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Epidemiology of Coronary and Peripheral Atherosclerosis in Diabetes

Prevalence of Impaired Glucose Metabolism in Patients with Manifest Atherosclerosis In patients with manifest coronary heart disease (CHD), based on the Ludwigshafen Risk and Cardiovascular Health (LURIC) study, approximately 20% of men and 25% of women had previously diagnosed diabetes. Newly detected diabetes was present in another 15% of men and approximately 10% of women. More detailed data on the prevalence of abnormal glucose regulation in…

Pharmacologic and Surgical Interventions That Prevent or Worsen Type 2 Diabetes

Detection of individuals at risk of future diseases and implementation of programs to reduce risk of progression to disease are fundamental objectives of reducing the burden of medical conditions such as diabetes. Prevention of diabetes also offers the opportunity to reduce the risk of cardiovascular disease (CVD), which is the major cause of premature death and chronic disability in patients with type 2 diabetes. CVD risk…

Lifestyle Interventions for the Prevention of Type 2 Diabetes Mellitus

In recent decades the world has experienced a significant increase in the number of patients with diabetes mellitus, primarily type 2 diabetes mellitus (T2DM). Parallel to this, the increase is mostly attributable to a significantly higher frequency of diabetes diagnosis in the age group younger than 60, but also younger than 35 years of age. The growing economic burden in complex socioeconomic structures becomes obvious. The…

The Metabolic Syndrome: Prevalence and Controversies in Clinical Context

The metabolic syndrome (MetS) is defined as clustering of metabolic components that occur together more often than by chance alone and predispose to atherosclerotic vascular disease and diabetes. First descriptions of associated metabolic diseases occurred at the beginning of the last century when Kylin reported a connection between hyperglycemia, hypertension, and gout. Thus, the intention with the introduction of MetS was primarily to get a clinical…

Type 1 Diabetes: Pathophysiology, Molecular Mechanisms, Genetic Insights

Type 1 diabetes mellitus (T1DM) is one of the most prevalent chronic diseases of childhood, affecting more than 1.4 million people in the United States, of whom 150,000 are children. , Over the past 50 years, the incidence in children has been increasing at a rapid rate of up to 5% per year worldwide—that is, doubling every 20 years. The lifetime risk of developing T1DM now…

Insulin Resistance: Pathophysiology, Molecular Mechanisms, Genetic Insights

Type 2 diabetes mellitus is a chronic disturbance of glucose metabolism without the absolute insulin deficiency that is typical for type 1 diabetes. Rather, type 2 diabetes is characterized by a reduced efficacy of insulin action in different peripheral tissues (insulin resistance) as well as a disturbance in beta cell function. These two important pathophysiologic characteristics in type 2 diabetes result in an imbalance of insulin…

Definition and Epidemiology of Type 2 Diabetes Mellitus

Worldwide, diabetes has reached epidemic proportions. Although diabetes encompasses a range of disorders (e.g., type 1 diabetes mellitus [T1DM], type 2 diabetes mellitus [T2DM], gestational diabetes mellitus, drug- or chemical-induced diabetes [from, for example, some second-generation antipsychotic drugs and some anti–human immunodeficiency virus [HIV] drugs, as well as exposure to combination antiretroviral therapy ]), most cases of diabetes—approximately 90% to 95%—are T2DM (hereafter referred to simply…

Chronological List of Publications 1961 to 2021

1961 1. Van Praagh R. Causes of death in infants with hemolytic disease of the newborn (erythroblastosis fetalis). Pediatrics. 1961;28:223-233. 2. Van Praagh R. Diagnosis of kernicterus in the neonatal period. Pediatrics. 1961;28:870-876. 3. Van Praagh R, Ongley PA, Swan HJC. Pathologic anatomy of single ventricle. Circulation. 1961;24:1061. 1962 4. Taussig HB, Crawford H, Pelargonio S, Zacharioudakis SC. Ten to thirteen year follow-up on patients after…

Understanding Normally and Abnormally Related Great Arteries

Equations, Apoptosis, Switches, Rotations, and Synergy Basic Principles 1. When the situs (pattern of anatomic organization) of the subarterial infundibulum and the situs of the great arteries are the same (concordant), the great arteries are normally related—solitus normally related, or inversus normally related. 2. When the situs of the infundibulum and the situs of the great arteries are different (discordant), the great arteries are abnormally related.…

