1/10. Diabetes-associated cardiovascular risk factors.Cardiovascular disease is the biggest killer in the UK and diabetes puts people at increased risk of this disease. The role of nurses in reducing cardiovascular risk in diabetes is explored.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
2/10. Acute renal failure secondary to angiotensin ii receptor blockade in a patient with bilateral renal artery stenosis.A 54-year-old man with diabetes mellitus, peripheral vascular disease, and hypertension was admitted to the hospital for an acute exacerbation of chronic heart failure. Therapy with intravenous furosemide and oral losartan 100 mg twice/day was begun. Ten days later, the patient's blood urea nitrogen and serum creatinine levels rose and peaked at 110 and 6.0 mg/dl, respectively. His serum potassium level increased to 5.7 mg/dl, urine output dropped to 400 ml over 24 hours, and mental status changes occurred. magnetic resonance angiography revealed bilateral renal artery stenosis. After losartan was discontinued and hemodialysis was performed for 3 consecutive days, the patient's renal function returned to his baseline level. Reports in the medical literature reinforce the importance of recognizing that angiotensin-converting enzyme inhibitors should be used with caution in patients with bilateral renal artery stenosis. However, the literature is not as definitive about using of angiotensin ii receptor blockers (ARBs) in these patients. Our patient's experience suggests that ARBs should be used with caution in patients with bilateral renal artery stenosis. Clinicians should be aware that renal failure might occur when using ARBs in these patients.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
3/10. hypertension, the endothelial cell, and the vascular complications of diabetes mellitus.hypertension is a major factor that contributes to the development of the vascular complications of diabetes mellitus, which primarily include atherosclerosis, nephropathy, and retinopathy. The mechanism of the pathophysiological effects of hypertension lies at the cellular level in the blood vessel wall, which intimately involves the function and interaction of the endothelial and vascular smooth muscle cells. Both hypertension and diabetes mellitus alter endothelial cell structure and function. In large and medium size vessels and in the kidney, endothelial dysfunction leads to enhanced growth and vasoconstriction of vascular smooth muscle cells and mesangial cells, respectively. These changes in the cells of smooth muscle lineage play a key role in the development of both atherosclerosis and glomerulosclerosis. In diabetic retinopathy, damage and altered growth of retinal capillary endothelial cells is the major pathophysiological insult leading to proliferative lesions of the retina. Thus, the endothelium emerges as a key target organ of damage in diabetes mellitus; this damage is enhanced in the presence of hypertension. An overall approach to the understanding and treatment of diabetes mellitus and its complications will be to elucidate the mechanisms of vascular disease and endothelial cell dysfunction that occur in the setting of hypertension and diabetes.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
4/10. Clinical and etiological heterogeneity of idiopathic diabetes mellitus. The banting memorial lecture.We have presented and reviewed evidence for the heterogeneous nature of diabetes mellitus in terms of genetics, environmental factors, insulin responses to glucose and vascular disease. We have reviewed evidence for heterogeneity between juvenile-onset diabetes (JOD) and maturity-onset diabetes (MOD) and maturity-onset diabetes of young (MODY) and for heterogeneity within groups of JOD and MOD and MODY patients. Although much remains to be learned, a beginning has been made and suggests that primary diabetes mellitus is not a single specific disease but a syndrome comprised of a variety of diseases all characterized by hyperglycemia and tissue changes that result from heterogeneous etiologic and pathogenetic factors. Future classifications of primary diabetes mellitus will undoubtedly be lengthy, as are for other diseases and syndromes also caused by a variety of etiologic and pathogenetic mechanisms.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
5/10. Fibrocalculous pancreatic diabetes in the elderly.Fibrocalculous pancreatic diabetes (FCPD) is a form of diabetes seen in tropical countries. It is secondary to chronic, calcific, non-alcoholic pancreatitis. FCPD is usually a disease of youth. This paper reports on two elderly onset cases of FCPD. Macrovascular complications are usually rare in FCPD patients. These two patients had evidence of macrovascular diseases probably due to the older age group of the patients.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
