Cases reported "Diabetes Complications"

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1/59. Clinical and radiological findings in patients with gas forming renal abscess treated conservatively.

    PURPOSE: Emphysematous pyelonephritis in diabetics is considered a potentially lethal infection. mortality rates of patients treated conservatively approaches 80% in some series. These patients often present with signs of sepsis or septic shock. In contrast, gas forming renal abscess is rare, with patients presenting entirely differently from those with emphysematous pyelonephritis. To our knowledge this process has been previously described only in isolated case reports. We describe a series of 5 patients with this distinct process. MATERIALS AND methods: We reviewed the clinical and radiological features of 5 patients with gas forming renal abscesses. RESULTS: Each patient presented with diabetes mellitus with initial blood glucose ranging from 313 to 552 mg./dl., fever (average 101F), flank or abdominal pain and pyuria. No patient had evidence of septic shock at hospitalization. escherichia coli was the documented organism in each case. Mild renal insufficiency was noted in most patients based on serum creatinine. Radiological evaluation revealed gas filled pockets within the renal parenchyma, which were most effectively shown by computerized tomography (CT) of the abdomen. There was no radiological evidence of pus. Percutaneous drainage of an abscess in 1 case did not produce any purulent material or alter the clinical course. Each patient responded to correction of the underlying metabolic abnormalities with intravenous antibiotics (average 23 days) followed by prolonged oral antibiotic therapy (average 9 weeks). In contrast to the management of emphysematous pyelonephritis, surgical or percutaneous drainage was not necessary. Serial CT revealed complete resolution of gas in the parenchyma within 6 months in patients with long-term followup. Of note, gas was persistent on CT months after infection had clinically resolved. CONCLUSIONS: We describe a unique entity within the spectrum of pyelonephritis. The clinical appearance of gas forming abscesses within the renal parenchyma without liquefaction in diabetic patients was remarkably benign compared to the radiographic appearance of the disease process. Conservative management with intravenous and oral antibiotics was successful in each patient, avoiding the need for invasive intervention.
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keywords = abdominal pain
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2/59. An unusual complication of subclavian vein catheterization for total parenteral nutrition.

    A 25-year-old woman with diabetic ketoacidosis and esophagitis was given total parenteral nutrition to improve her nutritional status. A central venous catheter inserted in the right subclavian vein was well tolerated for three weeks, when infection developed. The line was replaced by a left subclavian line. Within an hour the patient complained of back pain. A chest x-ray film showed that the tip of the catheter was to the left of the mediastinum and that left pleural effusion was present. The line was removed and 1,500 cc of fluid was removed from the left pleural space. The pleural fluid cleared gradually over several days and the patient became asymptomatic.
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ranking = 1.2674723713726
keywords = back pain, chest
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3/59. 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 = 0.078190304339957
keywords = upper
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4/59. Takayasu's arteritis on steroid therapy. Seven years follow-up.

    The authors report a 7 year follow-up of Takayasu's arteritis (TA) type III, group 1, in a young Italian woman. At diagnosis, at the age of 25, the echotomographic and angiographic studies showed narrow subclavian arteries, narrow abdominal aorta (diameter of 0.6-0.8 cm) below the renal arteries, stenotic left common carotid and renal arteries, and occluded upper mesenteric artery. With steroid therapy, (prednisone 50 mg/day per os), the erythrocyte sedimentation rate (ESR) normalized within 12 days. With a maintenance dosage of 7.5 mg/day per os, the patient achieved remission as documented by the absence of symptoms, the persistent normalization of ESR, and the improving of the diameter of the abdominal aorta (1.3-1.4 cm). On steroid therapy, the patient had a normal pregnancy and delivered a healthy baby girl. The disease has been stable for seven years. Recently, diabetes mellitus occurred and it has been treated with insulin therapy. The rising of ESR after tapering of steroid therapy (prednisone 5 mg per os on alternate days) suggests an alternative treatment with a cytotoxic agent.
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ranking = 0.078190304339957
keywords = upper
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5/59. Diabetic muscle infarction.

