Pankreaserkrankungen und Diabetes mellitus

The onset of diabetes mellitus is a common complication among patients with pancreatic disease. Although treatment of the primary disease takes priority over secondary complications, diabetes often represents a challenge in daily practice and has a major impact on the long-term prognosis and quality of life in those patients. This report provides information on the most relevant clinical conditions of the pancreas associated with diabetes and describes therapeutic strategies. Furthermore, the significance of new onset diabetes for early diagnosis of pancreatic disease is discussed.     

脊柱结核并发HIV感染/AIDS患者的诊治现状与进展概述

目前,脊柱结核并发HIV感染/AIDS患者逐年增多。临床工作者对该疾病缺乏统一认识,对该疾病最新诊治手段也缺乏了解。作者就该疾病诊断的新技术、新的抗结核治疗药物及治疗方案、高效抗逆转录病毒治疗进展、手术方式进展,以及脊柱结核并发HIV感染/AIDS患者手术时的术中防护、最新研究方向等进行简要概述,以期在一定程度上统一认识,提高对该疾病的诊疗水平。     

The glucagonoma syndrome. 3 new cases]

We report three new cases of glucagonoma revealed, 6 to 12 months after its onset, by non-specific and misleading skin lesions associated in all 3 cases with diabetes mellitus, severe deterioration of the general condition and hyperglucagonaemia. Non-invasive methods, such as ultrasonography and computerized tomography (CT), are most helpful to locate the pancreatic tumour. Phlebography with tiered venous blood sampling is useful in difficult cases. A false positive result has been recorded with arteriography. Ultrasonography and CT have yielded two false negative results. The alpha-chain of the chorionic gonadotrophin hormone has limited value in the diagnosis of malignant glucagonoma. Treatment is surgical, but despite it, the prognosis is severe (two of our three patients died), due to the risk of thromboembolism, to cachexia and to metastases that are frequent at the time of diagnosis.     

Behcet's disease manifested as a intracranial aneurysm

INTRODUCTION: Mostly venous (95% of all vascular complications), and less frequently arterial (2 to 7% of all cases), vascular complications are commonplace in Beh?et's disease (23 to 64% of the patients, depending on the series). Arterial complications are stenosis, occlusions and especially severe due to their unpredictable rupture risk, aneurysms. Intracranial aneurysms associated with Beh?et's disease are exceptional. Until now, only ten cases have been published. EXEGESIS: We report the case of a 36-year-old patient of Armenian origin in whom the diagnosis of Beh?et's disease was made after a subarachnoid hemorrhage caused by the rupture of a left superior cerebellar artery aneurysm. The endovascular treatment of the aneurysm was associated with an immunosuppressive treatment consisting of cyclophosphamide, corticoids and colchicine. Within a 6-month period of follow up the evolution has been favorable. This is the first published case report of Beh?et's disease associated with an aneurysm of the posterior circulation treated endovascularly. A review of the literature is also included. CONCLUSION: Intracranial aneurysms are an exceptional but nevertheless severe localization of vascular complications in Beh?et's disease. As in all other arterial lesions, recurrences are frequent. The treatment involves surgical or endovascular treatment that should be associated with corticoids and immunosuppressive therapy. Colchicine is useful for the prevention of relapses.     

Comparison of various classification algorithms in the diagnosis of type 2 diabetes in Iran

In today’s medical world, data on symptoms of patients with various diseases are so widespread, that analysis and consideration of all factors is merely not possible by a person (doctor). Therefore, the need for an intelligent system to consider the various factors and identify a suitable model between the different parameters is evident. Knowledge of data mining, as the foundation of such systems, has played a vital role in the advancement of medical sciences, especially in diagnosis of various diseases. Type 2 diabetes is one of these diseases, which has increased in recent years, which if diagnosed late can lead to serious complications. In this paper, several data mining methods and algorithms have been used and applied to a set of screening data for type 2 diabetes in Tabriz, Iran. The performance of methods such as support vector machine, artificial neural network, decision tree, nearest neighbors, and Bayesian network has been compared in an effort to find the best algorithm for diagnosing this disease. Artificial neural network with an accuracy rate of 97.44 % has the best performance on the chosen dataset. Accuracy rates for support vector machine, decision tree, 5-nearest neighbor, and Bayesian network are 81.19, 95.03, 90.85, and 91.60 %, respectively. The results of the simulations show that the effectiveness of various classification techniques on a dataset depends on the application, as well as the nature and complexity of the dataset used. Moreover, it is not always possible to say that a classification technique will always have the best performance. Therefore, in cases where data mining is used for diagnosis or prediction of diseases, consultation with specialists is inevitable, for selecting the number and type of dataset parameters to obtain the best possible results.     

