 type 2 diabetic patients had ankle-brachial index <0.97 (0.15-0.95; mean=0.74 /-0.20), 31 diabetic patients had ankle-brachial index >/=1.0 and 28 non-diabetic subjects for study. Older age, a longer duration of diabetes, higher systolic blood pressure, higher prevalence of history of hypertension were observed in patients with peripheral vascular disease. Type 2 diabetic patients showed impaired flow-mediated dilatation than non-diabetic and it showed more impaired in patients with peripheral vascular disease. Nitroglyerin-induced dilatation showed a trend of impairment in patients with peripheral vascular disease but did not reach statistical significance. Age (r=-0.259, P=0.019), baseline brachial artery diameter (r=-0.321, P=0.003), ankle-brachial index (r=0.259, P=0.002) and hypertension history (P=0.01) were significantly associated with flow-mediated dilatation. However, after adjusting for age, only baseline diameter and ankle-brachial index were independent predictors of flow-mediated dilatation. In conclusion, we demonstrated flow-mediated dilatation was impaired in type 2 diabetic patients and it was further impaired in patients with peripheral vascular disease. nitroglycerin-induced dilatation showed a trend of impairment but did not reach statistical significance.
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ranking = 2.5
keywords = diabetes
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13/74. Candida infection associated with a solitary mycotic common iliac artery aneurysm.

    We report on a case of an isolated common iliac artery aneurysm infected by candida albicans. To our knowledge, only one other case of this condition has been reported. The patient, a 49-year-old man with diabetes mellitus and a history of fungal urinary tract infections, had recurrent right knee pain and swelling. The knee effusion grew C albicans. Mild right hydronephrosis and a 4.6-cm aneurysm of the right common iliac artery without involvement of the aorta or iliac bifurcation was revealed by means of a computed tomography scan. The aneurysm wall was inflammatory, and there was associated purulence at the time of operation. The right ureter was densely adherent to the anterior aspect of the aneurysm, but could be palpated and dissected free because of a ureteral stent that was placed before the surgical incision. The aneurysm was resected, and the proximal and distal margins were oversewn without graft placement. C albicans was found in the resected aneurysm. The patient recovered without limb-threatening ischemia or claudication, but the distance he could walk remained limited because of right knee symptoms. The aneurysm may have formed by direct extension of infection from the right ureter or by hematogenous or lymphatic spread. This case raises interesting issues about operative strategies and etiology.
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ranking = 0.5
keywords = diabetes
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14/74. Beneficial effects of continuous subcutaneous insulin infusion in older patients with long-standing type 1 diabetes.

    OBJECTIVE: To assess the effect of continuous subcutaneous insulin infusion (CSII) on glycemic control, hypoglycemia, and daily insulin requirements in five older patients with long-standing type 1 diabetes previously treated with multiple-dose insulin injections (MDII). methods: We undertook a retrospective analysis of five older patients (three women and two men) with type 1 diabetes and a mean age of 66.4 years (range, 57 to 76). The mean duration of disease was 33 years (range, 18 to 49), and all patients had suboptimal glycemic control (glycosylated hemoglobin or HbA(1c) >8.0%), presence of microvascular complications, and unacceptably frequent hypoglycemia during MDII therapy. A diabetes care team monitored their clinical course after their treatment was changed to a CSII regimen. Data pertaining to HbA(1c), severe hypoglycemia, and insulin dose before and after conversion to CSII were compared with use of paired t tests. RESULTS: After initiation of CSII therapy, the mean HbA(1c) value decreased from 9.16% to 7.6% (P<0.0025), the rate of severe hypoglycemia decreased from 3.2 episodes to 0.4 episode per year (P<0.02), and the mean total daily insulin dose was reduced from 44.9 IU to 32.4 IU (P<0.05) during a mean duration of 12.6 months of CSII therapy. CONCLUSION: Insulin pump therapy can prove highly beneficial in older patients with type 1 diabetes by improving glycemic control, reducing hypoglycemic episodes and insulin dosage, and possibly increasing treatment satisfaction. These changes can potentially prevent morbidity and prove to be cost-effective. For implementation of pump conversion to be safe and successful, careful patient selection, proper education, and ongoing support through a comprehensive diabetes education and management program are imperative. Future reports of experience with CSII in elderly patients should help to elucidate its promising advantages in this patient population and provide guidelines for use.
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ranking = 4.5
keywords = diabetes
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15/74. Case report: diabetic muscle infarction presenting as knee arthralgia.

    Diabetic muscle infarction is a rare complication of diabetes and has characteristic clinical features including acute onset of pain with painful swelling, most commonly in the thigh or calf muscle, which gradually improves to complete resolution. Recently we experienced a case of diabetic muscular infarction presenting as knee joint pain due to involvement of the proximal portion of the leg muscle, which site has not been reported previously. This case shows that diabetic muscle infarction may involve sites other than the thigh and calf areas and should be considered in the differential diagnosis of knee arthralgia.
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ranking = 0.5
keywords = diabetes
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16/74. atrial fibrillation can cause major hyperglycemia.

    We report the case of a 66 years old woman with a well controlled, insulin-treated, type 2 diabetes, who experienced a ten-fold increase of her daily insulin needs (from 21 to 215 U/day) after the onset of a symptomatic atrial fibrillation. Check-up for another cause of insulin resistance was negative, and insulin doses could be decreased to preceding values only after electric cardioversion. Symptomatic atrial fibrillation should be considered as a potential cause of hyperglycemia.
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ranking = 0.5
keywords = diabetes
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17/74. Hyperosmolar hyperglycaemic nonketotic coma associated with acute myocardial infarction: report of three cases.

    diabetes mellitus is one of the most commonly associated diseases of patients suffering an acute myocardial infarction. Although the coexistence of acute myocardial infarction with other clinical manifestations of diabetes have been well described, extremely few data exists about the concomitant occurrence of hyperosmolar hyperglycaemic nonketotic coma and myocardial infarctions.This article presents three patients with this association and aimed to discuss the clinical course and treatment strategies of this rare condition.
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ranking = 0.5
keywords = diabetes
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18/74. The metabolic syndrome, type 2 diabetes, and cardiovascular disease: understanding the role of insulin resistance.

    The most common and clinically important complication in adults with diabetes is cardiovascular disease (CVD), which includes coronary heart disease, peripheral vascular disease, and stroke. Both type 2 diabetes and the insulin resistance syndrome are associated with a marked increase in the risk for CVD. The metabolic syndrome and the closely related insulin resistance syndrome have recently been recognized as important disorders, each being associated with an increase in CVD risk even in the absence of glucose intolerance. Given the significant public health burden of CVD, risk reduction has emerged as a significant clinical challenge for most practitioners. Diabetes and the insulin resistance syndrome are closely related disorders, with insulin resistance being more than a key pathogenic defect in type 2 diabetes. Even in the absence of glucose intolerance, these 2 disorders are both associated with a number of distinct pathologic findings, including hypertension, atherogenic dyslipidemia, a prothrombotic environment, and significant vascular and hemodynamic abnormalities that result from endothelial cell dysfunction. insulin resistance is now recognized to be closely associated with the development of each of these risk factors. This article uses a case-based approach to discuss the unique features of insulin resistance and type 2 diabetes considered to be key contributors to CVD risk. A systematic approach to both evaluation and management is proposed, with priority given to therapies of demonstrated clinical benefit. Because of its critical and central role in the development of many CVD risk factors, targeted treatment of insulin resistance will also be discussed as such therapy may prove to be a critical component of care in years to come.
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ranking = 4
keywords = diabetes
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19/74. Assessment of peripheral vascular disease in patients with diabetes. Two case studies.

    This report proposes that perfusion scanning in combination with arteriography be included in the diagnostic work-up of the diabetic patient who, because of peripheral vascular complications, is a candidate for surgery. Two cases are reported which illustrate the extremes of the findings: abnormal arteriogram-normal scan indicating large-vessel disease without significant small-vessel involvement. It is suggested that these patients are candidates for vascular reconstruction. The other extreme is the normal arteriogram-abnormal scan indicating small-vessels disease without significant large-vessel involvement. It is apparent that these patients are not candidates for vascular reconstruction.
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ranking = 2
keywords = diabetes
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20/74. Insulin-dependent diabetes mellitus showing microangiopathic hemolytic anemia and chronic disseminated intravascular coagulation.

    It has been reported that microangiopathic hemolytic anemia occasionally occurs in patients with severe diabetic microangiopathy. We report a case of insulin-dependent diabetes mellitus in whom microangiopathic hemolytic anemia and chronic disseminated intravascular coagulation (DIC) were thought to be complicated. The patient showed fragmentation hemolytic anemia and progressive diabetic microangiopathy, together with a mild elevation of serum fibrin(ogen) degradation products. Considering the state of chronic DIC, heparin therapy was started, but mild hemolysis persisted. It is possible that microangiopathic hemolytic anemia and chronic DIC cause a vicious cycle in patients with severe diabetic microangiopathy, leading to rapid progression of diabetic microangiopathy.
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ranking = 2.5
keywords = diabetes
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