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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diabetics have a higher prevalence of recurrent angina, myocardial infarction and hypertension compared with healthy individuals. This is partly due to the metabolic control, and partly to the development of nephropathy, but inherited factors also seem to contribute to their development. Another factor, to some extent inherited, could be magnesium-deficiency. Up to 30% of all diabetics suffer from magnesiumdepletion, which in other disease entities has been related to angina pectoris, myocardial infarction, and changes in blood lipids. Furthermore, magnesium-deficiency might be related to the development of hypertension. In diabetes, magnesium-depletion has been linked with the development of retinopathy, and an increase in abortions and malformations in diabetic pregnancies. No intervention trials with magnesium, to elucidate the question of magnesium depletion and diabetic late complications have hitherto been made. No methods for assessing magnesium-status in diabetes are available as yet, to select patients for this type of trial.
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PMID:[Magnesium deficiency and development of late diabetic complications]. 186 12

Much of the morbidity and mortality in sickle cell disease (SCD) is caused by tissue ischemia and infarction resulting from vascular occlusion. Research in this area has been dominated by the hypothesis that vascular occlusion in SCD is due primarily to microvascular obstruction by sickle erythrocytes (SS RBC), yet there is no direct evidence that microvascular occlusion is responsible for any of the vasocclusive complications of SCD. In this paper an alternate hypothesis is proposed: that thrombotic occlusion of larger arteries and veins is an important factor in many of the vasocclusive complications of SCD. Large-vessel cerebral arterial disease (intimal hyperplasia with superimposed thrombosis) has clearly been established as the most important cause of stroke in SCD, and considerable evidence suggests that pulmonary arterial thrombosis/embolism is a major cause of pulmonary infarction and hypertension. The involvement of large-vessel thrombosis in painful crisis, aseptic necrosis of bone, priapism, leg ulcers, retinopathy, and miscarriage has not been adequately investigated. Large-vessel occlusion in SCD is probably a consequence of the abnormal adhesive and procoagulant properties of SS RBC, which produce endothelial damage, secondary intimal proliferation, and thrombosis. Techniques currently used to treat large-vessel occlusion in other disorders (antiplatelet and anticoagulant agents, thrombolytic therapy, angioplasty, endarterectomy, and vascular bypass surgery) should be considered in sickle cell subjects with large-vessel occlusion, especially in the cerebral vasculature.
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PMID:Large-vessel occlusion in sickle cell disease: pathogenesis, clinical consequences, and therapeutic implications. 189 Sep 82

This review suggests the following risk factors which accelerate the natural progression of retinopathy during pregnancy: 1. Pregnancy per se is an independent risk factor which accelerates retinopathy. 2. Hypertension potentiates this acceleration. 3. Hyperglycemia also potentiates this acceleration. 4. The duration of diabetes and state of the retina at the beginning of the pregnancy influences the rate of acceleration. 5. Rapid normalization of blood glucose accelerates the progression of retinopathy. Prudent therapy would suggest that a pregnancy be planned to be able to normalize the blood glucose slowly (over 6-8 months) before conception. In addition, although there are no clinical trials, photocoagulation treatment should be according to the recommendations of the Diabetic Retinopathy Study despite the possibility that retinopathy may regress spontaneously postpartum. Unfortunately, clinicians often are faced with a fait accompli--the diabetic woman with retinopathy presents already pregnant. In this circumstance, we would recommend acute normalization of blood glucose with intensive surveillance of the retinal status and aggressive retinal treatment as necessary.
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PMID:Diabetic retinopathy. 193 3

