Reconstitution of SCID mouse with tonsillar cells from patients with IgA nephropathy

IgA nephropathy (IgAN) is characterized by a predominant IgA deposition to the renal mesangium. Immunological abnormalities are closely related to the occurrence and progression of IgAN. Many reports have indicated that tonsillectomy favours the clinical course of IgAN. To understand the role of tonsil glands in the occurrence and progression of IgAN, we injected tonsillar lymphoid cells from patients with IgAN into severe combined immuno-deficient mice (SCID). Tonsillar glands were obtained surgically from 3 patients with IgAN (experimental group) and from 7 patients with chronic tonsillitis without any manifestation of renal diseases (control group). Tonsils were homogenized and resultant cells cryopreserved. On the day of injection, cells were thawed and passed through Ficoll-Paque gradients to obtain mononuclear cells. Fifty million cells were injected intraperitoneally into the SCID mice. After 8 weeks, transferred cells successfully reconstituted SCID, as shown by the fact that human immunoglobulins were detected in the sera of both groups. Renal histopathological examination revealed there was no IgA deposition to the mesangial area in either group. These results indicate that tonsillar mononuclear cells alone may not directly relate to the occurrence of IgAN.

Significance of metabolic and blood pressure factors in relation to microangiopathy and macroangiopathy in patients with non-insulin-dependent diabetes mellitus

We are actively seeking methods to prevent and to limit the progression of angiopathy in patients with non-insulin-dependent diabetes mellitus (NIDDM). In the present study, we conducted a clinical and epidemiological survey to clarify the clinical factors responsible for the development and progression of diabetic microangiopathy (MI) and macroangiopathy (MA). A total of 107 patients (58 female and 49 male) were randomly selected from 145 NIDDM patients. Twenty-four patient variables were selected for analysis. We identified PWV, UAI, RETINOP, MCV-T, SCV-S, MCV-P, SBP, and DBP as responsible factors and carried out stepwise multiple regression analyses. The following explanatory variables were found to be significant: age > SCV-S (P < 0.0001) for the criterion variable PWV, BUN > HbA1c > MCV-P > HT-drug > HDL-C (P < 0.0001) for log(e) UAI, DM-thera > SBP (P < 0.0001) for RETINOP, MCV-P (P < 0.0001) for MCV-T, IRI > SBP > MCV-P > S-CR (P < 0.0002) for SCV-S, MCV-T > SCV-S > DM-thera (P < 0.0001) for MCV-P, DBP > HT-drug > BUN > MCV-P (P < 0.0001) for SBP, and SBP > PWV > sex (P < 0.0001) for DBP. In summary, responsible factors for MI and MA in NIDDM had metabolic and blood pressure factors in common. Moreover, MI was a responsible factor for MA, which becomes a responsible factor for MI because it is a responsible factor for blood pressure factors. Thus, all the responsible factors for MA represented by MI and PWV had metabolic and blood pressure factors in common. The results of this study suggest that metabolic and blood pressure factors must be controlled to prevent and to limit the progression of diabetic MI and MA in NIDDM patients.

Relationship between cardiac autonomic neuropathy and diabetic microangiopathies and macroangiopathy in patients with non-insulin-dependent diabetes mellitus

The relationship between cardiac autonomic neuropathy and diabetic microangiopathies and macroangiopathy was investigated in 103 patients with non-insulin-dependent diabetes mellitus. Cardiac autonomic nerve function was assessed by determining the uptake of [123I]metaiodobenzyl-guanidine into the myocardium. Cardioparasympathetic nerve function was assessed by comparing electrocardiographically the expiratory and inspiratory respiratory rate (RR) interval ratios, during a period of deep breathing, and the coefficients of variation of the RR intervals. Nerve conduction velocity measurements were used to assess diabetic somatic neuropathy, and measurement of pulse-wave velocity provided an indication of the extent of aortic sclerosis. The only correlations between the parameters of cardiac autonomic neuropathy and parameters of diabetic microangiopathies and macroangiopathy were between the expiratory to inspiratory RR interval ratio and both the conduction velocity of the tibial nerve and pulse-wave velocity, and between the heart to lung ratio (cardiac autonomic nerve function) and nephropathy. These correlations may have occurred by chance; alternatively they may indicate a difference in the onset mechanisms of cardiac parasympathetic and sympathetic neuropathies in diabetics.

