Journal of internal medicine. Supplement最新文献_第5页

Journal of internal medicine. Supplement Pub Date : 1994-01-01

G M Reaven

引用次数: 0

The contribution of lipids to coronary heart disease in diabetes mellitus. 血脂对糖尿病患者冠心病的影响。

Journal of internal medicine. Supplement Pub Date : 1994-01-01

M W Stewart, M F Laker, K G Alberti

{"title":"The contribution of lipids to coronary heart disease in diabetes mellitus.","authors":"M W Stewart, M F Laker, K G Alberti","doi":"","DOIUrl":"","url":null,"abstract":"Cardiovascular disease is two to three times more common in diabetic patients than in the non-diabetic population. Although risk factors that affect the general population such as age, cigarette smoking, hypertension, obesity and hypercholesterolaemia also affect diabetic subjects, the increased prevalence of hypertension and obesity in non-insulin-dependent diabetes mellitus (NIDDM) only partially explains the increased morbidity and mortality from coronary heart disease (CHD). Other factors must therefore be considered in this group of patients. Triglyceride concentrations, particularly post-prandial levels, may be important. Diabetic subjects have increased very-low-density-lipoprotein (VLDL), increased intermediate-density-lipoprotein (IDL) and low high-density-lipoprotein (HDL) concentrations, and differences in lipoprotein composition may partly explain increased atherogenesis. Although LDL levels of diabetic patients are not different from those of control subjects. LDL particles are potentially atherogenic as they are smaller, more dense and prone to oxidative modification. NIDDM subjects also have altered apolipoprotein concentrations, including increased apoB, apoC-III, and decreased apoA-I; in addition, apoE-2 may be over-represented in diabetic populations. Thus, apart from the traditional risk factors, there are several lipoprotein compositional abnormalities that may contribute to the increased prevalence of CHD in diabetes.","PeriodicalId":77556,"journal":{"name":"Journal of internal medicine. Supplement","volume":"736 ","pages":"41-6"},"PeriodicalIF":0.0,"publicationDate":"1994-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18983301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Non-insulin-dependent diabetes mellitus and atherosclerosis: a lipoprotein perspective. 非胰岛素依赖型糖尿病和动脉粥样硬化:脂蛋白的观点。

Journal of internal medicine. Supplement Pub Date : 1994-01-01

A Hamsten, G Steiner

引用次数: 0

Effects on chest pain of early thrombolytic treatment in suspected acute myocardial infarction: results from the TEAHAT Study. 早期溶栓治疗对疑似急性心肌梗死患者胸痛的影响:来自TEAHAT研究的结果。

Journal of internal medicine. Supplement Pub Date : 1991-01-01

M Risenfors, M Hartford, M Dellborg, N Edvardsson, H Emanuelsson, B W Karlson, B Sandstedt, J Herlitz

{"title":"Effects on chest pain of early thrombolytic treatment in suspected acute myocardial infarction: results from the TEAHAT Study.","authors":"M Risenfors, M Hartford, M Dellborg, N Edvardsson, H Emanuelsson, B W Karlson, B Sandstedt, J Herlitz","doi":"","DOIUrl":"","url":null,"abstract":"In a randomized, double-blind study, in which recombinant tissue plasminogen activator (rt-PA) administered at an early stage was compared with placebo in patients with suspected acute myocardial infarction (AMI), the effects on pain were studied in 312 patients. Inclusion criteria were as follows: (a) chest pain of duration less than 2 h and 45 min; and (b) age less than 75 years. Chest pain was estimated subjectively by the patients, using a 10-point numerical rating scale, at hourly intervals for the first 24 h, and by the requirement for narcotic analgesics. Compared with placebo, rt-PA treatment resulted in a 43% reduction in mean total pain score (P less than 0.0001), a 26% reduction in pain duration (P less than 0.01), and a 33% reduction in morphine requirement (P = 0.01). Fifty-seven per cent of all patients developed a confirmed AMI. In these subjects rt-PA reduced the pain score by 46% (P less than 0.001). Among patients without confirmed AMI, a 37% reduction in pain score was observed (P = 0.05). The effect on pain was most marked in patients with ST-elevation on the initial ECG. We conclude that early treatment with rt-PA in suspected AMI reduces chest pain considerably. The effect is most marked in patients with ST-elevation on the initial ECG.","PeriodicalId":77556,"journal":{"name":"Journal of internal medicine. Supplement","volume":"734 ","pages":"27-34"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13059754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Regulation of insulin action at the cellular level. 胰岛素作用在细胞水平上的调节

