OBJECTIVE -To study potential risk factors for retinopathy in diabetic and nondiabetic individuals. RESEARCH DESIGN AND METHODS -The HoornStudy is a population-based study including 2,484 50-to 74-year-old Caucasians. A subsample of 626 individuals stratified by age, sex, and glucose tolerance underwent extensive measurements during 1989 -1992, including ophthalmologic examination and two-field 45-degree fundus photography. The prevalence of (diabetic) retinopathy was assessed among individuals with normal glucose metabolism (NGM) and impaired glucose metabolism (IGM) and individuals with newly diagnosed diabetes mellitus (NDM) and known diabetes mellitus (KDM) (new World Health Organization 1999 criteria).RESULTS -The prevalence of retinopathy was 9% in NGM, 11% in IGM, 13% in NDM, and 34% in KDM. Retinopathy worse than minimal nonproliferative diabetic retinopathy was present in 8% in KDM and 0 -2% in other glucose categories. The prevalence of retinopathy was positively associated with elevated blood pressure, BMI, cholesterol, and triglyceride serum levels in all glucose categories. The age-, sex-, and glucose metabolism category-adjusted odds ratios were 1.5 (95% CI 1.2-1.9), 1.3 (1.0 -1.7), and 1.3 (1.0 -1.6) per SD increase of systolic blood pressure, BMI, and total cholesterol concentration, respectively, and 1.2 (1.0 -1.5) per 50% increase of triglyceride level. Elevated blood pressure and plasma total and LDL cholesterol levels showed associations with retinal hard exudates.CONCLUSIONS -Retinopathy is a multifactorial microvascular complication, which, apart from hyperglycemia, is associated with blood pressure, lipid concentrations, and BMI. Diabetes Care 25:1320 -1325, 2002T here is growing evidence that retinopathy is not only related to hyperglycemia and diabetes duration. Other cardiovascular risk factors have been shown to play an important role as well (1-4). The U.K. Prospective Diabetes Study (UKPDS) has shown that intensive blood pressure treatment in hypertensive subjects with type 2 diabetes prevented or delayed progression of retinopathy (5). There are also indications that elevated serum lipid levels promote retinopathy and especially hard exudates (6 -8). Most of these studies, however, are restricted to diabetic patients. A number of population-based studies have reported the presence of retinopathy in nondiabetic subjects (9 -14). However, there is only little information about risk factors for retinopathy in these individuals. We previously reported an association of hyperhomocysteinemia with retinopathy in the diabetic but not in the nondiabetic population (15). Therefore, the aim of the present study was to investigate the contribution of blood pressure, lipids, and obesity to retinopathy in diabetic and nondiabetic individuals. We also specifically analyzed associations of risk factors with hard exudates, a sight-threatening complication when associated with macular edema. In addition, we present the prevalence of retinopathy according to the new diagnostic criteria for diabetes of...

To investigate the effect of glycosylated hemoglobin, age, sex, hypertension, body mass index, waisthip ratio, serum lipid levels, and smoking on the incidence of retinopathy in persons with normal and abnormal glucose metabolism. Methods: The incidence of retinopathy was determined in 233 individuals, aged 50 to 74 years, by ophthalmoscopy and fundus photography at baseline and after an average follow-up of 9.4 years. Relative risks for retinopathy, estimated by odds ratios, were calculated for tertiles of cardiovascular risk factors at baseline. Logistic regression analysis was used, without and with adjustment for age, sex, hypertension, and glucose metabolism. Results: The cumulative incidences of retinopathy among individuals with normal, impaired, and diabetic glucose metabolism were 7.3%, 13.6%, and 17.5%, respectively. Adjusted odds ratios for retinopathy were 2.36 (95% confidence interval, 1.02-5.49) for hypertension and 3.29 (95% confidence interval, 1.11-9.72) and 8.67 (95% confidence interval, 1.85-40.60) for the highest tertiles of glycosylated hemoglobin level and waist-hip ratio, respectively. No consistent or statistically significant associations with retinopathy were present for age, sex, body mass index, smoking, and serum levels of triglycerides and total, high-density lipoprotein, and non-high-density lipoprotein cholesterol (PϾ.05 for all). Conclusion: Glycemia, hypertension, and abdominal obesity are determinants for retinopathy in a general population.

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PurposeThere is, in European countries that conduct medical chart review of intensive care unit (ICU) deaths, no consensus on uniform criteria for defining a potential organ donor. Although the term is increasingly being used in recent literature, it is seldom defined in detail. We searched for criteria for determination of imminent brain death, which can be seen as a precursor for organ donation.MethodsWe organized meetings with representatives from the field of clinical neurology, neurotraumatology, intensive care medicine, transplantation medicine, clinical intensive care ethics, and organ procurement management. During these meetings, all possible criteria were discussed to identify a patient with a reasonable probability to become brain dead (imminent brain death). We focused on the practical usefulness of two validated coma scales (Glasgow Coma Scale and the FOUR Score), brain stem reflexes and respiration to define imminent brain death. Further we discussed criteria to determine irreversibility and futility in acute neurological conditions.ResultsA patient who fulfills the definition of imminent brain death is a mechanically ventilated deeply comatose patient, admitted to an ICU, with irreversible catastrophic brain damage of known origin. A condition of imminent brain death requires either a Glasgow Coma Score of 3 and the progressive absence of at least three out of six brain stem reflexes or a FOUR score of E0M0B0R0.ConclusionThe definition of imminent brain death can be used as a point of departure for potential heart-beating organ donor recognition on the intensive care unit or retrospective medical chart analysis.

This study showed that the maximal number of potential organ donors is about three times higher than the number of effective organ donors. The main reason accounting for approximately 60% of the potential donor losses was the high family refusal rate. The year 2007 showed that a higher percentage of deceased organ donors can be procured from the pool of potential donors. All improvements should focus on decreasing the unacceptably high family refusal rates.