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Biomedical subjects

I Lerman Garber

Publications and source records attributed to I Lerman Garber.

12 recordsLinked to original sources
PubMed2000

[Prevalence of gynecologic changes in patients with diabetes mellitus and their correlation with other variables].

The structural abnormalities of the genitourinary tract and cervical/vaginal infections are common in patients with diabetes mellitus. The objective was to determine the prevalence of gynecological abnormalities in diabetic women and to investigate its association with different variables. Diabetic women, aged 20 years and older who were attending the diabetic outpatient clinic, were randomly selected. All patients underwent a clinical and gynecological examination and a urianalysis, and papanicolaou. Smear were obtained. A total of 98 women, 84.7% type 2 diabetics, with a mean age of 57 +/- 13 years were included. Uretherocele, cystocele and/or rectocele were present in 19% and cervicitis in 22% of the patients. Urinary incontinence (OR 3.1, p = 0.03) and the history of multiparity (OR 4.2, p = 0.03) were statistically associated with these structural abnormalities. The symptom of vaginal discharge (OR 3.8, p = 0.01) was the only one variable that correlated with cervicitis. By comparing patients with and without cervicitis or gynecologic abnormalities, no significant differences were observed related to the type, duration or treatment of diabetes, blood glucose control or the evidence of leukocyturia in the urine sample. There is an elevated prevalence (31%) of gynecological abnormalities (cervicitis and/or structural abnormalities) in diabetic women, and are mostly asymptomatic.

Aged↗
PubMedDate not supplied

[Postprandial lipemia in subjects with primary hypoalphalipoproteinemia and hypoalphalipoproteinemia associated with diabetes].

The postprandial (PP) elevations in triglyceride rich lipoproteins (TRL) are potentially atherogenic. We compared PP lipemia in non insulin dependent diabetes mellitus (NIDDM) with hypoalphalipoproteinemia (HA) and patients with primary HA. Eight males in each group, mean age +/- SD 54 +/- 10 years, were studied for 12 hours after the ingestion of a fat load (65 g of fat/square meter of body surface). Plasma glucose, triglycerides (TG) and cholesterol (C) in plasma and in the different lipoprotein fractions were measured. The PP triglyceridemia was significantly greater in NIDDM patients with HA and correlated with the fasting TG concentrations. The curve pattern of the lipemia (% delta) was otherwise similar in the patients with secondary or primary HA; only the triglyceridemia persisted for a longer period of time in the latter but was otherwise similar to that of the NIDDM patients with lower basal triglyceride values. Patients with primary HA may have a disturbed metabolism of triglyceride rich lipoproteins which have a delayed depuration during the postprandium. Basal HDL-C in patients with HA cannot predict the PP triglyceridemia.

Adult↗
PubMedDate not supplied

[Postprandial lipemia in the non-insulin-dependent diabetes mellitus patient. Effect of gemfibrozil].

The postprandial (PP) elevations in triglyceride rich lipoproteins are potentially atherogenic. To describe the characteristics of PP lipemia after a fat load in non insulin dependent diabetes mellitus (NIDDM) and evaluate the response to a fibric acid derivative, seven males with NIDDM were studied for 12 hours after the ingestion of a fat load (65 g of fat/square meter of body surface). Plasma glucose, and triglycerides and cholesterol levels were measured in total plasma and in the different lipoprotein fractions. The fat load study was repeated after four weeks of treatment with gemfibrozil (GEM) 600 mg x 2. PP triglyceridemia correlated significantly with the fasting triglyceride concentrations. Basal triglyceride levels diminished significantly with the use of gemfibrozil and so did the magnitude of the PP triglyceridemia. Otherwise the curve patterns of lipemia were similar before and after the use of the fibrate; only the triglyceridemia persisted for a longer period of time. Patients with NIDDM may have a significant PP lipemia which is not likely related to the diabetes per se as to the increased triglyceride levels frequently observed in these patients.

Cholesterol, HDL↗
PubMedDate not supplied

[The efficacy of cholestyramine as a hypocholesterolemic agent and its tolerance in a Mexican population].

The tolerance and efficacy of cholestyramine (12-16 gr/day) was evaluated in 19 patients with primary type-IIa hyperlipoproteinemia. All patients were on an isocaloric low-cholesterol diet that began at least one month before entry, and was continued during the eight weeks of the study. Cholestyramine significantly (p less than 0.001) lowered the plasma levels of cholesterol and of low density lipoprotein cholesterol from means of 288 +/- 46 mg/dl to 244 +/- 44 mg/dl and from 221 +/- 50 mg/dl to 171 +/- 46 mg/dl respectively. These were reductions of 15 and 22%. The magnitude of response to cholestyramine was unrelated to age, sex, cause of the hypercholesterolemia (familial or polygenic) or basal cholesterol levels. The drug was well tolerated. Only one patient was excluded because gastrointestinal discomfort. Because of its safety and efficacy, cholestyramine can be recommended as a first choice drug in the treatment of hypercholesterolemia.

