This study was designed to produce an ideal model of ischemic neuropathy, especially relevant to diabetic neuropathy (DN) with reference to vascular theory. Sprague-Dawley rats aged 11 weeks were used as experimental animals.Sodium laurate (0.3 mg) dissolved in saline (0.1 ml) was injected into the femoral artery on one side and the same volume of saline into the other side. The animals were examined clinically, electrophysiologically and histropathologically at intervals. The saline-injected leg showed no significant findings during the experimental period, whereas the laurate-injected leg manifested paresis and a persistent decrease in sciatic motor nerve conduction and low amplitudes of the muscle action potential. Histologically, swollen axons were observed with closure of microvessels on day 1 and myelin ovoids emerged on day 7. At month 1, the diameter of myelinated nerve fibers (MNFs) was significantly decreased as compared with the control side in all rats, and this was accompanied by neither increased density nor thinned myelin, suggesting fiber atrophy. Simultaneously, proliferative changes in microvessels were found and the number of nuclei in endothelial cells and the percent of closure in epineurial microvessels correlated sigfinificantly with the diameter of MNFs. At month 7, the attenuation of MNFs was more prominant and pathological changes in microvessels were persistently observed. Thus, pathological changes induced in the present study resembled some features of human DN. These results suggest that the neuropathy model induced by sodium laurate might provide a reasonably useful model for clarifying the pathogenesis of DN.

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As a method of epidemiologically evaluating childhood diabetes, application forms for medical care filed in Osaka area were collected and analyzed. A total of 465 patients under 18 years of age were identified during the period between 1978-1988, 371 (175 boys and 196 girls) of whom were classified as having insulin-dependent diabetes mellitus (IDDM). The mean annual incidence rates of IDDM were 1.68 for boys and 2.00 for girls per 100, 000 population, the rate being slightly higher in girls. The rates increased with age, peaking in the 10-14 year age group. The prevalence rates estimated on the basis of the cumulative incidence rate in 1988 were 1.29 for boys and 1.60 for girls per 10, 000 population, indicating a markedly increasing trend with age. A significant seasonal variation was observed in the incidence rates of IDDM, with higher rates during the winter time. Major symptoms reported at the time of onset of diabetes were coma or ketoacidosis (12.9%), ketonuria (9.7%) and thirst, polydipsia and polyuria (36.9%). The mean birth weight of the IDDM patients was slightly lower than the national average. The use of official documents obtained from the medical care system, as employed in this study, was found to be an effective method of identifying IDDM cases in a community, though further confirmation should be made for more accurate ascertainment of cases.

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The present study was undertaken to elucidate the platelet aggregation abnormality in diabetes mellitus. The subjects consisted of 25 patients with diabetes mellitus and 15 non-diabetic controls. In these subjectsplatelet aggregation was measured by two comparative methods. One was spontaneous platelet aggregation in whole bloodand the other was platelet aggregation in platelet rich plasma induced by 3.0μM ADP or 1.0μg/m/collagen. Spontaneous platelet aggregation in whole blood was significantly increased in diabetic patients as compared to non-diabetic subjects at 10 min. 15 min. 20 min. and 30 min. Maximal platelet aggregation in whole blood was also significantly increased in diabetic patients as compared to non-diabetic subjects. On the other hand, there was no difference in maximal platelet aggregation in platelet rich plasma between the two groups. A positive correlation between maximal platelet aggregation in whole blood and that in platelet rich plasma was found in non-diabetic subjectsbut was not found in diabetic patients. These findings indicated that there might be more active platelets and that there might be an abnormality in blood components other than platelets, i. e., red or white blood cellsin diabetic patients.

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The value of ultrastructural morphometric measurements of dermal unmyelinated nerves as morphological indicators of diabetic neuropathy was assessed. Axon area/cluster (AA/C)(P<0.05; 0.55±0.52vs0.92±0.61μm²), the Axon/Schwann cell area ratio (A/S·R)(P<0.01;0.11±0.10vs0.24±0.16) and number of axons/cluster (no. A/C)(P<0.05 1.9±1.0vs3.1±1.4) were significantly lower in diabetic patients (n=47) than in control subjects (n=16).Among diabetic patients, those with pain in their extremities had significantly lower values for AA/C (P<0.05; 0.30±0.68vs0.61±0.46 μm²), A/SR (P<0.05;0.04±0.08 vs 0.13±0.10) and no. A/C (P<0.05; 0.6±1.2vs2.2±1.9) than those with no pain. AA/C and no. A/C were significantly correlated with both vibration sense and the CV of the RR-interval.
These findings suggest that ultrastructural morphometric analysis of dermal unmyelinated nerves by means of the skin biopsy technique might be useful in the morphologic evaluation of diabetic neuropathy.

