1/13. myositis, microvesicular hepatitis, and progression to cirrhosis from troglitazone added to simvastatin.A 68-year-old woman, with type 2 diabetes mellitus, hypercholesterolemia, and prior long-term simvastatin therapy, self-resumed troglitazone after running out of metformin. She developed an acute severe hepatitis with microvesicular steatosis and mysositis. There was subsequent resolution of the myositis but progression of the hepatitis to symptomatic cirrhosis over a period of 12 weeks. Both troglitazone and simvastatin are metabolized by cytochrome P-450 3A4. Troglitazone typically induces metabolism of drugs metabolized by this cytochrome so that simple simvastatin toxicity seems less likely to have been involved. The association with myositis, the severity of the hepatitis with progression to cirrhosis, and the presence of microvesicular steatosis suggests altered mitochondrial metabolism, which has been described with each agent, as the underlying pathogenic mechanism. Although troglitazone (Rezulin) has been withdrawn from the market, other similar agents are available for therapy of type 2 diabetes mellitus. Increased awareness of a potential interaction between these two classes of drugs is warranted.- - - - - - - - - - ranking = 1keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
2/13. Eruptive xanthomas and chest pain in the absence of coronary artery disease.Because hyperlipidemia may present as xanthomas, a dermatologist may be the first to diagnose these skin lesions and associated lipid abnormalities. Xanthomas are of concern because of their association with coronary artery disease and pancreatitis. We describe the case of a 40-year-old white male with chest pain and eruptive xanthomas. Laboratory tests revealed severe hypercholesterolemia, hypertriglyceridemia, and diabetes mellitus, and the histopathology of the skin lesions was consistent with eruptive xanthomas. Surprisingly, even with overwhelming risk factors for both atherosclerosis and pancreatitis, this patient did not show evidence of either disease process. After initiating therapy for the diabetes and hyperlipidemia, the patient has had no recurrence of chest pain, and the skin lesions have gradually resolved. The most likely explanation for this patient's pattern of symptoms and laboratory results is the chylomicronemia syndrome, which can be seen in patients with type I or type V hyperlipoproteinemia.- - - - - - - - - - ranking = 0.60986504229158keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
3/13. Improvement of weight loss and metabolic effects of vertical banded gastroplasty by an added duodenal switch procedure.BACKGROUND: Some patients who underwent vertical banded gastroplasty (VBG) need revisional operations because of poor weight loss and remaining comorbidities. The duodenal switch (DS) procedure with partial gastrectomy is known as an effective method for treatment of severe obesity and related dyslipoproteinemias and diabetes mellitus type 2 (DM2). Other investigations have shown that DS without gastric resection similarly corrects hypercholesterolemia and DM2 in the "less than" morbidly obese patients. methods: Based on this knowledge, we performed a DS simultaneously with hernioplasty and panniculectomy in a 63-year-old woman with a fair EWL (36.4%), with remaining hypercholesterolemia and DM2 4 years after VBG. The pouch stoma diameter was 13 mm, and there was no pouch dilation nor staple-line disruption. The previously partitioned stomach was left in place. H2-blockers and polyvitamins were prescribed after operation. RESULTS: 1 year after DS there were no postoperative complications and undesirable effects except slight anemia. DS allowed improvement in weight loss, improved carbohydrate handling without need for insulin or other hypoglycemic agents, and corrected severe hypercholesterolemia. CONCLUSION: DS per se in the case presented had a decisive effect on DM2 and hypercholesterolemia. DS should be kept in mind as a second-step malabsorptive procedure after a failed purely restrictive operation.- - - - - - - - - - ranking = 0.5keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
4/13. Transient chylomicronemia preceding the onset of insulin-dependent diabetes in a young girl with no humoral markers of islet autoimmunity.OBJECTIVE: We investigated the possible causes of diabetes in a young child who presented with hyperglycemia associated with severe hypertriglyceridemia (>166 mmol/l), hypercholesterolemia (>38 mmol/l) and fasting chilomicrons. RESULTS: The patient did not have any of the HLA and autoantibody markers typically associated with type 1 diabetes. A glucose clamp failed to demonstrate insulin resistance (peripheral glucose utilization rate (M)=4.3 mg/kg per min) and there was no family history of type 2 diabetes or maturity onset diabetes in youth. Both fasting and stimulated c-peptide levels, including those in response to i.v. glucagon, were below the limit of detection. This is consistent with loss of beta-cell function. The family history did not reveal the existence of relatives with lipid abnormalities, coronary heart disease, and pancreatitis. We did not find any abnormality of plasma apoCII, lipoproteinlipase and hepatic lipase activities. The patients had a epsilon3/epsilon3 apoE genotype and she rapidly cleared an oral fat load after normalization of plasma lipids. CONCLUSIONS: The mild hyperglycemia seems an unlikely explanation for both the severe hypertriglyceridemia and chylomicronemia. A more plausible explanation is transient lipoproteinlipase deficiency. This rare condition, occasionally associated with a high-fat diet, could have caused the rapid and dramatic hypertriglyceridemia observed in this patient, which in turn might have led to the beta-cell destruction by direct lipid toxicity.- - - - - - - - - - ranking = 0.87892033833266keywords = diabetes (Clic here for more details about this article) |