Journal of internal medicine. Supplement Pub Date : 1991-01-01

P Lönnroth

引用次数: 0

Alpha 1 blockers: antihypertensives whose positive metabolic profile with regard to hyperinsulinaemia and lipid metabolism cannot be ignored. α - 1受体阻滞剂:抗高血压药，其代谢特征与高胰岛素血症和脂质代谢有关，不容忽视。

Journal of internal medicine. Supplement Pub Date : 1991-01-01

M A Waite

引用次数: 0

Regulation of glucose metabolism in man. 人体葡萄糖代谢的调节。

Journal of internal medicine. Supplement Pub Date : 1991-01-01

P E Cryer

{"title":"Regulation of glucose metabolism in man.","authors":"P E Cryer","doi":"","DOIUrl":"","url":null,"abstract":"Insulin is the dominant glucoregulatory factor; by suppressing endogenous glucose production and stimulating glucose utilization, it lowers the plasma glucose concentration. Normally, feedback-regulated changes in insulin secretion play a key role in maintaining plasma glucose levels within a rather narrow range (approximately 4.0-7.0 mmol l-1) despite marked changes in glucose influx (e.g. following a meal, compared to fasting), efflux (e.g. during exercise), or both. Severe insulin deficiency causes insulin-dependent diabetes mellitus (IDDM), and substantial insulin excess causes hypoglycaemia. However, the regulation of systemic glucose balance normally involves a highly co-ordinated interplay between the glucose-lowering effects of insulin and the glucose-elevating actions of an array of glucose counterregulatory hormones, primarily glucagon (and epinephrine under some conditions). Thus there are redundant glucoregulatory factors, and a hierarchy exists among the latter. Although insulin stands at the top of that hierarchy, glucoregulation is not achieved by insulin alone. This is emphasized by the glycaemic chaos of IDDM, with wide swings from hyperglycaemia to hypoglycaemia. The latter is not exclusively the result of the intermittent hyperinsulinaemia inherent in imperfect insulin replacement therapy. Deficient glucagon and epinephrine secretory responses occur, and are now known to increase the risk of iatrogenic hypoglycaemia. However, insulin is generally the dominant glucoregulatory hormone under physiological conditions. The glucose counterregulatory hormones approach parity with insulin only when plasma glucose concentrations are lowered to levels that threaten brain function.","PeriodicalId":77556,"journal":{"name":"Journal of internal medicine. Supplement","volume":"735 ","pages":"31-9"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"12839664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Early treatment with thrombolysis and beta-blockade in suspected acute myocardial infarction: results from the TEAHAT Study. 早期溶栓和β -阻断治疗疑似急性心肌梗死:来自TEAHAT研究的结果。

Journal of internal medicine. Supplement Pub Date : 1991-01-01

M Risenfors, J Herlitz, C H Berg, M Dellborg, G Gustavsson, C Gottfridsson, M Lomsky, K Swedberg, A Hjalmarsson

