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Novmber 8, 1976

Vasculitis in Maturity-Onset Diabetes Mellitus-Reply

Author Affiliations

St Louis University St Louis

JAMA. 1976;236(19):2171. doi:10.1001/jama.1976.03270200011003

Dr White indicates that diabetic retinopathy presents a broad spectrum without a constant relationship to the duration and severity of diabetes. The presence of retinopathy is associated with basement membrane thickening (BMT) in the muscular capillary bed, which is a segmental lesion.1 Basement membrane thickening is not known to be a contraindication to operation per se.

Dr White continues with the undisputed concept of treating the patient as an individual. He concludes by remarking that many of these patients "have such terrible generalized vascular disease that vascular surgery of any kind would be contraindicated." It was in the hope of dispelling this stereotyped reasoning that the commentary was written. The maturity-onset diabetic patient with symptomatic carotid stenosis, disabling angina pectoris, or impending gangrene cannot be assumed to have terrible generalized vascular disease until appropriate arteriography, and perhaps perfusion scanning,2 has been performed.