Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To test whether insulin is a regulatory factor of myocardial MB creatine kinase content, we investigated the correlation between the ability of insulin secretion and the MB fraction of cumulative CK released in patients with acute myocardial infarction. We analyzed 18 patients who underwent successful direct angioplasty within 10 hours of the onset of their first myocardial infarction. Exclusion criteria were age more than 75 years, heart failure, severe obesity, multivessel disease, and history of diabetes mellitus. Cumulative activity of serum MB CK divided by that of total CK was defined as MB%, which was considered to represent myocardial MB CK content. Two weeks or more after the onset of myocardial infarction, 75 gm oral glucose tolerance test with serial determination of plasma glucose and serum insulin (0, 0.5, 1, 2, 3 hours) was done. Urinary and plasma catecholamines and echocardiographic left ventricular (LV) mass were measured. MB% significantly correlated with insulinogenic index (r = 0.564, p = 0.019), insulin area (r = 0.594, p = 0.012), insulin area/glucose area (r = 0.630, p = 0.007), and urinary adrenaline (r = -0.542, p = 0.025) and tended to correlate with plasma adrenaline (r = -0.431, p = 0.084). Age, body mass index, infarct size, glucose metabolism, and LV mass were not significant univariate predictors of MB%. Multivariate analysis showed that the ability of insulin secretion contributed to MB% more than catecholamines did and that insulin area/glucose area was the strongest independent predictor of MB% (t = 3.01, p = 0.015). Thus MB fraction of cumulative CK released, indicative of Myocardial MB CK distribution, strongly related to the ability of insulin secretion in subjects without overt insulin resistance. Regulation by insulin of myocardial MB CK is suggested.
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PMID:MB fraction of cumulative creatine kinase correlates with insulin secretion in patients with acute myocardial infarction: insulin as a possible determinant of myocardial MB creatine kinase. 855 15

We evaluated 725 diabetic haemodialysis (HD) patients, inducted into HD from 1967 to 1993 in Niigata University Hospital and its affiliated hospitals, to clarify the relationships among the clinical course and features including diabetes mellitus treatment. The glucose metabolism was also studied during HD with dialysis fluids containing different glucose concentration. At the time of HD induction, diabetic patients showed lower serum creatinine and more frequent overhydration, compared with those with glomerulonephritis. Heart failure was the leading cause of (53%) among the symptoms as the direct cause of HD induction. The survival rate in Japan, particularly in our group, was more prolonged than that in USA and Europe. The rate was lower in patients with cardiac complications than in those with gastrointestinal problems, and also lower in older patients (more than 70 years old) than in younger patients. Among the patients less than 70 years old, the survival period was longer in patients with serum HbA1c values of less than 7.5%, compared to those with greater than 7.5% Cerebro- and cardio-vascular involvements and infectious diseases were three major causes of death, and cerebro- and cardio-vascular disorders and diabetic gangrene were three major complications. Serum HbA1c was not different among patients with or without these causes of death or complications. In 18.1% of non-insulin-treated NIDDM patients insulin was needed one year after HD induction, while 32.1% of insulin-treated NIDDM patients before HD induction became free from insulin, who showed body weight loss on average of 10 kg. In 33.6% of insulin-treated patients, insulin doses increased from 2 to 20 units/day on the non-dialysis day.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The treatment of the uraemic diabetic. Are we doing enough? A view from Japan. Fumitake Gejyo and Collaborate Study Group. 857 79

Sympathetic nervous system activation has been documented in several cardiovascular disorders. In some, characterized by cardiac failure and portal hypertension accompanying hepatic cirrhosis, the sympathetic nervous stimulation is reflex and, to some extent, compensatory but has adverse consequences. For example, in cardiac failure, the sympathetic nerves of the heart are preferentially stimulated, providing adrenergic support to the failing myocardium but at the probable cost of arrhythmogenesis and progressive myocardial deterioration. The sympathetic activation present in patients with essential hypertension, which involves the sympathetic outflows to skeletal muscle, heart, and kidneys and is seen particularly in younger patients, differs from these examples in that the sympathetic nervous stimulation is apparently not reflex and the primary cause is unknown. There is, however, evidence that activation of forebrain pressor noradrenergic nuclei may be of importance as an underlying central nervous system mechanism. This sympathetic nervous stimulation in patients with essential hypertension, in addition to initiating the blood pressure elevation, may also contribute to the commonly associated metabolic abnormalities of insulin resistance and hyperlipidemia, with neural vasoconstriction having metabolic consequences, impairing glucose delivery and causing insulin resistance in muscle, and retarding postprandial clearing of lipids in liver. Trophic effects of sympathetic activation on cardiovascular growth are claimed but have yet to be demonstrated conclusively in humans.
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PMID:Sympathetic nervous system: contribution to human hypertension and related cardiovascular diseases. 864 1

