Non-invasive assessment of skin microcirculatory changes in diabetic foot

The objective of this study was to evaluate the skin microcirculation in the lower limbs in type 2 diabetic patients for early detection of microvascular changes and prevention of its complications. This study was conducted on 30 patients with type 2 diabetes mellitus, 20 patients had clinical evidence of diabetic foot ulcers and 10 patients had no clinical evidence of foot ulcers. Ten age-matching healthy subjects were chosen as controls. Skin microcirculation was assessed by plethysmography [ankle-brachial and toe-brachial indices], laser Doppler flowmetry [LDF] and laser Doppler imaging [scanner]. It was concluded that noninvasive vascular tests, particularly toe-brachial index, measured by photoplethysmography and tissue perfusion measured by laser Doppler flowmetry are valuable in early detection of microcirculation impairment and prevention of serious complications, e.g. diabetic foot ulcers

Gastric emptying in insulin treated diabetics, a new equation for insulin meal interval

Gastric emptying time was studied in 25 insulin-treated diabetics, compared with 12 matched healthy volunteers. Both liquid and solid meals labeled by technetium sulfur-colloid [99m Tc] as the isotopic marker were used. The results showed delayed gastric emptying time in the diabetic group for liquid [0: 45 +/- 14 min.] and solids [1: 20 +/- 38 min.] compared with [0: 31 +/- 10 and 0: 49 +/- 0: 15 min.] in the control group [P = 0.04 and 0.008, respectively]. The delay in the diabetic group was apparent in males, older age and with longer duration of diabetes, and also in those who had gastrointestinal symptoms, peripheral or autonomic neuropathy. Adjusting the time of insulin injection in relation to the times of meals according to the solid-lag time by applying the equation [the onset of insulin action-solid lag time] caused significant reduction in fasting and post-prandial blood glucose level resulting in a better glycemic control

Effect of high voltage galvanic stimulation on blood flow in patients with arteriosclerotic disease of the lower limbs

The study was conducted to evaluate the effect of high voltage galvanic stimulation [HVGS] on arterial blood flow of the lower limbs in 20 male subjects with intermittent claudication of the lower limbs due to arteriosclerosis. The arterial blood flow was calculated using ultrasonic Doppler flow meter before and after stimulation by HVGS for 20 minutes and intensity of 60 voIts and frequency of 20 PP. A significant increment in arterial blood volume was observed following high voltage galvanic stimulation. It was concluded that HVGS could be a helpful tool in increasing blood volume to the exercising muscle reducing claudication pain and improving the claudication time

Doppler evaluation of peripheral arterial blood flow in patients with liver cirrhosis

Doppler waveform pattern of both the radial and digital arteries were studied in 30 patients with liver cirrhosis, 17 of whom had ascites. 13 without ascites and 10 control subjects. Six parameters were evaluated as indices of blood flow velocity and peripheral vascular resistance [peak systole, peak diastole, ratio of pourcelot, pulsatility index, damping factor and reversal of flow]. The study showed that peripheral arterial blood flow in patients with liver cirrhosis is characterized by an increase in systolic peak velocity, a significant forward velocity component during diastole and a low reversal of flow, the pulsatility index and the damping factor were found to be lower in patients with liver cirrhosis relative to controls. These findings points to decreased peripheral vascular resistance, peripheral vasodilatation and increased diastolic runoff of blood as the major factors contributing to the hyperdynamic circulatory state frequently seen in patients with liver cirrhosis. The findings were more pronounced in non ascetic patients presumably due to the mechanical effect of asites in addition to the role of angiotensin II in counteracting the peripheral vasodilatation of ascetic patients

Effect of conventional diuretics and angiotensin enzyme inhibitors on some renal functions in converting liver disease

Advanced liver disease is associated with a high incidence of renal failure and the rate of diuresis in non azotemic cirrhotic patients with ascites should not exceed the maximal rate of reabsorption of ascitic fluid to avoid plasma volume contraction and renal hypoperfusion. The reduction of markedly elevated angiotensin II production by an angiotensin converting enzyme inhibitor [Captopril] could suppress hyperalodosteronism without impairment of renal functions. On this assumption captopril could be useful in treatment of ascites. This study was performed on 15 non azotemic patients with ascites. They were given diuretics daily [Furosimide 40 mg once per day, and spironolactone 25 mg t. d. s.] for seven days. This was followed by the addition of captopril 50 mg per day in two divided doses to the previously used diuretics for seven days more. Fractional sodium excretion and creatinine clearance were measured before treatment, after giving diuretics for seven days and at the end of the study. Before treatment nonazotemic patients with ascites showed low fractional sodium excretion value and creatinine clearance. Both parameters were improved after the use of conventional diuretics. Whereas the addition of captopril was followed by significant decrease of the creatinine clearance while the fractional sodium excretion showed no significant change compared to the results obtained after the use of diuretics alone. One could conclude that the use of furosimide and spironolactone in non azotemic cirrhotic patients with ascites is effective and is not followed by impairment of renal functions. Whereas Captopril administration did not increase the fractional sodium excretion and resulted in decrease in creatinine clearance

