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

This study examined the acid base disturbances in 18 adults with acute renal failure (ARF) from one of new aspects, which is lactate metabolism and pathophysiology. 10 patients (55%) of them were accompanied by lactic acidosis and 9 patients (90%) of those with lactic acidosis also had severe hepatic failure. Mortality of patients with lactic acidosis was 80%, and much higher than that of ARF (66.7%). Lactate, pyruvate, lactate-to-pyruvate ratio (L/P) were 76.7 +/- 15.66 mg/dl, 3.30 +/- 0.74 mg/dl and 19.9 +/- 1.41, respectively. All of them significantly raised, compared to values of healthy adults, patients with liver cirrhosis, chronic renal failure and diabetes mellitus. Arterial pH and HCO3- levels were 7.20 +/- 0.04 and 10.6 +/- 1.20 mEq/l. Anion gap (AG) was 30.0 +/- 3.66 mEq/l. Significant correlations of lactate with pH, HCO3-, AG and L/P were demonstrated, while correlations of lactate with BUN, CR and prothrombin time were not significantly observed. Lactic acidosis results from two mechanisms. One is lactate overproduction (e.g tissue hypoxia) and the other is lactate underutilization (e.g severe liver and/or renal failure). Whenever lactic acidosis occurred, both mechanisms were present simultaneously and continuously. Especially, the latter mechanism had a very important role on it, and seemed to decide the prognosis of the patients with lactic acidosis. Therapy of lactic acidosis was very difficult. First of all, we tried to improve the circulatory failure and severe acidemia (pH less than 7.20) not to fall into vicious cycle. Then, CAVH, if combined with alkali infusion, seemed to be the most useful technique in managing lactic acidosis with ARF.
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PMID:[Acute renal failure with lactic acidosis]. 221 21

A 84-year-old man was admitted with palpitation, edema of legs and anemia during a long course of diabetes mellitus, prostatic hypertrophy and prostatic cancer. He revealed purpura on the hands and massive microhematuria. He had received antibiotic therapy for a urinary tract infection for a period of time, but he had no history of hemorrhagic tendency or blood transfusion. Coagulation studies showed the prolongation of whole blood clotting time and PT (prothrombin time). Activity of factor V was 14% of that normal control plasma. The titer of factor V inhibitor was 4.9 Bethesda units/ml. The inhibitor of the patient was supposed to belong to IgA and IgG judging from inhibitor neutralization test. PT was improved after discontinuance of administration of antibiotics and administration of azathioprine. Moreover, even after administration of prednisolone with antibiotics, PT and activity of factor V recovered to normal range. He died from respiratory failure. Autopsy revealed double cancer of prostate and descending colon. The appearance of factor V inhibitor was likely caused by antibiotics, double cancer, and age-related immune disorders.
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PMID:[Factor V inhibitor with double cancer]. 276 72

In 35 patients with decompensated diabetes mellitus the following hemostatic indices were studied: glycohemoglobin, prothrombin time, partial thromboplastin time, fibrin monomers (determined by protamine sulfate test), fibrinogen and platelet count. A statistically significant decrease of the prothrombin time (p less than 0.001) and of the partial thromboplastin time (p less than 0.001) was found. Glycohemoglobin was significantly increased in all patients. The remaining indices were in the normal ranges. A syndrome of increased latent coagulability emerges which explains the tendency to thromboembolism in diabetes.
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PMID:[Hemostatic studies in decompensated diabetes mellitus]. 321 38

Indices of the system of hemostasis, the levels of glycolysated hemoglobin were studied in 67 patients suffering from non-insulin-dependent diabetes mellitus with lower limb angiopathies (aged 40 to 60). Rheovasography of the lower limbs was performed. The patients were treated with antidiabetic drugs per os (with the exception of hydroxydione sodium succinate), platelet aggregation inhibitors (pentoxifylline, acetylsalicylic acid) and vasodilators (xanthinol nicotinate, solcoseryl and cinnarizine). The use of pentoxifylline after therapy increased the rate of platelet aggregation inhibition and decreased the prothrombin index, not influencing the other indices of the system of hemostasis. Pentoxifylline combined with acetylsalicylic acid at small doses normalized not only platelet indices but also the other indices of the system of hemostasis. Positive changes in the system of hemostasis were accompanied by a rise of the rheographic index in patients with vascular functional changes. In obliterating atherosclerosis the rheographic index was not on an increase indicating the necessity of corrective therapy of vascular lesions, first of all in the system of hemostasis, in the early period of diabetes mellitus.
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PMID:[Characteristics of disturbances in the hemostasis system in patients with insulin-dependent diabetes mellitus with angiopathies of the vessels of the lower extremities]. 321 77

