XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Cerebral venous thrombosis is a relatively uncommon but serious neurologic disorder that is potentially reversible with prompt diagnosis and appropriate medical care. Because the possible causal factors and clinical manifestations of this disorder are many and varied, imaging plays a primary role in the diagnosis. Magnetic resonance (MR) imaging, unenhanced computed tomography (CT), unenhanced time-of-flight MR venography, and contrast material-enhanced MR venography and CT venography are particularly useful techniques for detecting cerebral venous and brain parenchymal changes that may be related to thrombosis. To achieve an accurate diagnosis, it is important to have a detailed knowledge of the normal venous anatomy and variants, the spectrum of findings (venous sinus thrombi and recanalization, parenchymal diffusion or perfusion changes or hemorrhage), other potentially relevant conditions (deep venous occlusion, isolated cortical venous thrombosis, idiopathic intracranial hypertension), and potential pitfalls in image interpretation.

Imaging of cerebral venous thrombosis : Current techniques, spectrum of findings, and diagnostic pitfalls. Commentary and Authors' reply

[Cushing's syndrome].

High Incidence of Benign Testicular Neoplasms Diagnosed by Ultrasound

Ultrasonography (US) is well suited to the study of pathologic conditions of the scrotum in children. US provides excellent anatomic detail; when color Doppler and power Doppler imaging are added, testicular perfusion can be assessed. Gray-scale, color Doppler, and power Doppler US were used to study a spectrum of scrotal disorders in 750 boys aged 1 day to 17 years. The entities studied included processus vaginalis-related disorders (cryptorchidism, inguinal-scrotal hernia, and hydrocele); varicocele; acute scrotum (epididymo-orchitis, torsion of the testicular appendages, and testicular torsion); scrotal tumors; testicular microlithiasis; scrotal trauma; and systemic diseases with scrotal involvement. When combined with the results of clinical and physical examination, the information obtained with US is sufficient to enable diagnosis in most cases of scrotal disease. Moreover, color Doppler imaging is essential for differentiation between processes such as epididymo-orchitis or torsion of the testicular appendages and testicular torsion, which have similar clinical manifestations (pain, swelling, and redness) but are managed differently.

https://pubs.rsna.org/doi/pdf/10.1148/rg.255045109

Gray-Scale and Color Doppler Sonography of Scrotal Disorders in Children: An Update

OBJECTIVE. The purpose of this study is to analyze the sonographic and MR imaging findings of testicular epidermoid cysts.CONCLUSION. Sonographic findings of a markedly heterogeneous intratesticular mass with or without alternating hypo- and hyperechoic layers surrounded by a hypoechoic or echogenic rim and the absence of flow on color Doppler sonography suggest the preoperative diagnosis of testicular epidermoid cysts. T2-weighted MR imaging findings of a high-signal-intensity mass with or without low-signal-intensity foci surrounded by a low-signal-intensity rim and the absence of enhancement on contrast-enhanced T1-weighted MR images can strengthen the preoperative diagnosis. These imaging findings can offer a basis for surgeons to attempt testis-sparing surgery instead of orchiectomy.

Sonographic and MR Imaging Findings of Testicular Epidermoid Cysts

BACKGROUND/AIMS Overt hypothyroidism is frequently found in patients with type 2 diabetes mellitus (T2DM), but it remains unknown the relationship between subclinical hypothyroidism (SCH) and T2DM. We attempt to evaluate the difference in prevalence of SCH between patients with T2DM and general population, and the association between SCH and glycemic control status ofdiabetic patients. METHODS This was cross-sectional study. Total 8,528 subjects who visited for health check-up were recruited. SCH was defined as an elevated level of serum thyroid stimulating hormone (> 4.0 mIU/L) with a normal level of free thyroxine. T2DM group was categorized into three groups by glycosylated hemoglobin (HbA1c): < 7% (reference), ≥ 7% and < 9%, ≥ 9%. RESULTS Finally, 7,966 subjects were included. The prevalence of SCH was not different between healthy controls and subjects with T2DM (8.1% vs. 7.4%, p = 0.533; in men, 5.7% vs. 5.1%, p = 0.573; in women, 10.9% vs. 11.7%, p = 0.712), but it was increased with highest HbA1c group more than well controlled group, especially in women. The risk of SCH was increased by group with poorer glycemic control; the odds ratio for HbA1c ≥ 9% compared to < 7% was 2.52 (95% confidence interval [CI], 1.09 to 5.86; p = 0.031), and 4.58 (95% CI, 1.41 to 14.87; p = 0.011) in women, but not significant in men. CONCLUSIONS The prevalence of SCH was similar between T2DM and healthy group. Poor glycemic control in T2DM was obviously associated with the risk of SCH, especially in elderly women. These results suggest SCH as comorbidity may be considered in elderly women with poor glycemic control.

