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Query: UMLS:C0020473 (hyperlipidemia)
 15,891 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetes mellitus is one of the most common medical problems in elderly patients. There is a strong rationale for therapy in most patients with diabetes, even those who are asymptomatic. Family physicians should be aware of several age-associated differences in the management and treatment of diabetes in older patients. For elderly patients, dietary modifications may include an increase in the percentage of carbohydrates and a decrease in the percentage of fat. For obese patients, dietary therapy should also emphasize a decrease in overall calories. Oral hypoglycemic agents are generally used as the initial drug therapy. Insulin therapy should be instituted when oral agents fail to reduce the blood glucose level, when the blood glucose level is very high and in other special circumstances. A careful choice of medications for other common problems associated with diabetes, such as hypertension, hyperlipidemia and peripheral neuropathy, is also essential.
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PMID:Treatment of diabetes in the elderly. 187 33

The clinical recognition of dioxin-associated illness can be extremely difficult for the physician. After analyzing the relative sensitivity and specificity of reported manifestations of exposure to 2,3,7,8 tetrachlorodibenzo-p-dioxin (TCDD), we suggest criteria for the diagnosis of dioxin toxicity. Exposure to higher doses of 2,3,7,8-TCDD may lead to the appearance of chloracne and the increased excretion of porphyrins and porphyria cutanea tarda. Liver function abnormalities, peripheral neuropathy, hyperlipidemia, and evidence of weakness and depression may occur following exposure; however, these findings are less specific since diseases such as diabetes or alcoholism could cause several of these problems. The long-term effects of exposure to low-dose TCDD are currently uncertain.
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PMID:The diagnosis of dioxin-associated illness. 296 9

Primary biliary cirrhosis (PBC) is a chronic nonsuppurative, destructive cholangitis, whose etiology is unknown. Morbidity arises early from pruritus and later from hypercholesterolemia with xanthoma formation. Therapy is supportive and directed at the complications of cholestasis. Plasmapheresis has been reported to benefit patients with hyperlipidemia and PBC; thus a pilot study of plasmapheresis utilizing the Haemonetics Model 30 with replacement by albumin and saline was conducted. Five patients (four female and one male) with a mean age of 43 (range 29-58) and a mean duration of illness of 9.5 years (range 6-21) with marked jaundice, xanthomas, xanthelasma, hepatomegaly, fatigability, anorexia, and pruritus, as well as mild nausea were studied. Peripheral neuropathy was present in two patients. Two patients had splenomegaly. Two patients had an associated Sjogren syndrome. All patients had high serum bilirubin, alkaline phosphatase, and cholesterol levels and mild elevations in aspartate amino transferase and alanine amino transferase activities. Immune complexes measured in four patients were present. Antimitochondrial antibody titers were significant in all patients. Patients underwent a mean of 63 plasmapheresis procedures over a mean of 112 weeks removing a mean of 94.7 liters of plasma. No serious toxicity was seen. All patients showed a reduction in pruritus, xanthomas, xanthelasmas, and serum cholesterol values. The two patients who had evidence of Sjogren syndrome noted subjective improvement. All patients who had fatigue, anorexia and nausea also noted moderate improvement. There was no change in hepatomegaly or splenomegaly in patients demonstrating such organomegaly. Liver function did not change significantly. Overall, four patients had improvement in their condition and one patient achieved stability.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The clinical effectiveness and safety of chronic plasmapheresis in patients with primary biliary cirrhosis. 403 Jul 9

Secondary hyperparathyroidism is a universal complication of chronic renal failure. It has been proposed that the markedly elevated levels of immunoreactive parathyroid hormone (i-PTH) in uremia may represent a "uremic toxin" responsible for many of the abnormalities of the uremic state. Plasma i-PTH consists of a mixture of intact hormone, a single-chain polypeptide of 84 amino acids, and smaller molecular weight hormonal fragments from both the carboxy- and amino-terminal portion of the PTH molecule. The hormonal fragments arise from metabolism of intact PTH by peripheral organs as well as from secretion of fragments from the parathyroid glands. The structural requirements for the known biological actions of PTH reside in the amino-terminal portion of the PTH molecule. Carboxy-terminal fragments, biologically inactive at least in terms of adenylate cyclase activation, hypercalcemia, or phosphaturia, depend on the kidney for their removal from plasma, and thus accumulate in the circulation in chronic renal failure. It is unknown at the present time if other biological effects of these carboxy-terminal fragments may contribute to some of the biochemical alterations observed in uremia. The most significant consequence of increased PTH levels in uremia is the development of bone disease characterized by osteitis fibrosa. In addition, it would appear that PTH plays an important role in some of the abnormal electroencephalographic patterns observed in uremia. This may be due to a potential role of PTH in increasing calcium content of brain. Parathyroid hormone also has been implicated as a pathogenetic factor in many other alterations present in uremia, i.e., peripheral neuropathy, carbohydrate intolerance, hyperlipidemia, and other alterations. Unfortunately, outstanding clinical research is lacking in this field and conclusive experimental data are practically nonexistent. Further studies are necessary if one is to accept the concept of PTH being a significant "uremic toxin."
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PMID:Parathyroid hormone metabolism and its potential as a uremic toxin. 699 9

