1/11. 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 = vessel (Clic here for more details about this article) |
2/11. Documented acquired asteroid hyalosis in a case of early diagnosed diabetes mellitus.BACKGROUND: There have been many reports in the literature of the possible linkage of asteroid hyalosis (AH) to diabetes mellitus (DM). The controversy regarding an association between AH and DM has been one of the longest disputes in the ophthalmic literature. Here we present a case in which AH developed in a patient followed for 9 years after being diagnosed with DM. CASE REPORT: The patient had been examined on nine occasions (since his initial visit in June 1989) and asteroid hyalosis was not discovered until July 1996, when he came in with newly diagnosed diabetes mellitus. This suggests there may well be an association of asteroid hyalosis and diabetes mellitus. DISCUSSION: The patient in this case had a number of risk factors for the development of this ocular condition. He had a long history of systemic arterial hypertension, which has been reported to be linked to the formation of AH. He also had a chronic case of cystoid macular edema, which indicated a vascular compromise to the retinal vessels in the posterior pole, and this leakage may be responsible for serous constituents leaking into the vitreous, which may have caused AH. CONCLUSIONS: This may be the first time in the reported literature that AH was found to occur in a previously normal-appearing vitreous, which was documented over a 9-year period. We would suggest that asteroid hyalosis may be secondary to some form of vasculopathy in many incidences and that diabetes mellitus is one of the conditions that may be associated with the formation of AH.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/11. Fusiform aneurysm of a persistent trigeminal artery.OBJECTIVE: Fusiform aneurysms of the persistent trigeminal artery are rare and endovascular treatment of these aneurysms has not been attempted previously. We describe a case of persistent trigeminal artery with a fusiform aneurysm in its middle third, managed using Guglielmi detachable coils (GDC). CLINICAL PRESENTATION: A 50-year-old, diabetic and hypertensive patient presented with sudden onset headache and neck stiffness. On examination, she was conscious but disoriented, without cranial nerve or sensorimotor deficits. Four-vessel cerebral digital subtraction angiography revealed a fusiform aneurysm of the middle third of a persistent trigeminal artery on the left side with adult type posterior cerebral arteries. INTERVENTION: Guglielmi detachable coils were used for occlusion of the persistent trigeminal artery. RESULTS: The procedure was well tolerated but delayed ischemic neurological deficits developed due to vasospasm. CONCLUSIONS: (1) In spite of angiographically documented independence of the anterior and posterior cerebral circulation, occlusion of a persistent trigeminal artery using endovascular techniques may result in posterior circulation stroke due to a number of factors, including occlusion of brainstem perforators taking origin from the persistent trigeminal artery or vasospasm. (2) The timing for endovascular intervention following aneurysmal rupture remains poorly defined.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/11. Simultaneous liver and pancreas transplantation in patients with cystic fibrosis.BACKGROUND: Improved survival in patients with cystic fibrosis (CF) has led to an increased incidence of extrapulmonary complications of this disease. Of these, cirrhosis and pancreatic insufficiency, including CF-related diabetes (CFRD) and exocrine insufficiency, are significant causes of morbidity and mortality. Liver transplantation is the treatment of choice for cirrhosis in this setting, but the addition of an isolated simultaneous pancreas transplant in patients with CFRD has not been reported. methods: Two female patients with CF underwent simultaneous pancreas and liver transplantation. Both had pancreatic insufficiency, CFRD, cirrhosis, and preserved renal function. In each case, the liver and pancreas were procured from a single cadaveric donor. The liver transplant was performed first. A lower midline extension was added for improved exposure of the iliac vessels. The donor pancreas transplant was performed with systemic venous drainage and enteric exocrine drainage. immunosuppression included rabbit anti-thymocyte globulin, tacrolimus, mycophenolate mofetil, and early steroid withdrawal. RESULTS: Both patients recovered well with normal liver function, resolution of portal hypertension, and normal blood glucoses independent of insulin. As a result of the enteric exocrine drainage of the pancreas, they are now independent of supplemental pancreatic enzymes. CONCLUSIONS: Simultaneous liver and pancreas transplantation in CF patients provides the advantages of normalization of glucose and improved nutrition for patients requiring liver transplantation and should be considered in CF patients with CFRD who require liver transplants.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/11. hypertension, the endothelial cell, and the vascular complications of diabetes mellitus.hypertension is a major factor that contributes to the development of the vascular complications of diabetes mellitus, which primarily include atherosclerosis, nephropathy, and retinopathy. The mechanism of the pathophysiological effects of hypertension lies at the cellular level in the blood vessel wall, which intimately involves the function and interaction of the endothelial and vascular smooth muscle cells. Both hypertension and diabetes mellitus alter endothelial cell structure and function. In large and medium size vessels and in the kidney, endothelial dysfunction leads to enhanced growth and vasoconstriction of vascular smooth muscle cells and mesangial cells, respectively. These changes in the cells of smooth muscle lineage play a key role in the development of both atherosclerosis and glomerulosclerosis. In diabetic retinopathy, damage and altered growth of retinal capillary endothelial cells is the major pathophysiological insult leading to proliferative lesions of the retina. Thus, the endothelium emerges as a key target organ of damage in diabetes mellitus; this damage is enhanced in the presence of hypertension. An overall approach to the understanding and treatment of diabetes mellitus and its complications will be to elucidate the mechanisms of vascular disease and endothelial cell dysfunction that occur in the setting of hypertension and diabetes.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