The prevalence of micro- and macroalbuminuria was determined in Type 2 (non-insulin-dependent) diabetic patients, less than 76 years of age, attending a diabetic clinic during 1987. All eligible patients (n = 557) were asked to collect a 24-h urine sample for quantitative albumin analysis. Urine collections were obtained in 296 males and 253 females (96%). Normoalbuminuria were defined as urinary albumin excretion less than or equal to 30 mg/24 h (n = 323), microalbuminuria as 31-299 mg/24 h (n = 151), and macroalbuminuria as greater than or equal to 300 mg/24 h (n = 75). The prevalence of macroalbuminuria was significantly higher in males (20%) than in females (6%), while the prevalence of microalbuminuria was almost identical in males (26%) and females (29%). The prevalence of arterial hypertension increased with increased albuminuria, being 48%, 68%, and 85% in patients with normoalbuminuria, microalbuminuria, and macroalbuminuria respectively. Prevalence of proliferative retinopathy rose with increasing albuminuria, being 2%, 5% and 12% in patients with normoalbuminuria, microalbuminuria, and macroalbuminuria respectively. Prevalence of coronary heart disease, based on Minnesota coded electrocardiograms, was more frequent in patients with macroalbuminuria (46%) compared to patients with microalbuminuria (26%) and patients with normoalbuminuria (22%). Foot ulcers were more frequent in micro- and macroalbuminuric patients, being 13% and 25%, respectively, compared to 5% in patients with normoalbuminuria. This cross-sectional study has revealed a high prevalence of microalbuminuria (27%) and macroalbuminuria (14%) in Type 2 diabetic patients. Patients with raised urinary albumin excretion are characterized by obesity, elevated haemoglobin Alc, increased frequency of arterial hypertension, proliferative retinopathy, coronary heart disease and foot ulcers.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prevalence of micro- and macroalbuminuria, arterial hypertension, retinopathy and large vessel disease in European type 2 (non-insulin-dependent) diabetic patients. 195 98

Between 1985 and 1986, during a population survey of diabetes in 1 urban and 5 rural areas of Taiwan, a total of 11,478 adults aged 40 or older were screened. Capillary whole blood glucose was determined with a glucometer (Ames Co.) The diabetic criteria followed the WHO designations. From this survey, a comparison of 225 newly diagnosed and 383 previously diagnosed diabetics was conducted. Multiple regression analysis revealed a highly significant correlation for all diabetics with regard to age, body mass index, family history and hypertension, but no specific correlation to habitat. Mean fasting glucose levels in previously and newly diagnosed diabetics were 172 and 158 (males 158 vs 147 and females 184 vs 165) mg/dl, respectively, which suggest that treatment is apparently inadequate in this population. The prevalent rate (%) of retinopathy for previously and newly diagnosed diabetics was 45.2 and 28.3 (males 42.8 vs 33.3 and females 47.5 vs 24.8), respectively. The prevalence is as common as those reported in western countries. In conclusion, previously diagnosed diabetics had higher fasting glucose concentrations and prevalent rates of retinopathy than newly diagnosed diabetics, and these findings were particularly prominent in females.
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PMID:A comparison of newly and previously diagnosed diabetics in Taiwan. 197 42

We report an outbreak of tetrodotoxin poisoning resulting from consumption of ovaries of an unidentified species of fish. Thirty victims manifested the typical neurologic symptoms of tetrodotoxin poisoning. Although hypotension is the classically described blood pressure reaction, eight individuals developed hypertension (average blood pressure 192/110 mm Hg); one died of acute pulmonary edema. Semi-quantitative tetrodotoxin bioassay of two uneaten ovaries revealed tetrodotoxin concentrations of 54 Mouse Units/gm and 287 Mouse Units/gm, respectively. To gain insight into the unusual phenomenon of hypertension observed in our outbreak, we interviewed the victims, performed a funduscopic exam for hypertensive retinopathy and checked their blood pressure periodically in the ensuing year. Mild hypertension evidenced by retinopathy and elevated blood pressure was found in all seven who manifested hypertension during the acute event and survived. We postulate that individuals with pre-existing hypertension responded to the relatively small doses of tetrodotoxin with a dramatic rise in blood pressure. This resulted in the fatal outcome for one individual with severe coronary artery disease. Hypertension should be recognized as a possible feature of tetrodotoxin poisoning, especially in predisposed individuals.
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PMID:Hypertension as an unusual feature in an outbreak of tetrodotoxin poisoning. 200 68

