SUMMARY Two groups, one of 824 adult diabetics and one of 320 age and sex matched non-diabetics, were examined for abnormal glucose metabolism and calcifications on anteroposterior shoulder x rays. Two hundred and sixty two (31-8%) of the diabetics had shoulder calcification compared with 33 (10-3%) of the control group, with a preponderant localisation in the right shoulder. Diabetes of long duration treated with insulin for a long time was associated with a larger percentage of shoulder calcifications. These data and previous laboratory findings suggest a possible pathogenetic correlation between the prevalence of calcific shoulder tendinitis and diabetes.Diabetes is a common disease, affecting about 6% of the Athens population, and generally making the patient susceptible to a wide range of metabolic disturbances. 1 A variety of rheumatological syndromes, such as osteopenia, gout, pseudogout, neuroarthropathy, osteolysis, carpal tunnel syndrome, osteoarthrosis, Dupuytren's contracture, cheiroarthropathy, diffuse idiopathic skeletal hyperostosis, and periarthritis, may all present in association with diabetes mellitus. Only neuroarthropathy and osteolysis are definite associations, the others being considered as probable or even possible associations. 2 Periarthritis is a term which refers to inflammatory disorders of structures surrounding joints-that is, tendons, tendon sheaths, capsules, and bursae. Publications discussing the relation between diabetes mellitus and periarthritis are few. Only three controlled studies have been published. Two suggest a four-to sixfold increased prevalence of association between frozen shoulder and diabetes3 4 whereas the third records calcifications of the shoulders in a small group of diabetics.5The purpose of this controlled study was to investigate the prevalence of calcific shoulder tendinitis in a large group of adult diabetics and to report

Sympathetic and parasympathetic activity was evaluated on 39 occasions in 17 patients with the sepsis syndrome, by measurement of the variation in resting heart rate using frequency spectrum analysis. Heart rate was recorded by electrocardiography and respiratory rate by impedance plethysmography. The sepsis syndrome was established on the basis of established clinical and physiological criteria. Subjects were studied, whenever possible, during the period of sepsis and during recovery. Spectral density of the beat-to-beat heart rate was measured within the low frequency band 0.04 to 0.10 Hz (low frequency power, LFP) modulated by sympathetic and parasympathetic activity, and within a 0.12 Hz band width at the respiratory frequency mode (respiratory frequency power, RFP) modulated by parasympathetic activity. Results were expressed as the total variability (total area beneath the power spectrum), as the spectral components normalized to the total power (LFPn, RFPn) or as the ratio of LFP/RFP. During the sepsis syndrome, total heart rate variability and the sympathetically mediated component, LFPn were significantly lower than during the following recovery phase (ANOVA, p < 0.0001, p < 0.01 respectively). Both APACHE II (Acute Physiological and Chronic Health Evaluation) and TISS (Therapeutic Intervention Scoring System) scores showed an inverse correlation with total heart rate variability, logLFP, LFPn and the LFP/RFP ratio (p < 0.002 to 0.0001). Sympathetically mediated heart rate variability was significantly lower during the sepsis syndrome and was inversely proportional to disease severity.

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Reduced LF components of the variability of cardiovascular signals are characteristic of septic shock, confirming the presence of abnormal autonomic control. Restored sympathetic (LF) modulation seems to be associated with a favourable prognosis.