Intrarenal microaneurysms in diabetic nephropathy.
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Biomedical subjects
Publications and source records attributed to E Takazakura.
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A patient who developed pancytopenia and hepatosplenomegaly with portal hypertension is described. Liver wedge biopsy at the time of operation showed typical histology of congenital hepatic fibrosis. Renal surgical biopsy revealed tubular ectasia. A continuous anastomosing network of the biliary tree was observed by reconstruction of serial sections of the liver. Some parts of the network were dilated and no isolated bile ducts were present.
Clinical factors related to the development and progression of renal lesions were studied in twenty-three diabetics by the use of serial renal biopsies or autopsy. The results were as follows: Most of the juvenile and intermediate type diabetics were poorly controlled, with the glomerular lesion progressing rather rapidly. In contrast, many cases of the adult type were able to be maintained under good control and the renal lesion neither developed nor progressed. Two of the adult type diabetics with poor control showed slowly and slightly progressing renal lesions. The progression of glomerular lesions was significantly related to the control of blood glucose, type of diabetes, age at onset, type of treatment, and degree of obesity, but not to the duration of diabetes or the length of the follow-up period. There was a significant correlation between the type of diabetes and the control of blood glucose over the years. Arteriolar lesions developed concurrently with the progression of the glomerular lesion. Retinopathy also had a tendency to develop in proportion to the progress of glomerular lesions although it was not statistically significant. We have discussed the clinical factors responsible for the progression of diabetic glomerulosclerosis and have suggested that the type of diabetes rather than the degree of control of blood glucose might be more important in determining the development and progression of diabetic glomerulosclerosis. Nevertheless, the possibility remains that successful control of blood glucose may prevent or retard the development of diabetic glomerulosclerosis.
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A 63-year-old male, who had undergone angiography using thorium dioxide (Thorotrast) at the age of 15 for investigation of a giant hemangioma on his left thigh, developed anemia in September 1986 (47 yrs after the angiography). A diagnosis of erythroleukemia was made from a bone marrow study which showed 56.4% megaloblastoid erythroblasts and 12.8% myeloblasts. Autopsy revealed Thorotrast deposition in the liver, spleen, bone marrow, and lymph nodes, and monotonous proliferation of myeloblasts in the bone marrow. He also had differentiated tubular adenocarcinoma of the posterior wall of the stomach.
After the administration of TRH the hyperresponse of TSH was observed in the non-treated addisonians and the normal response in the treated addisonians. These reulsts are inverted to those found in the patients of hyperadrenocorticism or treated with corticoid. This hyperresponse of TSH to TRH is due to the lack of corticoid and makes us suppose that the corticoid controls the TRH-TSH system as well as the CRF-ACTH system.
A 74-year-old man presented with chest pain, dry cough, progressive respiratory distress and infiltrative lung shadow. Diagnosis of acute eosinophilic pneumonia was confirmed by histological examination as well as clinical features. On the 8th day post-admission, he developed progressive generalised muscle weakness that required mechanical ventilation. Clinical investigations revealed features concurring with the accepted diagnostic criteria for Guillain-Barré syndrome. Although precise aetiologies for the disorders suffered by this case were unknown, a common cause of allergic nature was speculated. This is the first report of acute eosinophilic pneumonia accompanied by Guillain-Barré syndrome.