ACEI form a group of antihypertensives which inhibit the angiotensin II (A II) production and thus not only reduce the blood pressure but exert also a positive metabolic and antiproliferative effect (A II is a proliferative hormone). They are therefore indicated nowadays in the treatment of essential and secondary hypertension, left-ventricular hypertrophy, chronic heart failure, acute myocardial infarction, insulin resistance and other disorders. Despite intensive studies we still do not know many, in particular mediated effects, of ACEI but these drugs have become one of the key groups in therapy.
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PMID:[Pharmacodynamics of angiotensin-converting enzyme inhibitors]. 868 97

The aim of this study was to define a population of diabetics exhibiting an increased risk of developing severe periodontitis by comparing the medical status of 2 groups of diabetics, 1 with no/minor periodontal disease and 1 with severe periodontal disease. The case-control study consisted of 2 parts, a baseline study and a follow-up study. 39 case-control pairs were selected. They were adult, long-duration, insulin-dependent diabetics matched according to sex, age and diabetes duration. One individual in each pair (the CASE) exhibited severe periodontal disease while the other (the CONTROL) exhibited gingivitis or only minor alveolar bone loss. The median age of the cases was 58 years (range 36 to 70 years) and of the controls 59 years (range 37 to 69 years). The median disease duration in cases and controls was 24 years and 25 years, respectively. The median follow-up time was 6 years. The medical variables analysed were weight, insulin dose, systolic and diastolic blood pressure, vibratory threshold, triglycerides, total-cholesterol, HDL-cholesterol, creatinine, HbA1, proteinuria, ECG, retinopathy, stroke, transient ischemic attacks (TIA), angina, myocardial infarct, heart failure, hypertension, intermittent claudication, foot ulcer, death, cause of death, and smoking habit. Biochemical analyses and clinical variables used as a routine in the monitoring of diabetics failed to differentiate between diabetics with severe and minor periodontal disease. In the follow-up study, significantly higher prevalences of proteinuria and cardiovascular complications such as stroke, TIA, angina, myocardial infarct and intermittent claudication were found in the case group. An association between renal disease, cardiovascular complications and severe periodontitis seems to exist. This indicates that a closer cooperation between the diabetologist and the dentist is necessary in monitoring the diabetic patient.
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PMID:Medical status and complications in relation to periodontal disease experience in insulin-dependent diabetics. 870 78

Patients with diabetes mellitus have a high morbidity and mortality from acute myocardial infarction, the reason for which is not fully understood. The relationship between congestive heart failure symptoms, left ventricular ejection fraction, and long-term mortality was examined in 578 hospital survivors of acute myocardial infarction, 47 of whom had Type 2 (non-insulin-dependent) diabetes mellitus. None of the patients were treated with insulin. The prevalence of congestive heart failure during hospitalization was similar in patients with and without diabetes, although mean diuretic dose was higher in the former patients. Left and right ventricular ejection fraction was measured with radionuclide ventriculography in the second week after acute myocardial infarction. At discharge from the coronary care unit, patients with and without diabetes had similar left ventricular ejection fraction (with diabetes: median 46% vs without diabetes: median 43%; p = 0.89). Median right ventricular ejection fraction (62%) was within normal limits in both groups and did not differ statistically. Survival data were obtained for all patients. The 5-year mortality was increased in patients with diabetes compared with non-diabetic patients independent of left ventricular ejection fraction. Univariate analysis showed that the cumulative 5-year mortality rate was 53% in the group with diabetes compared with 43% in the non-diabetic group (p = 0.007). Using multivariate regression analysis presence of diabetes was found to have a significant association with long-term mortality after myocardial infarction, that was independent of age, history of hypertension, congestive heart failure symptoms during hospitalization or of either left or right ventricular ejection fractions at discharge. We conclude that the excess mortality in patients with non-insulin-dependent diabetes mellitus is not explained by available risk markers after myocardial infarction. Even though left ventricular ejection fraction and serum creatinine did not differ significantly, the apparent higher dose of Frusemide in patients with than without non-insulin-dependent diabetes mellitus might indicate that heart failure, it present, is more severe in patients with than in those without diabetes. The importance of diastolic dysfunction in this context needs to be determined.
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PMID:Clinical characteristics, left and right ventricular ejection fraction, and long-term prognosis in patients with non-insulin-dependent diabetes surviving an acute myocardial infarction. 873 27

