In order to clarify the renoprotective effect of angiotensin converting-enzyme inhibitor (ACE-I) in diabetic glomerulosclerosis, the degree of glomerulosclerosis in non-insulin-dependent diabetic model rats, male Otsuka Long-Evans Tokushima Fatty rats (OLETF), were evaluated in a semi-quantitative manner. The administration of temocapril (TP group) in tap water, was started at 26 weeks of age and was continued for another 26 weeks. The administration of temocapril (TP) improved hyperglycemia and prevented hypertension. Proteinuria was remarkable at the age of 26 weeks and increased with time in both the control and TP groups However, proteinuria in the TP-treated group was significantly lower than in the control group. The mean of indices of glomerular sclerosis in the TP group was significantly less than that of the control group.
Several mechanisms, such as improvement of glucose metabolism and prevention of hypertension or other local effects on vascular tone, may participate in the renoprotective effects of ACE-I.

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This study was carried out to make a definite diagnosis for diabetic autonomic neuropathy.The baroreflex activated by a Valsalva manoeuvre (VM) is an excellent gauge of autonomic function.The VM is a convenient way to measure accurately the time relationships between blood pressure and heart rate response, Such latency measurements consist of5elements:1) tachycardia latency (TL), 2) bradycardia latency (BL), 3) blood pressure latency (BpL), 4) overshoot latency (OvL), and5) Valsalva ratio (VR).R-R_db is measured as the difference between the maximum and minimum heart rates during deep breathing.A significant prolongation of BL was observed in patients with diabetic neuropathy as compared to the control group.This may indicate that BL is a good parameter of parasympathetic impariment.On the contrary, the Valsalva ratio (VR), which is believed to be valuable for assessingautonomic function, showed no statistically significant difference between the diabetic group and the control group, nor did latencies correlate significantly with R-R_db.Our observation leads us to suggest that abnormality of the VM-induced baroreflex in the diabetic group is characterized by an absence of overshoot and/or bradycardia in phase 4.In addition, slow return of blood pressure to baseline and prolongation of the latency values are associated with abnormal baroreflex.A significant delay of TL in the overshoot (-) group was observed as compared to the overshoot (+) group.This delay of TL may be a good indicator of diabetic symapathetic failure.These changes, such as absent baroreflex and/or prolonged latencies, may show a definite discriminating criteria in autonomic dysfunction in diabetes mellitus.

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Urinary FN-f before and during L-arginine infusion (LA) was measured by ELISA in39healthy subjects and in NIDDM patients with (NIDDM-II, n=23) or without microalbuminuria (NIDDM-I, n=27). Urinary FN-f before and during LA was isolated by gelatin-affinity column andsubjected to SDS-PAGE, in subjects from the three groups. LA induced a 2 to 3-fold increase of FN-f in the 3 subject groups. FN-f before and during LA in NIDDM-II was higher than that of NIDDM-I, and the latterwas increased compared with control subjects. In all groups, urinary FN-f during LA was significantly correlated with AER and glomerular filtration of albumin, and inversely correlated with tubular reabsorption of albumin. By SDS-PAGE, urinary FN-f was distributed from 10kDa to 120kDa. Compared with controls, the 30kDa fraction of FN-f was relatively decreased and the 48kDa fraction was increased in NIDDM-I. A further relative decrease in the 30kDa fraction was seen in NIDDM-II. These results suggest that the increased urinary FN-f might be related to the development of microalbuminuria in NIDDM. As with diabetic retinopathy, changes in the distribution of molecular size of urinary FN-f in NIDDM warrant the further sophistication.

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The influence of urine glucose screening for school children and intermittent treatment of diabetes was investigated in early-onset diabetic patients. A total of 283 patients (142 male, 141 female) were recruited, who were diagnosed with type 2 diabetes mellitus before 18 years of age and were registerd in the Diabetic Center of Tokyo Wemen's Medical School of Medicine from 1980 to 1998. A total of 183 cases (64.7%) were diagnosed as diabetes mellitus by urine glucose screening test for school children (school urine group). After 1992, 76.5% were diagnosed by the urine glucose screening. There were 57 cases in the school urine group who entered the intermittent treatment group. School urine screening had no effect on protecting against diabetic complications at the visit to our center. However, comparison with the intermittent group (91 cases) and continuous treatment group showed that the intermittent treatment group had a significant increase in development and deterioration of diabetic complications. After consideration of the diabetic duration, intermittent treatment was found to render the diabetic complications severe.

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We report a male patient who was diagnosed, although the lesion appeared in an unusual area, with scleredema, a type of cutaneous mucinosis, associated with pancreatic diabetes.
The chief complaints included cutaneous redness, edema, scleroderma and pain in the anterior aspects of the lower legs and dorsal feet.
Clinical history included chronic calcific pancreatitis, pancreaticoduodenectomy due to strongly suggested pancreatic carcinoma in 1986, pancreatic diabetes and postoperative malabsorption followed by malnutrition which was treated by intravenous hyperalimentation on admission to our hospital.
In Nov. 1996, at 57years of age, onset of the above mentioned cutaneous lesion occurred and appeared similar to lymphangitis. However, biopsy findings showed increased collagen and mucin in some skin regions and subcutaneous tissue. These symptoms and signs completely disappeared when the nutritional status was recovered.

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[in Japanese]

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[in Japanese]

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We report two cases of non-insulin-dependent diabetes mellitus complicated by bacterial arthritis. Patient 1was a 63-year-old man with a 10-year history of diabetes who developed high grade fever, pain and swelling in the left knee. Twenty days before admission he had fallen with direct injury to his left knee. Bacterial arthritis was diagnosed based on isolation of Staphylococcus aureus from a culture of joint fluid.
Patient 2 was a65-year-old woman with a3-year history of diabetes who developed pain and swelling in the right knee. Bacterial arthritis was diagnosed based on isolation of Methicillin resistant streptococcus epidermidis from a culture of joint fluid. She had experienced no direct injury to her joint and had no preexisting joint disease.
Both patients improved through intensive treatment with open drainage followed by needle aspiration, lavage of the infected joint and intravenous injection of antibiotics in addition to subcutaneous insulin administration. Bacterial arthritis is a very uncommon condition, however, it has a poor prognosis due to sepsis, especially in elderly diabetic patients.

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[in Japanese]

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