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At least 145 records · Page 8Linked to original sources
PubMed2003

Serum lipoproteins in the diabetes control and complications trial/epidemiology of diabetes intervention and complications cohort: associations with gender and glycemia.

OBJECTIVE: To relate the nuclear magnetic resonance (NMR)-determined lipoprotein profile, conventional lipid and apolipoprotein measures, and in vitro oxidizibility of LDL with gender and glycemia in type 1 diabetes. RESEARCH DESIGN AND METHODS: In the 1997-1999 Diabetes Control and Complications Trial/Epidemiology of Diabetes Intervention and Complications (DCCT/EDIC) cohort, serum from 428 women and 540 men were characterized by conventional lipids, NMR, apolipoprotein levels, and LDL susceptibility to in vitro oxidation. Simple and partial correlation coefficients were calculated for each lipoprotein-related parameter versus gender, with and without covariates (age, diabetes duration, concurrent HbA(1c), DCCT randomization, hypertension, BMI, waist-to-hip ratio, and albuminuria). For concurrent HbA(1c), data were analyzed as above, exchanging gender for HbA(1c). Associations were significant if P < 0.05. RESULTS: Although men and women had similar total and LDL cholesterol and triglycerides, men exhibited the following significant percent differences in NMR profiles versus women: small VLDL 41; IDL -30; medium LDL 39; small LDL 21; large HDL -32; small HDL 35; LDL particle concentration 4; VLDL and HDL diameters -8 and -4, respectively. Small VLDL, small HDL, medium LDL (women only), small LDL (men only), and LDL particle concentration were positively correlated, and HDL size was inversely correlated, with concurrent HbA(1c). NMR profile was unrelated to prior DCCT randomization. Susceptibility of LDL to oxidation was unrelated to gender and glycemia. CONCLUSIONS: Male gender and poor glycemia are associated with a potentially more atherogenic NMR lipoprotein profile. Neither gender nor glycemia influence LDL oxidation in vitro.

Adult↗
PubMed2003

Beta-cell function and the development of diabetes-related complications in the diabetes control and complications trial.

In patients with type 1 diabetes, measurement of connecting peptide (C-peptide), cosecreted with insulin from the islets of Langerhans, permits estimation of remaining beta-cell secretion of insulin. In this retrospective analysis to distinguish the incremental benefits of residual beta-cell activity in type 1 diabetes, stimulated (90 min following ingestion of a mixed meal) C-peptide levels at entry in the Diabetes Control and Complications Trial (DCCT) were related to measures of diabetic retinopathy and nephropathy and to incidents of severe hypoglycemia. Based on the analytical sensitivity of the assay (0.03 nmol/l) and study entry criteria, the DCCT subjects were divided into four groups of stimulated C-peptide responses: 40 mg/24 h once and repeated at the next annual visit). There were also differences in severe hypoglycemia across C-peptide levels in both treatment groups. In the intensively treated cohort there were essentially identical prevalences of severe hypoglycemia ( approximately 65% of participants) in the first three groups; however, those subjects with mixed-meal stimulated C-peptide level >0.20 nmol/l for at least baseline and the first annual visit in the DCCT experienced a reduced prevalence of approximately 30%. Therefore, even modest levels of beta-cell activity at entry in the DCCT were associated with reduced incidences of retinopathy and nephropathy. Also, continuing C-peptide (insulin) secretion is important in avoiding hypoglycemia (the major complication of intensive diabetic therapy).

Adult↗
PubMed1999

Early complications. Cardiac complications.

Cardiopulmonary complications developing after pneumonectomy are described. Arrhythmias are seen in about 25% of patients undergoing pneumonectomy, and supraventricular tachyarrhythmias are common. To date, the efficacy of medical prophylaxis has not yet been defined. Postpneumonectomy heart failure shares a common cause with postpneumonectomy edema. Cardiac herniation with subsequent torsion is a rare but fatal complication after pneumonectomy. Early recognition and prophylaxis are always crucial.

Anti-Arrhythmia Agents↗
PubMed1999

[Extra-intestinal complications of ulcerative colitis: hematologic complication].

