The relationship of plasma viscosity with microvascular complications in the diabetic elderly and its predictive value

PurposeThe aim of our study is to define the association between microvascular complications and plasma viscosity (PV) in the diabetic elderly and to determine whether PV measurement can be used as a potential marker for microvascular complications of diabetes.MethodsIn this cross-sectional study consisted of people aged 65 or over, 226 of them had diabetes and 59 of them did not. Those with inflammatory disease, infection and organ failure were not included in the study as they could affect PV. Diabetic cases are categorized into groups according to their microvascular complications. The PV of all the cases was measured by Brookfield DV-II viscometer.ResultsPV is significantly higher in diabetic patients when compared to the non-diabetic control group (1.71 ± 0.17 mPa s and 1.48 ± 0.06 mPa s respectively, P < 0.001). PV is higher in DM patients with neuropathy as compared to those without any microvascular complications (1.76 ± 0.16 mPa s and 1.60 ± 0.07 mPa s respectively, P < 0.001). In all the dual and triple combinations of microvascular complications, the average PV is found to be significantly higher than those with no complications (for all groups P < 0.001). In addition, there is statistically significant positive association between the severity of diabetic retinopathy and PV (P < 0.001).ConclusionPV is clearly elevated in the diabetic elderly, particularly in patients with microvascular complications. These elevations are significantly correlated with the duration of diabetes, metabolic control level and the number of microvascular complications. Studies are needed to show the cause and effect relationship between diabetic complications and PV in the elderly.     

Undeniable need for ultrafast-acting insulin: the pediatric perspective

Insulin therapy in youth with type 1 diabetes mellitus (T1DM) poses a special challenge because childhood is an unsteady state with increasing weight, height, and caloric needs, leading to varying insulin requirements. The current rapid-acting insulin analogs are not as fast and short-acting as needed to meet these challenges. This review describes the unique characteristics of insulin action in youth with T1DM based on previously published euglycemic clamp studies. It also explains the rationale behind the need for ultrafast-acting insulins to advance open- and closed-loop insulin therapy for the pediatric population with diabetes. Lastly, it briefly summarizes ongoing and future projects to accelerate insulin action in youth with T1DM.     

Cardiac involvement of hydatid disease

Objectives|Echinococcosis is a serious health issue occurring in some geographical region of the world. Cardiac involvement is rare and early diagnosis and prompt surgical intervention are critical.Subjects and Methods: Six patients with cardiac hydatid cysts underwent surgical treatment in our institution between April, 1996 and March, 2002. Five of the patients were female and one was male. Average age was 40±5 years with a range of 19 to 72 years. Cysts were located in the right ventricular outflow tract in two patients, the left ventricular outflow tract in one, the right atrial in one, the right ventricular in one and the right atrioventricular groove in one. Five patients were operated on using standard cardiopulmonary bypass techniques, and one was operated on without cardiopulmonary bypass.Results: In the perioperative and the early postoperative period, no cardiac problems was observed. On control echocardiography, a ventricular septal defect was detected in one patient in the late postoperative period. The ventricular septal defect was repaired using standard cardiopulmonary bypass and was closed with a teflon patch. Patients were followed up for a mean period of 3.4±2.5 years. No mortality or recurrence was observed during the follow-up period.Conclusions: When hydatid cyst is diagnosed, the possibility of cardiac involvement should also be investigated. The treatment of cardiac hydatid cyst is surgical extraction of the cyst.     

Effect of gestational nicotine treatment on newborn rat retina: a histopathological and morphometric analysis

