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

A 21 years old female patient with lipoatrophic diabetes, a distinct syndrome of insulin resistant diabetes mellitus, loss of subcutaneous fat, hepatosplenomegaly, hyperlipidemia, increased basal metabolic rate, subvalvular aortic stenosis and cystic bone lesions is described. She exhibited all clinical signs of diabetic microangiopathy. Quantitative estimation revealed severely thickened basement membranes of muscle capillaries. It is concluded that the extent of her microangiopathy is a consequence of her excessive metabolic abnormalities.
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PMID:Muscle capillary basement membrane thickness in lipoatrophic diabetes. 59 1

For the evaluation of myocardial perfusion in patients with left bundle branch block (LBBB), we performed exercise stress (Ex)-redistribution (RD) myocardial tomography with thallium-201 (201Tl) in 23 patients with LBBB and without coronary artery disease (CAD). Myocardial images in patients with LBBB were compared with those of 9 patients with CAD who showed Ex induced transient septal defect. Bull'-eye maps (201Tl distribution maps at Ex and RD and 201Tl washout rate [WOR] map) were made from myocardial tomograms. In 23 patients with LBBB, 15 patients (65%) developed myocardial perfusion abnormality. In 10 (67%) of these 15 patients, transient perfusion defect appeared in the entire septum (diffuse type). On the other hand in 5 patients (33%), localized fixed perfusion defect developed at the boundary between septum and anterior wall (focal type). In focal type, every patient had other disease such as hypertension, aortic stenosis or sick sinus syndrome. While in patients with diffuse type, other diseases were observed in 30% (p less than 0.05) and they were limited to hypertension or diabetes mellitus. These facts suggested that mechanisms of perfusion abnormalities might be different between these two groups. We compared the perfusion abnormality between LBBB diffuse type and CAD. The extent of the defects was not different between two groups. Although apex was included within the defect in 89% of CAD population, apical defect was observed in only 20% of diffuse type (p less than 0.05). Minimal 201Tl WOR and 201Tl uptake ratio of septum to lateral wall indicated that exercise induced septal defect was slighter in diffuse type than CAD.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Myocardial perfusion in patients with left bundle branch block and without coronary artery disease]. 160 38

Hospital records of 120 patients undergoing aortic valve replacement were retrospectively reviewed for risk factors associated with early aortic valve replacement. Patients were separated into four groups (rheumatic, congenital bicuspid, degenerative, and miscellaneous) based upon the morphologic etiology of aortic stenosis. Multiple regression analysis was performed using age at surgery as the dependent variable. Independent variables for the study were race, gender, systemic hypertension, total triglyceride level, total serum cholesterol level, tobacco smoking history, diabetes mellitus, and angiographic coronary artery disease. In the rheumatic valve group only race showed a statistically significant risk effect whereas in the congenital bicuspid valve group race, gender, and triglycerides were statistically correlated with age at surgery. In the degenerative valve group gender and smoking were found to be statistically significant risk factors. The establishment of aortic stenosis risk factors might be an indication for clinical trials of risk factor modification in patients with aortic stenosis.
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PMID:Development and progression of aortic valve stenosis: atherosclerosis risk factors--a causal relationship? A clinical morphologic study. 184 Oct 25

To analyze whether atherosclerotic risk factors, including systemic hypertension, an elevated serum cholesterol level, smoking and diabetes, were associated with the presence of aortic stenosis (AS) in adults, 105 adults who had AS without coronary artery disease (CAD) were compared with 110 control subjects who had other types of valvular disease, 170 control subjects who underwent catheterization and had neither valvular disease nor CAD, and 269 matched control subjects who underwent general surgery. When using each control group separately or in combination, no risk factor showed consistent evidence of a significant association with the development of AS. If the true magnitudes of these associations are of the order previously reported for the development of CAD, the power of our study for detecting statistical significance ranges from 56 to 99%. In a supplemental analysis, 45 cases with both AS and CAD did not have a higher prevalence of risk factors than cases without CAD. Although a weak association between atherosclerotic risk factors and AS cannot be excluded, any such association is unlikely to be as strong as for predicting CAD.
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PMID:Case-control analysis of risk factors for presence of aortic stenosis in adults (age 50 years or older). 391 53

