OBJECTIVE: To investigate and describe the peak plantar pressures and ground contact times of the foot during walking in diabetic patients and healthy adults. METHOD: 17 age-matched diabetic patients without any complications and 33 healthy adults participated in this study. The foot was divided into 10 different areas, and peak plantar pressures and ground contact times were measured during walking by EMED system . RESULTS: There were no significant differences in peak plantar pressures of both feet in both groups, but there were significant increases in peak plantar pressures of hindfoot and hindfoot contact times in the diabetic group. CONCLUSION: Despite having no definite diabetic neuropathy and vascular disease, diabetic patients have higher peak plantar pressures of hindfoot and prolonged hindfoot contact times because limb muscle dysfunction or impairment of proprioception may induce faster descent of the foot towards the ground or improper pattern of stance phases.
Adult* ; Diabetic Angiopathies ; Diabetic Neuropathies ; Extremities ; Foot ; Humans ; Proprioception ; Walking

PURPOSE: This study analyzed protein alterations between the normal vitreous and the vitreous with proliferative diabetic retinopathy by proteomics to find the proteins which may elicit diabetic retinopathy. METHODS: Two-dimensional electrophoresis was used to make the protein map. Image analysis between the spots on each gels by a proteomics based approach were used to reveal vitreous protein alterations which may elicit proliferative diabetic retinopathy. MALDI-TOF/ESI-TOF mass spectrometry also was used to identify altered protein spots on the gel. RESULTS: Of the 110 different spots on each gels, 36 different proteins were identified and among them 23 proteins were altered in the vitreous with proliferative diabetic retinopathy compared with normal vitreous. Nineteen proteins including alpha-1-antitrypsin, Ig G and A, and complement C3 and C4 were increased in the vitreous with proliferative diabetic retinopathy and 4 proteins includng pigment epithelium derived factor were decreased compared to the normal vitreous. CONCLUSIONS: The authors found that pigment epithelium derived factor may be the key protein that induces the neovascularization in the vitreous with proliferative diabetic retinopathy. Increased levels of Ig G and A and C3 and C4 is thought to be related to the autoimmune inflammation in early diabetic microangiopathy. Furthermore, proteins such as alpha-1-antitrypsin may contribute to protective functions of the ischemic retinal cells.
Complement C3 ; Diabetic Angiopathies ; Diabetic Retinopathy* ; Electrophoresis ; Epithelium ; Gels ; Inflammation ; Mass Spectrometry ; Proteomics ; Retinaldehyde

OBJECTIVE: To report a case of radiation retinopathy, a common complication in the treatment of nasopharyngeal carcinoma. METHOD:This is a case report. RESULTS:A 59-year-old Chinese man with a history of external beam irradiation for nasopharyngeal carcinoma presented with mild blurring of vision of the left eye.Examination revealed bilateral scattered cotton-wool spots, intraretinal hemorrhages, and microaneurysms.The left eye had peripapillary cotton-wool spots and hemorrhages, disc edema, and semimacular star.Funduscopic findings were similar to those of diabetic retinopathy except for the abundance of cotton-wool spots and the presence of macular star. CONCLUSION:Radiation retinopathy usually develops 6 months to 3 years after exposure.In this patient, it occurred 2 years after radiotherapy.Neovascularization at the disc developed 15 months after initial presentation, which required treatment with panretinal photocoagulation, resulting in regression of the new vessels.As severe late ocular complications frequently occur after radiation therapy, periodic ophthalmologic examinations should be considered.
Human ; Male ; Middle Aged ; NASOPHARYNGEAL NEOPLASMS ; RETINAL NEOVASCULARIZATION ; DIABETIC ANGIOPATHIES ; DIABETIC RETINOPATHY ; ;

