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

Sixteen cases of lactic acidosis are reported: 7 phenformin treated diabetes, 5 cardiovascular diseases (2 myocardial infractions, 2 pulmonary embolisms, 1 heart failure). In 2 patients no etiology was found. Concomittant renal failure or liver diseases were found in respectively 9 and 4 cases. Patients presented the usual criteria of lactic acidosis: clinical, polypnea, severe hypotension (9/16), peripheral symptoms of shock (12/16), hypothermia (9/16), abdominal pain (9/16): biologically, acidosis (pH = 6,99 +/- 0,01, HCO3- = 5,9 +/- 1,5 mmol), hyperlactatemia (14,1 +/- 3,6 mmol/l) with hig lactate/pyruvate ratio (105 +/- 73), and anion gap (24,3 +/- 4,2 mmol/l). Sodium bicarbonate infusion was performed in all cases (2,5 to 42 mmol/kg). Few cases required volhemic expansion or furosemid induced diuresis. One patient was treated with extrarenal dialysis. 13 patients were alkalinised with less than 185% of estimated deficit measured from alkalin reserve: 12 died. 3 patients received 185% more than this deficit, associated with furosemid (1,8 to 12,5 mg/kg): only one patient died ten days after by casual disease, with lactatemia of 3,2 mmol/l. In spite of the small number of patients, these findings suggest that an early and massive alkalinisation, with large doses of furosemid, can improve the severe lactic acidosis prognosis.
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PMID:[Lactic acidosis and intensive care. 16 cases (author's transl)]. 23 77

A basic understanding of fetal nutrition and metabolism is essential in the clinical management of the obstetric patient. The fetus depends upon a constant infusion of glucose for energy production and growth. Maternal glucose is the prime source of this nutrient. Alterations in maternal carbohydrate homeostasis will lead to changes in fetal metabolism. In diabetes mellitus, hyperglycemia may produce hyperinsulinemia and macrosomia. The growth-retarded fetus may have a decreased supply of maternal glucose and reduced amounts of hepatic glycogen and adipose tissue. The fetus must depend upon these stores for survival during periods of intrauterine hypoxia. In the newborn period, hypothermia and hypoxia may rapidly deplete energy reserves. With this information, the clinician may more knowledgeably manage dietary demands in the antepartum patient, fetal distress during labor, and the immediate newborn period.
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PMID:Fetal carbohydrate metabolism: its clinical importance. 31 3

The phenomenon called paradoxical undressing has been described from 33 cases of hypothermia collected from Swedish police reports. The cases were almost evenly distributed with regard to sex, age, and geographical distribution. The cases occurred more frequently in open land although cases from town areas were also found. Most incidents were recorded from November to February at low ambient temperatures, although cases were also reported at temperatures above 0 degree C. Arteriosclerosis and chronic alcoholism were important concomitant illnesses, the latter being frequent in middle-aged men. Epilepsy, diabetes, and pregnancy were present in single cases. Ethanol and other drugs were present in 67% of the males and in 78% of the females, ethanol predominating in men and various psychotropic agents in women. The mean blood ethanol concentration in males was 0.16% and in females, 0.18%. Most frequent findings at necropsy were purple spots or discoloration on the extremities, pulmonary edema, and gastric hemorrhages. It is concluded that paradoxical undressing might be explained by changes in peripheral vasoconstriction in the deeply hypothermic person. It represents the last effort of the victim and is followed almost immediately by unconsciousness and death.
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PMID:"Paradoxical undressing" in fatal hypothermia. 54 27