A 42-year-old insulin-dependent diabetic man presented with severe bilateral gustatory sweating associated with a deterioration in his glycaemic control. Conventional oral antimuscarinic medication was contraindicated because of his cardiac insufficiency. Topical 0.5% glycopyrrolate cream was tried and applied on alternate days to his face, which resulted in the complete cessation of his gustatory sweating without side-effects. Topical glycopyrrolate cream is an effective treatment of diabetic gustatory sweating without the adverse effects commonly found with oral anti-muscarinic medication.
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PMID:Treatment of diabetic gustatory sweating with topical glycopyrrolate cream. 873 34

We performed right lower lobectomy for lung cancer in a 62-year-old man who had been under hemodialysis for 4 years. During the operation, hyperkalemia occurred and was treated by GI therapy (continuous intravenous infusion of glucose + insulin). On the 3rd postoperative day, CVP was increased and hypotension occurred during hemodialysis. It was considered that heart failure had developed. Attention to the possibility of heart failure is important in the postoperative management of patient on chronic hemodialysis who require lung resection. He was discharged without bleeding of infection. There have been few reports on operations for lung cancer in such patients, so our experience is significant.
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PMID:[Surgical treatment to the lung cancer in a patient receiving hemodialysis]. 874 66

Metformin is contraindicated in patients with renal failure because of the risk of lactic acidosis. This study assessed the complications of metformin treatment in patients with non-insulin-dependent diabetes mellitis with normal and raised serum creatinine. Subjects using metformin with serum creatinine above the upper reference range (120 mu mol/l) were identified (n = 17) from a hospital diabetes register; those with abnormal liver function, cardiac failure, peripheral vascular disease or recent severe illness were excluded. Reference plasma lactate levels were established, mean 1.742 mu mol/l (SD 0.819) using age-matched non-diabetic subjects. Age-matched patients treated with metformin with normal serum creatinine levels formed the control group (n = 24). Details of gastrointestinal disturbance were recorded, and plasma lactic acid and vitamin B12 levels measured. The median total daily dose of metformin in both groups was 1700 mg. The mean plasma lactate in subjects with serum creatinine 80-120 mu mol/l (2.640 mmol/l (SD 1.434) p < 0.02) was higher than non-diabetic control levels while diabetic subjects with serum creatinine 120-160 mumol/l had a mean of 2.272 mmol/l (SD 0.763) p < 0.05. There was no significant difference between the two groups taking metformin, nor any significant difference in the reporting of gastrointestinal symptoms between the groups on metformin (11.76% vs 12.5%). Plasma lactic acid levels are higher in diabetic subjects taking metformin compared with healthy volunteers but, within the diabetic groups, the small elevation of serum creatinine was not associated with higher plasma lactate levels.
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PMID:Metformin treatment in NIDDM patients with mild renal impairment. 875 14

Hypotension in patients on CAPD is almost an unexplored area in the literature. This retrospective analysis of 525 patients treated at the Toronto Hospital. Toronto over the last five years, of whom 65 were hypotensive, describes the possible causes of hypotension, the response to treatment, morbidity and mortality rates. The incidence of hypotension was 12% in our CAPD population. The mean age of these patients was 58 +/- 17 years with a male to female ratio of 1.25:1. The distribution of various comorbid conditions such as, insulin-dependent diabetes mellitus, neoplasia coronary/cerebro/peripheral vascular diseases was similar to nonhypotensive patients. There was a higher proportion of malignancies, noninsulin-dependent diabetes mellitus and chronic obstructive pulmonary disease (CAPD) in hypotensive group. Hypotension was attributed to hypovolemia in 16 (25%), heart failure in 15 (23%) and antihypertensive medications in 12 (18%) patients. In 26 (34%) patients the exact cause of hypotension was unclear. Five patients had malignancies and 4 had severe autonomic neuropathy. Among 16 hypovolemic patients, 14 responded to volume expansion and 2 did not because of concurrent administration of coronary vasodilators. Seven out of 12 patients with hypotension due to antihypertensive medications improved. In 3 patients, blood pressure increased marginally after stopping the drugs and 2 remained hypotensive because of continuation of the drugs. Of the patients with heart failure, 40% (6/15) responded to a decrease to the target weight. Two patients treated with captopril did not respond. Of the patients from the unknown category, 50% (13/26) improved. One out of 4 patients treated with midodrine responded. The mortality rate was higher among hypotensive patients than among the nonhypotensives on CAPD.
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PMID:Hypotension on continuous ambulatory peritoneal dialysis. 879 32


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