Microvascular association

O Diabetes mellitus (DM) describes a group of chronic metabolic disorders that are characterized by hyperglycemia and are associated with long-term microvascular, macrovascular, and neuropathic complications. 

A primary concern when administering PN is safety. The FDA published a safety alert in 1994 in response to two deaths associated with TNA infusion.16 Autopsy reports from these patients revealed diffuse microvascular pulmonary emboli I containing calcium-phosphate precipitates. The FDA provided... 

Pathological findings frequently observed in organs of patients who have died of sepsis include disseminated intravascular coagulation (DIC), manifested as diffuse thrombotic occlusions in the entire microvascular system, associated with alterations in the hemostatic mechanism and clinical signs of hemorrhagic diathesis. Many observations indicate that DIC contributes to the major symptoms of the systemic inflammatory response syndrome (SIRS), which frequently complicate sepsis (HI, H2, H3, T6). 

Diabetes mellitus is associated with many complications that are increased in the setting of poor glycemic control. Diabetes mellitus can cause microvascular... 

Adler AI etal Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36) Prospective observational study. Br Med J 2000 321 412. [PMID 10938049]... 

Drugs that selectively inhibit the aldose reductase enzyme represent a possible method for reducing peripheral neuropathies and other microvascular complications associated with poorly controlled type 1 or type 2 diabetes.26,45 This enzyme, which is located in... 

Intensive pharmacologic treatment of diabetes is known to decrease the risk for microvascular events such as nephropathy and retinopathy, but there is less evidence that it decreases macrovascular disease (28,29). DCCT/EDIC trial, however, demonstrated reduction in CVD (nonfatal Ml, stroke, death from CVD, confirmed angina, or the need for coronary-artery revascularization) in patients with type I diabetes assigned to intensive diabetes treatment compared with conventional treatment by 42% (p = 0.02) (30). Patients with lower extremity PAD and both type I and type 2 diabetes should be treated to reduce their glycosylated hemoglobin (Hb AIC) to less than 7%, per the American Diabetes Association recommendation (31). Subanalysis of the UKPDS showed no evidence of a threshold effect of Hb AIC a I % reduction in Hb Al C was associated with a 35% reduction in microvascular endpoints, an 18% reduction in Ml, and a 17% reduction in all-cause mortality. Frequent foot inspection by patients and physicians will enable early identification of foot lesions and ulcerations and facilitate prompt referral for treatment (32). 

A common genetic variation (A1166Q in the 3 untranslated tract at the ATI locus is associated with a small effect on blood pressure that may predispose individuals to essential hypertension (132,133). No consistent association of genetic variation in ATI has been observed to predispose individuals to myocardial infarction, ventricular hypertrophy, and microvascular complications (134)... 

There is little debate today regarding the benefits of tight glycemic control in type 2 diabetes. Results of the landmark United Kingdom Prospective Diabetes Study demonstrate conclusively that intensive glycemic control significandy influences the development of many of the destructive effects of type 2 diabetes. Over a 10-year period, for example, a reduction of 11 % in the HbAic of patients receiving intensive therapy was associated with a 25% reduction in microvascular complications (114). 

Figure 8.9 Predicted three-dimensional distributions of oxygen partial pressure in tissue. Model simulations from Tsoukias et al. [196] are based on a realistic model of the microvascular network associated with skeletal muscle. Predicted partial pressure distributions are illustrated for a control simulation (upper panel) and for a simulation of hemodilution - reduced hematocrit - plus addition of blood substitute (lower panel.) Predicted oxygen tension in mmHg is indicated by grayscale. Figure provided courtesy of Nicolaos Tsoukias.

Surgery for hemifecial spasm involves microvascular decompression of the fecial nerve by placement of a sponge under posterior fossa vessels (Jannetta procedure). Surgery for hemifecial spasm is associated with cure rates exceeding 80%, and beyond 2 years there appears to be little risk of relapse. However, surgical intervention can have serious complications such as permanent facial paralysis, deafness, stroke, and even death. 

Stratton IM, Adler Al, Neil HAW, Matthews DR, Manley SE, Cnll CA, et al. Association of glycaemia with macrovascnlar and microvascular complications of type 2 diabetes (UKPDS 35) prospective observational study. BMJ. 2000 321 405-412. 

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