[Diabetes in the aged--senile diabetes].
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Biomedical subjects
Publications and source records attributed to V Schliack.
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In 130 type I and II diabetics with normal serum lipids and in 98 diabetics with type IIa-V hyperlipoproteinemia (HLP), liver biopsies were performed if clinically indicated. During histological examinations of one half of the biopsy specimen lipid droplet size was classified into 4 categories, which were proved by morphometric studies, independent of the amount of fat. From the remaining part the fatty acid composition of triglycerides was analyzed by gas liquid chromatography. Moreover, the fatty acid pattern of serum triglycerides and subcutaneous adipose tissue from the abdominal wall was estimated. The percentage of eicosapentaenoic acid (EPA) in triglycerides of normal diabetic liver (no visible fat) was remarkably high (greater than 30 per cent). In adipose tissue it was low (less than 1 per cent). In serum triglycerides it remained between liver and depot fat (about 3 per cent). EPA decreased with rising lipid droplet size in hepatocytes. Liver diseases, like chronic hepatitis, had no influence on the results. One year after clofibrate treatment, the percentage of EPA in liver appeared increased. In adipose tissue, however, it remained constant. In general, EPA in liver and serum triglycerides was higher in diabetics with normal serum lipids as compared to diabetics with HLP. The decreased availability of EPA in liver and serum triglycerides of diabetics with HLP suggests a significant correlation between this fatty acid and hepatic lipid accumulation which itself is associated with diseases known as risk factors of atherosclerosis.
Simultaneous biopsies of liver and subcutaneous adipose tissue have been carried out in 228 patients with diabetes mellitus. In liver triglycerides a marked variability of the fatty acid pattern in relation to fatty degeneration of liver parenchyma has been confirmed. In adipose tissue fatty acid pattern was relatively constant. The most striking finding was a high content of eicosapentaenoic acid in normal liver and its decrease with the rise of lipid droplet size in the hepatocytes. No correlation with the quantity of liver fat or inflammatory liver diseases could be ascertained. When diabetes was associated with hyperlipoproteinemia (HLP) the percentage of eicosapentaenoic acid was significantly less. From the results the suggestion is obvious that a diminution of eicosapentaenoic acid in hepatic triglycerides is associated with lipid accumulation in the liver cells. A local mechanism, possibly the antilipolytic potency of prostaglandins, may be responsible for the creation of lipid droplets in liver cells of patients with metabolic disturbances. The alterations of eicosapentaenoic acid should be considered in view of recent data on the antiaggregatory effect of this fatty acid and its possibly preventive role for atherosclerosis.
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The triglyceride fatty acid pattern [TFAP] in arterial wall, adipose tissue and serum has been estimated in diabetic subjects by gas-liquid chromatography simultaneously. The samples were taken shortly before or during femoral amputation performed under halothane anaesthesia. In addition, in some probands the fatty acids of cholesterol esters of vascular walls have been obtained. The following differences in the TFAP of the tissues under study were discovered. In arterial wall compared to serum, lauric, myristic, myristoleic, palmitoleic, stearic, oleic and linolenic acid were increased; palmitic and linoleic acid were decreased, whereas eicosatrienoic, arachidonic and eicosapentaenoic acid were at the same level. In arterial wall compared to adipose tissue, myristic, palmitic and nervonic acid were decreased; eicosatrienoic, arachidonic and eicosapentaenoic acid were increased. Most differences concern the TFAP of adipose tissue compared to serum: lauric, myristic, myristoleic, palmitoleic, oleic, linolenic, lignoceric and nervonic acid were elevated in the former; palmitic, linoleic, eicosatrienoic, arachidonic and eicosapentaenoic acid were increased in the latter. In consideration of different content of fatty acids in the tissues studied the authors conclude that certain fatty acids have distinct metabolic positions such as depot fatty acids and precursors of prostaglandins.
The triglyceride fatty acid pattern (TFAP) in arterial wall, adipose tissue and serum in vivo has been estimated in amputated diabetic subjects by gas-liquid chromatography simultaneously. Besides, in some probands the fatty acid pattern of cholesterol esters of vessel walls has been obtained. In arterial wall the percental content of lauric, myristic, myristoleic, palmitoleic, stearic, oleic and linolenic acid was high and that of palmitic and linoleic acid was low, when compared to serum, whereas eicosatrienoic, arachidonic and eicosapentaenoic acid were of similar magnitude. In comparison to adipose tissue myristic, palmitic and nervonic acid were decreased and eicosatrienoic, arachidonic and eicosapentaenoic acid were increased in arterial wall. In view of the results the speculation is obvious that certain fatty acids have distinct metabolic positions in several tissues, such as depot fatty acids and precursors of prostaglandins, for example.
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On the basis of 763 cases with diabetic coma from 1960 to 1973 is referred to the advantages of the foundation of a coma ward as department of intensive observation. It is reported on some successful changes of therapy in recent years. The introduction of methods of intensive therapy has led to a significant decrease of lethality. A sufficient administration of potassium (not less than 200 mval/die) and the prevention of a cerebral oedema are actual demands for the improvement of the prognosis of diabetic coma.
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On the basis of the experiences of the Berlin Central Institution for Diabetes and Metabolic Diseases is reported on the capacity to earn their living and the fitness for work of diabetics, especially of 268 long-term diabetics at the age in which they can earn their living and at the retirement age. 31% of these patients belonged to the group of pensioners, 19% of them are still working. 69% of the long-term diabetics are at working age, of them 24% are already pensioners due to diabetes and 4% due to other diseases. Among the complications of diabetes leading to pensioning are frequently mentioned retinopathy, nephropathy in the wider sense, macroangiopathy and neuropathy, rarely, however, instable metabolism. The peculiarities are discussed. In answering the difficult question of the estimation of the incapacity to earn one's living in diabetics in every case the diabetologist should be consulted.
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