We measured pancreatic volume (PV) using helical computed tomography (CT) in 26 patients with type 1 diabetes mellitus (DM), 29 patients with type 2 DM, and 22 healthy individuals. We also evaluated the relationship between PV and the body surface area (BSA), established the pancreatic volume index (PVI) by dividing PV by BSA to correct PV for the body build, and examined its relationships with the duration of illness, serum C-peptide immunoreactivity level (CPR), and serum immunoreactive trypsin level (IRT). BSA and PV were correlated significantly (p<0.0001, r=0.645) in healthy individuals, and they were correlated also in the diabetic patients (p=0.0023, r=0.563 in type 1 DM; p=0.0346, r=0.392 in type 2 DM). PV was significantly smaller in the type 1 DM group than in the healthy group and type 2 DM group (p<0.001 for both). PVI was also significantly smaller in the type 1 DM group than in the healthy group and type 2 DM group (p<0.001 for both). PVI and IRT were significantly correlated in both DM groups (p<0.0001, r=0.732 in type 1 DM; p=0.0469, r=0.371 in type 2 DM). PVI was not correlated with the duration of illness or CPR. Helical CT was useful for the measurement of the pancreatic volume, and the pancreatic volume was reduced particularly in the patients with type 1 DM. A strong correlation was observed between PV and exocrine pancreatic function in type 1 DM, but the correlation between PV and exocrine pancreatic function was weak in type 2 DM.

No abstract

The close relationship between diabetes mellitus and arteriosclerosis of the cerebral arteries has recently been reported. However, in these studies, the subjects included older patients with hypertension, which itself is a significant risk factor for arteriosclerosis of the cerebral arteries. [1][2][3] Thus, previous studies on the effect of diabetes on the development of sclerosis were confounded by hypertension and aging. Therefore, we examined relatively young patients with diabetes mellitus who did not have hypertension in order to clarify the influence of diabetes mellitus itself on the development of sclerosis of the cerebral arteries.The subjects included 30 patients with type 2 diabetes mellitus (DM). The subjects with DM did not have hypertension (systolic blood pressure Ͻ140 mm Hg, diastolic blood pressure Ͻ90 mm Hg) and had no history of cerebral infarction, diabetic retinopathy, diabetic neuropathy, or diabetic nephropathy. Among the 30 diabetic patients, 4 were being treated with insulin injections, 10 with oral hypoglycemic agents, and 16 with dietary therapy alone. The control group (C) consisted of 20 healthy adults without a history of diabetes, hypertension, or cerebral infarction. There were no significant differences in age (DM: 50.1Ϯ7.0 years versus C: 49.7Ϯ6.7 years), sex (DM: 21/9 versus C: 11/9 [M/F]), systolic blood pressure (DM: 120Ϯ11 mm Hg versus C: 117Ϯ10 mm Hg) between the DM and control groups. The diastolic blood pressure was significantly lower in the DM group than in the control group (DM: 72Ϯ8 mm Hg versus C: 77Ϯ5 mm Hg, PϽ0.05). There were no significant differences in total cholesterol (DM: 197Ϯ24 mg/dL versus C: 218Ϯ41 mg/dL), triglyceride (DM: 88Ϯ41 mg/dL versus C: 110Ϯ61 mg/dL), nor high-density lipoprotein cholesterol levels (DM: 59Ϯ17 mg/dL versus C: 67Ϯ23 mg/dL) between the DM and C groups. The fasting plasma glucose was significantly higher in the DM group than in the control group (DM: 147Ϯ38 mg/dL versus C: 89Ϯ9 mg/dL, PϽ0.05). The hemoglobin A1c was significantly higher in the DM group than in the control group (DM: 7.2Ϯ1.6% versus C: 5.1Ϯ0.4%; PϽ0.05) (Mann-Whitney U test).Lacunar lesions (LA) were depicted as a low-signal area on T1-weighted images and as a high-signal area on T2-weighted images of MRI (field strength, 1.5 T: CV, General Electric). Such areas with the largest diameter exceeding 3 mm were considered to represent LA. 4 As to atherosclerosis (AS), subjects with positive findings on either magnetic resonance angiography (MRA) or ultrasonographic scanning of the intracranial and extracranial arteries or both were identified as having AS. Images of arteries in the head and neck were obtained by MRA. A reduction in the diameter of an artery by Ͼ25% was considered to indicate stenosis. On ultrasonographic scanning, the common and the internal carotid artery were observed on both the left and right sides. We measured the intima-media thickness (IMT) and the thickness of the plaque. An IMT of Ͼ1.0 mm was considered to indicate significant thickening. 5,6 ...

We previously showed that diabetes contributes to the development of sclerotic lesions in cerebral arteries. In this study, we attempted to clarify whether differences in heart rate variability in non-hypertensive diabetic patients were dependent on the presence or absence of underlying cerebrovascular disease. Thirty diabetic subjects between 40 and 59 years of age and who had no prior history of hypertension were used in this study. Lacunar lesions (LA) were detected with magnetic resonance imaging and atherosclerotic lesions (AS) were detected using intra- and extracranial magnetic resonance angiography, and by ultrasonographic scanning of the carotid artery. Patients underwent a full clinical laboratory screening and a power spectrum analysis of their heart rate variability. Subjects were divided into two groups: those with and without LA. The low frequency/high frequency ratio (LF/HF ratio) was found to be significantly increased (P<0.01) in subjects with LA (2.2 +/- 0.3) compared to those without LA (1.3 +/- 0.1). When subjects were divided into groups based on their presence or absence of AS, high-frequency power was found to be significantly reduced (P<0.05) in the subjects with AS (12.8 +/- 3.4 ms) compared to those without AS (19.4 +/- 1.7 ms). The LF/HF ratio was found to be significantly increased (P<0.05) in the subjects with AS (2.2 +/- 0.3) compared to those without AS (1.4 +/- 0.1). Our data suggested that atherosclerotic lesions in cerebrovascular diseased linked to decrease of vagal nerve activity in non-hypertensive diabetic patients.

The purpose of this study was to ascertain whether abdominal compression with an inflatable abdominal band, a device we developed, improved post-dialytic orthostatic hypotension (OH) in hemodialysis (HD) patients. Twenty-five chronic HD patients with intractable post-dialytic OH were recruited. Post-HD changes in systolic blood pressure (DeltaSBP) in the supine and standing positions were compared in the patients, measured with or without the use of the band. The study showed DeltaSBP after HD without the band was significantly greater than that measured before HD (-36.1+/-18.2 vs -13.1+/-16.8 mm Hg; P<0.0001). DeltaSBP after HD with the band was reduced significantly in comparison to DeltaSBP after HD without the band (-19.4+/-21.2 vs -36.1+/-18.2 mm Hg; P<0.002). Use of the band did not cause an elevation in SBP in the supine position (149.0+/-29.6 vs 155.4+/-25.7 mm Hg); however, it did increase SBP upon standing (129.6+/-27.3 vs 117.2+/-22.6 mm Hg; P<0.05). Eight patients in whom an increase in SBP of 25 mm Hg or more was achieved with the band were classified as responders. Ejection fraction was significantly higher (76.4+/-11.1 vs 61.9+/-13.6%; P<0.02) and atrial natriuretic peptide concentration significantly lower (27.9+/-22.0 vs 68.9+/-47.5 pg/ml; P<0.02) in responders than in non-responders. We conclude that the abdominal band was effective for overcoming post-dialytic OH, without elevating supine SBP in some patients.