Crystal induced osteoarthritis

Microscopical study using regular, polarized and electron microscopy, were done in 40 patients with 1ry osteoathritis, for detection of crystals in their synovial fluid and to correlate their presence especially apatite crystals with markers of inflammation detected in their serum and synovial fluids. Eight cases [20%] had negative findings to all types of crystals, 16 cases had calcium pyrophosphate dihydrate [40%] and ten cases [25%] showed Hydroxyapatite crystals. Five cases showed ureate crystals [12. 5%] three of them were accompanied by calcium pyrophosphate dihydrate crystals. Seven cases contained oxalate [17. 5%] three of them were accompanied by other types of crystals [one with hydroxyapatite and 2 with calcium pyrophosphate]. Patients with hydroxyapatite crystals had a significantly higher mean of TLC in their synovial fluids compared to other groups, they also had high mean tenderness score, denoting a possible inflammatory arthritis. It is concluded that [Apatite Associated Arthropathy] detected by electron microscopy was found in a significant number of patients with 1ry osteoarthiritis and their presence could be linked to inflammatory flares in such patients

role of C3 level in cirrhotic ascites and its relation to spontaneous bacterial peritonitis

The risk of developing spontaneous bacterial peritonitis [SBP] in relation to the concentration of the third component of the complement system [C3] in ascitic fluid has been studied prospectively in 30 patients with liver cirrhosis and ascites, nineteen of them had evidence of spontaneous bacterial peritonitis as proved by culture and eleven patients had no such evidence. Serum C[3] in the pathological group was lower than in the control and this was attributed mainly to decreased synthesis. Serum and ascitic fluid C[3] concentration of patients who developed infection [0.294+0.117 g/l] was significantly lower than those who did not [0. 534 + 0. 095 g/l and 9. 682 + 1. 327 mg/l], suggesting increased consumption in addition to decreased synthesis as the possible mechanisms. We conclude that a low C[3] concentration in ascitic fluid may predispose to spontaneous bacterial peritonitis and may identify those of high risk for developing this serious complication

Screening of microalbuminuria in simple intestinal schistosoma mansoni

Microalbuminuria was detected in the morning urine sample of 82 cases of simple intestinal S. mansoni infection without hepatosplenic affection, and 12 healthy controls. The schistosomal cases had a mean age of 17+08 years [range 8 -25y] and a mean duration of infection of 7. 01 years. [range 2-12 y] Four cases had gross albuminuria, of the remaining 78 cases, 14 had microalbuminuria ranging from [25 - 75 microg/ml]. This forms an incidence of 17. 94%. A concluding remark would be that micro albuminuria is rather more frequent finding in simple S. mansoni infection than gross proteinuria, indicating that subclinical renal affection is more common than manifest renal disease. Granting the special sensitivity of microalbuminuria to detect early subclinical affection, it can be a valuable test in identifying patients prone to the development of schistosomal nephropathy

Study of some hormonal aspects in acute and chronic peptic ulcer

The role played by some gastrointestinal hormones [Gastrin and Bombesin] in the pathogenesis of peptic ulcer disease was studied in 50 patients with peptic ulcer diagnosed endoscopically,5 oesophageal, 6 gastric, 39 dudenal and 20 control subjects. Fasting serum gastrin was elevated in gastric ulcer group as compared to controls and this was due to a reflection of the generally lower rate of acid secretion in these patients. Oesophageal ulcer patients also had higher levels compared to controls, but the difference was not statistically significant. No significant difference could be found between dudenal ulcer patients and controls. Serum bombesin was lower in all the types of peptic ulcer relative to the control. The low serum bombesin level in gastric ulcer group corresponds with the finding of high serum gastrin in these patients. Bombesin is found to be a potent releaser of gastrin in man and gastrin exerts a feed back inhibitory mechanism on bombesin level. The finding of low serum bombesin with normal fasting gastrin in dudenal ulcer patients indicates that the feed back inhibitory mechanism of elevated gastrin on bombesin level in these patients is not valid and other factors must be involved

Study of some colonic microflora in patients with liver cirrhosis before and after lactulose administration

Stool culture for lactobacilli and enterococci before and after 14 days of lactulose therapy was done in 25 cirrhotic patients and 10 healthy control persons. The quantitative bacterial estimation of stool lactobacilli and enterococci showed no significant difference between normal controls and cirrhotics. A significant increase in lactobacilli count was noticed in cirrhotics following lactulose administration. Whereas lactulose administration to cirrhotic patients caused non significant increase in stool enterococci. It is to be concluded that the benificial effect of lactulose is likely related to the total increase in the number of lactobacilli leading to acid production and hence decrease in the colonic pH