1/12. Novel surgical treatment and gastric pathology in diabetic gastroparesis.AIMS: Observations are made on four Type 1 diabetic patients with the rare syndrome of intractable vomiting from confirmed gastroparesis, to determine whether radical surgery would alleviate their symptoms and subsequently to examine in detail the gastric histopathology. methods: The surgical approach consisted of an approximate 70% resection of the stomach, including the antrum and pylorus, with closure of the duodenum and restoration of gastrointestinal continuity with a 60-cm Roux-en-Y jejunal loop. Four longstanding Type 1 diabetic patients were examined and treated as described. They were all women in the age range 2741 years with grossly abnormal autonomic function tests in whom other causes for gastric paresis had been excluded. RESULTS: vomiting episodes leading to multiple hospital admissions (6-8) in the year preceding surgery were eliminated in three of the four patients, while in the fourth initial success was followed by the need for dialysis for renal failure. Gastric histopathology showed evidence of smooth muscle degeneration and fibrosis, with eosinophilic inclusion bodies (M-bodies) which appear to be unique to this condition. The findings suggest the presence of a gastromyopathy. CONCLUSIONS: Satisfactory relief of intractable vomiting from diabetic gastroparesis was achieved by a novel radical surgical procedure. Histopathological findings suggest that gastromyopathy may contribute to the production of this syndrome.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
2/12. gastroparesis and jejunal feeding.A kidney transplant patient with diabetic gastroparesis was effectively treated by jejunal feeding. The patient, a 31-year-old woman, has a complicated medical history, with insulin-dependent diabetes mellitus. Complications include kidney failure followed by transplantation, bilateral knee amputations, and being registered blind. She was admitted with nausea and vomiting for the previous 6 days; the provisional diagnosis was diabetic gastroparesis. Various treatments were tried, including several prokinetic drugs and total parenteral nutrition. The total parenteral nutrition provided most of the patient's nutritional requirements, and, only slight weight loss was observed. Nothing seemed to improve the symptoms of vomiting. An endoscopic retrograde cholangiopancreatography, a radiographic examination of the bile and pancreatic ducts, was performed to exclude obstruction. At the same time, having found nothing, a gastrostomy was placed with a jejunal extension. Feeding was established within 3 days. Her weight remained stable after 7 weeks of jejunal feeding. She had started to increase her oral intake of solid foods and fluids. By 8 weeks, she was taking a full oral diet and fluids. Now, 14 weeks after the placement of the gastrostomy tube with the jejunal extension, she is doing well. Her weight remains stable and her oral intake is excellent. Her diabetes is under control. After 22 weeks, the gastrostomy was removed. After this success with jejunal feeding when all other treatments had failed, this treatment could be used to treat future diabetic gastroparesis. Slow introduction of the feed seems to help toleration.- - - - - - - - - - ranking = 0.42857142857143keywords = diabetic (Clic here for more details about this article) |
3/12. Severe respiratory depression in a patient with gastroparesis while receiving opioids for pain.OBJECTIVE: To increase awareness of the possibility of severe respiratory depression when oral opioids are used in patients with gastrointestinal motility disorders. SETTING: A major county hospital affiliated with a university. PATIENT: A patient with severe pain from diabetic muscle necrosis with a history of gastroparesis. INTERVENTIONS: Attempted pain control with oral and transdermal opioids. RESULTS AND CONCLUSIONS: pain control in our patient was attempted using potent oral opioids on two occasions. However, this patient suffered severe respiratory depression after each attempt. Transdermal delivery of fentanyl eventually provided satisfactory pain relief without side effects. We conclude that patients with gastrointestinal motility disorders may be at high risk for side effects of oral opioids due to altered absorption kinetics. Suggestions are made for alternative strategies for opiate delivery in patients with gastrointestinal motility disorders.- - - - - - - - - - ranking = 0.14285714285714keywords = diabetic (Clic here for more details about this article) |
4/12. Should cisapride be avoided in patients with diabetic gastroparesis?The gastrointestinal motility stimulants, cisapride and erythromycin, have been used in the management of diabetic gastroparesis. However, drug interactions may result in prolongation of the electrocardiographic QT interval with the risk of ventricular arrhythmias. These drugs should, therefore, not be used in combination. We report two cases that illustrate inappropriate use of these agents. Moreover, patients with recurrent severe hypoglycemia or renal impairment may be at increased risk from cisapride-related cardiotoxicity. Thus, even as monotherapy, cisapride may pose dangers for high-risk diabetic patients.- - - - - - - - - - ranking = 0.85714285714286keywords = diabetic (Clic here for more details about this article) |
