Cases reported "Obesity"

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1/52. Syndromal obesity due to paternal duplication 6(q24.3-q27).

    The likelihood of a paternally expressing imprinted gene in chromosome region 6(q23-24) has been highlighted by cases of transient neonatal diabetes mellitus (TNDM) in which paternal uniparental disomy (UPD) for chromosome 6 or paternal duplication 6(q23-qter) was detected. We present the case of a 38-year-old man with moderate to severe intellectual delay, short stature, small hands and feet, eye abnormality, small mouth, and obesity (without hyperphagia) beginning in mid-childhood. The perinatal and neonatal histories were normal. The patient had a duplication within 6q. fluorescence in situ hybrisation studies were performed with single and dual hybridisations using a chromosome 6 library probe, short and long arm subregional probes, 6q23-24, 6q25.3-6qter locus-specific probes, and a 6q telomere probe. The hybridisation results defined an inverted duplication of 6q24.3 to 6q27. dna studies with microsatellite markers from 6p and 6q showed regular biparental inheritance of chromosome 6 and confirmed that the duplication was paternal in origin. Our patient appears to be the first one known to have paternal duplication of chromosome area 6(q24-q27) who did not have TNDM as an infant. He has remained nondiabetic, although obesity, without hyperphagia, has been a constant problem since its onset in mid-childhood.
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ranking = 1
keywords = diabetic
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2/52. Bilateral ovarian stromal hyperplasia concealing a nonhilar, pure stromal-Leydig cell tumor. A case report.

    BACKGROUND: Of ovarian stromal tumors containing leydig cells, nonhilar, pure stromal-leydig cell tumor is rare. CASE: An obese, diabetic, borderline hypertensive 41-year-old woman with a five-year history of oligomenorrhea and amenorrhea presented with complaints of masculinization. physical examination revealed hirsutism and an enlarged clitoris. The only abnormal serum marker was elevated testosterone. At laparotomy both ovaries were enlarged and suspected to have bilateral stromal hyperthecosis. histology revealed stromal hyperplasia along with a 1.5-cm, testosterone-producing pure stromal-leydig cell tumor of the right ovary. CONCLUSION: Bilateral ovarian enlargement secondary to stromal hyperplasia in patients with masculinizing signs can conceal a small, unilateral pure stromal-leydig cell tumor.
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keywords = diabetic
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3/52. Patient case studies.

    Three contrasting cases of obese patients with type 2 diabetes mellitus are presented, which illustrate the management difficulties faced by clinicians. The first raises the issue of when to commence an oral hypoglycaemic agent in a newly diagnosed but asymptomatic obese patient; the second case addresses the problem of when to commence insulin in the face of continuing weight gain and poor glycaemic control; the final case is an example of the vicious metabolic spiral which so many patients enter, with increasing body weight, poor diabetic control and associated co-morbidities. The discussion that follows each case presentation recognises the considerable cardiovascular risk faced by such patients and provides guidance about possible management pathways including adjunctive anti-obesity pharmacotherapy.
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ranking = 1
keywords = diabetic
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4/52. Bone amyloidoma in a diabetic patient with morbid obesity.

    Bone localisations of amyloidosis are rare, usually diffuse and associated with myeloma. We report the case of a patient with massive obesity complicated by diabetes, hypertension, sleep apnea and liver steatosis, who complained of rapidly worsening bilateral polyradiculalgia of the lower limbs. After sufficient weight loss made nuclear magnetic resonance imaging feasible, a spinal tumour was visualised on the 5th lumbar vertebra, extending to soft tissues. Total excision was performed, and pathological studies revealed an amyloid bone tumour with no evidence of myeloma.
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ranking = 4
keywords = diabetic
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5/52. Brachial plexopathy in diabetic ketoacidosis.