Diversity of the neuropathies in patients with non-insulin-dependent diabetes mellitus

The relationships between cardiac autonomic neuropathies, diabetic somatic neuropathy, metabolic parameters, general parameters (such as age and duration of illness) and diabetic microangiopathy and macroangiopathy were investigated in 103 patients with non-insulin-dependent diabetes mellitus (NIDDM). Spearman's correlation coefficients were calculated for the comparisons of all the parameters of the neuropathies with all the other parameters. Variables were selected using a stepwise procedure and multiple regression analysis was carried out using these variables. The results of the regression analysis show that diabetic neuropathy is correlated with vascular parameters including blood pressure and pulse-wave velocity, as well as with parameters of sugar and lipid metabolism. The results confirm the diversity of the clinical characteristics of the neuropathies in patients with NIDDM and confirm that these neuropathies do not always occur in parallel.

Use of an alpha-glucosidase inhibitor to synchronize sugar absorption with delayed insulin secretion in a patient with non-insulin-dependent diabetes mellitus

The case of a 67-year-old women with non-insulin-dependent diabetes mellitus is described. Diabetes was first diagnosed when the woman was aged 55; a diet of 1440 kcal daily was recommended and 500 mg tolbutamide daily was prescribed. Hypoglycaemia was improved for a while but the blood-sugar concentration gradually increased until a tolbutamide dose of 2000 mg/day was needed. The patient eventually came to an out-patient clinic for diabetes control due to continuous hyperglycaemia. Her diabetes proved difficult to control, probably due, in part, to excessive eating and lack of exercise, despite appropriate education and glibenclamide treatment. After 15 months, an alpha-glycosidase inhibitor, at a dosage of 0.75 mg/day, was added to the treatment with glibenclamide at 7.5 mg/day and the glycosylated haemoglobin level was reduced to normal levels within 2 months. After a further 6 months the glibenclamide dose was reduced to 3.75 mg/day with no ill effects during the subsequent 4 weeks, up to the present day.

[A case of malignant oncocytoma of the parotid gland]

A case of malignant oncocytoma of the left parotid gland occurring in a 57-year-old man presenting with a painless lump is reported. The tumor was round, firm, mobile, well defined, and located in the left preauricular area. There was no evidence of facial weakness. At operation the left parotid gland was exposed to reveal a tumor arising from the superficial lobe, but involving the facial nerve. Superficial lobectomy was performed followed by reanastomosis using the great auricular nerve for the sacrificed facial nerve. Subsequently, the tumor recurred 13-months after the primary excision. The patient underwent radical neck dissection and was given supplementary radiation therapy. Because DNA-FCM of the tumor showed diploid-type with a large G2/M peak, we regarded radiation therapy as being potentially effective. Follow-up examinations performed two years later revealed no evidence of regional or distant metastases. The histologic examination of the original and the recurrent lesion showed large atypical cells, with abundant eosinophilic granular cytoplasm, which were often pleomorphic and highly-mitotic. Under ultrastructural examination, the cytoplasm contained numerous mitochondria of various shapes and sizes. These pathological findings were consisted with malignant oncocytoma.

