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

The early diagnosis of heart disease during or better before pregnancy is one of the most important problems, as cardiac diseases are the most common cause for maternal deaths throughout the world. The knowledge of hemodynamic alterations in circulatory and respiratory physiology during pregnancy complicated by heart disease is a prerequisite for their management. The following indications for therapeutic abortion of pregnancy complicated by heart disease can be concluded according to our own observations: 1. history of significant heart failure (more than grade IV according to the classification of the New York Heart Association), frequent attacks of angina pectoris and longstanding cyanosis: 2. in spite of the most careful heart treatment with digitalis, diuretics and salftree diet cardiac-thorax-rate of more than 55% in congenital heart disease, cardiac-thorax-rate of more than 60% in acquired heart disease, significant signs of heart failure, namely more severe than grade III, tachycardic atrial fibrillation, pulse deficit of more than 30/min, active inflammatory processes of the heart (rheumatic fever, subacute bacterial endocarditis, Takayasu's disease); 3. especially severe metabolic disorders, i.e. diabetes mellitus, malignant hypertension, kidney diseases; 4. primiparae of an age of more than 35 years with any heart disease. Commissurotomy can be accomplished during pregnancy if it is too late for therapeutic abortion. Pregnancy in case of artificial valves is not recommended in general because of impending hemorrhagic diathesis.
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PMID:[Indication for pregnancy interruption in patients with heart diseases]. 85 89

Plasma renin activity (PRA) was determined in 48 patients with diabetes mellitus in sodium balance on a 10-20 mEq. Na diet. Nine were normotensive (group I), 11 11 were hypertensive without diabetic nephropathy (group III). Results were compared with those in 16 normal subjects and 49 nondiabetic patients with essential hypertension in similar Na balance. Mean supine PRA did not differ significantly among groups I and II, normal subjects, and patients with essential hypertension. Group III diabetics had a supine PRA of 2.4 +/- 0.4 ng./ml./hr. (x +/- S.E.M.), significantly lower than the other diabetic groups (P less than 0.005) and normal subjects (P less than 0.05). Upright PRA was 12.8 +/- 2.2 in group I diabetics, similar to that in normal subjects (13.3 +/- 2.3), and 8.1 +/- 1.4 in group II diabetics, similar to that in essential hypertensives (6.8 +/- 0.8). In group III diabetics, upright PRA was 4.0 +/- 0.5, significantly lower than that in any other group. These results suggest that (1) PRA is normal in normotensive diabetics, (2) upright PRA in diabetics with hypertension but no nephropathy is similar to that in essential hypertension, and (3) patients with diabetes, hypertension, and nephropathy have "low renin hypertension," explaining the virtual absence of malignant hypertension in this group. Although the major mechanism for this low PRA may be volume expansion, indicating the need for potent diuretics, other mechanisms include hyalinization of the afferent arteriole, decreased cathecholamine stimulation of renin release, and inadequate conversion of prorenin to renin.
Diabetes 1976 Oct
PMID:Plasma renin activity and hypertension in diabetes mellitus. 97 6

We performed a retrospective study in 72 autopsies of diabetic patients (DMP) selected out of 2,239 adult autopsies, comprehending the period between 1966 to 1982. In order to analyse the possible Diabetic Cardiomyopathy, the DMP were divided into 8 groups according to the presence or the absence of Myocardial Fibrosis (MF) and Congestive Heart Failure (CHF). The Diabetes Mellitus (DM) incidence according to the race, sex, age and the presence of Kimmestiel-Wilson (KW) were in agreement with the literature data. The majority of the deaths occurred after the sixth-decade and we did not find any DMP with Malignant Hypertension. Hypertension and Coronary Artery Disease (CAD) increased the frequency of anatomical cardiac alterations, as follows: 1. MF was more associated with CAD, 2. Hypertension was more frequent in DMP with KW in the nodular form; 3. Hypertension increased the frequency of left ventricular hypertrophy; 4. Myocardial Infarction occurred in the absence of occlusive vascular phenomena. The Myocardial Fibrosis (MF) observed in DMP without ACD and without hypertension may be final anatomic demonstration of a gradual metabolic-functional process, and not the basic mechanism of the CHF in the possible Diabetic Cardiomyopathy.
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PMID:[The heart and diabetes. An anatomo-clinical study]. 269 52

