1/10. hypothermia with acute renal failure in a patient suffering from diabetic nephropathy and malnutrition.We report a rare case of hypothermia with acute renal failure in a patient suffering from diabetic nephropathy. A 71-year-old male who had been receiving insulin therapy for the treatment of diabetes mellitus complicated with advanced diabetic nephropathy since 1998 was malnourished with an extremely decreased muscle mass. Without any prolonged exposure to excessively low external temperatures or hypothyroidism, pituitary insufficiency, adrenal insufficiency, sepsis, hypoglycemia, and diabetic ketoacidosis, acute hypothermia appeared together with an aggravation of diabetic nephropathy. His skin temperature fell to below measurable levels and his rectal temperature fell to 30.0 degrees C. His consciousness was drowsy and the hypothermia was not accompanied by shivering. Skeletal muscle is known to play an important role as a center of heat production and shivering thermogenesis in skeletal muscle mainly operates on acute cold stress. Therefore, in this case, hypothermia may have occurred because the shivering thermogenesis could not fully act on the acute cold stress due to the dramatically reduced muscle mass. We should always keep in mind that older, malnourished diabetic patients can easily suffer from impairments of the thermoregulatory system.- - - - - - - - - - ranking = 1keywords = diabetes mellitus, mellitus, diabetes (Clic here for more details about this article) |
2/10. Profound postoperative hypoglycemia in a malnourished patient.PURPOSE: To present an unusual case of profound postoperative hypoglycemia resulting in irreversible brain damage in a malnourished patient. CLINICAL FEATURES: A 56-yr-old malnourished woman underwent laparotomy for intestinal obstruction under general anesthesia. Five hours postoperatively she was found to be unresponsive with an immeasureably low blood glucose level. This event was not associated with hyperinsulinemia. Predisposing factors like diabetes mellitus, pheochromocytoma, insulin secreting tumours, adrenal or pitutary deficiency were absent. She was treated with iv dextrose and hydrocortisone with blood glucose levels stabilizing fairly rapidly. However, she unfortunately had sustained irreversible cerebral damage and is left with significant neurological disability. CONCLUSION: Severe postoperative hypoglycemia has several well documented causes. Although hypoglycemia does occur to a moderate degree in malnutrition, it has not been reported to be so severe as to cause cerebral damage in the postoperative setting.- - - - - - - - - - ranking = 1keywords = diabetes mellitus, mellitus, diabetes (Clic here for more details about this article) |
3/10. Clinical nutrition in primary health care.Nutritional diagnosis and management are important aspects of general practice. This information, which is presented in two parts, offers the general practitioner a practical framework and an approach to nutritional advice. Part 1 outlines the clinical conditions and principles involved in nutritional diagnosis with a management approach to macrovascular disease and obesity. Part 2 covers protein malnutrition, eating disorders, osteoporosis, nutrient toxicity, cancer, inherited metabolic disorders, nutrient deficiency and diabetes mellitus. This material is based on a seminar organised by Kellogg (australia) Pty Ltd in Melbourne in 1989 and the material is reproduced with the kind permission of Kellogg (australia) Pty Ltd.- - - - - - - - - - ranking = 1keywords = diabetes mellitus, mellitus, diabetes (Clic here for more details about this article) |
4/10. Triple-layer laryngeal closure for intractable aspiration.Impaired laryngeal protective function can result in intractable aspiration, which causes recurrent life-threatening pneumonia. Several surgical operations have been developed to treat intractable aspiration. In this case, we report a successful case of triple-layer laryngeal closure, which was performed in a patient with type II diabetes mellitus and nutritional failure due to intractable aspiration that had been caused by several stroke attacks. Triple-layer laryngeal closure is a unique modified technique that combines laryngotracheal separation and glottic closure operations. The method that we performed can be done more safely in patients who have higher post-operative and general anaesthesia risks.- - - - - - - - - - ranking = 1keywords = diabetes mellitus, mellitus, diabetes (Clic here for more details about this article) |
5/10. Congenital diabetes mellitus and fatal secretory diarrhea in two infants.Two unrelated male infants presented with brittle insulin-dependent diabetes mellitus in the first days of life. Subsequently they each developed severe secretory diarrhea, with stool volumes of more than 100 ml/kg/day. Extensive biochemical and serological investigation failed to reveal the etiology of the diarrhea. The infants, cared for at different institutions, underwent therapeutic trials of various agents including loperamide, cholestyramine, prednisone, indomethacin, and somatostatin analogue, without response. Both infants succumbed to septicemia and malnutrition related to diarrhea and poor control of glycemia. At autopsy, both were found to have absence of islets of langerhans in the pancreas, and diffuse dysplastic changes in small and large intestinal mucosae. In particular, the entire alimentary tract in each case was lined by epithelia most typical of foregut mucosa: secretory-type glands, absent crypts of Lieberkuhn, and absent villi. These cases are contrasted with previously-reported infants with congenital diabetes mellitus, and the possible interrelation of these two highly unusual findings, congenital diabetes mellitus and diffuse intestinal dysplasia, is examined.- - - - - - - - - - ranking = 7keywords = diabetes mellitus, mellitus, diabetes (Clic here for more details about this article) |
