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

The fibrinolytic system has been studied in 168 patients with diabetes mellitus (DM) and compared to that of a group of 153 sex- and age-matched control subjects. The following determination were made: spontaneous fibrinolytic activity of the blood; fibrinolytic response to standardized venous stasis (stimulated fibrinolytic activity, "fibrinolytic capacity"); histochemical determination of fibrinolytic activators in the walls of superficial veins collected by biopsy. Diabetic patients were found as a group to have an impaired fibrinolytic system with the above fibrinolytic parameters decreased to various degrees in comparison with those of the controls. Less clear differences were observed between patients with and without ophthalmoscopically visible diabetic changes of the retina. However, patients with beginning angiopathy were found to have a significantly higher amount of fibrinolytic activators in their vessel walls than patients with more advanced retinopathy and without ophthalmoscopically detectable retinopathy. Furthermore, unlike patients without retinopathy, patients with retinopathy increased less or did not increase at all their spontaneous and stimulated fibrinolytic activity along the duration of the disease. The defective fibrinolytic system of diabetic patients may contribute to the occurrence of the vascular complications frequently seen in this disease. In the diabetic group, those patients who develop retinopathy show an impaired fibrinolytic defense with the duration of the disease.
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PMID:The fibrinolytic system in patients with diabetes mellitus with special reference to diabetic retinopathy. 112 75

Diabetic capillaropathy is defined and reviewed. A number of physiological and pathological variables, such as aging, venous stasis, and environment, may affect the thickness of the capillary basal lamina. Since these effects have not been adequately measured, it is impossible to know precisely what increment diabetes mellitus adds to the basal lamina. Because of these variables and technical difficulties, the detection of early diabetes is impossible at this time. However, the ultrastructure of the peripheral capillaries in the late stages of diabetes provides a means of detecting the presence of widespread capillaropathy when clinical evidence is difficult to obtain or uncertain.
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PMID:Diabetic capillaropathy. 115 Feb 22

According to a theory of the authors both senile osteoporosis and pathologic osteoporoses (rheumatic, in diabetes, bronchial asthma, pulmonary emphysema, portal hypertension and Cushing's disease) are due to disturbances of the circulation of the blood in bone. Every type of stasis in the sinusoids, be it due to reduced arterial supply or venous stasis or to a reduction of extravascular fluid-pressure will provoke an increase in osteoclastic activity and thus osteoporosis.
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PMID:[Osteoporosis -- due to reduced blood circulation of bone (author's transl)]. 121 86

Acquired hypercoagulable states comprise a diverse group of clinical conditions that are associated with an increased risk of thrombosis. These clinical conditions include malignancy, diabetes mellitus, venous stasis, pregnancy, oral contraceptive use, lupus anticoagulant, postoperative state, immobilization, myeloproliferative disorders, and nephrotic syndrome. Recognition of these associations, possible underlying mechanisms, identification of high risk individuals, thromboembolic prophylaxis, and other clinical implications are discussed.
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PMID:Acquired hypercoagulable states. 139 74

Patients presenting with symptoms suggestive of amaurosis fugax, or with findings of Hollenhorst plaques on fundoscopy are frequently referred for duplex evaluation to detect possible carotid artery disease. To better determine the reliability of monocular visual loss and the presence of Hollenhorst plaques for predicting the presence or significance of carotid artery stenosis, we prospectively studied 66 patients with these ocular signs and symptoms. After evaluation, the patients were categorized as follows: 34 of 66 (52%) patients had amaurosis fugax, 23 (35%) had asymptomatic Hollenhorst plaques, 7 (11%) had retinal artery occlusion, and 2 (3%) had venous stasis retinopathy. All patients were evaluated ophthalmologically, with carotid duplex scanning and spectral analysis. A stenosis of greater than 60% was regarded as significant. The presence of risk factors including hypertension, diabetes, a history of CVA or TIA's, tobacco use and hyperlipidemia was recorded. There were no statistically significant differences (p greater than 0.05) in the incidence of atherosclerotic risk factors between the four groups. Patients with amaurosis fugax were more likely to have a significant carotid artery stenosis than those with asymptomatic Hollenhorst plaques or retinal artery occlusion (53% vs 9% vs 0% respectively) (p less than 0.006). We conclude that routine carotid duplex scanning is indicated in all patients with amaurosis fugax in view of the frequent association with significant carotid stenosis (53%). However, the presence of Hollenhorst plaques in the absence of visual symptoms appears not to have a significant association with carotid disease and may not necessarily require routine screening unless other risk factors for carotid stenosis are present.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Correlation of ophthalmic findings with carotid artery stenosis. 152 43