Iron deficiency anemia, autoimmune hemolytic anemia, folic acid deficiency megaloblastic anemia, granulocytopenia, acute or chronic leukemia, idiopathic thrombocytopenic purpura have been reported as blood diseases among the extra-intestinal complications with ulcerative colitis until now. Iron deficiency anemia is most frequently seen, and it often derives from apparent or inapparent continuous gastrointestinal bleeding. Autoimmune hemolytic anemia produces antierythrocyte membrane autoantibody while idiopathic thrombocytopenic purpura produces antithrombocyte autoantibody leading to anemia or thrombocytopenia. For folic acid deficiency megaloblastic anemia and granulocytopenia, adverse reaction of sulfasalazine being administered to the patients with ulcerative colitis has been pointed out. While the cases with acute or chronic leukemia are reported increasingly, its cause is still unknown. For treatment of ulcerative colitis, it is considered necessary to find blood complications by carrying out general examinations of peripheral blood and examinations of blood picture, serum iron and folic acid routinely.

Agranulocytosis↗
PubMed2001

[Prevention of complications: a forgotten aspect of therapy? Thromboembolic complications].

In Heart Failure (HF) there is a prothrombotic state or hypercoagulation by changing of the blood flow, and by endothelial vessels or blood viscosity changes. Although these alterations in HF, the indication for an anticoagulant therapy is not precise, generally being done an empirical therapy, being still as a forgotten aspect in preventing the complications of this syndrome. When anticoagulant therapy is implemented the hemorrhagic complications risk must be carefully observed, for a significant quantity of patients may need hospital care. In spite of the existence of guidelines of the European Society of Cardiology and of the American Society of Heart Failure the decision of hypocoagulation treatment must be studied case by case, considering multiple facts, as the social state of the patient, because this therapy needs a good follow-up, a clinical surveillance and a frequent laboratory control.

Blood Coagulation Disorders↗
PubMed2001

[Bone complication in diabetic subjects with good metabolic control and without any late complications: selected problems. Part I: calcium, phosphorus and magnesium metabolism].

The aim of the study was to evaluate whether in diabetics with good metabolic control and without any diabetic complications, disturbances of calcium, phosphorus and magnesium metabolism or hormonal regulation (parathormone/calcitonin) were present, and if they depended on type of diabetes, duration time of diabetes, kind of hypoglycaemic treatment, sex or age of patients. 83 subjects were examined, including: 14 with type 1 diabetes mellitus, 49 with type 2 diabetes mellitus and 20 healthy persons. All tests were performed in standarized low-calcium diet conditions. In basal conditions both serum concentrations and daily urine excretion of calcium, phosphorus, magnesium were estimated. Oral and intravenous calcium load tests with simultaneous parathormone, calcitonin, calcium, magnesium and phosphorus concentrations estimation were done. The final conclusions were as follow: Both in type 1 diabetes mellitus and type 2 diabetes mellitus subjects with good metabolic compensation and without advanced diabetic complications a tendency to early disturbances of calcium-phosphorus metabolism is observed. Physiological hormonal control (parathormone/calcitonin) is preserved. Correlations between mineral metabolism and type of diabetes, duration time of diabetes, daily insulin dose, body mass index and sex are observed. Kind of hypoglycaemic treatment has only slight influence on the mineral metabolism.

Adult↗
PubMed1990

[Value of vitrectomy and lensectomy in the treatment of complicated cataracts and complications of eye injuries].

Vitrectomy and/or lensectomy was performed in 33 successive cases of traumatic and complicated cataracts. The discussed cases were divided into 2 groups: 1. late reconstructions of the anterior eye segment after injuries and 2. complicated cataracts. After surgery the visual acuity amounted 6/60 or better in 27 from 33 eyes (81.8 per cent). Full visual acuity was attained in 18 patients (54.5 per cent).

Adolescent↗
PubMed1979

[Participation of vaccinia virus in the pathogenesis of different clinical forms of postvaccinal complications. I. Frequency of vaccinia virus detection in the vaccinted who have usual and complicated reactions to vaccination].

