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

Recipient selection criteria for pancreas (Px) transplantation differ among centers, based on perceived recipient risk factors, and their validity has not been determined. At the University of Minnesota we have been very liberal in accepting patients for Tx, some of whom have risk factors cited as exclusion criteria by other centers, giving us the opportunity to determine, retrospectively, the impact of their presence on outcome. Between July 1986 and March 1993, we performed 319 bladder-drained cadaver Px Txs at the University of Minnesota, 166 simultaneous with a kidney (SPK), 68 after a kidney (PAK), and 85 alone (PTA). To determine which putative "risk factors" influence patient and graft survival, we used uni- and multivariate (Cox regression) analyses to assess the impact of recipient category, duration of diabetes, and age at onset and at Tx; presence of pre-Tx cardiac (CD) disease (myocardial infarction, bypass, angioplasty), peripheral vascular disease (PVD) (stroke, bypass, angioplasty, amputation); blindness, hypertension, and excess weight; and of Px re-Txs. The incidences of all risk factors except re-Tx were significantly higher in SPK than PTA recipients. Px re-Txs comprised 40% of PAK, 26% of PTA, and 10% of SPK cases (P < 0.0001). Duration of diabetes correlated (P < or = 0.01) with all risk factors but one (hypertension). Recipient age correlated (P < or = 0.01) with CD, blindness, duration of diabetes, and age at onset of diabetes; CD risk factors correlated (P < 0.015) with hypertension and PVD. Recipient age (> or = 45) influenced the technical failure rate only in SPK recipients, with a relative risk (RR) of 2.13 (P = 0.08). Recipient age influenced Px graft and patient survival rates in both SPK and PAK recipients; for those > or = 45, the RR of graft loss was 1.73 and 1.76, respectively (P < or = 0.25), and the RR for ultimately dying was 3.07 in PAK (P = 0.02) and 5.86 in SPK (P = 0.17) recipients. SPK recipients with CD factors were at higher risk to ultimately die (RR = 3.78, P = 0.009), independent of age. Px re-Txs were not at higher risk to fail in PTA, but were in PAK recipients (RR = 1.86, P = 0.09); the risk for technical failure was higher for re-Txs only in SPK recipients (RR = 2.11, P = 0.24). Blindness, hypertension, PVD, and duration of diabetes did not negatively influence patient and graft outcome in any recipient category.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Recipient risk factors have an impact on technical failure and patient and graft survival rates in bladder-drained pancreas transplants. 800 94

Diabetic retinopathy is a major cause of morbidity and the leading cause of legal blindness in working-age persons in the United States. Retinopathy affects both juvenile-onset and noninsulin dependent diabetics. Most visual loss occurs in patients because they are seen late in the course of their disease. Several clinical trials have aided in establishing recommended screening and referral guidelines for patients with diabetes mellitus. Treatment strategies based on clinical trials are reviewed as well as the importance of control of both hyperglycemia and hypertension. Ocular findings are illustrated and discussed. The primary care physician can substantially reduce the risk of blindness and visual impairment in diabetic patients by prompt recognition of the ocular findings and understanding the importance of timely ophthalmologic evaluation.
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PMID:Diabetic retinopathy. Preserving your patients' sight. 804 60

Twenty-four cats with spontaneous systemic hypertension were retrospectively studied. Blood pressure (BP) was measured indirectly by the Doppler technique in 17 cats (mean systolic 219.4 +/- 43.2 mm Hg) and directly by femoral arterial puncture in 15 cats (mean systolic/diastolic 233.2 +/- 40.9/148.1 +/- 28.7 mm Hg). All cats had bilateral retinal hemorrhages and/or detachments. Twenty cats presented because of blindness. Other presenting signs included polyuria/polydipsia, weight loss, neurological signs, and/or epistaxis. Diagnostic tests were performed to determine the presence and the cause of any secondary organ damage. Common findings included retinal hemorrhages/detachments, low-grade systolic murmurs, cardiomegaly with left ventricular hypertrophy (LVH), small kidneys, mild azotemia, and urine specific gravity < or = 1.020. Only 3 cats had hyperthyroidism. One cat was transiently diabetic. Necropsies on 2 cats with neurological signs showed nephrosclerosis, arteriosclerosis, and multifocal cerebral hemorrhages. Twenty cats were treated with diuretics, beta-adrenergic antagonists, and/or an angiotensin converting enzyme (ACE) inhibitor. One cat was treated with methimazole only, and 1 was treated with insulin transiently. The median survival of the 24 cats was 18 months. Response to therapy did not appear to have an impact on survival time.
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PMID:Spontaneous systemic hypertension in 24 cats. 804 80

Industrial solvents mixed from thinner, used in paints, leathers, rubber, varnishes, have neurotoxic action. By laboral inhalation or spontaneously these are absorbed from the lungs, transported by blood and because of this high lipophilic section are retained within the lipid rich nervous system. Euphoric effects appear accompanied with visual and additive halucinations. In chronic abusers it produce schizophrenic-paranoid consequences with encephalic and peripheral neuronal and nervous fibers destruction, accompanied of blindness and paralysis. Cocaine is another neurotoxic drug. At first it produces euphoria, arterial hypertension and symptoms suggestive of underlying psychiatric diseases. The cocaine addicts often suffer depression, paranoia, hallucinations, seizures and suicidal ideation. The morphological base of the symptomatology is the encephalic and peripheral neuronal and nerve fibers destruction.
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PMID:[Clinico-pathologic correlation of dementia produced by thinner and cocaine]. 806 72

