Pulmonary diffusing capacity for carbon monoxide: a marker of depressed hypercapnic drive in type 1 diabetes mellitus?

AIMS: Decreased chemosensitivity to hypercapnia, a common finding in Type 1 diabetes mellitus, seems related to autonomic neuropathy. We proposed to verify whether simple neuroautonomic cardiovascular tests or indexes of severity of diabetes and respiratory impairment can identify patients with such a dysfunction, but no clinical evidence of autonomic neuropathy. METHODS: Forty patients with Type 1 diabetes, 20 with autonomic neuropathy according to the results of a standardized test battery, were studied and compared with 40 normal subjects matched by age and sex. Spirometry and pulmonary diffusing capacity for carbon monoxide were performed. The chemosensitivity to hypercapnia was tested by the rebreathing method. RESULTS: There was no significant difference between patients with and without autonomic neuropathy in chemosensitivity to hypercapnia, as expressed by the ventilation response to increasing end-tidal pressure of carbon dioxide; however, it was lower in the whole group of patients with diabetes than in control subjects (1.71 ± 0.80 vs. 2.45 ± 1.11 l⁻¹ min⁻¹ mmHg, respectively, P=0.002). No significant correlation was found between ventilation response to increasing end-tidal pressure of carbon dioxide and the results of autonomic tests. In patients with diabetes mellitus, the ventilatory response to hypercapnia significantly correlated with pulmonary diffusing capacity for carbon monoxide (Spearman's rho=0.387, P=0.013) and this was the only variable significantly associated with ventilation response to increasing end-tidal pressure of carbon dioxide in a multiple regression model. CONCLUSIONS: Chemosensitivity to hypercapnia was depressed in patients with diabetes mellitus, irrespective of autonomic neuropathy, in comparison with control subjects. The correlation with pulmonary diffusing capacity for carbon monoxide suggests that microcirculatory damage might contribute to depress the central chemosensitivity.

[Critical evaluation of phytothermotherapy ("hay baths") in degenerative arthropathies]. / Valutazione critica del trattamento fitotermoterapico ("bagni di fieno") nelle artropatie degenerative.

It is a traditional practice of the Alpine region of Trentino and Alto Adige to use phytothermotherapeutic treatment with fermenting grass ("hay baths") for chronic degenerative arthropathies. A marked lack of clinical validation is however to be found in current literature as to its efficacy and tolerability. To verify these two aspects 27 patients (mean age 59 +/- 8.7 years, range 43-82) with osteoarthritis (15 of them with a generalized form) were evaluated before and after a ten-day treatment with immersion of the whole body in a bed made with fermenting grass according to the traditional method. The following clinical features were considered: pain in affected joints evaluated by visual analog scale, presence of global subjective improvement (or lack of it) immediately and 6 months after treatment, degree of global functional impairment, stiffness duration, handgrip strength. The mean score at the affected joints (on the visual analog pain scale) was 2.51 +/- 0.71 before and 1.83 +/- 0.89 after treatment (p < 0.001), with improvement in 68% of patients. Morning stiffness was reduced from 38.9 +/- 30.5 to 17.5 +/- 17.2 minutes (p < 0.05), with improvement in 57% of patients. Grip strength measure went from 136 +/- 59.7 to 147 +/- 51 mmHg (p < 0.01), with improvement in 77% of patients. Forty-eight percent of the patients were reassigned to better class of functional capacity (p < 0.001). Patient general assessment signaled improvement in 72% of cases immediately after treatment, and in 80% after six months. Tolerability was high in 23 out of 25 patients, nobody was taken off treatment because of side effects, in two cases a one day interval due to asthenia was introduced. In conclusion, improvement rates were found higher when compared with controlled trials on efficacy of nonsteroidal antiinflammatory drugs. Noteworthy is also the persistence of improvement 6 months after treatment compared to the above mentioned drugs and usual physiokinesitherapeutic treatments.

[Arterial hypertension and hyporeninemic hypoaldosteronism. Description of a clinical case]. / Ipertensione arteriosa ed ipoaldosteronismo iporeninemico. Descrizione di un caso clinico.

In a clinical case of arterial hypertension with hypopotassiaemia and hyporeninaemic hypoaldosteronism due to the use of a dermatological cream containing 9-alpha-fluoroprednisolone, late identification of the iatrogenic cause forced attention on the differential diagnosis of the less frequent hyporeninaemic hypoaldosteronism.