The aim of this study was to investigate the prevalence of psychological morbidity in the local secondary care population of people with type 1 diabetes or type 2 diabetes (T1DM or T2DM) in order to determine appropriate treatment provision. Four hundred patients seen in diabetes outpatient clinics were sent a number of standardised and validated questionnaires designed to measure: diabetes related distress; anxiety and depression; disordered eating behaviours; and borderline personality disorder. A response rate of 52.7% was achieved, providing a total of 211 completed questionnaires (111 T1DM, 100 T2DM) for analysis. This study has demonstrated a high prevalence of psychological morbidity in the local secondary care population of people with diabetes, with as many as half of those surveyed (52%) reporting some level of psychological disturbance. After controlling for age, gender and diabetes type, few differences in levels of psychological dysfunction were identified between the T1DM and T2DM cohorts. The exception to this was disinhibited eating behaviours: 22% of people with T2DM had severe levels of disinhibited eating, twice that recorded in the T1DM population. Overall, 36% (n=76) of study participants had moderate–severe levels of depression, anxiety or both, and 9.5% (16 of 168) had scores suggestive of borderline personality disorder. Copyright © 2010 John Wiley & Sons.

Experience with 146 in-situ vein bypass procedures for obliterative arterial disease are reviewed to determine the specific complication of the technique. Vein wall injury with the Hall valvulotome occurred in 6 patients (4%) and vein patching of a stenosed femoral vein was required in 2 patients. Residual arteriovenous fistulae occurred in 24 patients (16.5%) of whom 9 had an associated graft thrombosis distal to the fistula of which 6 were corrected by thrombectomy and fistula ligation. Perioperative thrombosis occurred in 29 grafts (20%) and was more common in the femoropopliteal group (23/80) than in the femorocrural group (6/66) (P less than 0.01, X2 = 7.55). Fourteen of the femoropopliteal and two of the femorocrural thromboses were corrected resulting in an immediate patency of 89% and 94% respectively with the cumulative patency at one year being 77.5% and 79%. Complications of the in-situ bypass technique remain despite having largely overcome the problems of valve disruption. However, until a standard method emerges careful note must be made of technique and complications when considering reports of in-situ bypass patency.

A rare complication of balloon embolectomy — pseudoaneurysm of the pos terior tibial artery — is described in a 72 year old patient who underwent femo ral embolectomy after emergency aortic aneurysmectomy.