Adult↗
PubMedDate not supplied

[The effect of psyllium plantago in slightly to moderately hypercholesterolemic patients].

The hypocholesterolemic effect of psyllium plantago (PP) was evaluated in 14 individuals with polygenic hypercholesterolemia. Subjects with secondary dyslipidemias were excluded. Since their admission until the end of the study all the patients had to follow an isocaloric diet, with less than 10% of the calories provided as saturated fats, P/S relation greater than 1 and daily intake of less than 300 mgr of cholesterol. The study was divided in two stages; the first one, from week -6 to 0 evaluated exclusively the response to diet, and the stage II, from week 0 to +12, evaluated the response to PP. The PP in envelopes with 3.4 grs each, was taken dissolved in water three times daily before meals. In the weeks -6, 0, +4, +8 and +12 were done lipid profiles that included; total cholesterol, triglycerides, and high density cholesterol. Cholesterol of the low density lipoproteins was obtained with the formula of Friedewald modified by De Long. The use of PP produced at week 12 a reduction of 8% in total cholesterol and 11% in LDL cholesterol. With non significant changes in triglycerides and HDL-C. We conclude that PP can be used as a complement of diet in the management of polygenic hypercholesterolemia.

Adult↗
PubMedDate not supplied

[The heart and diabetes mellitus].

The atherosclerotic process in the diabetic patient, is more common, it is noticed at early ages, advances more rapidly and almost equally affects males and females. This data, can not be explained on the basis of the association with other coronary heart disease risk factors, there is an intrinsic atherogenic factor attributed to diabetes, and can be related, to the early hyperinsulinemia, coagulation and lipid disorders, hyperglycemia or diabetic microangiopathy. Coronary heart disease has an increased prevalence in diabetic patients, that is not related with diabetes duration or the type of treatment. Early and late morbimortality after acute myocardial infarction and/or revascularization surgery is twice as common in the diabetic patient. Diabetic cardiomyopathy related to small vessels disease is still a matter of controversy and many authors doubt about its relevance in clinical practice. The presence of autonomic neuropathy with the cardiovascular denervation syndrome carries a poor prognosis. Early cardiovascular changes in asymptomatic patients, are detected with non-invasive test, and can help to introduce measures to protect individuals at a greater risk.

Cardiomyopathies↗
PubMedDate not supplied

[Metabolic control and the prevalence of dyslipidemia in children and adolescents with insulin-dependent diabetes mellitus].

Cholesterol, triglycerides and lipoprotein levels were assayed in serum of 152 children and teenagers with IDDM and in 228 non-diabetic siblings. A poor control of diabetes, reflected by high levels of glycosylated hemoglobin and/or high fasting blood glucose, was associated with statistically significant increases in total cholesterol, LDL-cholesterol and triglycerides, and a reduction in HDL-cholesterol. Mean total cholesterol levels in diabetic patients (171 +/- 33 mg/dL for males and 199 +/- 53 mg/dL for females) were statistically higher than those in their siblings (158 +/- 30 mg/dL and 164 +/- 33 mg/dL respectively). The prevalence of hypercholesterolemia (HC) and hypertriglyceridemia (HTG) were higher in the diabetic patients but statistically significant exclusively in females (prevalences of 40% vs 12% for HC and 30% vs 9% for HTG with a p value < 0.005). The diabetic patients in good metabolic control had similar lipid levels to those of their non-diabetic siblings. These data support the hypothesis that poor control of blood glucose is associated with atherogenic lipid profiles. The prevalence of hypercholesterolemia is impressively high in our diabetic population and indicates that all IDDM patients should have a serum lipid and lipoprotein analysis done annually; blood glucose control and dietary guidelines should be improved in these cases.

Adolescent↗
PubMedDate not supplied

[Non-insulin-dependent diabetes mellitus increases early mortality due to acute myocardial infarct].

