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

Victims of atherothrombotic infarction of the brain, the most common variety of stroke, frequently have recurrent strokes. Risk factors believed to accelerate such events include hypertension, diabetes mellitus, hyperlipidemia, atherosclerotic disease (of heart, aortocervical and intracranial vessels), erythrocythemia, stress, tobacco smoking, hyperuricemia, and perhaps obesity. Most prior studies indicate average anticipated 5 year mortality of 35 to 65 percent and stroke recurrence rate of 20 to 40 percent. A consistent effort to control risk factors in 88 survivors of a first cerebral infarction yielded 17 percent mortality and 16 percent stroke recurrence rates during the 5 years following first stroke. This sustained and systematic approach to risk factor management seemed beneficial to these stroke victims.
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PMID:Prevention of recurrent stroke. 730 62

A method for measuring regional cerebral circulation time (rCCT) between the hemispheres using intravenous pertechnetate and a multidetector system is presented. Interhemispheric differences of rCCT instead of absolute values were selected because of the variation of pertechnetate bolus dispersion due to changes in the systemic circulation and injection technique inter-and intraindividually. Time activity curves over one minute were analyzed by a modified gamma function fitting method. The results are printed as a brain map which shows reference values and abnormal findings. Abnormal rCCT asymmetry was observed in 10 out of 77 controls (13%) and 58 out of 65 patients with cerebral infarction (89%). Within 2 weeks after a stroke shorter circulation time values on the side of the lesion than on the contralateral side were found in 5 patients. In the severe infarction cases and in the acute stages of infarction circulatory changes could be found in a great number of areas. In patients with manifest diabetes abnormal circulatory findings occurred in larger regions and in a greater number of the patients than in those without that disease. Although the luxury perfusion and diaschisis phenomena, as well as the influence of cross-over of the count rates between the hemispheres, reduce circulatory time differences, use of the present pertechnetate method allows detection of subtle regional circulatory changes in patients with brain infarction.
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PMID:Non-invasive external regional measurement of cerebral circulation time changes in supratentorial infarctions using pertechnetate. 731 65

We investigated the association of amyloid beta-protein precursor (APP) and platelet derived microparticles in 20 normal controls and 91 patients with various diseases causing a thrombotic tendency. Compared with the controls, the mean percentage of APP-positive microparticles was significantly greater in the patients with cerebral infarction (39.1 +/- 17.7%, p < 0.001), diabetes (31.1 +/- 12.6%, p < 0.001), and uremia (30.1 +/- 14.7%, p < 0.01), but not in those with hypertension (8.2 +/- 6.3%, p = NS). Sixteen patients with cerebral infarction, 20 with diabetes, and 11 with uremia had microparticles with very high APP levels. In normal controls, 7.2 +/- 3.7% of the microparticles were positive for P-selectin, while the percentage in cerebral infarction, diabetes, uremia, and hypertension was respectively 43.5 +/- 15.1%, 40.0 +/- 12.8%, 31.8 +/- 12.2%, and 11.6 +/- 7.3%. There was a significant correlation between P-selectin and APP positivity of microparticles. Our results suggest that microparticle APP may have a regulatory influence on coagulation abnormalities.
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PMID:Amyloid beta-protein precursor-rich platelet microparticles in thrombotic disease. 753 36

Blackfoot disease (BFD) is an endemic peripheral arterial disease confined to the southwestern coast of Taiwan. The cause of the disease has been ascribed to the high-arsenic artesian well water. The purpose of this study was to examine the possible association between the long-term exposure to artesian well water and the change in microvascular circulation in the absence of peripheral arterial insufficiency. A total of 45 men living in the BFD-hyperendemic villages and another 51 age- sex- body-mass index-matched men who lived in nonendemic villages nearby were recruited into this study. All subjects were free from peripheral vascular disease (resting ankle-brachial index > 1.00), clinical claudication, cigarette smoking, diabetes mellitus, hypertension, ischemic heart disease, cerebral infarction and obesity. Laser Doppler flowmetry was used to measure the peripheral microcirculation on the big toes both at 36 degrees C (basal perfusion, Pb) and after a hyperthermic test at 42 degrees C (Ph). The time required to reach Ph (T), and the average rate (R) of increase from Pb to Ph measured by (Ph-Pb)/T were also calculated. Results showed that those living in the BFD-hyperendemic area had a lower Pb [32.8 +/- 6.0 perfusion units (PU) vs. 67.0 +/- 4.3 PU, p < 0.001], a lower Ph (193.2 +/- 13.6 vs. 231.1 +/- 6.3 PU, p < 0.005), a longer T (3.04 +/- 0.19 vs. 1.31 +/- 0.08 min, p < 0.001) and a slower rate of increase from Pb to Ph (48.0 +/- 4.8 vs. 76.2 +/- 5.4 PU/min, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Abnormal peripheral microcirculation in seemingly normal subjects living in blackfoot-disease-hyperendemic villages in Taiwan. 755 22