The virological examination of 1365 samples taken from 469 children vaccinated against smallpox revealed considerable differences in the frequency and the time of vaccinia virus detection in different clinical forms of postvaccinal pathology as compared with uncomplicated vaccinal process. During the postvaccinal period taking its normal course vaccinia virus was isolated from 7.3% of children only from the pharynx till day 8 following vaccination. In generalized and creeping vaccinia the virus was isolated from 71.4% of children, in postvaccinal encephalitis from 57.1% of children, in vaccinal angina frove-mentioned complications vaccinia virus was detected in the samples obtained from the patients till days 24, 35, 15 and 24 respectively. The etiopathogenetic role of vaccinia virus in a number of postvaccinal complications is discussed.

Child, Preschool↗
PubMed1996

Lifetime benefits and costs of intensive therapy as practiced in the diabetes control and complications trial. The Diabetes Control and Complications Trial Research Group.

OBJECTIVE: To examine the cost-effectiveness of alternative approaches to the management of insulin-dependent diabetes mellitus (IDDM). DESIGN: A Monte Carlo simulation model was developed to estimate the lifetime benefits and costs of conventional and intensive insulin therapy. Data were collected as part of the Diabetes Control and Complications Trial (DCCT) and supplemented with data from other clinical trials and epidemiologic studies. SETTING: Twenty-nine academic medical centers. PATIENTS: Persons with IDDM in the United States who meet demographic and clinical eligibility criteria for enrollment in the DCCT. INTERVENTIONS: Conventional vs intensive diabetes management. RESULTS: Approximately 120 000 persons with IDDM in the United States meet DCCT eligibility criteria. Implementing intensive rather than conventional therapy in this population would result in a gain of 920 000 years of sight, 691 000 years free from end-stage renal disease, 678 000 years free from lower extremity amputation, and 611 000 years of life at an additional cost of $4.0 billion over the lifetime of the population. The incremental cost per year of life gained is $28 661. CONCLUSIONS: Over a lifetime, DCCT-defined intensive therapy reduces complications, improves quality of life, and can be expected to increase length of life. From a health care system perspective, intensive therapy is well within the range of cost-effectiveness considered to represent a good value.

Cost of Illness↗
PubMed1997

[Investigation of complications of bronchial artery embolization using superselective catheter system and platinum coil-major complications as vascular detachment].

We have performed bronchial artery embolization (BAE) in patients with hemoptysis using a superselective catheter system and a permanent-emboli coil. We performed an investigation because major complications were observed. Of a total of 57 BAE using this system, 7 cases of major complications as detachment of the large vessel were found. Although BAE using this system is effective because permanent emboli can be selectively in-dwelled in abnormally developing vessels, detachment of vessels were developed in 7 cases. They are found more frequently for embolization of the left bronchial artery and full attention should be paid to this phenomenon when performing this surgery.

Adult↗
PubMed1997

[Hemorrhagic complications of oral anticoagulant therapy: results of a prospective multicenter study ISCOAT (Italian Study on Complications of Oral Anticoagulant Therapy)].

BACKGROUND: To assess the incidence of bleeding complications during oral anticoagulant therapy (OAT) in a population of patients representative of daily practice in Italian anticoagulation clinics. METHODS DESIGN: prospective, inception-cohort, multicentre. SETTING: Thirty-four anticoagulation clinics federated in the Italian Federation of Anticoagulation Clinics. PATIENTS: 2745 consecutive patients, included from beginning of their first OAT course. Most patients were aged between 60 and 79 y (57.8%), with 8% being > or = 80 y. Venous thromboembolism was the most frequent indication for OAT (one third of all the patients), followed by non ischemic heart disease which mainly included atrial fibrillation (16.8% of patients). Warfarin (in 63.8% of patients) and acenocoumarol were the only anticoagulant drugs used. The targeted anticoagulation intensity was low (INR < or = 2.8) in 71% of patients and high (INR > 2.8) in the remainder. OUTCOMES: Fatal, major and minor bleeding events. Thrombotic events were also recorded, though not analyzed in the present report. FINDINGS: During the 2011 patient-years (pt-y) of follow-up, 153 bleeding complications (7.6% pt-y) were recorded--5 fatal (all cerebral haemorrhages, 0.25% pt-y), 23 major (1.1% pt-y) and 125 minor (6.2% pt-y). The rate of events did not vary according to sex, coumarin type, size of enrolling centre or targeted therapeutic range; it was higher in older patients (10.5% pt-y in those aged > or = 70 y, relative risk--RR--1.75, p < 0.001), in cases where indication for anti-coagulant treatment was peripheral and/or cerebrovascular disease (12.5% pt-y; RR 1.80, p < 0.01) and during the first 90 days of treatment (11% pt-y, RR 1.75, p < 0.001). One fifth of bleeding events occurred at a very low anticoagulation intensity (INR < 2; the category rate being 7.7% pt-y); the rate was 4.8% pt-y in the 2.0-2.9 INR category, reaching 9.5% pt-y, 40.5% pt-y and 200% pt-y in the 3-4.4, 4.5-6.9 and > or = 7 INR categories respectively (RR for INR levels > 4.5 = 7.91, p < 0.0001). CONCLUSIONS: The overall rate of bleeding events recorded in the present study was much lower than that recorded in other (including recent) observational and experimental studies. The risk of bleeding increased in the following cases: age > 70 y; arterial vascular disease as indication for OAT; first 3 months of treatment; INR values > or = 4.5. OAT has become safer in recent years, particularly if monitored in special anticoagulation clinics. Caution should be exercised when prescribing OAT in elderly patients and the intensity anticoagulation levels should be closely monitored to minimize incidental periods of overanticoagulation.