Previous reports suggest that morbidity and mortality post acute myocardial infarction (AMI) are increased in patients with non-insulin-dependent diabetes (NIDDM). To obtain information in our population related to the prognosis after an AMI in diabetic patients and its major determinants, we studied 96 NIDDM patients admitted consecutively with a diagnosis of AMI. We used a control group (CG) of age and sex matched non-diabetic individuals. Patients with NIDDM had more frequently a history of angina (40 vs 23%, p < 0.001) and previous MI (30 vs 15%, p < 0.05). The AMI localization and extension, and the presence of arrhythmias were similar for both groups. Early mortality after the AMI was 22% in the NIDDM group and 12% in the CG with Odds ratio of 1.9 (CI 95% 0.91-5.15), being higher in diabetic females [2.3 (CI 95% 0.77-14.6) vs female CG and 1.5 (CI 95% 0.8-7.6) vs male NIDDM]. Extended MIs predicted higher mortality rate, especially among NIDDM patients (p < 0.05). Stepwise logistic regression test supported diabetes mellitus, per se, as a major contributor for mortality (p < 0.02), followed by MI localization and extension. The worst outcome was in NIDDM female patients of advanced age and hypertensive (p < 0.00001).

Age Factors↗
PubMedDate not supplied

[The absence of characteristics lesions in the microcirculation of non-insulin-dependent diabetic patients].

Diabetic cardiomyopathy apparently has an important role in the increased cardiovascular morbi-mortality of diabetic patients and its cause is likely to be secondary to small vessel disease. We undertook the present study to compare small and large vessel disease in hearts of patients who died with coronary disease, and determine how diabetes and/or hypertension correlates with these findings. The paraffin blocks of 52 hearts were used in this study. Cases were selected if they died from coronary artery disease and excluded if they had a previous angioplasty, revascularization surgery, congenital, rheumatic or other causes of heart disease. They were divided in two groups; diabetics and non-diabetics and each group was subdivided in hypertensives an non hypertensives. They were matched by age and sex. DM duration was 11 +/- 6 years and known hypertension of 10 +/- 4 years with no significant differences between both groups. The results were recorded without knowledge of patients clinical findings. Atherosclerotic heart disease was more advanced in DM patients, with an increased prevalence of three vessels disease, and more extensive myocardial infarctions. Diabetic subjects had increased (non significant) basal membrane thickening of the capillaries. We could not find differences in parenchymal hypertrophy, interstitial edema, proliferative endothelial lesions and luminal width in middle and large size vessels. Hypertensive patients had increased perivascular fibrosis (NS). Our results suggest that advanced atherosclerotic heart disease is more common in diabetic patients and diabetic cardiomyopathy, if present, seems not to related to a particular structural microvascular disease.

Aged↗
PubMedDate not supplied

[Thyroid nodule. Study of 88 cases].

We present a prospective study of 88 patients with thyroid nodules seen in our institution in 1985-86 and the results of a 5 year follow up. The algorithm for resolution among different therapeutic options was established in regard to the clinical characteristics, imaging and particularly the histopathologic studies. Their age ranged from 18 to 79 years; 94% of the patients were females. Most of the nodules were solid (69%) and measured 1-4 cm in diameter. The image of 62% of the thyroid scans was of a non-functioning nodule and 13% were hyperfunctioning. In 80% the ultrasonographic pattern was solid or mixed. Surgery was undertaken in 19 patients (21%). In 58%, a diagnosis of malignancy was established. The biopsy (aspiration and tru-cut) suggested the presence of the malignant tumors when taken together in 90% of the cases. Hormonal treatment was given to 62 patients; in 40-45% of them there was a significant reduction in the size of the nodule. Aspiration and sclerosis of cystic nodules were performed in 19 patients with significant shrinkage in 82%. Radioactive iodine was used in 11 patients. Our algorithm reduces costs and precludes unnecessary morbidity in patients with thyroid nodules.

Adolescent↗
PubMedDate not supplied

[Microalbuminuria and macrovascular risk factors in insulin-dependent diabetic children].

OBJECTIVE: To investigate the prevalence of microalbuminuria in children and teenagers with IDDM and its relationship with other variables. METHODS: We studied 160 IDDM children and teenagers with a mean age of 13 +/- 4 years from our endocrine department outpatient clinic. A complete medical history was obtained as well as a fasting blood sample for glycemia, glycosilated hemoglobin and lipid profile and a urine sample for microalbuminuria using laser immunonephelometry. RESULTS: 13 patients (8%) had microalbuminuria (20-200 micrograms/min) and 5 (3%) clinical proteinuria (> 200 micrograms/min). The abnormal excretion was more prevalent in females with the poorest metabolic control, the longest duration of diabetes, and the highest age (13-18 years). The presence of microalbuminuria or clinical proteinuria associated with a more atherogenic risk profile compared to patients with a normal urinary albumin excretion. CONCLUSIONS: There was a poor metabolic control in our IDDM population. In addition, our current findings in a population with a relatively short duration of their diabetes point out the need to improve an integral management strategy to prevent or delay the late complications associated with IDDM.

Adolescent↗