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

Multi-infarct dementia (MID) indicates a dementia disorder primarily caused by multiple cerebral infarcts. Since other pathogenetic mechanisms cause vascular dementia we evaluated clinical, CT scan and CSF neurochemical parameters of 134 MID and 67 PVD (probable vascular dementia) patients. We found no differences with regard to the presence of major risk factors. Only TIA/stroke episodes and focal neurological signs were significantly more frequent in MID than in PVD cases, an anticipable result on the basis of MID definition. CT scan findings showed a prevalence of subcortical with respect to cortical lesions in both groups, with a higher frequency in MID patients. Subjects with deep infarcts more frequently showed TIA/stroke episodes and diabetes mellitus. No differences were detectable in CSF monoamine metabolite levels. We conclude that in the majority of vascular dementias subcortical damage seems to have a major pathogenetic role.
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PMID:Is multi-infarct dementia representative of vascular dementias? A retrospective study. 169 87

The classic Framingham Study suggests that the duration of diabetes is a contributing factor in the development of PVD. The major objective of all podiatric physicians should be to provide patients with the necessary information about the severity of their disease, particularly alerting them that noncompliance may lead to a lower extremity amputation and enlisting them as part of the treatment team in managing their condition.
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PMID:Diabetes and peripheral vascular disease. 173 57

To identify a relationship between atherosclerotic vascular disease and differences in blood pressure between the right and left arms, blood pressure differences between arms were measured in patients with peripheral vascular disease (PVD, n = 58), in patients with coronary artery disease (CAD, n = 38), and in patients with no evidence of atherosclerotic disease, who served as a control group (n = 38). The incidence and magnitude of right and left arm pressure difference determined by the oscillometric technique were compared between the patient groups. The incidence of systolic pressure difference greater than or equal to 20 mmHg between arms in patients with PVD (21%) was greater than that in either those with CAD (3%) (P less than or equal to 0.05) or control subjects (0%) (P less than 0.01). The incidence of systolic pressure difference greater than or equal to 45 mmHg between arms in patients with PVD (10%) was greater than that in either those with CAD (0%) (P less than 0.05) or control subjects (0%) (P less than 0.05). Patients with PVD also had a greater incidence of right and left arm difference than did those with CAD or controls for mean and diastolic blood pressures. Of all patients with a systolic difference greater than 10 mmHg, neither the right nor the left arm blood pressure was consistently higher: 21 of 35 (60%) had a higher pressure in the right arm, and 14 of 35 (40%) had a higher pressure in the left arm (P = 0.33). Gender, diabetes, hypertension, smoking, and age were not associated with a difference in blood pressure between the right and left arms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Right- and left-arm blood pressure discrepancies in vascular surgery patients. 188 53

The ankle/brachial index (abPI) may be falsely raised, notably in diabetes, due to the relative incompressibility of the tibial artery. This paper presents a method of determining tibial artery compressibility by deriving abPIs with the patient supine and with legs raised in increments up to 0.55 m (ankle to heart). The effective negative hydrostatic pressure superimposed on the blood pressure at the ankle was converted to mmHg, normalised with respect to the brachial systolic pressure and then expressed as a hydrostatic pressure index (hPI). abPI was regressed on hPI and the gradient of the regression line calculated. If the arterial wall offers no significant resistance to compression the measured pressure will equal intraluminal pressure. In this case regression of the changing arterial pressure with the applied hydrostatic pressure would be expected to produce a gradient of -1. With resistance to compression the measured pressure is greater than the intraluminal pressure and a steeper gradient would be expected. The method was tested using age and sex matched groups, (A) controls (16 arteries), (B) patients with PVD and no diabetes (17 arteries), and (C) diabetics with PVD (34 arteries). There was no significant difference between the regression line gradients of groups A and B but both differ significantly from group C. The difference between the medians of groups B and C was 0.46, the 95% confidence interval for the difference being 0.66 to 0.02. Twelve of the diabetic arteries had a gradient steeper than -1.8 compared with one from group (B) and none from group (C).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Falsely raised ankle/brachial pressure index: a method to determine tibial artery compressibility. 200 80

