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

A total of 4,000 consecutive electrocardiograms covering an 8-yr period was studied and all cases with pure left anterior hemiblock reviewed on the basis of clinical diagnosis and subsequent follow-ups. There were 66 cases in all, representing 1.6% of the total series with an age range of 30--81 and a mean of 53.4 yr; 43 males to 23 females--a ratio of approximately 2 : 1. 34 cases (51.5%) were hypertensives all with a minimum diastolic pressure of 120 mm Hg before treatment. Congestive cardiomyopathy accounted for 16 cases (24.3%) and diabetes mellitus unassociated with other ailments for another 6 cases (9.1%). Other causes included mixed aortic valve disease with 2 cases (3%), endomyocardial fibrosis with 2 cases (3%). In 6 patients (9.1%), all above the age of 70, who had been admitted for minor surgical operations, no cause could be found. This etiological pattern differs from that seen in white populations where ischemic heart disease is by far the commonest cause. The extreme rarity to left anterior hemiblock in rheumatic mitral valve disease is considered of help in separating cases of lone rheumatic regurgitation from those of mitral regurgitation complicating congestive cardiomyopathy if and when diagnostic difficulty arises.
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PMID:Left anterior hemiblock in adult Africans. 64 77

During a 28-year period, 52 bronchopleural fistulas developed after pulmonary resection of 49 primary and three recurrent lung cancers at the National Cancer Center Hospital, Tokyo. During the same period there were 2359 pulmonary resections for primary lung cancer; the prevalence of bronchopleural fistula was 2.1%. Multivariate analysis on 15 variables in the most recent 1360 resections revealed significant risk factors for bronchopleural fistula: wider resection such as pneumonectomy, residual carcinomatous tissue at the bronchial stump, preoperative irradiation, and diabetes. Univariate analysis further recognized a risk in preoperative bronchial arterial infusion and the postsurgical stage of lung cancer. Six patients were not treated. Apart from chest tube drainage in seven patients, surgical repair was attempted in 39, direct resuture of the stump in 16, wrapping in 25, thoracoplasty in 31, completion pneumonectomy in 6, and other treatments. Despite various treatments, 37 patients (71.2% mortality) died from fistula-related complications (such as regurgitation of infected pleural fluid through the fistula and airway/intrathoracic bleeding). Even for patients whose fistulas were cured and who were discharged, the average hospital stay was 189 days. Further investigation is necessary to answer whether prevention by flap coverage is of any benefit.
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PMID:Bronchopleural fistulas associated with lung cancer operations. Univariate and multivariate analysis of risk factors, management, and outcome. 143 30

The existence of specific, age-related changes in gastrointestinal motility with clinical significance is controversial. Beside the more infrequent primary motility disorders, secondary motility disturbances associated with collagen vascular diseases, endocrinopathies, and neuromuscular diseases are prominent in the older and often multimorbid patients. Especially in geriatric patients, motility associated symptoms are undesired side-effects of drug therapy. The pathophysiology, clinical syndromes, and therapeutic principles of motility disorders in the elderly are discussed. The major symptoms of esophageal dysfunction are dysphagia, chest pain, heartburn, and regurgitation. Oropharyngeal dysphagia, mostly caused by cerebrovascular accidents and other neurologic disorders, leads to disturbances in food intake, and is often complicated by broncho-pulmonary infections arising from recurrent aspiration of food or saliva. Gastrointestinal reflux disease and spastic motility disorders of the esophagus are regarded as possible causes of angina-like chest pain after exclusion of cardiac diseases. Motility disturbances of the stomach and small bowel are often related to systemic disease (i.e., diabetes mellitus, chronic intestinal pseudo-obstruction) of drug side-effects. Mental and physical decline, reduced fluid intake, and constipating drugs are the most relevant factors for idiopathic constipation in the elderly. Fecal incontinence means a great psychological strain for older patients and leads to social isolation.
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PMID:[Gastrointestinal motility in the elderly]. 144 9