Efficient production of the C-terminal domain of secretory leukoprotease inhibitor as a thrombin-cleavable fusion protein in Escherichia coli

We have developed a high-level production system for the C-terminal domain of secretory leukoprotease inhibitor (SLPI) to investigate its pharmacological activities. A gene for the C-terminal domain of SLPI, (Asn55-Ala 107)SLPI, was constructed from chemically synthesized deoxyoligonucleotides. It was fused to a gene for the N-terminal portion of human growth hormone via a DNA sequence encoding Leu-Val-Pro-Arg, which can be cleaved by thrombin. The fused gene was expressed in Escherichia coli under the control of a trp promoter, and the fusion protein was obtained as an inclusion body. After sulfonation of the cysteine residues, the sulfonated fusion protein was cleaved at the desired site by thrombin. Sulfonated (Asn55-Ala107) SLPI was refolded in Tris buffer containing reduced and oxidized glutathione. The resulting (Asn55-Ala107) SLPI was purified by cation-exchange chromatography and reverse-phase high performance liquid chromatography. The final yield was 50 mg/I culture. (Asn55-Ala107) SLPI was as active against elastase as, but had less trypsin inhibitory activity than, native SLPI. This system is suitable for the large-scale production of the C-terminal domain of SLPI, which is an elastase-specific inhibitor.

Epidural dumbbell-shaped chordoma mimicking a neurinoma

The authors present a case of cervical chordoma which manifested in a 5-year-old boy as a dumbbell-shaped epidural tumor without bone destruction. Both CT and MRI demonstrated tumor features suggesting this diagnosis, which was confirmed by histology.

Enhanced liver injury in acatalasemic mice following exposure to carbon tetrachloride

The hypothetical involvement of hydrogen peroxide (H2O2) in carbon tetrachloride (CCl4)-induced acute liver injury and the potential preventive effect of catalase on hepatotoxicity have been studied in acatalasemic (C3H/AnLCsbC2b) mice and compared with normal (C3H/AnLCsaCsa) mice. A single intraperitoneal injection of CCl4 (20% in olive oil/g body weight) caused increases in serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in both mouse groups, but the extents of increases did not show significant differences between the two mouse groups until 12 h. The variation in increases of serum AST and ALT levels in acatalasemic and normal mice turned to be distinctly different from 12 h. At 18 h (peak point for ALT) and 24 h (peak point for AST), the serum enzyme levels in acatalasemic mice were nearly two-fold higher than those in normal ones, the difference being statistically significant (p < 0.01). The liver malondialdehyde (MDA) level in acatalasemic mice was also higher than that in normals at 18 h (p < 0.05). The extent of the centrilobular necrosis was histologically more severe in acatalasemic mice. The catalase activity in livers of acatalasemic mice was one-third to one-fifth those of normal mice (p < 0.05) before and after treatment. The decreased catalase activity in acatalasemic mice might increase tissue or cellular levels of H2O2 during the later phase of the acute liver injury. From these findings, we conclude that H2O2 breakdown in liver would account for the difference in the later stages of the acute liver damage between the two groups of mice, and catalase is important in inhibiting hepatotoxicity of CCl4 in the later stage.

Involvement of neurohumoral factors in the pressor mechanism of NG-nitro-L-arginine

The mechanism of the NG-nitro-L-arginine (L-NNA)-induced pressor response was examined in pentobarbital-anesthetized dogs. The pressor effect of L-NNA (50 mg/kg, i.v.) was significantly and equally diminished by pretreatment with either hexamethonium (25 mg/kg, i.v.) or phentolamine (5 mg/kg, i.v.). The intracisternal administration of L-NNA (1 mg/kg), which did not cause changes in cardiovascular parameters when administered systemically, produced a significant pressor response and tachycardia. Furthermore, significant suppression of L-NNA-induced pressor responses was observed after treatment of dogs with captopril (5 mg/kg, i.v.) or a non-peptide angiotensin II receptor antagonist, losartan (10 mg/kg, i.v.), or bilateral occlusion of renal veins. The inhibitory effects of hexamethonium and losartan were additive. These results suggest that, in addition to vasoconstriction due to the inhibition of endothelial nitric oxide production, increased activity of the sympathetic nervous and renin-angiotensin systems contributes significantly to the development of pressor responses produced by the intravenous injection of L-NNA in anesthetized dogs.

