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Query: UMLS:C0151744 (myocardial ischemia)
 31,282 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pre-operative and operative complications in 2266 patients having undergone transurethral resection of prostate (TURP) for the past 20 years at Kitasato University Hospital were analyzed. They consisted of 2008 benign prostatic hyperplasia and 258 prostate cancer patients. Seven hundred and fifty four patients showed some of physical disorders prior to TUR:hypertension in 147 cases, diabetes mallitus in 87, ischemic heart disease in 46, chronic obstructive lung disease in 41 and others. Operative and postoperative complications of TURP were seen in 308 cases (13.6%). Perforation of the prostatic capsule was seen in 100 cases (4.4%) and bladder perforation into intraperitoneal cavity in 6 cases (0.3%). Transurethral fulgulation for postoperative hemorrhage was conducted on 79 cases (3.5%). Hyponatremia lower than 130 mEq/L was noted in 14 cases (0.6%). Severe urinary tract infection leading to bacteremia was observed in 9 cases (0.4%). Postoperative epididymitis was evident in 20 cases (0.8%). There was postoperative urinary incontinence in 19 cases, 3 of which was treated with Teflon-paste injection successfully. One patient had to undergo AMS-800 artificial sphincter implantation. The number of postoperative urethral stricture patients requiring urethral dilatation or internal urethrotomy was 12 (0.5%) and postoperative bladder neck contracture was seen in 20 cases (0.9%). One patient (0.04%) who developed DIC after profuse postoperative hemorrhage died on the 37th postoperative day. The efficiency of TURP depends not so much on the skill of cutting as on the speed and accuracy of orientation and haemostasis. The quick recognition of anatomical landmarks will assure effective and safe resection.
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PMID:[Pre-operative, operative and postoperative complications in 2266 cases of transurethral resection of the prostate]. 768 90

Still under debate is the prevalence of microalbuminuria in patients with recently diagnosed Type 2 (non-insulin-dependent) diabetes mellitus and its relation to existing macro-vascular disease and the major vascular risk markers. Hence, from a representative sample of 1512 patients with Type 2 diabetes of varied duration (recruited from 22 non-specialized medical practices of the Greater Munich Area) 68 (26 males, 42 females) of 71 eligible subjects with a known duration of diabetes of up to 17 weeks and not less than 4 weeks were examined in the present study. Median age was 61 (39 to 75) years, prevalence of ischaemic heart disease (case history plus ECG, Minnesota code, Whitehall criteria) 41.2%, and that of peripheral vascular and carotid artery disease (both assessed by ultrasound-Doppler) were 35.3 and 4.4%, respectively. Diabetes was well controlled (HbA1c: 6.9%, 5.6-8.3; fasting blood glucose: 7.7 mmol/l, 5.4-10.4; median +/- interquartile range IQ), the cardiovascular risk profile was most prominent in terms of triglycerides (3.1 mmol/l, 2.1-4.6, median +/- IQ range) and systolic blood pressure (164 mm Hg, 140-186, median +/- IQ range). 13.2% showed signs of urinary tract infection. Of the remainder, 19.0% exhibited microalbuminuria (RIA, > 30-200 mg/l), and 5.2% macroalbuminuria (> 200 mg/l). Significant correlations (p < 0.05) were found between urinary albumin concentration and beta 2-microglobulin in serum, systolic blood pressure, serum triglycerides, serum HDL-cholesterol (inversely), HbA1c, and peripheral vascular disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Microalbuminuria in a random cohort of recently diagnosed type 2 (non-insulin-dependent) diabetic patients living in the greater Munich area. 824 49