1. Thermoregulation and non-shivering thermogenesis have been studied in the genetically diabetic obese (db/db) mouse. 2. At all environmental temperatures between 33 and 10 degrees C the body temperature of the diabetic mice was lower than that of the normal littermates, the difference varying from 1.1 degrees C at 33 degrees C to 4.5 degrees C at 10 degrees C. 3. At 4 degrees C the diabetic mice rapidly died (3.2h) of hypothermia while the normal mice maintained their body temperature within the normal range. 4. At 23 degrees C the diabetic animals exhibited a diurnal rhythm in body temperature which was similar in both phase and amplitude to the controls, but at every point throughout the 24h cycle the temperature of the mutants was lower by 1--2 degrees C. 5. The resting metabolic rate at thermoneutrality (33 degrees C) was higher per whole animal for the diabetics than for the normals. However, at temperatures below thermoneutrality the converse was observed; between 30 and 4 degrees C the RMR of the mutants was lower than the controls by approximately 25%. 6. The capacity for non-shivering thermogenesis in diabetic mice was only one-half that found in normal animals. 7. The diabetic mouse has abnormalities in thermoregulation and non-shivering thermogenesis which are similar to those found in the genetically obese (ob/ob) mouse. It is concluded that the high metabolic efficiency of the diabetic mouse, like that of the ob/ob mouse, can be explained by a reduced energy expenditure on thermoregulatory thermogenesis; this may represent a primary mechanism for the operation of the "thirfty genotype" associated with obesity and diabetes.
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PMID:Thermoregulation in the diabetic-obese (db/db) mouse. The role of non-shivering thermogenesis in energy balance. 57 63

A procedure was developed in the laboratory for pancreatic allotransplantation in pancreatectomized dogs. Dogs with such grafts have survived for many months when treated with azathioprene and prednisone to prevent rejection. Contrary to usual beliefs, the pancreas is not unduly sensitive to total ischemia since it has been possible to successfully preserve a canine pancreas in vitro with hypothermia for periods up to 24 hours. Such preserved pancreas' have then been allotransplanted into pancreatectomized dogs with survival of the dogs for long periods. We have now done pancreaticoduodenal allotransplantation in 13 patients with juvenile onset diabetes mellitus. Nine of these patients also had renal failure and received simultaneously a renal allograft taken from the same cadaver. In all but one of these patients the pancreas functioned immediately. Two patients with juvenile onset diabetes mellitus and severe retinopathy but without terminal renal failure have received pancreaticoduodenal allografts alone. In both of these patients the pancreas functioned immediately but problems with the duodenum necessitated the removal of the pancreaticoduodenal allograft which did not show signs of rejection. As a result of the findings of increased sensitivity of the kidney and duodenum to rejection we have now modified our technique to transplant the pancreas alone. This technique was used in one patient with juvenile onset diabetes mellitus and severe retinopathy. Her renal function was only moderately reduced. The pancreatic allograft initially functioned normally but then was removed at 28 days because of clinical signs of rejection of the pancreas which were confirmed by the microscopic findings. Despite the promise of islet-cell transplantation, no long term functioning allografts have resulted in animals or man. Thus we need to continue with whole organ pancreatic allografts by various techniques if diabetes mellitus is to be controlled.
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PMID:Transplantation of the pancreas. 82 66

The cardiac transplantation experience at Stanford University School of Medicine commenced in 1959 with the development of a comprehensive surgical method for successful orthotopic cardiac transplantation in experimental animals. The steps involved included atrial level transection and anastomosis, local myocardial hypothermia and cardiopulmonary bypass. From the first Stanford clinical case in January 1968 until May 1974, 73 transplants have been carried out in 71 patients. Cardiac transplantation is indicated in myopathic disease of an advanced nature with the prospect of imminent death. Contraindications are high pulmonary vascular resistance and intercurrent infection. Relative contraindications are advanced age and insulin-dependent diabetes. Previous cardiac surgery procedures are not contraindications to transplantation. Maintenance immunosuppression requires azathioprine and prednisone indefinitely. Antithymocyte globulin is used for a short time in the postoperative period. Anticoagulants and antiplatelet agents are also used. Therapy for rejection crises includes methylprednisolone, in gram amounts, and actinomycin D. The diagnosis of graft rejection is based on a decrease in electrocardiographic voltage, transvenous endomyocardial biopsy and clinical examination of the patient. The overall survival rate is 43% at one year and 39% at two years. The longest-living survivor in the series is doing a regular day's work five years after transplantation.
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PMID:Stanford cardiac transplantation. A review. 108 17

Hyperthermia has recently been recognized as a manifestation of hypoglycemia. We describe two episodes of hypoglycemia associated with nausea, vomiting, chills, and impaired consciousness which were followed by marked hyperthermia. We suggest that the hyperthermia may result from excessive reaction to preceding hypothermia caused by the hypoglycemia. We would like to alert the clinician to the possibility of a previous, severe hypoglycemic episode in any diabetic patient with hyperthermia and coma.
Diabetes 1975 Sep
PMID:Marked hyperthermia as a manifestation of hypoglycemia in long-standing diabetes mellitus. 115 46

