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

The early renal effects associated with streptozotocin-induced diabetes in rats (glomerular hyperfiltration and increase in filtration fraction) are similar to modifications reported in the early stage of human diabetic nephropathy. We examined the reversibility of these early renal diabetic effects by dopamine, which might correct glomerular hyperfiltration thanks to its preferential vasodilatory action on glomerular efferent arterioles. A dopamine prodrug, L-dopa was used to increase endorenal dopamine synthesis. Studies were carried out on streptozotocin-treated (60 mg/kg, i.v.) Wistar rats, supplemented with NPH insulin (2 to 3 U/day) such as to stabilize hyperglycemia at 22 mmol/l. One week after diabetes induction, animals were treated during a week either with L-dopa (10 mg/kg, s.c. twice daily) or L-dopa plus a dopa-decarboxylase inhibitor, carbidopa (10 mg/kg, s.c. 30 min before each L-dopa injection) or L-dopa plus a selective D1 receptor antagonist, SCH 23390 (100 micrograms/kg, s.c., with each L-dopa injection). Control diabetic animals received the solvent of L-dopa and control non-diabetic animals received the solvent of streptozotocin. After one week of L-dopa or other treatment, the renal functions of the rats were investigated (polyfructosan and PAH clearances) under inactin anaesthesia. As expected, streptozotocin induced glomerular hyperfiltration (1.3 +/- 0.07, n = 14, versus 0.93 +/- 0.05 ml/min.g kidney weight in non-diabetic controls, p less than 0.001) and an increase in filtration fraction (52.4 +/- 5.1 versus 32.1 +/- 1.7%, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Prevention by L-dopa of early renal consequences of diabetes induced by streptozocin in rats]. 214 79

Diabetic angiopathy prevents adequate access of antibiotic agents to septic areas of the diabetic foot. We treated 22 such patients with antibiotics infused through a superficial vein associated to tourniquet occlusion of the limb (Group A). A control group of 47 patients, similar in age, sex and severity of diabetes received conventional systemic therapy (Group B). 45% of the patients exhibited occlusive arterial disease. Surgery was performed by the same team in both groups. Group A received regional anesthesia at the same time of the first antibiotic infusion. Group B received general or spinal anesthesia. Amputation was required in 5% of patients in Group A compared to 30% of patients in Group B (p < 0.02). Hospital stay was also significantly shorter in patients from Group A. No complications of this form of therapy were observed. Thus, regional antibiotic therapy may improve prognosis and facilitate management in patients with septic diabetic foot.
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PMID:[Antibiotic treatment for diabetic foot. Advantages of intravenous regional route as alternative for systemic route]. 215 32

Current practice of investigating abnormal uterine bleeding via dilatation and curettage is sometimes open to question, and outpatient procedures are emphasised. The therapeutic effect of curettage in normalising menstrual patterns is being discussed. In a prospective study we answered the question of diagnostic and therapeutic effects of curettage. Over a period of 6 months, all patients with curettage treated in our department were investigated (history, risk factors, previous hormonal treatment, preoperative haemoglobin value, type of anaesthesia, complications, histology). Curettages performed for the purpose of abortion, as well as in combination with conisation of the uterine cervix, were not included in the study. 234 curettages were carried out. Clinical indications were as follows: in 29% of the cases recurrent preclimacteric metrorrhagia, in 27% climacteric metrorrhagia, in 24% PMB (postmenopausal bleeding). In 19 cases we found an Hb value lower than 10.5 g%. Risk factors (obesity, hypertension, diabetes mellitus) for endometrial cancer were found in 38% of MB and in 20% of climacteric metrorrhagia. In 9 cases, the histological diagnosis was endometrial cancer (clinical indications: 5 PMB, 3 climacteric metrorrhagia, 1 recurrent preclimacteric metrorrhagia). Our study shows, that the indication for curettage should be applied generously, especially in cases of abnormal postmenopausal and perimenopausal bleeding.
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PMID:[The value of curettage in the assessment of abnormal uterine bleeding]. 221 Mar 9

