Clinical usefulness of videocapillaroscopy and selected endothelial cell activation markers in people with Type 1 diabetes mellitus complicated by microangiopathy.

PURPOSE: Microvascular abnormalities are one of the most important causes of persistent diabetic complications. The aim of our study was to compare microvascular changes examined by nailfold videocapillaroscopy (NVC) examination with serum concentrations of vascular endothelial growth factor (VEGF), soluble thrombomodulin (sTM) and endothelin-1 (ET-1) in people with Type 1 diabetes with and without microangiopathy. MATERIAL/METHODS: The study included 106 people with Type 1 diabetes and 40 healthy controls. All participants were evaluated by extensive clinical, laboratory and capillaroscopic studies. NVC was performed using a stereomicroscope SZ 4045 (Olympus, Germany). The intensity of morphological changes was graded from 0 to 3. Serum levels of VEGF, sTM and ET-1 were determined by an enzyme-linked immunosorbent assay (ELISA). RESULTS: Morphological changes were observed by NVC in 86 out of 106 (81%) people with Type 1 diabetes mellitus. Severe capillaroscopic changes (score 3) were seen in 32 out of 54 (59%) people with microangiopathy, but in only seven out of 52 (13%) individuals without microangiopathy. Higher serum concentration of VEGF (p<0.001), ET-1 (p<0.001) and sTM (p<0.05) were demonstrated in people with diabetes complicated with microangiopathy compared to healthy controls. Moreover, comparison between people with and without microangiopathic complications showed a significantly higher capillaroscopic score and sTM serum concentration in the group with retinopathy (p<0.001) nephropathy (p<0.001) and neuropathy (p<0.01). CONCLUSIONS: Our results suggest that abnormalities in NVC may reflect the extent of microvascular involvement and associated with higher VEGF, sTM and ET-1 serum levels, as well as with microangiopathic complications in diabetic people.

[Rotational atherectomy in a patient with non-ST elevation acute coronary syndrome]. / Technika "rota-DES" u pacjenta z ostrym zespolem wiencowym bez uniesienia odcinka ST.

Rotational atherectomy is a valuable technique complementary to PCI in complex calcified coronary artery stenoses. A case of a 65 year-old man with non-ST elevation acute myocardial infarction (NSTEMI) treated with PCI with rotational atherectomy followed by two drug eluting stents (DES) implantation is presented.

Microvascular abnormalities in capillaroscopy correlate with higher serum IL-18 and sE-selectin levels in patients with type 1 diabetes complicated by microangiopathy.

Microvascular abnormalities are one of the most important causes of persistent diabetic complications. The aim of this study was to compare microvascular changes examined by nailfold capillaroscopy with serum concentrations of soluble E-selectin (sE-selectin) and IL-18 in type 1 diabetic patients with and without microangiopathy. Serum levels of sE-selectin and IL-18 were determined by an enzyme-linked immunosorbent assay in 106 patients with type 1 diabetes and in 40 healthy controls. All diabetic patients were evaluated by extensive clinical, laboratory and capillaroscopic studies. Morphological changes were observed by nailfold capillaroscopy in 86 out of 106 (81%) diabetic patients. Severe capillaroscopic changes were seen in 32 out of 54 (59%) patients with microangiopathy, but in only seven out of 52 (13%) patients without microangiopathy. Higher serum levels of sE-selectin (p < 0.001) and IL-18 (p < 0.05) were demonstrated in diabetic patients compared to controls. Significant differences of sE-selectin (p , 0.001) and IL-18 (p < 0.01) serum concentrations were observed between diabetic patients with microangiopathy and controls. Moreover, comparison between patients with and without microangiopathic complications showed a significantly higher capillaroscopic score and sE-selectin serum concentration in the group with microangiopathy (p < 0.001). Furthermore, diabetic patients with severe microvascular changes in capillaroscopy showed significantly higher IL-18 (p < 0.001) and sE-selectin (p < 0.05) serum levels than subgroups without changes or with mild abnormalities. Our findings suggest that abnormalities in nailfold capillaroscopy may reflect the extent of microvascular involvement and are associated with higher sE-selectin and IL-18 serum levels, as well as with microangiopathic complications in diabetic patients.

