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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The prevalence of abdominal aortic dilatation among 201 men and 86 women who underwent carotid endarterectomy in 1971-1982 was studied from the date of operation to the end of 1984. Of the 109 patients who died during this time, 96 were autopsied, and 13 (13.5%) of them had aneurysm of the abdominal aorta. Ultrasonographic screening of the abdominal aorta was performed on 154 survivors, and showed dilatation in 17 (11%), 12/100 men and 5/54 women. The prevalence of hypertension, intermittent claudication, diabetes mellitus and coronary insufficiency at the time of endarterectomy did not differ between the patients with or without aortic aneurysm or dilatation. Patients who have undergone endarterectomy of the internal carotid artery constitute a group with high prevalence of abdominal aortic dilatation.
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PMID:Abdominal aortic dilatation in patients operated on for carotid artery stenosis. 318 91

Forty-five patients with symptomatic (20 with transient ischemic attack, 25 with minor stroke) greater than or equal to 75% stenosis of the cervical internal carotid artery had no endarterectomy and received only medical therapy because the surgical risks (severe cardiac disease, chronic obstructive pulmonary disease, hypertension or diabetes with systemic complications, aortic aneurysm) were believed to be unacceptable. During follow-up (mean 48 months), occlusion of the internal carotid artery developed without symptoms in two patients and with symptoms in three patients. The cumulative stroke and/or death rate was 24% at 2 years and 50% at 6 years. The ipsilateral infarct rate was 10% after the first year, but decreased markedly thereafter (2.4% per year), and one third of these infarcts were probably lacunes due to hypertensive small vessel disease. Overall, stroke related to previously symptomatic internal carotid artery stenosis was not the major problem during follow-up but was largely overcome by other strokes and cardiac death.
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PMID:Prognosis of high-risk patients with nonoperated symptomatic extracranial carotid tight stenosis. 333 90

Recent demographic and biochemical studies have suggested that there may be significant differences in the population of patients undergoing reconstruction for an aortic aneurysm (AA) or atherosclerotic occlusive disease (OCC) of the abdominal aorta. The purpose of this retrospective study was to compare the results of aortic surgery in these different patient groups. One hundred three patients undergoing aortic grafting were reviewed. Twenty-four patients underwent reconstruction for OCC, 65 selectively for asymptomatic aneurysms (EAA), and 14 for ruptured aortic aneurysms (RAA). The mean age for OCC patients (54 years) was significantly lower than that for EAA (68 years) or RAA patients (71 years). Patients with AA were predominantly male (92%) compared with those with OCC (62%). Despite the age and sex differences, there were no significant differences between the groups in the incidence of cardiac disease, hypertension, smoking history, diabetes mellitus, or renal or pulmonary disease. In addition, there were no significant intraoperative differences in terms of operative and clamp times, fluid administration, urine output, hypotension, or subsequent postoperative morbidity and mortality. We conclude that despite AA and OCC patients being demographically distinct, there is essentially no difference in elective aortic bifurcation graft surgery between these two populations.
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PMID:Results of aortic grafting in occlusive vs aneurysmal disease. 401 73

Assessment of the predictive value of preoperative factors in the determination of operative risk in 50 patients who underwent simultaneous aortic and renovascular procedures over a 10-year period is reported. There were six operative mortalities (12%). Factors associated with increased mortal risk were azotemia (43% vs. 7%), associated complex renal or visceral procedures (31% vs. 5%), treatment of aortic aneurysm vs. occlusive disease (17% vs. 5%), positive EKG (19% vs. 4%), age over 60 years (20% vs. 4%), and a history of diffuse peripheral vascular disease (18% vs. 7%). None of these differences, by themselves, had statistical significance. Through discriminate analysis with assignment of weighted scores to the five most powerful predictors of operative death (complex procedure--4, azotemia--4, aortic aneurysm repair--3, positive electrocardiogram--2, history of diffuse vascular disease--2), a weighted score of greater than or equal to 10 predicted operative death with an 83% sensitivity and 93% specificity (p = 0.003). Although advanced age, diabetes, severity of hypertension, and history of heart disease were associated with increased operative risk, they contributed minimal discriminate value to that provided by the preceding five variables. This was because these weaker risk factors were usually found in association with the predictors in the discriminant score. This study suggests that in patients with high weighted discriminant scores (greater than or equal to 10), consideration of operative risk is particularly important in evaluation of the proposed value of combined procedures.
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PMID:Aortic and renal vascular disease. Factors affecting the value of combined procedures. 646 84

