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Query: UMLS:C0011849 (diabetes)
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Blood has particular rheological properties which partly condition its flow, especially in capillary vessels, and its ability to deliver oxygen. It is not subject to gravitation, pseudoplastic, thixotropic and visco-elastic. Blood viscosity depends upon macroscopic factors, such as erythrocyte aggregation and deformability. Hyperviscosity is observed in cases of increased haematocrit (polycythaemia and relative polycythaemia), increased serum proteins and changes in protein balance (e.g. rise in fibrinogen and immunoglobulins, fall in albumin) as seen in inflammation and dysglobulinaemia, drop in temperature (hypothermia), increased erythrocyte aggregation (shock, fat embolism) or imparied deformability due to various acquired or inherited disorders of red cell membrane or cytoplasma (e.g. sickle cell anaemia, renal failure, hyperlipoproteinaemias, thrombosis, diabetes). The various factors may be combined, as in diabetes. Conversely, hypoviscosity may result from decreased haematocrite, fall in blood proteins and fibrinogen, or hyperthermia. Hyperviscosity can be corrected by acting on its various constituents. Treatments include haemodilution, plasmapheresis, anti-aggregants and drugs improving red cell deformability.
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PMID:[Blood viscosity. Measurement and applications (hyper--and hypoviscosity syndromes) (author's transl)]. 723 52

Hypothermia, especially in an urban environment, is often an unsuspected and therefore underdiagnosed clinical entity. Of 60 cases recorded over a two-year period in a typical community hospital in Philadelphia, 26 (43%) involved patients under 60 years of age; ambient air temperatures at admission exceeded 50 F (10 C) in 28 (47%) of the 60 cases. Hypothermia thus cannot necessarily be attributed to advanced age or cold climates or seasons. The severity of hypothermia did not correlate with either the season of the year or the ambient air temperature. Diabetes and alcohol abuse appear to be risk factors for hypothermia, being present in 18 (30%) and 14 (23%) of our patients, respectively. Every emergency department should have a protocol for identification and management of the hypothermia victim to allow timely institution of appropriate rewarming techniques.
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PMID:Accidental hypothermia: a community hospital perspective. 730 62

Hypothermia in the elderly is a medical emergency with mortality varying from 32-80%. Its most frequent predisposing factors, as reported in the current literature, are extremes of age, cold environment and alcoholism. In the Negev (southern region of Israel, mostly desert area) the mean temperature range during November-March is 9.6 to 15.2 degrees C and during April-October, 16-25.9 degrees C. The records of all patients with hypothermia, aged 65 and above admitted over a 5-year period (1984-1988) were reviewed (44 admissions of 39 patients of whom 23 were females). 34 were admitted during the winter months and 10 during the rest of the year. Important associated or predisposing conditions included infections in 54.5%, renal failure in 29.5% and diabetes mellitus in 29.5%. Alcoholism (13.6%) was relatively infrequent. Those of Asian or African origin appeared to be at greater risk, constituting 73% of admissions, but only 47% of the elderly population of the Negev. The annual incidence of up to 4/1000 of elderly patients admitted to our medical wards, which serve a population of 350000, indicates that hypothermia is not rare in this desert region.
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PMID:[Hypothermia in the elderly in the Negev]. 781 22

The elevated hemidiaphragm after coronary artery bypass grafting (CABG) that occurs in some patients is associated with internal thoracic artery (ITA) grafting as well as with the use of topical cardiac hypothermia. An increased incidence of elevated hemidiaphragm after CABG surgery in diabetic patients was observed. To determine the incidence and risk factors of elevated hemidiaphragm after CABG surgery and the relationship to preoperative diabetes, 200 consecutive patients undergoing CABG were studied; 29 (14.5%) had hemidiaphragm elevation postoperatively (25 on the left, 1 on the right, 3 bilateral). In the remaining 171 there was no hemidiaphragm elevation. Factors analyzed were age, gender, preoperative diabetes, duration of cardiopulmonary bypass (CPB) and aortic cross-clamping, minimum esophageal temperature during CPB, and use of the ITA graft. Univariate analysis showed a significant association between elevated hemidiaphragm and diabetes (P < 0.05), left ITA grafting (P < 0.01), and age (P < 0.05). Right ITA was not used for any patient. Multivariate analysis ruled out age, whereas preoperative diabetes and the use of the ITA remained the independent factors associated with elevated hemidiaphragm (odds ratio, 3.41; 95% confidence interval 1.41 to 8.18, and 2.86; 1.01 to 8.06, respectively). The relative risk of an elevated hemidiaphragm was 9.75 in diabetic patients with the ITA graft, as compared with nondiabetic patients without this graft. All 3 patients with bilateral diaphragm paralysis and a patient with a right hemidiaphragm elevation were diabetic. In conclusion, both diabetes and use of the ITA graft appear to be important risk factors for the development of elevated hemidiaphragm following CABG.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diabetes mellitus, internal thoracic artery grafting, and risk of an elevated hemidiaphragm after coronary artery bypass surgery. 794 1