Detecção de diabetes no doente coronário. Que orientações para diagnosticar?

Type 2 diabetes is one of the most prevalent among the growing chronic diseases menace in the world. The costs associated to its diagnosis, treatment and micro and macrovascular complications are also rising exponentially in the last years. People with diabetes have also longer stays in hospital with increased hospital lethality and with a general increase in morbidity and mortality that represents a reduction in the potential years of life. 10% of the Portuguese health costs are spent in diabetes.Coronary disease is strongly associated to diabetes resulting from coexisting pathological pathways, namely through dyslipidaemia and hypertension.In Portugal 43% of the population with diabetes is not diagnosed representing a population with a high cardiovascular risk not subject to treatment. This late diagnosis and intervention is usually associated with a poorer prognosis for both situations.Healthcare providers should be aware of this association and know the relevance of the different diagnostic tests (fasting glycaemia, occasional glycaemia, oral glucose tolerance test and HbA1c) to be used in acute or chronic settings of coronary disease.With an early diagnosis doctors can initiate a more intensive treatment with more stringent glycaemic goals with significant health gains avoiding the costs associated to late complications of diabetes.     

Endoscopic management of pancreatic disease.

Since its introduction in 1968, ERCP has developed from being a purely diagnostic method, mostly used in the investigation of unexplained upper abdominal pain, to an invaluable tool for the management of patients with pancreatic disorders. In cases with severe gallstone pancreatitis, the biliary obstruction is disclosed and relieved by ERCP and ES. In patients with severe acute pancreatitis of other aetiologies, as well as in post-traumatic pancreatitis, ERCP is indispensable for revealing complications (e.g. pancreatic duct rupture) and/or for planning the treatment strategy. Furthermore, in cases of pancreatitis not related to alcohol or gallstones, it often demonstrates causes which may be treatable, and it is also useful for evaluation of the gland after massive pancreatic necrosis. Moreover, ERCP is helpful in establishing the diagnosis of chronic pancreatitis and its complications as well as in demonstrating morphological grounds for therapeutic intervention. Although the indications, limitations, and practicability of the different techniques of therapeutic ERCP in various pancreatic diseases still remain to be defined, the method appears to offer an alternative to surgery, particularly in cases in which operative treatment is technically difficult and the results are less favourable. Frequency and severity of complications associated with both diagnostic and therapeutic ERCP seem to be, at least in the hands of experts, reasonably low.     

Coeliac disease and diabetes

Coeliac disease is associated with type 1 diabetes mellitus more than ten times more frequently than it is present in nondiabetic population. It often exists with minimal signs or without them. It may cause different complications if it would remain without treatment. Active screening of coeliac disease and similarly of autoimmune thyreopathy is therefore an integral part of examination in type 1 diabetic patients.     

Specific diabetes education in children

Education is an integral part of diabetes care. The structured self-management education is the key to improve glycemic control, to reduce the risk of acute and long term complications and it is associated with improved quality of life. Type 1 is the most common type of diabetes in children and adolescents. Although the basic treatment principles are the same as in adults, the developmental characteristics during childhood need to apply age-appropriate, different teaching and learning techniques that should be adaptable to individual abilities, skills, needs and requirements of patients and parents, as well.     

Diabetes management. Analysis of the American Diabetes Association's clinical practice recommendations

Type 2 diabetes generally develops in persons older than age 45 and comprises more than 90% of the estimated 15 million diabetes cases identified in the United States. Due to the burgeoning population of older Americans and the increased prevalence of obesity and sedentariness, type 2 diabetes is nearing epidemic proportions. Tight glycemic control combined with good diet and regular exercise can reduce the incidence of complications associated with unchecked disease. To help physicians and patients achieve such objectives, the American Diabetes Association publishes clinical practice recommendations that propose the most effective methods for screening, diagnosis, and disease management. The position statements presenting the standard of care for treatment of diabetes are reviewed and critiqued from an evidence-based medicine perspective.     