It is common for patients to be diagnosed as having valvular regurgitation by Doppler echo when no such murmur has been heard by the referring clinician. To test the hypothesis that such patients have clinically unimportant heart disease, the authors evaluated the records of 213 consecutive men in whom mitral regurgitation had been found by pulsed Doppler. In 95 patients (group I) mitral regurgitation was audible, whereas in the other 118, it was not. In 97 patients with inaudible mitral regurgitation there were no structural mitral valve abnormalities by 2D echo. This group of 97 patients (group II) was defined as having unexpected Doppler mitral regurgitation. In group II patients there was a high prevalence of hypertension (50%), congestive heart failure (44%), alcohol abuse (46%), diabetes (27%), coronary artery disease (63%), and atrial fibrillation (13%). The following variables were distributed similarly in groups I and II: survival time, age, presence of congestive heart failure or coronary artery disease, left ventricular short-axis end diastolic and end systolic dimensions, E point septal separation, and the severity of dyssynergy. Atrial fibrillation was more common in group I (p = 0.017), and group I patients had a higher Quetelet's Index (weight/height squared) (p = 0.03). In group II, the factors most closely related to survival were the presence of dyssynergy, of atrial fibrillation, or of congestive heart failure. Although no group II patient had endocarditis or required mitral valve replacement, their survival was markedly decreased compared with people of similar age in the general population. The majority of cardiogenic deaths in group II patients were due to coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The natural history of unexpected Doppler mitral regurgitation. 270 50

Skin necrosis has not been described as a complication following epidural sympathetic blockade. We report a case of bilateral extensive skin necrosis of the lower limbs after a 48-hour lumbar epidural blockade in a 71-year-old patient with right hemiplegia and mitral valve regurgitation, without any preoperative clinical evidence of peripheral vascular disease or diabetes, who underwent transurethral prostatectomy.
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PMID:Bilateral extensive skin necrosis of the lower limbs following prolonged epidural blockade. 320 56

In this case report, the authors describe an esophageal bezoar found in a mechanically ventilated patient receiving sucralfate, antacid, and tube feeding via a nasogastric tube. The presence of a prosthetic device in the esophagus (such as a nasogastric or endotracheal tube) in conjunction with functional esophageal abnormalities is a common link in the development of esophageal bezoars. These bezoars form in the esophagus as a result of regurgitation of stomach contents. In addition, bezoars are a known complication of gastric motility disorders, such as gastric paresis of diabetes. Critically ill patients are frequently given antacid and sucralfate therapy while being enterally tube fed, often by nasogastric tubes. This combination of treatment modalities in patients with esophageal and/or neurological abnormalities warrants vigilant adherence to measures to prevent reflux and gastric pooling.
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PMID:Esophageal bezoar formation in a tube-fed patient receiving sucralfate and antacid therapy: a case report. 772 68

Right ventricular (RV) involvement is frequent during inferior wall acute myocardial infarction (AMI) and has been reported as a risk factor for in-hospital morbidity and mortality. The objectives of the present study were: (1) to evaluate in-hospital events in patients with and without RV involvement as diagnosed by abnormal flow characteristics derived from pulmonary regurgitation (PR) analysis (pressure half-time of PR, PHT(PR) < or = 150 ms and the lowest mid-diastolic to peak early diastolic velocity ratio, Vmin/Vmax < or = 0.5); and (2) to determine the influence of RV involvement in complications at long-term follow-up. Among 126 consecutively admitted patients with inferior wall AMI (mean age, 58 +/- 13 years), 101 had PR. We determined the prognostic significance of in-hospital and long-term events for the following variables: age > or = 65 years, ST-segment elevation > or = 1 mm in lead V4R, RV dilation, PHT of PR < or = 150 ms and Vmin/Vmax < or = 0.5, thrombolytic therapy, 3-vessel disease, and diabetes mellitus. We found that the PR derived Doppler index (PHT of PR < or = 150 ms and Vmin/Vmax < or = 0.5) was the only predictor of overall in-hospital clinical events (hazards ratio, 2.7, 95% confidence interval, 1.2 to 6.1, p = 0.016). At long-term follow-up (mean: 20 +/- 12 months, range 12 to 69), event-free survival analysis showed that age > or = 65 years was the only predictor of any event (relative risk, 3.7, 95% confidence interval, 2.1 to 6.3, p < 0.0001). Thus, RV involvement diagnosed with the use of PR flow-derived variables is an accurate and independent predictor of in-hospital complications. However, RV involvement does not influence long-term prognosis.
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PMID:Usefulness of pulmonary regurgitation Doppler tracings in predicting in-hospital and long-term outcome in patients with inferior wall acute myocardial infarction. 946 67