The value of the vascular examination cannot be over-estimated. Symptoms of vascular disease present in the foot and lower extremity may actually be manifestations of severe life-threatening disease. Symptoms, their location, and the frequency and quality of the patient's pain often provide valuable clues for the clinician's diagnosis. Central nervous system symptoms, ocular disturbances, cardiac symptoms, impotence, or constitutional disturbances may all indicate systemic arterial disease. Risk factors for this disease include smoking, hypertension, hyperlipidemia, genetic predisposition, diabetes, emotional stress, and physical inactivity. Those factors attributable to hypercoagulability and venous disease are birth control pill use, estrogen chemotherapy, obesity, prolonged immobilization, paralysis, previous thrombotic episodes, venous stasis disease, and varicose veins. An accurate bilateral assessment of blood pressure, pulses, and capillary perfusion is of critical importance. Careful inspection of the extremity for trophic changes, skin color, texture, temperature, edema, ulceration, atrophy, or paresis, will provide clues of vasculopathy. A relatively accurate assessment of circulatory status may be obtained without the use of exotic instruments. Simple tests such as the elevation and dependency tests, capillary bed return test, venous filling time test, along with blood pressure, pulse, and possibly oscillometry data are valuable in arterial evaluation. Such venous tests as inspection, percussion, Homan's sign, Trendelenburg, and Perthes' tourniquet are useful in the determination of the presence of venous disease. Fortunately, over the past few years tremendous advances have been made in the technology of the vascular laboratory. If symptoms are discovered during the vascular history and physical examination, the complete noninvasive study will provide impressive data to quantitate and specifically establish the diagnosis.
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PMID:The vascular history and physical examination. 173 54

A nonoperative approach to venous stasis ulceration of the lower extremity, consisting of initial bedrest, ulcer cleansing, dressing changes, and ambulatory elastic compression stocking therapy, has been maintained for over 15 years. All patients had class III, severe chronic venous insufficiency. One hundred five of 113 patients (93%) experienced complete ulcer healing in a mean of 5.3 months. One hundred two patients were compliant with elastic compression stockings, and 11 patients were noncompliant. Complete ulcer healing occurred in 99 of 102 patients (97%) who were compliant versus six of 11 patients (55%) who were noncompliant (p less than 0.0001). The influence of noncompliance, previous venous ulceration, previous venous surgery, previous known deep venous thrombosis, peripheral arterial insufficiency (ankle brachial systolic blood pressure index less than or equal to 0.60), pretreatment ulcer duration, ulcer size, age, sex, diabetes, smoking, and photoplethysmography venous refill time on ulcer healing was determined by logistic regression analysis. Only noncompliance with elastic compression stockings (p less than 0.0001) and a pretreatment ulcer duration of more than 9 months (p = 0.02) significantly decreased initial ulcer healing. Posthealing follow-up was available in 73 patients for a mean of 30 months. Fifty-eight patients (79%) continued to be compliant with stockings; 15 patients were noncompliant. Total ulcer recurrence in patients who were compliant was 16%. Five-year lifetable recurrence was 29%. All patients who were noncompliant had recurrent ulceration by 36 months. Previous ulceration, previous venous surgery, and peripheral arterial insufficiency had no effect on ulcer recurrence (p greater than 0.05).
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PMID:Fifteen-year results of ambulatory compression therapy for chronic venous ulcers. 202 Sep 2