Historically, intracardiac operations have carried a higher risk of neurologic complications than coronary artery bypass grafting (CABG) procedures, although the incidence of such complications has been increasing after CABG in recent years. In both intracardiac and extracardiac surgery, macroemboli from the surgical field cause most neurologic complications. The periods of highest risk for emboli are during aortic cannulation, onset of bypass, and weaning from bypass. Risk factors include atherosclerosis of the ascending aorta, advanced age, presence of concomitant cerebral vascular disease, previous neurologic abnormality, duration of surgery, diabetes, and history of failure of the native circulation. Although hypothermia is beneficial in elective circulatory arrest, its usefulness in reducing postoperative central nervous system deficits during routine cardiac operations may be limited. Studies suggest a role for barbiturate protection in intracardiac but not in extracardiac surgery. Studies have not shown better neurologic or neuropsychological outcome with the use of membrane oxygenation and arterial filtration. Recent studies suggest no correlation of neurologic injury with serum glucose levels during CABG, with either duration or severity of hypotension during hypothermic CABG, or with blood gas management during hypothermic CABG.
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PMID:Neuropsychiatric complications of cardiac surgery. 816 98

From March 1991 through July 1992, 1,001 patients having elective coronary artery bypass grafting were randomized to receive either continuous warm (> or = 35 degrees C) blood cardioplegia with systemic normothermia (> or = 35 degrees C) or intermittent cold (< or = 8 degrees C) oxygenated crystalloid cardioplegia and moderate systemic hypothermia (< or = 28 degrees C). Preoperative variables including age, sex, prior coronary bypass grafting, hypertension, prior myocardial infarction, diabetes, angina class, and preoperative heart failure class were similar in both groups, as were the intraoperative variables of number of coronary grafts, mammary artery use, and cardiopulmonary bypass time. Aortic cross-clamp time was significantly longer in the warm group (46 +/- 23 minutes versus 40 +/- 21 minutes). Most postoperative variables including mortality (warm, 1.0%, and cold, 1.6%), Q wave infarction (warm, 1.4%, and cold, 0.8%), and need of an intraaortic balloon pump (warm, 1.4%, and cold, 2.0%) were similar between groups. Total neurologic events (warm, 4.5%, and cold, 1.4%; p < 0.005) and perioperative strokes (warm, 3.1%, and cold, 1.0%; p < or = 0.02) were significantly higher in the warm group. Neurologic events included perioperative stroke (warm, 15 patients, and cold, 5 patients; p < 0.02), perioperative encephalopathy (warm, 2 patients, and cold, 1 patient), and delayed (> or = 3 in-hospital days) stroke (warm, 5 patients, and cold, 1 patient). All patients experiencing a stroke had a persistent neurologic deficit at the time of discharge. Encephalopathy resolved completely in all instances.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prospective, randomized trial of retrograde warm blood cardioplegia: myocardial benefit and neurologic threat. 784 93

In developing countries, child mortality declined during the 1980s, but neonatal mortality did not improve. Ministries of Health do not consider reduction of early neonatal mortality to be a priority. Underreporting of perinatal deaths is common (e.g., at least 40% of perinatal deaths). Researchers sometimes categorize perinatal deaths as other causes of infant mortality. Many people believe too technological or costly interventions are needed to reduce perinatal mortality, but simple, low-cost principles of newborn care do exist: keep the newborn warm, feed often, avoid infection, and keep the newborn close to the mother. A study in Zimbabwe shows that asphyxia, a preventable condition, occurred in 76% of cases. Prenatal care; education; improved treatment of syphilis, hypertension, diabetes, and amniotic fluid infection; closer monitoring of the fetal condition during labor; and proper management of abnormal labor would reduce perinatal deaths. Premature infants are at greater risk of death than are intrauterine growth retarded infants. Research is needed to learn more about the epidemiology, causes,, and sequelae of asphyxia as well as the most cost-effective interventions. 38% of newborns at a hospital in Kathmandu had mild or moderate hypoglycemia, 44% of whom experienced at least 3 hypoglycemic episodes in the first 2 days. Known hypoglycemic risk factors are low birth weight and hypothermia. Possible hypoglycemic risk factors are prelactal feeds and a delay in beginning breast feeding. Effective perinatal health care in developing countries requires a tired system of referral and a motivated community health worker trained to manage safe delivery and newborn care. Unfriendly staff and user charges are obstacles to primary perinatal health care, however. UNICEF's Baby Friendly Hospital initiative aims to stop distribution of free infant formula in maternity wards and to improve perinatal care.
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PMID:Perinatal health in developing countries. 846 75

