1/15. 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.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/15. A case of obesity, diabetes and hypertension treated with very low calorie diet (VLCD) followed by successful pregnancy with intrauterine insemination (IUI).The patient was a 32-year-old obese woman with a history of type 2 diabetes and hypertension for 6 years. Although she was treated with antihypertensive agents and intensive insulin therapy, her hyperglycemia was difficult to control. She wanted to have a baby but pregnancy was not recommended because her diabetes was under poor control and the use of antihypertensive medication. To achieve good control of obesity, diabetes and hypertension, she was admitted to our clinical department for weight reduction using very low calorie diet (VLCD). During VLCD she had a 19.8 kg reduction in body weight and her blood glucose and blood pressure were in good control without the use of drugs. Five months later, she became pregnant after the fourth trial of intrauterine insemination (IUI) and gave birth to a female baby under insulin therapy. This is the first report that showed the usefulness of VLCD for prepregnant control of glucose metabolism and blood pressure in an obese hypertensive patient with type 2 diabetes mellitus.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
3/15. Type a syndrome of insulin resistance: anterior chamber anomalies of the eye and effects of insulin-like growth factor-I on the retina.BACKGROUND: The purpose of this work was to describe the anterior chamber and iris anomalies as well as to evaluate the effects of recombinant human insulin-like growth factor-I (rhIGF-I) on the retinal vessels in 2 diabetic patients with type A syndrome of insulin resistance, a rare condition associated with acanthosis nigricans. methods: Ophthalmologic examinations, including photographs and fluorescein angiograms, were performed before, and 2 and 4 weeks after starting subcutaneous rhIGF-I treatment, and 3 months after withdrawal of rhIGF-I treatment. RESULTS: Both patients had goniodysgenesis with mild elevation of the intraocular pressure. Before and after 2 weeks of treatment with rhIGF-I, the fundus and the fluorescein angiograms were mainly normal. After 4 weeks of rhIGF-I treatment both patients' retinas revealed leakage of fluorescein. Three (case 1) and 4 months (case 2) after withdrawal of rhIGF-I, the fundus of all four eyes were again without leakage. CONCLUSIONS: The anterior chamber anomalies found in these patients may be part of the type A syndrome of insulin resistance and could alert clinicians that these patients might not have the usual type of diabetes. Moreover, the data show that exogenous rhIGF-I administration in patients with type A syndrome of insulin resistance alters the permeability of the superficial layer of retinal capillaries which is comparable to the earliest angiographic changes in childhood diabetic retinopathy. Whether this is a direct effect of rhIGF-I, as suggested by experiments in an animal model, or an indirect effect due to the near-normalization of the glucose levels by rhIGF-I warrants further investigations. Finally, this work points to an important caveat regarding the therapeutic use of rhIGF-I in this patient population.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/15. diabetes mellitus and its chronic complications.diabetes mellitus is a major cause of morbidity and mortality, and it is a major risk factor for early onset of coronary heart disease. Complications of diabetes are retinopathy, nephropathy, and peripheral neuropathy. Currently, treatment involves diet modification, weight reduction, exercise, oral medications, and insulin. In recent years, important advances have been made into the pathogenesis of diabetes that affect the cardiovascular, renal, and nervous systems; vision; and the lower extremities, especially the feet. The progression of diabetic retinopathy and nephropathy can be slowed or prevented with tight glucose and blood pressure control. Neuropathy remains a major problem causing significant impairment. Ongoing clinical trials and testing of various medications to determine their effectiveness in treating the complications of diabetes have met with some success, but there still is much to learn about this disease.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/15. nitrogen metabolism and insulin requirements in obese diabetic adults on a protein-sparing modified fast.A protein-sparing modified fast (PSMF), which is a total fast modified by the intake of 1.2-1.4 gm. protein per kilogram ideal body weight (IBW), fluids ad libitum, and vitamin and mineral supplementation, allows effective control of carbohydrate metabolism and hunger. It reduces serum glucose and insulin concentrations in obese diabetic patients and increases free fatty acid and ketone body concentrations; ketonuria appears within 24-72 hours. When this fast was applied to seven obese adult-onset diabetics who were receiving 30-100 units of insulin per day, insulin could be discontinued after 0-19 days (mean, 6.5). In the three patients who had extensive nitrogen-balance studies, balance could be maintained chronically by 1.3 gm. protein per kilogram IBW, despite the gross caloric inadequacy of the diet. The PSMF was tolerated well in an outpatient setting after the initial insulin-withdrawal phase had occurred in the hospital. Significant improvements in blood pressure, lipid abnormalities, parameters of carbohydrate metabolism, and cardiorespiratory, symptoms were associated with weight loss and/or the PSMF. For diabetics with some endogenous insulin reserve, the PSMF offers significant advantages for weight reduction, including preservation of lean body mass (as reflected in nitrogen balance) and withdrawal of exogenous insulin.