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Resume: The paper describes the case of a patient recently diagnosed as suffering from type 2 diabetes mellitus whereby her polyneuropathic complaints were at first erroneously interpreted as a sacroiliacal blockage, subsequently as diabetic polyneuropathy. Only when the complaint persisted an EMG examination led to a diagnosis of a Guillain-Barre syndrome.

Key words: diabetic polyneuropathy, Guillain-Barre syndrome, electro-myography

Resume: This is a case report of a man aged 59 with a thirty-year long anamnesis of diabetes mellitus leading to serious organ complications (periphery angiopathy, renal insufficiency requiring regular hemodialysis, diabetic retinopathy etc.) The diabetic gangrene (with an arteriosclerotic element of the affected arteries) required amputation at the thigh. Post-operation hemorrhage secretions from the wound occurred from the very beginning and healing per secundam. Gradually a chronic septic condition developed. Prior to the operation and after it an embolus occurred in a branch of the arterium pulmonalis. Fifty days after the amputation the patient was transferred to a more specialized department for the removal of the arterial venous fistula and the possible subsequent induction of a permcath. We consulted a surgeon when seeping of fluid from the stump continued. The stump was reexamined and the blood seeping from the stump was diagnosed as coming from the femoral stump. The stump, otherwise dehiscent and massively filled with coagula was adequately surgically treated.

Key words: diabetic gangrene, amputation, bleeding

Resume: The immediate compensation of diabetes mellitus is the rational underlying treatment. The case of a patient undergoing treatment for over 10 years with poor compensation demonstrates the fast development of serious diabetic retinopathy necessitating laser coagulation and subsequently pars plana vitrectomy of both eyes along with a manifestation of viscera neuropathy, where the underlying cause lies in neglecting intensive education and failure to adhere to a strict diet. Manifestations of accelerated diabetes complications may arise in spite of such measures with a minimal modification of insulin doses. 

Key words: type 1 diabetes mellitus, retinopathy, fast development of subsequent complications

Resume: The paper describes the case of a 25-year old woman suffering from type 1 diabetes mellitus which manifested itself as gestation diabetes requiring insulin therapy from the very initial stage. At the time of the diagnosis there were no organ complications. But in the course of the next five years diabetic non-proliferative retinopathy, arterial hypertension, chronic renal insufficiency of the first degree with 2,5g proteinuria developed. During the sixth year of the diabetes complaint an unusually speedy progression of vascular disorders occurred, notably retinopathy leading to practical blindness of the left eye in spite of repeated laser coagulation, renal failure accompanied by a metabolic failure of the internal organs requiring the introduction of hemodialysis. A coincidence of another auto-immune complaint with a possible share in the progression of microangiopathy has not be proven so far. The main reason for the development of organ complications is doubtlessly due to long-term decompensation of diabetes, the patient's non-compliance in as far as she failed to adhere to a system of measures to treat hypertension, hypercholesterolemy, a persistent weight increase, smoking, planned pregnancy counter to doctor's recommendations.

Key words: type 1 diabetes mellitus, microangiopathy, retinopathy, nephropathy, proteinuria, hypertension, pregnancy, ACE inhibitors

Resume: The case report of a 36-year old woman suffering from a metabolic syndrome (diabetes mellitus, obeseness, arterial hypertension. mixed hyper-lipoproteinemia, hyper-uric acid). There was a significant loss in the patient's weight (first by dieting, subsequently with the application of orlistat therapy and finally by gastric banding). Within a year the patient lost cca 28 kg. Diabetes mellitus is currently very well compensated merely by dieting. Moreover, the patient's blood pressure and uric acid levels are now within normal limits. Mixed hyper-lipoproteinemia persists.

