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Morbid obesity causes co-morbidity such as diabetes mellitus, hypertensive heart disease, sleep apnoea, degenerative bone diseases and increased incidence of malignancy. Life expectancy and quality of life are reduced significantly. Without adequate weight loss, treatment of co-morbidity remains symptomatic only. Surgical treatment of morbid obesity is the one therapy promising long-term success, since conservative procedures normally lead to recurrence of overweight. We performed laparoscopic gastric banding on 130 patients between 1.11.95 and 31.10.97. Mean overweight was 63 +/- 12.7 kg (SD), and mean BMI was 46.5 +/- 4.6 kg/m2. The average hospital stay was 5.5 +/- 1.5 days. 4 patients with postoperative pulmonary embolism were treated with oral anticoagulation. We performed 9 (6.9%) reoperations because of pouch dilatation or dorsal slipping with food intolerance in the first series of 70, and none in the second series of 60 patients. Median weight loss after 3 months was 14.7 +/- 4.2 kg, after six months 24.0 +/- 6.6 kg and after 12 months 33.2 +/- 8.5 kg, corresponding to excessive weight loss (EWL) of 55.9 +/- 14.8% in the first year. 14 (70%) of 20 patients with diabetes mellitus normalised and 6 patients with diabetes mellitus normalised and 6 patients showed improved blood sugar levels. All 36 patients with hypertensive heart disease had normalised blood pressure, 60% of them without further medical antihypertensive treatment after median EWL of 36%. Cholesterol levels normalised in 30 (57%) patients and improved in 20 (38%) after 6 months. Laparoscopic gastric banding is a suitable method for reducing weight in morbid obesity patients and provides a better quality of life in a group of patients who are carefully evaluated and followed. Reducing co-morbidity and improving ability to work have a positive economic impact on health care costs.
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PMID:[Morbid obesity: 130 consecutive patients with laparoscopic gastric banding]. 975 89

Drugs classified as calcium channel blockers (CHBs) are now among the most frequently prescribed drugs for the treatment of cardiovascular disease. Although the currently available CCBs have major differences in their structural and cardiovascular effects, they share the common property of blocking the transmembrane flow calcium ions through voltage gated L-type channels. These drugs have been approved for the treatment of hypertensive heart disease: they reduce left ventricular hypertrophy and improve its sequelae, such as ventricular dysrhythmias, impaired filling and contractility, and myocardial ischemia. Long-acting CCBs have been shown to reduce mortality and morbidity in elderly patients with systolic hypertension, appear to be extremely useful in patients with cyclosporin-induced hypertension, and can be used as alternatives to ACE inhibitors in patients with hypertension and concomitant diabetes mellitus, renal disease, Raynaud's phenomenon or migraine. Long-acting dihydropyridine have been shown to be effective and safe in the treatment classic angina pectoris and vasospastic angina, supraventricular arrhythmias, particularly reentrant AV-nodal tachycardia, others to be beneficial in patients with congestive heart failure, and all of them have potential for decreasing atherogenesis.
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PMID:[Calcium channel blockers in the treatment of cardiovascular disease]. 1157 40

The prevalence of comorbidities in patients dismissed from hospitals has already been investigated to obtain economical, administrative and epidemiological information, or for health insurance-related problems. Originally designed for billing purposes, administrative data could be the basis for clinical research as well, although the clinical element has somehow been disregarded till now. The aim of this research is (i) to study the prevalence, and (ii) to evaluate the clinical relevance of comorbidities in patients dismissed from a Department of Internal Medicine. In a recent series of 1605 patients (since the Diagnosis-Related Groups-DRG-based hospital financing system has come into common use in Italy) comorbidities have been observed in 92.65% of the cases, while the percentage of comorbidities was rated as 71.97% in a previous series of 2551 patients dismissed from the same Department before the introduction of the DRG system. In the recent series, the prevalence of a single comorbid condition and of two and of three comorbid conditions was 19.50, 32.89 and 47.61%, respectively. In any case, the so-called comorbid conditions were active diseases requiring medical investigation and therapy. They included hypertensive heart disease, ischemic heart disease and angina, arrhythmias, peripheral vascular diseases, chronic bronchitis, chronic hepatitis, liver cirrhosis, diabetes, metabolic disorders, etc. In conclusion, patients referred to a Department of Internal Medicine have a high severity of illness due not only to the gravity of the primary diagnosis but also to the number and seriousness of comorbid conditions. For these patients more hospital resources and a high level of professional skill are required.
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PMID:[Comorbidity in internal medicine: analysis of a caseload of 4,156 subjects at their first hospitalization]. 1168 49