5/13. Acute onset and worsening of diabetes concurrent with administration of statins.We report a patient in whom the administration of HMG CoA reductase inhibitors (statins) might have triggered the onset and worsening of diabetes. The patient was a 48-year-old Japanese man who underwent annual medical examination but had never been told of hyperglycemia. Four months after the commencement of atorvastatin (10 mg/day) treatment, a diagnosis of diabetes mellitus was made from his typical symptoms of hyperglycemia, postprandial plasma glucose level of 29.8 mmol/l and HbA1c of 11.5%. After 2 months of insulin therapy and 3 months after the cessation of atorvastatin, almost complete resolution of diabetes was observed. During the subsequent 3 months, diet therapy alone was sufficient to control blood glucose level. Then, we prescribed pravastatin (20 mg/day). During the subsequent 3 months, HbA1c was gradually increased. However, after discontinuation of pravastatin, HbA1c was gradually decreased. In the general population, statin does not seem to have critical adverse effects on glucose tolerance, but it may uncommonly modify the natural course of the development of diabetes in certain patients.- - - - - - - - - - ranking = 1.2690552960411keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
6/13. Managing the whole patient with hypertension: practical applications in a clinical setting.physicians are aware of the value of treating hypertension. Complications such as stroke and congestive heart failure are less likely to occur in the well-controlled patient. In our quest to add coronary heart disease to this list, we must go beyond simple reduction of blood pressure. We must consider other risk factors such as hypercholesterolemia, cigarette smoking, diabetes mellitus, and family history. The presence of one or more of these may indicate a more aggressive treatment approach. Similarly the presence of left ventricular hypertrophy, coronary disease, or renal disease may indicate specific pharmacotherapy. On the other hand, the low-risk patient with no other problems or conditions may be treated with only nonpharmacologic therapy such as weight loss, dietary sodium reduction, and/or alcohol restriction. Every patient has a different constellation of findings. Every patient should be treated individually. It is no longer sufficient just to lower blood pressure; we need to manage the whole patient with hypertension; keeping in mind that most antihypertensive agents are equally effective, the side effect profile is often the decisive factor in choosing an antihypertensive agent.- - - - - - - - - - ranking = 0.5keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
7/13. Multiple asymptomatic yellowish-white nodules on the free gingiva.Gingival plane xanthomas are unusual oral presentations of hyperlipidemia and they may be of minimal clinical significance to the patient because they are asymptomatic. However, the presence of gingival xanthomas should be considered as a possible precursor of an underlying life-threatening disease process. Many of these systemic conditions may severely compromise dental therapy; they include atherosclerotic coronary disease, peripheral vascular disease, diabetes mellitus, biliary cirrhosis, multiple myelomas, leukemia, and hyperthyroidism. Clinicians should be aware of this association and its important implications.- - - - - - - - - - ranking = 0.5keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
8/13. Type II diabetes: some problems in diagnosis and treatment.This case is a rather typical presentation of a patient with mild, type II diabetes. His case illustrates some of the pitfalls in the dietary management of diabetes, in treating the glucose abnormality and hypertension, and in diagnosing the mental obtundation that can occur in type II disease. This patient inverted question marks glucose abnormality can probably be treated adequately with a normal- or low-calorie diet that is appropriately high in carbohydrates and low in fats. His hypertension must be treated adequately, preferably with lower doses of diuretics or, if other drugs are necessary, one other than a beta-adrenergic blocking drug. Clearly, his cholesterol should be treated too, but the high-carbohydrate, low-fat diet now prescribed for diabetics will probably be adequate to reduce this risk factor for cardiovascular disease. Finally, the last major risk factor for cardiovascular disease, namely smoking, should unquestionably be removed.- - - - - - - - - - ranking = 0.65919025374949keywords = diabetes (Clic here for more details about this article) |
9/13. diabetes mellitus and cerebrovascular disease: prevalence of carotid artery occlusive disease and associated risk factors in 482 adult diabetic patients.The prevalence of carotid artery occlusive disease (CAOD) in a population of adults with diabetes mellitus was determined, and factors associated with its presence were identified. By oculoplethysmography and phonoangiography, 20% of the population studied had detectable CAOD. Univariate analyses revealed that patients with CAOD had a higher prevalence of retinopathy proteinuria, a slower mean conduction velocity in two of three nerves tested, and more atherosclerosis in the leg arteries. Furthermore, increased age, higher cholesterol, lower fasting insulin, higher systolic blood pressure, and less adiposity were associated with the presence of CAOD. sex, race, type of diabetes (type I or II), duration of diabetes, and measures of glycemia were not related to CAOD. When 10 variables were analyzed by multivariate methods, higher systolic blood pressure, higher cholesterol, and reduced adiposity were found to be the combination most significantly related to CAOD.- - - - - - - - - - ranking = 1.0042215106747keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
10/13. Severe hypertriglyceridaemia responding to insulin and nicotinic acid therapy.A patient with unusually severe hypertriglyceridaemia (serum concentration initially 258 mmol/l or 22600 mg/dl) and hypercholesterolaemia is reported and discussed. The triglyceride elevation was found to reside within the very low density lipoprotein fraction and was probably attributable to the combination of diabetes mellitus and familial hypertriglyceridaemia. Treatment with insulin and restriction of dietary carbohydrate led to a 50% reduction in the triglyceride concentration, and the addition of nicotinic acid in modest doses led ultimately to a complete normalization of the patient's lipid values. A close correlation was noted between the falling triglyceride concentration and the rising serum sodium concentration during the course of successful therapy. overall, it is felt likely that this patient's severe and reversible hypertriglyceridaemia was on the basis of excessively rapid lipolysis leading to high concentrations of very low density lipoprotein production. Combined therapy with insulin and nicotinic acid is recommended for other patients of this nature.- - - - - - - - - - ranking = 0.5keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
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