Cases reported "Diabetic Angiopathies"

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1/155. osteomyelitis associated with peripheral vascular disease secondary to diabetes mellitus.

    diabetes mellitus and arteriosclerotic vascular disease have been found to be the predisposing factors of osteomyelitis associated with peripheral vascular disease (10). A diabetic person is more susceptible to osteomyelitis because of the microangiopathy, peripheral neuropathy and decreased resistance to infection. In diabetes mellitus there can be microangiopathy which results from the proliferation of the endothelium of the intima and thickening of the basement membrane. This further contributes to a sluggish blood flow. In the patient with arteriosclerotic vascular disease, the lumens of the arterioles and arterioles are compromised by the atheromatous plaques. The anatomic structure of the blood supply to bone along with the pathologic membrane thickening, allows for slowing of blood. This slowing of blood flow causes micro-thrombi and enhances bacterial growth. In diabetes mellitus it has been shown that there is a decreased immunologic response which, along with the above, contributes to the sheltering and proliferation of bacteria in the small bones of the foot. ( info)

2/155. 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. ( info)

3/155. Diabetic microangiopathy in the small bowel.

    AIMS: Microangiopathic changes in the gastrointestinal tract of patients with diabetes mellitus are frequently mentioned in the clinical literature. To our knowledge, pathological studies documenting these changes in bowel biopsies have not been previously reported. In this report, we describe striking duodenal biopsy findings of diabetic microangiopathy in a patient with long-standing insulin-dependent diabetes mellitus and chronic diarrhoea. methods AND RESULTS: The diagnosis was based on the histopathological and immunohistochemical findings in the appropriate clinical setting. blood vessels within the duodenum displayed prominent mural thickening and luminal narrowing secondary to accumulation of hyaline material, which was periodic acid-Schiff positive and intensely stained with monoclonal antibodies against type IV collagen. CONCLUSIONS: This is the first report of diabetic microangiopathy in a bowel biopsy. The pathogenesis, specificity and significance of these angiopathic changes, controversies about diabetic microangiopathy in the gastrointestinal tract, and the association with hypertension are discussed. ( info)

4/155. Transthoracic fistula with erosion of the ascending aorta along an IMA-protecting graft.

    Internal mammary artery (IMA) graft protection with nonbiodegradable material, such as polytetrafluorethylene (PTFE), is recognized as an effective means for preventing overexuberant adhesion development as well as injury of retrosternally crossing arterial grafts in the event of resternotomy and should enable better identification of the IMA graft. It is still uncertain whether the use of PTFE material is suitable for diabetic patients with complete arterial revascularization due to potential infectious complications. We report on a young diabetic patient after arterial T-grafting due to severe coronary disease and readmission with wound infection and retrosternal fistula formation 8 months after operation. ( info)

5/155. Late patency of recycled internal mammary artery: verification by Doppler echocardiography and coronary angiography.

    We report the case of a 57-year-old man who had presented with exertional angina early in 1997 and had subsequently undergone myocardial revascularization with the use of both internal mammary arteries. Two months after surgery, the patient was readmitted to the hospital with unstable angina. coronary angiography revealed a 90% occlusion of the left internal mammary artery anastomosis, which was attached to the left anterior descending coronary artery. At reoperation, the left internal mammary artery was detached from the left anterior descending coronary artery, probed and injected with papaverine, checked for patency, and regrafted to the same coronary artery. recycling of the left internal mammary artery was facilitated by the harvesting and routing technique that had been used during the previous operation. At the patient's 1-year follow-up visit, both Doppler echocardiography and coronary angiography showed patency of the recycled graft. We conclude that recycling of the left internal mammary artery is a safe and effective option in selected patients who require reoperation after myocardial revascularization. ( info)

6/155. Enhanced platelet aggregation, high homocysteine level, and microvascular disease in diabetic muscle infarctions: implications for therapy.

    Muscle infarction is a rare complication in patients with diabetes mellitus, probably because of the rich vascular supply of this tissue. We describe a patient with type 1 diabetes who had infarction of the muscles in her right thigh. We report, for the first time, that the patient, in addition to an advanced microvascular disease in the muscle, had increased plasma total homocysteine levels and increased platelet aggregation. These pathologies might have a synergistic effect on the development of this rare complication and should be treated aggressively to prevent further episodes. ( info)

7/155. Spontaneous splenic infarction secondary to diabetes-induced microvascular disease.

    splenic infarction is a clinical entity seldom encountered. The most frequent causes of splenic infarction include thromboembolic phenomena, hematologic malignant neoplasms, and vasculitides. We describe a patient who sustained splenic infarction secondary to diabetes-induced, small-vessel atherosclerotic disease. ( info)

8/155. Relocation of the internal mammary artery graft in a case of coronary-subclavian steal.

    Reverse flow in the internal mammary artery coronary graft in the presence of subclavian stenosis is rare. We describe a 67-year-old man who 7 years after coronary artery surgery was admitted with left subclavian artery stenosis and retrograde flow in the pedicled left internal mammary artery graft. Subsequent redo triple coronary artery bypass grafts included regrafting the left internal mammary artery graft to a new vein conduit. ( info)

9/155. A diabetic patient with a black penile tip.

    This is a report of a patient with diabetes mellitus type II who presented with the rare complication of penile gangrene. The gangrene was unilateral and was associated with ipsilateral partial stenosis of the common iliac artery. An angioplasty followed by insertion of a stent, rehydration, and improved diabetic control did not improve the penile lesion, and penile amputation was carried out. In the postoperative period, the patient developed a bilateral basal pneumonia with a significant growth of saprophyte mycobacterium gordonae from the bronchial aspirate. This is the first reported case of unilateral penile gangrene and also that of mycobacterium gordonae infection in a patient with diabetes mellitus. ( info)

10/155. Combined long-segment angioplasty and stenting of the superficial femoral artery and popliteal-distal bypass for limb salvage.

    The treatment of multisegment superficial femoral artery and tibial vessels atherosclerotic disease is traditionally a femoro-distal bypass using in situ or reversed autogenous vein. The improved result of balloon angioplasty and stenting of the superficial femoral artery (SFA) has extended its application to treat long segment SFA stenosis. A combined endovascular-open surgery approach of SFA endovascular stenting with a popliteal-distal bypass is an alternative less invasive procedure to achieve optimum distal revascularization for limb salvage. ( info)
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