1/16. Pulmonary mucormycosis in a diabetic patient.We present the case of a 54 year-old male from Moldavia with diabetes mellitus (type II diabetic), admitted to hospital in January 1999, with ketoacidosis and consolidation of the lower left lobe. The diagnosis of mucormycosis was confirmed by identification of large, nonseptate hyphae of the order mucorales. A strain of rhizopus oryzae (rhizopus arrhizus) was isolated from culture on sabouraud medium. The patient was treated by systemic amphotericin b, associated with surgical debridement (lobectomy).The treatment with amphotericin b was stopped after ten days and the patient was completely asymptomatic and returned to Moldavia. Mucormycoses are rare, and tend to be encountered in individuals with predisposing factors such as malignant blood disorders (immunocompromised patients) or diabetes mellitus. prognosis is poor, resembling infection with aspergillus, despite aggressive treatment as in the present case. The gravity of the condition can be accounted for by the thrombotic and necrosing nature of the fungal invasion of lung vessels.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/16. Progressive opacification of hydrophilic acrylic intraocular lenses in diabetic patients.Four patients with diabetes mellitus had cataract extraction with implantation of a hydrophilic acrylic intraocular lens (IOL) (ACRL-C160, Ophthalmed). The IOLs showed progressive and generalized opacification 10 to 20 months after implantation, decreasing visual acuity. All 4 IOLs were removed. By light microscopic examination, the IOL surfaces were wrinkled and encrusted with microspheres. Electron microscopy revealed the material to be crystalline in nature. Energy dispersive x-ray spectrum analysis showed that the deposits were mainly composed of calcium and phosphate.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/16. paecilomyces varioti pneumonia in a patient with diabetes mellitus.paecilomyces is a saprophytic soil fungus that is an uncommon human pathogen. We report a diabetic patient who developed an upper lobe pulmonary infection due to paecilomyces varioti. This pneumonia responded poorly to oral imidazole therapy with ketoconazole. Eventual treatment of the chronic infiltrating process required administration of intravenous amphotericin b. This experience emphasizes the potential pathologic nature of this fungus when immunity is compromised by poorly controlled diabetes.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/16. Transient myoclonic state with asterixis in elderly patients: a new syndrome?We report 7 patients who developed acute co-occurrences of fragmentary generalized myoclonus and asterixis. All patients were elderly and had other chronic diseases. This condition appeared acutely, progressed over several hours and then disappeared in 2-3 days with diazepam administration. No sequelae were noted, although most cases developed recurrences. The myoclonus occurred spontaneously and was slightly enhanced by action. The myoclonus was widely distributed but predominated in the neck, shoulder girdle, and upper extremities. Opsoclonus was not noted. Clinically apparent myoclonus was not evoked by sensory stimuli. Asterixis was observed in the upper extremities in all cases. Asterixis-like movements of the protruded tongue were also observed. Neurological findings other than the myoclonus and asterixis were unremarkable. Neither metabolic nor organic abnormalities clearly responsible for this condition were identified. Cerebral potentials preceding the myoclonic jerks recorded in one case suggested that the myoclonus may have been a spontaneous cortical myoclonus. We named this condition a transient myoclonic state with asterixis (TMA). awareness of this syndrome is clinically important because of its benign nature, although it can recur.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/16. Nonclostridial gas gangrene.Although nonclostridial gas gangrene is not an unusual occurrence, relatively few cases including the distal lower extremity have been reported. Due to the serious nature of some of these infections, it is important for physicians to familiarize themselves with these nonclostridial crepitant infections, which are often confused with clostridial myonecrosis. Etiology, evaluation, and treatment is described by the authors. Also, a case study is presented.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/16. Undetected diabetes and the plastic surgeon.Plastic surgery candidates are generally healthy. Therefore, major postoperative complications are rare. Should they happen, the surgeon should search for possible causes, one of which is undetected diabetes mellitus. Six patients are presented who, based on the individual or family history or the unusual nature of their complications, were suspected of having diabetic tendencies. This experience necessitated our in-depth search into the role of silent or undetected diabetes. This report emphasizes the importance of positive family history of diabetes and the role of glucose tolerance tests on suspected cases. Even with normal glucose tolerance tests, however, some of these patients with a positive family history of diabetes and history of previous infections suffer from deficiencies in the chemotactic immune system. We recommend full discussion of the increased risk of infection and delayed healing with these patients, conservatism during surgical procedures, and prophylactic use of antibiotics perioperatively.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/16. Severe persistent biphasic local (immediate and late) skin reactions to insulin.A patient with adult-onset insulin-requirging diabetes mellitus had persistent severe local reactions to all available insulins of animal origin. skin reactions were biphasic in nature with both immediate and late characteristics. An extensive immunologic investigation of this problem was undertaken, revealing evidence of reaginic antibody involvement in the reactions. Routine histologic studies suggested the possibility that Arthus-type mechanisms played a part, although this impression was not confirmed by immunofluorescent microscopy. A program of medical management provided some relief of symptoms.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/16. Diabetic osteomyelitis: long-term attempts at salvage with eventual mortality.Long-term complications of diabetes mellitus with respect to the lower extremities are well known to the podiatric profession. The author presents a case of a diabetic with multisystem pathology who underwent several salvage procedures for osteomyelitis and later expired from cardiovascular disease. The multi-system nature of diabetes necessitates a team approach in management of the acutely ill diabetic patient.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/16. anorexia nervosa and diabetes mellitus.Four patients who developed anorexia nervosa after the onset of diabetes mellitus are described. It is postulated that the co-occurrence of the two conditions was not coincidental, but that each contributed to the development of the other. The nature and treatment of diabetes offer numerous opportunities for the anorexic patient to lose weight by a variety of dangerous maneuvers, including adjustment of the insulin dose, failure to inject insulin, secret vomiting, and failure to provide urine samples. Treatment of patients with both conditions is a therapeutic challenge to the psychiatrist and diabetologist. A behavior management program combined with psychotherapy is most often effective.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/16. Idiopathic hemochromatosis, an interim report.Experience over the last 20 years with 34 patients with idiopathic hemochromatosis is summarized and the literature is reviewed. methods are now available which are highly effective in the diagnosis of iron overload and virtually all diagnoses are made antemortem. The nature of the disease has changed through the removal of iron by phlebotomy. Early deaths are limited to patients with severe and rapidly progressive heart disease and to those presenting with neoplasm. The major mortality has shifted to a much later period and the incidence of hepatoma is increasing. There is particular interest at the present time in family studies since excessive iron stores are frequently found within the family. The significance of intermediate degrees of iron overload is unclear, but future attention should be given to the recognition of iron overload long before clinical manifestations appear.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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