Although much has been learned about cerebral physiology during CPB in the past decade, the role of alterations in CBF and CMRO2 during CPB and the unfortunately common occurrence of neuropsychologic injury still is understood incompletely. It is apparent that during CPB temperature, anesthetic depth, CMRO2, and PaCO2 are the major factors that effect CBF. The systemic pressure, pump flow, and flow character (pulsatile versus nonpulsatile) have little influence on CBF within the bounds of usual clinical practice. Although cerebral autoregulation is characteristically preserved during CPB, untreated hypertension, profound hypothermia, pH-stat blood gas management, diabetes, and certain neurologic disorders may impair this important link between cerebral blood flow nutrient supply and metabolic demand (Figure 5). During stable moderate hypothermic CPB with alpha-stat management of arterial blood gases, hypothermia is the most important factor altering cerebral metabolic parameters. Autoregulation is intact and CBF follows cerebral metabolism. Despite wide variations in perfusion flow and systemic arterial pressure, CBF is unchanged. Populations of patients have been identified with altered cerebral autoregulation. To what degree the impairment of cerebral autoregulation contributes to postoperative neuropsychologic dysfunction is unknown. It must be emphasized that not the absolute level of CBF, but the appropriateness of oxygen delivery to demand is paramount. However, the assumption that the control of cerebral oxygen and nutrient supply and demand will prevent neurologic injury during CPB is simplistic. A better understanding of CBF, CMRO2, autoregulation and mechanism(s) of cerebral injury during CPB has lead to a scientific basis for many of the decisions made regarding extracorporeal perfusion.
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PMID:Cerebral blood flow and metabolism during cardiopulmonary bypass. 846 2

At the end of cardiopulmonary bypass (CPB) diuresis and natriuresis are widely modified. Those are classically due to the CPB conditions (mean arterial pressure, non pulsatile flow, hypothermia, long duration ...). Previous studies showed no evidence of these modifications being due to variations of hormones such as vasopressin, renin or aldosterone. The atrial natriuretic factor, cardiac hormone mainly known for its natriuretic effect, would contribute to explain these facts. This study includes 17 patients NYHA I or II without any renal dysfunction or diabetes mellitus. They were scheduled for cardiac surgery under CPB (valvular replacement or aortocoronary bypass). Sampling times were: TO: after induction of anaesthesia and before surgical incision; T1: during steady CPB; T2: 30 min after CPB release. At each time were obtained: diuresis, osmolar and free water clearance, fractional excretion of sodium, haematocrit, plasma concentration of ANF (pANF), and right atrial pressure and capillar wedge pressure in case of aortocoronary graft. FeNa at the end of CPB is significantly linked to the osmolar clearance and the CPB duration. FeNa evolution is parallel with pFAN evolution. At the end of CPB pFAN is first linked to cardiac rate, then to CPB duration. Cardiac filling pressures after and before CPB are not different. pANF after CPB cannot be attributed to these pressures. Numerous factors are involved in the renal sodium elimination. An evident statistic link between pANF and FeNa is then difficult to demonstrate. Their parallel evolution is coherent and suggests that ANF is the main hormone of natriuresis at the end of CPB. ANF secretion factors at the end of CPB remain unclear. This study emphasizes the involvement of cardiac rate and CPB duration in pANF increase at the end of CPB.
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PMID:[Natriuresis and atrial natriuretic factors during extracorporeal circulation for cardiac surgery]. 856 51

Multimodality (auditory, visual and somatosensory) evoked potentials were recorded in the sand rat (Psammomys obesus) and compared to those obtained in albino rats, under almost identical conditions. Clear responses could be obtained from each species. The evoked potentials from the sand rat were qualitatively similar in waveform, latency and amplitude to those recorded in albino rats. Since there is a strain of sand rat which develops diabetes when on standard chow and since the sand rat has adapted to the desert environment, further study should involve evoked potential recordings in sand rats during hyper- and hypothermia and in diabetic sand rats.
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PMID:Multimodality (auditory, visual and somatosensory) evoked potentials in the sand rat, Psammomys obesus. 867 7


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