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Biomedical subjects

E Standl

Publications and source records attributed to E Standl.

161 records · Page 9Linked to original sources
PubMed1975

The problem of tissue oxygenation in diabetes mellitus. I. Its relation to the early functional changes in the microcirculation of diabetic subjects.

The underlying cause leading to the reversible functional changes in the microcirculation of insulin-dependent diabetic subjects early during the disease prior to any clinical signs of retinopathy and nephropathy (functional microangiopathy) is discussed. It is suggested that the initial microvascular dilation observed in diabetics is due to an autoregulatory response to relative tissue hypoxia providing an increased tissue perfusion in order to improve tissue oxygen delivery. Supporting evidence for this suggestion is derived from the findings that diabetics simultaneously may show increased tissue oxygen consumption and decreased ability of the circulating blood to release oxygen to the tissues. The latter defect is likely to be caused by two interrelated factors: 1. an increased proportion of haemoglobin A1c with high oxygen affinity, and 2. difficulties of maintaining a sufficiently high concentration of plasma inorganic phosphate in order to provide an optimal 2,3-diphosphoglycerate (2,3-DPG) content in the erythrocytes. The basal oxygen demand of diabetics may fluctuate even within a few hours dependent upon the state of metabolic control and is increased at times of poor regulation. Hence, diabetics may suffer from innumerable cellular hypoxic injuries, which during the first years of the disease are counteracted in the microcirculation by an autoregulatory response. These microvascular reactions associated with increased plasma permeation may over the years be of major importance for the development of the degenerative microangiopathy in diabetes.

Diabetes Mellitus↗
PubMed1973

[Insulin].

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Insulin↗
PubMedDate not supplied

QTc interval and scintigraphically assessed myocardial perfusion in newly diagnosed and long-term type 1 diabetes mellitus.

In diabetes mellitus, heart rate corrected QT interval (QTc) has been suggested to be related to ischemic heart disease and increased risk of sudden cardiac death. The aim of the study was to analyze the length of QTc interval with regard to global and regional myocardial perfusion in type 1 diabetic patients. Myocardial perfusion was investigated in 20 newly diagnosed and 40 long-term type 1 diabetic patients without clinical evidence for coronary artery disease by means of Tc-99-methoxyisobutylisonitrile (Tc-99m-MIBI)-scintigraphy (myocardial uptake (MU) score: 1-6). Five consecutive RR and QT intervals of resting electrocardiogram (ECG) tracing were measured and corrected for the previous cycle length. ECG-based cardiac autonomic neuropathy (CAN) was assessed with five cardiac reflex tests. Length of QTc interval was 423+/-29 ms in newly diagnosed and 433+/-26 ms in long-term type 1 diabetic patients. Nine (45%) newly diagnosed and 18 (45%) long-term diabetic patients demonstrated a prolonged QTc interval (>440 ms). Both newly diagnosed and long-term diabetic patients did not display significant global or regional myocardial perfusion defects (mean MU scores<3). In newly diagnosed diabetic patients, the length of QTc interval was related to global, posterior and septal Tc-99m-MIBI uptake (p<0.05, respectively). In long-term diabetic patients, the length of QTc interval was associated with apical Tc-99m-MIBI uptake (p<0.05). Two (10%) newly diagnosed and 19 (48%) long-term type 1 diabetic patients demonstrated ECG-based CAN. In long-term type 1 diabetic patients, global myocardial Tc-99m-MIBI uptake did not differ significantly between patients with and without CAN. QTc interval was not significantly different between diabetic patients with and without ECG-based CAN (433+/-19 ms vs. 428+/-17 ms). Long-term diabetic patients, of whom 10 (25%) patients had microalbuminuria and seven (18%) patients had macroalbuminuria, demonstrated an association between QTc interval and albuminuria (p<0.05). The results somewhat suggest an association between QTc interval and vascular factors in type 1 diabetes mellitus. Future investigations are required to analyze the role of QTc interval in the pathogenesis of abnormalities of myocardial perfusion.

Adult↗
PubMedDate not supplied

Three-year follow-up on scintigraphically assessed cardiac sympathetic denervation in patients with long-term insulin-dependent (type I) diabetes mellitus.