Hardness of denture reline materials polymerized with different techniques

Two kinds of hard type self-cured denture reline materials were polymerized using three different techniques: (1) on a surface of glass plate, (2) under water, (3) under water with some hardening agent. Hardness of specimens were measured longitudinally during three weeks periods of storage in water at 37 degrees C. Results of our study indicated that the specimen cured with the special hardening agent showed the higher hardness than those cured only in water. Most of the hardness changes took place during first three days of the experiment period.

Cerebral blood flow measurement with iodine-123-IMP SPECT, calibrated standard input function and venous blood sampling

We previously reported simple methods for measuring cerebral blood flow (CBF) with 123l-labeled N-isopropyl-p-iodoamphetamine (IMP) and SPECT: table look-up method and autoradiography. With these methods, the arterial input function is obtained by calibrating the standard input function using one-point arterial blood sampling 10 min after IMP infusion. In this study, we sought to determine if these approaches can be as successful when used with venous blood sampling.

METHODS

After IMP infusion, simultaneous arterial and venous blood samples were drawn from 30 subjects without heart or lung disease.

RESULTS

The activity ratios of venous whole blood from the cubital vein to arterial blood were 0.75 +/- 0.09, 0.77 +/- 0.10, 0.78 +/- 0.03 and 0.83 +/- 0.11, respectively, at 10, 20, 30 and 50 min after IMP infusion. Venous blood activities were always 20% lower than the artery values over 50 min. When blood was sampled from the dorsal hand vein, however, the respective ratios were 0.92 +/- 0.03, 0.93 +/- 0.05, 0.97 +/- 0.04 and 0.98 +/- 0.08 after 10, 20, 30 and 50 min. Furthermore, when the palm was exposed to heat during the sampling period, blood activity levels increased to 0.92 +/- 0.04, 0.96 +/- 0.04, 0.99 +/- 0.05 and 0.98 +/- 0.03. Thus, venous blood activities were consistent with arterial activity, presumably because of the numerous arteriovenous anastomoses in the palm. Optimal times for venous blood sampling, with and without palm heating, were determined by error analysis to be 15 and 20 min, respectively, after IMP infusion.

CONCLUSION

Venous blood sampling from the dorsal hand can be substituted for arterial blood sampling in IMP-CBF studies.

Existing variations on the gene structure of hepatitis E virus strains from some regions of China

The isolation and identification of the 87A strain of hepatitis E virus (HEV) by means of cell culture have been described previously. This paper reports the nucleotide sequence of a portion of this HEV strain. The RNA extracted from the supernatants of the different passages of the 87A strain cultured in the A549 cell line was reverse-transcribed (RT) to cDNA, and then the polymerase chain reaction (PCR) amplification was carried out using the primers of HEV ET1.1 region. The PCR products from 1) the supernatant of the infected cells at the fourth passage, 2) the virus concentrated by polyethylene glycol (PEG) precipitation at the tenth passage, and 3) the virus purified by a sucrose gradient at the tenth passage were sequenced. In addition, three other PCR products obtained from sera of acute hepatitis E patients in Beijing (B-9) and Guangzhou (G-9 and G-20) were also sequenced. The nucleotide sequences of the above four strains of HEV (located in the genome from positions 4545-4754) were compared to those of some reported HEV strains. The nucleotide sequences of the B-9 strain and the 87A strain were similar to the Burmese strain and may belong to the same branch of HEV. The nucleotide sequences of the G-9 strain and the G-20 strain were a novel and unique branch. The Chinese HEV strains are multiplex and variable in gene structure.

Bilateral common iliac artery aneurysms secondary to fibromuscular dysplasia accompanied with a coronary aneurysm. A case report

Fibromuscular dysplasia (FMD) is found in various arteries but the common iliac arteries and the coronary arteries are seldom involved. A 49-year-old woman was referred to our hospital with a pulsatile mass in her right lower quadrant. She had subdural hemorrhage in a postpartum state at the age of 27. After admission angiography diagnosed the bilateral iliac artery aneurysms and coronary angiography revealed a coronary artery aneurysm, the size of which was 12 mm x 19 mm in the region of the left main trunk. The bilateral iliac artery aneurysms were resected and Y-shaped vascular prosthesis was replaced. Microscopic sections of the aneurysm showed remarkable decrease of elastic fibers and thinning of the media, but no increase occurred in the smooth muscle. Histopathological diagnosis was FMD (periarterial fibroplasia). To our knowledge, no patient with a iliac arterial aneurysm caused by FMD has been reported and only a few cases with coronary arterial FMD have been described. This is the first report of iliac arterial aneurysm due to FMD. Since this case has multiple aneurysms, a long-term follow-up is definitely required, especially focusing on the coronary aneurysm.