6/10. hyperparathyroidism and coexisting diabetes mellitus. Altered carbohydrate metabolism.hyperparathyroidism was diagnosed in a 67-year-old diabetic man treated for 20 years with isophane insulin suspension, 40 to 45 units/day. It was also diagnosed in a 64-year-old diabetic with severe retinopathy and vascular disease, who was not dependent on insulin. In the first case, removal of a parathyroid adenoma resulted in frequent hypoglycemic attacks, which led to a reduction of the administration of insulin isophane suspension to 20 units/day. In the second case, there was a notable improvement in the glucose tolerance testing that followed surgery, accompanied by a decrease in total plasma insulin response from 17,838 to 5,605 units, by planimetry. These observations suggest that hyperparathyroidism worsens coexisting diabetes mellitus and that one must be aware of increased insulin sensitivity and the possibility of severe hypoglycemia in cases that require insulin after surgical correction of the hypercalcemic state.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
7/10. Major complications of silicone penile prosthesis: predisposing clinical situations.necrosis of the corpora cavernosa of the penis developed in 2 patients with diabetes mellitus complicated by significant vascular disease following insertion of a silicone penile prosthesis necessitating its removal. The surgical maneuvers thought to predispose to these complications will be considered.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
8/10. Transcutaneous oxygen tension measurement in peripheral vascular disease.To date, results of laboratory and clinical investigations suggest that transcutaneous pO2 measurements hold considerable promise as a technique for evaluating the adequacy of cutaneous circulation. The advantages of this technique are that it is simple to use, noninvasive and does not require the use of radioactive isotopes. Since the available data are, as yet, insufficient to confirm the reliability of this technique, a prospective study of segmental transcutaneous pO2 values in patients with peripheral vascular disease is being continued. These values are then being correlated with the subsequent clinical course.- - - - - - - - - - ranking = 5keywords = vascular disease (Clic here for more details about this article) |
9/10. Free-tissue transfer for lower-extremity reconstruction in the immunosuppressed diabetic transplant recipient.The technique of free-tissue transfer for complex wounds has become a common tool in reconstructive surgery. The use of this modality in immunosuppressed transplant patients, who often have associated metabolic and vascular disease, has not been well-documented. The authors report three cases of lower-extremity reconstruction in renal-transplant recipients, utilizing microvascular free-tissue transfer. All three patients were hypertensive diabetic patients with symptomatic peripheral vascular disease and chronic wounds. One patient presented with an exposed achilles tendon; the second had a complex wound of the forefoot; and the third patient had a large ulceration on the heel of the right foot. These three patients underwent successful free-tissue transfer, and have regained full use of their limbs and ambulation. Free-tissue transfer in the immunosuppressed transplant recipient is a viable reconstructive option. Careful perioperative metabolic monitoring and surgical care are critical for success. A multispecialty approach is advocated, to coordinate limb salvage in these patients.- - - - - - - - - - ranking = 2keywords = vascular disease (Clic here for more details about this article) |
10/10. Fatal hand sepsis in Tanzanian diabetic patients.hand infections are common presentations among diabetic patients admitted to hospital in tanzania. The morbidity and mortality are high and patients' hospital inpatient stay tend to be prolonged because of suboptimal therapy. We describe four diabetic patients with hand infections and fatal outcomes. In contrast to patients with foot infections, none of our patients had clinical evidence of peripheral neuropathy or vascular disease. All four patients eventually died in hospital after acquiring hand sepsis and diabetic ketoacidosis which did not respond to prolonged courses of intravenous insulin and antimicrobials. literature review suggests such infections are at least as likely to include Gram-negative organisms as staphylococcus aureus. Primary management should have included aggressive surgery with limb amputation if necessary with adjunctive antimicrobial therapy.- - - - - - - - - - ranking = 1keywords = vascular disease (Clic here for more details about this article) |
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