1/98. Takayasu's arteritis on steroid therapy. Seven years follow-up.The authors report a 7 year follow-up of Takayasu's arteritis (TA) type III, group 1, in a young Italian woman. At diagnosis, at the age of 25, the echotomographic and angiographic studies showed narrow subclavian arteries, narrow abdominal aorta (diameter of 0.6-0.8 cm) below the renal arteries, stenotic left common carotid and renal arteries, and occluded upper mesenteric artery. With steroid therapy, (prednisone 50 mg/day per os), the erythrocyte sedimentation rate (ESR) normalized within 12 days. With a maintenance dosage of 7.5 mg/day per os, the patient achieved remission as documented by the absence of symptoms, the persistent normalization of ESR, and the improving of the diameter of the abdominal aorta (1.3-1.4 cm). On steroid therapy, the patient had a normal pregnancy and delivered a healthy baby girl. The disease has been stable for seven years. Recently, diabetes mellitus occurred and it has been treated with insulin therapy. The rising of ESR after tapering of steroid therapy (prednisone 5 mg per os on alternate days) suggests an alternative treatment with a cytotoxic agent.- - - - - - - - - - ranking = 1keywords = diabetes, diabetes mellitus, mellitus (Clic here for more details about this article) |
2/98. Central pontine myelinolysis: association with parenteral magnesium administration.A 29-year-old woman with diabetes mellitus and nephrotic syndrome was given 30 g of magnesium sulfate over 14 hours after a cesarian section. Her serum magnesium level increased to 7.4 mg/dl. Five days later, she became quadriplegic with inability to speak or swallow. Cranial magnetic resonance imaging demonstrated central pontine myelinolysis (CPM). Initial serum sodium was not measured. Although CPM is usually associated with a rapid increase in serum osmolality, most patients who experience a rapid increase in serum osmolality do not develop the clinical syndrome of CPM. Consequently, additional factors may also be important in the pathogenesis of CPM. Parenteral magnesium administration may be a potential contributing factor in the pathogenesis of some cases of CPM.- - - - - - - - - - ranking = 1keywords = diabetes, diabetes mellitus, mellitus (Clic here for more details about this article) |
3/98. Twin pregnancy following gonadotrophin therapy in a patient with Sheehan's syndrome.A case of Sheehan's syndrome presented with secondary amenorrhea and was put on L-thyroxine, prednisolone and cyclical estrogen and progestin. ovulation induction with gonadotrophins and intrauterine insemination with husband's semen resulted in a twin pregnancy. Antepartum course was complicated by bronchial asthma, gestational diabetes and pregnancy-induced hypertension. Cesarian section was done at 34 weeks gestation for preterm rupture of membranes and breech presentation. Both babies and their mother were doing well at 6 months of follow-up.- - - - - - - - - - ranking = 0.63520444528621keywords = diabetes (Clic here for more details about this article) |
4/98. Successful outcome of pregnancy in a patient with generalized lipoatrophic diabetes mellitus.OBJECTIVE: To report the first known case of a successful outcome of pregnancy in a patient with generalized lipoatrophic diabetes. methods: We present a detailed case report of a patient who achieved and successfully completed a pregnancy despite having lipoatrophic diabetes. RESULTS: With careful attention to glycemic control with use of U-500 insulin and strict avoidance of dietary fat, a 23-year-old woman with lipoatrophic diabetes maintained a pregnancy to 28 weeks. The infant weighed 1,235 g and was devoid of serious metabolic complications. Three months after childbirth, the patient died of gastrointestinal bleeding. CONCLUSION: We are not aware of any previously published report of a successful pregnancy in a patient with generalized, acquired lipoatrophic diabetes. Because of the involvement of multiple organ systems in generalized lipoatrophic diabetes, female patients should be thoroughly advised of the serious pregnancy-associated risks to both the mother and the fetus and the need for extremely close monitoring.- - - - - - - - - - ranking = 7.176022226431keywords = diabetes, diabetes mellitus, mellitus (Clic here for more details about this article) |
5/98. Fatal fetal outcome with the combined use of valsartan and atenolol.OBJECTIVE: To report a case of anhydramnios, pulmonary hypoplasia, very small placenta, and fetal death in a pregnancy complicated by chronic hypertension and diabetes mellitus that had been treated through the first 24 weeks of gestation with valsartan and atenolol. CASE SUMMARY: A 40-year-old Hispanic woman with well-controlled chronic hypertension and diet-controlled type 2 diabetes mellitus was treated with valsartan and atenolol until pregnancy was diagnosed at 24 weeks' gestation. An ultrasound examination revealed normal fetal growth and anatomy but anhydramnios (amniotic fluid index 0). Valsartan was discontinued, and amniotic fluid volume normalized within two weeks. Intrauterine fetal death was documented at 33 weeks' gestation. Labor was induced, with the delivery of a stillbom female fetus with small, hypoplastic lungs (weight 41% of expected) and an extremely small, 148-g placenta (weight 48% of the 10th percentile for gestational age). DISCUSSION: The use of valsartan, a selective angiotensin ii receptor antagonist (ARA), in human pregnancy has not been reported, but this class of agents would be expected to cause fetal toxicity similar to that observed with angiotensin-converting enzyme inhibitors. This toxicity includes reduced perfusion of the fetal kidneys, resulting in anuria, oligohydramnios, and subsequent pulmonary hypoplasia. The small hypoplastic lungs and very small placenta were probably a consequence of valsartan and atenolol combination therapy. CONCLUSIONS: Resolution of anhydramnios after discontinuing valsartan is evidence for ARA-induced fetal toxicity. The pulmonary hypoplasia observed in the stillbom infant was a direct result of the severe oligohydramnios. The cause of fetal death nine weeks later is uncertain, but because the woman's chronic hypertension and diabetes were well controlled, we believe the primary cause was chronic placental insufficiency resulting from the previous combination of valsartan and atenolol.- - - - - - - - - - ranking = 2.6352044452862keywords = diabetes, diabetes mellitus, mellitus (Clic here for more details about this article) |
