[Pyogenic sacroiliitis: study of seven cases].
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Biomedical subjects
Publications and source records attributed to A Balcells.
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Eight tests for cardiovascular reflex function were evaluated in a group of 140 diabetic patients. The sensitivity, reproducibility and normal values of each test were previously assessed in a group of 70 normal controls. The measure of the R-R interval variation during six cycles of deep breathing (expiration/inspiration ratio) proved to be the most sensitive test, and was selected for screening. The Valsalva ratio, the bradycardia/tachycardia ratio post-standing and the blood pressure response to standing and to sustained handgrip served as a confirmatory test of autonomic neuropathy and were related to the severity of the lesion. The R-R interval variation during one deep breathing cycle, the post-standing tachycardia, and the R-R 30/15 standing ratio proved to be of little or not value in assessing cardiovascular neuropathy. Cardiovascular autonomic neuropathy was diagnosed in 38.5% of our diabetic population, predominantly in patients with other clinical evidence of autonomic neuropathy. In a few asymptomatic patients, abnormal cardiovascular responses were the first evidence of autonomic lesion.
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The second case in the medical literature of hypersensitivity vasculitis induced by glybenclamide is reported, and for the first time vasculitic lesions are demonstrated in the histopathological study of liver tissue. The case was a male patient admitted because of a febrile illness and generalized malaise of long duration. He had diabetes mellitus that was being treated with glybenclamide. Physical examination disclosed fever, poor general condition, hepatomegaly, and red nodes in the finger-tips of both hands. Abnormal laboratory parameters included normochromic normocytic anemia, leukocytosis with a high eosinophil count, and markedly elevated erythrocyte sedimentation rate. There was as well slight cytolysis and marked elevation of cholestatic serum enzymes without hyperbilirubinemia. Biopsy of the skin lesions demonstrated anular granulomata, a common lesion in diabetics. The histopathological study of the liver revealed a vasculitic hypersensitivity reaction with conspicuous granulomata located in the vicinity of blood vessels and in the wall of portal arterioles, the endothelium of the latter being disrupted at different levels. Glybenclamide withdrawal resulted in a clinical, biological and histopathological cure of the disease. Unlike the previously reported case, the patient remains alive, and this may partly have been due to early institution of corticosteroid therapy.