Nobusada Kuzuya

Characteristics of cranial nerve palsies in diabetic patients.

The incidence of palsy in the third, sixth and seventh cranial nerves was studied with regard to central nervous system involvement in diabetic patients. Among 1961 diabetic patients, 19 (0.97%) demonstrated cranial nerve palsies. Nine out of these 19 patients showed facial palsy; 6 palsy of the oculomotor nerve; 2 palsy of the abducent nerve; and 3 both oculomotor and abducent nerve palsies. In contrast, only 5 out of 3841 non-diabetic patients (0.13%) had any cranial nerve palsies; all 5 were cases of facial palsy. The incidence of cranial palsies in diabetic patients was significantly higher than that in non-diabetic patients (P less than 0.01). Concerning age, sex, the state of glycemic control, diabetic complications and method of treatment, there were no differences disclosed in the diabetic patients with cranial nerve palsy. The incidences of diabetic complications were compared between the patients with facial palsy and those with ophthalmoplegia. Only one out of 9 patients with facial palsy (11%) had diabetic complications, whereas 7 out of 10 patients with ophthalmoplegia (70%) demonstrated diabetic complications and the difference was significant. Thus ophthalmoplegia appears to be more closely related to diabetic metabolism while facial palsy is less strongly correlated with diabetes.

Positive Correlation of Serum Lecithin: Cholesterol Acyltransferase Activity with Relative Body Weight

Abstract. The activity of serum lecithin:cholesterol acyltransferase (LCAT) was measured in 33 subjects who had no apparent diseases except obesity in some cases. Their liver function tests were all within normal limits. The correlations of serum LCAT activity with sex, age, glucose tolerance, relative body weight, basal immunoreactive insulin, and fasting serum cholesterol and triglyceride were studied. – The results indicate that an increase in serum LCAT activity is significantly correlated with increases in relative body weight, serum total cholesterol, serum unesterified cholesterol, serum basal immunoreactive insulin, and serum triglyceride. – At present the physiological significance of serum cholesterol es‐terification is not fully established. However, the present findings suggest an increased turnover of serum esterified cholesterol in obese subjects.

Immunological reactivity of insulin to sepharose coupled with insulin-antibody---its use for the extraction of insulin from serum.

Abstract Anti-insulin serum globulin fraction coupled to agarose (Sepharose 2B) bound labeled and nonlabeled insulin at pH 8.2–8.4 by a specific antigen-antibody reaction. Insulin bound to this matrix was dissociated with 1 M acetic acid. Anti-insulin globulin-coupled agarose could be used repeatedly after regeneration of its insulin-binding capacity by washing with Tris-HCl-albumin buffer (pH 8.2–8.4). The column of this matrix appeared of practical value to extract insulin from serum.

Chlorpropamide-induced Hyponatremia: Incidence and Risk Factors

The incidence and risk factors of chlorpropamide-induced hyponatremia were assessed in diabetic outpatients. In 176 chlorpropamide-treated patients, 11 (6.3%) exhibited hyponatremia (serum sodium ≤ 129 meq/L) during the mean follow-up period of 7.4 yr. In contrast, only one (0.6%) developed hyponatremia in 162 tolbutamide or glibenclamide-treated patients (P < 0.005). Moreover, administration to elderly patients and combination with thiazide diuretics were regarded as significantly potent risk factors for the development of hyponatremia in patients receiving chlorpropamide.

Serum gliclazide concentration in diabetic patients: Relationship between gliclazide dose and serum concentration

Serum levels of gliclazide were determined by radioimmunoassay in seven healthy controls and in 18 diabetic in-patients receiving single oral dosing and consecutive dosing over 5 days. Following a single oral dose of 40 mg in the seven controls and eight diabetic patients, and 120 mg in ten diabetic patients, the serum levels of gliclazide peaked on average at 2 h, followed by a slow decline, the t1/2 being 16.5 h in the volunteers, 12.3 h in the diabetic patients receiving 40 mg, and 10.5 h in those receiving 120 mg. During consecutive administration, the serum levels both at fasting and at the peak reached a plateau in 2 days and no further accumulations were observed. The steady-state peak levels of gliclazide in the diabetic patients revealed a strongly positive correlation with the dose per m2 body surface area (r = 0.78, P less than 0.001), and their steady-state fasting levels correlated positively but weakly with the dose per m2 body surface area (r = 0.48, P less than 0.05). Thus, measuring either the fasting or the peak concentration of gliclazide will be useful for monitoring drug concentration in the serum. Pharmacokinetics of gliclazide will contribute to the elucidation of the relationship of serum level and clinical effectiveness in diabetic subjects.

Studies of Glucose Metabolism Immediately Following Total Pancreatectomy

Blood sugar changes were studied in anesthetized dogs before and after pancreatectomy, which was carried out in two stages, the latter being relatively atraumatic. The blood sugar remained normal for 1.5 to 4 hrs. after total pancreatectomy, then increased to the diabetic level. Comparison of glucose tolerance before and immediately after acute pancreatectomy revealed no significant change by either intravenous or intraduodenal route. Thus, a sudden cessation of insulin supply does not necessarily result in immediate hyperglycemia. A normal glucose tolerance appears possible temporarily in the absence of any increase in insulin secretion.

Nodular Glomerulosclerosis (Kimmelstiel-Wilson) After Total Pancreatectomy

There is controversy about the frequency of nephropathy in pancreatogenic diabetes. Many reports have appeared on diabetic nephropathy in humans with chronic pancreatitis or hemochromatosis. To our knowledge, however, only two reports have been made on nephropathy after total pancreatectomy (1,2), one of which is devoid of histological documentation (2). We describe a case of histologically proved nodular glomerulosclerosis in a totally pancreatectomized patient. In 1972, a Japanese man, 50 yr of age, underwent total pancreatectomy after diagnosis of gastric cancer invading the pancreas. There was no family history of diabetes or any past history of obesity. His fasting blood glucose was 94 mg/dl, and glycosuria had not been found before the operation. After total pancreatectomy, ketosis-prone insulin-dependent diabetes developed. Despite daily insulin injections of 12—18 U, his fasting blood glucose ranged from 43 to 714 mg/dl. Between 1976 and 1979, paresthesia of the lower extremities, intermittent proteinuria, pedal edema, and high blood pressure (170/96 mmHg) emerged one after another. He died of pulmonary edema in November 1982. One month before his death, his urine protein was 2.8-11.4 g/day, blood urea nitrogen was 45.2 mg/dl, serum creatinine was 1.8 mg/dl, serum growth hormone was 1.6 ng/ml, and no serum or urine C-peptide immunoreactivity was detected. The kidneys weighed 170 and 220 g. On microscopic examination, nodular and diffuse glomerulosclerosis, microaneurysms, hyalinization of arterioles, and capsular drops were noted (Fig. 1). A diligent search of a trypsin-digested specimen of the retina failed to show any microaneurysms. Thus, despite the nephropathy, there was no evidence of retinopathy.