Microvascular autoregulation in children and adolescents with type 1 diabetes mellitus.

AIMS/HYPOTHESIS: Deterioration of microvascular function may have an early onset in individuals with type 1 diabetes mellitus. We hypothesised that microvascular autoregulation is impaired in children with type 1 diabetes and can be detected non-invasively by postocclusive reactive hyperaemia (PORH). METHODS: Microvascular autoregulation was assessed in 58 children with type 1 diabetes and 58 age- and sex-matched healthy controls by PORH using laser Doppler fluxmetry. Baseline perfusion, biological zero (defined as a 'no flow' laser Doppler signal during suprasystolic occlusion), peak perfusion following occlusion, time to peak and recovery time (time until baseline perfusion is resumed) were recorded and compared between the groups. RESULTS: Peak perfusion was higher in children with type 1 diabetes than in healthy controls (1.7 ± 0.93 AU [arbitrary units] vs 1.29 ± 0.46 AU; p = 0.004), and biological zero was lower in children with type 1 diabetes vs controls (0.14 ± 0.04 AU vs 0.19 ± 0.04 AU; p < 0.0001). No differences were seen between the groups in baseline perfusion, time to peak during PORH and recovery time following PORH. CONCLUSIONS/INTERPRETATION: PORH reveals impaired microvascular autoregulation in children with type 1 diabetes. The higher peak perfusion might reflect a decline in the vasoconstrictive ability of arteriolar smooth muscle cells upstream of capillary beds in children with type 1 diabetes.

Wall shear stress in the superficial femoral artery of healthy adults and its response to postural changes and exercise.

OBJECTIVES: Alterations of wall shear stress (WSS) are considered to precede atherosclerosis. Local variations of WSS might contribute to the typical distribution of atherosclerotic lesions along the superficial femoral artery (SFA). We investigated the course of WSS and its response to postural changes and exercise along the SFA of healthy adults. METHODS: In forty-six healthy subjects, we determined flow velocities and internal vessel diameters in five predefined segments of the SFA using duplex ultrasound; measurements were done at rest, following exercise (30 toe raises) and after postural changes (supine and sitting). Peak and mean WSS were calculated from peak systolic and mean velocities, vessel diameter and whole blood viscosity. RESULTS: At rest, peak and mean WSS did not vary along the femoro-popliteal axis (p > 0.05); peak and mean WSS were lower in the sitting than in the supine position (p < 0.0001). After exercise, peak and mean WSS increased in all segments (p < 0.0001), showing the lowest increase in the distal Hunter's canal. CONCLUSION: Healthy adults do not exhibit local variations of WSS in the SFA at rest, but segmental differences in WSS occur after exercise. Whether these findings are related to the typical distribution of atherosclerotic lesions later in life requires further investigation.

Impact of international guidelines on the management of cardiovascular risk factors in diabetic patients with peripheral arterial disease.

AIM: Recent data on the management of cardiovascular risk factors in high risk patients showed that dyslipidemia is still treated in an inadequate way, especially in diabetic patients. We wanted to analyze the impact of the recommendation of the Inter-Society Consensus for the management of PAD (TASC-II) on the actual situation. METHODS: In this retrospective cohort study we analyzed total-, HDL-, LDL-cholesterol, triglycerides and blood glucose using capillary blood in diabetic patients, admitted to our outpatient department. Besides the recording of a complete medical history and vascular risk factors, an ABI-measurement and a carotid Duplex ultrasonography were performed at presentation. RESULTS: We studied 111 diabetic patients (44 female and 67 male) with a mean age (+/-SD) of 70, 3 (+/-9, 9) years; a BMI of 28, 2 (+/-4, 2) and a mean waist circumference of 103 (+/-12, 2) cm. Metabolic syndrome according to the NCEP-ATP-III criteria (2001) was shown in 86% (N.=95). 41% (N.=45) had clinically manifest vascular disease in a second and 23% (N.=26) even in a third vascular territory. Total-cholesterol was 183+/-43 mg/dL; LDL-C 94 +/-30 mg/dL; HDL-cholesterol 44 +/-12 mg/dl and triglycerides 219+/-103 mg/dL. A total of 33% (N.=37) in this high risk cohort attained the LDL-C target levels according to the TASC-II guidelines. A total of 68% (N.=76) was on a HMG-CoA-reductase-inhibitor, 61% (N.=68) had platelet aggregation inhibitors. CONCLUSIONS: We found poor adherence to international guidelines for secondary prevention in diabetic patients with PAD in this outpatient setting.

[Esophageal stenosis and esophagotracheal fistula with concomitant gastric ulcer in "caustic soda" ingestion]. / Stenoza de esofag si fistula esotraheala însotite de ulcer gastric, în ingestia de "soda caustica".

The article deals with a special case through it's gravity and lesional complexity. A forty years old ill person with esophagus stenosis and postcaustic esophagotracheal fistula, having both a gastric ulcer on the date of surgery is operated in three stages: 1. Vagotomy, pyloroplasty and gastrotomy. 2. Esophagectomy with Kirschner-Nakayama gastric grafting. Posterior tracheorraphy with esophageal muscular patch. 3. Anastomotic cervical stenosis--plastic replacement (grafting) with a fat-less skin.