Cardiovascular autonomic neuropathy in type 1 diabetic patients with and without peripheral neuropathy.

One hundred Type 1 diabetic patients (54 men, 46 women) mean age 28.9+/-8.4 years, were selected from among individuals referred to our hospital, with no previous diagnosis of diabetic chronic complications including diabetic neuropathy. After clinical and physical examinations, subjects were divided into two groups: with (n = 37) and without (n = 63) peripheral neuropathy. The percentage of subjects with cardiovascular autonomic neuropathy (AN), diagnosed by positive results to at least two of the five cardiovascular tests (Valsalva ratio, EI ratio, 30/15 ratio, blood-pressure response to standing up and handgrip test), was 40%: 72.9% in the group with peripheral neuropathy and 20.6% in the group without peripheral neuropathy (P < 0.0001). The prevalence of cardiovascular AN was related to the duration of the diabetes (P < 0.0001) and to HbA1c (P < 0.02). The presence of microalbuminuria and the existence of retinopathy were higher (P < 0.01 ) in group 1 (with peripheral neuropathy). Logistic regression analysis showed that only the presence of higher excretion of albumin is independently related to the presence of peripheral neuropathy. In conclusion, cardiovascular AN is frequent in Type 1 diabetes; furthermore, prevalence increases with the existence of peripheral neuropathy and with duration of the diabetes.

[Psoas abscess secondary to lumbar spondylodiscitis caused by gram negative bacilli]. / Absceso de psoas secundario a espondilodiscitis lumbar por gram negativos.

The association between psoas abscess and lumbar spondylodiscitis by Gram negative bacilli represents a rare clinical entity. Sometimes the absence of demonstrative symptoms complicates the diagnostic schema. We report about a 72 year-old woman, without previous known diabetes mellitus, who was admitted because of fever of one week duration and a non-ketotic hyperosmolar coma. A left psoas abscess was identified by abdominal computed tomography (CT). The abscess was in communication with the L1-L2 intervertebral space. Although Escherichia coli was identified as the causing agent and appropriate antibiotic therapy was administered, the resolution of the abscess occurred only after the implantation of a percutaneous catheter guided by CT without additional surgery. Percutaneous drainage as a diagnostic-therapeutic technique has rendered the surgery as the last resort in the treatment of psoas abscess.

Plasma Lp(a) values in familial hypercholesterolemia and its relation to coronary heart disease.

BACKGROUND AND AIM: To analyze plasma Lp(a) levels and examine different risk factors and coronary heart disease (CHD) in a sample of genetically diagnosed familial hypercholesterolemia (FH) patients. METHODS AND RESULTS: Ninety heterozygous FH patients and 41 non-FH relatives were enrolled in a study to evaluate their plasma and lipoprotein cholesterol, as well as their triglyceride and Lp(a) levels. We found no differences in plasma Lp(a) levels and log transformed values between 90 FH subjects and their 41 unaffected relatives (22.3 mg/dl +/- 19.4 vs 17.7 mg/dl +/- 21.3 and 1.12 +/- 0.5 vs 0.96 +/- 0.54) nor between null allele and defective allele FH subjects (log Lp (a) levels 2.013 +/- 0.282 vs 1.959 +/- 0.151). FH CHD+ were significantly older, and had higher mean systolic and diastolic blood pressure and higher mean plasma triglyceride levels than FH CHD-. No differences in mean and log transformed Lp(a) plasma concentrations were found. CONCLUSIONS: Plasma Lp(a) levels are not related to LDL receptor status and class mutations, nor to the presence of CHD in FH patients.