Hepatitis E virus (87A strain) propagated in A549 cells

A strain of hepatitis E virus (HEV), the 87A strain isolated in 2BS cells from the feces of a patient with hepatitis E, has been reported previously. In this study, the 87A strain was propagated in A549 cells, and the marked cytopathic effect (CPE) appeared in the infected monolayer cells. The size of this virus is about 30 nm in diameter. Furthermore, HEV-RNA from the supernatants of the virus of different passages was detected by polymerase chain reaction (PCR) amplification using ET1.1 HEV primers. A band of HEV for 239 bp from PCR products was revealed by electrophoresis. PCR products of the fourth passage were sequenced. These results show that the 87A virus replicates in the A549 cell line.

Cerebral metabolism of oxygen and glucose in a patient with MELAS syndrome

We studied cerebral oxygen and glucose metabolism as well as cerebral blood flow using positron emission tomography (PET) in a case with MELAS showing dementia, diabetes mellitus, ataxia and lactic acidosis without any signs of stroke. This case, confirmed to have a point mutation at position 3243 in the transfer RNA gene of mitochondrial DNA, developed a stroke-like episode 8 months after the PET study. Uncoupling was observed between cerebral oxygen metabolism and cerebral blood flow with reduced fractional oxygen extraction ratio, indicating "hyperemia", not ischemia. The "hyperemia" may be closely related to the malfunction of mitochondria in aerobic energy production. A drastic decrease in cerebral oxygen metabolism (CMRO2) was found globally in contrast to preserved cerebral glucose metabolism (CMRglu), resulting in a remarkable decrease in the metabolic ratio (CMRO2/CMRglu). The dissociation between cerebral glucose and oxygen metabolism may be characteristic of MELAS.

Cloning of a cDNA encoding a 190-kDa insulin receptor substrate-1-like protein of simian COS cells

Major insulin signals such as stimulation of glucose uptake and DNA synthesis and modification of hexose metabolism are mediated by the tyrosine-phosphorylated insulin receptor substrate-1 (IRS-1; pp180) in many species of cells. We cloned cDNA encoding a 190-kDa IRS-1-like protein (pp190) in simian COS cells and which is slightly larger than IRS-1 (pp180) of human, rat, and mouse cells. The deduced amino acid sequence of COS pp190 consisted of 1251 amino acids and was 96.4%, 87.9% and 88.7% identical to human, mouse and rat IRS-1. The COS pp190 bound to SH2 (src-homology 2) domains of p85, Grb2/Ash, and SH-PTP2, as did IRS-1. In IRS-1-knockout mice, insulin signals are thought to be mediated by IRS-2 (pp190), which is an alternative signaling molecule and is slightly larger than IRS-1. However, the COS pp190 may be a simian homologue of IRS-1, but not of IRS-2. The results of Southern blotting suggested the possibility that Chinese hamster ovary (CHO) cells have not only the IRS-1 gene but also a gene related to the COS pp190.

