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

The correlation of serum levels of lipoprotein (a) [Lp(a)] with the progression of cervical atherosclerosis was investigated and compared with the common risk factors. The carotid arteries of 100 subjects were examined by direct bi-directional Doppler ultrasonic imaging. A highly significant elevation of the mean values of Lp(a) in group 1 (P1, with smooth surface plaques) and in group 2 (P2, with exulcerations) vs the control (P0, with no detectable plaques) was established. Low density lipoprotein cholesterol (LDL-C) was highly significantly elevated in P1, but only significantly higher in P2. Total cholesterol (TC) was significantly higher in P1 and highly significantly elevated in P2. Diabetes was also found to be significantly associated with atherosclerotic plaque formation, in contrast to triglycerides (TG), high density lipoprotein cholesterol (HDL-C) and its ratio to TC, hypertension and cigarette smoking. In a smaller collective of 30 patients--40-60 years old--being equally divided into 3 groups (p0, p1, p2), Lp(a) showed again to be the most significant parameter. LDL-C, TC and its ratio to HDL-C were highly significantly altered in subgroup p1 and significantly altered in subgroup p2. In this selection there were 12 patients with and 18 without cerebral infarction (CI). The difference of the medians of Lp(a) serum levels between these 2 groups was also found to be highly significant.
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PMID:A dominant role of lipoprotein(a) in the investigation and evaluation of parameters indicating the development of cervical atherosclerosis. 293 55

Steroid treatment is widely used in acute cerebral infarction yet its value is controversial. High dose dexamethasone (480 mg over 12 days) was given in a double blind, randomised controlled trial to 113 consecutive eligible patients with acute cerebral infarction admitted to an acute stroke unit. Those with stroke for more than 48 hours, known embolic sources, diabetes, and infection were excluded. Death and quality of survival were recorded over 21 days. The active drug group (54 patients) matched the placebo group (59 patients) for age, initial stroke score, delay in beginning treatment, and other relevant variables. The two groups did not differ significantly in death rate or quality of survivorship. The small difference in mortality between the two groups may have represented a marginal therapeutic effect, which might reach significance in a larger sample. The widespread use of steroids in response to such a marginal therapeutic gain would expose large numbers of patients with stroke to more serious hazards of steroid treatment and convert patients who would otherwise have died into neurovegetative survivors. High dose steroid treatment was ineffective in ischaemic stroke, and the data suggest that further evaluation by a larger multicentre trial is not justified.
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PMID:High dose steroid treatment in cerebral infarction. 308 50

This study is a review of our experience with elderly patients, who have undergone coronary artery bypass grafting (CABG). Of 357 patients who underwent elective CABG from April 1982 to May 1986, 50 patients (14.0%) were 65 years old or older. The incidence of preoperative cardiac conditions in the elderly was almost the same as that in patients less than 65 years of age. The incidence of noncardiac preoperative conditions in the older patients, such as diabetes mellitus, renal dysfunction, concomitant malignant disease, atherosclerotic lesion of the ascending aorta, was significantly higher than that in the younger age group. Early surgical mortality was 4.0% (2 cases) in the older group, and 1.3% (4 cases) in the younger group. There was no significant difference in statistics. The incidence of major postoperative complications was not significantly different between the two age groups, except that of cerebral infarction, which was significantly higher in the elderly group (6.0% vs 0.3%, p less than 0.001). The rate of a long postoperative hospital stay was also significantly higher in the older group (43.8% vs 30.0%, p less than 0.05). Long-term results, such as late mortality, symptom-free rate and graft patency, showed no significant differences between the two age groups. It is concluded that CABG can be performed in selected older patients with relatively low mortality and morbidity. Special attention should be paid to prevent perioperative cerebral infarction.
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PMID:Early and late results of coronary artery bypass grafting in the elderly. 326 6

We studied the ability of serum glucose concentration and neurologic deficits at admission in predicting the outcome of acute cerebral ischemia in 65 patients given naloxone. Among our patients, the volume of infarction on computed tomograms and outcome were strongly related to the severity of neurologic deficits found at admission. Neither a history of diabetes nor hyperglycemia when added to the results of the initial neurologic assessment improved prediction of outcome after acute cerebral infarction.
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PMID:Comparison of admission serum glucose concentration with neurologic outcome in acute cerebral infarction. A study in patients given naloxone. 336 74

The author observed high sugar level in 22 patients who had cerebrovascular diseases (cerebral hemorrhage and cerebral infarction). They tried to diagnose the cause of the increased sugar level with HbA1 test after the registration of the patients to the hospital within 24-48 hours. They found normal, less than 8% HbA1 concentration in 12 patients, increased, more than 8% values in 10 cases. They made oral glucose tolerance test in 19 survived patients after the acute symptoms had finished. The oral glucose tolerance test with increased HbA1 concentration showed in 5 patients diabetes, in 3 cases impaired glucose tolerance. The author observed from all hyperglycemic patients with low HbA1 level only 2 cases impaired glucose tolerance. Hyperglycemia with increased HbA1 concentration indicates previous carbohydrate intolerance.
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PMID:[Differentiation of stress-induced hyperglycemia from diabetes mellitus in cerebrovascular strokes by hemoglobin A1 determination]. 337 5

