Bernard I. Chazan

Personality patterns in patients with diabetes mellitus of long duration.

One hundred and twelve patients with diabetes for twenty-five to forty-eight years were studied with the Minnesota Multiphasic Personality Inventory. Of these, sixty-seven had been awarded the Quarter Century Victory Medal, having been found free of vascular complications after twenty-five or more years of diabetes. The personality inventory disclosed statistically significant differences between medal and nonmedal patients in three of the thirteen scales, and three other scales approached significance. When divided as to sex, different personality patterns characterized the groups but in both sexes nonmedal patients had significantly higher hypochondriasis scores. When depression, a frequently elevated score, was excluded, significantly more nonmedal patients had other abnormal scale scores (above 2 standard deviations). The differences in scores between medal and nonmedal patients warrant early personality screening and appropriate therapy to help the adaptation process of the person with diabetes.

Microcirculation in young adults with cystic fibrosis: Retinal and conjunctival vascular changes in relation to diabetes

Conjunctival biomicroscopy and retinal photography were utilized in 67 patients with cystic fibrosis, ages 15 to 26 years, to detect a possible prediabetic vascular change. Examination revealed venular congestion and tortuosity as well as venular and arteriolar red cell aggregation. These changes were related to the severity of the cystic fibrosis and not to glucose intolerance. Both clinical and chemical diabetes occur more frequently in older patients with cystic fibrosis than in normal subjects. The diabetes is not related to the severity of the cystic fibrosis. A prediabetic vascular change could not be reliably detected by this study.

Quarter Century Victory Medal for Diabetes. A follow-up of patients one to 20 years later.

Abstract Of 124 patients who were free of vascular complications after 25 years of diabetes and who were awarded Joslins Quarter Century Victory Medal, 105 were evaluated by a questionnaire. These latter patients presented, in general, a juvenile-type, insulin-dependent, ketoacidosisprone diabetes. They belonged to a middle or higher social class, maintained a near ideal body weight and possessed a favorable hereditary beckground as demonstrated by parental longevity. In one third of the patients at the time of study (an average of 12 years after the medal award) there was evidence of vascular and microvascular complications indicating that the appearance of recognizable angiopathy was considerably postponed but not entirely avoided.

Capillaries of the nailfold of the toe in diabetes mellitus

Abstract The nailbed capillaries of the fingers and toes were examined by biomicroscopy in 20 healthy offspring of two diabetic parents (“prediabetics”), in 20 patients with diabetes of long duration, 20 diabetic patients with proliferative retinopathy, and in 20 nondiabetic controls. The capillary loops of the toes were in general shorter and more tortuous than those of the fingers. Congestion of the venular limb of the loops in the toe was more common in the diabetics than in the controls. A “glomerulus” type lesion was found in 16 of the 40 diabetic patients, in one prediabetic, and in none of the controls. This latter lesion was particularly common in the patients with proliferative retinopathy and would appear to be related to diabetic angiopathy rather than to uncomplicated diabetes even of long duration.

Lipemia retinalis: Microcirculatory changes and lipid studies in a family☆

Abstract A 13-year-old girl with diabetic acidosis had lipemia retinalis and massive hyperchylomicronemia ( 19.5 Gm. 100 ml. total lipids) corrected by insulin administration. Fat uptake by embryonic cells in tissue culture using the patients lipemic serum was very marked and was maximal after heparin administration. Red-cell aggregation could be induced in the retinal vessels at the height of her hypertriglyceridemia while conjunctival red-cell aggregation persisted at lower levels of hyperlipemia. Whole-blood viscosity was actually subnormal during the stage of lipemia. With clearing of the hyperchylomicronemia a pre-β band appeared in the lipoprotein electrophoretic pattern of the plasma, which persisted when blood lipid levels returned to normal. The patients father, mother and brother had pre-β bands despite normal blood lipid and insulin levels and normal glucose tolerance. The pre-β band disappeared on heparin administration. This pattern may represent a prototype of carbohydrate-induced lipemia.