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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetes mellitus is found in up to 5 per cent of the population. There is an excess of blood sugar due to a deficiency or diminished effectiveness of insulin. It is a complex disease which, if not controlled, has many major complications including an increased incidence of heart attacks, strokes and vascular changes in many other organs. The management of young onset diabetic patients is directed towards: controlling the carbohydrate intake, testing the blood sugar by the patient and regular insulin injections. Great care must be taken in treating diabetics in the dental surgery. Except for children, any diabetic can be treated for simple dental procedures by ensuring freedom from pain, by eliminating stress and by ensuring that the patient does not miss a meal. Children, unstable diabetic patients and those with infections or requiring multiple extractions should be treated in hospital under the care of an endocrinologist. In hypertension it is only after a number of years that complications begin to appear. The main ones are those of stroke, retinal haemorrhages, renal failure and heart disease. Dentists should be encouraged to take the blood pressure of all adults who present for treatment. Patients with increased blood pressure yet controlled by drugs may be treated as normal patients. Those that are not well controlled should be referred to their physician. Dental appointments must be free of pain and stress should be avoided. A screening method is presented which assists in the evaluation of medically compromised patients.
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PMID:The medically compromised patient. 294 77

We have used a sensitive direct radioimmunoassay to study the effects of exercise on plasma atrial natriuretic peptide (ANP) concentrations in man. Plasma ANP concentration increased three-fold in sixteen patients undergoing bicycle ergometer electrocardiographic tests for the investigation of chest pain. Resting ANP concentrations were higher in those patients in whom there was more evidence of heart disease, such as a positive exercise test, treatment with a beta blocker or history of myocardial infarction, although exercise resulted in increased ANP in both groups. We also confirm the increased plasma ANP concentration observed in patients with congestive cardiac failure and renal failure. In nine patients with renal failure routine haemodialysis was accompanied by a 30 per cent reduction in plasma ANP concentration. Plasma ANP concentrations were similar in treated hypertensive patients, untreated borderline hypertensive patients and normotensive subjects.
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PMID:Direct radioimmunoassay of human plasma atrial natriuretic peptide in various normal and pathophysiological states: increase in renal and cardiac failure during exercise. 295 25

Continuous and progressive fluid removal was performed by continuous peritoneal dialysis in 19 patients (14 men, 5 women, mean age 60.7 years) suffering from refractory congestive heart failure. All patients were in NYHA class IV and had a life-threatening fluid overload. Twelve had normal renal function or functional renal failure, and 7 had organic renal failure. The continuous peritoneal dialysis technique with a high K+ concentration in the dialysate did not raise any particular problem. Mean survival of the whole group was 7.1 months. This figure rose to 16 months (rang 2-51 months) in the patients who survived at the end of the first month. Sixteen out of 19 patients eventually died, most of them suddenly and probably of ventricular arrhythmia. Nine patients were discharged on continuous ambulatory peritoneal dialysis and remained on it for 2 to 48 months. Drug therapy could be reduced in all cases. Dialysis was discontinued in 5 patients without organic renal failure who thereafter survived for a mean period of 5 months. Functional improvement and duration of survival were uncorrelated with heart disease, fluid overload, initial renal function or initial left ventricular ejection fraction. A cardiothoracic ratio greater than 0.70 and the need for mechanical ventilation seemed to be of poor prognosis. Such results justify the pursuit of this study before defining selection criteria.
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PMID:[Treatment of refractory congestive cardiac insufficiency by continuous peritoneal dialysis. Long-term course]. 297 12

Prolonged hypoglycaemia (serum glucose levels of 50 mg/dl and less, for more than 12 h in spite of treatment with periodic injections of hypertonic glucose) secondary to treatment with glibenclamide was found in 13 hospitalized patients. The mean daily dose of glibenclamide was 6.7 mg. In nine patients, the hypoglycaemia developed within 7 days of treatment. In two patients the tendency to hypoglycaemia lasted for more than 60 h in spite of continuous infusion of 5% or 10% glucose. Old age seems to be a crucial predisposing factor as none of the patients was under the age of 68 years. Contributing factors were renal failure and congestive heart disease. We feel that glibenclamide should be used with care in the elderly and in patients with renal or cardiac failure.
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PMID:Glibenclamide induced prolonged hypoglycaemia. 309 Aug 65

