Autonomic function in neuropathic diabetic patients with foot ulceration

OBJECTIVE

The aim of this study was to compare peripheral autonomic function in neuropathic diabetic subjects with and without foot ulceration.

RESEARCH DESIGN AND METHODS

Measurements were made on 57 diabetic subjects; 35 subjects had evidence of peripheral neuropathy, 14 of these had a history of foot ulceration, and 22 subjects had no evidence of peripheral neuropathy. No patient had peripheral vascular disease. Measurements were made of motor and sensory nerve conduction. Autonomic function was investigated by using standard cardiovascular reflex tests and by measuring blood flow variability in the foot. The vasoconstrictor responses to deep breathing and body cooling were measured by using venous occlusion plethysmography.

RESULTS

Peripheral sympathetic function was significantly worse in the DU group. The vasoconstrictor response to deep breathing in the DU group was significantly smaller than the response in the DN group (15.3 +/- 2.7 vs. 38 +/- 4%, P < 0.001). The response to body cooling in the DU group was significantly smaller than the response in the DN group (6.2 +/- 3.1 vs. 20.8 +/- 3.5%, P < 0.01). Tests of cardiac autonomic function and measurements of motor and sensory nerve conduction were similar in both neuropathic groups.

CONCLUSIONS

Peripheral autonomic neuropathy is associated with the development of foot ulceration in diabetic subjects.

A comparison of peripheral vasoconstrictor responses and cardiovascular autonomic function tests in diabetic patients

Venous occlusion plethysmography has been used to measure sympathetic vasoconstrictor responses in the feet and hands to a deep breath and body cooling and to assess blood flow variability. Measurements were made in 14 non-diabetic control subjects and 52 diabetic patients, 30 of whom had evidence of peripheral neuropathy. All the measurements were significantly reduced in the feet of patients with neuropathy. Vasoconstrictor responses were not significantly impaired in the hands of these patients. Cardiovascular autonomic function was assessed in the same subjects by standard tests of reflex heart rate responses and compared to sympathetic vasoconstrictor function as determined by the response to a deep breath. Eighteen of the 30 diabetic patients with peripheral neuropathy had impairment of both cardiovascular and sympathetic vasoconstrictor function. Five had normal vasoconstrictor but impaired cardiovascular responses and two had normal cardiovascular but impaired vasoconstrictor function. It may therefore be important to assess both systems in diabetic patients.

A study of drug compliance, including the effect of a treatment card, in elderly patients following discharge home from hospital

Compliance with prescribed medication was assessed in 104 mentally alert elderly patients one and two months after discharge from a geriatric medical unit. Of the 82 patients (58 females, 24 males) who completed the study, 72% were compliant by average tablet count after one month and 69% after two months. Using urinary riboflavin excretion as a marker of compliance, 69% were compliant after one month and 59% after two months. These differences were not significant, nor was any significant difference shown when a crossover design was used to study the effect of a treatment card on compliance. No differences in age, sex, social support or number of tablets taken were found between compliant and non-compliant patients. The value of a careful explanation of drug therapy by both a hospital pharmacist prior to discharge, and a research nurse, one and two months after discharge, has been highlighted. A considerable number of patients benefited from the assistance of a relative or home helper in administering their own treatment. It is recommended that a suitable helper be identified and counselled to assist at risk elderly patients with their medication. Thus, elderly mentally alert patients can achieve a satisfactory level of compliance equivalent to younger patients if appropriate counselling is undertaken.

Conjunctival melanocytic lesions in children

Seventy-one conjunctival melanocytic proliferations in patients 20 years of age or younger were examined. Sixty-five (91.5%) were nevi; there were three cases (4.2%) of racial or acquired melanosis, and three patients were identified who had malignant melanoma of the conjunctiva. The melanoma patients are presented in detail, and additional cases of conjunctival melanoma in children and adolescents reported in the literature are reviewed to determine factors that might influence prognosis. The number of cases is so small, however, that factors cannot be identified with confidence. Follow-up data are presented. Conjunctival nevi are relatively common in children, and appear to carry no risk for the development of melanoma during childhood. However, -conjunctival melanomas do occur rarely in children and have a variable prognosis.

The Abraham lens with the neodymium-YAG laser

We have used the neodymium-yttrium-aluminum-garnet (YAG) laser effectively to cut posterior capsules and pupillary membranes, but the procedure was difficult. Using the Abraham contact lens facilitated the procedure, but may be related to the development of retinal damage.

An inexpensive ultrasonic device for intraocular lens power determination

The Echo-oculometer is a relatively inexpensive ultrasonic device for measuring anterior chamber depth and axial length prior to lens implantation. It is uncomplicated, easy to use and functioned very well in this limited study, giving an average error of 0.98 D when preoperative measurements were compared to postoperative refraction.