Aged↗
PubMed2002

[Treatment of complicated fracture of the distal radius with external fixator. Follow-up--complications--outcomes].

The performance of the external fixation regarding severe fractures of the distal radius was evaluated by means of a very detailed retrospective study. Between 1989 and 1994 74 Patients with 76 fractures of the distal radius with a mean age of 69 years for female and 39 years for male patients were treated with the external fixator. 37% were open fractures. Using the ASIF classification, 21% were type A-fractures, 8% were type B-fractures and 71% were type C-fractures. In 44 cases the external fixator was used primarily, in 32 cases secondarily after failed conservative treatment. Additional procedures were partially necessary (K-wires, screws, bone grafts etc.). 32 complications had to be noted, the lesion of the superficial branch of the radial nerve being the most common (16%). After a mean follow up of 36 months 60 patients with 61 fractures could be evaluated clinically and radiologically. With the Sarmiento score as well as the Castaing score, 84% could be classified as very good or good, 16% as fair, no poor results were recorded. From this study we conclude that the primary treatment of complex fractures of the distal radius can be performed with external fixation along with the additional procedures necessary (K-wires etc.). Because of the reliable elimination of pain caused by the fracture, it forms a preventive measure against reflex sympathic dystrophy.

Adult↗
PubMedDate not supplied

Obstetric complications as antecedents of schizophrenia: empirical effects of using different obstetric complication scales.

The new McNeil-Sjöström Scale for obstetric complications (OCs), as well as scales of Lewis et al. (Schizophrenia: Scientific progress. Oxford University Press, 1989) and Parnas et al. (British Journal of Psychiatry, 140, 416-420, 1982), were applied to the OC histories of 70 singleton schizophrenics and 70 demographically-matched controls from the same hospital delivery series, using blindly assessed hospital pregnancy and birth record information. With the McNeil-Sjöström scale, schizophrenics were found to have significantly increased rates of OCs for the total reproduction, as well as for labor-delivery and the neonatal period but not for pregnancy. Significant increases in OCs in these schizophrenics were also found in scores produced by the Lewis et al. scale but not by the Parnas et al. scale. Further application of these three scales to OC data obtained through parental report for 23 monozygotic (MZ) twin pairs discordant and 10 pairs concordant for schizophrenia, as well as seven normal control MZ pairs, showed a significant difference in OC rates across the different twin pair groups, when assessed by the McNeil-Sjöström and Parnas et al. scales, but not by the Lewis et al. scale. The particular scoring system used in a study is thus of considerable importance not only for findings concerning OC histories of schizophrenics vs. controls, but also for the relationship between OCs and other presumed etiological factors in schizophrenia. Among the three scales, the McNeil-Sjöström scale provided the most sensitive assessment of OC history for schizophrenics.

Adult↗
PubMed1983

Complications of vitreous surgery for diabetic retinopathy. I. Intraoperative complications.