An increase in the capillary permeability to albumin (CPA) has been reported in diabetic patients. We observed this frequently with a non-invasive isotopic test derived from the Landis method, using 99mTc-albumin and measuring residual radioactivity externally after removal of forearm venous compression. Evidence of the independent effects of hypertension and microangiopathy on CPA has already been found. The present work was designed to investigate CPA using the same test on diabetic patients without retinopathy and clinical proteinuria. Some of these patients had objective clinical distal and symmetrical polyneuropathy. Neuropathy was clearly present in 10 of the 11 patients with an abnormal test unexplained by causes other than diabetes and in only one of the 17 patients with a normal test. The most frequent abnormality affected the late radioactivity disappearance curve, which probably reflects an impaired lymphatic wash-out of interstitial albumin. These results strongly suggest a link between peripheral neuropathy and diabetic functional microangiopathy. An elevated blood flow secondary to sympathetic nerve failure may induce an increase in CPA and a saturation of lymphatic pumping which could also be deficient due to impaired lymphatic innervation.
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PMID:Increased capillary permeability to albumin and diabetic neuropathy. 201 34

Since the late 1970s patients with diabetic nephropathy have formed an increasing proportion of new entrants to the Hospital renal dialysis and transplantation programme, reaching 28% for the three year period to December 1988. Between 1 January 1975 and 31 December 1988, 87 diabetic patients were accepted for treatment. Fifty-one per cent were European, predominantly type I diabetics. Maori (9% of the total reference population) accounted for a disproportionately high 47% due to an over-representation by type II diabetic patients (34 of 41 Maori). These findings cannot be explained by the higher prevalence in Maori of type II diabetes but appear to be due to a more prevalent and/or aggressive diabetic renal lesion in this group. On commencing treatment, nearly all patients had retinopathy and the majority had evidence of peripheral vascular disease, hypertension and neuropathy. CAPD was the initial mode of renal replacement therapy in 70% of patients. Overall patient survival was 77% at one year and 42% at three years, and survival on CAPD was 76% and 37% at one and three years, respectively. Patient survival on transplantation was 63% at one year and 58% at three years. Graft survival was 51% at one year and 46% at three years. Although the short term outlook for diabetic patients on renal replacement therapy is encouraging, longer term survival compared to non-diabetic patients is poor. Vascular disease is the major cause of death and an important factor in patient morbidity.
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PMID:Diabetic end stage renal failure--the Wellington experience 1975-1988. 203 73

This study correlates the fundus signs with the severity and signs of hypertension and evaluates the role of fluorescein angiography in detecting changes in the retinal and choroidal capillary bed in hypertension and defines its advantages over direct ophthalmoscopy. 37 hypertensives belonging to all grades of hypertension were studied. A thorough physical examination, hypertension work up, direct ophthalmoscopy and fluorescein angiography was done in all cases. A significant association was found between the presence of marked arteriolar narrowing and the presence of severe hypertension, left ventricular hypertrophy (LVH) and cardiomegaly. Patients having definite arterio-venous crossing changes and exudative retinopathy had a higher incidence of LVH and cardiomegaly. Renal functions and neurological signs in hypertension showed no correlation with the fundus signs. Capillary bed and choriodal abnormalities could be better studied on fluorescein angiography. Hard exudates were not visualized on fluorescein angiography. There was total resolution of exudative phenomenon on treatment.
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PMID:A correlative study of ophthalmoscopy and fluorescein angiography in systemic hypertension. 208 68

In a retrospective study, we analyzed the prevalence of diabetes-associated late complications in 549 type 1 (insulin-dependent) diabetic patients who have been treated at the University Hospital of Ulm between 1980 and 1987. Retinopathy, proteinuria and neuropathy depended on the duration of the disease, whereas age was the major determinant of large vessel disease. After 20 years of diabetes, 85% of the patients showed retinopathy, half of them proliferative retinopathy, 52% had persistent proteinuria (greater than 500 mg/day), 20% of them were under dialysis. 74% of the patients showed signs of peripheral and/or autonomic neuropathy, 19% had manifestations of large vessel disease. There was no consistent correlation between the levels of glycosylated hemoglobin and the occurrence of diabetic late complications. However, hypertension was closely associated with both small and large vessel disease.
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PMID:[Prevalence of secondary complications in patients with type I diabetes mellitus. Results of a retrospective analysis of 549 type I diabetic patients of the Ulm University clinic]. 208 8


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