Factors related to stress in patients with non-insulin-dependent diabetes mellitus

Stress was assessed using State-Trait Anxiety Inventory scores in 40 non-insulin-dependent diabetes mellitus (NIDDM) patients, and the results were compared with those for 40 sex- and age-matched healthy controls. Fludiazepam was administered to the patients for 12 weeks and stress was reassessed. The Manifest Anxiety Scale score correlated with Trait (r = 0.548, P < 0.0001) and State (r = 0.474, P = 0.0001) scores, validating the latter as measurements of stress. Both Trait (43.4 vs 35.8, P < 0.001) and State (41.6 vs 33.8, P < 0.001) scores were significantly higher in NIDDM patients than in healthy controls. Administration of an anxiolytic, fludiazepam (0.25 mg, three times daily, orally) for 12 weeks lowered Trait score (43.5 to 36.9, P < 0.0001), State score (41.6 to 35.8, P < 0.0002), glycosylated haemoglobin (8.4 to 7.3%, P < 0.0001), systolic blood pressure (151.2 to 143.4 mmHg, P < 0.0017) and diastolic blood pressure (84.2 to 77.7 mmHg, P < 0.0018). Multiple regression analysis revealed that the significant explanatory variables for the change in State score during anxiolytic administration were the changes in total cholesterol, high-density lipoprotein cholesterol, triglycerides, apolipoprotein B:A1 and glycosylated haemoglobin (R2 = 0.3224, P < 0.0022). The results indicate that stress is detected at a higher frequency in patients with NIDDM than in healthy controls, and that blood glucose and lipid metabolic factors are significant explanatory variables for this stress. This stress is correlated with glucose metabolism and blood pressure and, moreover, these factors could all be proved concomitantly by the administration of an anxiolytic.

Error analysis of autoradiography method for measurement of cerebral blood flow by 123I-IMP brain SPECT: a comparison study with table look-up method and microsphere model method

N-isopropyl-p-[123I]iodoamphetamine (IMP) has been commonly used as a cerebral blood flow tracer, but, significant clearance of IMP from the brain to the blood causes underestimation of cerebral blood flow (CBF) as compared with true CBF when the conventional microsphere model method is applied. Previously, we reported an "Autoradiography method" (ARG method) for measuring CBF by using IMP in which this clearance effect was corrected. This method was based on a two-compartment model (influx: K1, efflux: k2, K1/k2 = distribution volume of IMP (Vd)), the K1 (corresponding to CBF) being obtained form the table which showed a correlation between CBF and the brain counts of SPECT scan with a constant Vd value. Arterial input data used were obtained by one point blood sampling 10 min after IMP infusion against the standard input function. In the present study, the ARG method was compared with the table look-up method (TLU method) and the conventional microsphere model method (MS method) for 30 subjects. When the Vd value in the ARG method was assumed to be 50 ml/ml, CBF values obtained by the ARG method were correlated well with those obtained by the TLU method (Y = 1.04X-2.5; X: TLU, Y: ARG r = 0.97) and those obtained by the MS method (Y = 0.82X + 12.1; X: ARG, Y: MS, r = 0.84). But, when the Vd value was assumed to be more or less than 50 ml/ml, ARG method CBF were under- or overestimated compared with the TLU method. This indicated that the ARG method could be a reliable method for CBF measurement if the Vd was determined properly. CBF values obtained by the MS method were actually 13.2% higher than those obtained by the ARG method against previous studies. As reasons for this, errors in the effects of gray-white matter mixture in the ARG method and in estimation of the SPECT brain counts at 8 min in the MS method were considered.

[Analysis of infiltrating lymphocytes in choroidal melanoma]

We performed immunohistochemistry on tumor infiltrating lymphocytes (TILs) in a 78-year-old man with choroidal malignant melanoma. Cell suspensions of TILs from fresh specimens and peripheral blood lymphocytes (PBLs) were stained with anti-CD3, anti-CD4, anti-CD8, anti-CD29, anti-CD45RA, and anti-human leukocyte antigen (HLA)-DR monoclonal antibodies and analyzed using three-color flow cytometry. In light microscopy, the number of infiltrating lymphocytes around the tumor was very small. Immunohistochemically, T lymphocytes were more numerous than B lymphocytes. Flow cytometric analysis showed that CD8+ cells were more numerous than CD4+ cells in CD3+ cells in TILs, and most of these cells also expressed HLA-DR antigen. CD29+ (memory) cells were increased and CD45RA+ (naive) cells were decreased in CD4+ cells in TILs as compared with PBLs. We concluded that the increase in the percentage of activated memory T lymphocytes and the decrease of naive T lymphocytes may reflect a localized antigen-specific immunological response in choroidal malignant melanoma.

