Medial arterial calcification is frequently seen in diabetic patients with severe diabetic neuropathy. Sixty patients (19 diabetic and 41 non-diabetic) were examined radiologically for typical Mönckeberg's sclerosis of feet arteries 6-8 years after uni- or bilateral lumbar sympathectomy. Fifty-five out of 60 patients (92%) revealed medial calcification. This calcification was observed in both feet of 93% of patients, who had undergone bilateral operation. After unilateral sympathectomy the incidence of calcified arteries on the side of operation was significantly higher than that on the contralateral side (88% versus 18%, p less than 0.01). Although diabetic patients showed longer stretches of calcification than non-diabetic subjects, the difference was not significant in terms of incidence and length. Of 20 patients who had no evidence of calcinosis pre-operatively, 11 developed medial calcification after unilateral operation exclusively on the side of sympathectomy. In seven patients calcinosis was detected in both feet after bilateral operation. In conclusion, sympathetic denervation is one of the causes of Mönckeberg's sclerosis regardless of diabetes mellitus.

Two psychotic patients developed hyperglycaemia several weeks after starting olanzapine. In one case the elevated glucose concentrations returned to normal soon after withdrawal of olanzapine. In the second case severe ketoacidosis with lethal outcome occurred.

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Occurrence prior to the age of 25 years, dominant inheritance, metabolic control without insulin for more than two years and mild course without late complications are considered characteristic of maturity-onset diabetes of young people (MODY). Diabetes or glucose tolerance disturbance was observed in 30 members of a family in five successive generations. The course of the disease within the family was variable: even after disease for several decades no diabetes-specific late complications were seen in 20 diabetics, six, in contrast, had serious complications such as proliferative retinopathy, nephropathy and coma. The different clinical course is expression of the considerable variability of this genetically uniform metabolic disorder. Our observations demonstrate that vascular complications in MODY are less frequent than in type II diabetes, however are not excluded. Thus, also MODY diabetics require life-long careful metabolic surveillance.

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