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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To determine the frequency of and risk factors for adverse reactions to high-osmolality contrast media, the authors prospectively studied hospitalized patients undergoing cardiac catheterization. The authors also studied patients undergoing peripheral angiography and contrast material-enhanced computed tomography (CT) of the head or body who met at least one of the following criteria thought to increase the risk of adverse reactions: age of more than 60 years, diabetes, renal or liver disease, concurrent nephrotoxic drug use, or a history of allergic reactions (n = 795). Criteria were defined and used to group adverse reactions into three classes of clinical severity. Overall, class I (mild), class II (moderate), and class III (severe) reactions occurred in 362 (45%), 44 (5.5%), and three (0.4%) patients, respectively. Class II reactions were relatively common (25%) in patients undergoing cardiac catheterization yet were uncommon (2%) in patients undergoing the other three procedures. Nephrotoxicity occurred in 18 of 651 patients who had follow-up creatinine levels obtained at 48-72 hours. With multivariate regression analysis, the only risk factor (P less than .05) for combined class II and III reactions was diabetes. Diabetes, furosemide use, and a history of atopy (odds ratio = 2.8) were associated with nephrotoxicity (P less than .05). Underlying renal insufficiency was not a risk factor for nephrotoxicity.
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PMID:Frequency and determinants of adverse reactions induced by high-osmolality contrast media. 291 27

A case-control study comprising 216 cases of pancreatic cancer and 279 controls was conducted to investigate the relationship of pancreatic cancer with certain chronic medical conditions and with the consumption of tea, coffee and alcoholic beverages. Significant positive associations with pre-existing diabetes mellitus and gall-bladder disease were observed and there was weak evidence of association with liver disease. The relative risks for diabetes mellitus and gallstones diagnosed at least one year previously were 4.1 (p = 0.005) and 2.8 (p = 0.01) respectively. Cases drank significantly more beer than controls (p = 0.005) and there was evidence of a positive trend in risk with total alcohol consumption. Smoking was a clear risk factor, but cases and controls were very similar with respect to tea and coffee drinking habits.
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PMID:Pancreatic cancer, alcohol, diabetes mellitus and gall-bladder disease. 292 72

In 1983, 28 Rohsai Hospitals in Japan cooperated to study 926 spinal cord injury (SCI) patients to reveal the problems of their rehabilitation. Fifty per cent complained of poor physical condition and were anxious about their health. In addition to complications rising from the SCI, the morbidities of heart disease, diabetes mellitus, liver disease, hypertension and CVA were higher than the Japanese average. It was noted that 1) 44% of tetraplegic patients were confined to living in their home. 2) Ageing exerted a serious influence upon daily life. 3) Crutch gait for patients with paraplegia was not practical. It was also shown that utilisation of automobiles played an important role in extending social activities. For SCI patients, especially those with tetraplegia, it was very difficult to find employment. The rate of employment was only 30% in all and 46% of these were self-employed.
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PMID:Physical and social condition of rehabilitated spinal cord injury patients in Japan: a long-term review. 304 34

A 50-year-old man with diabetes was found to have sepsis with multiple small hepatic abscesses secondary to Yersinia pseudotuberculosis which were detected by computed tomography (CT) scan. Sepsis with Y. pseudotuberculosis is uncommon but usually seen in patients with underlying liver disease. Those patients with liver abscesses invariably have multiple small abscesses. Widespread use of CT scanning is likely to uncover more cases of hepatic microabscesses; in the appropriate clinical setting, Y. pseudotuberculosis should be considered as a possible cause.
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PMID:Yersinia pseudotuberculosis sepsis presenting as multiple liver abscesses. 327 8

