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At least 595 records · Page 33Linked to original sources
PubMedDate not supplied

Unawareness of hypoglycaemia in insulin-treated diabetic patients: prevalence and relationship to autonomic neuropathy.

Three-hundred and two insulin-treated diabetic patients were questioned about hypoglycaemia using a structured questionnaire interview. Two-hundred and twenty-six patients (75%) had normal symptomatic awareness, 48 (16%) had partial awareness, 21 (7%) had absent awareness of hypoglycaemia, and 7 (2%) denied ever experiencing hypoglycaemia. Patients with complete loss of awareness of hypoglycaemia had diabetes of longer duration; none had a HbA1 concentration within the non-diabetic range. Loss of awareness of hypoglycaemia was associated with an increased incidence of severe hypoglycaemia, 19 (91%) of the patients with absent awareness, and 33 (69%) with partial awareness of hypoglycaemia experiencing severe hypoglycaemia over 1 year compared with only 41 (18%) of patients with normal awareness of hypoglycaemia (p less than 0.001). Cardiovascular autonomic function tests were performed in 226 (75% of the whole group). Of the patients who had diabetes for more than 15 years, 54% (n = 39) with normal awareness of hypoglycaemia, compared with 59% (n = 10) with absent awareness of hypoglycaemia, had evidence of cardiovascular autonomic impairment (NS). Seven (41%) of the 17 patients with absent awareness of hypoglycaemia and diabetes of greater than 15 years duration had no evidence of autonomic dysfunction. Loss of hypoglycaemia awareness is a common problem in patients with insulin-treated diabetes of long duration, is associated with an increased incidence of severe hypoglycaemia, but is not invariably associated with abnormal cardiovascular autonomic function tests.

Adolescent↗
PubMed1983

Autopsy-determined causes of death after cardiac valve replacement.

We reviewed records of 378 patients who died after cardiac valve replacement and underwent autopsy at The Methodist Hospital, Houston, from 1962 through 1979. Patients were divided according to postoperative interval at death: within 30 days (early) or 30 days to ten years (late). Early deaths (279 patients) were due almost exclusively to cardiovascular abnormalities or operative complications (94%). Only 6% of early deaths were caused by prosthesis-associated complications. In contrast, late deaths (99 patients) were valve related in 47% of cases, including complete thrombotic occlusion or systemic thromboembolism (21%), prosthetic valve endocarditis (14%), valve dehiscence (6%), anticoagulation-related hemorrhage (3%), and mechanical degeneration (2%). Nine percent of late deaths were unrelated to cardiovascular disease. Thus, while early deaths primarily reflected the severity of preexisting or associated cardiovascular disease, prosthesis-associated complications were an important cause of late death after cardiac valve replacement.

Anticoagulants↗
PubMed1993

Cardiorespiratory effects of laparotomy in patients with spinal cord injury.

Patients with spinal cord injuries who require laparotomy are often difficult to diagnose and have an acute illness superimposed on a background of respiratory and cardiovascular abnormalities. Although pulmonary capacity is markedly reduced by paralysis, these patients tolerate elective laparotomy well. Emergency surgery for abdominal infection led to cardiac instability in two patients and prolonged respirator support in a third. This series of 12 patients supports elective colostomy for colon and perineal problems in these patients, even those with poor ventilatory volumes. Emergency surgery was marked by dramatic cardiovascular problems, which were corrected with pulmonary artery pressure monitoring of fluid resuscitation.

Adult↗
PubMedDate not supplied

[Immunogenetic study in a case of DiGeorge syndrome].

DiGeorge Syndrome is a congenital immunodeficiency characterized clinically by hypocalcemic tetany, congenital heart disease, unusual facies, and increased susceptibility to infection. Pathologically, the syndrome is marked by the abscence or hipoplasia of the thymus and parathyroid glands as well as cardiac or aortic arch abnormalities. Most patients show partial or complete T cell immunodeficiency and normal or near-normal B-cell immunity. A review is made on a clinical case of DiGeorge syndrome is presented. A 52 days old boy, was admitted through emergency. There was no familial evidence of alcoholism or immunodeficiency. He showed irritability due to hypocalcemia. The examination revealed facial and cardiovascular abnormalities and the immunological investigation revealed hypogammaglobulinemia, deficiency of the cell, CD4 and CD8 decreased and with inverted relation. Chest X ray showed cardiomegaly grade II, and no thymus was seen. The diagnosis of the complete DiGeorge syndrome was based on the abnormalities found.

