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

Decisions to resect small aortic aneurysms or employ non-operative treatment for aorto-iliac occlusive disease must depend on current rather than historical surgical results. To assess current morbidity and mortality, we reviewed 200 consecutive aortic resections in two groups of patients treated from 1981 to 1989: those undergoing elective aortofemoral bypass for occlusive disease (AFB, no. 100) or resection of infrarenal abdominal aortic aneurysms (AAA, no. 100). Indications for AFB included claudication (54%), rest pain (32%), and gangrene (13%). AAA size ranged from 3 to 14 cm (mean 6.5 +/- 2.4 cm); 45% presented with abdominal or back pain. Patients undergoing AFB were younger (AFB 61.5 +/- 10 years vs AAA 68.7 +/- 8.9 years) with a higher incidence of some atherosclerotic risk factors, diabetes mellitus 30% vs 10%, tobacco use 77% vs 49%, hyperlipidemia 21% vs 7%; p less than 0.001). Coronary artery disease (CAD) was more prevalent in AAA patients (49% vs 34%; p less than 0.001). Postoperative mortality was not different in occlusive or aneurysmal disease (3% AFB vs 2% AAA), nor was the occurrence of serious complications such as myocardial infarction (2% vs 1%) or pulmonary embolism (2% vs 3%). Improvements in patient selection, perioperative care and surgical technique have lowered the mortality of elective aortic surgery. Given the current standard of care, an aggressive approach to AAA even in high risk patients is appropriate. The low morbidity of AFB for occlusive disease mandates a critical appraisal of less effective nonoperative therapies.
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PMID:Current results of elective aortic reconstruction for aneurysmal and occlusive disease. 221 95

Cohorts of diabetic (n = 121) and non-diabetic (n = 584) patients were prospectively followed for up to ten years after having suffered from a stroke. All but six of the diabetic patients had Type 2 (non-insulin-dependent) diabetes mellitus. The diabetic patients had more risk factors associated with stroke: heart failure (p less than 0.001) and angina pectoris (p less than 0.001), than the non-diabetic patients. Neither body mass index nor blood pressure levels differed between the groups at admission. Haematocrit levels were higher in the diabetic group (p less than 0.01). The diabetic patients were more commonly afflicted by cerebral embolism and to a lesser extent by transient ischaemic attacks than the non-diabetic patients. When calculated by log-rank tests, the diabetic group had an increased risk of death (p less than 0.001), recurrent stroke (p = 0.001), and of myocardial infarction (p = 0.001) after the initial stroke. Autopsy-verified causes of death between the groups did not differ significantly, although half of all deaths during the period one to six months after stroke were caused by pulmonary embolism in the diabetic group. Thus, diabetes increases the risk of death after a stroke, and it also increases among stroke survivors the risk of recurrent stroke and myocardial infarction.
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PMID:Prognosis after stroke in diabetic patients. A controlled prospective study. 234 37

Acute fatal pulmonary embolism is one cause of sudden death which should be guarded against. It is the most often missed diagnosis in sudden death cases within the hospital. Clinical pictures of 10 patients with acute fatal pulmonary embolism proved by autopsy were examined to elucidate the problems of diagnosis, and to look for an effective treatment, and a method of prevention. Common risk factors were old age and immobility due to stroke or postoperative state. Common past histories were hypertension, diabetes mellitus, obesity, atrial fibrillation and hyperlipidemia. Electrocardiogram and echocardiogram showed that in these patients there was definite evidence of acute right ventricular overload. High doses of intravenous urokinase should be given whenever acute cardiovascular collapse develops in such high risk patients. Emergent pulmonary angiogram and pulmonary embolectomy could be life-saving in patients with acute massive pulmonary embolism. Prevention is, however, the best treatment. In addition to anticoagulation medication, frequent change of body position and early mobilization are important precautions to prevent fatal pulmonary embolism developing in such patients.
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PMID:[Acute fatal pulmonary embolism: its prevention, diagnosis and treatment]. 236 72

Vascular risk, mainly thromboembolitic risk, attributed to oral contraceptives (OCs) since 1962, has been primarily linked to ethinyl estradiol (EE). OCs which combine estrogen and have been associated with cerebral vascular accidents. A 1977 study showed a 40% increase of mortality due to cardiovascular complications in women taking OCs. There were of both an arterial and a venous character. The risk of myocardial infarction was 3 times more frequent among OC users. Deep venous thrombosis and pulmonary embolism were more numerous. Some other risk factors include smoking, hypertension, diabetes, and age 35. The risk of heart attack vanishes a few years after stopping OC use. The reduction of EE (and similarly progesterone) dosage from 100-50 mcg also lower the risk of hypertension, cerebral vascular accidents, and venous thrombosis. Prolonged use of OCs causes disorders of hemostasis affecting the walls of blood vessels, modifying the viscosity of blood flow (increase of hematocrits, reduction of venous tonus), modifying plasmatic coagulation (increase of platelets, increase of factors VII and X and plasma fibrinogen, and decrease of antithrombin III activity), and increased fibrinolysis. These anomalies are exclusively associated with high doses of estrogens. 5% of women using OCs develop moderate hypertension of 5-10 mm Hg of systolic pressure 5 years later, but after cessation it is reversed. OCs stimulate the renin-angiotensin-aldosterone system causing accelerated production of angiotensin II with the resultant forceful vasotension. 3 months after quitting OC use, high blood pressure returns to normal. EE can provoke diabetes; it increases very low density lipoprotein (VLDL) and high density lipoprotein (HDL) production, but total cholesterol is hardly affected. The androgenic property of progestogens reduces HDL. Combined OCs are contraindicated for women with hypertension, hyperlipidemia, diabetes, and a family history of vascular accidents.
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PMID:[Oral contraception and the vascular risk]. 251 20