6/98. Hepatocyte nuclear factor-1beta: a new kindred with renal cysts and diabetes and gene expression in normal human development.The hepatocyte nuclear factor-1beta (HNF-1beta) transcription factor controls endoderm development. Human mutations cause early-onset diabetes mellitus and have recently been associated with dysplastic, hypoplastic, and glomerulocystic kidneys. A new kindred with this "renal cysts and diabetes" syndrome is described, and nephrogenic HNF-1beta expression is defined. The proband had congenital cystic kidneys: over the next 12 yr, his renal function was impaired, but he was normoglycemic. His mother developed diabetes during pregnancy: renal ultrasonography at age 24 yr was normal, but she subsequently developed cysts. Both subjects have a heterozygous frameshift mutation in HNF-1beta that results from a 1-bp insertion in exon 5 (Y352fsinsA). When reverse-transcription PCR and in situ hybridization were used, HNF-1beta mRNA was detected in normal human metanephroi, with the highest levels of transcripts localized to fetal medullary and cortical collecting ducts and low levels of expression in nephrogenic cortex mesenchyme, primitive nephron tubules, and immature glomeruli. These results constitute the first demonstration of HNF-1beta expression during human nephrogenesis and emphasize a disease spectrum associated with HNF-1beta mutation.- - - - - - - - - - ranking = 4.8112266717172keywords = diabetes, diabetes mellitus, mellitus (Clic here for more details about this article) |
7/98. Contraindication of magnesium sulfate in a pregnancy complicated with late-onset diabetes mellitus and sensory deafness due to mitochondrial myopathy.A primipara affected by late-onset diabetes and sensory deafness because of mitochondrial myopathy was hospitalized for threatened preterm delivery. magnesium sulfate was started for tocolysis, resulting in general muscle damage, although the mitochondrial myopathy did not deteriorate during pregnancy. magnesium sulfate may be contraindicated in pregnancy with mitochondrial myopathy.- - - - - - - - - - ranking = 4.6352044452862keywords = diabetes, diabetes mellitus, mellitus (Clic here for more details about this article) |
8/98. Case report and review of the perinatal implications of maternal lithium use.The purpose of this study was to review the use of lithium in pregnancy and its effects on the neonate. This was a case study and review of the published literature.lithium is commonly used in the treatment of psychiatric disorders, specifically bipolar depression. Bipolar disorders that require treatment with lithium demand special consideration when the woman becomes pregnant. Reported neonatal problems with maternal lithium therapy include Ebstein's anomaly, poor respiratory effort and cyanosis, rhythm disturbances, nephrogenic diabetes insipidus, thyroid dysfunction, hypoglycemia, hypotonia and lethargy, hyperbilirubinemia, and large-for-gestational-age infants.lithium can have adverse effects on the fetus and newborn infant, but data suggest normal behavioral patterns in childhood.- - - - - - - - - - ranking = 0.63520444528621keywords = diabetes (Clic here for more details about this article) |
9/98. Fulminant diabetes mellitus associated with pregnancy: case reports and literature review.We report two cases of type 1 diabetes mellitus fulminantly developed as diabetic ketoacidosis (DKA) at 19 weeks of gestation and immediately after delivery. Development of type 1 diabetes around pregnancy is not rare, but its fulminant development is highly uncommon. We also review the relevant literature concerning mostly Japanese cases. In our cases, the group of patients with fulminant progressive diabetes mellitus associated with pregnancy required insulin replacement therapy even after the acute period and showed high value of pancreatic exocrine enzymes, i.e. amylase, elastase, and lipase. The phenotype of this group was similar to "nonautoimmune, fulminant type 1 diabetes" described by Imagawa et al., where the laboratory data of type 1 diabetes-related autoantibodies showed negative. It is well known that autoimmune diseases are in good control during pregnancy. Our present finding suggests that this type of fulminant type 1 diabetes mellitus associated with pregnancy might develop as a consequence of a nonautoimmune mechanism.- - - - - - - - - - ranking = 8.9056133358586keywords = diabetes, diabetes mellitus, mellitus (Clic here for more details about this article) |
10/98. African American women describe support processes during high-risk pregnancy and postpartum.OBJECTIVE: To explore social support processes in low-income African American women during high-risk pregnancy and postpartum. DESIGN: A qualitative grounded theory approach. interview was the primary data collection technique and was combined with observation, medical chart review, and literature review. SETTING: A high-risk pregnancy clinic and participants' homes. PARTICIPANTS: Ten pregnant women, 3 social network members, and 11 health care providers. Four of the women at high risk tell their in-depth stories in this article: Yolanda, coping with gestational diabetes; Frances, participating in drug rehabilitation; Trista, waiting to deliver a fetus with severe congenital anomalies; and Beatrice, hiv positive and carrying her seventh child. RESULTS: The substantive theory of support developed in the study was termed mutual intentionality. Narratives illustrate the mutual roles that women at high risk and support givers played in the helping process. Support themes included being there, caring, respecting, sharing information, knowing, believing in, and doing for the other. CONCLUSION: The theorsy of mutual intentionality suggests that social support is a process or transaction involving intentionality. For support to happen, the therapeutic relationship must be valued as a mutual resource.- - - - - - - - - - ranking = 0.63520444528621keywords = diabetes (Clic here for more details about this article) |
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