Mechanism of bradykinin-induced cyclic GMP accumulation in bovine tracheal smooth muscle

Bradykinin (10(-8) - 10(-5) M) caused a concentration-dependent increase in cyclic GMP (cGMP) production in bovine tracheal smooth muscle in the absence of epithelium. The effect was calcium-dependent and was inhibited by pyrogallol (10 microM) and methylene blue (10 microM). The inhibition of pyrogallol was reversed by superoxide dismutase (100 U/ml). Nitric oxide (NO) synthase inhibitors, NG-methyl-L-arginine (10-100 microM) and NG-nitro-L-arginine (10-100 microM) reduced cGMP accumulation induced by bradykinin in a concentration-dependent fashion, and the inhibition was reversed by L-arginine. Immunohistochemistry with a specific antibody against neuronal NO synthase from rat cerebellum showed positive staining localized in some nerve fibers. Bradykinin-induced cGMP accumulation appears to be related to the release of NO, part of which is probably synthesized in nonadrenergic noncholinergic nerve in bovine trachea.

Can alpha-glucosidase inhibitors reduce the insulin dosage administered to patients with non-insulin-dependent diabetes mellitus?

For 10 patients (three women and seven men) with noninsulin-dependent diabetes mellitus, who had been given insulin (22.6 +/- 19.6 U/day) and had frequently shown hypoglycaemia, the insulin dose was slightly reduced and the administration of an alpha-glucosidase inhibitor was simultaneously started. Hypoglycaemic symptoms disappeared immediately and completely, and sugar metabolism immediately before the withdrawal of treatment was not aggravated: the glycosylated haemoglobin level was unchanged and the post-prandial blood glucose level was increased though not significantly. The results of the present study indicate that the combined used of an alpha-glucosidase inhibitor with a reduced insulin dose improves the quality of life of patients and may improve hyperinsulinaemia.

Is there a correlation between cardiac sympathetic neuropathy or diabetic somatic neuropathy and glycosylated haemoglobin or blood pressure in patients with non-insulin-dependent diabetes mellitus?

The possibility that glycosylated haemoglobin levels and/or blood pressure might correlate with cardiac sympathetic neuropathy and/or diabetic somatic neuropathy was investigated in patients with non-insulin-dependent diabetes mellitus. Sympathetic nerve function was quantified by analysis of [123I]metaiodobenzylguanidine accumulation in the cardiac muscle. Somatic nerve function was assessed by measuring the motor nerve conduction velocities of the peroneal and tibial nerves, and the sensory nerve conduction velocity of the sural nerve. None of the parameters of cardiac sympathetic neuropathy or diabetic somatic neuropathy showed any correlation with blood pressure, nor was there any evidence of a correlation between cardiac sympathetic neuropathy and glycosylated haemoglobin levels; there was, however, a significant correlation between diabetic somatic neuropathy (as indicated by tibial nerve conduction velocity) and glycosylated haemoglobin levels. The results are consistent with the view that different mechanisms are involved in the two types of neuropathies.

Effect of alpha-glucosidase inhibitor in combination with sulphonylurea compounds on lipid profile in patients with non-insulin-dependent diabetes mellitus

The effects of administration of an alpha-glucosidase inhibitor and a sulphonylurea compound on lipid profile were investigated in patients with non-insulin-dependent diabetes mellitus, (NIDDM) previously treated with sulphonylurea compounds alone, but in whom metabolic control was inadequate. A group of patients (n = 10) were treated with the alpha-glucosidase inhibitor at a dose of 0.2 mg, three times daily, for 4 weeks. Treatment significantly reduced the post-prandial glucose level and the serum total cholesterol level. In addition, there were non-significant reductions in the triglyceride and very low density lipoprotein levels. These preliminary results suggest that administration of alpha-glucosidase inhibitors might improve the lipid profile of patients with NIDDM.