Tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1) in diabetic foot syndrome.

PURPOSE: The aim was to evaluate tissue plasminogen activator (tPA) and plasminogen activator inhibitor type 1 (PAI-1) concentration using enzyme linked immunosorbent assay method (ELISA) in diabetic foot syndrome (DFS) as compared to a group of healthy people and patients with diabetes mellitus without symptomatic vascular complications (DM2T). MATERIAL/METHODS: Venous blood samples were collected from 90 patients with type 2 diabetes mellitus (30 - DM2T; 60 - DFS). Age-matched controls were also included (n=30). tPA and PAI-1 plasma levels were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: We found a significantly lower concentration of tPA:Ag in patients with DFS in comparison to the DM2T group; tPA concentrations were significantly higher in DM2T as compared to the control group. We observed significantly lower concentration of PAI-1:Ag in DF patients treated for hypertension as compared to patients without hypertension. The tPA:Ag and PAI-1:Ag concentration analysis in DFS depending on age, gender and BMI did not show any significant differences. CONCLUSIONS: A lower concentration of tPA in patients with DFS may be associated with damage to the endothelial cells, especially in the microvasculature, and the sympathetic nervous system.

Effect of uncontrolled hyperglycemia on levels of adhesion molecules in patients with diabetes mellitus type 2.

OBJECTIVE: Uncontrolled diabetes has become a major cause of mortality and morbidity by reason of vascular angiopathy. The aim of this study was to evaluate the concentrations of soluble forms of vascular adhesion molecule-1 (sVCAM-1), intercellular adhesion molecule-1 (sICAM-1), E-selectin, and thrombomodulin in patients with well-controlled and uncontrolled diabetes type 2. METHODS: The study was conducted on 62 patients with diabetes. Group I consisted of 35 patients with well-controlled diabetes. The second group included 27 patients with uncontrolled diabetes with micro-albuminuria. A control group was made up of 25 healthy volunteers. The concentrations of sVCAM-1, sICAM-1, sE-selectin, and soluble thrombomodulin were assayed in plasma. Serum concentration of creatinine was measured and the plasma concentrations of fasting glucose and glycated hemoglobin (HbA1c) determined. RESULTS: Lower concentrations of ICAM-1 were found in the group of uncontrolled diabetes patients compared with those with well-controlled disease. In patients with uncontrolled diabetes, VCAM-1 levels were significantly higher compared with the group with well-controlled diabetes. In patients with uncontrolled diabetes a positive correlation was obtained between glomerular filtration rate and sE-selectin and a negative correlation between the levels of creatinine and ICAM-1, although there was a positive correlation between (HbA1c) and ICAM-1. CONCLUSIONS: The study confirmed the participation of the inflammatory process associated with impaired vascular endothelial function in the pathogenesis of type 2 diabetes. The opposite effect of uncontrolled hyperglycemia on adhesion molecules suggests different functions of VCAM-1 and ICAM-1 in complications of diabetes.

A preliminary evaluation of VEGF-A, VEGFR1 and VEGFR2 in patients with well-controlled type 2 diabetes mellitus.

OBJECTIVE: Decompensated chronic hyperglycemia often leads to late microvascular complications such as retinopathy, diabetic foot syndrome, and diabetic kidney disease. The aim of this study was to determine the concentration of vascular endothelial growth factor A (VEGF-A) and its receptors in patients with well-controlled diabetes. METHODS: The study was conducted on 31 patients with well-controlled type 2 diabetes without micro- or macroangiopathy. Thirty healthy volunteers were enrolled in a control group. Serum concentrations of VEGF-A, VEGF receptors 1 and 2 (VEGFR1 and VEGFR2), fasting glucose, and lipid profiles were measured, and the plasma concentration of glycated hemoglobin (HbA1c) was determined. RESULTS: No significant differences were observed between the concentration of VEGF-A, VEGFR1 or VEGFR2 in the subject group and that in the control group. Positive correlations were noted between the levels of VEGF-A, VEGFR2, and triglyceride, and there was a negative correlation between the levels of VEGFR2 and high-density lipoprotein (HDL)-cholesterol in the study group. CONCLUSIONS: The concentrations of VEGF-A and its receptors 1 and 2 in patients with well-controlled diabetes are comparable to those of healthy individuals, which may indicate that appropriate control of glucose levels delays the occurrence of vascular complications. A negative correlation between VEGFR2 and HDL-cholesterol levels, and positive correlations between VEGF-A, VEGFR2, and triglyceride levels, suggest that lipid abnormalities occurring in diabetes may be involved in the modulation of angiogenesis.

