Reports on the histologic aspects of the autonomic nerves in diabetics are infrequent. This investigation was carried out to study histologically and histochemically the autonomic nerve fibers of the urinary bladder wall in ten diabetic patients. Of the five subjects examined by biopsy, four showed damage of nerve fibers; absence of cholinesterase activity was the only finding in the fifth patient who had chemical diabetes.In four autopsies we found alterations in all the cases. The lesions appeared as beaded or spindle-shaped fibers or small vacuolated or uniformly thickened fibers. The most severe cases exhibited fragmentation of the fibers.Histochemical analysis demonstrated absence of cholinesterase activity in the muscle, in all cases, and absence or decrease of such activity in the nerves in all but one case.Similar studies performed on eight nondiabetic subjects revealed no anatomic or histochemical lesions.The findings lead to the hypothesis that diabetic neuropathy injures the biochemical phase of the myelin sheath in the first stage and the nerve fibers later. No previous reports on the subject here studied could be found in the literature. DIABETES 22:225-37, April, 1973.

Normal androgenic function has already been reported elsewhere as a fact in impotent diabetic males. Many of these patients show some type of visceral or peripheral diabetic neuropathy. Looking for a possible neurological origin for impotence in diabetic men, we have undertaken the present study, analyzing the autonomic nervous fibers of the corpora cavernosa of the penis by means of light microscopy.In five autopsies of impotent diabetics, mean age 51, with an average duration of diabetes of 9.6 years, the following stainings were made: hematoxylin-eosin, P.A.S. and silver impregnations. Out of five cases, four showed morphological alterations of varying degrees (hyperargentophilia, beaded thickening, spindle shaped thickening, and argentophilic spherical swellings).No correlations were found with diabetic microangiopathy. Only one of the diabetics did not show any lesion. The control group, five non-impotent, nondiabetic patients of similar age, did not show alterations at all. This first study of the autonomic nervous system in the corpora cavernosa of impotent diabetics lends strong support to the idea that their sexual impotence is due to a neurological lesion of the nerve fibers that control erection. DIABETES 23:971-76, December, 1974.

Myocardial infarction is considered the prime cause of death among adult diabetic patients. In a great number of cases, during myocardial infarction the patients don't feel pain or it is atypical. Diagnosis can be neglected, and mortality increases. In search of an explanation for the absence of pain in these patients, the authors studied the autonomic nerve fibers of the heart muscle with argentic and combined techniques, looking for lesions in the sympathetic or parasympathetic nerve fibers that conduct pain. In the five cases of painless myocardial infarction studied, the nerve fibers showed typical lesions of diabetic neuropathy: beaded thickenings, spindle-shaped thickenings, fragmentation of fibers, and diminution of the number of fibers in the nerves. The patients in the control group (five diabetics with painful infarction, five diabetics with infarction, five nondiabetics with painful infarction, and five nondiabetics without infarction) had no lesions. These facts led us to assume that the absence of pain in diabetics with myocardial infarction could be due to a lesion of the afferent nerves that conduct pain.

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