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

To assess the results and incremental risk factors affecting outcome after multiple-valve operation in the early blood cardioplegia era of cardiac surgery, follow-up data (mean +/- SD 3.1 +/- 2 years) were obtained on 97% of 513 patients (mean age +/- SD 58.8 +/- 10.5 years) who underwent a multiple-valve procedure between June 1976 and August 1985. Preoperatively 41% of patients were in New York Heart Association functional class III and 54% in class IV. Three groups accounted for 98.6% of the patients: 57.7% had an aortic and mitral valve procedure, 29% had a mitral and tricuspid valve procedure and 11.9% had a triple-valve procedure. The overall hospital mortality rate was 12.5% and overall 5-year survival rate was 67.1%. Hazard function analysis for all deaths revealed systolic pulmonary artery pressure (p less than 0.0001), age (p = 0.005), triple valve procedure (p less than 0.005), concomitant coronary bypass operation (p less than 0.005) and prior cardiac surgery (p less than 0.002) as the significant incremental risk factors predicting decreased survival in the early hazard phase; diabetes (p less than 0.005) predicted decreased survival in the late hazard phase. Postoperatively the condition of 80% of the patients improved to functional class I or II; only 0.6% remained in functional class IV. The 5-year rate of freedom from late combined valve-related morbidity was 81.7% and that of freedom from late combined valve-related morbidity and mortality was 71.7%. These results demonstrate excellent clinical improvement and late survival after multiple valve operation in patients with advanced valvular heart disease, justifying aggressive surgical therapy in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Multiple valve operation for advanced valvular heart disease: results and risk factors in 513 patients. 154 66

It is claimed that long-term treatment with beta-blockers improves cardiac function and exercise capacity in patients with various forms of congestive heart failure. This was first reported by Waagstein and coworkers in patients with idiopathic dilated cardiomyopathy in 1975 and was later confirmed in 8 further studies in this type of patient. A total of 211 patients with idiopathic dilated cardiomyopathy were treated for 12-19 months. About two thirds of the patients have improved to some extent. Seven other studies reported favourable long-term effects of beta-blockers in 120 patients with other forms of dilated cardiomyopathy, e.g. caused by coronary artery disease, adriamycin, diabetes, or valvular heart disease. Pooled data from 10 studies on 153 patients with various forms of cardiomyopathy, showed that ejection fraction was improved by 40% from 27 to 38%. Only two studies were inconclusive, both with only one month's treatment. In all studies with favourable effects of long-term beta-blockade, treatment was given for more than 2 months and in most cases for about 6 months. A number of beta-blockers have been used in the studies, including acebutulol, alprenolol, bucindolol, labetalol, metoprolol, practolol and propranolol. In most cases, a rather low dose was given initially and there was a stepwise increase in the dosages. After 6-8 weeks most patients were given beta-blockers in daily doses comparable to those given in patients with angina pectoris and hypertension. There is at present no indication that one beta-blocker is superior to others. It therefore seems reasonable to believe that the effects are due to beta 1-blockade.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:New therapeutic strategies in chronic heart failure: challenge of long-term beta-blockade. 168 18

This intervention program investigated the applicability and the effects of intensive physical exercise and low-fat diet on the progression of coronary atherosclerotic lesions and stress induced myocardial ischemia in patients with stable angina pectoris. Patients participating in this study were recruited following routine coronary angiography for angina pectoris. Inclusion criteria were male sex, stable symptoms, a willingness to participate in the study for at least twelve months, and coronary artery stenoses well documented by angiography. Exclusion criteria were unstable angina pectoris, left main coronary artery stenosis greater than 25% luminal diameter reduction, severely depressed left ventricular ejection fraction (less than 35%), significant valvular heart disease, insulin-dependent diabetes mellitus, primary hypercholesterolemia (type II hyperlipoproteinemia, low-density lipoprotein greater than 210 mg/dl), and conditions precluding regular physical exercise. 18 patients participated in this program for one year; they consumed a low-fat, low-cholesterol diet (less than 20 energy % fat, cholesterol less than 200 mg/day) and exercised for more than 3 h/week. Myocardial oxygen consumption was estimated from maximum rate-pressure product at peak exercise; it was correlated to stress induced myocardial ischemia, as measured by 201Tl-scintigraphy. Results were compared with those of 18 matched patients on "usual care". In the intervention group, physical work capacity (161 +/- 34 W vs. 194 +/- 42 W) and maximum rate pressure product (25.0 +/- 6.3 x 10(3) vs. 27.2 +/- 5.3 x 10(3)) increased significantly (p less than 0.01). Patients willing to devote time and effort to intensive physical exercise and to comply with a low-fat diet may benefit from this form of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Modification of risk factors through physical training and low-fat diet]. 191 19