{"title":"Early treatment with thrombolysis and beta-blockade in suspected acute myocardial infarction: results from the TEAHAT Study.","authors":"M Risenfors, J Herlitz, C H Berg, M Dellborg, G Gustavsson, C Gottfridsson, M Lomsky, K Swedberg, A Hjalmarsson","doi":"","DOIUrl":"","url":null,"abstract":"Independent trials of early administration of beta-blockers and thrombolytic agents have shown beneficial effects on both short- and long-term prognoses in acute myocardial infarction (AMI). The effects of a combination of the two strategies have not been thoroughly documented. Three hundred and fifty-two patients, of less than 75 years of age, with chest pain indicative of AMI, and onset less than 2 h and 45 min before first examination, were randomized to treatment with rt-PA or placebo. All patients without contraindication were given intravenous metoprolol 15 mg acutely and then 200 mg orally daily. Treatment was started either at the prehospital stage or in hospital. Thirty-seven per cent of patients had contraindications to beta-blockade, the most frequent of which were heart rate less than 60 beats min-1 and hypotension. The remaining 63% were given intravenous beta-blockade. No side-effects of metoprolol, alone or in combination with rt-PA, were observed during the prehospital phase. Overall, toleration of the treatment was good. Reduction in enzymatically estimated infarct size by rt-PA was more pronounced in patients who were also treated with metoprolol (41%, P less than 0.001) than in those with contraindications to beta-blockade (15%, NS). Patients who were also treated with metoprolol also had a lower incidence of Q-wave infarctions, congestive heart failure and ventricular fibrillation than those who were not given intravenous beta-blockade. In conclusion, toleration of intravenous administration of rt-PA and metoprolol was good, and this was also the case in the prehospital phase.(ABSTRACT TRUNCATED AT 250 WORDS)","PeriodicalId":77556,"journal":{"name":"Journal of internal medicine. Supplement","volume":"734 ","pages":"35-42"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13059756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hypertension in glucose intolerance and diabetes. 葡萄糖耐受不良和糖尿病引起的高血压。

Journal of internal medicine. Supplement Pub Date : 1991-01-01

R J Jarrett

引用次数: 0

Metabolic adverse effects of thiazide diuretics: the importance of normokalaemia. 噻嗪类利尿剂的代谢不良反应:正钾血症的重要性。

Journal of internal medicine. Supplement Pub Date : 1991-01-01

O K Andersson, T Gudbrandsson, K Jamerson

{"title":"Metabolic adverse effects of thiazide diuretics: the importance of normokalaemia.","authors":"O K Andersson, T Gudbrandsson, K Jamerson","doi":"","DOIUrl":"","url":null,"abstract":"It has been suggested that the failure of thiazide therapy, administered to treat high blood pressure, to prevent coronary heart disease is related to the metabolic adverse effects of these drugs. The almost consistent observation of reduced serum potassium and total body potassium associated with diuretics appears to be of clinical importance. It may cause not only an increased risk of cardiac arrhythmias but also impaired glucose tolerance and abnormal lipid metabolism, while replacement of potassium has been shown to eliminate the risk of arrhythmias as well as thiazide-induced hyperglycaemia. The effect of the thiazide-induced short-term changes in serum lipids is unclear. Present experience suggests that thiazide-induced impairment of glucose tolerance is due to both reduced glucose-stimulated insulin release and increased peripheral resistance to the action of insulin. The blunted initial response of the pancreatic beta-cells to glucose is clearly dependent on serum potassium, and may cause postprandial hyperglycaemia during most of the day and night. This hypothesis is supported by the observation of enhanced glucose and insulin levels after an overnight fast, as well as 60-120 min after glucose challenges. Increased average levels of insulin may eventually cause down-regulation of cellular insulin receptors, i.e. insulin resistance. It is also conceivable that elevated insulin levels may cause hypertriglyceridaemia and possibly other abnormalities of lipid metabolism. Some recent observations indicate that the prognosis in treated hypertensive patients improves if both blood pressure and cholesterol levels are successfully controlled. We therefore emphasize the importance of normalizing serum potassium when using diuretic-based therapies in the treatment of hypertension.","PeriodicalId":77556,"journal":{"name":"Journal of internal medicine. Supplement","volume":"735 ","pages":"89-96"},"PeriodicalIF":0.0,"publicationDate":"1991-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"13199160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0