Despite dramatic improvements in the management of hypertensive cardiovascular disease, much remains to be accomplished. Arterial stiffness, through its effects on central aortic pressure, is a key determinant of increased cardiovascular risk. Increased pulse pressure is a late manifestation of increased arterial stiffness. What is needed is a simple, reliable, non-invasive method of detecting early disturbances in central artery stiffness at a time when therapeutic intervention can be most beneficial. Currently, intervention studies support initiating antihypertensive therapy in uncomplicated hypertension when systolic blood pressure > or = 160 mmHg, whereas the benefit of treating systolic blood pressure of 140-159 mmHg, the largest subset of persons with hypertension, has yet to be tested in controlled trials. Further studies are needed to determine the optimal target goal for blood pressure reduction in both uncomplicated hypertension and in hypertension complicated by diabetes, coronary heart disease, or renal disease. Angiotensin converting enzyme inhibitors may provide selective cardiac and renal protection beyond their blood pressure-lowering effect in the presence of specific cardiovascular disease and/or diabetes. In contrast, there is as yet no definitive answer as to the relative benefit of blood pressure lowering versus specific drug effects in minimizing cardiovascular events in uncomplicated hypertension. Although there has been a recent increase in hypertension awareness and treatment, only a small percentage of affected individuals are being treated to goal. Hypertensive cardiovascular disease represents a world-wide public health challenge that can be solved only by new innovative measures aimed at both prevention and treatment.
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PMID:Blood pressure and cardiovascular disease: what remains to be achieved? 1171 48

This paper describes the South African cause-of-death profile in 1996, the latest year for which routine data are available. Underreporting of deaths, misclassification of causes and HIV/AIDS make face value interpretation of reported cause-of-death data difficult. Changes in subsequent years due to HIV/AIDS are considered using model projections. South Africa is undergoing a protracted bipolar transition with the coexistence of both diseases of poverty and emerging chronic diseases. In 1996 these accounted for similar proportions of the premature mortality, about 27% for males and 35% for females, with the added burden of injuries accounting for a further 35% in males and 16% in females. Tuberculosis (TB), lower respiratory tract infections, diarrhoea, HIV/AIDS, perinatal diseases, malnutrition and septicaemia contributed to the pretransitional conditions, while stroke, diabetes, ischaemic heart disease, hypertensive heart disease, asthma, chronic obstructive lung disease, cancer of the lung in men and cancer of the cervix in women contributed to the premature mortality due to non-communicable diseases. Homicide is the major cause of injury death for men while unintentional injuries are the major cause of injury death for women. Projections suggest that this triple burden (diseases of poverty, emerging chronic diseases and injuries) has now become a quadruple burden resulting from the HIV/AIDS epidemic and that without interventions to reduce mortality, by the year 2010, AIDS deaths will account for double all other causes of death combined. While efforts to improve the cause-of-death statistics are needed, the current data clearly suggest that comprehensive public health strategies to improve the health of the nation must be strengthened, and reducing the number of deaths that can be expected to result from AIDS requires urgent attention.
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PMID:South African cause-of-death profile in transition--1996 and future trends. 1224 21

The existence of a diabetic cardiomyopathy has been proposed as evidence has accumulated for the presence of myocardial dysfunction in diabetic patients in the absence of ischemic, valvular or hypertensive heart disease. Diastolic dysfunction has been described as an early sign of this diabetic heart muscle disease preceding the systolic damage. Abnormalities in diastolic performance have been first demonstrated by cardiac catheterisation and subsequently by mainly using echocardiography. The pathogenesis of this left ventricular dysfunction is not clearly understood. Microangiopathy, increased extracellular collagen deposition, or abnormalities in calcium transport alone or in combination are considered to be associated with this dysfunction. The relationship between diastolic dysfunction and glycemic control is still a matter of debate. Some epidemiological and clinical arguments suggest that diastolic abnormalities may contribute to the high morbidity and mortality among diabetic patients. However, the prognostic importance of subclinical diastolic dysfunction and the possibilities for intervention are not fully known. Eventually, despite numerous studies, evidence of an intrinsic diastolic dysfunction in diabetes mellitus remains questionable. Indeed, quite contradictory results have been reported. They have been obtained in small, inhomogeneous populations, with sometimes confounding factors, using various echocardiographic indices with known limitations. Also, further studies using more refined techniques for the evaluation of diastolic function are needed, as a prerequisite, to unequivocally relate diabetes mellitus to a specific cardiomyopathy.
Diabetes Metab 2003 Nov
PMID:Left ventricular diastolic dysfunction: an early sign of diabetic cardiomyopathy? 1463 22

