Interaction between risk factors and the evaluation of quality of life in diabetic sufferers in relationship to the introduced therapy

Wstęp: Cukrzyca jest chorobą przewlekłą, prowadzącą do wielu powikłań. Poprzez kompleksową opiekę diabetologiczną i skuteczne postępowanie terapeutyczne można kontrolować i aktywnie stymulować subiektywne poczucie jakości życia. Celem pracy była ocena wpływu czynników ryzyka u chorych na cukrzycę typu 2 na domeny Quality of Life (QoL). Materiał i metody: Badania przeprowadzono wśród 101 pacjentów chorych na cukrzycę typu 2, powi­kłaną miażdżycą tętnic obwodowych (makroangiopatia cukrzycowa) w okresie niedokrwienia II B według klasyfikacji Fontaine’a. Każdy zakwalifikowany do badania pacjent został zbadany według kwestionariusza ogólnej oceny jakości życia SF-36 oraz autorską ankietą, uwzględniającą specyficzność choroby. Do analiz statystycznych wykorzystano elementarne metody statystyczne: test t-Studenta, test Chi-kwadrat, test Wilcoxona, test Kruskala-Wallisa oraz test U Manna-Whitneya. Wyniki: W grupie I analiza wieloczynnikowa predyktorów wpływających na ocenę jakości życia ankie­towanych osób wykazała istotną statystycznie zależność między domenami role-physical (RP), physical functioning (PF) i vitality (VT) a wiekiem, czasem trwania choroby i dolegliwościami bólowymi, domeną mental health (MH) a wiekiem i dolegliwościami bólowymi, oraz domeną social functioning (SF) a dole­gliwościami bólowymi. W grupie II analiza wieloczynnikowa wykazała istotną statystycznie zależność między domenami PF a wie­kiem, czasem trwania choroby i nasileniem bólu, domeną VT a nasileniem bólu, domeną MH a wskaźnikiem body mass index (BMI) oraz wiekiem, wskaźnikiem BMI i czasem trwania choroby w domenie SF. Wnioski: Grupę chorych, którym do leczenia włączono insulinę cechuje gorsza ocena jakości życia, zarówno w obszarze fizycznym, jak i psychicznym. Wybór sposobu leczenia okazał się nie mieć istotnego wpływu na QoL, determinować go mogły czas trwania choroby oraz otyłość.Introduction: Diabetes is a chronic disease that leads to various complications. Through complex diabetic care and effective therapy, it is possible, though, to control and actively influence the sufferers subjective experience and quality of life. The aim of study was an evaluation on influence of the risk factors on domains of quality of life in type 2 diabetes patients. Material and methods: The subjects of the study were 101 diabetic patients suffering from type 2 diabetes, complicated by peripheral arterial disease (diabetic macroangiopathy), at the stage of Fontaine stage II ischemia. Each patients who qualified for the study was evaluated with SF-36 questionnaire evaluating general quality of life and with the authors own survey which takes into consideration the specific nature of the disease. In the statistical analysis basic statistical tests were used, t-Student test, Chi-square test, Wilcoxon test, Kruskal-Wallis and U Mann-Whitney test. Results: In the group I, the multi-factor analysis of predictors influencing evaluation of quality of life of the surveyed patients revealed statistically significant correlation between domains role-physical (RP), physical functioning (PF) and vitality (VT) and age, disease duration and pain, in the mental health (MH) domain with age, pain and in social functioning (SF) it correlated with pain. In the second group, the multi-factoral analysis showed statistically significant correlation between the following domains: PF domain and age, disease duration and pain intensity, VT domain and pain intensity, MH domain and body mass index (BMI) and age, BMI index and disease duration in SF domain. Conclusions: The group of patients treated with insulin evaluated their quality of life lower. The kind of treatment way did not influence on the quality of life. The important determination could be disease duration or obesity

Zmiany w hemodynamice przepływu krwi w kończynach dolnych na przykładzie pomiarów termograficznych

