Eosinophilic pancreatitis in the newborn infant of a diabetic mother

Summary The authors have studied the pancreas of a premature female infant born to a diabetic mother. The findings included a peri-insular eosinophilic leucocyte infiltration, macropolinesia and a marked increase in B cells. In the exocrime parenchyma small B cells aggregates were also observed. B cells contained voluminous hypercromatic muclei and degranulated cytoplasm. Morphometric data demonstrated an increase in islet tissue. These morphological findings are indicative of excessive insulin secretion. The presence of eosinophilic leucocytes in pancreatic tissue and the pathogenic mechanism involved are discussed.     

Microangiopathy in human diabetic neuropathy

Summary Morphological change of endoneurial and perineurial vessels accompanied severe loss of myelinated axons in peripheral nerves of each of 17 patients with diabetic neuropathy. Vascular mural thickening averaged 18.9±9.9 m² in diabetic capillaries (n=11) vs. 6.9±4.1 m² in controls (n=7). Electron microscopy revealed vigorous endothelial proliferation as well as thickening and reduplication of basal lamina in each instance. Particular attention was paid to vessels which penetrate the perineurium en route to the endoneurial intertitium, since they provide a major portion of the endoneurial blood supply. Luminal narrowing and mural thickening of these vessels was compounded by basal laminar thickening of the perineurium. Fenestrated endoneurial capillary endothelium was noted in one case. Both demyelination and axonal degeneration were observed with intra-axonal glycogen accumulation in some axons. Morphometric analysis revealed extensive myelinated nerve fiber loss in diabetic nerves. These morphological findings emphasize the impact of diabetic microangiopathy on specialized endothelium and suggest that local anatomic factors in the perineurial sheath render the nerve vulnerable to chronic ischemia.Supported in part by the National Institute for Communicative Disorders and Stroke NS-14162 and by the Veterans Administration Research Service     

前列地尔辅助硫辛酸治疗糖尿病足溃疡合并感染的临床效果

目的探讨前列地尔辅助硫辛酸治疗糖尿病足溃疡合并感染对患者胰岛素样生长因子-1(IGF-1)、纤维连接蛋白(FN)、血管内皮生长因子(VEGF)水平及足背血流动力学的影响。方法选取2017年5月-2019年5月新疆医科大学第一附属医院收治的104例糖尿病足溃疡合并感染患者,采用随机数字表法将所选患者分为研究组(n=52)和对照组(n=52)。对照组给予硫辛酸进行治疗,研究组在此基础上给予前列地尔进行治疗,两组均治疗4周。比较两组治疗4周后的下肢静息疼痛改善情况,治疗前、治疗4周后的血清IGF-1、FN、VEGF水平及足背动脉血流速度和足背动脉内径,统计两组治疗期间的不良反应发生率。结果治疗4周后,研究组下肢静息疼痛总改善率为96.15%,高于对照组(P<0.05)。与治疗前比,治疗4周后,两组血清IGF-1、FN、VEGF水平及足背动脉血流速度、足背动脉内径均升高,且研究组均高于对照组(P<0.05)。治疗期间,研究组不良反应发生率为5.77%,低于对照组(P<0.05)。结论前列地尔辅助硫辛酸治疗糖尿病足溃疡合并感染,可显著提高患者血清IGF-1、FN、VEGF水平,改善其足背血流动力学,并能缓解患者下肢静息疼痛,降低不良反应发生率。     

老年Ⅱ型糖尿病患者血清NO水平与肾功能变化的相关性研究

目的探讨一氧化氮(NO)在老年Ⅱ型糖尿病肾病发病过程中的变化规律及其与肾功能的关系。方法采用Griess法检测48例Ⅱ型DM病人血清NO值在水平及与肾功能有关的指标,并与17例正常人进行比较,结果血清NO值在正常尿蛋白(DMI)组(88.86±9.61umol/l)和微量尿蛋白(DMII)组(90.00±17.94umol/l)明显高于对照组(56.70±9.53umol/l)(P＜0.01),至临床肾病期血浆NO浓度明显降低(63.25±8.64umol/l)(P＞0.05);NO与BUN、BCR呈负相关,而与CCR呈正相关。结论血清NO水平的动态变化与Ⅱ型DM肾病的发生、发展有密切联系。     

血管紧张素转换酶和内皮素与糖尿病微血管病变的关系

目的 探讨血管紧张素转换酶（angiotensin converting enzyme,ACE)和血浆内皮素（endothelin,ET)水平与糖尿病微血管病变的关系。方法 用紫外分光光度法和直接放射免疫法测定55例糖尿病患者和30名正常人血清ACE和血浆ET水平。结果 糖尿病微血管病变患者血清ACE和血浆ET水平显著高于糖尿病无微血管病变患者,且随着糖尿病微血管病变的加重,血清ACE和血浆ET水平显著增高。糖尿病患者血清ACE和血浆ET水平呈显著正相关。结论 糖尿病微血管病变患者血清ACE和血清ET水平增高可能与糖尿病微血管病变的发生发展有关。     