BACKGROUND: Smoking is a significant risk factor in several debilitating and fatal diseases. It has been implicated in bilateral tobacco-toxic and Leber's hereditary optic neuropathies. Although it has been demonstrated that smoking has a cumulative effect on retinal and optic nerve functions and causes diffuse and localised retinal sensitivity decrease in healthy chronic heavy smokers, the affected retinal layer has not been identified and there is no experimental study investigating the effect of nicotine exposure during gestation on the newborn rat retina. PURPOSE: This experimental investigation evaluated histologically the influence in vivo of maternal nicotine treatment during pregnancy on the newborn rat retina. Different dosages of the test compound simulated the range of low, moderate, and heavy smokers in humans. METHODS: Experimentally naive, adult female Wistar-albino rats weighing 200-250 g were mated with adult male rats over 2 days for copulation in the proportion of two females for every male animal. After confirming pregnancy with vaginal smear method, 40 gravid rats (dams) were then randomly assigned into four equal groups (three experimental and one control; n = 10 in each). On day 9 of gestation, groups 1, 2, and 3 experimental dams were treated with intraperitoneal (i.p.) (-)-nicotine tartrate at doses of 0.5, 1, and 2 mg kg body weight-1 day-1, respectively during pregnancy from gestational day 9-21. Group 4 control dams were given i.p. saline solution daily for the same period. After normal delivery, the newborn litters were sacrificed at postnatal day 1 or day 30. The eyes were enucleated for histopathologic and morphometric analysis of the retinas. Nicotine-induced neuronal changes were measured by morphometric analyses on cell counts of ganglion cell layer (linear cell density in number per unit length of retina) and thickness of the various retinal layers. RESULTS: The litters in control group 4, and experimental groups 1 and 2 had normal retinal findings. On the other hand, morphometric analysis of retinal sections in experimental group 3 eyes demonstrated a 20.7% decrease in the number of surviving ganglion cells (40.7 +/- 2.0) compared with controls (51.3 +/- 1.1; p < 0.001). The thickness of whole retina (126.6 +/- 5.4 microm) was also reduced by 13.5% compared with controls (146.3 +/- 4.5 microm; p = 0.007). The main site of retinal atrophy was the inner plexiform layer (30.1 +/- 1.6 microm vs 43.5 +/- 1.3 microm; p < 0.001) with almost no change in the other retinal layers. CONCLUSIONS: Gestational nicotine treatment induces marked changes in the organisation of the developing retina in newborn rats histopathologically. Quantitative morphometric analysis clearly demonstrated that the two most affected structures were the retinal ganglion cells and the inner plexiform layer, both of which are supplied by central retinal artery.     

Epilepsy in vacuolating megalencephalic leukoencephalopathy with subcortical cysts.

Vacuolating megalencephalic leukoencephalopathy with subcortical cysts (MLC) is a disorder characterised by acquired macrocephaly, developmental motor delay of varying degrees, slowly progressive cerebellar and pyramidal signs, and initially preserved intellectual function. More than 60% of the published cases had epileptic seizures. In this study, we analysed the seizures and EEG findings of nine patients with MLC. Six patients (66.6%) with moderate to severe neurological impairment had epilepsy, four with partial and two with generalised seizures. The EEG of five epileptic patients revealed epileptogenic foci over the temporal, frontal and parietal regions with variable predominance during waking and sleep. The facilitation of spike-and-wave paroxysms by eye closure, by intermittent photic stimulation and by hyperventilation were determined in four patients. Four patients also showed abnormalities in the background activity. In conclusion, we think that epilepsy is a significant component of MLC compared to the other leukodystrophies. The elucidation of the underlying molecular defect may explain the unusual pathogenetic relation between this leukoencephalopathy and the associated seizures.     

High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis

In this study, the results of open-wedge osteotomy with Puddu plate for the treatment of varus gonarthrosis have been evaluated prospectively. This study assessed 65 knees of 60 patients with varus gonarthrosis who underwent high tibial osteotomies. Our study population consisted of 13 male and 47 female patients with a mean age of 54 (range 39–76) years. For the clinical evaluation of the patients Hospital of Special Surgery (HSS) score, American Knee Society and Oxford knee scores, and for the radiological assessment mechanical axis deviation (MAD), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), femorotibial angle and Insall-Salvati index were basically taken into consideration. Our patients were followed up for an average of 34 (range 18–60) months. In the last assessments of our cases, mean improvements detected in HSS scores, Oxford knee scores, knee and functional scores of Knee Society were 26.72, 19.18, 49.9, and 30 points, respectively. The radiological examinations revealed that their mechanical axes on the average passed 5.09 mm laterally achieving an average of 6.5° genu valgum, and a mean Insall-Salvati index of 1.09. As complications, superficial wound infection in two patients (3%), implant infections in one patient (1.5%), deep vein thrombosis in two patients (3%), peroperative lateral tibial plateau fracture in one patient (1.5%), and postoperative lateral tibial plateau fracture due to a falling down were encountered. According to the results obtained, postoperative pain resolves promptly and a significant degree of improvement of knee functions of the patients are achieved. Therefore, we believe that high tibial osteotomy with a Puddu plate is a valuable alternative to total knee arthroplasty in cases with varus gonarthrosis. Although early results are satisfactory, long-term follow-up studies are required especially in the middle aged and elderly patient populations.