Nodular glomerulosclerosis was first described by Kimmelstiel and Wilson in 1936. Diabetic retinopathy and nephropath y are manifestation of the microangiopathy associated with diabetes. The severity of diabetic nephropathy and the occurrence of retinopathy correlate with the duration of clinical diabetes. However, there have been few reports of patients presents presenting with the classic lesions of diabetic microangiopathy in the absence of a known history of diabetes. These reports raise questions regarding the relationship and significance of carbohydrate intolerance to these pathologic abnormalities. A 34-year-old male patient clinically characterized by massive proteinuria and hypertension without evidence of systemic disease is reported. Renal biopsy showed the nodular glomerulosclerosis (Kimmelstiel-Wilson lesion) characteristic of diabetes. Direct opthalmoscopy and fluorescein angiography demonstrated a picture of advanced proliferative diabetic retinopathy. The patient had no history of diabetes mellitus and upon testing had normal glucose values in response to an oral glucose tolerance test. It is concluded that the nodular glomerulosclerosis lesions and proliferative retinopathy, thought to be specific for diabetes mellitus, may present in the absence of either overt clinical diabetes or impaired glucose tolerance.
Adult ; Biopsy ; Diabetes Mellitus* ; Diabetic Angiopathies ; Diabetic Nephropathies ; Diabetic Retinopathy ; Fluorescein Angiography ; Glucose ; Glucose Tolerance Test ; Humans ; Hypertension ; Male ; Proteinuria

An open, randomized and prospective study was conducted at the H÷u NghÞ Hospital. Participants were 30 male patients with type II diabetes with age ranged from 50-80 years. The results showed that age, duration of disease, hypertension, hypercholesteremia and hypertriglyceremia related to major vascular complications. Type II diabetics with hypertension need to control the blood pressure to slow the progress of major vascular complications. Individuals who have high BMI without diabetes should take physical exercise to prevent from diabetes.
Diabetic Angiopathies ; Diabetes Mellitus

BACKGROUND: Several epidemiological studies have shown that high plasma concentration of lipoprotein(a) [Lp(a)] is associated with an increased risk for atherosclerotic cardiovascular disease and works as an independent risk factor for atherosclerosis. But, the significance of Lp(a) in diabetic microangiopathy & neuropathy is unclear essentially due to a paucity of relevant studies. This study was designed to evaluate whether Lp(a) concentration may be increased in patients with diabetic microangiopathy & neuropathy. METHODS:We studied 96 patients who visited the department of internal medicine in Pusan National University Hospital from May 1995 to May 1996. The patients were grouped according to the presence of diabetic complications(microangiopathy and neuropathy, microangiopathy included retinopathy and nephropathy) and therapeutic modalities(diet, insulin, insulin with oral hypoglycemic agent, and oral hypoglycemic agent). RESULTS: 1) Concentration of Lp(a) was significantly higher(p < 0.05) in patients with diabetic retinopathy(nonproliferative, 38.6+/-33.6 mg/dl, proliferative, 39.5+/-32.1 mg/dl) than that of patients without retinopathy(23.3+/-25.3 mg/dl). The duration of diabetes was significantly longer(p < 0.05) in patients with diabetic retinopathy(nonproliferative, 12.0 years, proliferative, 13.2 years) than that of patients without retinopathy(5.9 years). 2) Concentration of Lp(a) was significantly higher(p < 0.05) in patients with diabetic nephropathy(36.5+/-39.3 mg/dl) than that of patients without nephropathy(23.3+/-17.8 mg/dl) and the duration of diabetes was also longer in patients with diabetic nephropathy(10.7+/-7.2 years vs 6.3+/-5.8 years, p < 0.005). 3) Concentration of Lp(a) was significantly higher and the duration of diabetes was longer in patients with diabetic neuropathy than that of patients without neuropathy(35.9+/-31.7 mg/dl vs 23.2+/-25.1 mg/dl, p < 0.05 and 10.8 years vs 6.2 years, p < 0.005). 4) Concentration of Lp(a) was significantly higher in patients with three complications(53.6 mg/dl, p < 0.005) and duration of diabetes was significantly longer in patients with two or three complications(11.3 years, 13.6 years, respectively, p < 0.0001). than those in patients without complications. 5) When the patients were subgrouped according to the treatment modalities, there were no significant difference in Lp(a) concentration, however the duration of diabetes was longer in patient group treated with combination of insulin and oral hypoglycemics than that of the other groups(p < 0.05). 6) In multivariate logistic regression analysis, concentration of Lp(a) > or = 50 mg/dl was significantly correlated with diabetic retinopathy & nephropathy, but was not significantly correlated with diabetic neuropathy. Duration of diabetes(> or =7 years) and total cholesterol(> or =240 mg/dl) were significantly correlated with diabetic retinopathy, nephropathy and neuropathy. CONCLUSIONS: Lp(a) concentration is increased in patients with diabetic microangiopathy and neuropathy compared with patients without these complications. So, Lp(a) may works as risk factor for diabetic microangiopathy and neuropathy, and further study to evaluate the role of Lp(a) as a risk factor of such complications would be necessary in large number of patients.
Atherosclerosis ; Busan ; Cardiovascular Diseases ; Diabetic Angiopathies* ; Diabetic Neuropathies ; Diabetic Retinopathy ; Epidemiologic Studies ; Humans ; Hypoglycemic Agents ; Insulin ; Internal Medicine ; Lipoprotein(a)* ; Logistic Models ; Plasma ; Risk Factors

