The influence of sympathetic failure on the skin microcirculation of the diabetic neuropathic foot

Contains fulltext : mmubn000001_207001979.pdf (publisher's version ) (Open Access)Promotores : T. Thien, H. Wollersheim en J. Lutterman199 p

Skin microcirculation of the foot in diabetic neuropathy

Contains fulltext : 22992.PDF (publisher's version ) (Open Access

Autonomic dysfunction in Parkinson's disease, tested with a computerized method using a Finapres device

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Pain in the hip area accompanied by a fever.

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Asymptomatic bacteriuria in women with diabetes mellitus - Effect on renal function after 6 years of follow-up

Background: The long-term consequences of asymptomatic bacteriuria (ASB) on renal function in women with diabetes mellitus (DM) are unknown. Methods: A prospective study was performed among women with type 1 or type 2 DM. Women with ASB (diagnosis based on findings from 1 urine culture specimen) were compared with women without ASB for differences in renal function development and incidence of hypertension. Results: A total of 644 women were included in the study (296 with type 1 DM and 348 with type 2 DM; mean [SD] age, 51 [15] years) and followed up for a mean (SD) duration of 6.1 (1.9) years. The prevalence of ASB was 17%. In women with DM and ASB, the creatinine clearance decreased from 87 mL/min (1.45 mL/s) at baseline to 76 mL/min (1.27 mL/s) at study end point; in women with DM without ASB the creatinine clearance decreased from 97 to 88 mL/min (from 1.62 to 1.47 mL/s). In the multivariate analyses, adjusted for age, length of follow- up, duration of DM, and microalbuminuria at baseline, no association was found between ASB and the relative or the absolute decrease in creatinine clearance; the same results were shown also when women with DM type 1 and women with DM type 2 were analyzed separately. Women with ASB developed hypertension more often than women without ASB (54% vs 37%; P=. 045), but there was no significant association in the multivariate analysis ( odds ratio, 1.5; 95% confidence interval, 0.7-3.6). Conclusion: Women with DM (type 1 or type 2) with ASB do not have an increased risk for a faster decline in renal function or the development of hypertension after 6 years of follow-up

Prevalence and clinical characteristics of insulin-treated, anti-GAD-positive, type 2 diabetic subjects in an outpatient clinical department of a Dutch teaching hospital.

BACKGROUND: In clinical practice, type 1 and type 2 diabetic patients are sometimes difficult to distinguish. Type 1 diabetes has an immune-mediated pathogenesis, resulting in a loss of insulin-secreting beta-cells. Type 2 diabetes mellitus is characterised by a relative insulin insufficiency, without the presence of an autoimmune aetiology, initially due to insulin resistance and later also accompanied by defective insulin release. Latent autoimmune diabetes of the adult (LADA) is a subgroup of diabetes, somewhere on the borderland between type 1 and type 2 diabetes. LADA is characterised by a late-age onset and relatively mild progression, but with unmistakable signs of autoimmunity, such as the presence of the autoimmune antibodies anti-GAD65, anti-insulin antibodies, or anti-Ia-2ab. OBJECTIVE: To establish the prevalence of anti-GAD ina diabetic outpatient clinic of a Dutch, non-university,teaching hospital and to describe these patients clinical and laboratory features, especially of the metabolic syndrome. METHODS: We evaluated GAD65 antibodies and other parameters in 244 selected diabetic patients, who had been on oral therapy for at least three months before becoming insulin-dependent. RESULTS: Twenty-six patients (11.6%) were positive for GAD65 antibodies. These patients had a significantly lower BMI (27.8 +/- 4.5 vs 31.1 +/- 4.9; p<0.01); less often cerebrovascular accidents (19.2 vs 34.9%; p<0.01) and a higher HDL cholesterol (1.73 +/- 0.53 vs 1.21 +/- 0.38; p<0.05). In contrast, anti-GAD patients had a significantly higher prevalence of hypothyroidism (23.0 vs 6.6%; p<0.05). CONCLUSION: Anti-GAD-positive patients represent a sizable proportion of type 2 diabetes in a second-line outpatient clinic, and they are characterised by lower parameters of the metabolic syndrome, but higher prevalence of other autoimmune phenomena such as hypothyroidism

Reproducibility of skin microcirculatory measurements in humans, with special emphasis on capillaroscopy.

The reproducibility of capillaroscopic measurements of capillary blood cell velocity (CBV) in human nailfolds was investigated by use of the computerized system CapiFlow. Therefore, CBV measurements of two capillaries of each of three fingers together with laser Doppler fluxmetry (LDF) and skin temperature measurements were performed three times in five healthy volunteers. Short-term (1.5 h) intra-individual coefficient of variation (CV) of CBV was 18.4%. Long-term (7 days) CV amounted to 55.8%. Inter-individual CV was 55.9%. Short- and long-term intra-individual CVs of LDF were 25.4% and 37.3%. Inter-individual variation was 36.0%. Skin temperature showed short- and long-term CVs of 3.7% and 5.5% and inter-individual CV of 5.8%. In conclusion, measurement of CBV using CapiFlow is a suitable method to assess acute effects, but has limited value in investigating long-term effects. Because of the wide interindividual variability in both CBV and LDF, power calculations will reveal large numbers to investigate. Skin temperature has a relatively small intra- and inter-individual variation and is more suitable for long-term studies

Autonomic dysfunction in Parkinson's disease, tested with a computerized method using a Finapres device

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