Intraepidermal nerve-fibre density as a biomarker of the course of neuropathy in patients with Type 2 diabetes mellitus.

AIMS: This paper aims to investigate whether intraepidermal nerve-fibre density (IENFD) may be used as a marker of the course of neuropathy in patients with Type 2 diabetes mellitus. METHODS: Skin biopsies from the distal leg were serially evaluated in a group of 30 patients with Type 2 diabetes mellitus (median age 60 years, 17 men) with a short duration of diabetes (< 3 years) and good glucose control, and in 23 age- and sex-matched controls. The time intervals between biopsies were > 2 years (median 33.8 months). Eighteen patients with Type 2 diabetes mellitus had symptoms or signs of distal symmetrical diabetic polyneuropathy, 12 had no neuropathy. RESULTS: At first skin biopsy, IENFD was normal in all controls and in patients without neuropathy (mean 9.5 and 7.9 fibres/mm, respectively) compared with abnormal IENFD in 77.8% in patients with polyneuropathy (mean 3.4 fibres/mm). The annual rate of intraepidermal nerve-fibre (IENF) loss expressed as a percentage of the first IENFD value in patients with diabetic polyneuropathy was significantly higher [mean (se), 11.95 (3.82)%] compared with controls [1.92 (1.81)%, P < 0.001] and similar to patients without polyneuropathy [12.16 (4.38)%]. The rate of IENF loss did not correlate with degree of glucose control. CONCLUSIONS: The annual rate of IENF loss in patients with Type 2 diabetes mellitus was several times higher than that of healthy participants, irrespective of the presence of signs or symptoms of diabetic polyneuropathy at initial evaluation. The change in IENFD is not linear and should be expressed as a proportion of initial IENFD to serve as a marker of the course of diabetic neuropathy.

Special features of burn injuries in elderly patients.

Types of burns and other aspects of burn injuries and case outcomes were assessed in a group of geriatric patients (> 60 years) and a younger group of patients (40-59 years). Between 1990 and 1999, 137 geriatric patients (47 [34%] males and 90 [66%] females) were admitted to the Burn Centre and Reconstructive Surgery Centre at University Hospital in Brno. We compared findings in this elderly group to those in 176 younger burn patients (126 [72%] males and 50 [28%] females) who were treated at the centre during the same time period. Age and concomitant chronic disease contribute to the high mortality and a higher frequency of complications in geriatric patients who suffer burn injuries. In this study, the complication rates for geriatrics during hospitalization (44% in males and 32% in females) and the elderly patients' mortality rates (26% in males and 17% in females) differed statistically from the corresponding rates in the younger patient group. It is important to know the special needs of elderly burn patients because this patient group is expected to grow in parallel with the rising average age of the Czech Republic's population.