Lesions In Diabetic Patients Research Articles

TRANSLUMINAL BALLOON ANGIOPLASTY IN DIABETIC PERIPHERAL VASCULAR DISEASE

Transluminal (balloon) angioplasty of iliac or superficial femoral stenoses in 18 diabetic patients resulted in a significant improvement in ankle/brachial systolic pressure index with marked symptomatic improvement in 16, little change in one and deterioration requiring arterial bypass surgery in one patient. Follow-up for 12 months or more showed that the initial good results were sustained despite a downward drift in ankle pressures. These findings indicate that transluminal angioplasty has a useful place in the management of proximal atherosclerotic stenotic lesions in diabetic patients with symptomatic peripheral vascular disease.

Skeletal lesions and arterial calcifications of the feet in diabetics.

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.

Natural history of asymptomatic coronary arteriographic lesions in diabetic patients with end-stage renal disease

Arteriosclerotic heart disease is a major cause of death in insulinrequiring juvenile diabetic patients treated for end-stage renal disease. Eleven consecutive diabetic patients without clinical evidence of coronary artery disease underwent complete cardiac evaluations, including coronary arteriography, as part of transplant recipient work-ups. Seven were women and four were men; their mean age was 32 (21 to 50 years). Angiographically, every patient had multifocal atherosclerotic coronary disease. Four of seven patients tested had positive-stress electrocardiograms. In this group of patients followed for a mean of 19.8 months, eight died. Of these deaths, six were due to coronary heart disease and another due to a stroke. In two patients who became clinically symptomatic, serial angiograms revealed progressive disease of the coronary circulation; (n one case, despite normal renal allograft function and serum lipid levels. The mode of end-stage renal disease treatment, serum lipids or blood pressure control could not be linked to mortality. It is concluded that arteriosclerotic heart disease is common in diabetic patients with end-stage renal disease even when angina is absent. The natural history in this high risk population is an important consideration in the selection of patients for end-stage renal disease treatment.

CENTRAL NERVOUS SYSTEM IN DIABETES MELLITUS: LOWERED FREQUENCY OF CERTAIN INTRACRANIAL NEOPLASMS.

RETROSPECTIVE studies which had been designed to yield data about the frequency and topography of nervous system vascular lesions in diabetic patients coincidentally revealed a striking paucity of intracranial neoplasms in the same group.¹The present communication represents a summary of these unanticipated findings and is based upon observations taken from 9,223 autopsies. <h3>Materials and Methods</h3> The autopsies which form the basis of this study were performed at Kings County Hospital Center during the period from 1953 to 1963 and represent all autopsy examinations, during this interval, in which the central nervous system was studied. Excluded, however, are those patients who died, either in transit to the hospital or in the admitting room, before any historical information or pertinent laboratory tests could establish or exclude the diagnosis of diabetes mellitus. There were very few patients in this category. The general autopsies were undertaken by the resident physicians in pathology

The Pathology of Diabetes Mellitus.

In this book, which is based on the study of 300 cases, Warren again brings into focus the various phases of the pathology of diabetes. A consideration of the insular hypothesis is followed by the description of the histology of the normal pancreas. The lesions of the pancreas seen in diabetes are then described and compared with lesions observed in the pancreas of nondiabetic individuals. A conclusion at this point is important. "It is striking that practically any lesion found in the pancreas of diabetic individuals, either involving the island tissue, the acinar tissue or both, can be duplicated in the pancreas of nondiabetics." Only the greater frequency of such lesions in diabetic patients justifies their consideration as presumptive evidence of diabetes, and, without information of the previous clinical course or without studies of the glycogen distribution in other organs, the diagnosis of diabetes cannot be made. The complications of