Introduction. The flow of blood in the arterial and venous vessels of various organs is holds according to the difference of the value of systolic and diastolic pressures and is dependent from many factors connected with the control of the change of the vessel diameter. Arteriosclerosis can make difficult the access of the blood in the essential way to organs laid distally. Available diagnostic methods can increase in the essential way to the quicker intervention in the inhibition of the morbid process.The valuation of usability of method of thermography to rating of haemodynamics changes of blood flow in lower limbs at persons with ischaemia in II period according to Fontaine’a is the aim of study. Material and methods. Fifty persons was qualified to surveys in II period of the ischaemia of lower limbs, waiting on the endovascular intervention and 49 persons without the affirmed arteriosclerosis of lower limbs, with diseases coexisting characteristic for this aged group. The measurement of the temperature of lower limbs, was made with termographic camera Trotec IR 060. Results. The assessment of the temperature of lower limbs at persons with their ischaemia showed sig­nificant differences in average values in the comparison with healthy persons (35,4 vs. 36,5°C). The time of duration of the disease moreover was factor determining the evaluation of the changes of the value of the temperature — they diminished together with outflow of time of duration of the disease from 35,8 on 35,1°C in the studied group. Conclusions. Conducted studies let certify, that morbid process in the character of the ischaemia of lower limbs found reflection in the average values of the temperature on the skin surface of limbs in studied groups carrying out 1.1°C ± 0.7. The results of the examination with the thermographic camera confirmed dependence between the time of duration of the disease and the changes of the temperature of lower limbs. The registration of the range of the flow blood in the arteries of lower limbs made using the thermal photography can provide many interesting information to the valuation of the changes of the circulation in the indicated area.  Wstęp. Przepływ krwi w naczyniach tętniczych i żylnych różnych narządów odbywa się zgodnie z różnicą wartości ciśnień naczyniowych skurczowych i rozkurczowych oraz jest zależny od wielu czynników związanych z regulacją zmiany średnicy naczynia. Proces chorobowy, jakim jest miażdżyca, może w sposób istotny utrudniać dostęp krwi do narządów położonych dystalnie. Dostępne metody diagnostyczne mogą w sposób istotny przyczynić się do szybszej interwencji służącej zahamowaniu procesu chorobowego. Praca bada przydatność metody termografii do oceny zmian w hemodynamice przepływu krwi w kończynach dolnych u osób z niedokrwieniem II stopnia według Fontaine’a. Materiał i metody. Do badań zakwalifikowano 50 osób z niedokrwieniem kończyn dolnych II stopnia, czekających na zabieg endowaskularny oraz 49 osób bez stwierdzonej miażdżycy kończyn dolnych, z cho­robami współistniejącymi charakterystycznymi dla tej grupy wiekowej. Pomiar temperatury kończyn dolnych wykonano kamerą termowizyjną Trotec IR 060. Wyniki. Ocena temperatury kończyn dolnych u osób z ich niedokrwieniem wykazała istotne różnice w średnich wartościach w porównaniu z osobami zdrowymi (35,4 vs. 36,5°C). Ponadto czynnikiem deter­minującym ewaluację zmian wartości temperatury był czas trwania choroby — w badanej grupie malały one wraz z upływem czasu trwania choroby z 35,8 do 35,1°C. Wnioski. Przeprowadzone badania pozwoliły stwierdzić, że proces chorobowy w postaci niedokrwienia kończyn dolnych znalazł odzwierciedlenie w średnich wartościach temperatury skóry kończyn w badanych grupach, wynoszących 1,1°C ± 0,7. Wyniki badania kamerą termowizyjną potwierdziły zależność między czasem trwania choroby a zmianami temperatury kończyn dolnych. Rejestracja przepływu krwi w tętnicach kończyn dolnych wykonana za pomocą kamery termowizyjnej może wnieść wiele interesujących informacji służących ocenie zmian krążenia we wskazanym obszarze.

Hematologic complications in vascular malformations: A case study of 2 patients

Vascular malformations are congenital vascular anomalies resulting from a disruption in the vasculogenesis process. (1)  They are congenital changes that enlarge as the child develops and do not undergo spontaneous involution. They can be classified based on the type of vessels involved (capillary, arterial, venous, lymphatic, mixed) and the nature of the vascular flow (low-flow and high-flow). The clinical presentation of vascular malformations is highly diverse, and despite being congenital, they can remain asymptomatic for a long time, complicating the diagnostic process. (1,3)   The presence of malformations carries the risk of health-threatening complications. One such complication is Kasabach-Merritt syndrome, characterized by thrombocytopenia, microangiopathic hemolytic anemia, and consumptive coagulopathy in the presence of a rapidly enlarging vascular tumor. (4,5) Another threat is a coagulopathy limited to the vascular anomaly (LIC). It is characterized by elevated D-dimers and fibrin degradation products, low levels of fibrinogen, FV, FVIII, FXIII, and antithrombin, and sometimes mild to moderate thrombocytopenia. (6,7) Early implementation of anticoagulant therapy allows for the avoidance of health-threatening conditions and the development of disseminated intravascular coagulation syndrome (DIC). (8