One hundred eighteen consecutive patients undergoing valve replacement for aortic stenosis were analyzed to determine the incidence of and predisposing factors to postoperative atrial tachyarrhythmias. Univariate and multivariate analyses were performed on 70 clinical, hemodynamic, radiographic, electrocardiographic, operative, and postoperative variables. Forty-seven patients (40%) experienced atrial tachyarrhythmias at a median of 3 days after surgery (70% atrial fibrillation, 22% atrial flutter, and 6% junctional tachycardia). Preoperative descriptors associated with an increased prevalence of atrial tachyarrhythmias were age 70 years or older (p less than .02), mitral regurgitation (p less than .002), history of paroxysmal atrial fibrillation (p less than .03), or antiarrhythmic therapy (p less than .006), diabetes mellitus (p less than .01), and elevated pulmonary systolic, mean, and capillary wedge pressures (p less than .02, p less than .007, p less than .005). Postoperative descriptors were prolonged respirator therapy (p less than .001), use of catecholamines (p less than .01) or vasodilators (p less than .05), and prolonged stay in the intensive care unit (p less than .04). Multivariate analysis of these 12 variables showed advanced age, diabetes mellitus, and prolonged respirator use to be independently associated with atrial tachycardias and to predict them with a sensitivity of 62% and a specificity of 77%. Anticipation of atrial arrhythmias in patients with specific clinical descriptors may be used to guide prophylactic therapy.
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PMID:Clinical correlates of atrial tachyarrhythmias after valve replacement for aortic stenosis. 402 60

The Transplant Service at the University of Minnesota Hospitals has performed over 2,000 kidney transplants. Fourteen of these patients have developed cardiac conditions necessitating surgical intervention at intervals of 9 to 144 months (mean 67 months) following their transplantation. These individuals had a mean age of 42 years, and five (36%) were diabetic. All patients had functioning renal allografts with preoperative serum creatinine levels ranging from 1.0 to 1.8 mg/100 ml (mean 1.4 mg/100 ml). Ten patients underwent aorta-coronary saphenous vein bypass grafting. One patient underwent bypass grafting and concomitant left ventricular aneurysmectomy. Native valvular endocarditis developed in two patients. One had tricuspid valve debridement for fungal endocarditis and the other had aortic valve replacement for bacterial endocarditis. The final patient had calcific aortic stenosis and coronary artery disease necessitating aortic valve replacement and coronary bypass. Two patients (14%) died perioperatively. One was a young woman with juvenile-onset diabetes and preinfarction angina who died suddenly several days after the operation; at autopsy, she was found to have an occluded graft to the right coronary artery and extensive infarction. The other was a 54-year-old woman with calcific aortic stenosis, coronary artery disease, and unstable angina who died perioperatively of uncontrollable arrhythmias. Autopsy suggested that she may have had an unsuspected infarction 1 to 2 days before the operation. The remaining 12 patients had uneventful postoperative courses and returned to Class I functional status from a cardiac standpoint. There has been one late death (7%), 45 months after successful coronary artery bypass grafting, as a result of complications attendant to a perforated gastric ulcer. The remaining 11 patients are alive and well at intervals of 8 to 93 months (mean 31 months) after operation. Postoperative serum creatinine levels at hospital discharge averaged 1.6 mg/100 ml, not significantly changed from preoperative levels. Cardiac operations can be performed safely in patients with functioning renal allografts. Patient survival is acceptable and preservation of renal function has been uniformly successful in surviving patients.
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PMID:Cardiac operations in patients with functioning renal allografts. 638 68

The clinical characteristics of 107 patients younger than 60 years with mitral anular calcium (MAC) were compared with those of 107 age- and sex-matched control subjects. The patients with MAC included 55 men and 52 women, mean age 51 years. The control group included 55 men and 52 women, mean age 51 years. Patients with MAC had a higher prevalence of cardiomegaly on chest x-ray (p less than 0.0001), left atrial and left ventricular enlargement by echocardiography (p less than 0.0001), precordial murmurs (p less than 0.0001), diabetes mellitus (p less than 0.0001), systemic hypertension (p less than 0.025) and total conduction defects on surface electrocardiograms (p less than 0.0001) compared with the age- and sex-matched control subjects. The mean serum phosphorus and product of serum calcium and phosphorus were higher in patients with MAC (p less than 0.0025) than in the control subjects. The prevalence of coronary heart disease, aortic stenosis and hypertrophic cardiomyopathy and the mean serum cholesterol, triglyceride, total protein, albumin, creatinine, alkaline phosphatase and calcium levels were not significantly different between patients with MAC and the control subjects.
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PMID:Clinical characteristics of patients younger than 60 years with mitral anular calcium: comparison with age- and sex-matched control subjects. 650 99