A retrospective analysis of 224 patients was carried out to evaluate the outcome of elderly patients after operation for acute abdominal pain. The mean (+/- SD) age of the patients was 74.6 (+/- 6.4) years (range 65-96) and the male/female ratio was 104/120. The most common causes for an emergency operation were acute biliary disease (26%), acute appendicitis (18%), gastrointestinal cancer (11%) and incarcerated hernia (10%). Twenty-nine patients (13%) died during the one-month postoperative period. The most common causes of death were gastrointestinal cancer (24%), ischaemic heart disease (14%) and complicated peptic ulcer disease (14%). Ninety-two (41%) patients had non-lethal postoperative complications, the commonest of which were wound infection or dehiscence (28%), urinary tract infection (17%), and paralytic ileus (8%). Ten patients were reoperated on for postoperative complications. The mean hospitalization time was 12.5 days (range 1-99). The results in the analysis of the long-term outcome (mean follow-up time 21 months) revealed that 17% of the primarily survived patients had died. Living patients were satisfied with the treatment and only a few patients were institutionalised after surgery. We conclude that both the short-term and long-term outcome of elderly patients after an emergency abdominal operation is good in benign diseases, and active surgery is justified.
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PMID:The outcome of elderly patients after operation for acute abdomen. 873 27

Cross-sectional studies suggest that an increased urinary albumin excretion rate is associated with cardiovascular disease, dyslipidemia, and hypertension. The purpose of this study was to analyze prospectively whether the urinary albumin-to -creatinine (A/C) ratio can independently predict ischemic heart disease (IHD) in a population-based cohort. In 1983, urinary albumin and creatinine levels were measured, along with the conventional atherosclerotic risk factors, in 2085 consecutive participants without IHD, renal disease, urinary tract infection, or diabetes mellitus. The participants were followed up until death, emigration, or December 31, 1993. IHD was defined as a hospital discharge diagnosis or cause of death including the diagnoses ICD-8 and 410 to 414. Seventy-nine individuals developed IHD during the 21 130 person-years of follow-up. They were characterized by a preponderance of males and higher age, body mass index, blood pressure, lipoproteins, and proportion of current smokers. Microalbuminuria was defined as an A/C ratio) >90 percentile (>0.65 mg/mmol). When adjusted for other risk factors, the relative risk of IHD associated with microalbuminuria was 2.3 (95% CI, 1.3 to 3.9, P=0.002), and the 10-year disease-free survival decreased from 97% to 91% (P<0.0001) when microalbuminuria was present. An interaction between microalbuminuria and smoking was observed, and the presence of microalbuminuria more than doubled the predictive effect of the conventional atherosclerotic risk factors for development of IHD. It is concluded that microalbuminuria is not only an independent predictor of IHD but also substantially increases the risk associated with other established risk factors.
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PMID:Urinary albumin excretion. An independent predictor of ischemic heart disease. 1044 83

The aim of the present study was to determine the prevalence of and the host factors for asymptomatic pyuria (ASP) in women with type 2 diabetes. The study included 179 type 2 diabetic women and consecutive 455 non-diabetic women attending as out-patients in 1996. Patients with symptoms of a urinary tract infection were excluded. ASP was defined as the presence of more than 10 leukocytes/high-power field in a random urine sample. Diabetic women more often had ASP than non-diabetic women (27.9 vs. 15.8%, P<0.001). The prevalence of ASP was significantly increased in patients with a duration of diabetes exceeding 15 years (0 approximately 4 years; 20.3%, 5 approximately 9 years; 24.3%, 10 approximately 14 years; 23.8%, and > or =15 years; 46.3%). No differences were evident in HbA(1C) between diabetic patients without ASP and those with ASP. Diabetic women with ASP more often had diabetic retinopathy, neuropathy, nephropathy, cerebrovascular disease, ischemic heart disease, and hyperlipidemia than those without ASP. However, no statistically significant differences were evident in the prevalence of hypertension, constipation, or dementia. As the degree of neuropathy increases, it is accompanied by an increasing prevalence of ASP (none, 21.4%; blunt tendon reflexes, 24.5%; symptomatic, 50.0%; and gangrene, 66.6%). The prevalence of ASP was significantly increased in the patients with proliferative diabetic retinopathy (none, 23.2%; background, 29.4%; pre-proliferative, 18.2%; and proliferative, 50.0%). As the degree of nephropathy increases, it is accompanied by an increasing prevalence of ASP (none, 20.0%; microalbuminuria, 31.9%; macroalbuminuria, 37.0%; and renal failure, 60.0%). Thus, the prevalence of ASP is increased in women with diabetes and increased with longer duration of diabetes but was not affected by glucose control. The incidence of ASP increases significantly as diabetic microangiopathy becomes severer.
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PMID:Asymptomatic pyuria in diabetic women. 1159 24