Wroclaw Epidemiological Trial on Diabetes - WET-Diab

WSTĘP. Aktywne poszukiwanie chorych z zaburzeniami gospodarki węglowodanowej stanowi najlepszą metodę zapobiegania późnym powikłaniom tego schorzenia. Celem pracy było określenie czynników ryzyka i częstości cukrzycy typu 2 - cukrzycy znanej i nieznanej w reprezentatywnej grupie mieszkańców Wrocławia. MATERIAŁY I METODY. Badaniu poddano grupę osób w wieku 55-75 lat dobraną drogą losowania warstwowego z bazy PESEL stałych mieszkańców Wrocławia. W pierwszym etapie przeprowadzono ankietę badawczą, analizując pomiary antropometryczne, ciśnienia tętniczego i glikemii we krwi włośniczkowej. Nieprawidłowy wynik glikemii stanowił podstawę zakwalifikowania do drugiego etapu badań, który obejmował glikemię na czczo i doustny test tolerancji glukozy (OGTT, oral glucose tolerance test) u osób z glikemią 5,5-6,7 mmol/l. WYNIKI. Spośród 1500 badanych do drugiego etapu z powodu glikemii powyżej 5,5 mmol/l zakwalifikowano 362 osoby: 216 kobiet i 146 mężczyzn. U 72 osób (19,8%) była to cukrzyca znana. U 10,34% osób potwierdzeniem cukrzycy było stężenie glikemii 2-krotnie przekraczające 7 mmol/l, natomiast na podstawie OGTT cukrzycę rozpoznano u 21,37% osób, nietolerancję glukozy u 37,24%, a nieprawidłową glikemię na czczo u 31,03%. Częstość cukrzycy nieznanej była wyższa niż częstość cukrzycy znanej u badanych w przedziale wiekowym 55–65 lat, natomiast u osób powyżej 65. roku życia większa była częstość cukrzycy znanej. WNIOSKI. Znamiennie częściej stwierdzano cukrzycę nieznaną u kobiet, z tym że wskaźnik masy ciała (BMI, body mass index) w cukrzycy znanej i nieznanej u kobiet nie różnił się istotnie statystycznie, natomiast u mężczyzn cukrzyca nieznana występowała znamiennie częściej, jeśli BMI wynosiło powyżej 30 kg/m2.INTRODUCTION. Active searching for patients with carbohydrate metabolism disorders is the best method for preventing of chronic complications of the disease. The aim of the study was to find risk factors and to estimate prevalence of type 2 diabetes (known and unknown) in Wrocław population. MATERIAL AND METHODS. The study was entered by subjects aged 55-75 years who were randomly chosen (the random number method) from the Wrocław population PESEL database. The first stage consisted of: age, profession, life-style questionnaire, family history, suffered diseases before and the anthropometrical evaluation, blood pressure and fasting capillary glucose level were performed. The patients with incorrect glucose level were included to second stage where fast glucose level and OGTT above 5.5-6.7 mmol/l evaluated. RESULTS. To second stage study 362 (216 women and 146 men) from 1500 subject were included with glycaemia higher than 5.5 mmol/l. The known diabetes was found in 72 persons (19.8%). The diagnosis of diabetes was confirmed because of two examination results higher than 7 mmol/l. Based on OGTT in 21.37% of patients diabetes and in 37.24% impaired glucose tolerance. CONCLUSIONS. Between 55-65 aged patients the prevalence of unknown diabetes was higher than known diabetes while known diabetes in patients older than 65 years was more common. Unknown diabetes was found significantly more often in females. In female with unknown and known diabetes BMI was not significantly different

Hematologic complications in vascular malformations: A case study of 2 patients

Vascular malformations are congenital vascular anomalies resulting from a disruption in the vasculogenesis process. (1)  They are congenital changes that enlarge as the child develops and do not undergo spontaneous involution. They can be classified based on the type of vessels involved (capillary, arterial, venous, lymphatic, mixed) and the nature of the vascular flow (low-flow and high-flow). The clinical presentation of vascular malformations is highly diverse, and despite being congenital, they can remain asymptomatic for a long time, complicating the diagnostic process. (1,3)   The presence of malformations carries the risk of health-threatening complications. One such complication is Kasabach-Merritt syndrome, characterized by thrombocytopenia, microangiopathic hemolytic anemia, and consumptive coagulopathy in the presence of a rapidly enlarging vascular tumor. (4,5) Another threat is a coagulopathy limited to the vascular anomaly (LIC). It is characterized by elevated D-dimers and fibrin degradation products, low levels of fibrinogen, FV, FVIII, FXIII, and antithrombin, and sometimes mild to moderate thrombocytopenia. (6,7) Early implementation of anticoagulant therapy allows for the avoidance of health-threatening conditions and the development of disseminated intravascular coagulation syndrome (DIC). (8

Successful surgical treatment of popliteal artery cystic adventitial disease

We present the case report of a 43-year-old male, professional sport user, complaining of pain in his right lower extremity. We have discussed the symptoms, diagnostics with its differentiation, treatment methods and their efficacy. The diagnosis of cystic adventitial disease was made on the basis of diagnostic imaging such as Doppler ultrasound and magnetic resonance imaging. Surgical procedure is the treatment of choice, to which the patient was qualified

