Wall thickening of common carotid arteries in patients affected by noninsulin-dependent diabetes mellitus: relationship to microvascular complications.

This study evaluates the wall thickness of common carotid arteries and the atherosclerotic involvement of the carotid bifurcations in patients with noninsulin-dependent diabetes mellitus (NIDDM), with and without microvascular complications. Seventy subjects affected by NIDDM, and 17 healthy controls were evaluated by means of high-resolution echo-Doppler scan. Twenty-six diabetics (Group A) and complications (overnight proteinuria > 500 mg, background retinopathy, sensory neuropathy), while 44 (Group B) had no complications. The two groups were comparable for age, sex, plasma lipid profile, and smoking habit. Arterial hypertension was present in 15 of 26 (58%) complicated patients (Group A) and in 18 of 44 (41%) uncomplicated patients (Group B). None of the patients had a history of cerebrovascular disease. The authors found that the wall thickness of the common carotid artery was greater and atherosclerotic lesions of the carotid bifurcation were more frequent in diabetic patients with microvascular complications than in uncomplicated diabetics (who had a similar distribution of other risk factors for atherosclerosis) and in nondiabetic controls. These data on the one hand confirm the role of diabetes as an independent risk factor for carotid atherosclerosis and, on the other hand, indicate a correlation between microvascular lesions and early atherosclerosis in diabetes.

Clinical follow-up and progression of carotid atherosclerosis determined by duplex scanning in patients suffering from TIA.

We investigated the clinical outcomes and the progression of the internal carotid arterial lesions of a group of patients presenting with hemispheric TIAs. The cumulative frequency of TIAs during a mean follow-up period of 40 +/- 14 months was 14%, and no relationship was found between new TIAs and the presence of known cardiovascular risk factors or plaque characteristics as determined by duplex scanning. With the exception of one patient who died of stroke, none of the patients developed a permanent neurologic deficit. The cumulative death rate was 6.5%; myocardial infarction was the most common cause (3 out of 7). Anatomic progression of plaques was determined by duplex scanning in 22% of the internal carotid arteries. No relationship between progression of these plaques and the development of new TIAs was evident. We conclude that, in this group of patients, TIAs do not inevitably lead to stroke and that TIAs are not predictable based on risk factors or plaques characteristics.

Transcutaneous oxygen tension (TcPO2) measurement as a diagnostic tool in patients with peripheral vascular disease.

Transcutaneous oxygen tension (TcPO2) was measured through Clark's electrode at the dorsum of the foot in 52 healthy controls whose ages ranged from twenty to sixty-five years (mean 45.05 +/- 14.09) and 36 nondiabetic patients with peripheral vascular disease (PVD) (5 stage I, 16 stage II, 4 stage III, 11 stage IV), under standardized conditions at rest and during recovery from limb ischemia obtained with pneumatic cuff compression for 3 minutes. At rest the TcPO2 averaged 71.20 +/- 14.26 mm Hg (range 46-92) in the controls and 51.56 +/- 26.38 in the PVD patients (p less than .01). A wide overlap was observed between the two groups and among the different stages of the disease, and consequently, the diagnostic value of TcPO2 at rest was limited (sensitivity equal to 32%). During the recovery from ischemia the time constant (recovery half-time, T1/2) averaged 38.01 +/- 7.23 sec in the controls and 55.84 +/- 19.82 in the PVD patients (p less than .01). The T1/2 added to the diagnostic value of the method, making it more sensitive (55%), especially for stage II patients. The TcPO2 at rest was lower with increasing severity of the disease; both the TcPO2 at rest and the T1/2 correlated with the ankle-arm pressure index in the diseased limbs (r = .48 and -.41 respectively, p less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)