OBJECTIVES: High serum Lp(a) concentration is associated with a high risk of coronary artery disease(CAD). This study was initiated to determine whether increased Lp(a) levels are associated with diabetic vascular complications in Korean patients with NIDDM. METHODS: A total of 183 NDDM patients were studied cross-sectionally for the presence of various vascular complications. Lp(a) levels were measured by 1-step sandwich ELISA method. RESULTS: The patients with overt proteinuria had higher Lp(a) levels than the patients with mormoalbuminuria or microalbuminuria(26.8mg/dl vs 13.8 mg/dl and 17.3mg/dl, p<0.05), The patients with proliferative retinopathy and/or those treated by photocoagulation had higher Lp(a) levels than those without retinopathy or those with background retinopathy(34.1mg/dl vs 13.3mg/dl and 16,9mg/dl, p<0.05), The Lp(a) levels were also higher in the patients with CAD than those without CAD(30.9mg/ dl vs 16.3mg/dl, p<0.05). Multiple logistic regression analysis revealed that high Lp(a) levels were independantly associated with CAD and severe diabetic retinopath3. CONCLUSION: High Lp(a) levels are associated with CAD and proliferative retinopathy in Korean patients with NIDDM.
Coronary Artery Disease ; Coronary Vessels ; Diabetes Mellitus, Type 2 ; Diabetic Angiopathies ; Diabetic Nephropathies ; Diabetic Retinopathy ; Enzyme-Linked Immunosorbent Assay ; Humans ; Light Coagulation ; Lipoprotein(a)* ; Logistic Models ; Proteinuria

BACKGROUND: It is not clear whether microangiopathies are associated with subclinical atherosclerosis in type 2 diabetes mellitus (T2DM). We investigated the relation of cardiac autonomic neuropathy (CAN) and other microangiopathies with carotid atherosclerosis in T2DM. METHODS: A total of 131 patients with T2DM were stratified by mean carotid intima-media thickness (CIMT) > or = or <1.0 mm and the number of carotid plaques. CAN was assessed by the five standard cardiovascular reflex tests according to the Ewing's protocol. CAN was defined as the presence of at least two abnormal tests or an autonomic neuropathy points > or =2. Diabetic microangiopathies were assessed. RESULTS: Patients with CAN comprised 77% of the group with mean CIMT > or =1.0 mm, while they were 29% of the group with CIMT <1.0 mm (P=0.016). Patients with diabetic retinopathy (DR) comprised 68% of the group with CIMT > or =1.0 mm, while they were 28% of the group without CIMT thickening (P=0.003). Patients with CAN comprised 51% of the group with > or =2 carotid plaques, while they were 23% of the group with < or =1 carotid plaque (P=0.014). In multivariable adjusted logistic regression analysis, the patients who presented with CAN showed an odds ratio [OR] of 8.6 (95% confidence interval [CI], 1.6 to 44.8) for CIMT thickening and an OR of 2.9 (95% CI, 1.1 to 7.5) for carotid plaques. Furthermore, patients with DR were 3.8 times (95% CI, 1.4 to 10.2) more likely to have CIMT thickening. CONCLUSION: These results suggest that CAN is associated with carotid atherosclerosis, represented as CIMT and plaques, independent of the traditional cardiovascular risk factors in T2DM. CAN or DR may be a determinant of subclinical atherosclerosis in T2DM.
Atherosclerosis ; Carotid Artery Diseases* ; Carotid Intima-Media Thickness ; Diabetes Mellitus, Type 2 ; Diabetic Angiopathies ; Diabetic Neuropathies* ; Diabetic Retinopathy ; Humans ; Logistic Models ; Odds Ratio ; Reflex ; Risk Factors