Of 44 male patients with idiopathic hemochromatosis who were diagnosed at an early stage without morphological or biochemical evidence of liver disease, 25% suffered from impotence and 34% manifested glucose intolerance. Impotence was correlated with a 50% reduction in plasma testosterone, resulting from a 63% decrease in testosterone production. Testicular atrophy was caused by insufficient secretion of gonadotropins due to the selective accumulation of iron in gonadotropic cells of the pituitary gland. However, peripheral sexual hormone metabolism, in particular the conversion of androgens to estrogens, remained unaltered. It was therefore possible to employ substitution therapy successfully with testosterone in these men, and hyperestrogenism was not observed as a side effect. The pathogenetic factors in the development of diabetes mellitus in patients with idiopathic hemochromatosis include impaired insulin secretion caused by the selective deposition of iron in B-cells of the pancreas and insulin resistance due to iron accumulation in the liver. In particular, the insulin resistance is markedly improved after depletion of body iron stores by phlebotomy treatment, resulting in lower insulin requirements in patients with insulin-dependent diabetes as well as improvement of carbohydrate metabolisms in about half of the patients with non-insulin-dependent diabetes. We have concluded that hypogonadism and carbohydrate intolerance are caused by the specific distribution pattern of excess iron in the organism, accompanied by functional impairment of affected parenchymal cells.
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PMID:Abnormalities in estrogen, androgen, and insulin metabolism in idiopathic hemochromatosis. 329 83

Diabetes mellitus was observed in 29 of 448 patients with thalassaemia major attending seven Italian centres. Twelve patients, at onset of clinical diabetes, presented with an asymptomatic glycosuria, 13 with ketosis, and four with ketoacidosis. All were diagnosed after 1979, at a mean age of 17 years. Mean age at diagnosis of diabetes was lower in patients born in the last two decades. In these patients transfusions were started at a younger age and pre-transfusion haemoglobin concentration, serum ferritin concentration, incidence of liver disease, and the presence of a family history of diabetes were higher than in patients born previously. Although 27 (93%) cases had iron chelating treatment the mean serum ferritin concentration was 5600 micrograms/l; 25 (92%) of these patients had signs of liver impairment. The determination of C peptide in 10 patients showed a wide variation in pancreatic beta cell function, and insulin requirements ranged between 0.15 and 1.72 U/kg body weight. Metabolic control was generally poor. The onset of diabetes mellitus was followed in most patients by the appearance of other endocrine or cardiac complications, or both. Fourteen patients died within three years of presenting with overt diabetes. Haemosiderosis, liver infections, and genetic factors seemed to be crucial in diabetes development. Thalassaemic patients developing clinical diabetes mellitus are at high risk for other complications and should be strictly monitored, especially for thyroid impairment.
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PMID:Insulin dependent diabetes in thalassaemia. 334 50

Our study was done to determine whether patients with schizophrenia and a coexisting physical disorder could adequately discuss the physical illness with a physician. We defined the minimal standard of adequate communication as the ability to acknowledge and name a physical problem during an index hospitalization. Of the 110 patients studied, 38 had a total of 54 medical illnesses (diabetes mellitus, hyponatremia, thyroid disorder, urinary tract infection, bladder dysfunction, hypertension, anemia, liver disorder, and seizure disorder). After two years of follow-up, 28 of these 38 patients agreed to participate in the second part of the study. Upon interview, 24 patients were unable to name at least one of their physical problems. This study reproduces the previous findings of psychiatric patients' difficulty in communicating about physical illness. It suggests that the communication difficulty is constant and not lessened in the nonacute situation.
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PMID:Communication difficulty of patients with schizophrenia and physical illness. 335 75