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/15. diabetes mellitus and the kidney in adolescents.Diabetic nephropathy continues to be a major complication of both types I and II diabetes; renal disease in the two types of diabetes exhibits no major differences with regard to initiation, progression, or treatment. The increasing prevalence of type II diabetes among adolescents means that understanding diabetic nephropathy and its prevention and treatment strategies is increasingly important for physicians caring for this population. The most important prevention and treatment modalities for diabetic nephropathy are improved glycemic control and aggressive blood pressure control, beginning as soon as possible after the diagnosis of diabetes.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/15. exercise for patients with diabetes. Benefits, risks, precautions.exercise is beneficial in both prevention and control of non-insulin-dependent (type II) diabetes. Whether a patient has insulin-dependent or type II diabetes, a regular exercise program can produce positive changes in the lipid profile, reduce blood pressure and weight, and improve other cardiovascular risk factors. The risks of an exercise program include precipitation of cardiovascular events, damage to the soft tissue and joints of the feet, visual loss, early and delayed hypoglycemia, and hyperglycemia and ketosis. Consequently, a comprehensive clinical assessment to identify potentially harmful diabetic complications and to determine the patient's fitness level is needed before a suitable exercise program can be prescribed. With careful manipulation of insulin doses and home monitoring of blood glucose levels, exercise need not adversely affect glycemic control. Moreover, the metabolic and cardiovascular benefits that result from a sensible exercise program can greatly improve the quality of life for most diabetic patients.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/15. Plantar pressure measurements and the prevention of ulceration in the diabetic foot.Static and dynamic measurements of foot pressure have been carried out on three groups of subjects: diabetic patients with neuropathy (with and without a history of ulceration), diabetic patients with no neuropathy, and normal subjects as controls. In many cases both techniques of measurement detected areas of abnormally high pressure under the foot, but in some cases a particularly high-pressure spot was detected on only one of the tests and sometimes both methods were needed to reveal all the areas of the foot which might be considered to be at risk. The dynamic measurements tended to show multiple areas of high pressure better than the static measurements. Our results indicate the importance of making both types of measurement when seeking to devise suitable means of protecting the foot from ulceration.- - - - - - - - - - ranking = 8keywords = pressure (Clic here for more details about this article) |
9/15. Phaeochromocytoma and diabetes mellitus: further evidence that alpha 2 receptors inhibit insulin release in man.An insulin-dependent diabetic presenting with thirst, polyuria and weight loss was noted to be hypertensive and shown subsequently to have a right adrenal phaeochromocytoma. Pre-operative control of both diabetes and hypertension was achieved with propranolol and phenoxybenzamine, but not with propranolol alone. Full recovery with restoration of normal glucose tolerance and blood pressure followed successful surgery. Analysis of this patient's response to medical therapy provides further evidence that alpha 2 receptors inhibit insulin release in man. Since as many as one-third of phaeochromocytomas are not detected during life, this diagnosis should be considered as an uncommon cause of carbohydrate intolerance in patients with diabetes mellitus, especially if accompanied by continuous or paroxysmal hypertension.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/15. Hb Marseille [alpha 2 beta 2 N methionyl-2 (NA2) HisPro]: a new beta chain variant having an extended N-terminus. A new abnormal hemoglobin was found in a diabetic Maltese woman by citrate agar electrophoresis. This variant was undetectable by isoelectric focusing. No hematological abnormalities were observed. The structural analysis included isolation of the abnormal beta chain, high pressure liquid chromatography of the corresponding tryptic peptides and then microsequencing of the abnormal T1. These procedures revealed a double abnormality: the presence of a methionyl residue extending the NH2 terminus and a histidine to proline substitution in position NA2.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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