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Cytoreduction with Hyperthermic Intraperitoneal Chemotherapy and Renal Insufficiency Related to Diabetes Mellitus: An Anesthetic Challenge

Abstract

Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) improves the prognosis in selected patients with peritoneal surface malignancies but it is an extensive procedure predisposing to major complications. Among them renal toxicity was reported. Severe renal insufficiency is considered a contraindication for this complex procedure. We present a patient with diabetic nephropathy with renal insufficiency KDOQI 3 and peritoneal metastasis from sigmoid adenocarcinoma with a good clinical outcome after CRS with HIPEC, highlighting the anesthetic precautions considered for this particular clinical case.

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Characteristics of Coronary Lesions in Small Vessel Disease Treated with Elective Stenting in Patients with Type 2 Diabetes Mellitus

Engl J Med . 1998;339:229-234. 4. Kornowski R, Mintz GS, Kent KM, et al. Increased restenosis in diabetes mellitus after coronary interventions is due to exaggerated intimal hyperplasia. A serial intravascular ultrasound study. Circulation . 1997;95(6):1366-1369. 5. Mintz GS. Diabetic Coronary Artery Disease. JACC . 2008;52(4):263-265. 6. Scognamiglio R, Negut C, Ramondo A, Tiengo A, Avogaro A. Detection of Coronary Artery Disease in Asymptomatic Patients With Type 2 Diabetes Mellitus. J Am Coll Cardiol . 2006;47(1):65-71. 7. Srinivasan MP

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Imaging Techniques for the Assessment of Coronary Arteries in Diabetic Patients Undergoing PCI with Bioresorbable Vascular Scaffolds

REFERENCES 1. Roffi M, Angiolillo DJ, Kappetein AP. Current concepts on coronary revascularization in diabetic patients. Eur Heart J . 2011;32:2748-2757. 2. Srinivasan MP, Kamath PK, Bhat NM. Severity of coronary artery disease in type 2 diabetes mellitus: Does the timing matter. Indian Heart J . 2016;68:158-163. 3. Mintz GS. Diabetic Coronary Artery Disease – How Little We Know and How Little Intravascular Ultrasound Has Taught Us. J Am Coll Cardiol . 2008;52:263-265. 4. McCullough PA, Fazel P, Choi JW. Screening, Diagnosis, and

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Screening for Cognitive Dysfunction Helped to Unmask Silent Cerebrovascular Disease in a Hypertensive Diabetic Patient — Case Report

Abstract

The current guidelines for the diagnosis and treatment of hypertension recommend screening for cognitive impairment in all hypertensive patients as part of the clinical assessment. However, the implementation of this recommendation in clinical practice is still unsatisfactory. We present the case of an elderly hypertensive female patient in order to highlight the importance of screening for cognitive impairment. A patient with a history of poorly controlled hypertension for the last 12 years and recently diagnosed with type 2 diabetes mellitus is admitted complaining of asthenia, dizziness, visual acuity impairment, and difficulty to remember recent information. Cardiovascular imaging showed 70% internal carotid artery stenosis in a neurologically asymptomatic patient. Cognitive testing showed mild cognitive impairment. Retinal imaging identified stage III hypertensive retinopathy accompanied by irreversible end-organ damage due to microvascular changes. At this point brain MRI was performed, which identified both macro- and microvascular brain lesions in the periventricular white matter and sequelae of a former ischemic stroke in the territory of the left posterior cerebral artery. Cognitive testing helped to unmask silent cerebrovascular disease in an otherwise oligosymptomatic hypertensive diabetic patient. Cognitive function testing should be introduced in routine clinical practice in order to help unmask silent cerebrovascular disease.

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Management of Microvascular Complications in Secondary Diabetes Associated with Autoimmune Diseases — Case Report

Abstract

The association of multiple autoimmune diseases may represent the main focus of physicians treating patients with such pathology presenting no comorbidities of different etiology. However, autoimmune diseases and side effects of drugs may lead to development of silent health-threatening diseases that should be identified promptly. We present the case of an elderly, obese, Caucasian female patient suffering of autoimmune thyroiditis, rheumatoid arthritis, and psoriasis, who developed arterial hypertension and insulin-treated secondary diabetes mellitus (due to long-term oral corticotherapy) with microvascular end-organ changes. Retinal imaging for capillary anomalies identified mild non-proliferative diabetic retinopathy with apparent diabetic macular edema and hypertensive retinopathy. Laboratory investigations looking for further vascular risk factors revealed zinc deficiency, elevated serum homocysteine levels, and constantly high C-reactive protein concentration. Attention should be payed to the proper investigation of patients with autoimmune diseases, targeting the early diagnosis of microvasculopathies due to autoimmune diseases or possible medication side effects, in order to prevent end-organ damage.