Acute renal failure (ARF) occurs in as many as 8% of neonates admitted to neonatal intensive care units. Most often, ARF is recognized because of oliguria (urinary flow rate less than 1 ml/kg per hour) although nonoliguric neonatal ARF is being detected with increasing frequency. Among urinary indices utilized to differentiate oliguric neonatal ARF from prerenal oliguria, a fractional excretion of sodium greater than 3% or a renal failure index (RFI) greater than 3 are helpful in confirming ARF. Such indices must be viewed with caution in very premature infants who may have a physiologically high sodium excretion rate and in neonates with the nonoliguric form of ARF. The mortality of oliguric neonatal renal failure may be as high as 60% in medical ARF and even higher in neonates with congenital heart disease, or with anomalies of the genitourinary system. In contrast, nonoliguric renal failure in neonates has an excellent prognosis. Long-term abnormalities in glomerular filtration rate and in renal tubular function are common in survivors of neonatal ARF.
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PMID:Acute renal failure in neonates: incidence, etiology and outcome. 315 95

Cardiovascular and Renal function were examined in two populations of long-term insulin-dependent diabetics, those with microalbuminuria, a sign of early, subclinical nephropathy and those with clinically manifest diabetic nephropathy. In addition, clinical variables of possible importance for the occurrence and prognosis of diabetic nephropathy were analyzed. Microalbuminuria - a mean of three over-night urinary albumin excretion rates greater than 20 micrograms/min - was found in 16% of Albustix-negative, normotensive, insulin-dependent diabetics. The microalbuminurics had higher supine blood pressures than normoalbuminurics. The albumin excretion rate in microalbuminurics correlated to blood pressure at rest but not to glycosylated haemoglobin. The cardiovascular responses to five different test manoeuvres revealed more evident signs of autonomic nerve dysfunction in microalbuminurics than in normoalbuminurics. The circulatory reactions during mental stress however, were almost identical in the two subgroups. Despite similar glomerular filtration rate and renal plasma flow the albumin excretion during mental stress increased in microalbuminurics, but remained unchanged in normoalbuminurics. It is postulated that a disturbance of glomerular basement membrane permeability is a pre-requisite for the elevated albumin excretion seen in microalbuminurics. Inability to regulate glomerular haemodynamics, due to autonomic nerve dysfunction, may also be a contributing factor. Such dysfunction perhaps even explains why microalbuminurics have higher blood pressures at rest compared with normoalbuminurics. In manifest diabetic nephropathy the rate of renal functional decline correlated to arterial blood pressure, while glycemic control showed no such relation. Patients with rapidly progressive nephropathy showed higher values of growth hormone than slow progressors. In patients with diabetic renal failure, cardiac catheterization revealed reduced stroke work and elevated left ventricular end-distolic pressure during exercise. Autonomic nerve dysfunction and arterial hypertension possibly contributed to the impaired cardiac performance. The existence of a specific diabetic cardiopathy must even be considered. There was a male predominance both in subclinical and manifest diabetic nephropathy. Age at onset of diabetes was lower in micro- as compared to normoalbuminurics. Duration of diabetes had no prognostic implication in subclinical or manifest nephropathy. The mortality rate was high in patients with manifest nephropathy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Studies of cardiovascular and renal function in subclinical and manifest diabetic nephropathy. 316 65

The purpose of this study was to determine the outcome of major surgical procedures in patients 90 years of age or older. The records of 46 patients in this age group who underwent surgical procedures were reviewed to determine the outcome and the postoperative quality of life. Overall, the perioperative mortality was 20%. Mortality was not influenced by such risk factors as diabetes mellitus, chronic obstructive pulmonary disease, renal failure, quantity of blood loss, duration of procedure, or total number of hospital days. However, patients with heart disease had a significantly higher mortality rate (78%). Overall, 39% of the patients experienced a subjective deterioration in their mental status after surgery. Of those patients who were ambulatory before surgery, 73% were ambulatory after surgery. Although this study indicates that the perioperative mortality is high and mental status changes frequent in this very elderly age group, the quality of life and longevity of the majority of these patients are good, and vigorous surgical intervention appears warranted.
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PMID:Surgical procedures in patients during the tenth decade of life. 317 63