The purpose of this study was to compare stroke severity, risk factors, and prognosis in patients with intracerebral hemorrhage versus infarction. We prospectively studied 1,000 unselected patients with acute stroke of a verified type in the Copenhagen Stoke Study. Neurological deficits and functional disabilities were evaluated weekly from the time of acute admission throughout the rehabilitation period. Eighty-eight (9%) had intracerebral hemorrhage. The relative frequency of intracerebral hemorrhage rose exponentially with increasing stroke severity. In multivariate analyses, stroke type had no influence on mortality, neurological outcome, functional outcome, or the time course of recovery. Initial stroke severity was the all-important prognostic factor. The relative importance of hypertension and blood pressure on admission was not greater for intracerebral hemorrhage than for infarction. No preponderance was found between type of stroke and sex, age, and smoking. Diabetes, ischemic heart disease, and elevated serum total cholesterol level all favored cerebral infarction as opposed to intracerebral hemorrhage. We conclude that the type of stroke per se has no influence on stroke prognosis in general; the extent of the injury is decisive. The poorer prognosis in patients with intracerebral hemorrhage is due to the increase in frequency of intracerebral hemorrhage with increasing stroke severity. The likelihood of cerebral infarction occurring as opposed to intracerebral hemorrhage seems increased fivefold in stroke patients with diabetes. Hypertension and blood pressure on admission were not predictors of stroke type.
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PMID:Intracerebral hemorrhage versus infarction: stroke severity, risk factors, and prognosis. 761 24

The average incidence, prevalence and mortality rates of cerebrovascular disease (CVD) in China were markedly increased with increase of age and were much higher in senile stage and males than those in presenile stage and females. The constituent ratio of CVD consisted cerebral infarction for 67.5% and cerebral hemorrhage about 24.8%. There was no difference between the characters of lesions confirmed by CT scan in senile and presenile groups. The majority of CT lesions in the two groups was lacunar infarction, being 76.3% and 85.9% respectively. There were more cases of lobar hemorrhage in the senile group. The most important risk factor for CVD was hypertension (65.8%). Heart disease and diabetes mellitus take second place, accounting 19.0% and 10.7% respectively. The incidence of mixed type of hypertension was high in CVD especially the isolated systolic hypertension. The incidence of cerebral stroke was obviously higher than myocardial infarction in China. The percentage of positive findings of atherosclerosis in extracranial portion of carotid artery system in elderly patients with thrombosis and transient ischemic attacks was 60-100% and 55-100%.
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PMID:Study on cerebrovascular disease of the elderly in China. 761 18

Focal status epilepticus and epilepsia partialis continua (FSE-EPC) are most frequently seen with chronic focal progressive encephalitis of Rasmussen and Russian spring-summer encephalitis. FSE-EPC may be the presenting feature of nonketotic hyperglycemic diabetes mellitus but is more often noted as a late complication especially if there is a coexistent cerebral lesion such as cerebral infarction. FSE-EPC may be related to multiple sclerosis, primary or metastatic brain tumors, the MERRF-MELAS syndrome, benign epilepsy of childhood with rolandic spikes, and in some adults with acquired aphasia. The physiological origin of the myoclonic jerks seen in EPC is cortical and may be either spontaneous or provoked by the joint position of the affected limb. The treatment of FSE-EPC is influenced by the underlying disorder.
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PMID:Focal status epilepticus and epilepsia partialis continua in adults and children. 768 71

