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  • 1
    Electronic Resource
    Electronic Resource
    Microangiopathy in human diabetic neuropathy: relationship between capillary abnormalities and the severity of neuropathy (1989)
    Springer
    Diabetologia 32 (1989), S. 92-102 
    Details
    ISSN: 1432-0428
    Keywords: Diabetes ; neuropathy ; microangiopathy ; heterogeneity ; morphometry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Clinical, electrophysiological and ultrastractural morphometric observations were made in 5 diabetic non-neuropathic patients, 5 diabetic patients with mild neuropathy and 11 diabetic patients with severe neuropathy. Capillary abnormalities were assessed in simultaneous nerve, muscle and skin biopsies and compared with results from 6 age-matched, non-diabetic control subjects. Nerve capillaries demonstrated markedly greater pathology than skin and muscle capillaries. Endoneurial capillary density was significantly reduced in severely neuropathic diabetic patients (p〈0.01) when compared with control subjects. Capillary basement membrane (p〈0.002), endothelial cell (p〈0.003) and total diffusion barrier (endothelial cell, pericyte, basement membrane) (p〈0.001) thickness were significantly increased, and oxygen diffusing capacity was significantly reduced (p〈0.001) in the nerves of patients with severe diabetic neuropathy when compared to control subjects. Endothelial cell profile number and luminal perimeter were significantly increased in asymptomatic (p〈0.01), (p〈0.05) and severely neuropathic (p〈0.001), (p〈0.05) diabetic patients respectively. However, endothelial cell outer perimeter, a measure of capillary size, showed no significant increase in diabetic patients when compared with control subjects. An association was observed between neurophysiological and neuropathological measures of neuropathic severity. There was no significant correlation between the duration of diabetes and HbA1 levels with capillary pathology or with neuropathic severity. Very few abnormalities of muscle and skin correlated with neuropathic severity. However, all measures of nerve capillary pathology correlated significantly with neurophysiological and neuropathological measures of neuropathic severity.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00505180
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  • 2
    Electronic Resource
    Electronic Resource
    Endoneurial localisation of microvascular damage in human diabetic neuropathy (1993)
    Springer
    Diabetologia 36 (1993), S. 454-459 
    Details
    ISSN: 1432-0428
    Keywords: Diabetes mellitus ; microangiopathy ; peripheral neuropathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Twenty diabetic patients with neuropathy underwent clinical and neurophysiological evaluation together with a detailed morphometric assessment of capillary pathology in endoneurial and epineurial microvascular beds of the sural nerve. Morphological data were compared with ten non-diabetic control subjects. There were no significant differences in control subjects between basement membrane area, endothelial cell area, endothelial cell profile number or luminal area of endoneurial when compared with epineurial capillaries. In contrast, when compared with epineurial capillaries, endoneurial capillaries from diabetic patients demonstrated a significant increase in basement membrane (p〈0.001) and endothelial cell (p〈0.001) area and a significant reduction in luminal area (p〈0.001). There was no significant difference in endothelial cell profile number between endoneurial and epineurial capillaries amongst diabetic patients. Previous studies have demonstrated a good correlation between the degree of microangiopathy and measures of neuropathic severity. In the present study increased endoneurial capillary basement membrane area was significantly related to reduced peroneal nerve conduction velocity (p〈0.001), myelinated fibre density (p〈0.001) and elevated vibration (p〈0.05) and thermal (p〈0.001) perception. Increased endothelial cell area and reduced luminal size were related to a reduced peroneal nerve conduction (p〈0.05, p〈0.01, respectively), reduced myelinated fibre density (p〈0.05, p〈0.01) and elevated thermal perception (p〈0.05, p〈0.001). Epineurial capillary basement membrane, endothelial cell and luminal area failed to relate to measures of neuropathic severity. This study has demonstrated more advanced microangiopathy and a more significant relationship to neuropathic severity in endoneurial compared with epineurial capillaries, thus providing further support for the role of microangiopathy in the pathogenesis of human diabetic neuropathy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00402283
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  • 3
    Electronic Resource
    Electronic Resource
    Vascular factors in diabetic neuropathy (1994)
    Springer
    Diabetologia 37 (1994), S. 847-854 
    Details
    ISSN: 1432-0428
    Keywords: Diabetic neuropathy ; microangiopathy ; nerve ; hypoxia ; blood flow
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Despite considerable research we still do not have a comprehensive explanation for the pathogenesis of diabetic neuropathy. Although chronic hyperglycaemia is almost certainly involved, it is not known whether the primary pathology is metabolic, microvascular, or an interaction between the two. Hyperglycaemia-induced polyol pathway hyperactivity associated with nerve sorbitol accumulation and myo-inositol depletion may play a part in the genesis of diabetic neuropathy. The case for microvascular disease in diabetic neuropathy is now strong. Fibre loss in human sural nerve is multifocal, suggesting ischaemia. The degree of vessel disease has been related to the severity of neuropathy. People with chronic obstructive pulmonary disease develop the so called “hypoxic neuropathy” in which similar microvascular changes occur as in diabetic neuropathy. In rats with experimental diabetic neuropathy nerve blood flow is reduced and oxygen supplementation or vasodilator treatment improved the deterioration in conduction velocity and nerve blood flow. Similarly, in human diabetic neuropathy, there is impaired nerve blood flow, epineurial arterio-venous shunting and a reduction in sural nerve oxygen tension. At what stage during the development of nerve damage these changes occur is yet to be determined.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00400938