5/12. Understanding diabetic gastroparesis: a case study.The purpose of this article is to present an overview of diabetic gastroparesis, defined as delayed gastric emptying in the absence of mechanical obstruction. Diabetic gastroparesis is a substantial and unrecognized problem. Failure to treat may result in a decreased quality of life and a potential increase for morbidity. The treatment protocol for diabetic gastroparesis combines dietary and pharmacologic measures. This article will discuss normal physiology of gastric emptying along with the pathogenesis of delayed emptying in patients with diabetes. nursing implications for the care of the patient with diabetic gastroparesis is also presented along with commonly used pharmacologic agents.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
6/12. Unanticipated full stomach at anesthesia induction in a type I diabetic patient with asymptomatic gastroparesis.We encountered a case of unanticipated full stomach at anesthesia induction, despite a 12-h fasting period, in a type I diabetes patient with diabetic neuropathy presenting for elective vitrectomy for proliferative diabetic retinopathy. The patient had ingested seaweed 24 h prior to the surgery, and it was later found in the aspirated gastric content. Gastrointestinal dysfunction due to diabetic neuropathy and the high fiber content of the ingested seaweed are the probable causes of unanticipated full stomach in our case.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
7/12. An unusual electrocardiogram artifact: what is its source?A diabetic female presented with nausea and vomiting. Her electrocardiogram showed sinus rhythm with two artifactual spikes, not synchronized with the cardiac rhythm. The patient had an implanted gastric electrical stimulation system for treating her diabetic gastroparesis. Recent DC shock for ventricular fibrillation during coronary angiography caused malfunction of the gastric pacemaker.- - - - - - - - - - ranking = 0.28571428571429keywords = diabetic (Clic here for more details about this article) |
8/12. Intrapyloric injection of botulinum toxin a for the treatment of persistent gastroparesis following successful pancreas transplantation.Intrapyloric injection of botulinum toxin A (BoTx) successfully improved symptoms in idiopathic and diabetic gastroparesis (DGP) refractory to medical treatment. Therefore, we used it in three pancreas transplant patients done in our institution during the last 18 months. They had severe, persistent DGP despite successful pancreas transplantation. They received 100 units of BoTx during the first injection. The clinical effect became evident within 2 weeks after the treatment, and lasted for an average of 29 weeks (range 14-44 weeks). The patients' subjective evaluation showed improvement of their symptoms and quality of life following BoTx. patients 2 and 3 had recurrent symptoms at 44 and 24 weeks, respectively, after the first injection; they required a second dose of 90 and 80 units, respectively. They are doing well at 3 months follow-up. Intrapyloric injection of BoTx is safe and efficient. It should be considered for treating residual DGP following successful pancreas transplantation.- - - - - - - - - - ranking = 0.14285714285714keywords = diabetic (Clic here for more details about this article) |
9/12. Overcoming diabetic gastroparesis en route to kidney transplant.gastroparesis is a debilitating condition that affects a significant number of diabetic patients. Some of these patients have end-stage renal disease and are in need of kidney transplant. Symptoms of gastroparesis include: early satiety, pyrosis, epigastric pain, nausea and vomiting, which may lead to caloric and electrolyte deficiencies as well as significant weight loss. A viable option for diabetic gastroparesis patients who fail first line treatments consisting of dietary changes and gastric prokinetic medications is gastric electrical stimulator (GES) implantation. We present a 41-yr-old man and 35-yr-old woman with diabetic gastroparesis, who were initially deemed unacceptable candidates for renal transplantation because of marked malnourishment and a concern that they would not be able to tolerate immunosuppressant medications. In less than two yr following GES implantation, each patient underwent a successful kidney transplant.- - - - - - - - - - ranking = 1keywords = diabetic (Clic here for more details about this article) |
10/12. Update on gastroparesis.gastroparesis is a manifestation of diabetic autonomic neuropathy. Gastrointestinal autonomic neuropathy contributes to morbidity, mortality, reduced quality of life, and increased healthcare costs of a patient with diabetes mellitus. Complications from gastroparesis include ketoacidosis, infection, and bezoar formation. The gold standard for the diagnosis of gastroparesis is a gastric emptying study. Other tests and procedures may also be performed to eliminate other causes of the symptoms. In general, treatment involves dietary and lifestyle adjustment as well as pharmacological interventions. Gastric electrical stimulation has recently emerged as an effective strategy in the management of these patients. research is evolving in this area to include the use of botulinum toxin to control symptoms of gastroparesis. patients with gastroparesis can be frustrated with the symptoms they experience, the intensive treatment regimens they must follow, as well as the medical procedures they undergo during the course of their treatment. quality of life is an important factor to consider when caring for and supporting these patients. This article will provide an overview of gastroparesis and the latest treatments available to improve gastric motility and prevent further complications.- - - - - - - - - - ranking = 0.14285714285714keywords = diabetic (Clic here for more details about this article) |
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