玻璃体视网膜手术病因分析

目的：研究玻璃体视网膜手术的主要致病。方法：对449例玻璃体视网膜手术做回顾性分析,男243例,女206例,术前视力光感－0．2;平均病史11．6月,手术采用三切口闭合式玻璃体切割术,结果：449例诊断明确,与术前诊断符合率为80．6％,病因中视网膜血管性疾病114例,占25．39％,眼外伤85例,占18．93％,糖尿病视网膜病变82例,占18．26％,黄斑部病变41例,占9．13％,孔源性视网膜脱离39例,占8．69％,眼内炎25例,占5．57％,结论：玻璃体视网膜手术正走向成熟,其适应证逐渐扩展,已成为治疗眼后段疾病的重要手段。     

用组织多普勒技术评价扩张型心肌病室壁运动

目的　用组织多普勒技术分析扩张型心肌病 (DCM)室壁运动。方法　选择 DCM患者和正常对照各 30例 ,用组织多普勒技术于胸骨旁长轴检测室间隔及左室后壁中间段短轴方向心肌运动速度 (MV) ,并计算心肌运动速度阶差 (MVG) ;经心尖窗检测左室前、后、下、侧壁和前、后室间隔中间段长轴方向 MV。结果　 DCM组患者有 4种 MV频谱异常表现 ,且 MV明显低于对照组 (P<0 .0 5 ) ,并以长轴为甚 ;MVG明显减低 (P<0 .0 5 ) ;室壁各种速度差异消失。结论　组织多普勒技术可定量反映 DCM患者室壁运动异常     

Bioactive glass,a new tool for the treatment in the diabetic foot recalcitrant osteomyelitis: A case series with 24-month follow-up

BackgroundThe bioactive glass (BAG) is a promising solution for the reconstruction of bone defects and the eradication of infection in patients with osteomyelitis, however references to the treatment of diabetic foot osteomyelitis are scarce in the literature.MethodsOur experience in patients with diabetic foot osteomyelitis, who required surgical debridement and void filling, in which we use bioactive glass (n = 6), was evaluated. During a minimum follow-up of 24 months, the presence of persistent infection and healing rate, post-surgical complications, surgical reinterventions, degree of osseointegration and BAG-related side effects was analyzed.ResultsAt the end of the follow-up, none of the patients showed signs of persistent infection and the healing rate was 66.6% (4/6).Postoperative complications were noted in 3 patients and two of the them required new surgical intervention, both due to skin coverage or vascular complications.A complete osseointegration in the 66.6% of the patients and no cases of local adverse effects were recorded.ConclusionsThe bioactive glass can be a useful tool in the treatment of certain cases of diabetic foot osteomyelitis, provided that a multidisciplinary approach and strict patient selection is in place.Level of evidenceIV.     

Conservative surgery for chronic diabetic foot osteomyelitis: Procedures and recommendations

Osteomyelitis (OM) is the most frequent infection associated with diabetic foot ulcers (DFU) that typically involve the forefoot, the most common location of DFU.Conservative surgical procedures could be attractive alternative that reduces minor and major amputations and avoid future recurrence thus preserving the functionally of the foot. This review aimed to analyze and describe the current evidence on conservative diabetic foot osteomyelitis (DFO) surgical procedures depending on DFU location and indications.A narrative revision of the evidence was carried out by searching Medline through PubMed databases from inception to late July 2020 to identify retrospective, prospective, and randomized controlled trials pertaining to conservative DFO procedures on the forefoot.Seven types of conservative surgical procedures for DFO treatment in the forefoot are described in this review: (1) partial or total distal phalangectomy, (2) arthroplasty of the proximal or distal interphalangeal joint, (3) distal Syme amputation, (4) percutaneous flexor tenotomy, (5) sesamoidectomy, (6) arthroplasty of the metatarsophalangeal joint, and (7) metatarsal head resection.When indicated, conservative surgery for DFUs in patients with chronic forefoot OM is a safe and effective option that increases the chances of healing and reduces the possibility of limb loss and death compared with radical amputation procedures.Since a lack of sufficient evidence supporting this procedure exists, future investigations should be focused on the random clinical trial (RCT) design. The results of prospective trials could help surgeons select the appropriate procedure in each case in order to minimize complications.     

Our experience of reinnervation of sole in diabetic sensorimotor polyneuropathy: A chance to change the natural history of disease

Diabetic sensorimotor polyneuropathy (DSPN) is the commonest form of neuropathy which leads to insensate sole, diabetic foot ulcers (DFU) and its complications. We share our experience in recovery of sensation in the sole after prophylactic surgery such as nerve decompression (ND) or sensory neurotization by nerve transfer (NT) in patients having Diabetic sensorimotor polyneuropathy DSPN. 32 patients (46 feet) were selected for either nerve decompression or sensory neurotization depending upon presence or absence of Tinel’s sign at tarsal tunnel. At 6 month post-operatively perception of touch and pain recovered in all feet; temperature and pressure perception recovered in ∼95% feet; average vibration perception threshold returned to normal range and 2-Point Discrimination came down significantly. There were no ulcers or amputation in operated limbs during follow up period of 6 months. Prophylactic surgery in the form of ND and NT can be offered with minimal complications which significantly improve sensations in the sole in selected cases of DSPN. These have the potential to improve the quality of life of patient and change the natural course of disease.