A Clinico-Pathological Study of Vascular-disordors, Particulary Artheriosclerosis in Diabetics

Abstract

The auther studied clinically and morphologically 26 morbid cases of diabetics during 1952-1958 in the medical department of The First National Hospital of Tokyo. Including 16 cases of Kimmelstiel-Wilson Syndrome, this study was especially concerned for clinical and morphological corelations about the vascular walls and the arteriolar changes in various organs. 1). The main cause of death were in 54% the brain, heart and renal failure with marked arteriosclerosis. 2). Arteriosclerotic changes of the diabetic cases were higher than the controle groups. Arteriosclerotic changes diminished in following order ; A. hypo gastrica, Aorta, A. ilica comm., Aa. coronaria, A. coeliaca, A. mes. sup.. 3). Mean age of morbid cases was 56.9 years. Arteriosclerosis was suspected to begin earlier and become heavier in the diadetics than non-diabetics. Males tend to affected heavier than females. 4). Long-term diabetics, positics of albuminuria, hypertensives and patients having some vascular disorders showed higher grade of arteriosclerosis. patients over 50 years tend to show thes condition, but not missing in youngers. 5). 16 of 26 cases showed intercapillary glomerulosclerosis, and 63.0% of which showed hypertension. Higher grade of sclerosis were found in tho long-term diabetics. Hypertensives. 6). Proximal aorta showed only slight sclerotic number of 0.98, meaning fatty and atheromatic small foci, distal aorta showed markedly atheromatous, calcified and ulcerative foci, this number was 3.24. The sclerosis of coronary arteries were most prominent in Ramus desc. ant., and lesser in Ramus des. Post. dex., and in Ramus circumflex. Thes sclerosis wers mostly atheromatic and sometimes calcified. Hypogastric and common iliac arteries were calcified or ulcerative. Renal arteries were atheromatous. Heart failures of long-term diabetics must be noticed clinico-patholo-gically. 7). Hyaline deposits of arterioles were noticed in various organs, especially in pancreas, spleen, kidneys and less often in stomach, liver and lungs. This changes were apparentry higher than controll cases. This changes also showed some relationship to diabetic anamnesis, hypertension, ocular symptoms and nephrotic syndrome. 8). There are some relationship between duration of diabetes and these irreversible vascular changes, ths latter may have be responsible for the deathe cause of diabetes. Tte peculiar hyaline deqosits of arteriolar walls and its distribution in visceral organs were studied.