| 1. |
- Larsson, J, et al.
(author)
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Clinical characteristics in relation to final amputation level in diabetic patients with foot ulcers: a prospective study of healing below or above the ankle in 187 patients
- 1995
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In: Foot & Ankle International. - 1944-7876. ; 16:2, s. 69-74
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Journal article (peer-reviewed)abstract
- The aim of this study was to describe the clinical characteristics in relation to final amputation level in diabetic patients with foot ulcers. In a prospective series, 187 consecutively presenting patients were investigated. From admission until final outcome, the patients were treated by a multidisciplinary team both as in- and out-patients. All the patients had one or more signs of neuropathy and 171 had evidence of peripheral vascular disease. Healing with an amputation below the ankle occurred in 74 patients, 88 patients healed with an amputation above the ankle, and 25 patients died unhealed. Amputation above the ankle was associated with high age, living in an institution, a limited walking capacity, cerebrovascular disease, congestive heart failure, and a low hemoglobin level. Amputation below the ankle was associated with diabetes diagnosis before 30 years of age and diabetes duration. In conclusion, older age, history of cerebrovascular disease and low hemoglobin level are associated with above ankle amputation level in diabetic patients with foot ulcers. However, level selection cannot be based upon these factors only, since some patients at high age, with cerebrovascular disease or with a low hemoglobin value, healed with an amputation below the ankle. None of these factors per se should be taken as a cause to choose a primary amputation above the ankle, unless amputation is supported by the total clinical picture, including local characteristics, such as type and localization of ulcer, and signs of peripheral vascular disease. More attention should be paid to biological than to chronological age.
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| 2. |
- Zhang, Hui, et al.
(author)
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Increased catalase levels and hypoxanthine-enhanced nitro-blue tetrazolium staining in rat retina after ischemia followed by recirculation
- 1995
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In: Current Eye Research. - : Informa UK Limited. - 0271-3683 .- 1460-2202. ; 14:1, s. 47-54
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Journal article (peer-reviewed)abstract
- In the present study, using retinal ischemia as a model, we examined if different periods of ischemia and recirculation influenced the generation of reactive oxygen species, i.e. in hydrogen peroxide generation and nitroblue tetrazolium (NBT) reduction. Ischemia was induced for 30 and 90 min by ligation of the optic nerve with the vessels and recirculation was established by removing the ligature. The rats were sacrificed after 15 min or 3 days of recirculation. The retinas were separated from the pigment epithelium for measurements of catalase activity and examination of NBT staining. Compared to controls, the catalase activity was increased after 30 and 90 min of ischemia followed by 15 min of recirculation, and after 90 min of ischemia followed by 3 days of recirculation. As in controls, NBT staining was observed, both after 30 and 90 min of ischemia followed by 15 min of recirculation, in photoreceptors, in both plexiform layers, in some ganglion and glial cells, and, occasionally, in cells in the inner nuclear layer. Opposite to controls, addition of hypoxanthine to the NBT solution resulted in an increased staining in vessels in the inner nuclear layer in retinas subjected to 30 min of ischemia followed by 3 days of recirculation. The increased catalase activity suggests an increased amount of this free radical scavenger after ischemia followed by short-term and long-term recirculation. The hypoxanthine-enhanced NBT staining of blood vessel walls after ischemia followed by long-term recirculation indicates an activation of xanthine oxidase and an increased production of NBT reductants, some of which may represent oxygen free radicals.
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| 3. |
- Eckert, Bodil, et al.
(author)
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The cerebral vascular response to a rapid decrease in blood glucose to values above normal in poorly controlled type 1 (insulin-dependent) diabetes mellitus
- 1995
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In: Diabetes Research and Clinical Practice. - 1872-8227. ; 27:3, s. 221-227
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Journal article (peer-reviewed)abstract
- The effect of rapid lowering of blood glucose on cerebral blood flow (CBF) was studied in 10 Type 1 (insulin-dependent) diabetic patients (age 23.5 ± 3.8 years; mean ± S.D.) with longstanding, poor metabolic control (HbA1c 11.2 ± 1.0%; normal value 4.0–5.3%) using an intravenous xenon 133 single photon emission computed tomography technique. After a fall in blood glucose, during 81 ± 11 min (mean ± S.E.M.), from 18.2 ± 1.4 mmol/l to 9.2 ± 0.9 mmol/1 CBF was unchanged, but increased from its initial value of 48.8 ± 2.9 ml/100 g per min to 57.1 ± 2.4 ml/100 g per min (P < 0.001) when the blood glucose level was restored. The CBF was higher in the right compared to the left hemisphere at all measurements (1.8 ± 0.5 ml/100 g per min, P < 0.01; 1.9 ± 0.5 ml/100 g per min, P < 0.05; 2.1 ± 0.7 ml/100 g per min, P < 0.05, respectively). The change in CBF was inversely correlated with time for fall of blood glucose, but there was no correlation with absolute levels of blood glucose. The respiratory end-tidal Pco2 decreased during the low blood glucose level, but there was no correlation between the Pco2 and CBF. The cerebral volume was unchanged during the study. The results indicate that in patients with chronic hyperglycemia a rapid fall in blood glucose may cause a rise in CBF of the same magnitude as previously shown during absolute hypoglycemia in patients with well controlled diabetes mellitus and in normal subjects. However, the rise occurred when the blood glucose had been restored to its initial value, indicating an altered vascular response to lowering of blood glucose during chronic hyperglycemia.