Abnormalities, Multiple↗
PubMed1979

Dysfunction of the sympathetic nervous system in tetanus. A study of 3 cases.

In severe cases of tetanus an overactivity of the sympathetic nervous system has been postulated because of the clinical symptoms including hypertension, fluctuating blood pressure, tachycardia, tachyarrhythmia and peripheral vasoconstriction. In the present study the involvement of the sympathetic nervous system in tetanus was investigated by serial determinations of plasma adrenaline (A) and noradrenaline (NA) in 2 patients who developed severe symptoms of tetanus and the characteristic cardiovascular disturbances. Sustained high circulating levels of NA and A could be observed indicating a prolonged overactivity of the sympathetic nervous system. In one case, the elevation of the NA level in plasma persisted until the disturbances of the motor nervous system ceased. In a third case of tetanus without cardiovascular abnormalities, the plasma NA and A only increased slightly on a few occasions. The results demonstrate that an overactivity of the sympathetic nervous system can complicate the course of severe tetanus.

Adult↗
PubMed2001

[Clinical features of a senior patient with Williams syndrome].

We experienced a case of 62-year-old woman who was admitted for the evaluation of her trembling hands. She was diagnosed as Williams syndrome (WS) by fluorescent in situ hybridization (FISH) analysis. She was short in stature, had a characteristic face and moderate mental retardation, whereas she was talkative and gregarious. She also presented impaired visuospatial cognition, cerebellar ataxia and tremor like involuntary movement of the hands. No remarkable abnormality is noted in MRI of the brain. MRA study of the brain revealed the arteriosclerotic vascular change, such as elongation of basilar artery and dilatation of bilateral carotid arteries. Heterozygous microdeletion of chromosome 7q11.23 of this patient is typical for WS, the delction including elastin (ELN) and LIMK 1 gene. Although she was complicated by diabetes mellitus and hyperlipidemia, she had no cardiovascular abnormalities like supravalvular aortic stenosis (SVAS), and survived to her age in good condition. The tremor-like involuntary movement disappeared after her discharge and its mechanism remains to be elucidated.

Brain↗
PubMed1998

[Immunoregulatory mechanisms of action of intravenous gammaglobulin in Kawasaki syndrome].

Kawasaki Syndrome (KS) is an acute vasculitis in young children associated with the development of coronary artery abnormalities. KS has been reported to occur in over 40 countries including Poland. The etiology of this disease remains controversial. However, recent studies suggest a potential role of bacterial toxins (superantigens) in the immunopathogenesis of KS. Immunomodulatory benefit and potential toxin neutralisation by intravenous immune globulin (IVIG) support the hypothesis of superantigen-related activation of the immune system in KS. The prevalence of cardiovascular abnormalities can be significantly reduced by treating patients during the first 10 days of illness with high-dose of intravenous gammaglobulin. The following predominant and non-exclusive mechanisms of action have been proposed to account for the immunomodulatory effects of IVIG in Kawasaki and other immune-mediated diseases: (i) functional blockade of Fc receptor on monocytes/macrophages; (ii) modulation of the production of cytokines and cytokine antagonists; (iii) inhibition of complement mediated damage; (iv) neutralisation of bacterial toxins by specific antibodies; (v) neutralisation of circulating autoantibodies by complementary (e.g. anti-idiotypic) antibodies in IVIG. These observations provide an important information that early recognition and prompt treatment of this illness is critical for a successful outcome.

Child↗
PubMedDate not supplied

[Aortic coarctation and pregnancy].

The association of coarctation of the aorta and pregnancy has been cause of concern among the various medical specialties involved in the care of patients with these conditions, as this cardiovascular abnormality is included in the list of disease potentially critical during pregnancy. The individually reported experience with this association has not been large, on account of the male predominance of this relatively rare congenital entity. The experience in the Internal Medicine Service of the "Concepción Palacios" Maternity Hospital of Caracas, Venezuela, between 1968 and 1985 is presented. Nine cases represented 2.9% of the congenital cardiovascular diseases, 0.84% of all cardiovascular diagnoses and 1.06 per 100.000 of all patients obstetrically attended during that period. In our experience, pregnancy is feasible in patients with coarctation, tolerance to gestation is generally good and fertility is not adversely affected, as well as prematurity and perinatal morbidity and mortality. The unique clinical situation of each patient, is to be nevertheless individually analyzed, especially in search for any other associated circulatory pathologic condition (s) which might render the patient more vulnerable than the average in the general group. The obstetric must prevail over the cardiologic criteria in the majority of cases, as to the mode of termination of pregnancy.

