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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Demonstration of a reduced restenosis rate after stent implantation (Benestent, STRESS) has initiated rapid increase in stent implantation rates with widening indications. At present, the majority of stents are implanted in "none-Benestent/STRESS-lesions" with the consequence of a higher restenosis rate as previously expected. Stent restenosis has therefore become a relevant problem in interventional cardiology. In contrast to balloon angioplasty, where acute and subacute recoil represents the major mechanism of restenosis, stent restenosis is exclusively attributed to neointima proliferation. Morphological studies have demonstrated that neointima is caused by early smooth muscle cell ingrowth with a maximum after 7 days which is then gradually replaced by extracellular matrix. Systematic clinical, angiographic and intravascular ultrasound studies have identified several risk factors for increased stent restenosis such as: diabetes mellitus, treatment of restenosis, serial stent implantation, small and calcified vessels, ostial lesions, venous bypass grafts and complex stenosis morphology. In addition, there is increasing evidence that aggressive implantation techniques with high pressures and oversized balloons may also induce higher restenosis rates. Optimal treatment of instent restenosis has not been determined so far. Balloon angioplasty is at present considered the therapeutic option of choice. Several small studies have shown, that in short, discrete lesions (< 10 mm) results of simple PTCA are acceptable with re-restenosis rates between 15 and 35%. The intervention is considered safe with low complication rates. In 10 to 15% additional stent implantation is necessary, usually due to dissections proximal or distal to the treated stent. In long, diffuse stent restenosis (> or = 10 mm), however, PTCA results in high re-restenosis rates up to > 80%. This is most likely due to insufficient early balloon angioplasty results with minimal luminal diameters (MLD) significantly below the previous stent diameter. Therefore, debulking techniques have been used to reduce neointima burden within the stent. At present 3 techniques are available: directional coronary atherectomy (DCA), Excimerlaser angioplasty (ELCA) or high frequency rotablation. All of these techniques achieve a significant reduction in plaque volume within the stent and in combination with balloon angioplasty allow larger MLDs than PTCA alone. Limited experiences with ELCA and rotablation have shown that the techniques are safe without major periinterventional complications. DCA, however, has been accompanied with stent destruction and therefore should be considered with large care, especially in stents with coil design. At present, no randomized controlled trials for the comparison of debulking techniques with or without balloon angioplasty versus balloon angioplasty alone are available. Three multicenter trials have been initiated (LARS, ARTIST and TWISTER) to compare debulking techniques versus balloon angioplasty in diffuse stent restenosis. Adjunct medical treatment after interventions for stent restenosis is usually limited to ASS alone, indications for additional application of Ticlopidine have not been verified so far. Positive results are expected for the use of local radiation therapy either by radioactive stent implantation or afterloading techniques. With increasing stent implantation rates and indications, about 400,000 stents will be implanted in 1997 worldwide. Considering a low restenosis rate of 20%, 80,000 stent restenosis will occur within one year. Final recommendations for optimal treatment of these patients are not yet available.
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PMID:[Pathophysiology and therapeutic concepts in coronary restenosis]. 948 38

Optimal metabolic control to minimize long-term complications is a major treatment goal for adolescents with diabetes mellitus. Reaching this goal is extremely challenging in this population due to unique physiological changes and psychosocial variables that affect metabolic control. Continuous subcutaneous insulin infusion (CSII) may be an excellent treatment alternative for selected adolescents to help overcome some of these challenges. CSII allows for minute insulin changes at variable times throughout the day, providing greater lifestyle flexibility. The purpose of this paper is to review the use of insulin pump therapy in adolescents. Specific strategies regarding screening, initiation, and maintenance of this therapy are described, and case examples are used for illustration. Implications for nursing practice and diabetes education are discussed.
Diabetes Educ
PMID:A primer on the use of insulin pumps in adolescents. 952 29

Diabetes mellitus is one of the more common endocrine disorders encountered in the anesthetic management of surgical and obstetrical patients. These patients often have complications associated with the disease process which may increase perioperative morbidity and mortality. Optimal management depends upon an understanding of the disease process as well as special considerations unique to the diabetic. This AANA Journal course reviews the pathophysiology of diabetes and common complications associated with the disease. Perioperative considerations include assessment and metabolic control during the time of surgical stress. In concludes with acute complications and their recognition and management.
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PMID:AANA Journal course: update for nurse anesthetists--diabetes mellitus: overview and current concepts in anesthetic management. 962 37

A retrospective review of patients in our practice who underwent abdominal panniculectomy to facilitate gynecologic cancer surgery was performed. The objective of the study was to determine if panniculectomy was a safe and useful procedure in the morbidly obese gynecologic cancer patient. A total of 12 patients underwent the procedure between 1992 and 1996. Optimal pelvic oncologic surgery was accomplished in all 12 patients. All aspects of those procedures were performed by gynecologic oncologists. The Buchwalter retractor was used in all cases. The patients' weights ranged from 170 to 429 pounds, with a mean of 275 pounds. The mean body mass index was 48, with a range from 37 to 67. Four patients had a history of diabetes mellitus. Nine patients healed without wound complications. Three patients developed superficial subcutaneous wound infections/necrosis that were successfully managed with office debridement. Abdominal panniculectomy is a reasonably safe procedure that makes radical pelvic surgery possible regardless of the patient's weight. Prolonged wound bulb suction drainage may decrease the incidence of wound necrosis/infection in these high-risk patients.
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PMID:"Medically necessary" panniculectomy to facilitate gynecologic cancer surgery in morbidly obese patients. 964 94

