Toshihide Shirota

Hypouricemia in NIDDM Patients

I n the epidemiological survey conducted by Herman et al. (1), serum uric acid levels were significantly lower in non-insulin-dependent diabetic (NIDDM) patients than in normal subjects. Gotfredsen et al. (2) also reported a decrease in serum uric acid levels in insulin-dependent diabetic patients, and increases in urinary uric acid excretion and uric acid clearance (Curate). In this study, we investigated the serum and urinary uric acid levels in NIDDM patients and discuss the mechanism of hypouricemia in diabetic patients. Two hundred and four nonnephrotic NIDDM patients (95 men, 109 women) and 44 normal controls (20 men, 24 women) were studied. All participants were admitted to the hospital between January 1984 and September 1987. Diagnosis of diabetes was based on the 1982 Japan Diabetes Society criteria (3). Patients with >25 mg/dl of proteinuria in morning urine samples, measured with a Combistix (Ames-Sankyo, Tokyo), were excluded from the study. Patients whose insulin dosage was >0.6 U/kg of body weight and who were receiving diuretics, antigout or antituberculous agents, antibiotics, aspirin, or anti-inflammatory agents were also excluded. Forty-nine of the diabetic patients were treated with insulin with the mean dosage consisting of 22.7 U/day. Forty-five patients received oral hypoglycemics, and the remainder were treated by diet therapy. Ageand body-weight-matched subjects with no major diseases were used as control subjects. Medical problems were either thyroid adenoma or simple goiter with normal thyroid function. Diabetic patients maintained their prescribed diets containing 25-30 kcal/kg of ideal body weight with 17% protein, 23% fat, and 60% carbohydrate. Control subjects maintained a normal hospital diet containing 2200 kcal/day with the same composition of protein, fat, and carbohydrate as diabetic patients. Blood and urine samples were collected at 0800 after at least 10 h of fasting. A 2-h postprandial plasma glucose level was measured at 1030. In 100 of the diabetic patients (49 men, 51 women) and all the controls, urine samples were collected for 3 days after the blood sampling day. From the 3-day measurements, the average data per 24 h were used for analysis. Serum and urinary uric acid levels were measured by a colorimetric procedure using an enzymatic (uricase) method, and plasma and urinary glucose levels were measured by the glucose oxidase method. Other serum chemicals were analyzed by an autoanalyzer (SMAC, Technicon Japan, Tokyo). Table 1 shows 13 clinical parameters in NIDDM patients and controls. Diabetic patients had a signifi-

Abnormal molecular weight profile of urinary protein in rats with streptozotocin-induced diabetes

A quantitative analysis of the molecular weight (MW) profile of urinary protein by SDS-PAGE was performed in streptozotocin (STZ)-injected, non-ketotic diabetic rats (DM group), diabetic rats receiving dipyridamole (DM-DIP group), normal rats (C group) and STZ-injected rats with near-normal glycemia due to insulin treatment (DM-INSULIN group). In the DM group, decrease of a small MW protein (SMWP) (MW 19.5 k) was found at 2.5 weeks, and an increase of larger MW proteins (LMWP) (MW 68 [albumin], 55 and 29 k) together with a decrease of SMWPs (MW 19.5 and 15 k) was found at 15 weeks, as compared to the C group: the MW profile of urinary protein in the DM-INSULIN and C groups was indistinguishable. At 15 weeks, creatinine clearance (Ccr) was significantly depressed and an increase in the mesangial matrix with electron dense deposits was evident in the DM group. The urinary protein abnormalities were partially corrected and the reduction of Ccr was absent in the DM-DIP group with no effect on glomerular morphology. STZ-induced diabetes in rats is accompanied by a reduction of urinary SMWP, and a subsequent increase of LMWP and depression of Ccr: dipyridamole ameliorates urinary protein abnormalities and prevents the reduction of Ccr.

Partial resection of atrial septal aneurysm with multiple fenestrations: a case report

Aneurysms of the interatrial septum are uncommon lesions that are often accompanied by other cardiac anomalies or systemic thrombosis. The authors report 1 case of atrial septum aneurysm that was diagnosed by two-dimensional contrast echocardiography. At surgery a membrane-like, fenestrated aneurys mal protrusion to the right atrium without thrombosis was seen. The atrial septum was closed without using an artificial patch after some of the aneurysm with fenestrations was resected.