A survey was conducted in asymptomatic aged individuals (> or = 60 years) in The National Capital Territory of Delhi for the prevalence of major health problems like hypertension, diabetes mellitus and respiratory diseases. A total of 200 individuals (100 males and 100 females) were studied over a period of three months in 1998-99. Hypertension was defined as BP > or = 140/90 mmHg (JNC VI criteria), while diabetes mellitus was diagnosed if fasting whole blood sugar was 120 mg/dl or more (WHO criteria). Diagnosis of other health problems was based on relevant history and physical examination. Prevalence of hypertension in the study group was 32.5 per cent (more in males). Of these 18 per cent and 4.2 per cent had isolated systolic and diastolic hypertension, respectively. Prevalence of diabetes mellitus in the same population was 13.0 per cent. Both diseases were more prevalent in urban population. A high prevalence of respiratory disorders was observed (pulmonary tuberculosis 16 per cent, COPD 10 per cent, asthma 4.5 per cent). Cataract was present in 7.5 per cent while 1.5 per cent had symptoms of urinary tract infection. History of Jaundice was present in 3.5 per cent. Three per cent each had a history suggestive of IHD and TIA, respectively. Proteinuria and glycosuria was seen in 22.2 and 7.6 percent, respectively. A large percentage of the study group (34.4 per cent) had asymptomatic ECG abnormalities.
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PMID:A study of prevalence of health problems in asymptomatic elderly individuals in Delhi. 1224 Aug 44

This study was designed to investigate the prevalence of risk factors, etiology, clinical course and outcome of the first-ever ischemic stroke in patients aged at least 85 when compared with younger patients with ischemic stroke. We studied 802 patients with first-ever ischemic stroke, including 103 patients at the age of 85 and more, and 699 patients at the age of 60-84. We collected data regarding the prevalence of risk factors, etiology of stroke, severity of neurological deficit and the presence of consciousness disturbances. The major complications were registered and the infarction volume was assessed using computed tomography. Mortality and functional status of the survivors were assessed on the 30th and 90th day after stroke using Barthel Index. Very old patients with ischemic stroke were characterized by greater percentage of women and higher frequency of ischemic heart disease; diabetes, obesity and smoking were all noted less frequently in this group. Very elderly subjects presented more frequently with TACI syndrome (24.3% and 14.6%, respectively; p < 0.05). They had greater neurological deficit in all days of assessment and were more likely to have the consciousness disorders on admission (39% and 22.3%, respectively; p < 0.001). Urinary tract infection was the only major complication more frequently seen in very old subjects (53.4% and 35.3%, respectively; p < 0.05). The studied groups did not differ regarding etiology of stroke, the length of hospital stay and the incidence of other complications. 30th and 90th-day mortality was greater among very elderly subjects (28.1% vs 16.4% and 46.6% vs 24.6%, respectively; both p < 0.05). The disability assessed 30 and 90 days after stroke was also much greater in very old patients. Very old patients with first ischemic stroke have greater neurological deficit, worse functional status and greater mortality after stroke. They are more likely to have ischemic heart disease and less likely to have diabetes or obesity. The causes of stroke, incidence of complications (with the exception of urinary tact infections), size of the lesion and length of hospital stay are similar in very old and younger patients with stroke.
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PMID:[First ischemic stroke in the very old: etiology, clinical course and outcome]. 1497 42

Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency in patients with diabetes mellitus. DKA most often occurs in patients with type 1 diabetes, but patients with type 2 diabetes are susceptible to DKA under stressful conditions, such as trauma, surgery, or infections. DKA is reported to be responsible for more than 100 000 hospital admissions per year in the US, and accounts for 4-9% of all hospital discharge summaries among patients with diabetes. Treatment of patients with DKA uses significant healthcare resources and accounts for 1 out of every 4 healthcare dollars spent on direct medical care for adult patients with type 1 diabetes in the US. Recent studies using standardized written guidelines for therapy have demonstrated a mortality rate of less than 5%, with higher mortality rates observed in elderly patients and those with concomitant life-threatening illnesses. Worldwide, infection is the most common precipitating cause for DKA, occurring in 30-50% of cases. Urinary tract infection and pneumonia account for the majority of infections. Other precipitating causes are intercurrent illnesses (i.e., surgery, trauma, myocardial ischemia, pancreatitis), psychological stress, and non-compliance with insulin therapy. The triad of uncontrolled hyperglycemia, metabolic acidosis and increased total body ketone concentration characterizes DKA. These metabolic derangements result from the combination of absolute or relative insulin deficiency and increased levels of counter-regulatory hormones (glucagon, catecholamines, cortisol, and growth hormone). Successful treatment of DKA requires frequent monitoring of patients, correction of hypovolemia and hyperglycemia, replacement of electrolyte losses, and careful search for the precipitating cause. Since the majority of DKA cases occur in patients with a known history of diabetes, this acute metabolic complication should be largely preventable through early detection, and by the education of patients, healthcare professionals, and the general public. The frequency of hospitalizations for DKA has been reduced following diabetes education programs, improved follow-up care, and access to medical advice. Novel approaches to patient education incorporating a variety of healthcare beliefs and socioeconomic issues are critical to an effective prevention program.
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PMID:Diabetic ketoacidosis: risk factors and management strategies. 1587 46

This report focuses on the role of Pseudomonas aeruginosa in complicated urinary tract infections in a prospective, open-label, multicenter study designed to evaluate the safety and efficacy of extended-release ciprofloxacin (ciprofloxacin XR) 1000 mg once daily for 7-14 days for the treatment of complicated urinary tract infections. A total of 204 patients were valid for intention-to-treat analysis, of whom 130 were included in the clinical efficacy population. In the 56 microbiologically valid patients the bacteriological eradication rate was 82.1% and the clinical cure rate was 94.6%. Patients with P. aeruginosa infections valid for microbiological efficacy (n = 7) had 100% bacteriological eradication and clinical cure rates. In the intention-to-treat population, the bacteriological and clinical cure rates were 42.1% (51/121) and 55.9% (114/204), respectively. These rates were 58.3% and 75.0% respectively, for patients with P. aeruginosa infections. To achieve the desired 10 patients with P. aeruginosa for analysis, these data were pooled with data from a previous study. Treatment failure correlated with pre-therapy P. aeruginosa isolates being resistant to ciprofloxacin. On exploratory multivariate regression analysis, presence of neurogenic bladder, urinary retention owing to benign prostatic hypertrophy, prior urinary tract infection, and ischemic heart disease predicted P. aeruginosa infection.
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PMID:Complicated urinary tract infections treated with extended-release ciprofloxacin with emphasis on Pseudomonas aeruginosa. 1823 May 53

Fibromuscular dysplasia (FMD) is an uncommon disorder, accounting for less than 10% of cases of renal artery stenosis, and typically presenting with hypertension in young women. This article reports the case of a previously healthy 37-year-old man presenting with acute-onset, severe, bilateral flank pain. Initially treated for ureteral colic and urinary tract infection, he was transferred to the nephrology clinic upon recognition of a rising serum creatinine. He was found to have FMD of bilateral renal arteries with a stenotic pattern on the right side and a dissecting aneurysm on the left side with resultant infarctions in both kidneys. On the basis of negative serological markers of vasculitis, a diagnosis of FMD complicated by bilateral renal infarctions was made. A stent was placed to the right stenotic renal artery, which resulted in sufficient lumen patency. No invasive procedure was performed on the other side owing to the complexity of the lesion. After 2.5 years of follow-up, the patient remained in good condition with normal renal function and adequate blood pressure control with dual antihypertensive therapy. Renal infarction complicating FMD of renal arteries is rare in the literature, with most of the cases having causative cardiovascular risk factors including coagulopathy, ischaemic heart disease, atrial fibrillation or structural cardiac abnormalities, none of which was present in this case. In conclusion, FMD may occur in atypical asymmetric presentations causing renal infarctions in both kidneys. Radiological interventions in such cases should focus on stabilizing renal lesions and renal function.
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PMID:Bilateral renal infarctions complicating fibromuscular dysplasia of renal arteries in a young male. 2162 38


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