Forty-two patients with proven intra-abdominal sepsis were studied in a prospective clinical trial. The following parameters were evaluated: (1) Nine parameters on admission: age, sex, obesity, malnutrition, history of cardiac, respiratory or renal disease, diabetes mellitus and malignant neoplasia. Four of these parameters had a prognostic value (p less than 0.05): age 65 years, diabetes mellitus and cardiac disease. (2) Thirty parameters representing the functional status of six organic systems during sepsis: respiratory, cardiovascular, nervous, kidneys, blood coagulation, liver. Six of these parameters had a prognostic values: PEEP 0-10 cm H2O to keep PaO2 greater than 60 mmHg (p less than 0.001), serum creatinine greater than 3.6 mg/dl (p less than 0.01), prothrombin time greater than 15'' or platelet count less than 100,000/mm3 (p less than 0.001), need of vasoconstrictive drug to keep arterial pressure greater than 100 mmHg (p less than 0.001), bilirubin greater than 3 mg/dl (p less than 0.01) and mental confusion. The combination of these ten statistically significant prognostic criteria for each patient showed that the mortality was 0 with 0-2 criteria, 36% with 3-5 criteria, 94% with 6-8 criteria and 100% with 8-10 criteria. Patients with more than five of these criteria had a significant higher mortality risk (p less than 0.001).
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PMID:Prognostic criteria in intra-abdominal sepsis. 367 39

The aim of our study was to evaluate the fibrinolytic system in patients with retinal branch vein occlusion (RVO). The following tests were carried out: prothrombin time, partial thromboplastin time (PTT), fibrinogen degradation products, euglobulin lysis time, fibrinogen, pasminogen, antithrombin III, alpha 2-antiplasmin and alpha 2-macroglobulin. Comparing the results of patients with those of normal controls, only the fibrinogen increase and PTT shortening were significantly different. All other tests taken into account were within normal limits. Only the patients without other associated diseases (diabetes or hypertension) showed a significant activation of fibrinolysis (either with respect to normal or to other RVO patient groups). In conclusion, no important fibrinolytic impairment was seen in our longstanding RVO patients. Fibrinolytic activation seen in patients without verified associated diseases may be related to the presence of a sound endothelium, still able to release plasminogen activators in response to RVO. The fibrinogen and PTT changes in RVO were probably due to other associated diseases.
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PMID:Fibrinolytic behavior in long-standing branch retinal vein occlusion. 369 97

With the help of 28 criteria, the authors analyze the factors influencing mortality and morbidity related to surgery in jaundiced patients. The results differed according to whether the patients were examined as a whole or whether patients with benign and malignant lesions were considered separately; there was a significant difference in mortality between these two groups. Five factors were noted to predict an unfavorable outcome in patients with malignant lesions: the duration of symptoms, the presence of preoperative diabetes, renal failure, hypoalbuminemia and the type of surgical procedure. In patients with benign lesions, five factors were also significant: previous biliary surgery, decreased prothrombin level, leucocytosis, renal failure and an age greater than 80 years. It is thus possible to isolate a population "at risk" for whom surgery should be preceded by the correction of disorders due to cholestasis, and particularly the renal consequences.
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PMID:[Risk factors in surgery of obstructive jaundice. Retrospective studies apropos of 176 patients]. 400 79

