Although most intracardiac defects are congenital, a small fraction may be acquired during life. The Gerbode defect is an abnormal anatomical connection between the left ventricle and the right atrium. We describe herein a patient who initially underwent repair of tetralogy of Fallot (TOF). Years after TOF repair, he developed severe dyspnea. Extensive evaluation revealed that he had developed a Gerbode defect. Very few cases of acquired Gerbode defect have been previously reported. Management options are predominantly surgical interventions.
Variation in blood glucose levels throughout the day was assessed in six diabetic maintenance hemodialysis patients and six diabetic renal transplant recipients. None of the twelve studied patients had good control. Glucose levels greater than 300 mg/dl were noted in four of six dialysis patients and five of six transplant recipients. A regimen of self blood glucose measurement and multiple insulin doses was instituted for four transplant and three dialysis patients. Each patient achieved the desired glucose range of 60 to 120 mg/dl most of the time, with a resultant fall in mean hemoglobin A1c concentration from 10.3% to 7.9%. It is suggested that a long term trial of self glucose monitoring might prove beneficial to treated uremic diabetics.
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