Critical ischemia of the fingers in an auto mechanic as a result of occupational exposure

Hypothenar hammer syndrome is a rare cause of ischemic fingers observed mainly in young men smoking cigarettes and it is associated with repeated trauma of the ulnar artery in the area of the hypothenar eminence of the dominant-hand arm, resulting in a deficit of blood supply with the occurrence of hand symptoms typical for chronic and sometimes critical ischemia. Artery injury in this location is most often the result of multiple repetitions of the same activity being mostly the result of occupational exposure. We present a case of a 27-year-old car mechanic admitted to the hospital with symptoms of critical ischemia of the fingers III, IV, and V of the right hand, which resolved after conservative treatment

Evaluation of the effectiveness of partial splenic endovascular embolization in patients with refractory thrombocytopaenia

Purpose: Partial splenic endovascular embolization (PSEE) could be an option for patients with thrombocytopaenia (TCP). We selected a group of 22 patients diagnosed with refractory TCP to undergo PSEE, and we followed them for detailed analysis. Material and methods: Twenty-two patients aged 27-75 years (mean 46.5 ± 3.5 years) underwent PSEE, and 5 participants underwent a second PSEE due to the lack of effectiveness after the first procedure. A total of 27 PSEEs were performed. A semi-quantitative scale was used to assess the severity of the post-embolization syndrome. The percentage of spleen parenchyma excluded from circulation was 30-70%. We used the mixture of Histoacryl N-butyl cyanoacrylate glue and Lipiodol in 10 cases, spirals in 10 cases, and polyvinyl alcohol in 7 cases, for the embolization. Results: The mean value of platelet count (PLT) before procedure increased from 22.0 ± 15.0 to 87.7 ± 67.9 (p < 0.05) in a mean period of 194 days. In 2 cases severe post-embolization syndrome was observed. Closure less than 50% of the spleen circulation was associated with poorly expressed post-embolization symptoms. Serious complications occurred in 1 patient (3.5%). A strong positive correlation (r = 0.8, p < 0.05) was found between C-reactive protein (CRP) and the severity of post-embolization syndrome. Increased symptoms of post-embolization syndrome were also associated with a significant increase in hospitalization time – 27.0 vs. 7.2 days (r = 0.66, p < 0.05). Conclusions: Partial endovascular embolization of the spleen (PSEE) may be a valuable therapeutic option for patients with refractory TCP. PSEE is a safe method with a low complication rate

Imaging difficulties in Takayasu arteritis : case report and review of the literature

Background: Takayasu arteritis is an inflammatory disease of large-diameter arteries. Aorta and its branches are most frequently affected. Takayasu arteritis occurs mainly in young women and, if left untreated, leads to fatal complications. Digital subtraction angiography (DSA) is considered the gold standard in imaging of Takayasu arteritis. Case Report: A thirty-five-year-old woman was admitted to the hospital with transient loss of consciousness, effort-associated vertigo, upper limb weakness and temporary vision problems. On admission, there was no pulse on the left radial artery while there were bruits over subclavian arteries. Imaging of the aortic arch (computed tomography angiography, DSA) revealed stenoses of its main branches, indicating Takayasu arteritis. Conclusions: Computed tomography angiography (CTA) performed with a 64-slice unit revealed high effectiveness in localization of vascular wall and lumen pathologies resulting from Takayasu arteritis. Thanks to this fast diagnostic method, it is now possible to perform successful monitoring of patients with Takayasu arteritis and to plan possible interventional treatment

Diabetic Muscle Infarction—A Rare Diabetic Complication: Literature Review and Case Report

We present a case of a 31-year-old patient with type 1 diabetes diagnosed at the age of 6. Diabetes is complicated with neuropathy, retinopathy, and nephropathy. He has been admitted to the diabetes ward due to inadequate diabetes control. Gastroscopy and abdominal CT were performed, and gastroparesis was confirmed as an explanation for postprandial hypoglycemia. During hospitalization, the patient reported sudden pain localized on the lateral, distal part of his right thigh. The pain occurred at rest and was aggravated by movement. Diabetic muscle infarction (DMI) is a rare complication of long-lasting, uncontrolled diabetes mellitus. It usually occurs spontaneously, without any previous infection or trauma, and is often misdiagnosed clinically as an abscess, neoplasm, or myositis. DMI patients suffer from pain and swelling of the affected muscles. Radiological examinations, including MRI, CT, and USG, are most important for the diagnosis, assessing the extent of involvement and differentiating DMI from other conditions. However, sometimes a biopsy and histopathological examination are necessary. The optimal treatment has still not been determined. There is also a potential risk of DMI recurrence