1/9. Pulmonary rhizopus infection in a diabetic renal transplant recipient.Infectious complications after renal transplantation remain a major cause of morbidity and mortality. mucormycosis is a rare infection in renal transplant recipients; however, mortality is exceedingly high. risk factors predisposing to this disease include prolonged neutropenia, diabetes, and patients who are immunosuppressed (Singh N, Gayowski T, Singh J, Yu LV. Invasive gastrointestinal zygomycosis in a liver transplant recipient: case report and review of zygomycosis in solid-organ transplant recipients, Clin Infect Dis 1995: 20: 617). life-threatening infections can occur, as this fungus has the propensity to invade blood vessel endothelium, resulting in hematological dissemination. We report a case of cavitary rhizopus lung infection, 2 months after renal transplantation, where the patient was treated successfully with amphotericin b and surgical resection of the lesions with preservation of his allograft function. In this era of intensified immunosuppression, we may see an increased incidence of mucormycosis in transplant population. Invasive diagnostic work-up is mandatory in case of suspicion; amphotericin b and, in selected cases, surgical resection are the mainstays of therapy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/9. Penile calciphylaxis: analysis of risk factors and mortality.PURPOSE: Penile calciphylaxis is a rare condition resulting in infection and gangrene. Most cases are associated with systemic calciphylaxis. The pathophysiology, diagnosis and management of penile calciphylaxis as a distinct entity have received little attention. We reviewed the literature to increase understanding of this disease. MATERIALS AND methods: A retrospective review of the literature was performed after treating a case of penile calciphylaxis. Patient characteristics, presentation, serum chemistry studies, management and outcomes are reported. RESULTS: A total of 34 cases of penile calciphylaxis were identified in the literature including our patient. Average patient age was 58 years. All patients had end stage renal disease, and diabetes mellitus was a co-morbidity in 76%. Additional areas of gangrene beyond the genitalia were found in two-thirds of patients. Average calcium phosphate product was 78.5 mg.2/dl.2 (range 20.6 to 52.5) and mean parathormone level was 553 pg./ml. (10 to 65). parathyroidectomy was performed in 8 patients. All patients were treated with either local debridement/wound care or partial/total penectomy. survival was better in patients who underwent parathyroidectomy (75%) than in those treated with local debridement or penectomy alone (28%). The overall mortality associated with this disease was 64% with a mean time to death of 2.5 months. CONCLUSIONS: Penile calciphylaxis is a result of medial calcification and fibrosis of blood vessels. The co-morbidity and mortality associated with this disease are extremely high. Secondary hyperparathyroidism and an increased calcium phosphate are characteristic and require aggressive medical management. Surgical management of penile lesions and parathormone is controversial. Our review suggests that parathyroidectomy may improve survival and that survival is independent of the type of local treatment for the penile lesions.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/9. 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 = vessel (Clic here for more details about this article) |
4/9. 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) |
5/9. Acute lumbosacral plexopathy in diabetic women after renal transplantation.Renal transplantation is an accepted treatment for patients with end stage renal disease from insulin-dependent diabetes mellitus. Acute lumbosacral plexopathy developed following renal transplantation in 4 female patients with insulin-dependent diabetes mellitus between January 1, 1981 and June 30, 1988. In all 4 patients the internal iliac artery was used for revascularization of the renal allograft with ligation of the anterior and posterior divisions. Within 24 hours of surgery they complained of ipsilateral buttock pain, numbness in the leg and weakness below the knee. This complication has not been observed in nondiabetic patients at our institution, nor in diabetic patients when the internal iliac artery was not used. However, lumbosacral plexopathy occurred in 4 of 27 (14.8%) female patients with insulin-dependent diabetes mellitus when the internal iliac artery was used (p less than 0.001). Age, duration of insulin-dependent diabetes mellitus, hypertension, cigarette smoking history and kidney donor were not significant predictors of this complication. This unusual and newly recognized complication appears to result from ischemia of the lumbosacral plexus following ligation of the internal iliac artery in patients with severe small vessel disease.