The subject of varied acceptance of clinical trial results is discussed in the context of review of trials with which I have been involved and my subjective evaluation of their impact on the practice of clinical medicine. My experience goes back to 1949 and a World Health Organization trial of hyperimmune gamma globulin against rabies. This was followed by a large trial of secondary prevention of poliomyelitis. I participated in the planning and initiation of the first chronic disease trial, the University Group Diabetes Program (UGDP). The latter lasted for 15 years and its ramifications continue to this day. My next trial was the Coronary Drug Project (CDP), a complex trial with more than 8,000 patients. The trials of aspirin and aspirin combined with persantine (the CDPA, AMIS, PARIS I, and PARIS II) followed. My last three trials were a trial of photocoagulation in diabetic retinopathy (DRS), a six-country trial of the antiarrhythmic drug mexiletine (IMPACT), and a study involving two diagnostic procedures for pulmonary embolism (PIOPED). When one considers, in retrospect, the plethora of trials one is struck by the uniform absence of a priori considerations of the impact on medical practice, or likely lack thereof, of possible outcomes.
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PMID:Varied acceptance of clinical trial results. 260 62

Mean values for serum angiotensin-I-converting enzyme (SACE), determined spectrophotometrically in 648 subjects, using the synthetic substrate hippuryl-L-histidyl-L-leucine, and expressed in units per milliliter, were: controls, 11.11 +/- 3.97 (n = 89); lung cancer, 6.50 +/- 3.26 (n = 87); tuberculosis of the lung, 8.93 +/- 4.60 (n = 68); pulmonary sarcoidosis, 21.18 +/- 14.93 (n = 48); pneumonia, 9.81 +/- 6.83 (n = 52); fibrosis, 11.18 +/- 8.26 (n = 34); diabetes mellitus, 10.90 +/- 7.51 (n = 29); ischemic heart disease, 8.98 +/- 6.19 (n = 42); pulmonary embolism, 13.20 +/- 3.91 (n = 5); and lymphomas, 11.66 +/- 5.44 (n = 36). The lowest values for SACE (5.92 +/- 1.95) were observed in 7 patients with pulmonary metastases. No relationship could be found between SACE and other laboratory parameters, nor between the enzyme activity in men and women. Evidence suggests that low SACE activity is often associated with extrapulmonary cancers of various organs. Levels were significantly decreased in cancer of the lung and pulmonary metastases and significantly (p less than 0.001) increased in sarcoidosis compared with other diseases, suggesting that SACE activity may be of value in the diagnosis and prognosis of cancer of the lung.
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PMID:The value of angiotensin-I-converting enzyme determinations in malignant and other diseases. 299 Jul 99

A total of 1605 patients with myocardial infarction had been admitted to the district hospital--Sliven for 24 years. The percentage of the deceased out of them is 26.5%. The patients with cardiogenic shock were 166 (10.3%) and 131 of them died (85%). The cardiogenic shock in myocardial infarction reduced its incidence within the 5 years, from 14/4% to 5.3%, and lethality was increased from 75.5 to 91.4%. The males represented 60%. To the age of 60 proved to be 30.1% of the patients. To the age of 45-3.6%; to from 46 to 60-26.5%; from 61 to 75-51.6% and over the age of 75-18%. Angina pectoris was present in 80% in the clinic of the patients with cardiogenic shock in myocardial infarction, with irradiating pain--41%, with asthmatic manifestations--49%, with abdominal manifestations--20% and cerebral manifestations--23%. According to localization the myocardial infarction was grouped as follows: 8.4%--anteroseptal; 17.4%--anterior, 9.6%--massive anterior, 1.8--anterior-apical, 6.4%--anterior lateral, 25.3%--posterior, 9%--posterior-lateral, 5.6%--anterior-posterior, 0.6%--focal and 1% subendocardial. Hypertension proved to be a favourable factor in the development of cardiogenic shock in myocardial infarction in 21.7% as well as diabetes in 15%, rhythm disorders--in 32.2%, pulmonary embolism in 7.9% and decompensation in 14.4%.
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PMID:[Cardiogenic shock in myocardial infarct]. 371 75

