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  • 1
    ISSN: 1432-0428
    Keywords: Key words Diabetes mellitus ; skin microcirculation ; capillary blood cell velocity ; laser Doppler fluxmetry.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We have recently shown that the skin microcirculation of toes is significantly impaired in patients with diabetes and peripheral vascular disease, and this may be one major reason why these patients are highly susceptible to developing skin ulcers. The aim of the present study was to investigate whether the skin microcirculation is impaired also in diabetic patients free from macroangiopathy. One foot in each of 20 patients with insulin-dependent diabetes was investigated: 10 patients with and 10 patients without late complications. All patients had normal arterial circulation of their lower extremities. Two groups of age- and sex-matched healthy subjects served as controls. The capillary blood cell velocity in the nailfold of the great toe was investigated by computerised videophotometric capillaroscopy, and the total microcirculation within the same area evaluated by laser Doppler fluxmetry. The capillary blood cell velocity and the total skin microcirculation were studied during rest, and during postocclusive reactive hyperaemia. The total microcirculation was similar in patients and control subjects, whereas the capillary circulation was markedly reduced (p 〈 0.01) in the patients. The ratio between the capillary and total microcirculation was significantly decreased (p 〈 0.05–0.01) in the patients as compared to the control subjects, indicating a local maldistribution of blood in the skin microcirculation of the diabetic patients. The results of the present study show that in spite of a normal total skin microcirculation in the toes of insulin-dependent diabetic patients, both with and without late complications, the nutritional capillary circulation is severely impaired. These findings indicate that a chronic ischaemia is present in the skin capillaries of diabetic feet, and is related to the diabetic disease per se and not to late diabetic complications, and may be a cause for these complications. [Diabetologia (1995) 38: 474–480]
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  • 2
    ISSN: 1432-0428
    Keywords: Diabetes mellitus ; skin microcirculation ; capillary blood cell velocity ; laser Doppler fluxmetry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We have recently shown that the skin microcirculation of toes is significantly impaired in patients with diabetes and peripheral vascular disease, and this may be one major reason why these patients are highly susceptible to developing skin ulcers. The aim of the present study was to investigate whether the skin microcirculation is impaired also in diabetic patients free from macroangiopathy. One foot in each of 20 patients with insulin-dependent diabetes was investigated: 10 patients with and 10 patients without late complications. All patients had normal arterial circulation of their lower extremities. Two groups of age- and sex-matched healthy subjects served as controls. The capillary blood cell velocity in the nailfold of the great toe was investigated by computerised videophotometric capillaroscopy, and the total microcirculation within the same area evaluated by laser Doppler fluxmetry. The capillary blood cell velocity and the total skin microcirculation were studied during rest, and during postocclusive reactive hyperaemia. The total microcirculation was similar in patients and control subjects, whereas the capillary circulation was markedly reduced (p〈0.01) in the patients. The ratio between the capillary and total microcirculation was significantly decreased (p〈0.05–0.01) in the patients as compared to the control subjects, indicating a local maldistribution of blood in the skin microcirculation of the diabetic patients. The results of the present study show that in spite of a normal total skin microcirculation in the toes of insulin-dependent diabetic patients, both with and without late complications, the nutritional capillary circulation is severely impaired. These findings indicate that a chronic ischaemia is present in the skin capillaries of diabetic feet, and is related to the diabetic disease per se and not to late diabetic complications, and may be a cause for these complications.
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  • 3
    ISSN: 1432-0428
    Keywords: Keywords Diabetes mellitus ; skin capillary circulation ; metabolic control
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Skin capillary circulation is impaired during postocclusive reactive hyperaemia (PRH) in toes of diabetic patients independent of diabetes duration and macrocirculation. The aim of this study was to examine its relation to metabolic control. The skin microcirculation was investigated in 20 patients with insulin-dependent diabetes mellitus: 10 patients with bad [HbA1c 〉 7.5 (8.7 ± 0.8) %], and 10 patients with good metabolic control [HbA1c 〈 7.5 (6.3 ± 1.0) %]. The diabetes duration was similar in both groups (16 ± 9 and 16 ± 6 years, respectively). None had macroangiopathy. Thirteen healthy subjects served as controls. The capillary blood cell velocity (CBV) in the nailfold of the great toe was investigated by videophotometric capillaroscopy, and the total skin microcirculation by laser Doppler fluxmetry (LDF). CBV and LDF were studied during rest and after 1-min arterial occlusion. The vibration perception thresholds (VPT) of the feet were higher (p 〈 0.05) in the patients with bad (34 ± 12 V), as compared to patients with good metabolic control (18 ± 10 V) and to healthy subjects (13 ± 3 V). Peak CBV during PRH was reduced in both patient groups (p 〈 0.01), and lowest in the patients with bad metabolic control (p 〈 0.05). Time to peak CBV was prolonged (p 〈 0.01) in the patients with bad, while normal in the patients with good metabolic control. LDF was similar in all groups. An inverse correlation was found between HbA1c and peak CBV during PRH (r = 0.60; p = 0.008), while positive correlations were found to time to peak CBV (r = 0.62; p = 0.004) and VPT (r = 0.60; p = 0.01). No associations were seen between VPT and the microcirculatory variables. The results indicate that the metabolic control is of importance for the nutritive capillary circulation and the peripheral nerve function in the diabetic foot. [Diabetologia (1998) 41: 410–415]