The purpose of this study was to assess the influence of aging on the surgical results. The subjects which were 70-year or older included 13 cases of acute myocardial infarction with mechanical failure (AMI), 36 of elective aortocoronary bypass (CABG) and 33 of valvular heart disease (VHD). The control group younger than 70 included 32 cases of CABG and 32 of VHD. The complication rate of hypertension or diabetes mellitus in the older group was not significantly higher than in younger group. The characteristics of the preoperative status in the older group, however, seemed to be renal and hepatic hypofunction and anemia. The amount of intraoperative bleeding in older group was larger than in younger group. The periods of ICU stay, respiratory assist and postoperative hospitalization in older group were significantly longer than in younger group. The operative mortality rate of AMI was 61.5%, of CABG 8.3% and of VHD 12.1%. The operative mortality rate of emergent or urgent operation was 47.6% and of elective one 8.2%. The 4-year survival rate of CABG was 82% and the 6-year survival rate of VHD was 85%. Sixty four survivors (95.5%) improved to I-II of NYHA classification and of only 3 survivors (4.5%) remained in NYHA III class. The operative and long term results of elective surgery in older patients were comparable to those in younger ones. Therefore aging, itself, should not be a limiting factor in 70-year or older patients with good mental activity.
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PMID:[Results and problems of open heart surgery in patients seventy years of age and older]. 194 70

Seventy two patients presenting with stroke to Kenyatta National Hospital were studied between January 1986 and January 1987. The majority were from the rural areas. There were about equal numbers between left and right sided hemipareses. The majority of the patients were in their 6th and 7th decades. 22 of the patients were hypertensive. Diabetes mellitus, cigarette smoking, alcohol consumption, and valvular heart disease were some of the other factors associated with strokes. 46% of the patients died while the remainder had residual neurological deficits.
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PMID:Stroke at Kenyatta National Hospital. 222 28

The disease entity "diabetic cardiomyopathy" has been extensively described in young patients with diabetes in the absence of ischemic, hypertensive or valvular heart disease. The most convincing data have been a 30% to 40% incidence of decreased radionuclide angiographic left ventricular ejection fraction response to dynamic exercise. In the current study, the hypothesis was tested that this abnormal ejection fraction response was due to alterations in ventricular loading conditions or cardiac autonomic innervation (extrinsic factors), or both, rather than to abnormalities in intrinsic ventricular systolic fiber function (contractility). Twenty normotensive patients with diabetes (mean age 30 +/- 5 years, mean duration 15 +/- 6 years) and 20 age-matched normal subjects were studied. All patients with diabetes had a normal treadmill exercise tolerance test without evidence of myocardial ischemia. By radionuclide angiography, all normal subjects increased ejection fraction with exercise (62 +/- 4% to 69 +/- 6%; p less than 0.001). In contrast, 11 (55%) of 20 patients with diabetes maintained or increased ejection fraction with exercise (group 1; 62 +/- 4% to 69 +/- 6%; p less than 0.001) and 9 (45%) of 20 showed an exercise-induced decrease (group 2; 73 +/- 4% to 66 +/- 6%; p less than 0.001). No difference in the incidence of microangiopathy, as noted by funduscopic examination, was present between the diabetic groups. Despite the abnormal ejection fraction response to exercise in the group 2 patients with diabetes, all patients with diabetes had a normal response to afterload manipulation, normal baseline ventricular contractility as assessed by load- and heart rate-independent end-systolic indexes and normal contractile reserve as assessed with dobutamine challenge. Autonomic dysfunction did not explain the disparate results between the group 2 patients' radionuclide angiographic data and their load-independent tests of ventricular contractility and reserve. In addition, the high ejection fraction at rest in group 2 patients (73 +/- 4% versus 62 +/- 4% for normal subjects; p less than 0.001) was not related to the abnormal tests of autonomic function. Thus, when left ventricular systolic performance was assessed by load- and rate-independent indexes, there was no evidence for cardiomyopathy in young adult patients with diabetes who have normal blood pressure and no ischemic heart disease.
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PMID:Myocardial mechanics in young adult patients with diabetes mellitus: effects of altered load, inotropic state and dynamic exercise. 234 31