We describe six patients with painful polyneuropathy associated with hyperlipidemia. Each had mild, slowly progressive neuropathy characterized by pain in feet, without proximal extension or involvement of hands. Weakness and autonomic symptoms and signs were absent. Three patients had normal tendon reflexes; three others had decreased ankle reflexes. Serum cholesterol levels were moderately increased; serum triglyceride levels were exceedingly high. In one patient, symptoms resolved with correction of hypertriglyceridemia. No other cause of peripheral neuropathy was found. Marked increases in serum triglycerides may cause painful small-fiber neuropathy.
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PMID:Neuropathy associated with hyperlipidemia. 750 Nov 85

Diabetics form a significant proportion of patients requiring admission to medical units in Singapore. We conducted a cross-sectional study of all diabetic patients admitted to Alexandra Hospital over a two-month period (1 September 1990 to 31 October 1990). One hundred and thirty-five patients (57 males, 78 females) were entered into the study. The population characteristics, admitting medical diagnoses, complications, treatment modalities and follow-up of these patients were studied. The study group accounted for 13.1% of all hospital admissions over the study period (total admissions 1033). Eighty-seven (64.4%) were Chinese, 25 (18.5%) Indians and 23 (17.1%) Malays. Of the microvascular complications, the most common was diabetic nephropathy. Eighty-two (60.7%) patients had albuminuria and 35 (25.9%) were azotemic. Dermopathy was present in 15.5% (21) and 32.6% (44) had peripheral neuropathy. Cataracts were present in 32.6% (44) of the study population and retinopathy in 18.5% (25). Associated diseases like hypertension were detected in 51.9% (70), hyperlipidemia in 41.5% (56) and coronary heart disease in 28.1% (38) of the group. Eighty-four patients (62.2%) were treated with oral hypoglycaemic tablets, 27 (20.0%) with insulin and 24 (17.7%) were managed with diet alone. Thirty-four patients (25.2%) were admitted with acute infections, most of which were respiratory infections. The mean glycosylated haemoglobin value was 11.7%. The mean duration of hospitalisation was 6.48 days. No significant correlation was found between the glycosylated haemoglobin value and the duration of hospitalisation.
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PMID:Epidemiology of diabetes mellitus in a regional hospital medical unit. 812 45

Autonomic and peripheral nerve function was examined in a group of patients with primary biliary cirrhosis using standard cardiovascular reflex tests and peripheral nerve conduction studies. Sixty-three percent had cardiovascular autonomic dysfunction with predominantly parasympathetic abnormalities. Symptoms of peripheral neuropathy were rarely volunteered spontaneously but occurred frequently when specifically sought; 40.7% had definite peripheral neuropathy, with symptoms and/or signs plus peripheral neurophysiological abnormalities. A close association between autonomic and peripheral nerve function was found with correlation between the heart rate variation on deep breathing and both peroneal nerve conduction velocity (r = 0.67, P < 0.001) and sural nerve conduction velocity (r = 0.52, P < 0.008). Correlations were also noted between other autonomic tests and peripheral nerve function. Both autonomic and peripheral nerve function correlated with serum bilirubin and albumin; no significant association was noted with vitamin E deficiency or hyperlipidaemia. A generalised neuropathy with peripheral and autonomic abnormalities is common in primary biliary cirrhosis and could be related to hepatic damage. Although rarely clinically disabling, the autonomic impairment associated with this neuropathy may be of prognostic significance.
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PMID:Autonomic and peripheral neuropathy in primary biliary cirrhosis. 769 49

With the development of more potent and better tolerated antiretroviral regimens, durable antiviral responses are being observed in an increasing fraction of patients. Substantial benefits are associated with these responses: Initially memory, then naive, CD4 cell counts may rise by 150-200 cells/mm3; CD8 cell numbers also rise sharply but then fall below pretreatment levels, presumably as antigenic stimuli driving the CD8 response decline; cellular activation markers decline; distortions in the T cell repertoire gradually lessen; and increases in proliferative responses to mitogens and recall antigens are more easily elicited. Clinical benefits directly accompany these immunologic benefits. Other than peripheral neuropathy, few long-term toxicities are associated with nucleoside analogue reverse transcriptase inhibitors. Recent reports, however, link protease inhibitors with hyperlipidemia, redistribution of body fat, and diabetes mellitus. As more human immunodeficiency virus type 1-infected persons receive long-term antiviral maintenance therapy, successful management of these toxicities will require more attention.
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PMID:Longer-term immunologic effects and side effects of successful antiretroviral therapy. 1043 60

Acute pancreatitis and eruptive xanthomata are the only recognised direct complications of severe hypertriglyceridaemia, although peripheral neuropathy has been described in patients with hyperlipidaemia. We describe a patient with mixed hyperlipidaemia presenting with severe scalp pain and eruptive xanthomata. Both resolved with treatment. We suspect that high triglyceride concentration can affect the function of sensory nerve fibres.
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PMID:Scalp pain and hyperlipidaemia. 1107 May 77

In clinical practice, combination antiretroviral therapy is frequently complicated by adverse reactions and drug-related toxicities. The incidence, presentation, differential diagnosis, and management of the most frequent and severe of these complications are discussed. The recently described spectrum of metabolic complications, including hyperlipidemia, fat redistribution, and lactic acidosis, are covered in detail. The management of nephrotoxicity, pancreatitis, bone marrow suppression, peripheral neuropathy, and hypersensitivity reactions related to antiretroviral therapy is also discussed.
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PMID:The management of the clinical complications of antiretroviral therapy. 1114 42


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