The medical model of obesity treatment--combining diet, exercise, and behavior modification with antiobesity agents--suffered a setback when fenfluramine and dexfenfluramine were withdrawn from the market because of an association between these medications and valvular regurgitation. The Food and Drug Administration has recently approved sibutramine (Meridia), a norepinephrine and serotonin reuptake inhibitor that was originally developed as an antidepressant, but which has also been shown to reduce weight. In a 1-year placebo-controlled trial, 65% of patients receiving 15 mg sibutramine daily lost more than 5% of their body weight, compared with 29% of patients receiving a placebo; 39% of patients in the sibutramine group lost more than 10% of their body weight, compared with 8% of patients in the placebo group. Health benefits observed in patients receiving sibutramine include reductions in levels of triglycerides, uric acid, total cholesterol, and low-density lipoprotein (LDL) cholesterol and an increase in high-density lipoprotein (HDL) cholesterol levels. Another antiobesity drug currently under review by the Food and Drug Administration is orlistat (Xenical), a pancreatic lipase inhibitor that reduces the absorption of dietary fat by approximately 30%, thus reducing energy intake. In a 1-year placebo-controlled trial, 55% of patients receiving orlistat lost more than 5% of their body weight, and 25% lost more than 10% of their body weight, compared with 33% and 15%, respectively, of patients in the placebo group. In addition, orlistat slowed the rate of weight regain in the second year of treatment. Health benefits demonstrated in clinical trials of orlistat include reduced LDL cholesterol levels and increased levels of HDL cholesterol, reduced blood pressure and fasting insulin levels, improved oral glucose tolerance test outcomes, and improved glycemic control in obese patients with diabetes. The future of the pharmacologic treatment of obesity is promising. Many new antiobesity agents are in the early stages of development, and our understanding of the body's weight-regulating mechanisms is advancing steadily. Human trials of recombinant leptin are underway. Other promising compounds include those that block the Neuropeptide Y5 and Y1 (NY5, NY1) and Melanocortin-4 (MC4) receptors, stimulate uncoupling proteins, and unbind corticotrophin-releasing factor from its binding protein. As better medical treatments for obesity become available, the focus in dietary prescription may shift away from reducing energy intake toward healthier eating for disease prevention. At present, a comprehensive approach, which, in some patients, may include medical therapy as an adjunct, is necessary to treat obesity effectively.
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PMID:Modern medical management of obesity: the role of pharmaceutical intervention. 978 32

The relation of impaired left ventricular relaxation, as measured by prolonged isovolumic relaxation time, to ventricular systolic function in hypertension remains uncertain in population-based samples. In the Hypertension Genetic Epidemiology Network (HyperGEN) Study, echocardiograms were analyzed in 1457 hypertensive participants without diabetes, >/=2+ valvular regurgitation, or coronary disease. Impaired relaxation (isovolumic relaxation time >100 ms) was present in 219 (15%) of the participants; they were older and had higher arterial pressure than did those with normal relaxation. Ventricular chamber size, wall thicknesses, mass, and relative wall thickness were greater, and stress-corrected midwall shortening and end-systolic stress/end-systolic volume index were lower with impaired relaxation than with normal relaxation time. Fractional shortening and ejection fraction did not differ between the groups. In logistic regression, the likelihood of prolonged isovolumic relaxation time decreased with higher stress-corrected midwall shortening (odds ratio, 0.97%; 95% confidence interval, 0.96 to 0.99), independently of age, heart rate, and ventricular mass. Neither ejection fraction nor the end-systolic stress/end-systolic volume index was independently related to isovolumic relaxation time. In hypertension, impaired left ventricular relaxation parallels ventricular midwall dysfunction but not systolic chamber function. Whether combined diastolic and systolic dysfunction identifies hypertensive patients at especially high risk of cardiovascular events requires further study.
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PMID:Relationship between left ventricular diastolic relaxation and systolic function in hypertension: The Hypertension Genetic Epidemiology Network (HyperGEN) Study. 1156 16

A 68-year-old woman with idiopathic thrombocytopenic purpura (ITP) was admitted to our hospital with acute myocardial infarction on 7 February 1999. She had been treated since 1991 for mitral stenosis and regurgitation, atrial fibrillation due to mitralism, diabetes mellitus, hypertension, hyperlipidemia. Chest radiograph on admission showed cardiomegaly with congestion and cardiothoracic ratio was 63%. The platelet count on admission was 22,000/microliter, but she did not have petechia or purpura. Urgent coronary angiography revealed total occlusion in segment 7, and 13 and 75% stenosis in segment 4PD, 9 and 10. Subsequently, direct percutaneous transluminal coronary angioplasty (PTCA) was performed in segment 7. Dissection occurred during the intervention, and a coronary stent was implanted, we started heparin infusion and medication with ticlopidine hydrochloride as post-stenting therapy after the intervention, and there was no bleeding tendency.
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PMID:[A case of intracoronary stent implanted for acute myocardial infarction in an elderly patient with idiopathic thrombocytopenic purpura]. 1185 81


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