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  • 4
    Electronic Resource
    Electronic Resource
    Vascular factors in diabetic neuropathy (1994)
    Springer
    Diabetologia 37 (1994), S. 847-854 
    Details
    ISSN: 1432-0428
    Keywords: Key words Diabetic neuropathy ; microangiopathy ; nerve ; hypoxia ; blood flow.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Despite considerable research we still do not have a comprehensive explanation for the pathogenesis of diabetic neuropathy. Although chronic hyperglycaemia is almost certainly involved, it is not known whether the primary pathology is metabolic, microvascular, or an interaction between the two. Hyperglycaemia-induced polyol pathway hyperactivity associated with nerve sorbitol accumulation and myo-inositol depletion may play a part in the genesis of diabetic neuropathy. The case for microvascular disease in diabetic neuropathy is now strong. Fibre loss in human sural nerve is multifocal, suggesting ischaemia. The degree of vessel disease has been related to the severity of neuropathy. People with chronic obstructive pulmonary disease develop the so called “hypoxic neuropathy” in which similar microvascular changes occur as in diabetic neuropathy. In rats with experimental diabetic neuropathy nerve blood flow is reduced and oxygen supplementation or vasodilator treatment improved the deterioration in conduction velocity and nerve blood flow. Similarly, in human diabetic neuropathy, there is impaired nerve blood flow, epineurial arterio-venous shunting and a reduction in sural nerve oxygen tension. At what stage during the development of nerve damage these changes occur is yet to be determined. [Diabetologia (1994) 37: 847–854]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00400938
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Arterio-venous shunting and proliferating new vessels in acute painful neuropathy of rapid glycaemic control (insulin neuritis) (1996)
    Springer
    Diabetologia 39 (1996), S. 329-335 
    Details
    ISSN: 1432-0428
    Keywords: Insulin neuritis ; diabetic neuropathy ; sural nerve ; nerve blood flow ; arterio-venous shunting ; nerve ; hypoxia ; new vessel formation ; fluorescein angiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Insulin neuritis, or painful neuropathy following rapid improvement in glycaemic control, is well recognised but its aetiology is unclear. An understanding of the processes involved in the genesis of acute painful neuropathy of rapid glycaemic control may give an insight into the early pathogenetic factors leading to diabetic nerve damage in general. We have identified five subjects with insulin neuritis including one who developed severe autonomic neuropathy following treatment with insulin. Subjects underwent: 1) assessment of neuropathic symptom and deficit scores; 2) quantitative sensory and electro-physiological studies and 3) sural nerve epineurial vessel photography and fluorescein angiography in vivo. The sural nerve photographs were independently graded by an ophthalmologist. All subjects with insulin neuritis presented with severe sensory symptoms but clinical examination and electrophysiological tests were normal except in the subject with the severe autonomic neuropathy in whom all the tests were abnormal. On nerve photography, there was an abundance of epineurial nutrient vessels although these showed severe abnormalities including arteriolar attenuation, tortuosity and arterio-venous shunting in all subjects. Proliferating neural ‘new vessels’ which bear striking similarities to those found in the retina and that were more leaky to fluorescein than normal vessels, were observed in three subjects. Venous distension and/or tortuosity was also observed in three subjects and this was most marked in the subject with severe autonomic neuropathy. This study shows that epineurial nutrient vessel anatomy is abnormal in subjects with acute painful neuropathy of rapid glycaemic control, a condition previously thought to be purely metabolic in origin. The presence of epineurial arterio-venous shunting and a fine network of vessels resembling the new vessels of the retina, may lead to a ‘steal’ effect rendering the endoneurium ischaemic. This process may be important in the genesis of neuropathic pain, and further supports the importance of vascular factors in the pathogenesis of diabetic neuropathy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00418349
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  • 6
    Electronic Resource
    Electronic Resource
    Arterio-venous shunting and proliferating new vessels in acute painful neuropathy of rapid glycaemic control (insulin neuritis) (1996)
    Springer
    Diabetologia 39 (1996), S. 329-335 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Insulin neuritis ; diabetic neuropathy ; sural nerve ; nerve blood flow ; arterio-venous shunting ; nerve ; hypoxia ; new vessel formation ; fluorescein angiography.