6/10. A case of transient elevation of the serum carcinoembryonic antigen and associated with severe malnutrition and low T3, T4 syndrome.A patient with a transient elevation of the serum carcinoembryonic antigen (CEA) associated with a benign disease was reported. The elevation of CEA was noted in the patient with low T3, T4 syndrome associated with malnutrition due to malabsorption syndrome induced by post-gastrectomy and chronic pancreatitis. Mild liver dysfunction and diabetes mellitus were also noted. The CEA level decreased as T3, T4 level and malnutrition were improved by administration of a massive digestive enzyme preparation. This inverse correlation between the serum CEA and serum T3, T4 levels suggested that high levels of the serum CEA can be found in the patient with malnutrition.- - - - - - - - - - ranking = 1keywords = diabetes mellitus, mellitus, diabetes (Clic here for more details about this article) |
7/10. The presence of islet cell antibodies in malnutrition-related diabetes mellitus.The etiology of malnutrition-related diabetes mellitus (MRDM), mostly seen in the developing countries, is still unknown, though an excessive consumption of cassava and a low intake of protein are considered to be its causative factors. Previous immunological studies, though rarely performed, have so far, to our knowledge, shown no case of MRDM with iselt cell antibodies (ICA). We found a 16-year-old MRDM boy with ICA and report on this in the present communication.- - - - - - - - - - ranking = 5keywords = diabetes mellitus, mellitus, diabetes (Clic here for more details about this article) |
8/10. Fibrocalculous pancreatic diabetes in papua new guinea.While fibrocalculous pancreatic diabetes (FCPD) has long been recognized in neighboring indonesia, there has been only one single case reported from papua new guinea. Over an eighteen month period, four new cases of FCPD were seen at this hospital, making FCPD the predominant form of diabetes seen in papua new guinea highlanders. abdominal pain was prominent in only one patient. Cassava formed a small part of the diet of all patients. Control with tolbutamide alone was possible in two patients and the addition of a small dose of isophane insulin gave satisfactory control in the other two. Two patients were particularly sensitive to low doses of insulin.- - - - - - - - - - ranking = 0.57799080470591keywords = diabetes (Clic here for more details about this article) |
9/10. Surgical syndromes of the hypothalamus.The clinical syndromes described with lesions of the hypothalamus are summarized in Table 9.5-9.7. The anterior hypothalamic syndrome consists of insomnia and loss of thirst regulatory mechanisms. In occasional larger lesions which interrupt the output from the supraoptic and paraventricular nuclei, diabetes insipidus has been noticed. In the tuberal region of the hypothalamus the most prominent findings are those that are caused by the disruption of the final common pathway to the pituitary. This results in endocrinopathy, most often the syndrome originally reported by Frohlich, with failure of sexual maturation and obesity. In the tuberal region, differences between lesions of the medial and lateral portions are quite marked. Medial lesions result in obesity while bilateral lesions result in anorexia and emaciation. The diencephalic syndrome of infancy with it's severe emaciation in young years and obesity in later years clearly indicates a different organizational pattern in the neonatal hypothalamus. Emotional disorders may be seen with lesions either in the medial or lateral hypothalamus at the tuberal level. Finally, in the posterior hypothalamic region, which includes the greatest effector apparatus, hypersomnia, apathy, and poikilothermia have been reported. Emotional disturbances and the Wernicke-korsakoff syndrome also seemed to be associated with lesions in this area. The hypothalamus remains the single most important integrator of vegetative and endocrinologic regulation of the body. Cushing said of the hypothalamus, "here in this hidden spot, almost to be covered with a thumb nail, lies the very main spring of primitive existence: vegetative, emotional and reproductive".- - - - - - - - - - ranking = 0.096331800784319keywords = diabetes (Clic here for more details about this article) |
10/10. Two cases of fatal strongyloidiasis in hong kong.Two cases of fatal strongyloidiasis associated with diabetes mellitus and malnutrition are reported. The patients presented with repeated vomiting and upper gastrointestinal bleeding respectively. Unusual findings in these two patients included: unexplained peripheral leukocytosis, pulmonary infiltrates, gastric aspirate leukocytosis, progression of gastrointestinal symptoms and concurrent presence of adult worms, eggs, filariform and rhabditiform larvae of strongyloides stercoralis in alimentary canal specimens. Both patients succumbed while receiving treatment with mebendazole. The present report illustrates that unexplained gastrointestinal symptoms with extensive scratch marks below the umbilicus can be important clues to early diagnosis of the disease. In addition, the various presentations of S. stercoralis infestation are discussed with reference to predisposing factors. Current trends in laboratory diagnosis and therapeutic considerations are also delineated.- - - - - - - - - - ranking = 1keywords = diabetes mellitus, mellitus, diabetes (Clic here for more details about this article) |
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