Impotence and Diabetes: Histological Studies of the Autonomic Nervous Fibers of the Corpora Cavernosa in Impotent Diabetic Males

Faerman, Isaac; Glocer, Leticia; Fox, Dora; Jadzinsky, Mauricio; Rapaport, M

doi:10.2337/diab.23.12.971

Cited by 113 publications

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“…The results of the present study are compatible with this idea. It is also of interest that the histological abnormalities found in the present study are similar to those described in the bladder [15], in the corpora cavernosa [16] and in the myocardium [17], all of which are typical sites of diabetic autonomic neuropathy. Thus, autonomic neuropathy is a very common feature in diabetes and an important background to the development of other complications.…”

Section: Discussionsupporting

confidence: 65%

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Autonomic neuropathy in the skin: A histological study of the sympathetic nerve fibres in diabetic anhidrosis

Faerman¹,

Faccio

Calb³

et al. 1982

Diabetologia

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Summary. In diabetics with the anhidrotic syndrome, autonomic nerve fibres were studied in skin biopsies using argentic techniques and light microscopy. The Minor test was used to differentiate normal from anhidrotic skin areas. In the anhidrotic areas, histology of the nerve fibres showed beading, spindle-shaped thickening and fragmentation adjacent to the sweat glands. These changes were similar to those observed in two patients who had previously undergone lumbar sympathectomy. No abnormalities of the sympathetic nerve endings could be found in biopsies taken from normal areas of the forearm of the same patients. We conclude that the diabetic anhidrotic syndrome, a form of diabetic autonomic neuropathy, is due to a lesion of the sympathetic nerve supply to the skin. It is suggested that the Minor test or a skin biopsy should be performed in diabetic patients who are being considered for surgical sympathectomy.Key words: Anhidrosis, sweat secretion, autonomic nerve fibre, sympathetic chain, Minor test, skin biopsy, argentic techniques, sympathectomy, diabetic visceral neuropathy.Alterations in sweating are particularly common in diabetic patients with autonomic neuropathy [1]. The first reference to this anomaly was made by Pryce in 1893 [2], but it was Rundles who published the first clinical description in 1945 [3]. He found that 36 out of 125 patients with diabetic neuropathy had alterations in perspiration and he associated this change with other alterations of the autonomic nervous system, particularly changes in blood pressure and skin temperature. Similar descriptive clinical findings have been documented by several other authors [4,5].Physiological and histological research into changes in sweat production is difficult and this may have contributed to the scarcity of studies on this subject. Normal patterns of sweat production have been determined by List and Peet [6] and by Hyndman and Wolkin [7]. Perhaps the most reliable methods include those described by Minor [8] which depends on the starch-iodine reaction, and the technique of Brown and Adson [9] in which strips of paper soaked with cobalt chloride are applied to the skin. Alternatively, quinarizine may be used, which turns blue on contact with skin moisture [10]. Most of these methods are relatively simple although less accurate than the determination of sweating by galvanic skin resistence techniques.Although not specific, the symptoms suffered by diabetics from sweating disturbances are fairly typical [5]. Initially there is heat intolerance accompanied by hyperhidrosis of the upper half of the body, particularly affecting the face, neck, axillae and hands. It is of interest that these patients rarely perspire excessively below the umbilicus. This diabetic syndrome has been attributed to a lesion of the sympathetic nerve fibres which control sweat secretion [11] and follow the course of the peripheral nerves [12]. This affects the efferent branch of the reflex arch and is identical to that occurring distal to a surgical sympathectomy [13].To ...

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Section: Discussionsupporting

confidence: 65%

“…Two histopathologists (EF and IC) assessed each biopsy independently, without knowledge of the patients' details or site of biopsy. Nerve fibre morphology was considered normal or abnormal according to our previously published criteria [15][16][17].…”

Section: Methodsmentioning

confidence: 99%

Autonomic neuropathy in the skin: A histological study of the sympathetic nerve fibres in diabetic anhidrosis

Faerman¹,

Faccio

Calb³

et al. 1982

Diabetologia

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“…Similar degenerative process of the peripheral nerves was reported in diabetic men [755]. Administration of L-NAME (N G -nitro-L-arginine methyl ester), the inhibitor of NO synthase, appeared to be protective in this condition [754].…”

Section: Diabetes Mellitussupporting

confidence: 63%

T. gondii Infection Acquired during Pregnancy and/or after Birth may be Responsible for Development of both Type 1 and 2 Diabetes Mellitus

