Nutritive toe skin capillaries in middle-aged patients with diabetes mellitus.

Vital capillary microscopy was employed in a study of the toe dorsum capillaries in 92 middle-aged diabetics and 96 controls of similar age and sex distribution. As a general finding most vision fields in the same toe showed an almost identical capillary pattern. In 17% of the toes in the controls compared to about 35% of the toes in the patients the capillaries were dilated more than 3 times. Such findings were unrelated to blood glucose control and a number of metabolic variables. In the patients with non-insulin dependent diabetes an abnormal capillary pattern was particularly common in patients with evidence of obstructive arterial disease. Such a relationship was not observed in patients with insulin-dependent diabetes in whom changes in the capillary pattern to a higher extent may be related to other mechanisms such as neuropathy.

Vital capillary microscopy for assessment of skin viability and microangiopathy in patients with diabetes mellitus.

Vital capillaroscopy is useful in clinical practice to study the nutritional skin capillaries and for evaluating the risk for skin necrosis in patients with peripheral ischemia. This method is especially valuable in the investigation of patients with diabetes mellitus (DM) in whom the arterial inflow to the foot can be almost normal despite the development of skin necrosis due to impaired nutritional circulation. When the capillary morphology in the feet of asymptomatic diabetic patients was investigated, significantly more areas with widely dilated capillaries were present both in insulin and tablet treated patients compared to controls. By using dynamic capillaroscopy the flow velocity in skin capillaries can be determined under physiological conditions. Fourteen diabetic patients were compared with matched non-diabetic controls. The capillary blood flow during resting conditions was equal in the two groups but a delay in the postocclusive reactive hyperemia response was seen in the diabetic patients. The reason for this may be a vasomotor dysfunction in the precapillary arterioles or an increased blood viscosity. Further studies using dynamic vital capillaroscopy may improve our knowledge of the complex mechanisms responsible for diabetic microangiopathy.

Myoglobin content in leg skeletal muscle in patients with chronic obstructive lung disease.

Myoglobin was determined in biopsy specimens from the quadriceps muscle of 3 female and 15 male 48-to 78-year-old patients with chronic obstructive lung disease. The patients were examined after an overnight rest. All but 2 were slightly to moderately hypoxemic. The myoglobin level was in all but 1 instance below the mean previously observed for apparently healthy subjects of similar age. The results are in line with earlier findings of an abnormal pattern of energy-rich phosphagens in the skeletal muscle of patients with chronic obstructive lung disease.