On 169 occasions anticoagulant therapy for thromboembolic disease was stopped electively and patients were followed for 16 subsequent weeks. The records of those who remained well and those who suffered a relapse were compared in an attempt to identify factors that might affect liability to thromboembolic relapse. During the follow-up period there were 37 thromboembolic recurrences, an incidence of 22 per cent. None occurred among the patients in whom the original diagnosis of thromboembolic disease was discarded or when a predisposing cause had ceased to be present. There was an inverse relation between liability to relapse and degree of prothrombin time prolongation.NO SIGNIFICANT RELATION COULD BE SHOWN BETWEEN LIABILITY TO RELAPSE AND ANY OF THE FOLLOWING: sex and age; type and severity of the initiating thromboembolic episode; history of earlier thromboembolic disease or relapse after stopping earlier anticoagulant courses; presence of hypertension, hypercholesterolaemia, or diabetes mellitus; type of anticoagulant drug used, duration of therapy, and method of stopping treatment. Patients with overt occlusive arterial disease at more than one site had a significantly increased liability to relapse when compared with patients with symptomatic disease at a single site. In the group of 134 subjects receiving anticoagulant therapy for coronary arterial disease, occurrence of a thromboembolic episode during the course of treatment and the presence of angina of effort in the months before it was discontinued were both associated with a significant increase in liability to relapse. It is suggested that, ideally, anticoagulant therapy should be continued indefinitely in any patient whose pattern of disease thus increases the likelihood of a thromboembolic recurrence.
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PMID:Recurrence of thromboembolic disease after discontinuing anticoagulant therapy. A study of factors affecting incidence. 542 82

Platelets have been shown to be capable of initiating and promoting some of the reactions in intrinsic coagulation and have been implicated in the pathogenesis of vascular lesions in diabetes mellitus. We have examined the contribution of platelets to the coagulation reactions in 39 patients having diabetes mellitus with and without retinopathy [background retinopathy (BR) or proliferative retinopathy (PR)], 18 patients with nonvascular eye diseases (patient controls), and 38 normal subjects. As compared to control patients, significant elevations were noted in four of the five assays for platelet coagulant activities in diabetic patients with PR and in three of five assays in patients with BR. Thus platelet coagulant hyperactivity is present in diabetics with retinopathy. Significant elevations were noted in two of the assays in patients without retinopathy (NR), suggesting that platelet coagulant hyperactivity may not necessarily be secondary to the vasculopathy. The predominant abnormalities noted were in assays reflecting the contribution of platelets to the early stages of intrinsic coagulation rather than to later stages of prothrombin activation. In addition, the mean platelet volume was found to be significantly greater in patients with PR and BR but not NR than in normal controls. A positive linear correlation (r = 0.81) was noted between the mean of the coagulant activities and platelet volume in diabetic subjects, suggesting a hitherto undescribed relationship between platelet coagulant activities and platelet volume.
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PMID:Platelet coagulant activities in diabetes mellitus. Evidence for relationship between platelet coagulant hyperactivity and platelet volume. 669 Jun 42

Forty-five cases of cervical necrotizing fasciitis are reported, and their clinical, bacteriologic, and therapeutic implications are considered. Fasciitis was of dental origin in 78% of cases, pharyngeal in 16%, and surgical or posttraumatic in 6%. The condition extended to the face in 22% of cases, to the lower part of the neck in 56%, and to the mediastinum in 40%. Soft-tissue cultures were positive in 78% of cases. Anaerobes were isolated along with aerobes in 49% of cases (mean, 2.2 isolates per patient) and in pure culture in 22%. Treatment included surgical debridement and drainage and the administration of antibiotics active against both anaerobic and gram-negative aerobic bacteria. Hyperbaric oxygen was used for adjunctive treatment. The bacteria involved did not affect clinical manifestations, extension, or mortality. The survival rate among our patients was 78%. Mortality was significantly higher among cases with mediastinal extension (44% vs. 7%; P < .01); thus the prompt recognition and drainage of sites of mediastinal extension are of critical importance. Other risk factors for death were an age of > 70 years, underlying diabetes, the development of septic shock within 24 hours after admission, and prolonged prothrombin time.
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PMID:Cervical necrotizing fasciitis: clinical manifestations and management. 757 59


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