This article discusses risk factors for cardiovascular disease in the minority community, including hypertension, obesity, diabetes,and diet. The minority community exhibits important population differences regarding risk and outcomes for cardiovascular disease. The complete explanation for these differential outcomes is lacking and likely to be multifactorial in origin; however, disparities in health care (differences in the quality of health care that are not due to access-related factors or clinical needs, to preferences, or to the appropriateness of the intervention) may emanate from decisions made by the patient, provider, or health care system. Hypertension as a disease entity is strikingly pathologic in African Americans. Correspondingly, the incidence of cardiovascular mortality due to hypertensive heart disease is fourfold higher in African Americans than in non-Hispanic whites. Hypertension and heart failure can be treated effectively in the minority community with a regimen of agents not dissimilar from that used for the general population. Treatment regimens should be individualized based on the disease presentation, associated comorbidity, and disease severity and not on something as arbitrary as race.
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PMID:The prevention of heart failure in minority communities and discrepancies in health care delivery systems. 1533 20

Diabetes mellitus is responsible for a spectrum of cardiovascular disease. The best known complications arise from endothelial dysfunction, oxidation, inflammation, and vascular remodelling and contribute to atherogenesis. However, the effects on the heart also relate to concurrent hypertensive heart disease, as well as direct effects of diabetes on the myocardium. Diabetic heart disease, defined as myocardial disease in patients with diabetes that cannot be ascribed to hypertension, coronary artery disease, or other known cardiac disease, is reviewed.
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PMID:Diabetic heart disease. 1615 78

Sequence variations in the human alpha2 adrenergic receptor genes (ADRA2A and ADRA2C) have been implicated as a cause of hypertension in blacks. Although certain alleles are selectively enriched in blacks, their association with hypertension is based on small convenience samples and has not been evaluated in larger populations. From a stratified random population sample of 3398 individuals (52% blacks), we obtained DNA samples together with an in-home health interview, 10 in-home measurements of blood pressure, and cardiac MRI. We tested for associations among hypertension, untreated blood pressure, and parameters of hypertensive heart disease with 2 alleles, a DraI restriction fragment length polymorphism in the ADRA2A gene and a deletion of residues 322 to 325 in the ADRA2C gene. Although both alleles were selectively enriched in this black population, we found no association of either allele with hypertension, untreated blood pressure, or any of the cardiac function parameters. In a logistic model that controlled for age, body mass index, diabetes, and smoking, the adjusted odds ratio (OR) for hypertension was 1.0 (95% CI, 0.8 to 1.2), and 1.0 (95% CI, 0.9 to 1.2) for ADRA2A and ADRA2C variant alleles. In subjects not receiving prescription blood pressure medication, neither of these alleles, alone or in combination, was predictive of blood pressure, heart rate, left ventricular mass, cardiac output, systemic vascular resistance, or aortic compliance. Both the DraI restriction fragment length polymorphism in ADRA2A and the ADRA2C (Del 322 to 325) can be excluded as major candidate alleles for hypertension in blacks.
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PMID:Do allelic variants in alpha2A and alpha2C adrenergic receptors predispose to hypertension in blacks? 1663

The elderly diabetic is a potential congestive heart failure patient. Cardiac involvement is multifactorial, particularly ischemic conditions because of the accumulation at that age of vascular risk factors and therefore the frequency of coronary damages. The elderly diabetic very often has high blood pressure, with the risk of developing a hypertensive heart disease. Beyond these issues, the effects of chronic hyperglycaemia and insulin resistance on the heart specifically alter left ventricle compliance and therefore diastolic function, thus accelerating the effects proper to aging. No specific recommendation has been published on the management of the elderly diabetic with congestive heart failure. Even at an advanced age, with a clinical diagnosis of congestive heart failure that is sometimes difficult to make, the cardiological evaluation should be conducted rigorously within a global evaluation, and treatment should follow the same rules as in younger patients, with great caution given to the iatrogenic risks inherent to this population.
Diabetes Metab 2007 Apr
PMID:Congestive heart failure in the elderly diabetic. 1770 97


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