The impact of diabetes was prospectively studied during a 5-year period in 428 unselected and consecutive patients with acute cerebrovascular disease of whom 18% were diabetic. Cerebral infarction was more frequent in diabetics (81 vs 70%, p less than 0.02) whereas transient cerebral ischaemia was less frequent (4 vs 14%, p less than 0.01). Case fatality rate during hospitalization was higher in the diabetic than in the non-diabetic patients (28 vs 15%, p less than 0.02). Patients who died during hospitalization, diabetic as well as non-diabetic, had significantly higher blood glucose concentrations on admission compared with patients who survived. Hematocrit values were higher in the diabetic than in the non-diabetic patients (p less than 0.02). Diabetics had higher systolic blood pressure levels than the non-diabetics in the acute phase (p less than 0.005). The diabetic stroke patients more often had a history of hypertension, atrial fibrillation, heart failure and angina pectoris than non-diabetics stroke patients and diabetic control patients without stroke. Stroke patients, not known to be diabetic, had larger mean oral glucose tolerance test curve areas when compared with healthy controls but not when compared with hospitalized controls. We propose that diabetes increases the risk for stroke through other concurrent risk factors, cardiac disorders in particular.
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PMID:Clinical characteristics in diabetic stroke patients. 339 27

Cerebrovascular events are the most common neurological complications seen in renal transplant recipients. Cerebral infarction and transient ischemic attacks are the most common events and may occur years after transplantation. Recipients older than 40 years at the time of transplantation and those with diabetes mellitus are at greater risk. No instances of aneurysmal subarachnoid hemorrhage occurred among 31 patients with polycystic kidney disease who had undergone transplantation.
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PMID:Stroke in renal transplant recipients. 351 93

Criteria for the diagnosis of exercise hypertension have not yet been established. Published values for blood pressure increase during dynamic exercise in normotensive healthy persons differ greatly dependent on age, sex, heart frequency and load of dynamic exercise. Upper normal systolic values during exercise reach levels between 200 and 230 mm Hg. The incidence of exercise hypertension is therefore reported to range from 1 to 10% of the total population. Follow-up studies show that 10 to 60% of persons with isolated exercise hypertension proceed to chronic arterial hypertension. No results are available on exercise hypertension as a risk factor in contrast to the well-known link between increased systolic and diastolic casual blood pressure and cardiovascular diseases. The development of left-ventricular hypertrophy depends mainly on the average systolic blood pressure during a 24-hour period. Peak values of systolic blood pressure during the day or blood pressure variability are less important. Drug treatment of isolated exercise hypertension is not generally accepted. Non-drug treatment is to be preferred, e.g. weight reduction in overweight, dietary sodium restriction and endurance training. Drug treatment must be considered, if non-drug treatment is unsuccessful and/or risk factors, for example hypercholesterolemia, diabetes, cigarette smoking, or complications of target organs, i.e. coronary heart disease or cerebral infarction, do exist. In antihypertensive treatment of increased exercise blood pressure, the influence of the drugs on the hemodynamic and metabolic parameters must be observed, especially in patients with concomitant coronary heart disease. Increases in blood pressure due to dynamic exercise are better attenuated by antihypertensive drugs than those caused by isometric exercise. The drugs of choice are beta-blockers, preferably beta 1-blockers without ISA. Alternatively, calcium antagonists of the verapamil-type or ACE-inhibitors may be used. In contrast to other antihypertensive drugs, labetalol, calcium antagonists and ACE-inhibitors have no influence on the exercise-induced increase of cardiac index and therefore little effect on the work capacity of the circulatory system.
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PMID:[Differential therapy of exercise hypertension]. 358 8

To elucidate the incidence of severe disability due to cerebral stroke and its related factors, prospective data of 1,621 Hisayama residents aged 40 and over were examined. Severe disability resulting from stroke was defined as patients who were unable to dress, take care of their toilet needs, and feed themselves without assistance, or who required a wheel chair for ambulation three months after the most recent episode. During 20 years of follow-up 255 stroke patients were observed among the sample population. The annual incidence of stroke per thousand was 9.8, and rate of severe disability was 2.8 for men and 6.4 and 2.0 for women, respectively. Of the 74 cases with severe disability, approximately 92% were attributed to cerebral infarction. Related factors to severe disability due to cerebral infarction were recurrent attacks, hypertension, changes in ocular fundi and diabetes mellitus among predispositions and quadriplegia or muscular contraction, and intelligent or mental disorders among inhibiting factors for functional recovery. Furthermore, in 59 autopsy cases with multiple cerebral infarctions, the frequency of disability increased as the number of infarcts increased. Hypertension and diabetes mellitus, as risk factors for cerebral infarction and factors inhibiting post-ictal functional recovery were discussed.
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PMID:Severe disability related to cerebral stroke: incidence and risk factors observed in a Japanese community, Hisayama. 358 64

Four hundred fifty-one patients with transient ischemic attacks (TIA) occurring within 1 month of hospitalization, admitted during 1977-1983, were analyzed to establish the effect on survival of age, race, sex, distribution of TIA, cigarette smoking, previous cerebral infarction or hemorrhage, previous TIA, or history of ischemic heart disease, valvular heart disease, cardiac dysrhythmia, hypertension, and diabetes mellitus. Proportional hazards analysis revealed that decreased survival was associated with increasing age, carotid artery distribution TIAs (compared with vertebrobasilar distribution TIAs), cigarette smoking, previous contralateral stroke, ischemic heart disease, and diabetes mellitus. We found great variation in the estimated survival of TIA patients, ranging from 5-year survivals of greater than 95% for 60-year-old patients with none of these risk factors to less than 25% for patients with all of these risk factors. Although the survival of the strata differed, the average mortality rates for this series of patients was about one-half of that observed for 225 patients accessed and followed by our center during 1961-1973.
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PMID:Factors influencing the survival of 451 transient ischemic attack patients. 359 Feb 45


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