Spontaneous baroreflex sensitivity in subjects with type 1 diabetes with and without cardiovascular autonomic neuropathy.

INTRODUCTION: The clinical usefulness of baroreflex sensitivity (BRS) in the early detection of autonomic dysfunction in patients with diabetes is not well established. The aim of the study was the evaluation of BRS in subjects with type 1 diabetes with and without cardiovascular autonomic neuropathy (CAN). MATERIAL AND METHODS: The group examined consisted of 39 patients with type 1 diabetes (mean age 30.5 +/- 8.8 years; diabetes duration 12.1 +/- 6.9 years; BMI 23.7 +/- 2.8 kg/m2; HbA(1c) 7.6 +/- 1.9%). The control group consisted of 18 sex and age-matched healthy adults. Blood pressure, heart rate and chest respiratory movements were monitored continuously by non-invasive means (Portapres). In order to recognise CAN standard Ewing tests were performed. BRS was assessed in the lying (L-BRS) and standing (S-BRS) positions by the frequency domain technique. RESULTS: Ten patients (25.6%) had CAN (the CAN(+) group). In the CAN(+) group BRS was significantly lower than in the CAN(-) group in the lying and standing positions (respectively L-BRS 4.4 +/- 2.1 vs. 10.0 +/- 4.9 ms/mm Hg; p < 0.05; S-BRS 3.3 +/- 1.6 vs. 7.0 +/- 2.2 ms/mm Hg p < 0.001). BRS did not differ significantly between the CAN(-) and control group (respectively L-BRS 10.0 +/- 4.9 vs. 13.1 +/- 5.5 ms/mm Hg p = NS; S-BRS 7.0 +/- 2.2 vs. 7.9 +/- 4.0 ms/mm Hg p = NS). CONCLUSIONS: BRS differentiated well the subjects with CAN from the group without CAN. However, the study did not enable us to confirm the value of BRS in the early detection of autonomic dysfunction among patients with type 1 diabetes who showed no abnormalities in standard cardiovascular tests.

[Assessment of selected factors influencing birthweight in pregnant women with gestational diabetes mellitus]. / Analiza wybranych parametrów wplywajacych na mase ciala noworodka u kobiet z cukrzyca ciezarnych.

OBJECTIVES: Giving birth to a chi;d with an excessive brithweight is one of the most common neonate complications observed in the pregnant women with gestation diabetes (GDM). DESIGN: The aim of the study was an evaluation of selected factors affecting birthweight in the GDM. MATERIALS AND METHODS: Data from 867 pregnant women were analysed. The influence of: age, height, place of living and mother's educational background and BMI before pregnancy and weight gain during pregnancy and also HbA1c, triglycerides (TG) and total cholesterol (TC) values in the 3rd term of pregnancy (T3) were determined. The TC and TG were assessed by the enzymatic method by means of the Bio Merieux firm set--France, HbA1c by means of the immunoturbidimetric method using the Roche firm sets--France. RESULTS: Statistically significant birthweight differences were affirmed according to: mother's height (respectively the groups: < or = 155 vs 156-169 vs > or = 170 cm), BMI before pregnancy (< 25 vs 25-29.9 vs > or = 30 kg/m2), weight gain in pregnancy (< 12 vs > or = 12 kg), TG (< 2.7 vs > 2.7 mmol/l) and HbA1c in T3. No influence of mother's age, her place of living, educational background, HbA1c at admission and TC values in T3 on the neonates birthweight was observed. CONCLUSIONS: The anthropometric and environmental factors (mother's height, weight, weight gain in pregnancy) have a more significant influence on the neonates birthweight of the mothers with GDM, than social-demographic factors (age, educational background, place of living), the way of treatment of GDM and TC in T3. The TG level in T3, beside HbA1c is an independent, prognostic factor of birthweight in GDM.

[Somatostatin analogs in the treatment of carcinoid syndrome: a case report and review of literature]. / Znaczenie analogów somatostatyny w leczeniu zespolu rakowiaka--opis przypadku z przegladem pismiennictwa.

We report the case of 48-year old patient with carcinoid syndrome successfully treated with somatostatin analogues. We also present the review of published literature about the use of somatostatin analogues in the treatment of carcinoid syndrome. In addition, reported case shows difficulties in access to this treatment, caused by economical reasons.