This discussion identifies the risks and benefits of each of the hormonal methods of contraception -- combined estrogen-progesterone oral contraceptive (OCs), progestogen-only pills, and depot progestogen injections. It also explains the use of a profile of risk factors in considering the appropriate prescription for each individual in relation to her contraceptive needs. Information regarding medical risks has come from the consideration of mortality rates in large cohort studies. Looking at categories of the causes of 249 deaths in ever-users of the pill and controls, Layde and colleagues were able to show that there was an excess mortality in the pill group of 40% and that the extra risk was concentrated in cardiovascular causes: myocardial infarctions, cerebral thrombosis, and cerebral hemorrhage constituted the largest proportions. A small proportion of combined OC users may develop clinical hypertension but more suffer a reduction in the high-density lipoprotein (HDL) cholesterol fraction of the blood lipids. Both of these effects tend to increase the risk of cardiovascular complications and both are positively related to the dose of the progestogen components. In prescribing combined OCs, attention needs to be paid to further moves away from the norm towards the extremes: the presence of cardiovascular risk factors and the use of certain longterm medications or the presumptive designation as a "rapid metabolizer." An analysis of progestogen only pill (POP) users in the Oxford-Family Planning Association study confirmed the reasonably low rates of accidental pregnancy in POP users. There is a marked reduction with increasing age, and it is significant that many prescribers are now giving POP to older women for whom combined OCs are contraindicated because of cardiovascular risks. It also seems reasonable to use them in women with some medical disorders, for example, recurrent pulmonary embolism, hypertension, and diabetes. Initially, depot injections of progesterone were developed to provide a long-acting or sustained-release type of drug administration to assist users of the progestogen-only method which, unlike combined OCs, does not make use of regular drug-free intervals. In practice it has been found that the effectiveness against pregnancy is enhanced and the side-effects are increased in giving progestogen by depot injection. The 2 preparations currently licensed in Britain are Depo-Provera (medroxyprogesterone acetate) and Noristerat (norethisterone enanthate). In some cases proper and clear information may not have been given to the patient and proper consent not obtained before giving the drug. This problem is magnified because of the occurrence in some women of disturbed bleeding patterns, especially if given immediately after childbirth or an abortion. Also, in a small proportion of users anovulatory amenorrhea may supervene for some months or even as long as 2 years following depot injection.
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PMID:Hormonal contraceptive methods. 401 68

Studies of blood clotting factors and prospective and retrospective studies on risk of thromboembolism are reviewed until 1969. Clotting factors 7, 8, 9, and 10, coagulation time, and platelet adhesiveness are increased during oral contraception. The significance, however, is unknown for developing thromboembolism. There are numerous publications on thromboemoblism in pill users, but most are statistically useless case reports. Risks of morbidity from this disorder in normal women are 1.2-2.9/1000 for nonpregnant, 3.1-10.4/1000 for postpartum, and .5/1000 for pregnant. A prospective study by the U.S. Food and Drug Administration found no increased risk, but 3 British retrospective studies found a 3-fold risk of phlebits, a 9-fold risk of hospitalization for thrombophlebitis, and an increased risk of death from pulmonary embolism or cerebral accident. Women at greater risk because of age, weight, or predisposing factors (diabetes, hyperlipidemia, surgery) should be meticulously eliminated by the clinician.
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PMID:[Statement on the thromboembolic risk while taking oral contraceptives]. 542 2

The purpose of this study was to assess the predictive values of the assays of fibrinopeptide A (FPA), beta-thromboglobulin (BTG) and their combination in patients suspected of having acute deep venous thrombosis (DVT) or pulmonary embolism (PE). In 80 controls the mean (+/- SD) plasma concentrations of FPA and BTG were 0.72 +/- 0.47 and 28.2 +/- 10.1 ng/ml, respectively. In 26 patients in whom DVT was confirmed by phlebography and Doppler ultrasound, clearly raised mean FPA (5.62 ng/ml) and BTG (70.6 ng/ml) concentrations were measured compared to those in 13 patients in whom this disorder was excluded (1.00 and 33.6 ng/ml, respectively). Also in 25 patients, in whom PE was established by perfusion lung scanning, clearly increased mean FPA (6.28 ng/ml) and BTG (82.4 ng/ml) concentrations were measured compared to those in 12 patients without this disease (1.03 and 32.5 ng/ml, respectively). Raised FPA and BTG concentrations were also found in 20 patients with inflammatory disorders and in 10 with various types of malignancy. The mean FPA and BTG concentrations did not differ between patients with renal failure or diabetes mellitus and patients without these diseases. From the predictive values of these assays and their combination it can be concluded that raised FPA and BTG concentrations are not specific for thrombosis. However, when normal FPA and BTG concentrations are present, acute DVT or PE can safely be excluded in symptomatic patients. In the group with confirmed DVT/PE, anticoagulant treatment (heparin and phenprocoumon) brought down the mean FPA concentration to levels within the normal range in less than 1 hour while the mean BTG concentration remained elevated throughout the 10-day study period.
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PMID:Diagnostic value of fibrinopeptide A and beta-thromboglobulin in acute deep venous thrombosis and pulmonary embolism. 618 Jun 2


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