CME is the final common pathway of many intraocular and systemic diseases. It involves the retinal vasculature and often has a choroidal and vitreal component. Obviously, at some level of this complex pathophysiological process, mediators must be involved. The question is whether the characteristic distribution of vascular leakage and retinal edema is best explained by the diffusion of mediators released by from a remote site, as proposed by Miyake (see Miyake et al., 1989), or whether it reflects the distribution of pre-existing anatomical structures causing the local release of mediators by exerting mechanical stress. The fact that vitreous adhesions are present at the lens and vitreous base anteriorly and at the major vessels, optic disc, and macula posteriorly support the mechanical concept. The anatomic sites of vitreo-retinal attachments have in common the thinness of their basal lamina and firmness of their fibrous vitreal attachments to the Muller cells. Although adhesion at two opposite sites is the precondition for the development of traction, it will only be generated through intrinsic or extrinsic pathologic changes in the vitreous. In a normal anatomical situation, many vitreous fibers distribute tractional forces evenly to numerous Muller cell attachments. In partial PVDs, fewer fibers and Muller cells endure most of the traction. This may lead to chronic Muller cell irritation and local release of a variety of mediators which, in turn, may facilitate vascular leakage. Vitreous shrinkage and possibly chronic Muller cell irritation may, therefore, facilitate abnormal leakage at all sites of attachment. A typical example is pars planitis, with leakage at the peripheral retina and around major blood vessels, the disc and macula. This pattern of leakage suggests that vitreous traction may be a co-factor in many cases. Most traction develops slowly, passing through stages of partial PVD. The occurrence of a traumatic macular hole and vitreous base avulsion as a result of trauma is the exception. While the pattern of PVD in vivo has not been investigated in detail, PVD with normal adhesions is frequently found in age-related liquefaction and collapse of the vitreous. PVD with abnormal adhesions and shrinkage is found in association with diabetes, proliferative vitreoretinopathy, and inflammation. As to the macula itself, two types of attachment are suggested, a firm central foveolar attachment and a larger, weaker perifoveal attachment, corresponding to the nuclear and cortical vitreous and to two types of pathologic traction; anteroposterior and tangential.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Cystoid macular edema: the apparent role of mechanical factors. 267 44

Although it is universally accepted that the grade of reduction of district blood flow in PVD is directly correlated to alteration of the haemorheological pattern, there is still no uniformity of opinion regarding the existence of a specific rheological alteration in PVD. The scope of our study was to discover the existence of possible PVD-specific markers; we thus carried out a comparative evaluation of the rheological characteristics in blood of controls and patients affected with PVD. Eighty-nine males between the ages of 50 and 65 years (median 58 +/- 1 SE) were studied, all with a stage II vascular pathology with clinical onset of less than three months. Exclusion criteria were: diabetes mellitus, hyperlipaemia, stable hypertension, presence of vascular disease in other districts, cardio-circulatory problems and serious medical or surgical pathologies, previous vascular surgery, a history of acute thrombo-embolic episodes, and chronic alcoholism. Each patient, after a drug wash-out of 20 days, was monitored for haemorheological parameters. At the same time, the above parameters were measured in a group of 50 male controls of the same age range. All 139 subjects were smokers (10-15 cigarettes average per day). Our results indicate that modification in the bio-humoral (fibrinogen and plasma globulins) parameters, a reduced red blood cell filterability and a relative increase in the number of activated polymorphonucleate cells are probably specific haemorheological markers of the clinical onset of PVD.
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PMID:Haemorheological markers in 89 patients with stage II peripheral vascular disease (PVD). 372 72

Scanning 3000 cases admitted for rehabilitation after cerebrovascular accident over a 20 year period produced a sample of 1369 subjects, without age restrictions, admitted within six months of a first stroke of thrombotic etiology. In this sample, survival rates showed no significant difference between men and women. Age at onset, however, clearly influenced survival changes; the expected mean survival was 6 years at 40 and 2 at age 80; average loss of life was 14 years for the whole sample, meaning a vital prognosis two to three times worse than that of the general population. At least 86% of the sample presented one or more of five etiological antecedents to stroke: hypertensive heart disease, peripheral vascular disease, diabetes mellitus, myocardial infarction and atrial fibrillation. In 87% of those, HHD and/or PVD were present. Presence of hypertension significantly lowered life expectancy and so did PVD; their influence is felt from the earliest stages. In contrast, diabetes mellitus, the next most common factor, has a late influence, starting about the fifth year after stroke. MI and AF were present in relatively fewer patients, but they contributed towards a considerable decrease in life expectancy, evident from the first stages, the more drastic reduction being observed in the AF group.
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PMID:Hemiplegics after a first stroke: late survival and risk factors. 665 53