Key words: type 2 diabetes mellitus, obesity, metabolic syndrome X, gastric bandin

Summary: The case study deals with a patient suffering from type 2 diabetes mellitus, arterial hypertension and obesity (BMI 41). The treatment with anti-hypertensives (diuretics, cardio-selective blockages, methyldopa) and a combination of roral antidiabetics (biguanids and derivatives of sulphonyurea). In the event of gastrointestinal complaints the therapy was not suitably modified. The patient developed hypoglycosuria comas in the course of a general reduction of food intake due to the co-effects of hypoglycemical drugs based on a loss of fluids caused by diaerhoea and subsequent acute renal failure. The patient is dying of a multi-organ failure and malignant lactic acidosis.

Key words: lactic acidosis, metformin, biquanids, metformin, hypoxia

Resume: The case study deals with a chance ascertainment during a preventive examination of arteriosus ducts (open arterial ducts) in an adult who exhibited no symptoms. In the course of a cardiological examination the ductus arteriosus patent was proven and following subsequent application of medication we plan its catheter closure.

Key words: ductus arteriosus patent

Resume: We describe the case of an 11-year old girl suffering from vitiligo who underwent endocrinological examinations when thyroid auto antibodies proved positive. In addition to the confirmation of positive antibodies against tyreoid peroxidation no other tyreoidal pathology was ascertained. But goal-directed screening proved the girl was suffering from type 1 diabetes mellitus which hitherto had been asymptomatic.

Key words: vitiligo, auto immune tyreoiditis, type 1 diabetes mellitus

Resume: The paper describes the case of a 51-year old patient suffering from ACTH -- dependent hypercortisolism based on microadenom of the hypophysis. A positive dexametazoan suppressive test with 8 mg of dexametazoan, catheterization of the sinus petrosi inferiores and a repeated performance of MR hypophysis significantly contributed toward reaching a definite diagnosis. Following an unsuccessful neurosurgical operation the microadenom was exposed to Leksell gama-knife radiation, however his hormonal activity 3 months after applying radiation persists.

Key words: ACTH, Cushing syndrome. cortisol, selective catheterization of the sinus petrosi inferiores

Resume: Feochromocytom is a tumour producing catecholamines. The symptoms may not draw attention for a long time and the tumour can be diagnosed only thanks to an image investigation concerning some other indices as we document in two patients. In such a case this was not incidental in the true sense of the word, because there were certain symptoms which however did not lead to a search for the possible causes.

Key words: feochromocytom, arterial hypertension, catecholamines, incidental

Resume: The case summarizes the examination and therapy of a patient suffering from Graves-Basedow tyreotoxicosis and endocrinal orbitopathy diagnosed in a patient already suffering from chronic hepatopathy and reduced sensitivity of the left side of the face due to a brain operation. We succeeded in stabilizing his condition by total thyroidectomy, corticoid therapy and somatostatin therapy. However, the results of endocrinal orbitopathy still persist.
 
Key words: tyreotoxicosis, endocrinal orbitopathy, total thyroidectomy, tyreostatics, somatostatin

Resume: This case demonstrates the cause and development of liver damage following the application of tyreostatics. When our patient was diagnosed to be suffering from tyreotoxicosis GB, we applied Carbimazol in the usual aggressive doses. However, after a month's treatment cholestatic damage to the liver was ascertained which progressed further even following a change in medication to Propycil. The liver lesions proved so serious that the patient had to be hospitalized in a hematology clinic. The relapse of tyreotoxicosis on ceasing the application of tyreostatics was solved by carrying out an acute tyreoidectomy having assured beta-blocators and lugolization. 

Key words: tyreotoxicosis, tyreostatics, cholestasis, lugolization, tyreoidectomy, icterus

Resume: Diagnosing hypopituitarism in new-born babies may play a fundamental role in preventing the development of diabetes which when neglected could lead to permanent disabilities for the child. The situation may be complicated when there is a suspicion of hereditary disorders of the metabolism, whose diagnostics are limited at an early age.

Key words: hypoglycaemia, Hypopituitarism, hereditary disorders of the metabolism of saccharides