Because surgery is a likely event during the lifetime of patients with diabetes, health-care team members need to be aware of the metabolic problems that may occur during the perioperative period. Surgery, especially in the presence of general anesthesia, will produce a diabetogenic response. This is generally due to an elevation of counterregulatory hormones, although endogenous insulin is also suppressed. The excessive lipolysis and ketogenesis that can occur during surgery can have particularly deleterious effects for patients with diabetes. Thus, sufficient insulin must be provided during this period to suppress these catabolic processes. The major controversy regarding surgery and diabetes concerns the route of insulin administration. This article reviews the various treatment options for patients with insulin-dependent and non-insulin-dependent diabetes mellitus, with particular emphasis on the role of insulin. Special situations, e.g., outpatient surgery, coronary artery bypass, and emergency surgery, are also discussed.
Diabetes Care 1990 Sep
PMID:Role of insulin in management of surgical patients with diabetes mellitus. 222 12

This study was designed to evaluate whether the decreased early survival rate of diabetic rats submitted to acute experimental myocardial infarction can be improved by pretreatment with lidocaine. Male Wistar rats (+/- 210 g) were rendered diabetic with i.v. injection of streptozotocin (50 mg/kg), and only those presenting 1 week later a tail-blood glucose value between 250-400 mg/dl were retained in the protocol. Eleven weeks after induction of diabetes, a bolus of lidocaine (2 mg/kg) was administered i.v. about 6 min prior to ligation of the left coronary artery under ether anesthesia in control (n = 54) and diabetic (n = 48) rats; similar studies were conducted in 53 control and 55 diabetic rats without lidocaine pretreatment. Adequate occlusion was confirmed by an elevation of plasma CK-MB levels 4 h later or by a toluidine blue injection technique in rats which died earlier. Rats were followed over 48 h and comparison in the survival rate in each group established with the Fisher's exact test. Early survival rate (measured after 20 min) was significantly decreased in diabetic rats (27% vs 45%; p = 0.04). This was greatly improved by lidocaine pretreatment in diabetic (60% vs 27%; p = 0.0013), but not in control animals (50% vs 45%; p = 0.348). Furthermore, the beneficial effect of prophylactic lidocaine observed early after coronary ligation in diabetic rats was maintained throughout the period of observation (48 h). These data suggest that the prophylactic use of lidocaine is able to reverse the increased incidence of sudden death following experimental myocardial infarction in chronically diabetic rats.
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PMID:Lidocaine improves survival rate in diabetic rats submitted to acute left coronary artery ligation. 224 70

Fifty-one surgical decompressions without nerve transposition for ulnar neuropathy were performed in 46 patients. All of the patients were men with an average age of 59 years at the time of surgery. The follow-up range was between 5 and 32 months (average, 17.8 months). The disease involved the nondominant arm in 24 patients (52%) and was bilateral in 5 (11%). In 23 cases (50%), no predisposing condition could be identified, whereas 15 patients (33%) abused alcohol and 8 patients (17%) had diabetes mellitus. Fifty-seven percent of the patients helped by surgery had symptoms for less than 1 year, whereas only 30% of patients with symptoms for more than 1 year had symptomatic improvement. The relative magnitude of the slowing of ulnar nerve conduction velocity across the elbow was not significantly correlated with the success of decompression in relieving symptoms. Ulnar nerve conduction velocities across the elbow were 36.13 +/- 11.76 m/s in those responding to surgery and 38.97 +/- 13.91 m/s in those not responding (c = 0.06, dF = 50, P less than 0.3). A total of 37 patients showed symptomatic improvement after decompression. Simple decompression of the ulnar nerve was performed under local anesthesia without transposition of the nerve. In all of these cases, compression of the nerve occurred predominantly in the epicondylar groove. Narrowing of the nerve in the groove was present in 28 cases (55%); scar tissue was found adhering to the nerve in 21 cases (41%); and two pseudoneuromas were found (4%). Forty-one operations (80%) resulted in symptomatic improvement, typically noted by the patient within the first month postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Surgical decompression without transposition for ulnar neuropathy: factors determining outcome. 225