The elastin content of the aortic muscle and the elastase-like activity of the extracts of aortic muscle were studied in spontaneously diabetic BB rats and in rats made diabetic by a single bolus i.v. injection of alloxan. In both modes of diabetes, the total alkaline-insoluble aortic elastin content was significantly reduced in diabetic rats compared to that in the corresponding control rats. This reduction in aortic elastin was also accompanied by a consistent increase in the elastase-like activities of the aortic extracts prepared from the same tissues. Such a reciprocal relationship between aortic elastin content and elastase-like activity has previously been reported in rats with malignant hypertension. Since the rats used in this study were not hypertensive, the altered elastin metabolism observed in this work is likely to be a manifestation of diabetic disease and may in part account for the vascular changes associated with diabetes mellitus.
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PMID:Alterations of elastin and elastase-like activities in aortae of diabetic rats. 319 Nov 58

In recent years, the prognosis for a successful pregnancy has greatly improved for women with insulin-dependent diabetes mellitus (IDDM) who are under good glycemic control and free of complications such as vascular disease and nephropathy. We report the rapid development of severe nephrotic syndrome, malignant hypertension, and microangiopathic hemolytic anemia during the first trimester of pregnancy in a 29-yr-old woman with IDDM of 18 yr duration. Our patient had no pregestational history of retinopathy or hypertension and only minimal proteinuria. Significant improvement in blood glucose levels had been achieved over the 6 mo before conception. Kidney biopsy performed before the termination of pregnancy at 10 wk gestation revealed diabetic nephropathy. No other etiology for her renal disease could be found. An arteriole was noted to have entrapped red blood cell fragments and platelet thrombi, revealing the probable source of her hemolytic process. By 8 wk postpartum, her nephrotic syndrome and hemolysis had completely resolved. At 3 mo postgestation, the patient's hypertension was still present but less severe. Her serum creatinine has continued to decrease toward normal. This is the first report of a woman with IDDM in White's classification C who developed a toxemia-like syndrome during the first trimester of pregnancy, attributable to the underlying diabetic state.
Diabetes Care 1988 May
PMID:Rapid development of nephrotic syndrome, hypertension, and hemolytic anemia early in pregnancy in patients with IDDM. 339 Oct 92

We report on a 70-year-old woman suffering from diabetes mellitus dependent on insulin and associated with malignant hypertension. Following heart catheter examination for the dilatation of the renal arteries, she developed acute, painful, persistent livedo racemosa of the buttocks and the lower extremities. Histological investigation revealed embolism of cholesterol crystals in arterioles of the corium-subcutis region. On the basis of the cases described in the literature so far, we discuss the clinical spectrum of cutaneous cholesterol embolism.
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PMID:[Symptomatic livedo racemosa in cholesterol embolism with occlusion of the arterioles in the area of the corium-subcutis]. 361 62

Pathophysiology, outcome and some therapeutic problems of hypertension were described. Frequency of secondary hypertension and its underlying diseases in a hypertensive population greatly varied by study population. In the adult general population (Hisayama study) it was estimated to be 3.8%. Significance of various tests was evaluated in the diagnosis of renovascular hypertension and primary aldosteronism. Consideration of sodium balance in the evaluation was very necessary. The usefulness of captopril test was emphasized. Blood pressure was tended to decrease in upright posture and ambulation in cases with essential hypertension responding to acute sodium depletion by a significant reduction in blood pressure. In the observation of diurnal rhythm of urinary sodium excretion, the peak phase appeared about 3 hours earlier in essential hypertension than in normal control and 5 to 6 hours later in primary aldosteronism and Cushing syndrome. Sympathoadrenal function was activated in young borderline hypertensives but not in middle-aged ones. Outcome of hypertension accompanying diabetes mellitus was poor. Cardiovascular disease and renal failure occurred much frequently. Significance of hypertension as a risk factor of cardiovascular disease was described based on the data obtained through prospective epidemiological study (Hisayama Study). Hypertension was significantly correlated with stroke but not with myocardial infarction. Serum cholesterol level did not significantly correlate with both stroke and myocardial infarction. Reduction in stroke incidence in recent years was described in relation to the changes in risk factors of cardiovascular diseases. Pathophysiology and outcome of malignant hypertension (KW III-IV) were described in relation to underlying disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pathophysiology and outcome of hypertensive subjects. 389 32