    Diabetic muscle infarction is a rare complication of diabetes mellitus that is not clearly defined in the orthopaedic literature. This study is a descriptive case series of 7 new cases of diabetic muscle infarction and 55 previously reported cases in the literature. In the majority of patients, diabetic muscle infarction presents as a localized, exquisitely painful swelling and limited range of motion of the lower extremity. No cases affecting the muscles of the upper extremity have been observed. The onset is usually acute, persists for several weeks, and resolves spontaneously over several weeks to months without the need for intervention. Diabetic muscle infarction is a condition that should be considered in the differential diagnosis of any diabetic patient with lower extremity pain and swelling without systemic signs of infection. magnetic resonance imaging is sensitive and specific enough to make the diagnosis. Muscle biopsy and surgical irrigation and debridement are not recommended since they are associated with complications. pain management and activity restriction in the acute phase followed by gentle physical therapy is the treatment of choice. Recurrences in the same or opposite limb are common. Although the short-term prognosis is very good and the majority of cases resolve spontaneously, the long-term survival is uncertain in this patient population.
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ranking = 0.078190304339957
keywords = upper
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6/59. Thoracoscopic resection of the pulmonary aspergilloma: report of two cases.

    Pulmonary aspergillomas causing hemoptysis were successfully resected through videothoracoscopy in two cases. We removed an aspergilloma located in the right lower lobe of the lung in a 48-year-old woman with a bronchial cyst and rheumatoid arthritis. We also removed an aspergilloma located in the left upper lobe of the lung in a 59-year-old man with emphysematous bullae and diabetes mellitus. In both cases, the aspergillomas were removed by pulmonary wedge resection through scheduled thoracoscopy.
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ranking = 0.078190304339957
keywords = upper
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7/59. Lymphocytic interstitial pneumonitis associated with autoimmune hepatitis.

    A 49-year-old woman was diagnosed as autoimmune hepatitis and started on steroids and azathioprine. Subsequently, she developed fever; chest radiograph showed lower lobe nodular opacities. bronchoalveolar lavage and transbronchial lung biopsy confirmed the diagnosis of lymphocytic interstitial pneumonitis.
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ranking = 0.13501752326838
keywords = chest
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8/59. Eruptive xanthomas and chest pain in the absence of coronary artery disease.

    Because hyperlipidemia may present as xanthomas, a dermatologist may be the first to diagnose these skin lesions and associated lipid abnormalities. Xanthomas are of concern because of their association with coronary artery disease and pancreatitis. We describe the case of a 40-year-old white male with chest pain and eruptive xanthomas. Laboratory tests revealed severe hypercholesterolemia, hypertriglyceridemia, and diabetes mellitus, and the histopathology of the skin lesions was consistent with eruptive xanthomas. Surprisingly, even with overwhelming risk factors for both atherosclerosis and pancreatitis, this patient did not show evidence of either disease process. After initiating therapy for the diabetes and hyperlipidemia, the patient has had no recurrence of chest pain, and the skin lesions have gradually resolved. The most likely explanation for this patient's pattern of symptoms and laboratory results is the chylomicronemia syndrome, which can be seen in patients with type I or type V hyperlipoproteinemia.
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ranking = 0.81010513961026
keywords = chest
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9/59. Mental practice combined with physical practice for upper-limb motor deficit in subacute stroke.

    BACKGROUND AND PURPOSE: This case report describes a patient with upper-limb hemiparesis (ULH) who received a program combining physical therapy for the affected side with mental practice. CASE DESCRIPTION: The patient was a 56-year-old man with stable motor deficits, including ULH, on his dominant side resulting from a right parietal infarct that occurred 5 months previously. He received physical therapy for an hour 3 times a week for 6 weeks. In addition, 2 times a week the patient listened to an audiotape instructing him to imagine himself functionally using the affected limb. The patient also listened to the audiotape at home 2 times a week. Pretreatment and posttreatment measures were the upper-extremity scale of the Fugl-Meyer Assessment of Sensorimotor Impairment (Fugl-Meyer Scale), the Action research arm Test (ARA), and the stroke rehabilitation Assessment of movement (STREAM). OUTCOMES: The patient exhibited reduction in impairment (Fugl-Meyer Scale) and improvement in arm function, as measured by the ARA and STREAM. DISCUSSION: Mental practice may complement physical therapy to improve motor function after stroke.
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ranking = 0.46914182603974
keywords = upper
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10/59. Pseudomembranous colitis without diarrhea presenting clinically as acute intestinal pseudo-obstruction.

    Pseudomembranous colitis usually presents with diarrhea in a clinical setting of recent antibiotic use. It is uncommon to see it as a cause of obstipation and colonic pseudo-obstruction. We report an unusual case of an elderly woman with hypertension, congestive heart failure, chronic obstructive pulmonary disease, chronic renal insufficiency, and diabetes mellitus, who was admitted with fever, abdominal pain, and distension without diarrhea. She presented with decreased stool frequency and obstipation. She did not respond to conservative management. colonoscopy revealed a picture of pseudomembranous colitis, and clostridium difficile toxin was positive. She responded well to metronidazole therapy.
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keywords = abdominal pain
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