Pr¹,

ota²

2013

J Diabetes Metab

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Recently, it was suggested that maternal T and potentially B cells transferred during pregnancy and/or the breast milk feeding and their encounter with the antigen in mesenteric lymph nodes might play a role in development of type 1 diabetes mellitus (T1DM). T. gondii infection during gestation and/or after birth may be responsible for development of both T1DM and T2DM in children, adolescents and adults because: a) maternal microchimerism in peripheral blood was demonstrated to be significantly higher in patients with T1DM compared to unaffected siblings and healthy subjects, b) transmission of T. gondii as a Trojan horse in various types of eukaryotic cells, including T and B lymphocytes, c) swallowing by the fetus of amniotic fluid containing infected leukocytes and other cells, d) elimination of T. gondii in the breast milk during lactation, e) involvement of mesenteric lymph nodes after oral infection with the parasite, and f) damage of the myenteric neurons during infection with the parasite in both the animals with streptozotocin-induced diabetes and diabetic patients. Moreover, a significantly lower occurrence of antibodies against T. gondii found in the sera of patients with T1DM compared with their first-degree family members or healthy controls may be due to their T and/or B cell exhaustion perspective caused by chronic infection with the parasite. This suggestion may be supported by the finding that latent toxoplasmosis was associated with markedly reduced lymphocyte B-cell counts responsible for production of antibodies, markedly lower serum IgG, IgM, and IgA levels, and a significant suppression of IL-2. On the other hand, patients with T2DM had increased anti-T. gondii antibodies significantly more frequently than respective controls. Impaired vascular endothelial function characteristic for the patients with diabetes mellitus may be at least in part due to the preferential T. gondii infection of endothelial cells. Vitamin D and minocycline exerted beneficial effects on development and clinical course of diabetes mellitus probably because of their immunomodulatory and antitoxoplasmatic activities. These data strongly suggest that the parasite play an important role in development of both types of diabetes mellitus.

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“…This is mainly based on indirect evidence that impotence is associated with both anatomical [9] and physiological abnormalities [6] of the bladder in some of these diabetics. There has been one unconfirmed study showing alterations in the autonomic nerve fibres in the corpora cavernosa in impotent diabetics [11], again suggesting that a neurological lesion could cause the impotence.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of diabetic impotence

et al. 1980

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Summary.In a survey of 541 diabetic males, aged 20-59 years, 190 (35%) had erectile impotence. Using linear logistic regression models for analysis the five most significant associations with impotence were age (p < 0.001), treatment with either insulin or oral hypoglycaemic agents (p < 0.001), retinopathy (p < 0.001), symptomatic peripheral neuropathy (p < 0.001) and symptomatic autonomic neuropathy (p < 0.005). The greatest correlations were found in patients with severe microangiopathy, as demonstrated by proliferative retinopathy and symptomatic autonomic neuropathy. In addition the duration of diabetes and the presence of ischaemic heart disease, nephropathy and poor diabetic control may also be associated with diabetic impotence. It is concluded that diabetic impotence is still a common problem and may have a multifactorial aetiology.Key words: Diabetic impotence, prevalence, aetiological factors.The increased frequency of impotence in the diabetic male has long been recognised [7]. Despite improvement in the treatment of diabetes since the early insulin era there has been no decrease in recent reports of the frequency of diabetic impotence [7,10,14]. Thus the prevalence of impotence with increasing age in diabetic men aged between 20-60 years is still approximately 18-71% [19] and considerably greater than 0.1-18.4% for the corresponding normal male population [13].There has been no previous extensive survey of the prevalence of diabetic impotence in the United Kingdom. The aim of the present study was therefore to ascertain the prevalence in males attending a large U. K. diabetic clinic. An assessment was also made of possible contributing factors involved in the aetiology of diabetic impotence. Materials and MethodsDuring a nine month period 563 males attending the Diabetic Out-Patient Department were interviewed. A total of 132 clinics were covered and at each clinic every male aged between 20-59 years was included. After three months an initial non-randomised group of 319 men (Group 1) had been interviewed. At this time it was decided to interview a random group of approximately 100 men to exclude the possibility of bias in the original group. The total clinic male population aged 20-59 years was 887 and from the remaining 568, a random sample of 101 men (Group 2) was drawn who were subsequently interviewed over a six month period. Over this latter period a second non-random group of 121 men (Group 3) who were attending the clinic and not included in the random sample were also interviewed.The total number of men included for study was thus 541, representing 61% of the male clinic population aged between 20-59 years. A further 22 who were unable to give satisfactory interviews were omitted: in the two non-random groups (Groups 1 and 3) 9 were mentally defective, 2 had cerebrovascular accidents with dysphasia and 2 were unable to speak English; in the random group (Group 2) 5 had recently left the area, 1 was hospitalised elsewhere, 2 were mentally defective and 1 had a cerebrovascular accident.A deta...

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Impotence and Diabetes: Histological Studies of the Autonomic Nervous Fibers of the Corpora Cavernosa in Impotent Diabetic Males

Cited by 113 publications

References 0 publications

Autonomic neuropathy in the skin: A histological study of the sympathetic nerve fibres in diabetic anhidrosis

Autonomic neuropathy in the skin: A histological study of the sympathetic nerve fibres in diabetic anhidrosis

T. gondii Infection Acquired during Pregnancy and/or after Birth may be Responsible for Development of both Type 1 and 2 Diabetes Mellitus

The prevalence of diabetic impotence

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