[Life-threatening alcoholic hypoglycemia in subjects free of diabetes mellitus].
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Biomedical subjects
Publications and source records attributed to V K Velikov.
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As shown by conjunctival biomicroscopy, 6-month administration of ticlid and gliclazide induced a statistically significant increase in the frequency of less severe microcirculatory disturbances compared to conventional hypoglycemic therapy. The drugs also restricted plasmatic impregnation and cell proliferation in skin biopsy microvascular wall. Following 2-year antiaggregation treatment (gliclazide, trental, dipiridomol) 48.9% of diabetes mellitus patients achieved regression of morphological manifestations of diabetic microangiopathy, 16.2% stabilization against 34.9% of progressive disease cases. Conventional sugar-reducing therapy fails to stop diabetic microangiopathy progression in 73.4-93.3% of the diabetics.
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Skin biopsies from 40 patients 17 to 75 years old with type I and II diabetes mellitus were studied morphologically. The formation of diabetic microangiopathy starts with the damage of endotheliocytes, vascular permeability disturbance, activation of pericytes and smooth muscle elements with subsequent thickening of basal membranes and capillary and arteriole hyalinosis, these lesions being directly related to the duration of diabetes. Diabetic microangiopathy is a manifestation of the disease and its morphology is similar in both type I and II diabetes.
Hemocoagulation was examined in 477 diabetes mellitus patients. Whatever the disease type, severity, duration and the intensity of microvascular complications, diabetes mellitus was discovered to be marked by the development of chronic intravascular blood microcoagulation associated with primary hyperactivation of the platelet component of hemostasis. The use of the new antiaggregation agents tiklid and diabeton allows an appreciable decrease of the activity of platelet microthrombus formation whereas the administration of the common sugar-reducing antidiabetic therapy favours the maintenance of its high level.
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A study was made of the immunological mechanisms implicated in the evolution of diabetic microangiopathy. For this purpose in 270 patients with type I and II diabetes mellitus, the concentration of IgA, IgM and IgG was measured and compared with morphological alterations in skin biopsy specimens. The control group was made up of 30 normal persons (donors). The sections were stained with conventional methods, which made it possible to reveal by light microscopy the correlation between the intensity of diabetic microangiopathy and the rise of the IgG level.
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The authors analyzed the results of a 2-year study of a course of diabetic microangiopathy on the basis of clinical tests and morphological control over microvessels of skin biopsy specimens from 61 patients with diabetes mellitus, of whom 36 regularly received coronary vasodilators (diamicron, pentoxifylline and dipyridamole). The rest of the patients (25) with diabetes mellitus were taken as controls: 10 patients were with unsatisfactory compensation of diabetes mellitus and 15 with a stable metabolic control. A possibility of stabilization and regression of diabetic microangiopathy during prolonged regular administration of coronary vasodilators was shown.
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As compared with normal persons, in 46 patients with diabetes mellitus there was a significant decrease in spontaneous leukocyte migration, a reduction in the absolute count of T-, B- and O-lymphocytes, and a rise in the relative count of D-lymphocytes. The disorders of cell-mediated immunity are formed during the first five years of illness. They do not depend on the diabetes severity, distinctly growing on with the appearance and increase of the degree of diabetic microangiopathy diagnosed on morphological analysis of skin biopsy specimens.