PubMed · 9239060
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M Gallichan. Reflective practice.. https://pubmed.ncbi.nlm.nih.gov/9239060/
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The perception that in type 2 diabetes mellitus the prognosis with regard to micro-angiopathic and macro-angiopathic complications significantly depends on the quality of metabolism and the level of the blood pressure, should prompt all of us to considerably intensify our efforts to ensure optimal treatment for the diabetic. For example, insulin will have to administered at an earlier time-point and to a much greater extent than formerly. In order to meet the objectives specified in the St. Vincent Declaration of 1989, not only close cooperations between family doctors and diabetologists in specialist practices and hospitals, but also comprehensive quality control measures will be needed. In new diabetes contracts, for example the interface model, attempts are being made to take account of these facts. The various tasks of family doctors and specialized diabetes practices are discussed on the basis of the interface model.
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A case of scleredema diabeticorum of Buschke associated with nuchal fibroma and organic solvent exposure is reported. The patient presented with a neck mass causing discomfort and restriction of movement. Histological examination showed this to be a nuchal fibroma. Additionally, there was widespread induration of the skin of his trunk which was asymptomatic. A biopsy showed features of scleredema. This is the first reported association of these two conditions, both of which show increased and thickened collagen bundles without significant fibroblast proliferation. They differ by the occurrence of mucin in scleredema, although this is not always demonstrable, particularly in late lesions. The possibility that nuchal fibroma is an end stage, localized form of scleredema is canvassed. The patient's medical history included insulin-dependent diabetes mellitus with complications of retinal vessel thrombosis and peripheral neuropathy. The patient also had significant past exposure to a wide variety of chemicals, including organic solvents.