Internal medicine
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Glucocorticoid (GC) causes various metabolic abnormalities; however, few prospective studies have examined the changes in glucose and lipid metabolism in newly GC-treated patients. ⋯ GC treatment induced changes in FPG, IRI, LDL-CHOL and HDL-CHOL levels from day 3 after start of GC. The dose of GC seemed to influence glucose metabolism, but not lipid metabolism.
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A male patient was diagnosed with diabetes mellitus at age 37 and insulin treatment was introduced at age 49. About 2 years after the introduction of insulin, the antihypertensive agent was switched from candesartan (4 mg/day) to telmisartan (20 mg/day). The alteration improved his glycemic control dramatically, with the HbA1c levels decreasing from 8.3% to 6.0% in 6 months. ⋯ Throughout the whole clinical course mentioned above, he was under treatment for schizophrenia with drugs including risperidone which possibly affects glucose metabolism. The medication for schizophrenia was not changed during this period. We present here the marked glycemia improvement effect and insulin sparing effect of telmisartan in a case of type 2 diabetes mellitus.
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A 48-year-old woman was admitted to our hospital in 2003, complaining of weight loss. Complete blood cell count revealed thrombocytopenia. Abdominal CT demonstrated marked splenomegaly. ⋯ CT scan showed a hepatic tumor. A fine-needle biopsy of the liver revealed the first relapse. Despite hepatic lobectomy, radiofrequency ablations and administration of recombinant interleukin-2, she died from respiratory failure in 2009.
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Marfan's syndrome (MFS) is an autosomal dominant disorder of connective tissue involving musculoskeletal, cardiovascular and ocular systems. Aortic disease is the leading cause of mortality in MFS. ⋯ We report a case of biventricular heart failure in a patient with MFS, complicated by chronic type A aortic dissection and right atrial thrombus. This report clearly highlights the importance of close cardiovascular follow-up in patients with MFS.