There have been numerous accounts of women on ovulation inhibitors developing hypertension or reactifying or intensifying previous hypertension. Concerning frequency of significant hypertension in pill users, there are reports varying from .66% (or even 0%) to 19%. The time interval between start of medication and manifestation of hypertension also varies according to different sources from 7 days to 5 years, with the critical point usually around 6-8 weeks. Degree of hypertension after ovulation inhibitors ranges from mildly significant increases in systolic and/or diastolic blood pressure to malignant hypertension with irreversible kidney insufficiency. Early observable symptoms of hypertension include migrainelike headaches and rapid weight gain (sodium and water retention). After discontinuation of the medication, normal blood pressure is attained either within a few days or after 6-8 months. If normalization of blood pressure does not occur spontaneously there may be other causes (e.g., secondary vascular disorders). Concerning pathogenesis of ovulation-inhibitor-related hypertension, changes (increases) in the renin-angiotensin-aldosterone system are assumed to play a major role (almost all women on the pill exhibit elevated renin-angiotensin-aldosterone activity). Sodium retention may also be determinative. Many clinical and laboratory studies have demonstrated that it is the estrogen content of ovulation inhibitors that is responsible for the increased plasma renin activity. The study recommends: 1) women who wish oral contraceptive therapy should give careful family and personal histories and be tested for blood pressure before and during treatment (monthly, then after 6 months twice yearly); 2) careful supervision is indicated for women with high blood pressure or other cardiovascular disorders in their history, present or former kidney disorders, arterial hypertension, pregnancy toxemias, adipositas, or diabetes mellitus; 3) abnormal weight gain may be an early symptom; 4) if any rise in blood pressure is observed, ovulation inhibitor medication should be discontinued immediately; and 5) ovulation inhibitor-induced hypertension should be considered in differential diagnosis in young women with arterial hypertension.
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PMID:[Oral contraceptives and arterial hypertension]. 437 45

Minoxidil (U-10,858) has been shown in several controlled and blind studies and numerous uncontrolled studies to be a potent peripheral vasodilator for use in the management of sustained, severe, accelerating or malignant hypertension and moderate hypertension inadequately controlled by conventional therapy. Some effect may be seen four hours after oral administration with the peak effect being seen between four and 18 hours. The drug has a plasma disappearance half-life of 4.2 hours despite a duration of action of approximately 24 hours, suggestive of extravascular accumulation. Reported dosages range from 2 mg to 80 mg daily, most patients requiring approximately 20 mg daily. Rapid loading schedules have been studied but are not yet widely used. Frequent adverse effects include sodium retention, tachycardia, EKG changes, and hypertrichosis. Pericardial effusion, altered renal function, diabetes mellitus, and changes in plasma renin, urinary norepinephrine, and aldosterone levels have been reported. Other minor problems have been reported infrequently.
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PMID:Minoxidil. 698 52

The low graft survival rate in black recipients (36 +/- 2% at 1 year) as compared with the graft survival rate in white recipients (48 +/- 1%) might be secondary to a higher incidence of vascular lesions, inducing hypertensive disease, in blacks than in whites. The relative frequency of malignant hypertension in black recipients was six times that of white recipients, and recipients with malignant hypertension had a significant lower graft survival rate (43 +/- 2%) than recipients with glomerulonephritis (54 +/- 1%). In addition, patients with vascular lesions (diabetes, malignant hypertension, and glomerulonephritis) showed significantly lower graft survival rates in black than in white recipients, in contrast to patients with primary tubular or interstitial lesions (polycystic kidneys and pyelonephritis), who showed similar graft survival rates in blacks and whites. Only a small fraction of this racial effect could be traced back to the higher incidence of Lewis-negative phenotypes in black recipients and a similar beneficial effect of transfusions, on graft survival, was observed in both black and white recipients. The effects of graft survival of age (6%), race (9%), and transfusions (18%) were significant in good (A) and poor (B) centers. No overlap between A and B centers was observed for any of these three parameters when analyzed separately. However, when the cumulative effects of these three risk parameters were analyzed together a partial overlap appeared, i.e., higher graft survival rates were observed in low-risk recipients that received transplants in B centers than in high-risk recipients that received transplants in A centers. Consequently, the selection of the recipient may play a role in the overall results of different transplantation units, leading to their classification into A or B centers, but cannot explain all of the differences between A and B centers.
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PMID:Influence of the original disease, race, and center on the outcome of kidney transplantation. 703 19


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