The aim of this study was to evaluate gallbladder dynamics in insulin-dependent diabetic patients with and without autonomic neuropathy. Gallbladder dynamics was studied by a scintigraphic method after a test meal in 26 insulin-dependent diabetic patients and 10 normal individuals. The presence and severity of autonomic neuropathy were defined according to the number of abnormal cardiovascular reflex tests: absent (no abnormal test), mild (1-3 abnormal tests), and severe (4-5 abnormal tests). The time from the moment when the patient started to take the test meal to the beginning of gallbladder emptying was longer (P = 0.01) in diabetic patients with mild (N = 11, 12.1 +/- 7.6 min) and severe neuropathy (N = 8, 11.0 +/- 10.6 min) than diabetic patients without autonomic neuropathy (N = 7, 3.9 +/- 4.4 min) and controls (N = 10, 4.8 +/- 4.2 min). The ejection rate was higher (P = 0.02) in the group with severe autonomic neuropathy (N = 8, 5.1 +/- 3.3%/min) than diabetic patients with mild (N = 11, 2.0 +/- 1.0%/min) or without autonomic neuropathy (N = 7, 1.8 +/- 0.8%/min) and controls (N = 10, 2.6 +/- 1%/min). Thirty-two percent of the diabetic patients with autonomic neuropathy presented increased perspiration, nausea and urgency to defecate after the ingestion of the test meal. A significant positive correlation of ejection rate with the presence of these symptoms (biserial point correlation test = 0.67, P < 0.01) was also observed. These data suggest that insulin-dependent diabetic patients with autonomic neuropathy present abnormalities of gallbladder emptying that could be related to specific gastrointestinal symptoms.

Autonomic neuropathy

Diabetic Neuropathy

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Relationship of the Valsalva ratio to autonomic neuropathy and other complications of diabetes mellitus.

PubMed (1982)

R H Kruter Décio L. Eizirik J L Gross

1. The Valsalva ratios (VR) of 48 diabetic patients and 48 normal individuals matched by age and sex were compared in order to examine the relationship between VR and the prevalence and severity of retinopathy, neuropathy and nephropathy, which are chronic complications of diabetes mellitus. 2. Diabetic patients without clinical evidence of neurological damage had the same VR (1.95 +/- 0.09) as the matched control group (1.95 +/- 0.14). Diabetic patients exhibiting some evidence of diabetic neuropathy showed VR values lower than their control groups (1.58 +/- 0.07 vs. 1.81 +/- 0.7), whereas patients with symmetric sensitive polyneuropathy plus autonomic neuropathy had the lowest VR scores (1.16 +/- 0.04 vs. 1.86 +/- 0.14). 3. An inverse relationship was shown between VR and the prevalence of retinopathy and nephropathy and the duration of diabetes mellitus. Low VR values correlated well with the prevalence and severity of complications. 4. It is concluded that the Valsalva ratio is an effective indicator of autonomic neuropathy.

Autonomic neuropathy

Valsalva maneuver

Diabetic Neuropathy

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[Assessment of diabetic autonomic neuropathy by heart rate monitoring].

PubMed (1990)

S Weitzman Dan Buskila R. Boehm Allon Eyal J L Gross

Assessment of diabetic autonomic neuropathy in a representative sample of 91 noninsulin-dependent diabetics was performed in 3 community clinics. A difference of less than 10 beats/min in heart rate between deep inspiration and deep expiration determined by ECG recording served as the criterion for autonomic neuropathy. By this test, 86% of the patients had diabetic autonomic neuropathy, a slightly higher proportion than that reported by others using similar criteria in more selected populations. The test is very sensitive and can be used for screening.