During the last few years atypical forms of human salmonellosis were observed in 27 patients. Most frequent were acute gastroenteritis with bacteraemia or septicaemia, abscess formations in various organs and septic infections with gastroenteritis Salmonellae but no demonstrable gastroenteritis. In addition there were cases of osteomyelitis, peritonitis, one case of infected hip replacement, one of infected adrenal cortical tumour, and one of infected aortic aneurysm. In 24 of the 27 patients there was an underlying disease likely to have favoured the development of such infections. Diabetes mellitus, cholelithiasis and malignant tumours were the most frequent condition. Isolation of the positive organism was obtained from various materials (blood, abscess pus, gallbladder smear, operative specimen). Chemotherapy is definitely indicated in such Salmonella infections. Often additional surgical measures, e.g. to control spread of septic foci, were necessary. Prophylactic chemotherapy is recommended for patients with risk factors in order to prevent bacteraemic-metastatic events.
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PMID:[Atypical course of human salmonellosis (author's transl)]. 741 26

We report a case of an elderly patient with diabetes with calcific aortic atherosclerosis in whom a juxtarenal aortic aneurysm developed after Candida fungemia. Our approach included extra-anatomic reconstruction of the lower extremities, hepatorenal arterial bypass of the right kidney, retroperitoneal excision of the infected aortic segment, intravenous administration of amphotericin B after operation, and lifetime suppression of Candida organisms with oral antifungal therapy.
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PMID:Candida infection with aneurysm formation in the juxtarenal aorta. 804 Sep 57

As part of the Birmingham Community Aneurysm Screening Project, 3500 men aged 65-75 years from 20 urban general practices were invited for aortic ultrasonographic screening at their own general practitioner's surgery; 2669 (76.3 per cent) attended. Compliance rates varied between catchment areas, from 52.1 per cent for inner-city areas to 89.6 per cent for suburbs. Successful aortic imaging was achieved in 97.3 per cent of scans. Aortic diameter > 29 mm occurred in 219 patients (8.4 per cent) and 79 (3.0 per cent) with a diameter > 40 mm were referred for vascular surgical assessment; 140 patients with an aortic diameter of 29-40 mm are currently undergoing follow-up by serial ultrasonographic examinations at intervals of 3 months at their doctor's surgery. Risk factor analysis revealed ischaemic heart disease in 21.9 per cent of men with aneurysm, compared with 11.6 per cent in those without (P < 0.001); 18.3 per cent of men with aneurysm had had a previous myocardial infarction and 13.2 per cent had peripheral vascular disease, compared with 7.4 per cent (P < 0.001) and 8.0 per cent (P < 0.01) respectively of those without. No association was found between aneurysm and hypertension or diabetes. Community-based aortic screening is an inexpensive, effective method of diagnosis of aneurysm, with high compliance from the at-risk cohort of an urban population. Such screening programmes may help to reduce the mortality rate from aortic aneurysm rupture.
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PMID:Ultrasonographic screening for abdominal aortic aneurysm in an urban community. 817 38