Cross-sectional data from the Epidemiology of Diabetes Complications Study were used to examine the relationships between waist to hip circumference ratio (WHR) and the presence of diabetes complications in IDDM adults ages 18-45 years (N = 586). Significantly higher WHRs were observed among both genders with proliferative retinopathy or peripheral vascular disease and only among males with either neuropathy or nephropathy compared to those free of these complications. Logistic regression to determine the strength of association between WHR and each complication demonstrated that although WHR was significantly related to each complication (except nephropathy among females), WHR was only independently related to neuropathy in males and PVD in females in the final model when hypertension, LDL- and HDL-cholesterol and fibrinogen were included. These findings suggest that WHR acts as a marker of risk for diabetes complications mainly through an influence on other complication risk factors.
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PMID:The association of waist/hip ratio with diabetes complications in an adult IDDM population. 773 Aug 70

The prevalence of peripheral neuropathy, peripheral vascular disease, and foot ulceration in Type 2 diabetic patients in the community were determined in a community-based study. Eight hundred and eleven subjects (404 male, 407 female, mean age 65.4 (range 34-90) years, diabetes duration 7.4 (0-50) years) from 37 general practices in three UK cities were studied. Neuropathy was diagnosed clinically using modified neuropathy disability scores which were ascertained using structured interviews and clinical examinations by one observer in each city. Peripheral vascular disease was diagnosed if a history of revascularization was present or > or = 2 foot pulses were absent. History of current or previous foot ulceration was recorded. The prevalence of neuropathy was 41.6% (95% confidence limits 38.3-44.9%) and the prevalence of PVD, 11% (9.1-13.7%). Forty-eight percent of neuropathic patients reported significant neuropathic symptoms. Forty-three patients (5.3% (3.8-6.8%)) had current or past foot ulcers; 20 of these were pure neuropathic ulcers, 13 neuroischaemic, 5 pure vascular, and 5 were unclassified. Multiple logistic regression showed history of amputation, neuropathy disability score, and peripheral vascular disease to be significantly associated with foot ulceration after adjusting for age and diabetes duration. A substantial proportion of Type 2 diabetic patients, often elderly patients who do not attend hospitals, suffered from peripheral neuropathy and peripheral vascular disease. These patients are at risk of foot ulceration and may benefit from preventive footcare.
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PMID:The prevalence of foot ulceration and its correlates in type 2 diabetic patients: a population-based study. 808 27

This study was designed to prospectively evaluate a previously published prognostic index for predicting deep venous thrombosis (DVT) in general surgical patients with conventional prophylaxis. Patients undergoing procedures of at least 1 hr duration (abdominal, thoracic, head and neck, inguinal) requiring general or spinal anesthetic were prospectively randomized into the following groups: Group 1, sequential pneumatic compression devices during surgery and 2 days postoperatively; Group 2, subcutaneous heparin (5000 U q 12 hr) starting 1 hr before surgery and for 7 days postop; Group 3, control group. All patients underwent duplex evaluation of bilateral lower extremity deep venous systems preoperatively and on postoperative Days 1, 3, and 30. In addition, a previously developed predictive DVT incidence indicator, the prognostic index (PI), was calculated for each patient. A total of 137 patients were entered into the study with 29 removed for patient/staff reasons. There were no differences in PI among the three groups at the 0.05 level (ANOVA). The distribution of risk factors for DVT including increased age, body size, hemoglobin (Hb), and colorectal procedures were distributed evenly among the groups. Additional factors such as diabetes, COPD, PVD, immobilization, and cancer were also evenly distributed among the groups. The PI predicted a 20% incidence of DVT. For Groups 1 (n = 25), 2 (n = 38), and 3 (n = 45) no DVTs were detected over the 30 days of study. During the study period, 8 DVTs were detected by duplex evaluation in general surgical patients not in the study (1.5%). In conclusion, in a prospective randomized study using sequential pneumatic compression devices, subcutaneous heparin or no prophylaxis in matched general surgical patients at moderate to high risk for thromboembolism, no DVTs occurred for up to 30 days. Furthermore, neither a PI nor other factors associated with DVT accurately predicted the incidence of DVT in this patient population.
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PMID:Is DVT prophylaxis overemphasized? A randomized prospective study. 859 56


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