The prevalence of peripheral vascular disease in type 2 diabetic patients with and without proteinuria.

It has been reported that albumin excretion rate may reflect not only an indication of renal disease but also a widespread vascular damage. We studied the relationship between overnight albumin excretion rate (AER) and peripheral vascular disease (PVD), using Doppler ultrasound, and its major risk factors in 80 Type 2 (non-insulin-dependent) diabetic patients. Thirty-eight of these patients had normoalbuminuria (AER < 30 micrograms/min), 22 had microalbuminuria (30-200 micrograms/min) and 20 had macroalbuminuria (> 200 micrograms/min). Patients with macroalbuminuria were older than those with normoalbuminuria (p < 0.01) and they also had a longer duration of diabetes (p < 0.05). Patients with elevated albumin excretion rates had elevated prevalence of PVD (macroalbuminuric 40%, p < 0.01; microalbuminuric 27.2%, p < 0.05; vs normoalbuminuric 7.8%). Among the risk factors analysed, hypertension and triglyceride concentrations were higher in the proteinuric diabetics (macroalbuminuric p < 0.001, p < 0.01; microalbuminuric p = NS, p < 0.01 respectively), while HDL-C levels were found to be significantly lower in this group (p < 0.05). In the diabetic group as a whole, raised AER was correlated with PVD (p < 0.05), duration of diabetes and systolic blood pressure (p < 0.01). We conclude that the prevalence of PVD was significantly higher in Type 2 diabetic patients with elevated albumin excretion rate. Furthermore, these patients had higher blood pressure and low HDL-C.

Serum levels of type III procollagen peptide and peripheral vascular disease in diabetic patients.

The aim of this study was to assess the possible relationship between serum levels of Type III procollagen peptide (PIIINP) and peripheral vascular disease (PVD) in diabetic patients. Ninety Type 2 diabetic patients being treated with sulfonylureas, and 37 non-diabetic subjects were studied using Doppler ultrasound. After an overnight fast, blood was taken for PIIINP, glucose, glucosylated hemoglobin (HbA1), C-peptide, and lipids. Data were analysed according to the non-paired Student's t-test and the correlation coefficient, after log transformation. PIIINP levels were significantly elevated in diabetics with PVD (n = 44), 4.3 micrograms/l (2.4-7.6, 95% confidence limits) compared with controls 3.1 micrograms/l (1.9-4.9), P < 0.001, and with diabetics without PVD (n = 46), 3.1 micrograms/l (1.9-5.0), P < 0.001. No correlation was found between PIIINP and HbA1, glucose, C-peptide, age or duration of diabetes. We conclude that PIIINP levels are elevated in Type 2 diabetics with PVD. It may reflect an increase in collagen deposition in the large arteries that accompanies the development of macroangiopathy.

Size of the pancreas in non-insulin-dependent diabetic patients.

We investigated the relationship between the size of the pancreas in non-insulin-dependent diabetic patients (NIDDs) and normal subjects, and also the possible correlation between pancreatic size in diabetics and basal C-peptide concentrations. Eighty-four non-insulin-dependent diabetics and eighty control subjects matched for age, sex and body mass index (BMI) were studied, using a realtime sector system, with which we measured the head and body of the pancreas in cm2. Scans were performed twice in 50 subjects with no significant difference. Both the head and the body of the pancreas were significantly smaller in diabetics (4.60 +/- 1.10 cm2, 5.92 +/- 1.53 cm2, respectively) than in normal subjects (6.09 +/- 1.62 cm2, 7.43 +/- 2.14 cm2) (p less than 0.001). The mean total area of the pancreas for the diabetics was 10.53 +/- 2.45 cm2, and for the controls 13.53 +/- 3.60 cm2 (p less than 0.001). No correlation was found between the total area of the pancreas and the BMI in the two groups. In the diabetic group, there was a positive correlation between C-peptide and the total area of the pancreas (r = 0.30, p less than 0.01). We concluded that the size of the pancreas is smaller in NIDDs than in healthy controls, and there is a positive correlation with the basal C-peptide concentration.

Elevated serum levels of angiotensin-converting enzyme in patients with diabetic retinopathy.