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  • 4
    ISSN: 1432-0428
    Keywords: Keywords Diabetes mellitus ; fibrinogen ; fibrin gel structure.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary High plasma fibrinogen levels are associated with vascular complications in the general population. Fibrin, the structural element in a clot, is derived from fibrinogen by activation of thrombin. An abnormal fibrin gel structure has been demonstrated in patients with myocardial infarction and in diabetic patients during poor metabolic control. In the present study the properties of fibrin gel structure were investigated in 20 patients with insulin-dependent diabetes mellitus (IDDM): 10 patients without (age: 30 ± 8; diabetes duration: 7 ± 6 years), and 10 patients (age: 44 ± 7; diabetes duration: 27 ± 9 years) with microangiopathy. Fifteen healthy subjects served as controls (age: 40 ± 8 years). The glycosylated haemoglobin level (HbA1c) was elevated (p 〈 0.001) in the patients: 6.5 ± 1.5 % in diabetic patients without, and 7.1 ± 1.0 % in diabetic patients with microangiopathy. C-reactive protein and plasma fibrinogen were similar as compared to healthy control subjects. The properties of the fibrin gel structure; i. e. the permeability coefficient (Ks) and the fibre mass length ratio (μ) formed in recalcified plasma on addition of thrombin were investigated. Ks was decreased in the diabetic patients, with (6.5 ± 2.0 cm2; p 〈 0.01) and without microangiopathy (6.5 ± 2.7 cm2; p 〈 0.05), as compared to healthy subjects (10.0 ± 3.4 cm2), while μ was not significantly (p = 0.14) altered. The results indicate a lower fibrin gel porosity in patients with IDDM, despite normal plasma fibrinogen and irrespective of microangiopathy. The abnormal fibrin gel structure may be due to an increased glycosylation of the fibrin (-ogen) molecule caused by long-term hyperglycaemia and may be of importance for the development of angiopathy in diabetic patients. [Diabetologia (1996) 39: 1519–1523]
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  • 5
    ISSN: 1600-079X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The aim of the present study was to determine the diurnal secretion of melatonin, cortisol, prolactin, calcitonin during chronic parathyroid hormone-dependent hypercalcemia. Eight women, aged 40–76 years, with primary hyperparathyroidism (PHPT) were studied before after surgical removal of a parathyroid adenoma. The hormone concentrations in blood were determined at 08, 12, 16, 22, 02, 04, 06 h. Concomitantly, the excretion of melatonin cortisol in urine between 07–19 h 19–07 h, the clearance of calcium creatinine were measured.Nyctohemeral serum prolactin calcitonin were unaffected by moderate parathyroid hormone-dependent hypercalcemia. In contrast, serum cortisol melatonin were significantly higher during active disease than after surgical cure. Mean 24-h variation of serum cortisol was 349 ± 34 nmol/liter vs. 223 ± 17 nmol/liter mean serum melatonin was 0.13 ± 0.04 nmol/liter vs. 0.06 ± 0.02 nmol/liter. Endogenous creatinine clearance was similar before after surgery, while the clearance of melatonin cortisol significantly increased after surgery, indicating an increased tubular reabsorption of both hormones during active disease. Fasting morning glucose concentrations were also significantly decreased after successful surgery, 6.1 ± 0.6 vs. 5.2 ± 0.5 mmol/liter. It is suggested that the relative hypercortisolism may be the cause of the glucose intolerance in primary hyperparathyroidism.Three to 4 months after surgical cure the serum melatonin levels were significantly lower than those seen in age-matched controls, indicating a melatonin insufficiency in patients successfully treated for PHPT. The meaning of this finding is not yet understood but might be of importance in the development of primary hyperparathyroidism.
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  • 6
    ISSN: 1432-1920
    Keywords: Empty sella syndrome ; Intrasellar cisternal herniation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The occurrence of empty sella was studied on 450 pneumoencephalograms. It was not sex dependent, and seemed to be an acquired condition increasing in frequency with age. Empty sella was found in 10% of subjects with otherwise normal encephalograms. The frequency was higher in persons with communicating hydrocephalus (32%), hormoneproducing pituitary tumors (33%) and increased intracranial pressure due to cerebral tumors (18%). In all these subjects empty sella was often accompanied by demineralization and erosion of the sella turcica. Independent of the lumbar pressure, empty sella was most often found in patients with communicating hydrocephalus with only moderately high ventricle index and comparatively increased volume of the third ventricle. Empty sella was also frequent among patients with temporal tumors (32%) causing deformation and displacement of the third ventricle but in whom signs of increased intracranial pressure were lacking. The disturbed anatomy of the third ventricle possibly explains the higher frequency of empty sella in association with these tumors compared to other supratentorial tumors. altogether, these findings indicate that disturbance of the cerebrospinal fluid (CSF) circulation, especially in the third ventricle, with or without established increase of the intracranial pressure, plays an important role in the etiology of empty sella. This is further substantiated by the demonstration that the type of intrasellar herniation could be related to the position of the third ventricle. Neither the type of herniation nor the form of the sella could be related to the presence or absence of a co-existing intracranial tumor or to the location of the tumor.
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  • 7
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Micron And Microscopica Acta 23 (1992), S. 91-92 
    ISSN: 0739-6260
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Electrical Engineering, Measurement and Control Technology , Natural Sciences in General
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