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| 4. |
- Hultberg, Björn, et al.
(author)
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Plasma beta-hexosaminidase isoenzymes A and B exhibit different relations to blood glucose levels in a population of Type 1 diabetic patients
- 1995
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In: Scandinavian Journal of Clinical & Laboratory Investigation. - : Informa UK Limited. - 1502-7686 .- 0036-5513. ; 55:8, s. 723-728
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Journal article (peer-reviewed)abstract
- The activity of lysosomal enzymes, such as beta-hexosaminidase (Hex), is increased in the plasma and serum of diabetic patients. A positive association has been shown between enzyme activity and glycated proteins, indicating an association with the degree of metabolic control. Several isoenzymes of Hex exist. Studies have reported different proportions of the isoenzymes in plasma from diabetic patients, compared with healthy subjects. In the present study, Hex isoenzymes were examined in 76 Type 1 diabetic patients, of mean age 37.4 years (SD 12.9) compared with 38 age- and sex-matched healthy control subjects in an attempt to evaluate the influence of long- and short-term changes in blood glucose levels on these isoenzymes. The results show that Hex A activity (p<0.01), but not Hex B activity, was higher in the diabetic patients. Hex A activity was positively associated with both the actual blood glucose levels (r = 0.48, p<0.001) and haemoglobin A1c (HbA1c) (r = 0.43, p<0.001), while Hex B activity was associated with the level of HbA1c only (r = 0.42, p<0.001). Both Hex A and B activities were also positively associated with early signs of diabetic nephropathy (e.g. urinary excretion of Hex, fractional albumin excretion ratio and urinary albumin). There was no association between Hex A and B activities and different degrees of retinopathy. In conclusion, the present study demonstrates an association between Hex A and B and metabolic parameters in diabetes as well as with clinical signs of early diabetic nephropathy, but no association with the degree of retinopathy. Furthermore, Hex A seems to be more influenced than Hex B by short-term changes in blood glucose levels.
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| 5. |
- Larsson, J, et al.
(author)
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Decreasing incidence of major amputation in diabetic patients: a consequence of a multidisciplinary foot care team approach?
- 1995
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In: Diabetic Medicine. - 1464-5491. ; 12:9, s. 770-776
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Journal article (peer-reviewed)abstract
- The purpose of this retrospective study was to evaluate the changes in diabetes-related lower extremity amputations following the implementation of a multidisciplinary programme for prevention and treatment of diabetic foot ulcers in a 0.2 million population with a 2.4% prevalence of diabetes. All diabetes-related primary amputations from toe to hip from 1 January 1982 to 31 December 1993 were included. In 294 diabetic patients, 387 primary major (above the ankle) or minor (through or below the ankle) amputations were performed, constituting 48% of all lower extremity amputations. The annual number of amputations at all levels decreased from 38 to 21, equalling a decrease of incidence from 19.1 to 9.4/100,000 inhabitants (p = 0.001). The incidence of major amputations decreased by 78% from 16/1 to 3.6/100,000 inhabitants (p < 0.001). The absolute number of amputations with a final level below the ankle showed no increase, but their proportion increased from 28 to 53% (p < 0.001) and the reamputation rate decreased from 36 to 22% (p < 0.05) between the first and last 3-year period. Thus, a substantial long-term decrease in the incidence of major amputations was seen as well as a decrease in the total incidence of amputations in diabetic patients. Seventy-one per cent of the amputations were precipitated by a foot ulcer. These findings indicate that a multidisciplinary approach plays an important role to reduce and maintain a low incidence of major amputations in diabetic patients.
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