One hundred seventy-nine eyes were analyzed to determine the incidence of intraoperative complications during vitrectomy for proliferative diabetic retinopathy. Inadvertent corneal epithelial defects occurred in 51 eyes (28%). The lens was removed in 42 (25%) of 170 phakic eyes. This was done through a pars plana approach. Accidental mechanical lens damage occurred in one eye, and mild pharmacologic lens damage occurred in two eyes. Some bleeding from fibrovascular tissue occurred in nearly every case, but this was controlled with diathermy except in seven eyes (4%) in which severe bleeding required premature termination of the operation. Latrogenic retinal tears occurred in 36 (20%) of the 179 eyes. Fifteen (34%) of the total of 44 retinal tears were anterior to the equator, and 11 (73%) of the 15 anterior tears were located posterior to the sclerotomy through which the vitrectomy probe was introduced. Twenty-nine (66%) of the 44 retinal tears were posterior to the equator, and 19 of the 29 occurred within 15 degrees radius of the fovea.

Adult↗
PubMed1985

Radial keratotomy complicated by sterile keratitis and corneal perforation. Histopathologic case report and review of complications.

A 35-year-old physician had radial keratotomy (RK) for correction of myopia. Combined radial and transecting circumferential incisions were used which resulted in wound gape, persistent epithelial defect, and severe sterile keratitis. Progressive corneal decompensation required an initial patch graft followed by a penetrating keratoplasty four months after RK. Histopathology of the cornea demonstrated epithelial edema and persistent incisional epithelial plug formation, deep and superficial vascularization, variable incision depth (superficial to full thickness), endothelial cell loss, and inflammatory cell infiltration at all levels of the cornea. A review of the reported complications of RK is included in the discussion of this case.

Adult↗
PubMed1995

Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. The Diabetes Control and Complications (DCCT) Research Group.

The Diabetes Control and Complications Trial (DCCT) has demonstrated that intensive diabetes treatment delays the onset and slows the progression of retinopathy, nephropathy, and neuropathy in patients with IDDM. A detailed description of the effects of this treatment on diabetic nephropathy is presented here. In the primary prevention cohort, intensive treatment reduced the mean adjusted risk of the cumulative incidence of microalbuminuria (> or = 28 micrograms/min) by 34% (95% CI 2, 56%; P = 0.04). Furthermore, intensive treatment decreased the albumin excretion rate (AER) by 15% after the first year of therapy (6.5 vs. 7.7 micrograms/min, P < 0.001). Thereafter the rates of change for AER within each treatment group were no different from zero, retaining a constant difference in AER between groups in the trial. In the secondary intervention cohort with baseline AER < 28 micrograms/min, intensive therapy reduced the mean adjusted risk of microalbuminuria (> or = 28 micrograms/min) by 43% (95% CI 21, 58%; P < 0.0001); the risk of a more advanced level of microalbuminuria (> or = 70 micrograms/min) by 56% (95% CI 26, 74%; P = 0.002); and the risk of clinical albuminuria (> or = 208 micrograms/min) by 56% (95% CI 18, 76%; P < 0.01). In the secondary intervention cohort, values for AER at year 1 were identical at 9 micrograms/min, but the 6.5% change per year in the conventional group greatly exceeded the rate of change of -0.3% in the intensive group (P < 0.001). Among the 73 secondary cohort subjects with AER levels > or = 28 micrograms/min but < or = 139 micrograms/min at baseline, the reduction of progression to clinical albuminuria with intensive therapy was not statistically significant. The longitudinal treatment effect of conventional versus intensive therapy (11.0% vs. 2.5% per year, respectively, P = 0.087) was similar in magnitude to that among patients with AER < 28 micrograms/min at baseline. For the primary, secondary and combined cohorts, there were no significant differences in the rates of change in creatinine clearance (CCr) between treatment groups during the study. Only seven subjects in the entire study (2 intensive, 5 conventional) developed urinary AER > or = 208 micrograms/min coupled with a CCr < 70 ml/min/1.73 m2. Neither the rate of change of blood pressure nor the appearance of hypertension (BP > 140/90 mm Hg) differed significantly between treatment groups in the primary, secondary or combined cohorts.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