BACKGROUND: It is not clear whether microangiopathies are associated with subclinical atherosclerosis in type 2 diabetes mellitus (T2DM). We investigated the relation of cardiac autonomic neuropathy (CAN) and other microangiopathies with carotid atherosclerosis in T2DM. METHODS: A total of 131 patients with T2DM were stratified by mean carotid intima-media thickness (CIMT) > or = or <1.0 mm and the number of carotid plaques. CAN was assessed by the five standard cardiovascular reflex tests according to the Ewing's protocol. CAN was defined as the presence of at least two abnormal tests or an autonomic neuropathy points > or =2. Diabetic microangiopathies were assessed. RESULTS: Patients with CAN comprised 77% of the group with mean CIMT > or =1.0 mm, while they were 29% of the group with CIMT <1.0 mm (P=0.016). Patients with diabetic retinopathy (DR) comprised 68% of the group with CIMT > or =1.0 mm, while they were 28% of the group without CIMT thickening (P=0.003). Patients with CAN comprised 51% of the group with > or =2 carotid plaques, while they were 23% of the group with < or =1 carotid plaque (P=0.014). In multivariable adjusted logistic regression analysis, the patients who presented with CAN showed an odds ratio [OR] of 8.6 (95% confidence interval [CI], 1.6 to 44.8) for CIMT thickening and an OR of 2.9 (95% CI, 1.1 to 7.5) for carotid plaques. Furthermore, patients with DR were 3.8 times (95% CI, 1.4 to 10.2) more likely to have CIMT thickening. CONCLUSION: These results suggest that CAN is associated with carotid atherosclerosis, represented as CIMT and plaques, independent of the traditional cardiovascular risk factors in T2DM. CAN or DR may be a determinant of subclinical atherosclerosis in T2DM.
Atherosclerosis ; Carotid Artery Diseases* ; Carotid Intima-Media Thickness ; Diabetes Mellitus, Type 2 ; Diabetic Angiopathies ; Diabetic Neuropathies* ; Diabetic Retinopathy ; Humans ; Logistic Models ; Odds Ratio ; Reflex ; Risk Factors

Foot complications are a well known factor which contribute to the morbidity of diabetes and increases the chance of amputation. A total of 126 consecutive diabetic patients were evaluated by diabetic foot screening. Forty-one patients showed an impaired protective sense when tested with Semmes-Weinstein monofilament 5.07 (10 g), and 92% of them showed peripheral polyneuropathy in nerve conduction study (NCS). The mean vibration score of the Rydel-Seiffer graduated tuning fork in patients with peripheral polyneuropathy in nerve conduction (NCV) study was 5.38+/-2.0, which was significantly different from that of patients without polyneuropathy in NCS. Among the deformities identified on examination, callus, corn, and hallux valgus were the greatest. While checking the ankle/ brachial index (ABI), we also evaluated the integrity of vasculature in the lower extremities. After extensive evaluation, we classified the patients into eight groups (category 0,1,2,3,4A,4B,5,6). The result of this study suggested that the Semmes-Weinstein monofilament test, Rydel-Seiffer graduated tuning fork test, and checking the ankle/brachial index were simple techniques for evaluating pathologic change in the diabetic foot by office screening, and that this screening based on treatment-oriented classification helps to reduce pedal complications in a diabetic population
Diabetic Angiopathies/diagnosis ; Diabetic Angiopathies/complications ; Diabetic Foot/physiopathology ; Diabetic Foot/diagnosis* ; Diabetic Foot/classification ; Diabetic Neuropathies/diagnosis ; Diabetic Neuropathies/complications ; Female ; Foot/physiopathology ; Human ; Male ; Mass Screening ; Middle Age ; Podiatry/methods ; Sensory Thresholds