Cerebral infarction (stroke) is a potentially disastrous complication of diabetes mellitus, principally because the extent of cortical loss is greater in diabetic patients than in nondiabetic patients. The etiology of this enhanced neurotoxicity is poorly understood. We hypothesized that advanced glycation endproducts (AGEs), which have previously been implicated in the development of other diabetic complications, might contribute to neurotoxicity and brain damage during ischemic stroke. Using a rat model of focal cerebral ischemia, we show that systemically administered AGE-modified bovine serum albumin (AGE-BSA) significantly increased cerebral infarct size. The neurotoxic effects of AGE-BSA administration were dose- and time-related and associated with a paradoxical increase in cerebral blood flow. Aminoguanidine, an inhibitor of AGE cross-linking, attenuated infarct volume in AGE-treated animals. We conclude that AGEs may contribute to the increased severity of stroke associated with diabetes and other conditions characterized by AGE accumulation.
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PMID:Neurotoxicity of advanced glycation endproducts during focal stroke and neuroprotective effects of aminoguanidine. 773 77

This study evaluates the prognostic factors and causes associated with mortality in Chinese diabetic patients after lower extremity amputations. Medical records of all diabetic patients admitted to the National Taiwan University Hospital for leg amputations from 1982 to 1991 were reviewed. Demographic data, medical history, amputation levels and admission routines, including fasting plasma glucose, cholesterol, triglycerides, blood urea nitrogen, creatinine, urine protein and electrocardiograms, and bacterial culture done during the admission period were recorded. The vital status of the patients was followed by personal contact and mortality was ascertained from government computer records. The causes of death were recorded according to the death certificates. Univariate analysis and multivariate Cox's proportional hazards model were used to identify the prognostic factors associated with mortality. A total of 87 diabetic amputees, of whom 34 died, were found within this 10-year period. Cerebral infarction, infection and diabetes mellitus were the most commonly reported causes of death. Their calculated mortality was 5.95 times higher than the mortality rate of the age-comparable population in Taiwan. A history of hypertension and coronary heart disease were found to be the best indicators for predicting a fatal outcome with rate ratios of over two-fold. This study shows that post-amputational mortality is high in diabetic patients and that the major cause of death is cerebral infarction. The major cause of death in this study differs from that reported for Caucasians, for whom cardiovascular disease is the most important cause of death.
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PMID:Mortality in diabetic patients after lower extremity amputations. 774 36

The purpose of this study was to evaluate risk factors associated with peripheral vascular disease (PVD) in patients with non-insulin-dependent diabetes mellitus (NIDDM). A group of 100 patients (50 men and 50 women) aged 50 years or over with PVD and another group of 200 age-sex-matched patients (100 men and 100 women) without PVD were studied. The mean +/- standard error of ages for subjects with and without PVD were 60.8 +/- 0.6 years and 59.7 +/- 0.3 years, respectively. Doppler ultrasound was used to measure the systolic pressures of the brachial, posterior tibial and dorsal pedal arteries bilaterally. The diagnosis of PVD was made by an ankle-brachial index (ABI) < 0.90 and the diagnosis of non-PVD by an ABI > 1.00. The association of PVD with diabetic duration, body mass index (BMI), cerebral infarction (CI), coronary heart disease (CHD), proteinuria, diabetic retinopathy, neuropathy, hypertension, and cigarette smoking was evaluated. In addition, biochemical data including fasting plasma glucose, hemoglobin (HD)Alc, cholesterol, triacylglycerol, high- and low-density lipoprotein cholesterol, uric acid, blood urea nitrogen (BUN) and creatinine (Cr) were studied. In univariate analysis, PVD was associated with an increased level of systolic blood pressure (SBP), BUN and Cr, cigarette smoking, CI, CHD, proteinuria and retinopathy. In stepwise logistic regression analysis, the level of SBP, cigarette smoking and CI remained statistically significant. The log odds of PVD could be expressed as: -2.834 + 0.013 (SBP in mmHg) + 0.577 (cigarette smoking) + 1.320 (CI). PVD is the result of aggregation of atherosclerotic risk factors; among those factors noted in this study, SBP, cigarette smoking and CI are important.
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PMID:Atherosclerotic risk factors for peripheral vascular disease in non-insulin-dependent diabetic patients. 785 48


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