This article deals with the use of oral contraceptives and IUDs by chronically ill adolescent females. Results of controlled studies of contraceptive choices and problems are reviewed for teenagers with cardiac disease, epilepsy, multiple sclerosis, migraine headaches, asthma, cystic fibrosis, inflammatory bowel disease, hepatitis, diabetes mellitus, thyroid disease, oligomenorrhea and amenorrhea. If oral contraceptives (OC) are prescribed for use in teens with cardiac disease, a contraceptive with 35ug or less of estrogen and the equivalent of 1 mg or less of norethindrone should be used. The low-dose progestin only pill can be prescribed, but should be used in conjunction with a back-up barrier method. Reports to date have failed to reveal increased seizure activity in epileptic pattients on OCs, and there is no significant evidence to date that OCs alter the course of multiple sclerosis. Although the evidence is inconclusive, the physician should use extreme caution in prescribing OCs for teens with prior migraines. Regarding asthmatic patients, no problems have been reported with IUD use except in regard to steroid therapy and its possible effect on reducing IUD effectiveness. No adverse effects 2ndary to the use of OCs in asthmatic patients have been reported. OCs should be avoided or used with extreme caution in the cystic fibrosis patient. Teens with active inflammatory bowel disease should be advised that OCs may be ineffective or dangerous; there are no reports available on the effects of the IUD on the disease. The pill is contraindicated during active liver disease or cirrhosis. The IUD is not highly recommended for contraception in diabetic teenagers, whereas a low-dose combined OC can be used with extreme caution. However, OCs should be avoided in the diabetic patient with nephropathy, vascular complications or retinopathy. There is at present no contraindication for contraceptive use by women with thyroid disease. Finally, patients with prolonged post pill amenorrhea and infertility are generally females with amenorrhea or oligomenorrhea before pill use.
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PMID:Contraceptive use in the chronically ill adolescent female: Part I. 351 58

We analyzed 137 episodes of hypoglycemia (serum glucose less than or equal to 49 mg per deciliter) occurring in 94 adult patients hospitalized during a six-month period at a tertiary care hospital. Forty-five percent of the patients had diabetes mellitus, and administered insulin was implicated in 90 percent of episodes in diabetics. Hypoglycemia in diabetic patients occurred under a variety of circumstances, frequently because of decreased caloric intake related to illness or hospital routine. Insulin-induced hypoglycemia also occurred during treatment of hyperkalemia (eight patients) or during hyperglycemia related to total parenteral nutrition (six patients). Forty-six of the 94 patients had chronic renal insufficiency, and 20 of these 46 had underlying diabetes mellitus. Thus, renal insufficiency unrelated to diabetes mellitus was the second most frequent diagnosis associated with hypoglycemia. The majority of other cases of hypoglycemia were related to liver disease, infections, shock, pregnancy, neoplasia, or burns. Hypoglycemia was not the apparent cause of death in any patient, but the overall hospital mortality was 27 percent and was related to the degree of hypoglycemia and the number of risk factors for hypoglycemia. We conclude that hypoglycemia is a common problem in hospitalized patients, is common in renal insufficiency, is usually iatrogenic, and correlates with high mortality in severely ill patients.
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PMID:Hypoglycemia in hospitalized patients. Causes and outcomes. 353 67

This prospective study was undertaken to assess the prevalence of Dupuytren's contracture (DC) and its relationship with possible causes, especially alcohol consumption and chronic liver disease. Four hundred thirty-two consecutively hospitalized patients were examined for evidence of DC. They were divided into five groups based on the following clinical, biologic, and histologic criteria: alcoholic cirrhosis (89 patients), noncirrhotic alcoholic liver disease (55 patients), chronic alcoholism without liver disease (46 patients), nonalcoholic chronic liver disease (68 patients), and a control group (174 patients). The prevalence of DC in these five groups of patients was 32.5%, 22%, 28%, 6%, and 12%, respectively; the prevalence of DC was higher in patients with cirrhotic or noncirrhotic alcoholic liver disease (25.5%) than it was in patients with nonalcoholic liver disease (6%), but it was not significantly different in alcoholic patients with or without liver disease. The relationship between DC and age, sex, manual labor, previous hand injuries, diabetes mellitus, alcohol consumption, and cigarette smoking was assessed by univariate and logistic regression methods. Nine variables were significantly different in patients with or without DC: age, sex, manual labor, previous hand injuries, diabetes mellitus, daily alcohol consumption, duration of alcohol consumption, total alcohol consumption, and duration of cigarette smoking. In our patients, variables that could explain DC were, in decreasing order, age, total alcohol consumption, sex (male), and previous hand injuries. In alcoholic patients, these variables were age and previous hand injuries; in nonalcoholic patients, these variables were age and cigarette smoking. These results emphasize the high prevalence of DC in alcoholic patients and the absence of a correlation between DC and chronic liver disease. Age and alcohol consumption are the best explanatory variables of DC in hospitalized patients.
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PMID:Dupuytren's contracture, alcohol consumption, and chronic liver disease. 359 73


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