/pdf/poor-glycemic-control-is-associated-with-the-risk-of-3p8k0c6x6o.pdf

Poor glycemic control is associated with the risk of subclinical hypothyroidism in patients with type 2 diabetes mellitus.

In this study, the antioxidant and anti-wrinkling effects of extracts from Aruncus diocius var kamtschaticus (ADV) were investigated According to the results, the ethanol extract has better antioxidant and anti-wrinkling effects than the water extract The amounts of total polyphenol and flavonoid compounds in the ethanol extract were 122 and 36 mg/g, respectively, while those in the water extract were 87 and 26 mg/g The antioxidant activities of the ethanol and water extracts were 395 and 4,682 as the values for the DPPH radical scavenging activity, and 227 and 366 for the radical scavenging activity, respectively The reducing power of the ethanol extract (158 at 2 mg/mL) was higher than that of the water extract (088 at 2 mg/mL) The astringent activities of the ethanol and water extracts were 9127 and 1635% at 10 mg/mL, respectively Furthermore, the ADV ethanol extract treatment of the fibroblast cell after UV irradiation resulted in increased cell viability (10% at 100 ) and collagen biosynthesis (33% at 100 ), with a lowering in the MMP-1 expression level (168 % at 100 ) These results demonstrate that AVD provides a remarkable and significant tensor and anti-wrinkling effect on the skin, which could be of a great use in anti-aging skin care products

Antioxidant and Anti-wrinkling Effects of Aruncus dioicus var. kamtschaticus extract

There has been an increase in the number of reports of atypical manifestations of Graves’ disease (GD), such as jaundice, anemia, thrombocytopenia and leukopenia. Pancytopenia also rarely occurs in GD. In this paper, a case of pancytopenia with GD that was successfully treated with an anti-thyroid drug is reported. In this case, a 69-year-old woman showed pancytopenia with a normal peripheral blood smear, bone marrow aspiration smear and bone marrow biopsy. Her thyroid function test and thyroid scintigraphy confirmed her hyperthyroid status. Her laboratory abnormality and clinical condition improved after she was treated with an anti-thyroid drug. This is a rare case of pancytopenia associated with GD.

/pdf/a-case-of-pancytopenia-with-hyperthyroidism-osh2ea22h9.pdf

A Case of Pancytopenia with Hyperthyroidism

Adrenocorticotropic hormone (ACTH)-producing pheochromocytoma has been rarely reported, whereas only a few cases of Cushing syndrome accompanied by opportunistic infections have been reported. We experienced a patient with pheochromocytoma with ectopic Cushing syndrome complicated by invasive aspergillosis. A 35-year-old woman presented with typical Cushingoid features. Her basal plasma cortisol, ACTH, and 24-hour urine free cortisol levels were significantly high, and 24-hour urine metanephrine and catecholamine levels were slightly elevated. The endogeneous cortisol secretion was not suppressed by either low- or high-dose dexamethasone. Abdominal computed tomography (CT) revealed a heterogeneous enhancing mass measuring approximately 2.5 cm in size in the left adrenal gland. No definitive mass lesion was observed on sellar magnetic resonance imaging. On fluorine-18 fluorodeoxyglucose positron emission tomography/CT, a hypermetabolic nodule was observed in the left upper lung. Thus, we performed a percu- taneous needle biopsy, which revealed inflammation, not malignancy. Thereafter, we performed a laparo- scopic left adrenalectomy, and its pathologic finding was a pheochromocytoma with positive immunohisto- staining for ACTH. After surgery, the biochemistry was normalized, but the clinical course was fatal despite intensive care because of the invasive aspergillosis that included the lungs, retina, and central nervous system.

/pdf/adrenocorticotropic-hormone-acth-producing-pheochromocytoma-1txuhwu9lc.pdf

Jae Ho Cho

Papers

Sonographic and MR Imaging Findings of Testicular Epidermoid Cysts

Poor glycemic control is associated with the risk of subclinical hypothyroidism in patients with type 2 diabetes mellitus.

Antioxidant and Anti-wrinkling Effects of Aruncus dioicus var. kamtschaticus extract

A Case of Pancytopenia with Hyperthyroidism

Adrenocorticotropic hormone (ACTH)-producing pheochromocytoma presented as Cushing syndrome and complicated by invasive aspergillosis