Between 1981 and 1987, 88 consecutive patients were operated on for a thoracoabdominal aortic aneurysm by simple crossclamping and a graft inclusion technique (without shunts or heparin). This article presents an analysis of the operative outcome and long-term follow-up. Patient- and operation-related variables are age (mean 64.3 years, range 28 to 82 years), sex (82% men), rupture (20.5%), diabetes (2.3%), renal insufficiency (34.1%), chronic obstructive pulmonary disease (27.3%), previous aortic operation (31.8%), arterial hypertension (66%), postdissection (18.2%) versus degenerative (80.7%) origin, preoperative shock (11.4%), ischemic cerebrovascular (12.5%) or ischemic heart (17%) disease, peripheral vascular disease (14.8%), renal (mean 48 minutes, range 0 to 83 minutes) and lower spinal cord (mean 21 minutes, range 0 to 68 minutes) ischemic time, number of reattached intercostals, blood loss, and extent of the aneurysm (Crawford classification: type I, 16 patients [18.2%]; type II, 21 patients [23.8%]; type III, 29 patients [33%]; and type IV, 22 patients [25%]. Intraoperative mortality is 1.1% (n = 1). Thirty-day mortality is 5.9% (n = 5). Hospital mortality is 11.4% (n = 10): 7% for elective cases and 28% for ruptured aneurysms (p = 0.014). The survival at 2 years is 78% +/- (4.4%) and at 5 years 54% +/- (5.3%). Postoperative spinal cord injury occurred in 12 patients (13.8%) (5 had paraplegia and 7 had paraparesis) and postoperative renal dysfunction necessitating dialysis in 12 patients (14.1%). Risk stratification for hospital death, late death, renal failure, and spinal cord dysfunction was performed by means of multivariate logistic regression and Cox proportional hazard regression as appropriate. The best fitting model to predict hospital death includes preoperative shock (p = 0.02), female sex (p = 0.06), preoperative elevated serum creatinine level (p = 0.06), and preoperative myocardial infarction (p = 0.08). Variables predictive for late death are postoperative dialysis (p = 0.002), age (p = 0.008), and rupture (p = 0.04). The risk factors of postoperative dialysis are age (p = 0.003) and preoperative serum creatinine level (p = 0.04). The risk of postoperative spinal cord dysfunction increases with longer lower spinal cord ischemic time (p = 0.02) and with the presence of preoperative shock (p = 0.06).
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PMID:Surgical treatment of thoracoabdominal aortic aneurysms by simple crossclamping. Risk factors and late results. 828 76

Familial hypercholesterolemia (FH) is a genetic disease characterized by high serum cholesterol levels and premature coronary atherosclerosis. Hypercholesterolemia is one of the factors promoting the arteriosclerotic process and is a major cause of aortic aneurysm. Few data are available, however, about abdominal aortic aneurysms (AAAs) in patients with FH. In this study, the clinical and angiographic characteristics of AAAs found in patients with FH were investigated. Thirty-one cases (23 men, 8 women, aged fifty +/- fourteen years) were examined by coronary angiography, thoracic and abdominal aortography, and clinical data. Abdominal aortography detected abdominal aneurysms in 8 cases (26%), all of whom were men, including 4 cases (50%) that were complicated by diabetes mellitus. The abdominal aneurysm patients manifested severe coronary atherosclerosis, severe abdominal aortic irregularity, and higher blood pressure than the nonaneurysm FH patients. These findings suggest that AAAs are an important and prevalent feature in FH, especially in men with diabetes mellitus and high blood pressure.
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PMID:Abdominal aortic aneurysms in familial hypercholesterolemia--case reports. 850 16

Endovascular infection of atherosclerotic aorta is a rare event in the setting of aged patients with gram negative bacteremia of the salmonella group. Until the beginning of the 60s this meant an ominous diagnosis with an almost unavoidable fatal prognosis. Presently, this trend has been reverted, mostly due to an earlier diagnosis, the development of more sophisticated imaging techniques, the correct use of broad spectrum bactericidal antibiotics and prompt surgical management. Paradoxically, the incidence of arterial infections has increased in recent years, specially in old people with atherosclerotic abdominal aortic aneurysms, in whom infective endocarditis could not be demonstrated. We describe the case of a 65 year old man, with a history of longstanding non-insulin-dependent diabetes, presenting with protracted fever, weight loss and thigh pain. Blood cultures and serologic studies as well as several echocardiograms yielded negative results. An abdominal CT scan showed an infrarenal aortic aneurysm raising the clinical suspicion of arterial infection of abdominal aorta. The patient underwent surgery because of highly presumptive diagnosis of complicated aortic aneurysm. The resection was followed by an in situ graft. There was no evidence of disruption or gross collection. Samples of the aortic wall and perianeurysmatic fluid grew Salmonella enteritides. We describe the main etiopathogenic and clinic features of the entity highlighting the high sensitivity and specificity of the CT scan in the identification and characterization of infected aortic aneurysm. Certain features may firmly suggest this diagnosis without using preoperative aortography.
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PMID:-Prolonged fever syndrome and infection of abdominal aortic aneurysm due to Salmonella enteritidis. 872 76


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