Intrinsic spectral broadening (ISB) in ultrasound Doppler as a combination of transit time and local geometrical broadening.

Doppler signals collected with a focused transducer are known to be affected by the so-called intrinsic spectral broadening (ISB). This article aims to point out how ISB is, in general, related to both the limited lateral extent of a focused beam (leading to a finite transit time), and the presence of several local insonation angles around the beam axis, due to focusing and diffraction effects (local geometrical broadening). The influence of these two elementary spectral contributions on the whole ISB is shown by considering the Doppler signal as simultaneously modulated in amplitude and frequency, and applying well-known relationships employed in the communication field. Such an analysis reveals that transit time and local geometrical broadening are two different phenomena, whose simultaneous knowledge is necessary for correctly evaluating the overall ISB. Finally, thanks to a novel technique for separately measuring transit time and local geometrical broadening effects on transducers with markedly different focusing properties, more than 1000 experimental acquisitions show how a proper combination of such measured contributions gives an accurate ISB estimation, confirming the theoretical expectations.

Efficacy of combined treatments in NIDDM patients with secondary failure to sulphonylureas. Is it predictable?

The treatment of NIDDM patients with secondary failure to sulphonylurea is a common problem. We performed a crossover study in 50 NIDDM patients with secondary failure to glibenclamide by comparing the addition to sulphonylurea of either a low-dose bedtime NPH insulin or a t.i.d. oral metformin and by analyzing treatment efficacy in relation to patient and disease characteristics. Both combined therapies clearly improved glycaemic control. HbA1 c were similarly reduced by the addition of either bedtime NPH insulin (7.6+/-0.34 vs 8.7+/-0.35, p<0.01) or metformin (7.6+/-0.22 vs 8.6+/-0.31, p<0.01). Also fasting plasma glucose (FPG) and post-prandial plasma glucose (PPPG) significantly decreased (p<0.01) with both treatments. Bed-time NPH insulin was more effective on FPG reduction than metformin (-36+/-2% vs -25+/-2%, p<0.01); in contrast, metformin addition was more effective on PPPG reduction than bedtime NPH insulin addition (-30+/-2% vs 20+/-3%, p<0.01). Serum cholesterol was marginally but significantly decreased after metformin (5.49+/-0.19 vs 5.91 +/-0.18 mM, p<0.05) but not after NPH insulin. Body weight increase was significantly greater after insulin addition than after metformin (1.47+/-0.25 Kg vs 0.64+/-0.17 p=0.02). All patients preferred the addition of metformin rather than NPH insulin. None of the measured clinical and metabolic variables (before treatment FPG and PPPG, HbA1 c, post-glucagon C-peptide levels, insulin sensitivity, patient age, BMI and diabetes duration) significantly correlated to the efficacy of the two combined treatments studied. In conclusion, in NIDDM patients with secondary failure to sulphonylureas the addition of either low-dose bedtime NPH insulin or t.i.d. metformin is similarly effective in improving glycaemic control. Metformin is better accepted by patients and provides a modest advantage in terms of body weight and cholesterol levels. The most common clinical and metabolic variables are not useful for predicting the efficacy of these two combined treatments.