1/24. I-123 MIBG cardiac imaging in diabetic neuropathy before and after epalrestat therapy.I-123 metaiodobenzylguanidine (MIBG) scintigraphy is a new method to evaluate cardiac sympathetic nerve disturbance in patients with diabetes mellitus. Epalrestat specifically inhibits aldose reductase and improves diabetic neuropathy. The authors report a case of improvement in cardiac sympathetic dysfunction using MIBG scintigraphy with epalrestat therapy. In this case, epalrestat effectively reversed diabetic neuropathy, and MIBG scintigraphy was useful to evaluate the effect of epalrestat.- - - - - - - - - - ranking = 1keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
2/24. Severe hypertension induced by the long-acting somatostatin analogue sandostatin LAR in a patient with diabetic autonomic neuropathy.A 26-yr-old woman with type 1 diabetes and severe symptomatic autonomic neuropathy was treated with the long-acting somatostatin analogue Sandostatin LAR for intractable diarrhea. Her diarrhea had previously been successfully managed with three daily injections of octreotide without adverse consequences. She was given a single dose of Sandostatin LAR and within 2 weeks reported the development of increasingly frequent and severe headaches. Three weeks after the injection, she was admitted to hospital with severe hypertension, which eventually resolved with the administration of antihypertensive agents. No other underlying cause of the hypertension was discovered. Rechallenge of the patient with octreotide resulted in a transient hypertensive episode, which lasted 3 h. Severe hypertension, therefore, seems to be a possible adverse effect of treatment of diabetic diarrhea with somatostatin analogues, which should be used with great caution in subjects with severe autonomic dysfunction.- - - - - - - - - - ranking = 0.20669744432152keywords = diabetes (Clic here for more details about this article) |
3/24. Clinico-pathological features of postural hypotension in diabetic autonomic neuropathy.We report the clinico-pathological features and management of a 49-year-old male with a 30-year history of Type 1 diabetes mellitus who had nephropathy (proteinuria 1.81 g/24 h, creatinine 136 micromol/l), proliferative retinopathy and severe somatic and autonomic neuropathy. A sural nerve biopsy demonstrated marked myelinated fibre loss with unmyelinated fibre degeneration and regeneration combined with extensive endoneurial microangiopathy. The management of the patient's blood pressure problems (supine hypertension) and symptomatic postural hypotension is discussed.- - - - - - - - - - ranking = 1keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
4/24. Familial mitochondrial intestinal pseudo-obstruction and neurogenic bladder.Intestinal dysmotility and neurogenic bladder have been described as part of two autosomal-recessive mitochondrial disorders assumed to be due to a defect in communication between the nuclear and mitochondrial genomes: myoneurogastrointestinal encephalopathy (MNGIE) and diabetes insipidus, diabetes mellitus, optic atrophy, and deafness (wolfram syndrome). Partial cytochrome c oxidase deficiency has been described in both. We describe three Ashkenazi Jewish siblings with progressive intestinal dysmotility, neurogenic bladder, and autonomic manifestations but no central nervous system involvement. Cytochrome c oxidase deficiency was demonstrated in peripheral and multiple intestinal muscle biopsies. Mitochondrial dna analysis of an intestinal biopsy of patient 1 showed heteroplasmy consisting of a normal 16.5-kb band and an approximately 28-kb band, suggestive of a duplication. Mitochondrial dna analysis of a muscle biopsy of patient 2 showed multiple deletions, mainly 10- and 11-kb bands. We suggest that this unique combination of intestinal pseudo-obstruction and neurogenic bladder could comprise a new autosomal-recessive mitochondrial disorder.- - - - - - - - - - ranking = 0.5580440531491keywords = diabetes, mellitus (Clic here for more details about this article) |
5/24. Resolution of diabetic autonomic neuropathy.Many consider diabetic autonomic neuropathy to be an irreversible complication of diabetes of long duration. Three patients developed symptoms of autonomic neuropathy which subsequently resolved. Their autonomic neuropathy was not associated with long duration of diabetes, but with weight loss. Each had marked weight loss and resolution occurred on regaining remembered premorbid weight. A woman aged 20 was admitted with anorexia nervosa (weight loss 6 kg). She complained of feeling bloated. Gastroenterological investigations showed delayed gastric emptying. RR ratio (respiration and standing) was abnormal. Resolution occurred after two years. A male aged 18 developed diabetic symptoms, which were overlooked. Twelve months later he presented underweight and ketonuric; insulin treatment was started but within one month he became impotent. Resolution occurred after 18 months. An 80 year old man presented after six months trial of diet and sulphonylurea therapy. He was underweight, had ketonuria, and such muscle loss that he was unable to sit unaided. insulin treatment was started. He developed severe symptomatic postural hypotension. This resolved six months later by which time he had regained his normal weight. These cases illustrated symptomatic autonomic neuropathy occurring in relation to weight loss with resolution on recovery of normal weight, a temporal pattern mimicking that of acute cachectic painful neuropathy. Treatment of autonomic neuropathy should be like that of cachectic neuropathy, that is with an expectation of recovery and should include strategies to regain premorbid weight and achieve glycaemic control.- - - - - - - - - - ranking = 0.41339488864304keywords = diabetes (Clic here for more details about this article) |
