In case of DM, lt. of the first reflex is characteristically only 3-4 sec. (NN = 6 sec.). Moreover, the “slow and progressive” increasing of gastric aspecific reflex persists for 3-4 sec. (NN = 2 sec.). At this point, we would like to outline this characteristic behaviour , i.e. slow and continuous “ascending” of gastric aspecific reflex, that parallels the behaviour of the same reflex, which takes part at “diabetic diagram of tissue micro-vascular unit” of the finger-pulp (See later on).
Our insistence on underscoring the coincidence of data, regarding the “same” event, gathered by different methods and observations, apparently repeated over and over again, and perhaps unpleasant to reader, aims to show the coherence of every part of the discussion about the theories of Biophysical Semeiotics and, consequently, of Clinical Microangiology, the later originated by the essential clinical method of investigation.
In IGT and type I and II DM, A phase, i.e. gastric aspecific reflex after lt < 6 sec. in lymphatic diagram, i.e., Bilancini-Lucchi’s sign, is delimited by a characteristic “ascending” line, rather than 6 sec. horizontal one, as in healthy. The underlying patho-physiological mechanism of this abnormal pattern of lymphatic diagram is really complex. In fact, this particular behaviour –A phase “ascending” line – is related to diabetic histangiopathy, present “ab initio”, when there is alterations of venous-arteriolar reflex (VAR), about which all authors agree.
Upon the abnormalities of VAR is based the test of two pressures or differential pressures test (DPT) as well as the biophysical-semeiotic preconditioning. The later tool allows to show, in easy and practical way, the diabetic constitution: Bilancini-Lucchi’s sign, normal (lt 6 sec.) when evaluated at rest – basal line – results not modified and of identical duration, after the second assessment, performed soon after an interval of 5 sec. exactly from the basal evaluation: in healthy, on the contrary, lt of the reflex increases from 6 sec. to ≥ 8 sec.: physiological preconditioning.
To summarize, biophysical-semeiotics “quantitative” evaluation of diabetic constitution can be performed, in the easiest manner, as follows: at first, doctor assesses, at rest, the diverse parameters of pancreatic-gastric aspecific and/or caecal reflexes. In practice, it is sufficient to evaluate the basal lt. (NN: lt = 12 sec.). After an interval of exact 5 sec. – pancreatic preconditioning – doctor performs the second "quantitative evaluation: in presence of diabetic constitution lt either results the same, e.g. 12 sec., or even shorter, in relation to the severity of diabetic “real” risk, while in healthy increases to ≥ 14 sec.
As regards the diagnosis of type 2 DM, the biophysical-semeiotic evaluation of pancreatic amyloid proved to be reliable and useful at the bed-side.
In order to understand what follows, doctor needs the mere knowledge of stomach auscultatory percussion and gastric aspecific reflex, described above.
Bed-side examination of microcirculatory bed, e.g. of finger-pulp, in both diabetic constitution and Impaired Glucose Tolerance (IGT) gives noteworthy diagnostic information. Particularly interesting is the diagram of tissue microvascular unit, obtained in a refined and reliable way, due to its clinical information (Fig.4).
Really, the evaluation of tissue microvascular unit diagram is so full of data, useful in both bed-side diagnosis and differential diagnosis, that all physicians must know it, so that the analysis of tissue microvascular unit diagram would become an essential component of common clinical examination.
|Figure 5 is a diagram of tissue microvascular unit of finger-pulp of a patient involved by Impaired Glucose Tolerance Digital pressure of mean intensity, applied upon a finger-pulp of a patient, psycho-physically relaxed and in supine position, brings about the gastric aspecific reflex, followed by three further increasing, and ultimately by tGC and a last gastric aspecific reflex or Z wave, related to local microcirculation metabolic events, and tissue pH.
( For further information, See the text).
In Fig. 4, latency time less than 6 sec., i.e. physiological value, indicates characteristically aspecific histangium suffering; this lt is inversely proportional to the severity of the underlying disorder and directly related with tissue acidosis (= lt of caecal and/or gastric aspecific reflex).
|h4. Fig. 5|
Apnea test (= the subject does not take breath for 5 sec.) normalizes transitorily latency time and causes disappearing of Dilation Area (DA), which, in healthy, is £ 1 cm., in an age-dependent manner: sympathetic hypertonus brings about increasing of resistance vessels tonus, demonstrating that the damage of initial phase, is mainly functional in origin, according to Ditzel’s functional diabetic microangiopathy.
In fact, in the “initial, functional” stage, venous arteriolar reflex (VAR) is still present (= lt of caecal-finger-pulp reflex is the same during the “test of three positions”).
Actually, for the time being, due to hyperinsulinemia-insulin resistance, microvessels are abnormally dilated showing a moderate, small basal membrane thickening and light increase of PAS-positive material. Interestingly, the urethral interstitial reflex, i.e. “in toto” urethral reflex, results greater than normal (NN £ 1 cm.), because of amyloid storage, already present in this stage, revealing the possibility of diagnosing DM type II in a refined manner (See DM, in the site and Piazzetta).
The “slow” raising of Ascending Line (AL) in A Phase, caused by increasing of interstitial space as well as thickening of arteriolar basal membrane, altered since very initial stage of diabetic syndrome, which oppose to vasomotility and vasomotion (= microvessels movements of arterioles and little arteries and, respectively, capillaries and post-capillaries venules) can be correctly interpreted in its patho-physiological mechanisms, even observing the behaviour of upper third urethral reflex (= interstitium of arterioles): during the first 6 sec., “in toto” urethral reflex appears “slowly” , with an intensity > 1 cm., and a “slow” reflex-increasing follows (= “slow”, slanting, oblique line, i.e. AL of A Phase, of which, however, exists still an horizontal, normal, tract, never present in overt DM: Fig. 4).
At this point, we have to remember interstitium typical behaviour, that is now really large.
Consequently, the characteristic A Phase of “initial” diabetic microvascular-tissue-unit diagram, and especially that of overt DM, is related to the situation of fundamental matrix as well as the entire interstitium, and the alteration progressively more severe of the small arterioles and arterioles wall, as we demonstrated clinically (1-4, 6).
All other parameters values are in normal ranges: “Critic Acidosis Point” (PC) – intensity of 5 cm. – is present – individual 30 years old – although it is localized in D Phase, without being exceeded, indicating the absence of pathological events at the base of diagram verticalization with shifting to the left, technically speaking.
Interestingly, the “slow” achievement of tGC (= stomach contraction) and its rapid disappearing (2 sec.), when digital pressure on patient’s finger-pulp has been withdrawn, as well as the presence of Z wave, indicating physiological capillaries elasticity (normal capillary structure), all corroborate our interpretation about the positive influence of apnea test on diagram pattern.
Of course, in absence of a correct diet, ethimologically speaking, patients immediately have to undergo, in following months or years, the apnea test will result abnormal, and local microcirculation will be worsened.
From the practical point of view, in fact, the correct diet and, if necessary, histangioprotective drugs (Co Q10, Carnitine, Bioflavonoids, a.s.o.) normalize IGT diagram abnormalities in almost all cases.