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Insulin neuritis, or painful neuropathy following rapid improvement in glycaemic control, is well recognised but its aetiology is unclear. An understanding of the processes involved in the genesis of acute painful neuropathy of rapid glycaemic control may give an insight into the early pathogenetic factors leading to diabetic nerve damage in general. We have identified five subjects with insulin neuritis including one who developed severe autonomic neuropathy following treatment with insulin. Subjects underwent: 1) assessment of neuropathic symptom and deficit scores; 2) quantitative sensory and electrophysiological studies and 3) sural nerve epineurial vessel photography and fluorescein angiography in vivo. The sural nerve photographs were independently graded by an ophthalmologist. All subjects with insulin neuritis presented with severe sensory symptoms but clinical examination and electrophysiological tests were normal except in the subject with the severe autonomic neuropathy in whom all the tests were abnormal. On nerve photography, there was an abundance of epineurial nutrient vessels although these showed severe abnormalities including arteriolar attenuation, tortuosity and arterio-venous shunting in all subjects. Proliferating neural ’new vessels' which bear striking similarities to those found in the retina and that were more leaky to fluorescein than normal vessels, were observed in three subjects. Venous distension and/or tortuosity was also observed in three subjects and this was most marked in the subject with severe autonomic neuropathy. This study shows that epineurial nutrient vessel anatomy is abnormal in subjects with acute painful neuropathy of rapid glycaemic control, a condition previously thought to be purely metabolic in origin. The presence of epineurial arterio-venous shunting and a fine network of vessels resembling the new vessels of the retina, may lead to a ’steal' effect rendering the endoneurium ischaemic. This process may be important in the genesis of neuropathic pain, and further supports the importance of vascular factors in the pathogenesis of diabetic neuropathy. [Diabetologia (1996) 39: 329–335]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00418349
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    Paper (German National Licenses)
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  • 7
    Electronic Resource
    Electronic Resource
    The differential effects of baclofen on segmental and descending excitation of spinal interneurones in the cat (1985)
    Springer
    Experimental brain research 58 (1985), S. 333-337 
    Details
    ISSN: 1432-1106
    Keywords: Spinal cord ; Descending excitation ; Primary afferent excitation ; Baclofen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Intravenous baclofen (1–6.25 mg kg-1) substantially reduced the monosynaptic excitation of neurones in the intermediate nucleus of the cat spinal cord by impulses in group I extensor muscle primary afferent fibres, but had little or no effect on excitation by stimulating fibres of the ipsilateral dorsolateral funiculus or the contralateral red nucleus. Relatively low concentrations of baclofen thus appear not to influence the release of excitatory transmitter from the terminals of rubrospinal, corticospinal and long descending propriospinal fibres, in contrast to the reduction of the release of primary afferent transmitters.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00235314
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  • 8
    Electronic Resource
    Electronic Resource
    A pharmacological study of group I muscle afferent terminals and synaptic excitation in the intermediate nucleus and Clarke's column of the cat spinal cord (1986)
    Springer
    Experimental brain research 64 (1986), S. 105-113 
    Details
    ISSN: 1432-1106
    Keywords: Spinal intermediate nucleus ; Clarke's column ; Primary afferent excitation ; GABA ; Bicuculline ; Baclofen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary When administered microelectrophoretically GABA and piperidine-4-sulphonic acid depolarized the central terminations of muscle group Ia and Ib afferent fibres in the lumbar intermediate nucleus and Clarke's column of cats anaesthetised with pentobarbitone sodium. Both this depolarization, and primary afferent depolarization, generated by impulses in other primary afferent fibres which produce prolonged bicuculline-sensitive inhibition of the firing of group I afferent fibre-excited interneurones in the intermediate nucleus and cells in Clarke's column, are reduced by microelectrophoretic bicuculline methochloride. Systemically administered (±)-baclofen hydrochloride (maximum dose 8 mg kg−1) depressed the monosynaptic excitation of Clarke's column neurones by impulses in muscle and cutaneous afferent fibres. Microelectrophoretically administered (−)-baclofen reduced the bicuculline-sensitive primary afferent depolarization of group I terminations without, however, reducing the depolarizing action of GABA or piperidine-4-sulphonic acid. The depression by (−)-baclofen of the group I monosynaptic excitation of intermediate nucleus neurones is not reduced by concentrations of bicuculline methochloride adequate to suppress prolonged inhibition of these neurones
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00238205
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  • 9
    Electronic Resource
    Electronic Resource
    Mycopathology of cerebral mycosis (1985)
    Springer
    Acta neurochirurgica 78 (1985), S. 161-163 
    Details
    ISSN: 0942-0940
    Keywords: Cerebral mycosis ; aspergillosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Seven cases of cerebral mycosis have been studied with respect to the pattern of distribution of the various cerebral fungi and the spectrum of histopathological changes. It has been found that aspergillosis is the most prevalent pathogen in our region unlike in the western world where candidosis dominates the picture. The relevant literature is discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01808697
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  • 10
    Electronic Resource
    Electronic Resource
    Evaluation of histological appearance of tissues removed by cavitron ultrasonic surgical aspirator (CUSA) (1986)
    Springer
    Acta neurochirurgica 81 (1986), S. 132-134 
    Details
    ISSN: 0942-0940
    Keywords: CUSA ; histological appearance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Histological appearances of the tissue fragments obtained by cavitron ultrasonic surgical aspirator (CUSA) were studied in 25 cases to determine whether the aspirated tissue could be used for diagnosis. It was found that a definite diagnosis could be made on the tissue removed by this method.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01401235
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