The prevalence of conduction defects was investigated in 51 patients older than 60 years with aortic stenosis (AS) who underwent aortic valve replacement. Thirty one of the 51 patients, (61%) had associated mitral anular calcium (MAC). The mean age and prevalence of coronary artery disease, systemic hypertension and diabetes mellitus were similar in both groups. The prevalence of conduction defects (atrioventricular block, sinoatrial disease, bundle branch block, left anterior hemiblock or intraventricular conduction defect) was 18 of 31 (58%) in patients with MAC and 5 of 20 (25%) in patients without MAC (p less than 0.025). We conclude that patients older than 60 years with AS have a high prevalence of MAC, and that the prevalence of conduction defects is higher in patients older than 60 years with combined AS and MAC than in patients with AS without MAC.
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PMID:Cardiac conduction defects in patients older than 60 years with aortic stenosis with and without mitral anular calcium. 669 Dec 56

To help clarify the etiology and pathogenesis of calcific aortic stenosis, we studied retrospectively the relationship existing between that condition and two presumptive risk factors: diabetes and hypercholesterolemia. Fifty-four patients with isolated aortic stenosis, undergoing cardiac catheterization, were compared to patients without aortic stenosis who underwent angiography for unrelated reasons. The effect of diabetes and hypercholesterolemia, singly and in combination, upon the prevalence of aortic stenosis, was tested by various methods, including mathematical model fitting: Both study factors were found to be associated with aortic stenosis; their combined effect upon the prevalence of that disease appeared to be multiplicative. These findings suggest that diabetes and hypercholesterolemia may play a role in the causation of aortic stenosis. Further studies among unselected populations are needed to confirm the existence of the associations uncovered.
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PMID:Diabetes and hypercholesterolemia among patients with calcific aortic stenosis. 671 6

Multiple Sclerosis (MS) cases found at autopsy in patients who had died from other diseases and in whom no sign or symptom could be related to MS are called "asymptomatic". Three cases are reported. The first patient was a 62 year old man who presented with a slowly progressive disturbance of gait, incontinence and deterioration of intellectual function. A falx meningioma was surgically removed. The patient died 3 years later with an acute respiratory illness. Examination of the brain disclosed evidence of the operation and numerous old plaques disseminated through the cerebral hemispheres (centrum semi-ovale, periventricular regions, internal thalamus and junction between cortex and white matter) and in the brain stem. The second case, a 77 year old woman with diabetes mellitus and hypertension, presented with cortical blindness and disturbances of memory of acute onset. She died one year later. Examination of the brain showed multiple infarcts involving the territories of both posterior cerebral arteries and the left middle cerebral artery. Numerous old plaques were seen in the periventricular regions, in the corpus callosum and in the left middle cerebellar peduncle. The third case, a 60 year old woman with mitral and aortic stenosis, presented with cortical deafness and transient right hemiparesis. She died 5 years later. Brain examination showed infarcts involving both middle cerebral artery territories. There was also many old plaques in the periventricular areas, thalamus, internal capsule, centrum semi-ovale, brain stem and right nucleus dentatus. In the 3 cases, the optic tracts were normal. The spinal cord, examined only in the first case, was also normal. The asymptomatic character of these MS cases can be explained first by the location of the plaques and the lack of spinal cord and optic tract involvement. It could also be due to the small size of the plaques and to axonal preservation. Such features are rare since our 3 observations have been selected from a pathological collection of 125 MS cases and 9,300 general neuropathological records. Six other cases have been previously reported by other authors.
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PMID:[Asymptomatic multiple sclerosis - 3 cases (author's transl)]. 733 73


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