In this retrospective study, distal hyperirrigation syndrome was identified by "irrigraphy", a functional exploration method used to define an irrigation index at various levels of the lower limbs as determined by pulse wave amplitude, heart rare and segmental resistances. In 47 lower limbs studied, there were 26 unequivocal, 14 relative and 7 "masked" hyperirrigations. The main etiology was diabetes (24 limbs), but the syndrome was also noted in cases of peripheral neuropathy and chronic venous insufficiency. There was no basic difference between unequivocal and relative hyperirrigations. Some hyperirrigation states were not apparent in irrigraphy because of arterial lesions on upstream axes. The syndrome was also observed in approximately the same number of cases in insulin-dependent and noninsulin-dependent diabetes. The clinical disorders observed were especially peripheral trophic ones, notably perforating ulcers of the foot or various ulcers. Changes in the irrigraphic profile were followed regularly in 20 limbs. The rise in distal irrigation indices was due to a drop in peripheral resistances related to an abnormal opening up of arteriovenous anastomoses. A state of spontaneous sympathectomy was thus constituted, particularly in diabetic patients. The process was similar in syndromes of neurologic origin and in venous stasis. The mechanism was local, with venous hypertension causing the opening up of arteriovenous shunts. However, microangiopathic lesions must also be taken into account, since they can cause or favor arteriovenous shunting. The opening up of arteriovenous anastomoses is in effect the element common to all syndromes of distal hyperirrigation of various origins.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Distal hyperirrigation syndrome. Clinical and physiopathological aspects]. 228 13

We used homologous platelet-derived wound healing factors (HPDWHF) to achieve complete healing of recalcitrant ulcers of diverse cause. Twenty-three patients with 27 skin ulcers who had been receiving conventional wound care with no evidence of healing for an average period of 25 weeks (range, 12 to 156 weeks) were studied. The patients were first subjected to controlled wound care for 3 months, with saline solution and silver sulfadiazine dressings used in all cases. At the end of this period, persistent nonhealing ulcers were treated by topical use of HPDWHF and silver sulfadiazine. Ulcer parameters were recorded on the first day and every week during therapy until complete epithelization was achieved in either group. Each ulcer acted as its own control. In the controlled wound care group, only three ulcers in three patients achieved complete healing; the remaining 24 ulcers in 20 patients failed to achieve even 50% healing in the stipulated 3-month period. However, when subjected to HPDWHF applications, these ulcers healed completely, 100% healing occurring in 9.67 +/- 4.9 weeks (range, 3 to 19 weeks), which is highly significant (p less than 0.01). The healing response to HPDWHF applications was of uniform progression over the weeks. Only the basic cause of the ulcer determined the healing rates in this group. The shortest and the longest time to achieve 100% healing occurred in patients with diabetes (6.88 +/- 2.97 weeks) and in the venous stasis group (14.00 +/- 7.07 weeks). Age, sex, location of ulcer, ulcer duration, and ulcer measurements had no influence on the HPDWHF-stimulated healing rates. This is the earliest report of HPDWHF-stimulated repair in chronic nonhealing skin ulcers.
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PMID:Use of homologous platelet factors in achieving total healing of recalcitrant skin ulcers. 239 95

Patients with carotid occlusive disease may develop a variety of symptoms and signs secondary to chronic ocular ischaemia. We report six cases affecting nine eyes and review the findings of teichopsia, anterior segment ischaemia, venous stasis retinopathy, and ocular neovascularisation. The assessment and surgical management of carotid obstruction are discussed. Some comments on the relevance of coexisting diabetes are made.
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PMID:Syndrome of ischaemic ocular inflammation: six cases and a review. 241 76


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