Max Ellenberg

Impotence in diabetes: the neurologic factor.

In this chapter, Ellenberg describes a study undertaken to investigate the influence of endocrine, neurologic, and urologic factors in the etiology of impotence in diabetic males. Accurate diagnosis of the basis for diabetic impotence is crucial, as diagnosis determines which treatment strategies are indicated and what the prognosis for reversal will be.

Development of Urinary Bladder Dysfunction in Diabetes Mellitus

The diabetic neurogenic paralytic bladder is characterized by marked residual urine, secondary infection, pyelonephritis, sepsis, and azotemia. Initial manifestations were studied in diabetic patients with and without neuropathy and in nondiabetic controls, all without symptoms referable to the urinary tract. The nondiabetic controls and the diabetics without neuropathy were urologically normal. Eighty-three percent of the diabetic patients with neuropathy had objective evidence of neurogenic bladder involvement; however, there was no residual urine, infection, pyelonephritis, sepsis or azotemia. The disparity between early and late bladder involvement is determined by the factor of residual urine, which is the measure of advancing bladder neuropathy leading to decompensation. Progressive decompensation of the asymptomatic diabetic bladder may be a cause of the increased frequency of renal infection in diabetic patients.

Diabetic Neuropathic Cachexia

Six patients with diabetic neuropathy are reported who conform to a hitherto undescribed syndrome. The two outstanding symptoms, namely profound weight loss and severe pain, led to the admitting diagnosis of metastatic carcinoma or carcinomatous neuropathy in each case. The patients were all males, chiefly in the sixth decade of life, had bilateral symmetrical peripheral neuropathy, severe emotional disturbances, anorexia, impotence, mild diabetes, simultaneous onset of neuropathy and diabetes, absence of other specific diabetic complications and a uniformly spontaneous recovery in about one year. Because of the cachectic appearance, the term ‘diabetic neuropathic cachexia’ is suggested.

Sexual Function in Diabetic Patients

Although sexual dysfunction in the male diabetic has been recognized for many years, only recently has systematic investigation been undertaken to understand the problems involved. The marked increase of impotence in diabetes has been shown to be, to a significant extent, a result of diabetic autonomic pelvic neuropathy. However, awareness of other causes of impotence is essential for proper diagnosis and appropriate therapy. Strikingly, the marked impact of diabetes on male sexual function is not shared by the female diabetic patient, whose sex interest and orgasmic reaction are essentially unimpaired when compared with those of the nondiabetic female.

Diabetic neuropathy: clinical aspects.

The importance of diabetic neuropathy derives from its remarkable frequency and its clinical impact. In view of the varying underlying pathogenetic mechanisms and the resulting diversity of clinical representations, it becomes apparent that there are diabetic neuropathies, rather than a single entity of diabetic neuropathy. The scope of involvement is widespread with virtually every system at risk. Although peripheral neuropathy is by far the most common expression, visceral neuropathy is also highly significant. It may affect every part of the gastrointestinal tract, the genitourinary tract, and sexual function, as well as direct autonomic nerve pathology. Clearly, neuropathy in diabetes offers a specific and important diagnostic challenge to the clinician and plays a definitive role in differential diagnosis. The problem is heightened by the fact that any and all of the diabetic neuropathic syndromes may be the initial clinical manifestation of diabetes in the absence of covert manifestations of carbohydrate metabolic disorder. It is to be stressed that the diagnosis is more than an academic exercise, since each diabetic neuropathic syndrome carries with it some beneficial therapeutic modality to aid the patient.

Retrograde Ejaculation in Diabetic Neuropathy

Excerpt Retrograde ejaculation as a complication of diabetes is unappreciated, unrecognized, and for the most part, clinically unknown. This paper records five such cases, documents this syndrome a...

The Incipient Asymptomatic Diabetic Bladder

To explore the problem of initial manifestations of the diabetic neurogenic bladder, diabetic patients with and without neuropathy and nondiabetic controls, all without symptoms or signs referable to the urinary tract, were studied urologically. The nondiabetic controls and the diabetics without neuropathy were normal. In striking contrast, 83 per cent of diabetic patients with neuropathy had clear, objective evidences of neurogenic bladder involvement as manifested by abnormal cystometrograms, and grossly enlarged bladders. However, the absence of residual urine was the rule. The typical case had no pyuria or bacteriuria, a negative bladder urine culture, no azotemia, pyelonephritis, sepsis or significant albuminuria. This differs sharply from the advanced diabetic neurogenic bladder with paralysis where there is a marked residual urine with secondary infection, pyuria, bacteriuria, positive urine cultures, pyelonephritis, sepsis, azotemia and conspicuous albuminuria. The disparity is determined by the factor of residual urine which is the measure of decompensation. It is suggested that the progressive decompensation of the incipient asymptomatic diabetic bladder is a cause of the increased frequency of renal infection in the diabetic.

Intrahepatic cholestasis following administration of chlorpropamide: Report of a case with electron microscopic observations

Abstract 1.1. A case of intrahepatic cholestasis secondary to the administration of chlorpropamide is presented. 2.2. Of a series of 1,819 diabetic subjects receiving chlorpropamide, collected from the literature, there were nine cases suggestive of intrahepatic cholestasis. 3.3. Abnormalities of the microvilli in the bile canaliculi of the liver cells, as seen in the electron microscope, suggest that this is the primary morphologic change in this and other instances of intrahepatic cholestasis. Unusual mitochondrial inclusions were also noted, the nature of which is unknown.

DIABETIC NEUROPATHY PRESENTING AS THE INITIAL CLINICAL MANIFESTATION OF DIABETES

Excerpt Neuropathy occurring in association with diabetes mellitus presents many obscure features. The etiology, pathology and therapy are essentially unknown, and the diagnosis itself is one of ex...

DIABETIC NEUROPATHY: A CONSIDERATION OF FACTORS IN ONSET

Excerpt Involvement of the nervous system in diabetes has long been recognized. Despite many studies, there still remain considerable doubt and lack of specific knowledge concerning many aspects of...