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We studied the effects of vanadete on DBcAMP-stimulated glucose output in isolated perfused rat liver and primary cultured rat hepatocytes.
Infusion of vandate 1.4μM started 10 min prior to glucagon 0.29 nM or DBcAMP 625 nM infusion decreased the glucose output induced by glucagon and DBcAMP, respectively.
Vanadate 200 μM also reduced DBcAMP 200 μM-mediated glucose output in primary cultured rat hepatocytes.
The effect of vanadate was dose-dependent.
These findings suggest that vanadate affects the glucagon-cAMP system leading to reduced glucose output and that it may not affect the insulin receptor system.

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In 21 female obese diabetic patients who could not reduce their body weight because of an irregular dinner schedule, combined diet therapy (960 kcal/day) consisting of a diabetic diet for breakfast and lunch and a very low-calorie diet (Optifast (R)) for dinner was prescribed for 2 months in our outpatient clinic. The patients were subsequently switched from combined diet therapy to a diabetic diet (1, 200 kcal/day). Two months of combined diet therapy significantly reduced body weight and %fat.The hyperglycemia and hyperinsulinemia during OGTT observed before therapy were improved after this therapy. HbA_1c and plasma lipids were normalized.Even at the end of a year, reduced body weight and normal HbA_1c were maintained in 18 patients. Obesity and hyperglycemia had recurred in 3 patients.
These findings indicate that this combined diet therapy is effective in 1) correcting of irregular dinner schedules, 2) maintaining weight loss and 3) improving diabetes mellitus in such patients, suggesting that this therapy would be useful in the treatment of obese diabetics who cannot reduce their body weight because of irregular dinner schedules.

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Capillary basement membrane thickening in diabetes mellitus is generally first observed in the early stages of microangiopathy. For this reason, we measured type IV collagen (IV-7S), laminin (lam), and type III procollagen peptide (P-III-P) in sera and urine by RIA in 23diabetic patients with and without microangiopathy and in patients with other diseases, such as chronic glomerulonephritis (n=13), nephrotic syndrome (n=8), collagen diseases (n=12), and liver cirrhosis (n=5). There were significant elevations in serum levels of IV-7S, lam and P-III-P in association with the severity of diabetic retinopathy and/or nephropathy, even in the early stage of both diabetic microangiopathies. There were also elevations of urinary IV-7S and lam associated with the severity of diabetic nephropathy, in contrast to the other diseases. In conclusion, determination of serum or urinary levels of basement membrane components, i. e., IV-7S, lam and P-III-P, could be helpful as early indicators of diabetic microangiopathy, including diabetic nephropathy, and may also facilitate the differential diagnosis of diabetic nephropathy from other renal diseases.

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A case of impetigo bullosa, a limited type of staphylococcal scalded skin syndrome (SSSS), with diabetes mellitus is reported.
A 74-year-old female hospitalized for diabetes mellitus and congestive heart failure had complained of fever and redness, pain and giant bulla on the left arm after common cold like symptoms in November 1990. On admission to our hospital, she had a positive Nikolsky phenomenon and Staphylococcus aureus was detected in fluid from the bulla and pharyngeal secretions.
She was diagnosed as having impetigo bullosa, with symptoms advancing to generalized SSSS, and was treated with antibiotics. Her clinical symptoms improved and she recovered completely within two weeks.
SSSS is a disease observed mainly in newborns and infants, and is rarely seen in adults. Moreover, SSSS combined with diabetes mellitus is exceedingly rare. We report here a rare case of impetigo bullosa with symptoms which progressed to the general type of SSSS in an adult female with diabetes mellitus.

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Spinal cord infarction is quite rare as compared with cerebral infarction. We describe here two cases of anterior spinal artery syndrome which occurred in NIDDM patients. Case 1, a 57-year-old man, who had NIDDM for 13 yrs, developed incontinence following transient lumbago and ileus-like symptoms. Neurological examination revealed dissociation of pain and temperature sensations, below the level of the 1st thoracic vertebra of the spinal column. After two months of rehabilitation, the patient recovered and was capable of walking with support and voiding urine by himself. Antiplatelet therapy with prostaglandin E1 and aspirin appeared to be effective.
Case 2, a 46-year-old woman, who had had NIDDM for 8 yrs, developed flaccid paralysis of the right leg with rectovesical incontinence. She manifested impaired pain, temperature, touch and vibration sensations below the level of the 1st thoracic vertebra of the column on the right side and only in the leg on the left side. After one month of rehabilitation the patient was able to walk and void and defecate by herself. In determining the location and nature of a cord lesion, spinal tap, myelography and MRI are all still of limited value. To date, 64 adult cases of anterior spinal artery syndrome have been reported in Japan. Among causes of this syndrome, diabetes mellitus may be an important predisposing disorder, since accelerated arteriosclerosis and increased platelet aggregation are frequently found in diabetic patients.

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