A total of 850 cases of septic diabetic foot infections were reviewed in 355 patients. Age, sex, other chronic diseases, site, etiology, Wagner grade, treatment, and results were analyzed. One third of the patients were in their sixth decade of life. There were 180 women and 175 men. Chronic diseases included hypertension, congestive heart disease, and renal failure. Staphylococcus aureus was the most common bacteria. Treatment was considered to meet protocol standards if Wagner's algorithms and infectious disease principles were followed. Thirty-nine Wagner grade 0 infections were seen: only one was not treated appropriately. Eighty-eight percent treated per protocol healed and the one not treated appropriately failed. In grade 1, 79% of the 154 evaluable patients were treated appropriately with a 86% success rate versus a 53% success rate for those not treated per protocol. Of three quarters of the 64 patients with grade 2 infections treated according to protocol, 73% healed. One of those in grade 2 who was not treated according to protocol healed. In grade 3, 64% of the 251 patients were treated per protocol with a 79% success rate versus a 12% success rate for those who were not treated per protocol. Most of the 189 patients with grade 4 cases were treated according to protocol with 88% success; the 20 not treated per protocol had a 15% success rate. Thirty of the 32 grade 5 patients were treated per protocol and all but one healed. Protocol therapy had a statistically significant effect by chi 2 test in the treatment of all groups.
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PMID:Treatment of diabetic foot infections: Wagner classification, therapy, and outcome. 322 95

Results with mechanical circulatory assistance for the treatment of profound cardiopulmonary failure after conventional heart surgery have been encouraging. Its usefulness after heart transplantation is not known. Since August 1982, eight patients (of 59 transplant patients) have required support 0 to 48 hours (mean, 19.5 hours) after transplantation. The ages of the patients ranged from 7 days to 52 years (mean, 28.4 years). Underlying recipient heart disease was ischemic in three patients, congenital in two, cardiomyopathic in two, and rheumatic in one patient. Preoperative North American Transplant Coordinators Organization (NATCO) classification was status 9 in one patient (on extracorporeal membrane oxygenation [ECMO]), status 1 in five patients, and status 3 in two patients. Reasons for graft failure, although usually multifactorial, were primarily pulmonary hypertension with right ventricular failure in five patients and pneumonia, hyperacute rejection, and fat embolus in one patient each. In three patients, there was a mismatch in graft size (too small in two adults and too large in one neonate). Graft ischemic times ranged from 75 to 229 minutes (mean, 171 minutes). Two patients received mechanical support with an intra-aortic balloon (IAB), three with ECMO, and three with a right ventricular assist device (RVAD). One of the patients on ECMO and two of the patients with an RVAD also had IABs. Duration of support ranged from 4 hours to 8 days (mean, 3.2 days). Initial hemodynamic stability was achieved in all patients. Complications were common, including sepsis in seven patients and kidney failure in five patients. Only three patients were weaned. One patient with pulmonary hypertension, who was treated with ECMO, died 36 hours after being weaned.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Mechanical circulatory assistance after heart transplantation. 330 17

Seven infants in congestive heart failure underwent high dose angiocardiography for diagnosis of severe congenital heart disease and subsequently displayed delayed opacification of the gallbladder. Biliary excretion of sufficient volume to opacify the gallbladder occurred despite structurally normal kidneys and no evidence of renal failure. Decreased renal clearance of contrast due to generalized diminution of glomerular filtration is postulated. The high doses of contrast and slow renal clearance allowed a relatively increased rate of hepatobiliary excretion and subsequent observation of the opacified gallbladder on abdominal radiographs. This phenomenon may not be as uncommon as is generally thought but its timing and location often do not allow an opportunity to make this observation.
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PMID:Gallbladder opacification in infants following high dose angiocardiography. 338 53


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