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PURPOSE: The authors compared the immediate, mid-term and long-term effectiveness of cryoplasty and conventional angioplasty for treating stenotic-occlusive lesions of the femoropopliteal arteries in diabetic patients. MATERIALS AND METHODS: From October 2006 to November 2009, 48 patients with non-insulin-dependent diabetes mellitus (DM) and an indication for percutaneous revascularisation of the femoropopliteal arteries were randomly assigned to treatment with angioplasty or cryoplasty. The following parameters were analysed and compared between the two groups: immediate technical success (residual stenosis <30%) and distal run-off as assessed on postprocedural angiography, and degree of restenosis and distal run-off at 6 and 12 months, as assessed with either colour Doppler ultrasound (CDUS) or digital subtraction angiography (DSA). RESULTS: Treatment with angioplasty revealed a significant superiority in procedural technical success (p=0.04), a significant reduction in the degree of restenosis at 6 months (p=0.02) and a significant increase in the distal run-off at 6 (p=0.005) and 12 (p=0.01) months. CONCLUSIONS: Conventional angioplasty is more effective than cryoplasty for treating stenotic-occlusive lesions of the femoropopliteal arteries in diabetic patients and provides better immediate, mid-term and long-term results.

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AIMS/HYPOTHESIS: Nepsilon-(carboxymethyl)lysine (CML) is one of the end products of protein glycoxidation and its accumulation is associated with diabetes complications. Since CML-modified proteins are immunogenic, we have investigated the presence of anti-CML antibodies in diabetic patients. METHODS: Antibodies against CML-modified human serum albumin (HSA) were measured by direct enzyme-linked immunosorbent assay in the sera from 289 non-selected diabetic and in 120 healthy control subjects. RESULTS: Immunoglobulin-G reactivity towards CML-HSA was significantly higher in diabetic than in control sera. The presence of anti-CML IgG in diabetics, however, was not influenced by age, duration of disease or glycaemic control. Analysis of distribution frequency revealed that anti-CML IgG in both control and diabetic subjects were not normally distributed and that the distribution curves were similar in the two groups. Moreover, only 14% of the diabetic subjects displayed antibody binding to CML-HSA above 95 centile in the control cohort. Competition experiments confirmed that the IgG detected in both control and diabetic groups were specific for CML epitopes and did not recognise glycated-HSA in which CML formation was inhibited. CONCLUSION/INTERPRETATION: The presence of anti-CML IgG in diabetic sera is probably not related to the development of an immune response against protein glycoxidation products.

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BACKGROUND: The aim of the study was to value the behaviour of systolic (S) and diastolic (D) arterial pressure (AP)/24 hrs in a group of diabetic patients insulin-dependent (IDDM) and non insulin-dependent (NIDDM) with preserved renal function. METHODS: We examined 65 diabetic patients (aged 39.1 +/- 23.3), 33 IDDM (aged 18.2 +/- 7.5; years of diabetes: 5.8 +/- 4.9) and 32 NIDDM (aged 60.7 +/- 11.4; years of diabetes: 7.2 +/- 7.5). In all of them we computed BMI and determined creatinine clearance, glycosylated haemoglobin A, total and HDL-associated cholesterol, triglyceridemia, middle glycemia and microalbuminuria. AP measurement was performed by 24 hrs monitoring (periodicity 15') using a Takeda 2420 measurer. Chronobiological characteristics of AP were analysed by statistical method of cosinor according to Halberg, examining if there was or not a blood pressure circadian rhythm (PCR) (p < 0.05) and its characteristics represented by the mesor, the amplitude and the acrophase. Moreover the patients were subjected to a diet with fixed contents of sodium (130 mEq/day) and afterwards we drew (every 4 hours) renin (R), aldosterone (A1) and atrial natriuretic factor (ANF) which were analysed with cosinor's method. The purpose was not to compare the two populations, not homogeneous between them and not different only for the years of diabetes, but to study their blood pressure behaviour, the rhythm, the order of the indicated hormones for possible pathogenetic connections. RESULTS: NIDDM presented higher blood pressure values (PAS 134.2 +/- 3.5 and PAD 80.9 +/- 2 mmHg) than IDDM (PAS 116.6 +/- 1 and PAD 66.4 +/- 1.7 mmHg), still in limits of substantial normality. The acrophase was in the midday for NIDDM (PAS 11:25', PAD 12:06') and in the early afternoon for IDDM (PAS 14:15', PAD 14:06'). Analysing the trend of the AP in the single cases, PCR was present in 70% and absent in 30% of IDDM while it was persistent in 56% and disappeared in 44% of NIDDM. IDDM without PCR differed from those with it in years of diabetes (p < 0.001), body weight (p < 0.02), BMI (p < 0.01), triglyceridemia (p < 0.05), all more elevated, as well as in higher PAS and PAD (p < 0.001) and in higher concentration of ANF (p < 0.05). The same comparison was done in NIDDM. Patients without PCR were older (p < 0.025), had higher PAS (p < 0.025) and PAD (p < 0.001) and also a more activated ANF (p < 0.001). CONCLUSIONS: This hormonal anomaly may be ascribed to a lower excretion of sodium with consequent expansion of extracellular volume due to antinatriuretic action of insulin often found at high plasmatic levels particularly in NIDDM.

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In the context of metabolic alteration in dialysis patients the Authors have studied the characteristics, incidence, pathogenesis, effect of dialysis, atherogenic risk and therapeutic approach to hyperlipemia in hemodialysis patients. Hypertriglyceridemia secondary to reduced lipolytic activity is the most frequent alteration observed in hemodialytic patients (36.7% of cases). In addition, hemodialysis reduces the levels of lipoprotein in the blood whereas the atherogenic role of hyperlipemia does not appear to be as important as that of arterial hypertension and smoking. Simvastatin breaks down the lipidic fractions which are involved in atherogenesis and coronary cardiopathy, thus acting as a valuable prevention against cardiovascular involvement in dialysis.

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A kinetic evaluation of dialytic methods using a diffusive-convective mechanism in comparison to the standard bicarbonate dialysis was performed in order to verify the possible therapeutic uses. The "kinetic" comparison of PFD and HDF to HBD, using equal quantities of dialysate, showed no significant change in the mention of uremic toxins of small molecular weight and a more efficient capacity to extract beta 2M by the diffusive-convective methods. The biophysical evaluation of dialysis still appears to represent the best means of defining the clearance possibilities and of identifying the most suitable technique for achieving a dialytic adequacy.

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