Association of diabetic retinopathy, ischemic heart disease, and albuminuria with diabetic treatment in type 2 diabetic patients

The management of type 2 diabetes has been a controversial issue. The objective of the present study was to estimate patients' characteristics, particularly diabetes treatment, associated with retinopathy, coronary heart disease, and microalbuminuria in an unselected population of 532 type 2 diabetic individuals from three communities. Questionnaires, clinic record review, and physical examination were used for the assessment of the three conditions. Fasting C-peptide was measured in all insulin-treated participants to establish type 2 diabetes. Patients with and without each of the studied complications were matched for age at diagnosis of diabetes and duration of diabetes. Univariate matched and multivariate conditional logistic regression analyses were used to estimate the independent association between each of the various factors studied and the three complications. Insulin treatment was the only factor independently associated with all three complications (odds ratios 3.3, 3.4, and 5.3 for diabetic retinopathy, coronary heart disease, and albuminuria, respectively). Glycosylated hemoglobin, uric acid, systolic blood pressure levels, and body mass index were also independently associated with at least one of the complications but not with all of them. Although no cause-effect relationship can be established from this cross-sectional design, insulin therapy seems to be a marker of severer diabetes from the time of diagnosis. Received: 14 March 1997 / Accepted in revised form: 4 September 1997     

Idiopathic inflammatory myositis is associated with a high incidence of hypertension and diabetes mellitus

Aims: The long‐terms complications of immunosuppressive and anti‐inflammatory treatment in idiopathic inflammatory myositis (IIM) are unknown. We sought to determine the complications of these treatments in a large cohort of patients with biopsy‐proven IIM. Methods: A South Australian database for patients with biopsy‐proven IIM was established. Clinical details of patients including treatment received were recorded. Results: Forty‐three patients with dermatomyositis (DM), 184 with polymyositis (PM) and 117 with inclusion body myositis (IBM) were registered on the database. The prevalence of hypertension and diabetes in this population was 62% and 29%, respectively, considerably higher than the background prevalence of 9.4% and 4%, making detection of treatment‐related adverse effects difficult. Hypertension and ischemic heart disease were more likely to be present prior to the diagnosis of IIM rather than following it. Hypertension and diabetes occurred more frequently following the diagnosis of myositis, in patients with DM compared with PM or IBM. Conclusions: We report a novel association of IIM with hypertension, diabetes and ischemic heart disease, indicating that a comprehensive assessment of vascular risk factors is essential in IIM.     

肺炎支原体肺炎并冷凝集素病的诊断与治疗

目的 提高对肺炎支原体肺炎并发冷凝集素病的认识,探讨其诊疗方法。方法 回顾分析３例临床病例,并结合献复习。结果 ３例急性呼吸道感染患,同时伴有溶血和微血管内血流淤滞表现,最后诊断为肺炎支原体肺炎并发冷凝集素病,经抗炎及血浆置换治疗效果满意。结论 肺炎支原体肺炎患如伴有溶血和微血管淤滞表现,应高度怀疑合并冷凝集素病,实验室检查可以确诊,综合治疗加血浆置换术为有效治疗手段。     

梅尼埃病研究进展

梅尼埃病可导致外周性平衡障碍和听力损失, 表现为发作性眩晕、波动性感音神经性耳聋, 耳鸣 和耳胀满感。近年来, 梅尼埃病的诊断和治疗有了新的进展, 有助于眩晕疾病的诊断和鉴别诊断。     

Data-mining technologies for diabetes: a systematic review

Background

The objective of this study is to conduct a systematic review of applications of data-mining techniques in the field of diabetes research.

Method

We searched the MEDLINE database through PubMed. We initially identified 31 articles by the search, and selected 17 articles representing various data-mining methods used for diabetes research. Our main interest was to identify research goals, diabetes types, data sets, data-mining methods, data-mining software and technologies, and outcomes.

Results

The applications of data-mining techniques in the selected articles were useful for extracting valuable knowledge and generating new hypothesis for further scientific research/experimentation and improving health care for diabetes patients. The results could be used for both scientific research and real-life practice to improve the quality of health care diabetes patients.

Conclusions

Data mining has played an important role in diabetes research. Data mining would be a valuable asset for diabetes researchers because it can unearth hidden knowledge from a huge amount of diabetes-related data. We believe that data mining can significantly help diabetes research and ultimately improve the quality of health care for diabetes patients.     