    We report the clinical and electrodiagnostic findings of a 39-year-old patient who presented with severe, bilateral and asymmetrical, axon-loss brachial plexopathies occurring in the midst of diabetic ketoacidosis. This patient's unusual presentation is not consistent with the rare diabetic polyradiculopathy of the upper extremities usually occurring in association with diabetic amyotrophy.
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ranking = 7
keywords = diabetic
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6/52. coronary artery bypass and superior vena cava syndrome.

    superior vena cava syndrome is the obstruction of the superior vena cava or its main tributaries by benign or malignant lesions. The syndrome causes edema and engorgement of the vessels on the face, neck, and arms, nonproductive cough, and dyspnea. We discuss the case of a 48-year-old obese diabetic woman who was admitted with unstable angina. She had previously been diagnosed with superior vena cava syndrome. Urgent coronary artery bypass grafting was necessary Although thousands of coronary artery bypasses are performed every year, there are not many reports on patients with superior vena cava syndrome who successfully undergo cardiopulmonary bypass and coronary artery grafting with an internal mammary artery as the conduit. The results of the case and alternative recommended methods are discussed.
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ranking = 1
keywords = diabetic
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7/52. radiation injury from x-ray exposure during brachytherapy localization.

    Two patients developed skin ulcers secondary to high doses of diagnostic-energy x rays received during localization procedures as part of brachytherapy treatments. Both were morbidly obese and diabetic. The obesity led to the delivery of estimated skin doses of 83 Gy in one case and 29 Gy in the other in attempts to produce readable images on localization radiographs. This report discusses the factors leading to the injuries, the progression of the injuries over time, and the variables involved in the localization procedures with the aim of preventing future mishaps. The greatest contribution to the large skin dose was the need, with the equipment available, to use multiple exposures to produce a single film, because of the effect of the resultant reciprocity failure.
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ranking = 1
keywords = diabetic
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8/52. review and case report of idiopathic lower extremity compartment syndrome and its treatment in diabetic patients.

    Diabetic muscle infarction is a rare complication of diabetes mellitus. However, idiopathic compartment syndrome in the diabetic patient is even a rarer disease, which has been reported only in three cases up to date. The disease seems to occur in patients affected by type 1 diabetes mellitus with a history of poorly controlled glucose levels. MRI aids in the diagnosis by delineating the edema of the muscle. However, definitive diagnosis is made using the Stryker needle unit. Treatment is accomplished by immediate two-incision fasciotomy. We present a case where a 34 yr-old female with a long standing history of poorly controlled Type 1 diabetes mellitus presented with a painful right lower extremity and was diagnosed with compartment syndrome. In our patient, a single incision fasciotomy to release the pressure was sufficient and might be considered as an alternative and less morbid procedure in the diabetic patient with already poorly healing tissues. We conclude that the muscle infarction in these patients is from diffuse microangiopathic disease leading to muscular infarction and fluid accumulation in the cells causing a decrease in the space in the compartment in question causing compartment syndrome.
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ranking = 6
keywords = diabetic
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9/52. diabetes mellitus and life-style--for the primary prevention of diabetes mellitus: the role of diet.

    Diet treatment for diabetes requires restriction of the food amount (energy intake). It is desirable that patients have a proper relative consumption of the three main nutrients (proteins, carbohydrates, fats) and also habitually take low-energy foods such as vegetables, mushrooms and seaweeds, etc. as often as possible in each meal. Therefore, we can replace the expression 'a diet for diabetes' with 'a diet for healthy living'. By showing a clinical case of an obese diabetic patient, who succeeded to reduce their body weight, HbA1c and oral agents through diet treatment, and finally could go on diet treatment only, the importance of diet therapy can be emphasized. Furthermore, the estimation index was examined to evaluate how accurately diabetic patients could estimate food energy. According to this study, a large amount of food on the plate leads most patients to underestimate the amount of real energy, and patients are apt to eat too much compared with having smaller amounts of food on the plate. By analyzing questionnaires on the diet therapy of approximately 3000 diabetics, it has been shown that the majority of patients at our hospital recognize that diet therapy is the most important factor in the treatment of diabetes. Interestingly, patients who ate all the food served showed a significantly higher body mass index compared with those who left served food.
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ranking = 3
keywords = diabetic
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10/52. Digestive hemorrhage caused by a Meckel's diverticulum in a metformin-treated patient: is there any connection?

    An obese patient, not diabetic, treated with metformin for some weeks, was referred to us with severe inferior digestive hemorrhage, diagnosed with Meckel's diverticulum. metformin is described as a glucose-lowering agent for treatment of type 2 diabetes mellitus and as antiobesity drug, though results achieved with this last indication are not conclusive. But metformin has fibrinolytic features by means of diminished plasminogen activator inhibitor 1 activity. Although no coagulation study was done and the Meckel's diverticulum is normally associated with bleeding, the particular intensity of the following hemorrhage may have been favored by metformin.
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ranking = 1
keywords = diabetic
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