RESUMEN
Complications of diabetes include sensory and autonomic neuropathy. The aim of the present paper was to study the degree of sensory and autonomic neuropathy and correlate these findings with the distribution and density of neuropeptidergic nerve fibers in the skin of the forearm of diabetic patients and healthy controls. We investigated 30 diabetics (24 type 1 and 6 type 2) and compared them with 13 healthy controls. There were no differences between the groups with respect to density and distribution of nerve fibers displaying immunoreactivity to the pan-neuronal marker PGP 9.5 and sensory and parasympathetic neuropeptides (substance P, calcitonin gene-related peptide and vasoactive intestinal peptide). By contrast, nerve fibers containing neuropeptide Y, a marker of sympathetic neurons, were reduced in number in the diabetic patients. C-fiber function (measured as the axon-reflex-evoked flare response) became impaired with increasing age in all subjects. The diabetic patients, however, showed a reduced flare compared to age-matched healthy controls. The reduction was particularly prominent in the younger patients (20-50 years). There was a greater reduction of the flare in neuropathic patients than in non-neuropathic patients, but there was no correlation between the degree of functional impairment and the duration of the disease.
Asunto(s)
Diabetes Mellitus/patología , Neuropatías Diabéticas/fisiopatología , Antebrazo/inervación , Fibras Nerviosas/fisiología , Piel/inervación , Adulto , Anciano , Sistema Nervioso Autónomo/fisiopatología , Axones/fisiología , Péptido Relacionado con Gen de Calcitonina/análisis , Estudios de Casos y Controles , Diabetes Mellitus/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neuronas Aferentes/fisiología , Neuropéptido Y/análisis , Sistema Nervioso Parasimpático/fisiopatología , Sustancia P/análisis , Sistema Nervioso Simpático/fisiopatología , Tioléster Hidrolasas/análisis , Ubiquitina Tiolesterasa , Péptido Intestinal Vasoactivo/análisisRESUMEN
The purpose of the present cross-sectional clinical study was to evaluate the prevalence of retinopathy in Type 1 diabetic patients without nephropathy and with different degrees of nephropathy. In addition we investigated the association between retinopathy, nephropathy, and other variables, and studied the importance of cardiovascular autonomic dysfunction to these conditions. 76 Type 1 diabetic patients were investigated. All patients were initially selected on the basis of body weight, and 47 proteinuric patients were further selected for age, diabetes duration and the duration of insulin treatment (see Table 1). Proteinuric diabetic patients were categorized by degree of nephropathy, i.e. for incipient nephropathy (proteinuria of less than 0.5 g/day), for overt nephropathy (proteinuria of more than 0.5 g/day), and for renal failure (serum creatinine of more than 103 mumol/l). Retinopathy was assessed by ophthalmoscopy. Cardiovascular autonomic dysfunction (CAD) was assessed by heart rate variations, 30:15 ratios, the Valsalva maneuver, and systolic blood pressure fall upon standing. Our findings revealed increased prevalence of retinopathy in patients with more advanced stages of nephropathy. CAD abnormalities exhibited increased prevalence among proteinuric patients. Our data clearly revealed differences between proteinuric and non-proteinuric patients. In both proteinuric and non-proteinuric patients there were found correlations of retinopathy with diabetes duration, and only in proteinurics was retinopathy correlated with kidney function, systolic blood pressure and CAD findings. In patients in identical stages of nephropathy, increased prevalence of CAD abnormalities was shown in patients suffering from proliferative retinopathy. Thus our data suggest that CAD abnormalities might be related in some way to both the proliferative retinopathy and to diabetic nephropathy.
Asunto(s)
Enfermedades del Sistema Nervioso Autónomo/epidemiología , Diabetes Mellitus Tipo 1/complicaciones , Angiopatías Diabéticas/epidemiología , Neuropatías Diabéticas/epidemiología , Retinopatía Diabética/epidemiología , Proteinuria/complicaciones , Adulto , Enfermedades del Sistema Nervioso Autónomo/etiología , Enfermedades del Sistema Nervioso Autónomo/fisiopatología , Presión Sanguínea/fisiología , Estudios Transversales , Diabetes Mellitus Tipo 1/fisiopatología , Angiopatías Diabéticas/etiología , Angiopatías Diabéticas/fisiopatología , Nefropatías Diabéticas/epidemiología , Nefropatías Diabéticas/etiología , Nefropatías Diabéticas/fisiopatología , Neuropatías Diabéticas/etiología , Neuropatías Diabéticas/fisiopatología , Retinopatía Diabética/etiología , Retinopatía Diabética/fisiopatología , Corazón/fisiología , Humanos , Riñón/fisiología , Prevalencia , Proteinuria/fisiopatologíaRESUMEN
Report on a 69-year-old male with spontaneous atraumatic rupture of the oesophagus (Boerhaave's syndrome) in clinically mentioned chronic abuse of alcohol and massive vomiting which preceded the event. Discussion of causes, differential diagnosis, therapy as well as of forensic aspects of this syndrome.