6/24. Evidence of impaired afferent vagal function in patients with diabetes gastroparesis.Two patients, a 28-year-old male and a 70-year-old female, with chronic insulin dependent diabetes mellitus and evidence of autonomic neuropathy were studied using cortical evoked responses following esophageal balloon and electrical stimulation. Both patients had symptomatic gastroparesis, poor gastric emptying, and reduced gastroduodenal motility including abnormal results of scintigraphy and manometry. There was slowing of afferent vagal conduction but good evoked potential responses were recorded even though one patient could not feel electrical stimulation of either the proximal or distal esophagus. It is improbable that the gastric symptoms are due to an afferent autonomic neuropathy, but symptoms may well be related to impairment of motor vagal pathways. Nevertheless, afferent vagal pathways are involved in severe diabetes mellitus. The clinical significance of this delay in conduction velocity of afferent pathways remains to be established.- - - - - - - - - - ranking = 2.8267897772861keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
7/24. hypoglycemia-induced neurogenic-type pulmonary edema: an underrecognized association.OBJECTIVE: To report a case of hypoglycemia-induced pulmonary edema and to analyze the underlying pathophysiologic processes. methods: A case report with clinical and laboratory data is presented, and related studies from the medical literature are discussed. RESULTS: A 23-year-old man with type 1 diabetes was brought to the emergency department because he was found unconscious at home. Despite a morning blood glucose level of 30 mg/dL, he had taken his usual dose of Lente insulin (40 U), and a period of unconsciousness of unknown duration ensued. Intravenous administration of dextrose increased his blood glucose level to 118 mg/dL, but x-ray films of the chest disclosed evidence of pulmonary edema. After 48 hours of supportive care, his respiratory signs and symptoms resolved. The pathophysiologic construct for hypoglycemia-induced pulmonary edema is thought to be the same as for neurogenic pulmonary edema, with a massive sympathetic nervous system discharge being the common denominator in both conditions. CONCLUSION: Clinicians should be aware that severe hypoglycemia can lead to noncardiogenic pulmonary edema as a result of a massive sympathetic nervous system discharge and its associated hemodynamic alterations, in the same manner as occurs in neurogenic pulmonary edema.- - - - - - - - - - ranking = 0.20669744432152keywords = diabetes (Clic here for more details about this article) |
8/24. Blisters, ulceration and autonomic neuropathy in carpal tunnel syndrome.We describe three patients with trophic ulceration and blistering of the fingertips associated with carpal tunnel syndrome. One of the patients also had non-insulin-dependent diabetes mellitus. Autonomic neuropathy distal to the carpal tunnel was probably present in all subjects at the time of presentation; in the patient with recent symptoms the skin was warm, and sweating was virtually absent, whilst the other two patients described cold skin, consistent with prolonged autonomic neuropathy.- - - - - - - - - - ranking = 1keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
9/24. Long current impulses may be required for nerve stimulation in patients with ischemic pain.PURPOSE: To report on the efficacy of peripheral plexus catheters in the treatment of ischemic pain in spite of nerve stimulation with long current impulses. CLINICAL FEATURES: Two patients with severe neuropathic ischemic foot pain are described. A 56-yr-old man with diabetes, renal failure, and autonomic neuropathy presented with severe ischemic foot pain. Opioids produced excess sedation and hypotension. A 62-yr-old woman was admitted after femoral-popliteal bypass and developed a reperfusion pain syndrome not relieved with opioids, gabapentin, amitryptiline, and clonidine. In both patients, a sciatic plexus catheter was placed with resolution of pain. Conventional nerve stimulation, which uses a pulse duration of 0.1 msec, did not result in muscle contraction. However, by using a nerve stimulator capable of delivering a 1.0 msec impulse duration, a muscle twitch or paresthesia endpoint ensued allowing for successful catheter placement. CONCLUSION: Peripheral plexus catheters provide a safe alter-native to systemic analgesics for pain relief in patients with ischemic foot pain. However, conventional nerve stimulation techniques may not elicit a motor response in patients with underlying neuropathy, and the use of nerve stimulators capable of delivering long current impulses is recommended.- - - - - - - - - - ranking = 0.20669744432152keywords = diabetes (Clic here for more details about this article) |
10/24. Normocytic normochromic anemia due to automatic neuropathy in type 2 diabetic patients without severe nephropathy: a possible role of microangiopathy.We describe here four male patients with long-term and poorly controlled type 2 diabetes mellitus. They shared many common characteristic complications, such as severe autonomic neuropathy, proliferative retinopathy and normocytic normochromic anemia without progressive renal failure and macroangiopathy. They also showed normal levels of erythropoietin and reticulocyte, which was considered relatively low. The coefficient of variation of R-R, a useful method to estimate autonomic failure, showed markedly advanced autonomic neuropathy in all four patients. coronary angiography did not reveal stenosis, anomaly or collateral vessels, but left ventriclography showed diffuse or partial hypokinesis. Massive proteinuria, high urinary levels of N-acetyl-beta-D-glucosamidase (NAG) and beta2-microglobulin (beta2M) were detected, though creatinine clearance (Ccr) was not so deteriorated. Treatment with recombinant erythropoietin increased their hemoglobin and hematocrit levels. These common points have a possibility to be brought about by tubulointerstitial damage and microangiopathy may be involved in it.- - - - - - - - - - ranking = 1keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
| | Next -> |