Adult↗
PubMed1997

Risk profiles and cardiovascular preparticipation screening of competitive athletes.

There has been heightened interest in the design and role of preparticipation screening for high school and college athletes. An American Heart Association consensus panel, composed of cardiovascular specialists and other physician experts having extensive clinical experience with athletes of all ages as well as a legal expert, assessed the benefits and limitations of preparticipation screening for early detection of cardiovascular abnormalities in competitive athletes. The panel addressed cost-efficiency and feasibility issues as well as the medicolegal implications of screening; and developed consensus recommendations and guidelines for the most prudent, practical, and effective screening procedures and strategies.

Adolescent↗
PubMed1997

Cardiovascular evaluation of the athlete. Issues regarding performance, screening and sudden cardiac death.

Recent studies have reported ECG anomalies and a high prevalence of exercise-related arrhythmias among well trained, apparently healthy endurance athletes with superior levels of cardiorespiratory fitness. The occurrence of sudden and premature cardiac deaths in amateur and professional athletes, who appear to embody all of the virtues of health and fitness, ahs raised our consciousness regarding the underlying atherosclerotic or nonatherosclerotic causes, and the need for, and extent of, preparticipation screening in competitive athletes. It appears that strenuous physical activity may trigger acute cardiovascular events in some athletes. Coronary artery disease is the most frequent autopsy finding in those over the age of 35 years who die suddenly. In contrast, structural cardiovascular abnormalities, including hypertrophic cardiomyopathy and malformations of the coronary arteries, are the major cause of sudden death in younger athletes. This article reviews these issues, with specific reference to the assessment of cardiorespiratory fitness, legal and prohibited performance-altering medications, the pathophysiological basis of exertion-related untoward events, the athlete at risk, limitations of conventional screening programmes and contemporary recommendations to identify latent cardiovascular disease in athletic populations.

Anaerobic Threshold↗
PubMed1983

What is an adverse health effect?

Health is defined as homeostasis of the cellular ecology, and a state where there has not been an inordinate loss, reversible or irreversible, of the structural and/or functional reserves of the body. An adverse health effect is defined as the causation, promotion, facilitation and/or exacerbation of a structural and/or functional abnormality, with the implication that the abnormality produced has the potential of lowering the quality of life, contributing to a disabling illness, or leading to a premature death. Experimental animal studies indicate that poor air quality has the potential for serious adverse health effects through perturbations of the cellular ecology over long-term periods. Some of the most important concerns are inordinate depletions of lung reserves (in particular, emphysema), the facilitation of cancer metastasis to the lung, the facilitation of immunologic deficits with the concomitant expression of opportunistic organisms, and amplification of cardiovascular abnormalities (in particular, ischemic heart disease). It is argued that air quality standard setting should more strongly consider adverse health effects that are presently subclinical in nature in order to achieve early prevention instead of late correction.

Adolescent↗
PubMed1998

Effect of orthotopic liver transplantation on the progression of familial amyloidotic polyneuropathy.

BACKGROUND: Familial amyloidotic polyneuropathy (FAP) is an autosomal dominant inherited disease associated with a mutant form of the protein transthyretin (TTR). It is characterized clinically by the systemic deposition of amyloid fibrils resulting in organ dysfunction and, ultimately, death. The majority of TTR is produced in the liver, and transplantation of the liver has been shown to ameliorate this source of mutant TTR, arresting the progression of this fatal disease. METHODS: Thirteen patients with FAP have undergone successful liver transplant surgery at our center since 1992. The impact of liver transplantation on amyloid-related polyneuropathy, cardiovascular, and gastrointestinal dysfunction is reported in this study. Three patients who died before cardiovascular and neurological follow-up are excluded from the analysis. RESULTS: Ten of 13 patients (77%) remain alive an average of 49 months (range, 17-64 months) after transplantation. Three patients suffered sudden death, with autopsy documentation of amyloid deposits involving the conduction system of the heart. Liver transplantation was performed more quickly, required less blood, and a shorter postoperative hospital stay in these patients, compared with patients with cirrhosis. Neurological and nutritional symptoms improved in the majority of affected patients. Those patients with echocardiographic evidence of ventricular wall and valve thickening before transplantation progressed postoperatively despite neurologic improvement. CONCLUSIONS: Liver transplantation offers the only cure for the genetic defect causing FAP and appears to result in subjective and objective improvement in neurological dysfunction. Patients with preexisting cardiovascular abnormalities progress despite transplantation; therefore, consideration for combined heart-liver transplantation may be warranted in this subset of patients.