Autonomic dysreflexia (AD) is a syndrome that consists of facial flushing, excessive sweating, nasal congestion, throbbing headache and paroxysmal hypertension which may occur in response to bladder distension in patients with spinal cord lesions above the T6 level. We report the case of a C2 quadriplegic patient who developed clinical features of AD along with cortical blindness and seizures after administration of meglumine (Hypaque) for diagnostic cystogram.
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PMID:Seizures and cortical blindness after meglumine (hypaque) administration: a variant of autonomic dysreflexia. 812 Mar 39

Tortuous variants of the carotid or vertebral morphology are apparent on 10 to 43% of angiograms. It is probable that the incidence of these anomalies is lower in the normal population. Rarely, their etiology is congenital explaining the existence of some pediatric cases. The etiology of most cases is acquired and linked with hypertension, atheroma and aging. Basically consisting of an excess of length of the common or the internal carotid artery, the tortuosity may take the form of simple or multiple kinking, coiling or looping. Isolated, these anomalies are asymptomatic in a large majority of the cases. However, hemispheric, vertebrobasilar or ocular ischemic symptoms may be caused by them through a thromboembolic or hemodynamic mechanism. Moreover, given their frequent association with atherosclerotic occlusive lesions, their participation in the production of ischemic symptoms is not easy to determine. Although not yet investigated by prospective randomized studies, symptomatic isolated of kinking or coiling of cerebral arteries are amenable to surgical revascularization in order to prevent stroke or blindness. Besides, the endarterectomy of atherosclerotic occlusive lesions of tortuous carotids requires a technical adaptation.
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PMID:[Loops and folds of the carotid and vertebral arteries: indications for surgery]. 815 90

Sudden blindness in pregnancy is a devastating experience for the patient, her family and the treating obstetrician. Four cases of cortical blindness with pregnancy induced hypertension are presented, seen at the General Hospital Kota Bharu, Kelantan, in 1990. The incidence at the GHKB was 1: 1559 (4 cases out of 6,237 deliveries) which is higher as compared to neighbouring Singapore. The pathophysiology of this condition is still not well understood, though it is hoped that newer sophisticated imaging techniques like magnetic resonance imaging (MRI), CT scan, and blood flow waveform analysis by Doppler ultrasound will throw some light on the subject. Two of our cases presented with antepartum and two with postpartum cortical blindness. Therefore, termination of pregnancy alone may not provide the solution to this therapeutic dilemma.
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PMID:Transient blindness in pregnancy induced hypertension. 817 27

A pilot study was carried out to determine the prevalence of ophthalmic disease in the Indian community of Southall and to ascertain the best methods applicable for a larger formal study. Three sites were chosen for the study, a Sikh gurdwara, a mosque and a Hindu temple. The subjects were volunteers aged 30 years and over who had visited the appropriate place of worship at least twice in the previous month. A total of 184 subjects were examined. The prevalence of blindness was 2.7% by the World Health Organization (WHO) criteria, while 9.8% had uniocular blindness. The prevalence of glaucoma and ocular hypertension was 2.7% and 7%, respectively. Of the 184 subjects examined, 58% had cataract and 3.8% had age-related maculopathy. The prevalence of visually disabling trachomatous eye disease was 9.7%. The prevalence of diabetes mellitus was 17.9%, and that of hypertension 22.8%. This small study suggests that people with origins from the Indian subcontinent have a higher prevalence of ophthalmic disease than the Caucasian population.
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PMID:A pilot study into the prevalence of ophthalmic disease in the Indian population of Southall. 819 34

Temporal arteritis is an insidious disease which, if not recognized and treated with high-dosage oral prednisone or intravenous prednisolone, can result in unilateral or even total blindness due to anterior ischemic optic neuropathy (AION) or closure of the central artery of the retina. Unfortunately, the symptoms and clinical signs of temporal arteritis mimic those of a number of other conditions including angle-closure glaucoma, hypertension, migraine, trigeminal neuralgia, temporomandibular joint syndrome, carotid artery occlusive disease, Foster-Kennedy syndrome, and nonarteritic AION. When a patient complains of a severe pain in the temporal region, along with scalp tenderness and a feeling of malaise or depression--with or without episodes of transient loss of vision--he or she should be referred for a diagnostic work-up which includes an erythrocyte sedimentation rate and a temporal artery biopsy. We present here a review of the recent literature concerning temporal arteritis, followed by a report of an unusual case in which high-dosage prednisone therapy was effective in relieving the patient's symptoms and lowering the sedimentation rate in spite of a negative temporal artery biopsy.
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PMID:Diagnosis and management of temporal arteritis: a review and case report. 823 73

Hyperglycemia plays a decisive role in development of diabetic retinopathy, nephropathy and neuropathy. Unfortunately, even modern antidiabetic means often fail to install normoglycemia or near normoglycemia. They also bear an important risk for hypoglycemia. What glucose levels (as measured by Hb-A1c) may be tolerated without consequences for the patient is unknown so far; therefore, we should presently still aim at lowering the blood glucose as often and as close to normal as possible and try to avoid severe hypoglycemias. Those who care for diabetics carry a high responsibility. The care diabetics should be improved as follows: Regular ophthalmologic controls could reduce occurrence of visual losses or blindness. Efficient lowering of hypertension prevents occurrence and progression of nephropathy. ACE-inhibitors turned out to be also useful in normotonic diabetics, because they prevent progression of nephropathy. Diabetics bearing a risk for lesions on the feet should be identified, instructed and treated adequately. This is the only way to reduce the rate of amputations. Risk factors for general arteriosclerosis should be efficiently treated or avoided, particularly in diabetics. In consideration of these factors, morbidity and mortality of diabetic patients could be influenced more efficiently. There is no justification for any defeatist attitude.
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PMID:[Can late sequelae of diabetes be avoided? Various critical observations]. 829 33


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