The effects of streptozotocin-induced diabetes and insulin on the duration of xylazine-ketamine anesthesia were studied in rats. The duration of anesthesia was significantly reduced in diabetic group as compared to control group. In contrast, the duration of anesthesia in insulin-treated non-diabetic group was not significantly different from control group. The plasma glucose level in control group was increased significantly during and upon recovery from anesthesia as compared to pre-anesthetic levels. The plasma glucose level in diabetic group was not changed during anesthesia; however, it was reduced significantly upon recovery. The plasma glucose level was significantly reduced in insulin-treated group as compared to pre-anesthetic levels. The reduction in duration of anesthesia in diabetic rats is possibly due to enhanced metabolism xylazine and/or ketamine and is independent of plasma glucose level.
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PMID:Effects of streptozotocin-induced diabetes on xylazine-ketamine anesthesia. 230 Nov 44

3905 patients of more than 60 years of age who underwent surgical, urological, orthopaedic or opthalmologic interventions, were retrospectively investigated with respect to preoperative condition, intraoperative peculiarities and postoperative complications. Only 3.2% of the old patients (of more than 75 years of age), but 7.2% of elderly patients (between 60 and 74 years of age) had no coexisting disease. Preexisting diseases were myocardial (54.5%) and respiratory diseases (41.3%), hypertension (32.6%), dysrhythmia (30.8%) and diabetes mellitus (17.6%). From the old patients, 58.1% were classified into ASA physical status III to V but only 43.2% from the elderly patients. Peculiarities during anaesthesia and recovery period were (in total): dysrhythmia (8.3%), blood pressure decrease (5.9%) and increase (1.6%) that were significantly more often seen in old than in elderly patients whereas bleeding (4.5%) in the old was not different from the elderly. Independent of age, 11.6% of patients were monitored postoperatively on an intensive-care unit. 47.3% of all patients did not develop any postoperative complication. The incidence of postoperative cardiac, respiratory, central nervous, and lethal complications was not significantly higher in old than in elderly patients. However, the incidence of complications increased significantly with ASA physical status. Mortality of elderly and old patients after emergency interventions was 17.8% and 24.7% respectively and about 10 times that high as after elective surgery (2% in both groups.)
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PMID:[Perioperative morbidity and mortality of geriatric patients. A retrospective study of 3905 cases]. 230 98

Of 10,122 singleton babies born from January 1, 1984 to March 31, 1988, we compared 1,154 term infants with high serum bilirubin levels (greater than 12.9 mg/dl) to 1,154 infants with low serum bilirubin levels (less than or equal to 12.9 mg/dl) randomly selected from the remaining 8,968 subjects. We found that a high bilirubin level was significantly associated with male sex; maternal diabetes (chronic and gestational); pregnancy-induced hypertension; previous sibling with neonatal jaundice; delivery by cesarean section, vacuum, or forceps; epidural anesthesia; mother with blood type O; first delivery; cephalohematoma; short gestation; lower birth weight; and lower birth order (p less than 0.01); and older maternal age, low percentile for birth weight, and the percentage of weight loss during hospitalization (p less than 0.05). Variables with significantly different frequencies in control and study groups were used in a multivariate analysis, thus further refining the data by the use of logistic regression. Teenage mothers (less than or equal to 19 years old) had the lowest risk, whereas older mothers (greater than 35 years old) had the highest risk of all age groups for having an infant with neonatal jaundice. First delivery and previous sibling with neonatal jaundice were also risk factors. Male sex, short gestation, and delivery by vacuum extraction were other notable risk factors. Our results suggest that, even among industrialized Western societies, risk factors may interact differently to produce higher neonatal serum bilirubin levels. The importance of a risk factor may also be dependent upon its relative prevalence in a parturient population.
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PMID:Epidemiology of neonatal jaundice in the Jerusalem population. 232 84

Serum levels of cortisol, T3, T4 and blood levels of glucose, lactate and pyruvate were measured 15 min before anaesthesia, 15 and 60 min after skin incision and at 2 h after surgery, in 16 patients undergoing elective surgery on lower extremities either under epidural analgesia (group I) or general anaesthesia (group II). The results showed that as long as the effect of epidural analgesia persisted, it could inhibit the increases in cortisol and blood glucose and the decreases in T3 levels, observed under general anaesthesia. This is probably because of the blocking effect of epidural analgesia on the afferent neurogenic impulses from the area of surgery. T4, lactate and pyruvate levels were not affected to any significant extent. These observations could be of value in the operative management of patients with diabetes mellitus and others with a high surgical morbidity.
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PMID:Role of epidural analgesia on endocrine & metabolic responses to surgery. 234 6


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