Scintigraphy using I-123-metaiodobenzylguanidine (I-123-MIBG) and Tc-99m-methoxyisobutylisonitrile (Tc-99m-MIBI) allows assessment of the cardiac sympathetic innervation and the myocardial perfusion. To investigate the natural history of cardiac sympathetic denervation in long-term diabetic patients without myocardial perfusion defects, global and regional I-123-MIBG and Tc-99m-MIBI uptake was determined (score 1-6; 1 = normal uptake, 6 = no uptake) in 22 patients with insulin-dependent (type I) diabetes mellitus (IDDM) at 3-year follow-up. All patients were treated with intensive insulin therapy and HbA1c was 8.0% +/- 1.0% at entry compared with 7.9% +/- 1.1% at follow-up. Cardiac sympathetic denervation (I-123-MIBG uptake score > 2), initially observed in 18 patients, was detectable in 21 patients at follow-up. The global myocardial I-123-MIBG uptake score deteriorated in eight patients, remained unchanged in 11 and improved in three patients. The changes in mean global I-123-MIBG uptake score (3.5 +/- 1.0 versus 3.8 +/- 0.8) were not significant. Reduction of the anterior, lateral, posterior, septal, and apical I-123-MIBG uptake did not progress significantly during follow-up. The mean uptake score of the posterior myocardial region (4.7 +/- 0.8) was smaller than the uptake score of the anterior (3.0 +/- 1.1, p = 0.001), lateral (3.2 +/- 0.9, p < 0.001) and septal (4.1 +/- 1.1, p < 0.05) myocardial regions. At follow-up, moderate myocardial perfusion defects (global Tc-99m-MIBI uptake score = 3) were detectable in four patients. Our study demonstrates that scintigraphically assessed cardiac sympathetic denervation does neither significantly regress nor progress on the average in a group of long-term IDDM patients during a 3-year follow-up. Thus, it is concluded that cardiac sympathetic abnormalities are a persistent, yet frequent phenomenon in long-term IDDM patients.

3-Iodobenzylguanidine↗
PubMedDate not supplied

Morbidity, mortality, and albuminuria in type 2 diabetic patients: a three-year prospective study of a random cohort in general practice.

In a 3-year prospective study, the prevalence of albuminuria and its relationship to macrovascular disease, pre-existing vascular risk factors and mortality rate were studied in a random cohort of 290 patients with Type 2 diabetes mellitus in general practice. Newly occurring micro- or macroalbuminuria was associated with significantly (p less than 0.05) higher systolic blood pressure: median (IQ range) 157 (140-170) vs 150 (130-160) mmHg, in addition to higher serum triglycerides: median (IQ range) 2.71 (1.84-4.25) vs 1.84 (1.35-3.14) mmol l-1, and C-peptide levels: median (IQ range) 1.30 (0.98-2.16) vs 1.10 (0.82-1.58) nmol l-1, at 3-year follow-up. Patients with macroalbuminuria at final examination had significantly higher systolic and diastolic blood pressure, serum triglyceride and beta 2-microglobulin levels, decreased HDL-cholesterol, and a significantly higher prevalence of carotid artery stenoses and peripheral vascular disease. Patients dying from vascular causes showed significantly higher urinary albumin levels at entrance as compared to the surviving patients: median (IQ range): 42.2 (11-249.7) vs 10.4 (4.6-28.0) mg l-1, p less than 0.008, and overall mortality rate was significantly linked with the presence of macroalbuminuria (26% vs 5% in normoalbuminuric patients). A comparison between the results of the initial and the final examination indicated an overall worsening of renal variables (albuminuria: median (IQ range): female 9.5 (4.5-21) vs 13.4 (5.1-39.7) mg l-1, (p less than 0.05); male 13.8 (4.7-34.1) vs 32.6 (8.1-78.7) (p less than 0.001), despite a significant improvement in metabolic variables.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMedDate not supplied

Peripheral vascular disease in diabetes mellitus and its relation to cardiovascular risk factors: screening with the doppler ultrasonic technique.

Data of 623 nonselected diabetic outpatients are presented who were screened for peripheral vascular disease (PVD) and for cardiovascular risk factors. PVD was diagnosed in 15.9% of the diabetic patients (14.4% women and 18.0% men). Nine percent of the patients had signs of marked mediasclerosis at the ankle level. Multivariate statistical analysis revealed that PVD was closely associated with systolic hypertension and also with the duration of diabetes, a relationship that was highly significant (P less than 0.001) for the peripheral type (below the knee) of PVD. Diabetic patients with arterial disease at the pelvic or femoral site exhibited a higher number of cardiovascular risk factors. In contrast, in patients with the peripheral type, significantly higher blood glucose values were found. Therefore, the quality of metabolic control may play an important part in the development of this form of diabetic macroangiopathy.

Cardiovascular Diseases↗