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/9. Ischaemic necrosis of the glans penis: a complication of urethral catheterization in a diabetic man.Ischaemic necrosis of the glans penis is rare. Diabetic patients commonly have small vessel disease which may affect the penis. We report the case of a man with extensive diabetic vascular disease, in whom partial penectomy was necessary for ischaemia of the glans penis, following urethral catheterization. The decision to use a urethral catheter in diabetics, particularly those with evidence of vascular disease, must be made with the knowledge that internal compression caused by the catheter may cause irreversible ischaemic changes. In such patients, a suprapubic catheter should be considered as an alternative.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/9. Clinicopathological conference: incidentally found renal mass.Doctor Petersen confirmed our preoperative suspicion that this lesion might represent a benign proximal tubular adenoma. Tessler and associates found 5 such cases from July 1974 to January 1975 and reviewed all cases of renal carcinoma in their institution from 1952 through 1975. An additional 9 cases were discovered with none before 1964. One must ask if there is an increased incidence now occurring or are we just beginning to recognize this entity with increasing sophistication? The question also must arise whether with a high degree of suspicion a less radical operation is indicated. Certainly, the angiogram is the only possible preoperative tool that can arouse suspicion but this still is far from diagnostic. The spoke-wheel configuration of vessels, a homogeneous nephrogram similar to the normal parenchyma and sharp margination in the absence of marked increased vascular puddling may all be suggestive. In this older patient with a normal contralateral kidney total nephrectomy still is indicated because angiographic patterns are not pathognomonic. Conversely, in the rare younger individual with concomitant unrelated bilateral renal disease or in the solitary kidney with a polar lesion partial nephrectomy should be considered. Although some differential recognition may be possible by gross examination, such as the tan color, sharp demarcation, absence of hemorrhage or necrosis and so forth, it always has been our policy not to violate Gerota's fascia or to biopsy in the treatment of suspected renal carcinoma. Thus, until a specific preoperative diagnosis is possible nephrectomy continues to be the treatment of choice in the proximal tubular adenoma with so-called oncocytic features. Debate will continue in urologic, pathologic and radiologic circles on whether such an entity is universally benign and with increasing recognition only time will tell.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/9. Pulmonary mucormycosis in diabetic renal allograft recipients.Renal allograft recipients are prone to opportunistic infections due to their need of immunosuppression to prevent rejection. mucormycosis is a rare opportunistic infection caused by a fungi of the order mucorales. risk factors predisposing to this disease include prolonged neutropenia, chelation therapy for iron or aluminum overdose, diabetes, and patients who are immunosuppressed. life-threatening infections can occur, as this fungi has the propensity to invade blood vessel endothelium, resulting in hematologic dissemination. early diagnosis and prompt aggressive therapy is imperative to achieve an improved outcome. We present two cases of pulmonary mucormycosis in diabetic renal allograft recipients who were treated successfully with amphotericin b and surgical resection of the lesions with preservation of their allograft function. In this era of intensified immunosuppression, we may see an increased incidence of mucormycosis in our transplant population.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/9. Microangiopathic hemolytic anemia as a complication of diabetes mellitus.A mature-onset diabetic patient who developed microangiopathic hemolytic anemia (MHA) is presented. Although numerous causes of hemolysis are reported in the literature, MHA is a rare complication of diabetes. The proposed mechanism of hemolytic anemia is thought to be related to the abnormal formation of cell membranes in the diabetic environment. The ratio of cholesterol to phospholipid in the core of the membrane is altered in diabetics; as a result, the red blood cell wall becomes rigid and nondeformable. The abnormal cells becomes disrupted as they circulate through the microangiopathic blood vessels. The mechanism of action of the antiplatelet agents is to enhance cell membrane compliance. With improved cell-wall compliance, one can expect a reduction in hemolysis, as occurred in our patient. The literature on diabetes mellitus-related microangiopathic hemolytic anemia is reviewed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |