ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb08732.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb08733.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

ABSTRACT.The relationship between neuropathy and peripheral circulation was assessed in 26 patients with a short to moderate duration (20 years, mean 35 years) of diabetes mellitus. Peripheral nervous function was evaluated from measurements of vibration thresholds and ankle reflexes and autonomic nervous function from deep breathing, Valsalva, and tilt table tests. Peripheral circulatory tests included plethysmography, systolic blood pressure ratios, and thermography. A markedly delayed toe temperature increase after cooling followed by indirect heating occurred in diabetics of short duration with autonomic neuropathy (AN). Judging from blood flows and pressure ratios, functional vasospasm caused abnormal toe temperature reactions in short duration diabetics. No correlation existed between AN and abnormal toe temperature reactions in diabetics of long duration. Macroangiopathy rather than AN seemed to be responsible for abnormal toe temperature reactions in long duration diabetics. Thus, an abnormal toe temperature reaction indicates AN in patients with a short duration and macroangiopathy in patients with a long duration of diabetes.

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb08734.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

ABSTRACT.Skin viability has during the last decades been studied by a number of different techniques. Some of these are briefly presented in this paper. One method, based on the laser‐Doppler principle, makes possible continuous and noninvasive measurement of blood flow in the outermost layer (1 mm) of the skin. The basic physical principles and the properties of this flowmeter are presented. Some clinical and research applications of laser‐Doppler flowmetry in a number of medical disciplines are discus

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb08735.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

ABSTRACT.Vital capillaroscopy is useful in clinical practice to study the nutritional skin capillaries and for evaluating the risk for skin necrosis in patients with peripheral ischemia. This method is especially valuable in the investigation of patients with diabetes mellitus (DM) in whom the arterial inflow to the foot can be almost normal despite the development of skin necrosis due to impaired nutritional circulation. When the capillary morphology in the feet of asymptomatic diabetic patients was investigated, significantly more areas with widely dilated capillaries were present both in insulin and tablet treated patients compared to controls. By using dynamic capillaroscopy the flow velocity in skin capillaries can be determined under physiological conditions. Fourteen diabetic patients were compared with matched non‐diabetic controls. The capillary blood flow during resting conditions was equal in the two groups but a delay in the postocclusive reactive hyperemia response was seen in the diabetic patients. The reason for this may be a vasomotor dysfunction in the precapillary arterioles or an increased blood viscosity. Further studies using dynamic vital capillaroscopy may improve our knowledge of the complex mechanisms responsible for diabetic microangiopath

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb08736.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

ABSTRACT.The predictive value of some routine laboratory tests given on admission was evaluated in a retrospective study to determine whether any given value could predict the outcome of distal gangrenous lesions and amputations in diabetic and nondiabetic patients. There was no difference in preoperative hemoglobin concentration between successful and unsuccessful amputations in 45 diabetic and 59 nondiabetic patients. In another group of 191 diabetic patients with distal gangrenous lesions, the lesions healed after nonsurgical treatment in 112 patients, 54 patients were submitted to amputation and 25 patients died before the lesions healed. Patients submitted to amputation had lower hemoglobin levels and higher erythrocyte sedimentation rates and white blood counts than patients in whom the lesions healed, whilst there were no differences between these two groups concerning blood glucose concentration or body temperature.

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb08737.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb08738.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

ABSTRACT.Five quantitative studies performed to disclose and measure diabetic abnormalities in the leg arteries are reported and briefly discussed. A medial as well as an intimal disease was found in the diabetic leg arteries. Thus roentgenological medial calcification correlated to glucose intolerance in older non‐diabetics and to diabetes duration in young insulin dependent diabetics. An intimal roughness was disclosed by arteriography in young insulin‐dependent diabetic patients. The roughness grew worse the longer the diabetes persisted. The development of this abnormality did not take place simultaneous with the medial calcification, but was closely connected with another disclosed abnormality, a uniform arterial narrowing, quite unlike the well known abrupt narrowing in older patients. The existence of a uniform arterial narrowing in diabetic patients was confirmed by ultrasonography and the use of this technique further revealed arterial stiffness as a long‐term diabetic phenomenon. A functional abnormality of the leg arteries of diabetic patients was disclosed by measurement of the postischemic peak blood flow in the leg in a 45° feet‐down position. A vast destruction of the autonomic nerves of the peripheral arteries was demonstrated by measurement of the norepinephrine content post mortem in long‐term diabetic patients. The results reported suggest a specific element in the large‐vessel disease of diabe

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb08739.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

ABSTRACT.A radiological study of the feet was performed in 162 unselected diabetic patients with gangrene. They were compared with 59 diabetic patients without gangrene, 45 patients with familial amyloidosis and polyneuropathy and 30 healthy controls. The patients with familial amyloidosis had severe distal neuropathy but normal oral glucose tolerance test curves. Radiographic findings, e.g. skeletal destructions (diabetic osteopathy) and arterial calcification of the medial type were classified without knowledge of the clinical findings. Osteopathy was more common in diabetic patients with gangrene than in the other groups of patients. Medial arterial calcification was more common among diabetics with gangrene compared to patients with amyloidosis and to controls. There were no differences between diabetics without gangrene and patients with amyloidosis, but both of these groups had more calcifications than the controls. Our study suggests that diabetic osteopathy is not caused by peripheral neuropathy per se. The skeletal and skin lesions in diabetic patients are probably equivalent lesions localized to different tissues in the feet. It has been suggested that medial degeneration in the arterial wall is due to neuropathy. In agreement with this suggestion, the patients with familial amyloidosis and neuropathy had medial calcification. However, in diabetic patients this does not exclude other etiological agents.

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb08740.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY

摘要:

ABSTRACT.Diabetic foot disease is a severe complication to diabetes mellitus. Preventive measures can reduce its occurrence and consequences. The present study was performed in order to assess the prevalence of diabetic foot disease in an urbanized area with well developed medical facilities. The study was based on a mail questionnaire to a stratified, randomized sample of 742 diabetics living in the Stockholm county. Only one third of these patients were free of diabetic foot symptoms. Many patients with severe signs found it difficult to take care of their feet, were living alone and did not seek professional help for their foot problems. Only 66% of the patients with severe foot disease utilized hospitals for their diabetes care. Furthermore, only half of them relied on some type of professional care for their feet.

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1984.tb08741.x

出版商:Blackwell Publishing Ltd    

年代:1984

数据来源: WILEY