Adult↗
PubMed2002

Blood flow response in individuals with incomplete spinal cord injuries.

STUDY DESIGN: Cross sectional comparison, control group. OBJECTIVE: To determine if incomplete spinal cord injured patients (SCI) have an abnormal blood flow response to cuff ischemia compared to able-bodied individuals (AB). SETTING: Academic institution. METHODS: Blood flow in five chronic incomplete SCI patients (C4-C5) and 17 able bodied individuals was measured in the common femoral artery using quantitative Doppler ultrasound (GE LogiQ 400CL) at rest and after distal thigh cuff occlusion of 2, 4 and 10 min to investigate whether blood flow or vascular control were different in SCI's and AB. RESULTS: Blood flow and the diameter of the common femoral artery at rest were similar in incomplete SCI and AB. Peak flow after 10 min of cuff ischemia (the highest found) was also comparable between incomplete SCI and AB. The half-time for recovery of blood flow to baseline after 2, 4 or 10 min of ischemia was 50% longer for incomplete SCI compared to the AB (P = 0.023). In addition, peak blood flow after 2 and 4 min of ischemia relative to the maximum, 10 min value (2/10 and 4/10 ratios) was lower in incomplete SCI compared to AB (0.65 +/- 0.06 vs 0.76 +/- 0.15, P = 0.029 and 0.75 +/- 0.10 vs 0.89 +/- 0.11, P = 0.014, respectively). CONCLUSION: This study demonstrated that incomplete spinal cord injured patients have impaired vascular control seen as a slower return to resting flow after cuff ischemia and reduced sensitivity to ischemia relative to maximum flow. However, incomplete SCI patients did not demonstrate impaired flow capacity as seen in complete SCI patients suggesting that smaller cardiovascular abnormalities are seen with incomplete versus complete SCI injury. Impaired vascular control may serve to limit exercise capacity and may contribute to increased cardiovascular disease. Impaired circulation could contribute to impaired muscle function and poor cardiovascular health in incomplete SCI's, although these findings need to be replicated in a study with more subjects.

Adult↗
PubMed1983

The cardiovascular profile of bupropion.

The cardiovascular profile of bupropion has been assessed in over 700 depressed patients. Most of the studies reviewed were double-blind comparisons with placebo or amitriptyline. Subjects included depressed adult outpatients without cardiovascular disease, elderly patients, and patients with cardiovascular disease. Increased heart rate was seen only with amitriptyline, which also caused a subclinical delay in cardiac conduction. Bupropion did not adversely affect supine or standing blood pressure, and patients with tricyclic-induced orthostatic hypotension did not show orthostasis when treated with bupropion. The incidence of subjective cardiovascular complaints with amitriptyline but not with bupropion exceeded that with placebo. Patients with cardiovascular disease who received bupropion had no change in heart rate or blood pressure compared to baseline; their incidence of cardiovascular complaints was comparable to that of disease-free controls. Finally, five patients who took large amounts of bupropion in suicide attempts showed no distinct cardiovascular abnormalities. Thus, bupropion appears safer than amitriptyline and other tricyclics in patients who are prone to orthostatic hypotension or cardiac conduction disorders, and may have a wider safety margin in overdose.

Adult↗
PubMedDate not supplied

Long-term outcome in hemodialysis: morbidity and mortality.

Despite technical and pharmacological improvements achieved over the past years, long-term prognosis of patients undergoing chronic hemodialysis is still rather poor. Cardiovascular disease is the leading cause of both morbidity and mortality in these patients, mostly because of their severely compromised cardiovascular conditions already at the time of starting hemodialysis. A proper management of factors involved in the development of cardiovascular abnormalities is therefore a basic pre-requisite for improving their clinical outcome. Hypertension and anemia should be adequately evaluated and corrected, in light of their primary involvement in the pathogenesis of left ventricular hypertrophy, whereas treatment of calcium and phosphate metabolism disorders, particularly of high serum phosphorus levels, is needed to prevent the development of severe secondary hyperparathyroidism and mainly vascular calcifications, whose detrimental pathophysiologic consequences on cardiovascular structures are huge. At the same time, the prescription of the hemodialytic treatment should be optimised, with a satisfactory removal of uremic toxins through the delivery of an adequate dialysis dose and with the use of biocompatible membranes, where possible, thus minimizing the inflammatory response secondary to the interaction between blood and the artificial material of the hemodialysis system. The clinical superiority of high-flux membranes, although suggested by all studies performed so far, has still to be demonstrated by well-conducted clinical studies; on-line convective treatments and daily hemodialysis, although promising, also need to be confirmed in randomized trials. In conclusion, long-term outcome of hemodialysis patients may only be improved by a complex, multi-factorial therapeutical approach.

