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  • 1
    Electronic Resource
    Electronic Resource
    Does combined kidney and pancreas transplantation reverse functional diabetic microangiopathy? (1990)
    Springer
    Transplant international 3 (1990), S. 167-170 
    Details
    ISSN: 1432-2277
    Keywords: Pancreas transplantation, microangiopathy ; Microangiopathy, pancreas transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Using videophotometric capillaroscopy and laser Doppler fluxmetry, we have investigated skin microvascular reactivity in the fingers of 14 diabetic patients with severe, late complications 20 months after combined kidney and pancreas transplantation. The results were compared with those obtained in 20 diabetic patients awaiting pancreas transplantation and in 19 healthy subjects. The capillary blood cell velocity at rest (P〈0.01) and during postocclusive reactive hyperemia (P〈0.05) was significantly lower in both patient groups than in the healthy controls. However, the time to peak capillary blood cell velocity during hyperemia was normal in the post-transplantation group (NS) but significantly prolonged in the pretransplantation group (P〈0.01). The ability to decrease flow during venous stasis—the so called venoarte-riolar reflex—was strongly impaired in the pretransplantation group (P〈0.001) but less so in the post-transplantation group (P〈0.05) as compared to healthy controls. It may be concluded that diabetic patients, after combined kidney and pancreas transplantation, show a tendency towards better microvascular reactivity than those awaiting transplantation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00355465
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  • 2
    Electronic Resource
    Electronic Resource
    Skin microvascular reactivity in fingers of diabetic patients after combined kidney and pancreas transplantation (1991)
    Springer
    Diabetologia 34 (1991), S. S135 
    Details
    ISSN: 1432-0428
    Keywords: Combined kidney and pancreas transplantation ; Skin microvascular reactivity ; Capillaroscopy ; Laser Doppler fluxmetry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Nine patients with severe late diabetic complications were investigated 2 and 38 months after successful combined kidney and pancreas transplantation. Nine healthy subjects served as controls. Blood cell velocity in single capillaries was evaluated by videophotometric capillaroscopy, and total skin microcirculation of the same area by laser Doppler fluxmetry. The measurements were performed during rest, and post-occlusive (1 min) reactive hyperaemia. Laser Doppler flux was also recorded during venous occlusion. The basal capillary blood cell velocity and laser Doppler flux values increased significantly (p〈0.05) during the observation period. The time to maximal capillary blood cell velocity during hyperaemia was prolonged 2 months after combined kidney and pancreas transplantation (p〈0.05), and still more so at 38 months (p〈0.05). The ability to decrease blood flow during venous occlusion was impaired at 2 months, and was not significantly better at reinvestigation. The results indicate a succesive increase of basal blood flow in the skin microcirculation after successful combined kidney and pancreas transplantation, but no improvement of the impaired microvascular reactivity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00587640
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Skin capillary circulation severely impaired in toes of patients with IDDM, with and without late diabetic complications (1995)
    Springer
    Diabetologia 38 (1995), S. 474-480 
    Details
    ISSN: 1432-0428
    Keywords: Diabetes mellitus ; skin microcirculation ; capillary blood cell velocity ; laser Doppler fluxmetry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We have recently shown that the skin microcirculation of toes is significantly impaired in patients with diabetes and peripheral vascular disease, and this may be one major reason why these patients are highly susceptible to developing skin ulcers. The aim of the present study was to investigate whether the skin microcirculation is impaired also in diabetic patients free from macroangiopathy. One foot in each of 20 patients with insulin-dependent diabetes was investigated: 10 patients with and 10 patients without late complications. All patients had normal arterial circulation of their lower extremities. Two groups of age- and sex-matched healthy subjects served as controls. The capillary blood cell velocity in the nailfold of the great toe was investigated by computerised videophotometric capillaroscopy, and the total microcirculation within the same area evaluated by laser Doppler fluxmetry. The capillary blood cell velocity and the total skin microcirculation were studied during rest, and during postocclusive reactive hyperaemia. The total microcirculation was similar in patients and control subjects, whereas the capillary circulation was markedly reduced (p〈0.01) in the patients. The ratio between the capillary and total microcirculation was significantly decreased (p〈0.05–0.01) in the patients as compared to the control subjects, indicating a local maldistribution of blood in the skin microcirculation of the diabetic patients. The results of the present study show that in spite of a normal total skin microcirculation in the toes of insulin-dependent diabetic patients, both with and without late complications, the nutritional capillary circulation is severely impaired. These findings indicate that a chronic ischaemia is present in the skin capillaries of diabetic feet, and is related to the diabetic disease per se and not to late diabetic complications, and may be a cause for these complications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00410286
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  • 4
    Electronic Resource
    Electronic Resource
    Skin capillary circulation severely impaired in toes of patients with IDDM, with and without late diabetic complications (1995)
    Springer
    Diabetologia 38 (1995), S. 474-480 
    Details
    ISSN: 1432-0428