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An Overview of Disease Burden, Mechanism, Traditional and Non-traditional Management of Type 2 Diabetes

. JMIR Diabetes . 2017;2:e7. 5. Wang R, Zhang P, Lv X, et al. Situation of diabetes and related disease surveillance in rural areas of Jilin Province, Northeast China. Int J Environ Res Public Health . 2016;13:538. 6. Gnavi R, Karaghiosoff L, Costa G, Merletti F, Bruno G. Socio-economic differences in the prevalence of diabetes in Italy: the population-based Turin study. Nutr Metab Cardiovasc Dis . 2008;18:678-682. 7. Kaiser A, Vollenweider P, Waeber G, Marques-Vidal P. Prevalence, awareness and treatment of type 2 diabetes mellitus in Switzerland

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Can Erectile Dysfunction Predict Major Cardiovascular Events?

, hyperlipidemia, diabetes mellitus and depression in men with erectile dysfunction. J Urol . 2004;171:2341-2345. 5. Solomon H, Man JW, Jackson G. Erectile dysfunction and the cardiovascular patient: endothelial dysfunction is the common denominator. Heart . 2003;89:251-253. 6. Feldman HA, Johannes CB, Derby CA, et al. Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med . 2000;30:328-338. 7. Fung MM, Bettencourt R, Barrett-Connor E. Heart disease risk factors predict erectile dysfunction 25

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Treading on tricky ground: reconstructive approaches to Charcot neuropathic arthropathy of the foot

. 17. Botezatu I, Laptoiu D. Minimally invasive surgery of diabetic foot - review of current techniques. J Med Life. 2016 Jul-Sep; 9(3):249-254. 18. DiDomenico L, Flynn Z, Reed M. Treating Charcot Arthropathy Is a Challenge: Explaining Why My Treatment Algorithm Has Changed. Clin Podiatr Med Surg. 2018 Jan; 35(1):105-121. doi: 10.1016/j.cpm.2017.08.012. 19. Wukich DK, Mallory BR, Suder NC, Rosario BL. Tibiotalocalcaneal Arthrodesis Using Retrograde Intramedullary Nail Fixation: Comparison of Patients With and Without Diabetes Mellitus

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Midshaft femoral fracture in an elderly patient with a rich history. Therapeutic and economic insights

. 2018; 9:2151458517750515-2151458517750515. doi: 10.1177/2151458517750515. 12. Wukich DK, Lowery NJ, McMillen RL, Frykberg RG. Postoperative Infection Rates in Foot and Ankle Surgery: A Comparison of Patients with and without Diabetes Mellitus. JBJS. 2010; 92(2). https://journals.lww.com/jbjsjournal/Fulltext/2010/02000/Postoperative_Infection_Rates_in_Foot_and_Ankle.4.aspx. 13. Levy D. The fat embolism syndrome. A review. Clin Orthop Relat Res. 1990; (261):281-286. 14. Ricci WM, Schwappach J, Tucker M et al. Trochanteric

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Toxic Epidermal Necrolysis - A Case Report

Abstract

Toxic epidermal necrolysis (TEN) is an acute, life-threatening muco-cutaneous disease, often induced by drugs. It is characterized by muco-cutaneous erythematous and purpuric lesions, flaccid blisters which erupt, causing large areas of denudation. The condition can involve the genitourinary, pulmonary and, gastrointestinal systems. Because of the associated high mortality rate early diagnosis and treatment are mandatory.

This article presents the case of a sixty-six years old male patient, known to have cirrhosis, chronic kidney failure, and diabetes mellitus. His current treatment included haemodialysis. He was hospitalized as an emergency to the Dermatology Department for erythemato-violaceous, purpuric patches and papules, with acral disposition, associated with rapidly spreading erosions of the oral, nasal and genital mucosa and the emergence of flaccid blisters which erupted quickly leaving large areas of denudation. Based on the clinical examination and laboratory investigations the patient was diagnosed with TEN, secondary to carbamazepine intake for encephalopathic phenomena. The continuous alteration in both kidney and liver function and electrolyte imbalance, required him to be transferred to the intensive care unit. Following pulse therapy with systemic corticosteroids, hydro-electrolytic re-equilibration, topical corticosteroid and antibiotics, there was a favourable resolution of TEN.

The case is of interest due to possible life-threatening cutaneous complications, including sepsis and significant fluid loss, in a patient with associated severe systemic pathology, highlighting the importance of early recognition of TEN, and the role of a multidisciplinary team in providing suitable treatment.

Open access