Serum levels of angiotensin-converting enzyme (ACE) were measured in 53 patients with type II (non-insulin-dependent) diabetes (25 without ophthalmologic complications, 20 with background retinopathy, and eight with proliferative retinopathy) and in 33 healthy nondiabetic subjects. Diabetic subjects were excluded if they had hypertension, ischemic heart disease, peripheral vascular disease, or an elevated urine albumin level. After an overnight fast, blood was taken for determination of ACE, blood glucose, glycosylated hemoglobin (HbA1), and C peptide levels. Data were analyzed according to the nonpaired Student's t test and linear regression analysis. Levels of ACE were significantly elevated in the whole diabetic group as compared with control subjects (334.0 U/L +/- 97.0 vs 250.5 U/L +/- 85.5, P less than .001). This elevation was more marked in those diabetics with background retinopathy (344.6 U/L +/- 96.8, P less than .001) and proliferative retinopathy (357.3 U/L +/- 93.2, P less than .01); no significant difference was found between ACE levels of diabetics without complications and those of control subjects. No correlation was found between ACE levels and HbA1, blood glucose, or C peptide values. We conclude that ACE levels are elevated in type II diabetes, chiefly in patients with retinopathy. This finding may reflect microvascular damage caused by secretion of ACE by the vascular endothelial cells.

Correlation between high density lipoprotein cholesterol and C-peptide in sulfonylurea-treated diabetic patients.

The aim of this study was to assess the possible relationship between high density lipoprotein cholesterol (HDL-C) concentrations and endogenous insulin secretion, as measured by basal serum C-peptide secretion. Eighty-nine non-insulin-dependent diabetic patients (NIDDs) being treated with sulfonylureas were studied. There were 47 men and 42 women matched for age, body mass index (BMI), duration of diabetes and glycemic control. Blood samples were taken after an overnight fast. HDL-C concentrations were significantly lower in males (45.9 +/- 11.2 mg/dl) than in females (52.9 +/- 13.1 mg/dl) (p less than 0.01). There was a negative correlation between C-peptide and HDL-C (males r = -0.40, p less than 0.01; females r = -0.42, p less than 0.01), and a positive correlation between C-peptide and serum triglyceride (Tg) (males r = +0.36, p less than 0.05; females r = +0.31, p less than 0.05).

Intracavitary use of two radiolabeled tumor-associated monoclonal antibodies.

Six patients with metastatic breast cancer and malignant pleural effusions and 13 patients with known or suspected ovarian cancer, underwent immunoscintigraphy after intracavitary (intrapleural or intraperitoneal) administration of iodine-131-(131I) or indium-111-(111In) labeled tumor associated monoclonal antibodies HMFG2 and H17E2. This method proved to be sensitive and specific with a true-positive result in 13 out of 14 patients with tumor and a true-negative result in five out of five patients without tumor. At any one time, 65%-80% of the whole-body radioactivity was closely associated with the cavity into which the radiolabeled antibody was administered while the radioactivity in the blood was always low, (approximately 4 X 10(-3) of administered dose/ml of blood). Concentrations of radiolabeled antibody (per gram of tumor tissue) ranged from 0.02%-0.1% of the injected dose in intracavitary tumors, but only 0.002% in a retroperitoneal metastasis. The specificity of this approach was documented in four control patients with benign ovarian cysts and in two patients who were imaged using both specific and nonspecific radiolabeled antibody. We conclude that the intracavitary administration of 131I- or 111In-labeled HMFG2 and H17E2 is a favorable route of administration and offers significant advantages over previously reported intravenous administration for the localization of breast or ovarian metastases confined to the pleural or peritoneal cavities.

Monoclonal antibodies in ovarian tumor imaging.

Immunoscintigraphy of ovarian tumors by intraperitoneal administration of I131 HMFG2 monoclonal antibodies (mabs) was used in this study. The purpose was to evaluate the diagnostic potential of this non-operative imaging technique in detecting ovarian tumor nature and spread. Sixteen patients that received 500-1000 microCi of I131 labelled HMFG2 mabs were evaluated. The scans obtained were compared mainly with the macro and microscopic operative findings of the subsequent laparotomy. Immunoscintigraphy accurately scanned tumor spread in 7 out of 9 patients with known ovarian cancer. It also successfully revealed the malignant or benign nature of pelvic masses in 6 out of 7 patients examined.

How do tears drain? Technetium studies.

We examined the tear drainage system of twenty-fiv normal volunteers by scintillography with Technetium Tc 99m (Pertechnetate). We photographed the changes occurring in the lacrimal sac and nasolacrimal duct during closure and opening of the eyelids. Our findings support Jones' views of normal tear drainage. The tracer was concentrated in the lacrimal sac while the lids were closed for 3 minutes and descended into the nasolacrimal duct as soon as they opened.