We reported a case of fibromuscular dysplasia (FMD) presenting lateral medullary syndrome accompanied with left truncal ataxia, left Horner's syndrome and superficial sensory deficit in the right extremities. He was 46-year-old man and had no remarkable risk factors for the cerebrovascular disease such as hypertension, diabetes mellitus and valvular heart disease. Cerebral angiography was performed and there was the string-of-beads-like shadow in the left vertebral artery, revealing a localized FMD. Wedge-shaped area of low signal intensity in the left lower medulla was recognized in magnetic resonance imaging (spin echo Tr/Te 600/30). It was suggested that the lesion of the lower medulla caused the patient's several symptoms. In Japan, there have been a few case reports of cervical or intracranial FMD, but we cannot find any report of FMD localizing in the unilateral vertebral artery. In general, it has been said that the etiology of lateral medullary syndrome under fifty years old differs from those of geriatric patients. The authors pointed out the significance of FMD as one of those risk factors causing lateral medullary syndrome and also discussed the mechanism of the sensory disturbance sparing face.
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PMID:[A case of fibromuscular dysplasia presenting lateral medullary syndrome]. 238 16

In the National Cardiovascular Center, 46 patients whose ages were above 70 underwent open heart surgery from 1977 to 1986. Twenty of them received AC bypass and 5 had repair of the rupture of ventricular septum or left ventricular aneurysm. Among them 2 had also insertion of left ventricular assist device because of acute myocardial infarction (MI). Eighteen underwent mitral and/or aortic valve replacement. The other 3 were operated on because of atrial myxoma etc. Preoperatively, in ischemic heart disease group, due to resultant heart failure, one third of the patients were given catecholamines. In valvular heart disease group, angina pectoris and old MI were also common. Beside arrhythmias, respiratory complications, renal dysfunction and diabetes mellitus, neurological complications such as brain infarction were prominent in both groups. Hospital mortality was 15% in AC bypass group, 40% in acute MI group and 11.1% in VHD group. In 36 patients who left hospital, mean NYHA class improved after operation. The mortality rate and symptomatic improvement demonstrate that cardiac surgery can be performed with acceptable risk in elderly patients. Anesthesiologists should manage them carefully, considering the problems stated above.
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PMID:[Anesthetic management of elderly patients in open heart surgery]. 277 47

Early detection of heart failure requires criteria by which to define the initial stages of a syndrome which often has an insidious onset and which may progress slowly for many years. The most specific definitions of heart failure are those obtained towards the end of the disease process, but reliance upon these means that, although few cases are misclassified, only manifest cases can be detected. Since prevention is the ultimate goal, early detection of subjects at risk and a wider understanding of the pathophysiological mechanisms and risk factors are necessary. The principal causes of heart failure in the Western world are coronary artery disease and hypertension; valvular heart disease and other cardiac disorders are relatively uncommon causes. The major risk factors are obesity, tobacco smoking and diabetes mellitus, and in a prospective large-scale study we have also shown that individuals who develop manifest symptoms of heart failure often have a long history of exercise-induced dyspnoea. Clearly, identification of the early symptoms of heart failure and prompt treatment of risk factors such as hypertension and obesity are important objectives. However, a better understanding of the underlying biochemical and structural abnormalities would help to define more appropriate preventive treatments.
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PMID:Improving the detection and diagnosis of congestive heart failure. 280 86

One hundred and seven patients aged greater than or equal to 60 years with cardiac surgery were reviewed. These patients underwent open heart surgery at University Hospital of Tokyo and JR Tokyo General Hospital during 1981 to 1987. Prevalence of the elderly with 60 years or older in all patients with cardiac surgery increased 4.1% to 20% during these seven years. Surgery for ischemic heart disease has become more common. There were less number of cases with valvular heart disease referred for surgery, but, not a few cases with calcified aortic valve or floppy mitral valve had valve replacement. Operative results were as follows: Hospital death was 6/107 patients (5.6%) and three patients died after discharge. This group of old patients was occasionally associated (14/107, 13%) with a variety of diseases including bronchial asthma, diabetes mellitus, and other atherosclerotic lesion or liver dysfunction. Valvular heart disease was not rarely complicated with ischemic heart disease. Postoperative complications were mainly due to renal failure, respiratory failure or low output syndrome, possibly related to associated disease. Intra-aortic balloon pumping was performed in seven of 107 patients, four of whom eventually died. In conclusion, there is a relatively high risk in cardiac surgery in old aged patients with associated diseases. We have to manage carefully old patients to avoid major postoperative complications including cardiac, respiratory and renal events. Much more old patients will have open heart surgery in the future.
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PMID:[Cardiac surgery in the aged]. 327 13


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