6/11. Pancreatic and islet autotransplantation.The techniques of segmental pancreatic autotransplantation and intraportal islet autografting have been reported to prevent diabetes after resection of the diseased pancreas. Unless total pancreatectomy is done, transplant function cannot be assessed without measuring insulin in the venous effluent. Islet infusion appears to be a more uncertain technique than segmental autotransplantation, probably because of technical difficulties in obtaining sufficient islets. Both methods have serious potential for morbidity and mortality, which must be balanced against the possible benefits of improved glucose homeostasis. In segmental autografts we recommend an intraperitoneal transplant site with iliac vessel anastomosis, and a lateral pancreaticojejunostomy to provide ductal drainage. For islet transplantation we recommend extreme caution and the use of only very pure islet preparations for portal vein infusions. There is insufficient long-term follow-up of patients with successful auto- or allotransplants to be certain that secondary complications of diabetes will be less than those of patients on insulin therapy. Further experience is necessary before the long-term functional survival of segmental or islet autografts will be known.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/11. Pancreatic autotransplantation following resection.A patient with recurrent pancreatitis was treated by near-total pancreatectomy. The tail of the pancreas, together with the splenic artery and vein, was transplanted into the thigh, with anastomoses of the splenic vessels to the femoral vessels. Two months after operation simultaneously drawn blood samples from both femoral veins showed elevated insulin on the grafted side. Two years after operation the patient is free of symptoms and is not diabetic.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
8/11. Pseudomonas mastoiditis.opportunistic infections of the external auditory canal or the middle ear due to pseudomonas aeruginosa occurring in patients with low resistance to infection have a 35 percent mortality rate. Once the process extends into the pneumatized temporal bone, eradication becomes more difficult and the mortality rate increases to 72 percent because of the high incidence of involvement of cranial nerves, adjacent intracranial vessels, and meningitis. Treatment is directed towards the underlying condition, administration of systemic carbenicillin and gentamicin, topical colistin therapy, and judicious surgical debridement. Pseudomonas vaccine may be of help. Fifteen cases are presented. Nine follow the pattern of malignant external otitis and six began as a primary acute otitis media.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/11. Pancreatic transplantation for diabetes mellitus. Discussion of indications and surgical technique with reference to 3 cases.Three patients reveived segmental pancreatic transplants. In two the main indication was hyperlabile diabetes, and in the third progressive loss of vision. Vascular anastomoses were to the iliac vessels, the graft being placed extraperitoneally. The pancreatic duct was ligated in the first case, while the other two, the transected end of the pancreatic graft was implanted into a jejunal Roux-Y loop. Two of the patients had normal blood glucose levels without insulin administration for 40 and 35 days, respectively. The grafts then underwent rejection and were removed. In both cases the postoperative course was complicated by pancreatic fistulae. In the 3rd patient the graft failed on the day after operation, due to venous trombosis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/11. Insulin edema in diabetes mellitus associated with the 3243 mitochondrial tRNA(Leu(UUR)) mutation; case reports.We encountered a patient with diabetes mellitus due to the 3243 mitochondrial tRNA mutation(DM-Mt3243), who developed insulin edema and hepatic dysfunction after starting insulin. Such a rare phenomenon was unlikely to be a fortuitous coincidence in mitochondrial diabetes, as none in 197 non-mutant NIDDM patients had same episode. Moreover, similar leg edema was noticed in another DM-Mt3243 patient, and other two DM-Mt3243 patients had leg edema which responded to coenzyme Q10. These observations suggest further a role of mitochondrial function on leg edema. The mechanism of his insulin edema may involve vasomotor changes induced by the rapidly glycemic control, because our case of insulin edema had a prominent increase of strong succinate dehydrogenase reactive vessels. Alternatively, myocardial dysfunction might have produced leg edema and hepatic dysfunction, because he had subclinical myocardial dysfunction, judged by imaging with beta-methyl-p-(123I)-iodophenyl-pentadecanoic acid. The third explanation is that a rapid improvement of glycemic control might have induced hepatic reoxygenation and the production of reactive oxygen species in the liver that contributed to cell damage. Thus, although we cannot draw definite conclusion, our experiences here suggest that mitochondrial dysfunction is important in the etiology of insulin edema.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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