[Morphological alterations in nailfold capillaroscopy and the clinical picture of vascular involvement in autoimmune diseases: systemic lupus erythematosus and type 1 diabetes]. / Morfologiczne zmiany w badaniu kapilaroskopowym a kliniczny obraz zajecia naczyn w przebiegu chorób autoimmunologicznych: tocznia rumieniowatego ukladowego i cukrzycy typu 1.

INTRODUCTION: Systemic lupus erythematosus (SLE) and type 1 diabetes mellitus (DM) belong to the group of autoimmune diseases presenting with a wide range of organ manifestations. Microvascular abnormalities seem to play a crucial role in the development of persistent multi-organ complications in both diseases. The aim of this study was to determine the relationship between microvascular changes examined with nailfold capillaroscopy and organ involvement. MATERIAL AND METHODS: We eurolled 76 SLE patients, 106 patients with type 1 diabetes, and 40 healthy controls. RESULTS: Morphological changes were observed with nailfold capillaroscopy in 86 (81%) diabetics and in 70 (92.1%) SLE patients. Severe capillaroscopic changes were disclosed in 32 out of 54 (59%) diabetic patients with microangiopathy and in only 7 out of 52 (13%) patients without microangiopathy. In the SLE group, severe capillaroscopic abnormalities were found in 18 out of 34 (52.9%) patients with organ involvement and in 9 out of 42 (21.4%) patients without organ involvement. The capillaroscopic score was significantly higher in diabetic patients with microangiopathic complications in comparison to patients without microangiopathy (p < 0.001). Moreover, diabetic patients with advanced microvascular changes had longer disease durations than patients with mild abnormalities. A similar comparison between SLE patients with and without systemic manifestations showed significantly higher capillaroscopic scores in the group with organ involvement (p < 0.001). Furthermore, a positive correlation between capillaroscopic score and disease activity was observed in SLE patients (p < 0.01). CONCLUSIONS: Our findings suggest that abnormalities in nailfold capillaroscopy reflect the extent of microvascular involvement and are associated with organ involvement in SLE and diabetes.

[Embolic central retinal artery occlusion as a complication of percutaneous coronary angioplasty--case report]. / Zator tetnicy srodkowej siatkówki jako powiklanie przezskórnej angioplastyki wiencowej--opis przypadku.

Procedures of the percutaneous coronary intervention are more often carried out in patients with coronary heart disease (CHD) because they are not very invasive and very effective. Even though a lot of procedures of this type are carried out, reports on the ophthalmic complications connected to them,are rarely found. The authors present the case of the 78-years-old patient in whom disturbances of the right eye vision occurred after coronary angiography combined with angioplasty of the narrowed artery with stent implantation. Ophthalmic examination revealed features of the central retinal artery occlusion. Even though an immediate treatment was applied, the function of the right eye was not improved. When general condition of the patient was normalized, the diagnosis was confirmed by the Color Doppler ultrasonography in the vessels supplying eye. The photographic documentation was prepared. The literature data indicate the necessity of immediate diagnosis of even mild vision disturbances in the course of and after the percutaneous coronary intervention because only an immediate treatment can protect the patient from a permanent vision decrease, due to the embolism of the retinal vessels.

[Transient cortical blindness--a complication after coronary angiography--case report]. / Przejsciowe zaburzenia widzenia korowe jako powiklanie po koronarografii--opis przypadku.

Transient cortical blindness is a very rare complication of cardiovascular and cerebral angiography procedures. We present a case of 63-years-old woman, who developed cortical blindness after coronary angiography. Computed tomography (CT) done immediately after blindness appearance showed bilateral hyperintensive areas (probably due to a leakage of contrast medium) in the occipital and parietal cerebral lobes. All visual symptoms disappeared during 48 hours and CT scan repeated after sight recovery did not show any focal lesions in the brain. A breakdown of the blood-brain barrier with direct contrast neurotoxicity seems to be the causal factor of neurological changes observed in our patient after coronary angiography.