Necrobacillosis-primary anaerobic septicaemia due to Fusobacterium necrophorum

Necrobacillosis is a severe septicaemic illness caused by an anaerobic Gram-negative bacillus, Fusobacterium necrophorum. It occurs predominantly in young people and is characterised by oropharyngeal infection and subsequent metastatic complications, frequently involving the lungs and/or large joints. We report four recent cases in previously healthy young men, describing the clinical features of the disease (including autopsy findings), and the problems associated with diagnosis and treatment.     

The future in diagnosis and staging of lung cancer. Molecular techniques

Lung cancers at the same stage of disease have markedly different rates of disease progression. In this review, we will address current molecular techniques which provide new opportunities according to diagnosis, prediction of survival or selection of therapy. New molecular techniques might be helpful in TNM staging and lead to additional individual prognostic information. A revised TNM system could include a TNM component and a molecular supplemental component allowing new markers to be evaluated without undermining the value of classic TNM staging. Furthermore, molecular techniques might be helpful in the early or differential diagnosis of lung cancer. Since many new targeted agents are effective only if their respective molecular markers are mutated or expressed at sufficient levels, DNA-based or RNA-based techniques have the potential to influence treatment selection in the future. Overall, we can expect that molecular markers will contribute to a more personalized lung cancer treatment.     

Increased serum levels of tumor necrosis factor alpha precede major complications of bone marrow transplantation

Acute graft-versus-host disease, interstitial pneumonitis, endothelial leakage syndrome, and veno-occlusive disease are major complications of bone marrow transplantation. Though several new regimens for prophylaxis and treatment of these syndromes have been introduced, the overall incidence has been only slightly reduced over the last few years. We retrospectively analyzed tumor necrosis factor alpha (TNF alpha) serum levels between day -8 and day 100 after bone marrow transplantation in 56 patients transplanted in our unit for a variety of hematological diseases. In 34 patients with uneventful courses, mean TNF alpha levels rose to a maximum of 76 +/- 29 pg/mL. In contrast, 22 patients with major transplant related complications showed mean increases of TNF alpha of 492 +/- 235 pg/mL (P less than .0001). Increases of TNF alpha occurred before interstitial pneumonitis and severe acute graft-versus-host disease with a latency of 25 to 54 days. Early complications such as endothelial leakage syndrome and veno-occlusive disease were closely associated with increases of TNF alpha serum levels. Our study suggests two pathways of TNF alpha release: activation of host macrophages and stimulation of donor cells in the course of acute graft-versus-host disease. Cytokine monitoring should be helpful for prediction and earlier treatment of major transplant related complications.     

Severe acidosis in patients taking metformin--rapid reversal and survival despite high APACHE score.

BACKGROUND: Metformin has been shown to reduce complications and mortality from Type 2 diabetes mellitus, and is increasingly used to treat this condition. This agent is, however, associated with a rare but serious risk of lactic acidosis. CASE REPORT: We present cases of 10 patients with Type 2 diabetes mellitus who developed acute renal failure and severe lactic acidosis. Despite the severity of their illness, all patients but one survived. CONCLUSIONS: The increasing prevalence of Type 2 diabetes and its treatment with metformin might result in more cases of lactic acidosis. However our case report demonstrates that early and aggressive treatment with haemofiltration can improve outcomes even in the presence of severe acidosis.     

Diagnostische Optionen

Background

A variety of diagnostic methods provide the necessary rational basis for diagnosis, assessment of disease activity and exclusion of possible complications for patients with inflammatory bowel disease (IBD).

Aim

Currently, a wide range of diagnostic methods is available and easily accessible. The clinical use of all these different methods is inherently possible. As there is no reference test for either diagnosis or monitoring of IBD, diagnostic techniques must be selected, applied and interpreted in an appropriate clinical context. The objective is to evaluate the clinical, laboratory and imaging techniques including ultrasound and endoscopy in different clinical situations.

Results

In addition to clinical parameters, fecal calprotectin and abdominal ultrasound are helpful tools to assess the inflammatory activity. In patients with high inflammatory activity, a routine endoscopy is not beneficial. At best, endoscopy can be performed to document the extent of mucosal inflammation before initiating an intensified immunosuppressive therapy. Knowledge and experience in the management and treatment of IBD complications are critical in providing a rational use of specific diagnostic methods.

Conclusion

As a basic principle, the critical evaluation of diagnostic methods in patients with IBD is of great importance. Specific clinical situations require specific diagnostic techniques. Every diagnostic method performed should have a purpose.