    Keywords: Key words Diabetes mellitus ; skin microcirculation ; capillary blood cell velocity ; laser Doppler fluxmetry.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We have recently shown that the skin microcirculation of toes is significantly impaired in patients with diabetes and peripheral vascular disease, and this may be one major reason why these patients are highly susceptible to developing skin ulcers. The aim of the present study was to investigate whether the skin microcirculation is impaired also in diabetic patients free from macroangiopathy. One foot in each of 20 patients with insulin-dependent diabetes was investigated: 10 patients with and 10 patients without late complications. All patients had normal arterial circulation of their lower extremities. Two groups of age- and sex-matched healthy subjects served as controls. The capillary blood cell velocity in the nailfold of the great toe was investigated by computerised videophotometric capillaroscopy, and the total microcirculation within the same area evaluated by laser Doppler fluxmetry. The capillary blood cell velocity and the total skin microcirculation were studied during rest, and during postocclusive reactive hyperaemia. The total microcirculation was similar in patients and control subjects, whereas the capillary circulation was markedly reduced (p 〈 0.01) in the patients. The ratio between the capillary and total microcirculation was significantly decreased (p 〈 0.05–0.01) in the patients as compared to the control subjects, indicating a local maldistribution of blood in the skin microcirculation of the diabetic patients. The results of the present study show that in spite of a normal total skin microcirculation in the toes of insulin-dependent diabetic patients, both with and without late complications, the nutritional capillary circulation is severely impaired. These findings indicate that a chronic ischaemia is present in the skin capillaries of diabetic feet, and is related to the diabetic disease per se and not to late diabetic complications, and may be a cause for these complications. [Diabetologia (1995) 38: 474–480]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00410286
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Altered properties of the fibrin gel structure in patients with IDDM (1996)
    Springer
    Diabetologia 39 (1996), S. 1519-1523 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Diabetes mellitus ; fibrinogen ; fibrin gel structure.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary High plasma fibrinogen levels are associated with vascular complications in the general population. Fibrin, the structural element in a clot, is derived from fibrinogen by activation of thrombin. An abnormal fibrin gel structure has been demonstrated in patients with myocardial infarction and in diabetic patients during poor metabolic control. In the present study the properties of fibrin gel structure were investigated in 20 patients with insulin-dependent diabetes mellitus (IDDM): 10 patients without (age: 30 ± 8; diabetes duration: 7 ± 6 years), and 10 patients (age: 44 ± 7; diabetes duration: 27 ± 9 years) with microangiopathy. Fifteen healthy subjects served as controls (age: 40 ± 8 years). The glycosylated haemoglobin level (HbA1c) was elevated (p 〈 0.001) in the patients: 6.5 ± 1.5 % in diabetic patients without, and 7.1 ± 1.0 % in diabetic patients with microangiopathy. C-reactive protein and plasma fibrinogen were similar as compared to healthy control subjects. The properties of the fibrin gel structure; i. e. the permeability coefficient (Ks) and the fibre mass length ratio (μ) formed in recalcified plasma on addition of thrombin were investigated. Ks was decreased in the diabetic patients, with (6.5 ± 2.0 cm2; p 〈 0.01) and without microangiopathy (6.5 ± 2.7 cm2; p 〈 0.05), as compared to healthy subjects (10.0 ± 3.4 cm2), while μ was not significantly (p = 0.14) altered. The results indicate a lower fibrin gel porosity in patients with IDDM, despite normal plasma fibrinogen and irrespective of microangiopathy. The abnormal fibrin gel structure may be due to an increased glycosylation of the fibrin (-ogen) molecule caused by long-term hyperglycaemia and may be of importance for the development of angiopathy in diabetic patients. [Diabetologia (1996) 39: 1519–1523]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050607
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  • 6
    Electronic Resource
    Electronic Resource
    Pronounced skin capillary ischemia in the feet of diabetic patients with bad metabolic control (1998)
    Springer
    Diabetologia 41 (1998), S. 410-415 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Diabetes mellitus ; skin capillary circulation ; metabolic control
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Skin capillary circulation is impaired during postocclusive reactive hyperaemia (PRH) in toes of diabetic patients independent of diabetes duration and macrocirculation. The aim of this study was to examine its relation to metabolic control. The skin microcirculation was investigated in 20 patients with insulin-dependent diabetes mellitus: 10 patients with bad [HbA1c 〉 7.5 (8.7 ± 0.8) %], and 10 patients with good metabolic control [HbA1c 〈 7.5 (6.3 ± 1.0) %]. The diabetes duration was similar in both groups (16 ± 9 and 16 ± 6 years, respectively). None had macroangiopathy. Thirteen healthy subjects served as controls. The capillary blood cell velocity (CBV) in the nailfold of the great toe was investigated by videophotometric capillaroscopy, and the total skin microcirculation by laser Doppler fluxmetry (LDF). CBV and LDF were studied during rest and after 1-min arterial occlusion. The vibration perception thresholds (VPT) of the feet were higher (p 〈 0.05) in the patients with bad (34 ± 12 V), as compared to patients with good metabolic control (18 ± 10 V) and to healthy subjects (13 ± 3 V). Peak CBV during PRH was reduced in both patient groups (p 〈 0.01), and lowest in the patients with bad metabolic control (p 〈 0.05). Time to peak CBV was prolonged (p 〈 0.01) in the patients with bad, while normal in the patients with good metabolic control. LDF was similar in all groups. An inverse correlation was found between HbA1c and peak CBV during PRH (r = 0.60; p = 0.008), while positive correlations were found to time to peak CBV (r = 0.62; p = 0.004) and VPT (r = 0.60; p = 0.01). No associations were seen between VPT and the microcirculatory variables. The results indicate that the metabolic control is of importance for the nutritive capillary circulation and the peripheral nerve function in the diabetic foot. [Diabetologia (1998) 41: 410–415]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050923
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    Paper (German National Licenses)
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