Lege Artis Medicinae

[Measurement of coronary artery calcification in adults with type 1 diabetes mellitus using dual-source, multi-slice computed tomography]


SEPTEMBER 21, 2009

Lege Artis Medicinae - 2009;19(08-09)

[INTRODUCTION - Coronary artery calcification can be characterized non-invasively and numerically using computed tomography (CT). In adult patients with type 1 diabetes mellitus, coronary atherosclerosis may be present without clinical symptoms. PATIENTS AND METHODS - Asymptomatic adults with type 1 diabetes mellitus (n=46) were investigated. Coronary artery calcification was expressed in Agatston-scores using a dual source CT scanner. RESULTS - Twenty-one patients had a coronary artery calcification score of ≥1 (range 1-2353), while in 25 patients no detectable calcium (score 0) was observed. Patients with vs. without coronary artery calcification had a higher age (51.0±9.9 vs. 42.8±7.8 years; p=0.0045), a longer duration of diabetes (30.6±9.2 vs. 24.2± 8.6 years; p=0.0238), a higher waist circumference (87.9±11.5 vs. 79.7±9.4 cm; p=0.0146), and a higher BMI (26.2±2.9 vs. 23.8±3.1 kg/m2;p=0.0109). Moreover, patients with vs. without detectable coronary artery calcification had higher serum lipid levels (LDL-cholesterol, 3.35±0.32 vs. 3.01±0.68 mmol/l; p=0.0069) and higher serum uric acid levels (228.4±48.7 vs. 195.1±39.4 µmol/l; p=0.0437). Hypertension was more common (p=0.0144) in patients with coronary artery calcification than in patients without it. There was no significant difference between the groups in HbA1c (7.97±0.85 vs. 8.26±1.28%; p=0.7491), however, estimated insulin sensitivity was lower in patients with vs. without detectable coronary artery calcification (7.15±2.09 vs. 9.20±2.03 mg/kg/min; p=0.0017). CONCLUSION - Our results suggest that coronary artery disease in type 1 diabetic patients is associated with higher age, longer duration of diabetes, and cardiovascular risk factors rather than with long-term glucose control.]



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Lege Artis Medicinae



[The number of diabetic patients will be doubled in the coming decades reaching 300 million for year 2025. The number of type 1 diabetics will also be increased but the majority of it will result from the increased number of type 2 diabetics. All types of diabetes are the consequence of a combination of genetic susceptibility and environmental factors, meaning that the prevention of diabetes epidemic cannot be done without the clarification of the genetic background. Significant progression has happened in the discovery of the genetic background of type 1 diabetes mellitus. It was helped by the etiologic classification of the disease: with the new classification the patient groups became more homogeneous. The HLA system is responsible for about 50-70% of the genetic risk while the effects of other genetic factors contribute 1-2% of the genetic susceptibility, respectively. Presently 25 gene regions are known as the different genetic factors of type 1 diabetes mellitus. Regarding the HLA system, the genes and pathomechanism causing the disease are not known. The classification of diabetes mellitus can be based on the HLA type while the predictability of type 1 diabetes mellitus is helped by the HLA type and the INS-VNTR. Much less is known about the genetic background of the polygenic type 2 diabetes mellitus. Its manifestation is now happening at younger age before. The best-fit genetic model consists of only a few genes with moderate effect superimposed on a polygenic background. Several „candidate” genes participating in the impaired insulin secretion and insulin action have already been investigated as the genes responsible for type 2 diabetes. These data showed the specificity in the population and most showed mild or modest association with the disease. Genomewide scans have resulted a number of significant diabetes susceptibility genes specific for a variety of populations, but these investigations have only resulted in the isolation of one gene (calpain 10) that is thought to contribute to type 2 diabetes. Most recent genomewide scans found loci on chromosome 20 in two different populations with significant segregation of type 2 diabetes. These loci are near to the region harboring the transcription factor hepatocyte nuclear factor genes. The transcription regulator HNF family is responsible for the regulation of the expression of several genes participating in the function of liver and pancreatic islet becoming a strong candidate for being a diabetes gene.]

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[Computed tomographic examination of cranial lesions, a paleoradiological approach]

ZÁDORI Péter, BAJZIK Gábor, BÍRÓ Gergely, LELOVICS Zsuzsanna, BALASSA Tímea, BERNERT Zsolt, ÉVINGER Sándor, HAJDU Tamás, MARCSIK Antónia, MOLNÁR Erika, ŐSZ Brigitta, PÁLFI György, WOLFF Katalin, REPA Imre

[Background and purpose - Introducing the multidisciplinary paleoradiology research at the Institute of Diagnostic Imaging and Radiation Oncology of the Kaposvár University, highlighting the cases with potential central nervous system involvement - from the scanning methods to the 3D printing - in order to draw attention to the historical background and clinical aspects of certain pathological conditions. Methods - The authors developed the examination protocols for three different CT scanners. Among the examined archaeological remains cranial lesions were identified in 26 cases, from which 4 cases with potential central nervous system involvement are demonstrated. The scanning parameters and the advantages of secondary image reconstructions (multiplanar reconstruction, maximum intensity projection, three-dimensional volume rendering technique) are presented with the cases. Results - The authors demonstrate a case with destructive skull lesions due to syphilis from the 15th century AD, a condition rarely seen or even unknown nowadays in the modern world. With the CT images of the skull base fracture from the Iron Age, signs of healing could be verified. Using the CT images a non-invasive approach is presented in the case of the craniofacial osteosarcoma in order to visualize the local status and the direct intracranial propagation. Advantages of the 3D VRT reconstructions are shown in the case of unilateral coronal suture synostosis. Conclusion - Paleoradiological CT examinations serve as a non-invasive, non-destructive tool for studying archaeological remains and artifacts. The special applications provided by the imaging modality contribute to the conventional paleopathological investigations. Keywords: paleoradiology, computed tomography, 3D reconstruction, skull lesions, paleopathology]