Anemia↗
PubMed1983

Relationship between impaired parasympathetic and sympathetic cardiovascular control in diabetes mellitus.

We have investigated the relationship between vagal and sympathetic lesions in 62 diabetic patients and compared the results with those from 37 healthy subjects. Vagal function was assessed by heart rate changes with forced breathing. Sympathetic control was measured by the heart rate and blood pressure changes after standing and the concomitant plasma catecholamine response. The integrity of the postganglionic sympathetic neuron was evaluated separately by testing sudomotor function. Impaired sympathetic control was found only in 15 diabetic patients with severely impaired or absent vagal heart rate control. In 12 patients the chief abnormalities consisted of a delayed and diminished heart rate increase, an excessive fall in systolic blood pressure (greater than 20 mmHg) in combination with an abnormally small noradrenaline increment (less than 120 ng/l) and a lesion of the postganglionic sympathetic neuron. Three patients with severely impaired parasympathetic heart rate control in combination with an intact postganglionic sympathetic neuron demonstrated a large noradrenaline increase on standing (greater than 700 ng/l). Measurement of vagal heart rate control and testing of sudomotor function makes it possible to classify a spectrum of abnormal cardiovascular responses to standing in diabetic patients.

Adult↗
PubMed2005

Arterial stiffness in mild primary hyperparathyroidism.

When primary hyperparathyroidism was a more symptomatic disease, it was often associated with increased cardiovascular risk. As the clinical manifestations of the disease have changed to a milder, more asymptomatic disorder, investigation is shifting to more subtle cardiovascular abnormalities. We measured arterial stiffness in 39 patients with mild primary hyperparathyroidism [serum calcium, 2.66 +/- 0.2 mmol/liter (10.7 +/- 0.6 mg/dl); PTH, 21.7 +/- 9.5 pmol/liter (89 +/- 39 pg/ml)] and in 134 controls. Arterial stiffness was measured mathematically at the radial artery with a noninvasive device as the "augmentation index" (AIx). The AIx measures the difference between the second and first systolic peaks in the pressure waveform and correlates with increased cardiovascular risk. When physiological variables affecting augmentation index and potentially confounding cardiovascular risk factors (age, gender, heart rate, height, blood pressure, diabetes mellitus, smoking, and hyperlipidemia) were adjusted for, primary hyperparathyroidism was an independent predictor of increased augmentation index (B = 3.37; P < 0.03). A matched-pair analysis showed that 15% of the variance in AIx was uniquely accounted for by the presence of primary hyperparathyroidism. The presence of primary hyperparathyroidism was a stronger predictor of elevated AIx than age, gender, smoking, hypertension, hyperlipidemia, or diabetes mellitus. AIx was also directly correlated with evidence of more active parathyroid disease, including higher PTH levels (r = +0.42; P < 0.05) and lower bone mineral density at the distal one-third radius (r = -0.33; P < 0.05). The diagnosis of primary hyperparathyroidism was therefore an independent predictor of increased AIx, an early measure of arterial stiffness, and the increase was associated with evidence of more active parathyroid disease.

Aged↗
PubMed1983

[Isolated azygos continuation of the inferior vena cava].

The finding, on systemic X-ray examination of a 20-years ol Algerian patient, of an opaque image along the right side of the suprahilar trachea led to the discovery of a rare abnormality of venous return known as azygos continuation of the inferior vena cava. The opacity was ovoid in shape, 4 X 1.7 cm in dimension, well circumscribed and homogeneous. It shrunk during a Valsalva's manoeuvre and increased in size when the patient was lying down. Angiography through the femoral vein showed that the inferior vena cava was interrupted below the liver and continued with the azygos vein. No other cardiovascular abnormality was detected and the situs was normal. Although rare or unrecognized because it is asymptomatic, azygos continuation of the inferior vena cava is the most common of congenital abnormalities of that vessel. It was described initially by Stark in 1835 and remained an anatomical curiosity until 1950. Since the development of vascular opacification techniques, it has been more frequently diagnosed, particularly in children, where it is usually associated with congenital heart disease and/or abnormal situs. Our case is peculiar in that no congenital abnormalities were present.

Abnormalities, Multiple↗