Conclusions

The new information, also presented in Chapter 15, Chapter 26, Chapter 27 , raises questions about how best to name and define various types of congenital heart disease. Consider, for example, transposition of the great arteries (TGA). At the present time, TGA is defined and named with reference to the anatomy of the normal heart. Compared with the normal human heart, in TGA the aorta is…

The Heterotaxy Syndromes: Asplenia, Polysplenia, and With Normally Formed but Right-Sided Spleen

What are the Heterotaxy Syndromes? Heterotaxy is derived from two Greek words: heteros, “other,” and taxis, “arrangement.” Hence, heterotaxy is an arrangement of the viscera that is other than normal (situs solitus) or its mirror image (situs inversus). Although there is now much literature relevant to the understanding of the heterotaxy syndromes(s), from very early in their recognition and delineation, anomalies of the spleen were identified…

The Cardiac Conduction System

The Sinoatrial Node The sinoatrial node (SAN) is the pacemaker of the human heart ( Fig. 28.1 ). In visceroatrial situs solitus, the normal pattern of anatomic organization of the viscera and atria, the SAN normally is located to the right of the superior vena cava (SVC; see Fig. 28.1 , left upper diagram ). The SAN is located in the sulcus terminalis (the terminal sulcus),…

Infundibuloarterial Situs Equations and Analysis

There is so much that is new in Chapter 22, Chapter 23, Chapter 24, Chapter 25, Chapter 26 , it may be helpful to summarize and to integrate this new understanding. The abbreviations, references, and implicit figures in this summary are the same as in Chapter 22, Chapter 23, Chapter 24, Chapter 25, Chapter 26 and will not be reiterated here. Infundibuloarterial Situs Concordance and Discordance…

What Prevents and What Permits the Embryonic Great Arterial Switch?

Basic Principles 1. When the situs (or pattern of anatomic organization) of the subarterial infundibulum and the situs of the great arteries are the same (concordant), the great arteries are normally related. 2. When the situs of the subarterial infundibulum and the situs of the great arteries are different (discordant), the great arteries are abnormally related. 3. A well-developed subarterial muscular infundibulum prevents the embryonic great…

Anatomically Corrected Malposition of the Great Arteries

Anatomically corrected malposition of the great arteries is defined as malposition of the great arteries in which both great arteries nevertheless arise above the morphologically appropriate ventricles, aorta above the morphologically left ventricle (LV), and pulmonary artery above the morphologically right ventricle (RV). Such cases have been regarded as errors of observation (Lochte, 1898), as inexplicable variations of nature (Geipel, 1903), as embryologically impossible and hence…

Double-Outlet Left Ventricle

Most pediatric cardiologists and congenital heart surgeons have never seen a patient with double-outlet left ventricle (DOLV). It is that rare. How rare is that? Well, in our cardiac pathology database on which this book is based (n = 3216 cases of congenital heart disease, mostly between 1966 and 2002, the approximately 36 years when I was the director of the Cardiac Registry), there were 14…

Double-Outlet Right Ventricle

Double-outlet right ventricle (DORV) is what Vierordt called partial transposition of the great arteries (TGA) in 1898, meaning that only the aorta was transposed from the left ventricle (LV) to the right ventricle (RV). Vierordt also renamed von Rokitansky’s anomalous transposition complete transposition, as opposed to his partial transposition. In 1923, Spitzer renamed Vierordt’s partial transposition simple transposition. Around 1960, Dr. Jesse Edwards et al decided that…

Transposition of the Great Arteries

What determines whether the great arteries are normally or abnormally related? That really is the basic question. The answer is thought to be as follows: When the situs (or pattern of anatomic organization) of the subarterial infundibulum and of the great arteries are both the same (both solitus, or both inversus), then the aorta and the main pulmonary artery are normally related (solitus normally related, or…

Absence of the Subpulmonary Infundibulum With Its Sequelae Has Been Misinterpreted as Common Aortopulmonary Trunk

As classically conceived, truncus arteriosus communis (common aortopulmonary trunk) seems not to exist. The classical embryologic conception is that the truncoconal septum has failed to grow downward from the aortic arch 4–pulmonary arch 6 junction. This results in a failure of septation (or separation) of the ascending aorta and main pulmonary artery, of the aortic and pulmonary valves, and of the subarterial pulmonary and aortic outflow…