Expiration

Autonomic neuropathy

Diabetic Neuropathy

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Perkutane endovaskuläre Prothesenimplantation bei akuter traumatischer Transsektion der thorakalen Aorta

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren (2013)

JP Schäfer AM Wulff FK Schäfer Markus Siggelkow J L Gross

Ziele: Single-Center Evaluation der Effektivität der perkutanen endovaskulären Prothesenimplantation bei akuter traumatischer Transsektion der thorakalen Aorta mit interdisziplinärem Team aus Interventionsradiologem und Gefäßchirurgem. Methode: Von 2008 bis 2012 wurde bei acht polytraumatisierten Patienten (sechs Motorrad- und zwei Autofahrer) nach Dezelerationstrauma die Diagnose einer akuten traumatischen Transsektion der thorakalen Aorta anhand der CT-Untersuchung im Schockraum gestellt. Das mittlere Alter betrug 42 Jahre, minimal 23 und maximal 76 Jahre. Alle Patienten wurden unmittelbar in den Angiografiesaal verbracht. In Intubationsnarkose wurde über einen perkutanen Leistenzugang die endovaskuläre thorakale Prothesenimplantation durchgeführt. Die Zeiten von Diagnosestellung und inguinaler Hautinzision bis zum Kontrollangiogramm nach endovaskulärer Prothesenimplantation wurden ermittelt. Die Verlaufskontrollen wurden mittels CT durchgeführt. Ergebnis: Alle Patienten überlebten. Die mittlere Zeit von Diagnosestellung bis Kontrollangiogramm betrug 55 min, minimal 42 min und maximal 81 min. Die mittlere Zeit von Hautinzision bis Kontrollangiogramm lag bei 8,3 min, minimal 5 min und maximal 14 min. Der Leistenzugang wurde in sieben Fällen sekundär gefäßchirurgisch und in einem Fall durch perkutanes Nahtverfahren verschlossen. Es trat eine Majorkomplikation mit Auslösen einer instabilen Angina pectoris durch intentionelle Überlegung der linken A. subclavia bei einem Patienten mit LIMA-Koronarbypass auf, was durch operative Transposition der A. subclavia erfolgreich behandelt wurde. Die CT-Verlaufskontrolle bestätigte in allen Fällen eine komplette Konsolidierung des behandelten thorakalen Aortensegmentes. Schlussfolgerung: Die perkutane endovaskuläre Prothesenimplantation zur Behandlung der akuten traumatischen Transsektion der thorakalen Aorta interdisziplinär durch Interventionsradiologen und Gefäßchirurg ist schnell und effizient.

10.1055/s-0033-1346500

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Lack of association between thyroid function and mitral valve prolapse in Graves' disease.

PubMed (1990)

Alfonso Alvarado-Lorenzo J P Ribeiro Fernando Freitas J L Gross

1. To determine whether the association between mitral valve prolapse and Graves' disease is related to thyroid function, three groups of individuals were studied: 16 patients with Graves' disease and hyperthyroidism (hyperthyroid: T4 greater than 11.5 micrograms/100 ml), 16 patients with Graves' disease without hyperthyroidism (euthyroid: T4 less than 11.5 micrograms/100 ml), and 40 healthy individuals. The three groups were similar in age, sex distribution, and anthropometrical characteristics. 2. All patients were evaluated clinically and by M-mode and two-dimensional echocardiography to determine the presence of mitral valve prolapse. 3. The frequency of mitral valve prolapse was similar in the hyperthyroid (31%) and euthyroid patients (25%), but was higher than in the normal individuals (5%). The frequency of systolic murmur was higher in the hyperthyroid patients (75%) than the euthyroid patients (19%) or the normal subjects (0%); however, the presence of a murmur was not associated with mitral valve prolapse. Hyperthyroid (13%) and euthyroid (13%) patients had a higher frequency of clicks than the normal individuals (0%), and the presence of click was associated with mitral valve prolapse. 4. Although patients with Graves' disease have a higher frequency of mitral valve prolapse, this is not associated with thyroid function. The presence of a click but not the presence of a systolic murmur may be a clinical indicator of mitral valve prolapse in Graves' disease.

Mitral valve prolapse

Thyroid disease

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Citations (5)