1/7. Rapid progression of cardiomyopathy in mitochondrial diabetes.Cardiac involvement and its clinical course in a diabetic patient with a mitochondrial tRNA(Leu)(UUR) mutation at position 3243 is reported in a 54-year-old man with no history of hypertension. At age 46, an electrocardiogram showed just T wave abnormalities. At age 49, it fulfilled SV1 RV5 or 6>35 mm with strain pattern. At age 52, echocardiography revealed definite left ventricular (LV) hypertrophy, and abnormally increased mitochondria were shown in biopsied endomyocardial specimens. He was diagnosed as having developed hypertrophic cardiomyopathy associated with the mutation. However, at age 54, SV1 and RV5,6 voltages were decreased, and echocardiography showed diffuse decreased LV wall motion and LV dilatation. Because he had mitochondrial diabetes, the patient's heart rapidly developed hypertrophic cardiomyopathy, and then it seemed to be changing to a dilated LV with systolic dysfunction. Rapid progression of cardiomyopathy can occur in mitochondrial diabetes.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/7. Tendon lengthening repair and early mobilization in treatment of neglected bilateral simultaneous traumatic rupture of the quadriceps tendon.Bilateral simultaneous traumatic rupture of the quadriceps tendon is a rare injury that is most frequently seen in elderly patients with predisposing diseases such as gout, hyperparathyroidism and diabetes. Delay in diagnosis is not uncommon. One of the main problems in treatment is loss of motion, especially flexion, after surgical repair. We report a case that was diagnosed 5 months after the trauma and was treated by Scuderi's tendon lengthening technique. Range-of-motion exercises were started early without using the generally recommended 4-6 weeks of immobilization in plaster cylinder or knee brace. Five years of follow-up showed full range of motion in both knees with sound tendons. Stable fixation makes starting early motion and accelerated rehabilitation feasible and thus the most common complication, loss of motion, is prevented.- - - - - - - - - - ranking = 5keywords = motion (Clic here for more details about this article) |
3/7. medical errors and the trainee: ethical concerns.How medical errors are handled by individual physicians and hospital systems is a topic of considerable interest. In teaching hospitals, medical students and house officers often observe and commit mistakes. Commission of a mistake is associated with serious emotional turmoil and uncertainty among trainees as well as experienced physicians. Although disclosure is the ethical standard, the consequences of disclosure are feared by many. This article focuses on the issues that surround medical errors as they pertain to medical students and residents. It is important that this group of future physicians has appropriate training, mentoring, and support when dealing with errors.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/7. health promotion when the 'vaccine' does not work.The epidemics of obesity, metabolic syndrome and type 2 diabetes have worsened over the past decades. During this time our preventive and therapeutic approach (the 'vaccine'), consisting of a low-fat diet and exercise, has remained fundamentally unchanged. A case is made that these conditions are inter-related and may be caused by a single underlying factor related to the carbohydrate content of diet. The validity of the present approach is challenged when those most knowledgeable in its application succumb to diseases it is meant to prevent. Others argue against the status quo that a low-carbohydrate diet may be more beneficial. A strong belief in the present approach discouraged research into low-carbohydrate diets until recently. Several studies have now demonstrated their benefits and are refuting old claims that they cause harm. Aboriginal people suffer more acutely from the epidemics in question and their dietary history suggests that a sudden increase in carbohydrates is to blame. Recent studies and a case history demonstrate that carbohydrate consumption can drive appetite and over-eating while carbohydrate restriction leads to weight loss and improvement in the markers for metabolic syndrome and type 2 diabetes. The growing evidence in support of low-carbohydrate diets will encounter resistance from economic interests threatened by changes in consumption patterns.- - - - - - - - - - ranking = 4keywords = motion (Clic here for more details about this article) |
5/7. Diabetic mothers and pregnancy loss: implications for diabetes educators.Perinatal deaths among diabetic women are sufficiently common that nearly all diabetes educators eventually care for someone who loses a baby. This case report and discussion identifies ways in which diabetes educators can promote patients' health and provide emotional first aid in the immediate aftermath of perinatal loss. Psychological reactions of both the mother and the health care providers are considered. Practical ways to assist patients, and pitfalls to avoid, also are presented.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/7. A case of hypertensive-diabetic cardiomyopathy demonstrating left ventricular wall motion abnormality.We report a case of hypertensive-diabetic cardiomyopathy demonstrating left ventricular regional wall motion abnormality, with a normal coronary artery documented on coronary arteriography. dipyridamole-infusion 201Tl scintigraphy demonstrated transient perfusion defects in the infero-posterior wall of the left ventricle, where reduced wall motion was demonstrated on contrast left ventriculography. Myocardial SPECT (single photon emission tomography) imaging with [123I] beta-methyliodophenylpentadecanoic acid (BMIPP) and 201Tl demonstrated reduced [123I]BMIPP uptake compared with 201Tl uptake in the infero-posterior wall of left ventricle. These results suggest that the impairment of myocardial free fatty acid metabolism is an etiologic or contributory factor for regional wall motion abnormality, together with small-vessel coronary artery disease, in this patient.- - - - - - - - - - ranking = 7keywords = motion (Clic here for more details about this article) |
7/7. Breakdowns on the path of chronic illness: opportunities for learning.An unusual case of calciphylaxis, presenting at the onset of end-stage renal disease and evolving into an extended and arduous hospital stay, is described. The medical approach to this case is addressed briefly, but the main focus of this paper is to describe, in the words of various participants, the events and interactions that occurred and to learn from this description how our management of such cases breaks down. When confronted by difficult circumstances, it is common for us to react emotionally in ways that are automatic and based on our own personal histories and behavior patterns. Such automatic reactions prevent us from seeing and understanding what we really need to know about a given situation and leave us vulnerable to discouragement and internal suffering when clinical events do not go well (A. Nierenberg, personal communication, April 1998). The result is often exasperation with patients and families, as well as emotionally laden interactions that do not forward problem solving. In retrospect, the appearance of such breakdowns is not only predictable in the course of chronic illness, but offers us the opportunity to observe our automatic reactions, to re-evaluate our approach, and to redesign our actions. We have written this review, not to find error or blame, but rather to emphasize that we are learning to view these breakdowns as signals first to step back from our automatic reactions and then to listen and communicate clearly as a means to navigating the best pathway through difficult and discouraging clinical challenges.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |