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

Of 3632 consecutive admissions to the Wilmer Ophthalmological Institute between July 1, 1987 and June 30, 1989, 27 patients required transfer to a medical or surgical service (0.74%). The major reasons for transfer included acute or decompensated cardiac disease (26%), poorly controlled diabetes mellitus (19%), acute renal failure (11%), coagulopathy, stroke, and hypertension (7% each). Only one transfer was a direct result of an anesthesia complication. The highest rates of transfers were associated with orbital (4.3%), enucleation/evisceration (3.1%), and glaucoma (2.3%) surgeries, while vitreoretinal surgery had the lowest rate of transfer (0.3%). Most of the transfers of patients with orbital disease were for management of related problems such as sinusitis or increased intracranial pressure.
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PMID:Transfer from ophthalmology to another service is a marker of high risk medical events. 190 39

The indices of aqueous-electrolyte metabolism in patients, who underwent the reconstructive operations on the aorta, were studied. In patients with concomitant diabetes mellitus, a method of choice for anesthesia is an epidural anesthesia, with ischemic heart disease--combined epidural anesthesia. The most severe changes in electrolyte metabolism were noted after restoration of blood flow in blood loss of more than 10 ml/kg, under conditions of epidural anesthesia these shifts are less pronounced.
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PMID:[Water-electrolyte balance in patients during operation on the aorto-femoral segment using various types of anesthesia]. 194 27

Percutaneous radiofrequency thermal lesion of the lumbar sympathetic chain (PRFS) was performed in 30 patients with diabetes mellitus suffering from unreconstractable endstage peripheral vascular disease. All of the patients had the feeling of warmth after PRFS, 45% were free of further complaints and 63% changed to stage II according fontaine. The reported data demonstrate a good comparability concerning amputation after a period of two years to the results obtained by surgical sympathectomy. As there is no need of general anesthesia PRFS turned out to be a good alternative to the surgical sympathectomy.
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PMID:Percutaneous radiofrequency thermolesion of the sympathetic chain in the treatment of peripheral vascular disease. 195 Mar 93

To examine the interaction of epidural anesthesia, coagulation status, and outcome after lower extremity revascularization, 80 patients with atherosclerotic vascular disease were prospectively randomized to receive general anesthesia combined with postoperative epidural analgesia (GEN-EPI) or general anesthesia with on-demand narcotic analgesia (GEN). Demographics did not differ between groups except that the GEN-EPI group had a higher incidence of diabetes mellitus and of previous myocardial infarction. Coagulation status was monitored using thromboelastography. An additional 40 randomly selected patients without atherosclerotic vascular disease undergoing noncardiovascular procedures served as controls for coagulation status. Vascular surgical patients were hypercoagulable compared with control patients before operation and on the first postoperative day. Postoperatively, this hypercoagulability was attenuated in the GEN-EPI group and was associated with a lower incidence of thrombotic events (peripheral arterial graft coronary artery or deep vein thromboses). The rates of cardiovascular, infectious, and overall postoperative complications, as well as duration of intensive care unit stay, were significantly reduced in the GEN-EPI group. Stepwise logistic regression demonstrated that the only significant predictors of postoperative cardiovascular complications were preoperative congestive heart failure and general anesthesia without epidural analgesia. We conclude that in patients with atherosclerotic vascular disease undergoing arterial reconstructive surgery (a) thromboelastographic evidence of increased platelet-fibrinogen interaction is associated with early postoperative thrombotic events, and (b) epidural anesthesia and analgesia is associated with beneficial effects on coagulation status and postoperative outcome compared with intermittent on-demand opioid analgesia.
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PMID:Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. 195 66

To assess the role of the central nervous system (CNS) in carbohydrate metabolism in diabetes, neostigmine was injected into the third cerebral ventricle in fed rats with streptozotocin (STZ; 80 mg/kg)-induced diabetes under pentobarbital sodium anesthesia. Changes in hepatic venous plasma glucose concentrations were monitored. Neostigmine injection caused no significant changes in the hepatic venous plasma glucose concentration in untreated diabetic rats, whereas the glucose level increased significantly in insulin-treated diabetic rats similarly to the changes in normal control animals. In diabetic rats, the plasma levels of glucagon, epinephrine, and norepinephrine were increased significantly by neostigmine. After various doses (35-80 mg/kg) were given to rats, it was found that the higher the STZ dose, the lower was the hepatic glycogen content and the smaller was the glycemic response to neostigmine. Our results indicate that, in severe diabetes, CNS stimulation with neostigmine fails to increase hepatic glucose output, because glycogen stores are nearly exhausted and gluconeogenesis is already maximal.
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PMID:CNS stimulation does not affect hepatic venous glucose concentration in severely diabetic rats. 200 97

The metabolic changes in connection with fasting, anaesthesia and surgery in diabetic patients and non-diabetic patients are reviewed. Various perioperative forms of treatment are described. The forms of treatment most commonly employed are infusion of glucose-insulin-potassium (GIK) and subcutaneous administration of insulin followed by infusion of glucose (KON). The more intensive GIK regime provides the diabetic patient with a biochemical regulation which resembles that found in non-diabetics. It has not been proved whether this marginal regulation influences the well-being, morbidity or mortality of the patients. In critically ill patients or patients with concurrent diseases, the GIK regime is recommended as this provides optimal regulation of the diabetes. In the remaining patients, local conditions will influence the choice of form of treatment.
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PMID:[Perioperative treatment of diabetics]. 765 62

This case chronicles the effect of a retrobulbar block on a coincident general anesthetic for enucleation in an elderly man. This ASA II patient had a medical history of insulin-dependent diabetes with few apparent cardiovascular complications and mild chronic obstructive pulmonary disease. Induction of anesthesia was accomplished with small doses of midazolam, droperidol, and alfentanil followed by thiamylal. The patient was intubated and maintained on isoflurane and nitrous oxide. A retrobulbar block was administered according to the surgeon's instructions without immediate, untoward consequences. Within 10 minutes the patient suffered a profound decrease in blood pressure and pulse requiring repeated doses of glycopyrrolate, phenylephrine, and ephedrine to maintain effective perfusion. These effects do not appear to have resulted from direct elicitation of the oculocardiac reflex, but rather from the loss of surgical stimuli from the block that essentially resulted in inadequate sympathetic tone. The author concludes that anesthetists in similar circumstances should anticipate the possibility of hypotension and lessened anesthetic requirements following retrobulbar block when coincident general anesthesia is planned.
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PMID:The effect of intraoperative retrobulbar block on anesthetic management of enucleation under general anesthesia. 202 56

Oculocardiac reflex (OCR) is a frequently occurring complication in eye operations. It is a trigemino-vagal reflex characterised by the clinical occurrence of bradycardia and other cardiac rhythm disturbances following manipulations on the eye and its surroundings especially after traction of the external eye muscles. In this paper based on an analysis of 402 anaesthesia records, a bradycardia frequency (f = less than 60/min) of 31.8% was noted while other rhythm disturbances occurred in 5.7%. Predisposition facts were identified as age over 50, hypertension and cardiac diseases requiring medication with cardiac drugs. The frequency of OCR is considerably lowered by diabetes mellitus. Examination of 159 traction measurements made at the lateral rectus muscle revealed that the first manipulation made at the rectus bulbi superior muscle resulted in a statistically significantly stronger reflex activity than at the other muscles. In a further series of investigations in which rectus bulbi superior muscle was tested last, this muscle again showed the biggest frequency deviation. Only determination of the percentage heart rate decrease is suitable for characterising reflex activity. The frequency of the reflex occurring in our study was 71.7%, the result being reduced by the high proportion of diabetics, who are relatively reflex insensitive.
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PMID:[The oculocardiac reflex during vitrectomy under neuroleptanalgesia]. 205 38

Effective clinical trials of islet transplantation have been limited by the inability to transplant enough viable human islets into patients with type I (insulin-dependent) diabetes mellitus to eliminate their exogenous insulin requirement. We report the first type I diabetic patient with an established kidney transplant on basal cyclosporin immunosuppression who was able to eliminate the insulin requirement after human islet transplantation into the portal vein. We successfully isolated approximately 800,000 islets that were 95% pure from 1.4 cadaver pancreases containing 121 U of insulin. Islets were proven viable by in vitro insulin response to glucose challenge. After 7 days of 24 degrees C culture, the islets were transplanted into the portal vein under local anesthesia. Seven days of Minnesota antilymphoblast globulin (20 mg/kg) administration followed the islet transplantation, with maintenance of the cyclosporin. Blood glucose was kept under strict control via intravenous insulin for 10 days posttransplantation, when all insulin therapy was stopped. Off insulin, the average 24-h blood glucose level remained less than 150 mg/dl, with the fasting glucose level at 115 +/- 6 mg/dl and the 2-h postprandial level at 141 +/- 8 mg/dl for 22 days posttransplantation (the time of this study). The C-peptide values post-Sustacal testing, although initially rising slower, exceeded the normal range, with peak values of 1.0-1.8 pmol/ml. This preliminary result represents the first essential step required to determine the feasibility of islet transplantation by future clinical trials.
Diabetes 1990 Apr
PMID:Insulin independence after islet transplantation into type I diabetic patient. 210 71

Non-insulin-dependent diabetes mellitus (NIDDM) is a heterogenous disorder characterized by defects in insulin action and secretion. This study was aimed at developing a rat model in which these pathogenic factors might be studied. Male Wistar rats were injected at 2 days of age with 45 or 30 mg/kg streptozocin (STZ) or vehicle (control). Fasting plasma glucose and insulin levels were not significantly different between the two groups between 5 and 8 wk of age. At 8 wk, half of each group was randomly assigned to isocaloric diets high in either fat (59% of calories) or starch (70% of calories). After 1 wk on the diets, 45-mg/kg-STZ-administered fat-fed animals displayed significant fasting hyperglycemia (8.6 +/- 0.2 mM; P less than 0.01), which was exacerbated by the stress of anesthesia and/or cannulation, whereas no changes were observed in any of the other groups before (STZ starch fed, 6.7 +/- 0.1 mM; control fat fed, 6.8 +/- 0.1 mM; control starch fed; 6.4 +/- 0.1 mM) or after anesthesia and/or cannulation. In the 30-mg/kg-STZ animals, fat feeding did not significantly elevate plasma glucose concentration, but a significant hyperglycemic response was seen with anesthesia and/or cannulation. In all STZ groups, substantial impairment of glucose-induced insulin secretion was observed, particularly early-phase insulin secretion. Further studies indicated that STZ animals on a diet conferring normal insulin sensitivity (starch) maintained basal normoglycemia and mildly impaired (i.v.) glucose tolerance despite this gross insulin secretory defect.(ABSTRACT TRUNCATED AT 250 WORDS)
Diabetes 1990 Feb
PMID:Inducement by fat feeding of basal hyperglycemia in rats with abnormal beta-cell function. Model for study of etiology and pathogenesis of NIDDM. 214 80


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