Recent trials have linked calcium antagonists with adverse cardiovascular events in hypertensive patients with diabetes. A closer examination of these trials (in particular the Appropriate Blood Pressure Control in Diabetes [ABCD] trial and the Fosinopril Versus Amlodipine Cardiovascular Events Trial [FACET]) reveals a lack of data from which to draw conclusions of harm. In fact, based on the results of these trials and the recent Hypertension Optimal Treatment (HOT) Trial, one may conclude that the combination of a calcium antagonist with an ACE inhibitor is a rational therapeutic choice in patients with coexisting hypertension and diabetes.
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PMID:Calcium antagonists and cardiovascular risk in diabetes. 982 45

Optimal management of the diabetic patient includes normalization of glucose concentration. Attainment of this goal is difficult because stress has long been shown to have a major effect on metabolic activity. The aim of this study was to assess the effect of stress on the pharmacokinetics and dynamics of glibenclamide in normal and diabetic rats. In this respect, administration of glibenclamide (1.4 mg/kg, p.o.) significantly reduced the blood glucose level estimated after an intravenous challenge dose (4 ml/kg) of 50% dextrose. Peak drug effect occurred at about 2 h in the control on diabetic group and this effect was clearly evident over a 6 h period in the diabetic group. The stressed diabetic group showed consistently higher blood glucose level at all time points than the nonstressed diabetic controls. Stress was also associated with significant reductions in glibenclamide Cp-max and AUC0-infinity and an increase in the Tmax. These results suggest that the response to glibenclamide in diabetics may be strongly modified by stress through a number of mechanisms. Changes in the bioavailability of the drug and activation of sympathetic nervous system and the hypothalamic-pituitary-adrenocortical axis are potential candidates. Further clinical and experimental studies in relevant models may, however, be needed to characterize fully and relate this effect to rational pharmacotherapy of type II diabetes.
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PMID:The effect of stress on the pharmacokinetics and pharmacodynamics of glibenclamide in diabetic rats. 984 79

The authors report on a case of a solitary liver abscess due to Listeria monocytogenes in a 53-year-old diabetic white male and review all published cases of solitary listerial abscesses of the liver. L. monocytogenes is a rare cause of solitary liver abscess which occurs in elderly patients with diabetes mellitus. The clinical signs are variable and often mimic malignancy, with epigastric pain, night sweats and weight loss. Prevalent features are poor control of glycemia, temperature up to 38.5 degrees C and elevated alkaline phosphatase. Optimal treatment includes percutaneous drainage of the hepatic abscess and antibiotic therapy with an aminopenicillin or trimethoprim/sulfamethoxazole. Outcome of the reviewed patients was favourable with no mortality and no relapse of the disease.
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PMID:Listeria monocytogenes causing solitary liver abscess. Case report and review of the literature. 984 15

In the Hypertension Optimal Treatment (HOT) study, hypertensive patients who were randomly assigned to undergo antihypertensive treatment to achieve a goal diastolic blood pressure of 80 mm Hg or lower did not experience fewer cardiovascular events than did patients who received treatment with goal pressures of 85 or 90 mm Hg. Such aggressive antihypertensive treatment was safe and well tolerated, and did result in fewer cardiovascular events in the subset of patients with diabetes. All patients were randomly assigned to take aspirin 75 mg/day or placebo, and patients in the aspirin group had a 15% lower rate of major cardiovascular events and myocardial infarctions than did patients who received placebo. This finding establishes the efficacy of aspirin in preventing strokes and myocardial infarctions in hypertensive patients.
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PMID:Aggressive blood pressure lowering is safe, but benefit is still hard to prove. 998 56

Optimal methods of endotracheal anesthesia using non-opiate drugs of four classes (clofelin, transamine, contrykal, ketanes) have been fundamentally grounded developed and tried in extensive and traumatic operations for ENT malignant and vascular tumors as well as inflammation in patients of high anesthesiological operative risk. The drugs were used in 174 patients including 13 children. 87.9% of the patients had concomitant diseases: blood hypertension, coronary heart disease, chronic nonspecific pulmonary diseases, bronchial asthma, asthmatic bronchitis, diabetes mellitus, anemia. Adequate stable anesthesia was achieved in reduced dosage of conventional anesthesiological agents.
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PMID:[Use of nonopiate agents for anesthesia in ENT patients at high surgical-anesthesiological risk]. 1008 93

As currently defined (5), gestational diabetes is associated with important perinatal and long-term health risks. Many of the risks increase, in relation to the severity of maternal hyperglycemia. For perinatal risks to infants, the relationship seems to be continuous. Maternal fasting glucose levels can be used to identify subsets of patients with very low and very high risks. The majority of pregnancies lie between these two extremes; and nonglucose measures, such as fetal ultrasound, can be used to enhance risk assessment, thereby minimizing over- and undertreatment of patients. The major long-term maternal risk is development of type 1 or type 2 diabetes, predominantly the latter. The risk increases continuously, in relation to maternal glycemia during and, especially, after pregnancy. Patients seem to have a B-cell defect that is characterized by maladaptation to insulin resistance. The B-cell defect is predictive of future diabetes, supporting the testing and clinical application of interventions that minimize insulin resistance to delay or prevent diabetes. Women with impaired glucose tolerance in the first few months postpartum are at particularly high risk for diabetes and should receive the most intensive education, intervention, and follow-up. Offspring of women with GDM are at increased risk for obesity and have an unexpectedly high prevalence of elevated glucose levels during childhood and adolescence. Both genetic and intrauterine environmental influences are likely to contribute to these abnormalities. Optimal strategies to detect and prevent the long-term risks to offspring remain to be established.
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PMID:Gestational diabetes: risk or myth? 1037 74


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