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ARM BLOOD FLOW AND ANTI-DIABETIC DRUGS IN MAN
Total arm blood flow measured by venous occlusion plethysmorgraphy average 4.37ml/100ml/minute. The arm blood flow was measured on 33 normal healthy subjects between 13 and 38 years old at room temperature, and one (1) diabetic aged 59 years, who had been on treatment with chlorpropamide (Diabetes). For the purpose of this experiment, the subject had gone off drugs and was uncontrolled with urine test using clinistix as +++ (> 300mg %) on that day. Comparison of the relative values of arm blood flow with certain parameters showed that arm blood flow increased with increase in age, weight and height in young adults but there was a decline in old age, overweight and very tall subjects. It was noticed that arm blood flow was influenced by changes in room or ambient temperature. It was also noticed that in the same diabetic subject, left arm blood flow was different from that of the right arm. Although variation in arm blood flow was not sex dependent, there was higher variation in men than in women. Arm blood flow was definitely higher in a pregnant subject than non-pregnant women. Diabetes mellitus is known to result in cardiovascular complications as well as complications in other systems such as the neuromuscular system. Anti-diabetic drugs such as chlorpropamide exert vasoconstrictor effect in man and could reduce arm blood flow; insulin infusion increased hand blood flow but tolbutamide resulted in capillary bleeding and consequently would affect arm blood flow.
TABLE OF CONTENTS
Title Page i
Table of Contents v
CHAPTER ON: INTRODUCTION
CHAPTER TWO: LITERATURE REVIEW
CHAPTER THREE: METHODS
3.1 Block Diagram of Apparatus
3.2 Plethysmographic Recording of a Subject EA.
3.3 Calculation of Arm Blood Flow (Illustration)
CHAPTER FOUR: RESULTS
4.1 Average and Range of Arm Blood Flow among Males and Females
4.2 Relationship of Arm Blood Flow in Male and Female
4.3 Relationship of Arm Blood Flow with Age
4.4 Histogram Showing the Relationship of Arm Blood Flow with Age
4.5 Graph of Arm Blood Flow versus Age
4.6 Relationship of Arm Blood Flow and Body Weight
4.7 Relationship of Arm Blood Flow and Height
4.8 Effect of Room or Ambient Temperature on Arm Blood Flow
4.9 Difference between Right and Left Arm Blood Flow
CHAPTER FIVER: DISCUSSION
CHAPTER SIX: CONCLUSION
CHAPTER SEVEN: APPENDIX
7.1 Appendix 1: Plethysmographic Recordings
7.2 Appendix 11: Tables
CHAPTER EIGHT: REFERENCES
Although numerous studies have been carried out on arm blood flow or control of diabetes, little work if any, has been done in Africa or Nigeria on arm blood flow and anti-diabetic drugs in man.
The flow of blood in extremities at rest is only partly to satisfy the oxygen requirements of tissues but the greatest role is in thermoregulation. Arm blood flow mainly represents muscle and skin flow and it is known that changes in environmental temperature and the nature of the vessels, posture, heat, cold, cardiovascular diseases and other complications of diabetes are associated with alterations in the quantity of blood brought to the skin areas of the extremities.
Pancreatic diabetes mellitus is common in Tropical Africa as well as in Nigeria and the patients exhibit unpredictable sensitivity to insulin therapy (Keller, P. et al 1965, Bank S. 1966; Adadevoh, 1970; Osuntokun, B.O. et al 1971).
In vitro work has shown that sulphonylureas such as acetohexcmide, chlorpropamide, tolazamide and tolbutamide have adverse inotropic effects on heart muscle and increase the automaticity of Purkinje fibres causing ischaemic myocardial damage and arrhythmias.
In early phase of diabetes or after it has existed for several years, structural and biochemical alterations are observed in the body involving chiefly the vascular system and frequently, abnormalities occur in the heart, aorta, arteries, arterioles, capillaries and venules. Most common changes consist of thickening of vessels walls with reduction in size of the lumen of the vessel due to an increase in lipid and polysachacharide deposits.
Ostrander, L.D. Jr. (1965) in a systematic study in a small community, found a higher prevalence of vascular disease in diabetics than non-diabetics of similar age and sex, and blood glucose level was significantly greater in the diabetics.
Among 2634 deaths in diabetics at Joslin Clinic in the United States during 1960 to 1964, 77.9% were cardiovascular renal with 53.3% attributed to coronary disease. (partaman, J.O. 1965). Also among Juvenile diabetics studied over 20 years, 92% was incidence of vascular disease, 75% had disease women of the heart and/or peripheral vascular system. (White, P. 1960). Cardiovascular disease is as common in diabetic women as in men but in non-diabetics, it is much more common in men particularly below 50 years of age.
Diabetes mellitus is known to result in cardiovascular complications, as well as complications in other systems, such as the neuromuscular system. The established cardiovascular complications of diabetes mellitus in brief are: arteriosclerosis, atheriosclerosis, cataracts, rubeosis, blindness, “diabetic feet”, gangrene, poor wound healing, blisters, ulcers, carbuncles, furuncles, sepsis, cellulites glomerulosclerosis (Kimmestiel-Wilson diease), Armani-Ebstein lesion (acute tubular neurosis), papillary necrosis, pyelonephritis, toxemia of pregnancy, myocardial infarction or stroke, cerebral thrombosis, peripheral neuropathy (pin and cotton wool test), auromomic neuropathy (decrease in the gastrointestinal tract and bladder functions)and diabetic pseudo tabes (height stepping gait) An American study has reported an increased risk of death from cardiovascular disease in diabetes treated with oral hypoglycaemic drugs compared with those treated by diet or insulin.
The problems posed by the present investigation will be studies in two parts:
i. Measurement of arm blood flow of normal healthy subjects and to find the correlation between age, sex, height and weight if any and to make possible deductions
ii. Effect of anti-diabetic drugs on arm blood flow in man.