Many aspects of peri-operative management of the diabetic patient remain controversial, although there are a variety of approaches towards management. These patients are at risk for certain complications related to the severity and chronicity of the disease. The surgeon and the anaesthetist must be conversant with the management of diabetes in elective and emergency situations. Reasonable metabolic control can be achieved within a few hours pre-operatively and clinical assessment can be performed on an out-patient basis. Anaesthetic management consists of assessment of the control of the disease followed by evaluation of diabetic complications and their severity. Different views are expressed regarding tight control of blood glucose level (4-8 mmol/l) versus moderate control (8-12 mmol/l) when managing diabetic patients. The importance of guarding against factors favouring metabolic decompensation in the peri-operative period, is stressed. Minor or major surgery has important implications regarding the management of diabetes. All patients scheduled for major surgery should be treated with intravenous insulin. Blood sugar should be monitored at regular intervals to protect the patient against hypoglycaemia. Emergency surgery is usually associated with an infectious process. Pronounced hyperglycaemia, dehydration and metabolic derangement may be present. The underlying pathology may aggravate the diabetic state and surgery may actually improve the patient's condition. It is unnecessary to postpone surgery to treat ketosis fully, because this may need 12-24 hours. Extreme insulin resistance and greater insulin requirements are present during cardiopulmonary bypass, hypothermia and rewarming. Beware of severe hypoglycaemia after cardiopulmonary bypass.
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PMID:Routine peri-operative management of the diabetic patient. 141 7

In a prospective study, 100 patients undergoing open heart surgery were randomly allocated to receive ice/slush topical hypothermia for myocardial protection (Group I, n = 56) or not (Group II, n = 44). Chest radiographs, diaphragm screening, lung function and phrenic nerve conduction time were assessed pre-operatively and at 1 week and 1 month post-operatively in all patients and subsequently at 3 months, 6 months, 1 year and 2 years in all patients with radiological evidence of diaphragm paralysis. The two groups were similar in terms of age, sex, diabetes and smoking habits. Cardiopulmonary bypass and aortic cross-clamp times were similar in the two groups. Radiological evidence of partial left lower lobe collapse was more frequent in Group I (79 per cent vs. 36 per cent, p < 0.01). Twenty (36 per cent) Group I patients developed unilateral diaphragm paralysis (19 left-sided) compared with none in Group II. Diaphragm paralysis was still present in 19 patients (34 per cent) at 1 month, in five patients (9 per cent) at 1 year and in one patient (2 per cent) at 2 years post-operatively. Phrenic nerve conduction time was recorded in 98 per cent of patients pre-operatively, but was unrecordable on the appropriate side in all 20 patients with diaphragm paralysis 1 week post-operatively. Prolonged phrenic nerve conduction time on the left side was found in a further seven Group I patients 1 week post-operatively. There were no significant differences between the two groups in terms of post-operative arrhythmias, myocardial infarction or mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Phrenic nerve and diaphragm function following open heart surgery: a prospective study with and without topical hypothermia. 148 46

From the viewpoint of the high frequency of mild hypothermia in patients with senile dementia, we investigated causative factors in comparison with accidental hypothermia. We also investigated the relationship between hypothermia and the type or grade of dementia. A total of 127 demented cases including 30 males and 97 females, whose mean age was 80.6 +/- 8.9 years, were classified into 3 groups according to the axillary temperature measured in August 1989. Group A consisted of 33 cases whose body temperature was below 36 degrees C on more than 25 days. Group C consisted of 24 cases whose body temperature was above 36 degrees C on more than 25 days, and the remaining 70 cases were classified as group B. The frequency of group A classification in demented patients was higher than age-matched non-demented controls (26% vs 13%, p less than 0.05). In demented males, serum total cholesterol, serum albumin, and hemoglobin were significantly higher in group A than in group B or C. Body weight and serum triglyceride were also higher in group A, but not significantly. In demented females, serum albumin and hemoglobin were higher in groups A and B than group C. In addition, cases with diabetes mellitus or cases receiving with major tranquilizers were more frequent in group A, and the index of activities of daily living was higher in group A, in both sexes. Factors such as age, CRP or thyroid hormone (free T3, free T4) showed no significant difference among the 3 groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Mild hypothermia in patients with senile dementia]. 156 Jun 9


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