Measurement of soluble thrombomodulin in sera from various clinical stages of diabetic nephropathy.

The levels of soluble thrombomodulin (TM) in serum samples were measured by one-step sandwich enzyme immunoassay. The aim of the present study was to determine if levels of soluble TM in sera might correlate with disease activity in patients with diabetic nephropathy. Three hundred and twenty patients with diabetic nephropathy were examined. Patients with diabetic retinopathy were excluded from the present study. This study showed an increase of soluble TM levels in sera from patients with diabetic nephropathy. The levels of soluble TM in sera from the macroalbuminuric stage with renal dysfunction were significantly increased compared with those from the normo-, micro-, or macroalbuminuric stage of diabetic nephropathy without renal dysfunction. The increase of soluble TM in sera paralleled levels of urinary albumin, blood urea nitrogen (BUN), s-creatinine (Cr), and duration of noninsulin-dependent diabetes mellitus (NIDDM). Furthermore, a decrease of TM staining in the glomerular capillary walls was observed in both microalbuminuric and macroalbuminuric stages by immunofluorescence. It appears that the measurement of soluble TM in sera is useful in evaluating the degree of glomerular endothelial injuries in patients with diabetic nephropathy.

Detection of glycosylated protein in renal tissues and dermal vascular vessels in the microalbuminuric stage of diabetic nephropathy using the nitro blue tetrazolium reaction.

Detection of glycosylated protein in renal and dermal tissues was performed in patients in the microalbuminuric stage of diabetic nephropathy using the nitro blue tetrazolium (NBT) reaction. The intensity of NBT staining in glomeruli and dermal vascular vessels was marked in the microalbuminuric stage as well as in the overtly proteinuric stage. The NBT staining in the renal and dermal vascular walls in both stages was significantly stronger than in the samples of control autopsy patients. It appeared that nonenzymatic glycosylation in various tissues, i.e. kidneys and dermal vascular vessels, had already progressed in the microalbuminuric stage in patients with diabetic nephropathy.

[Solitary ostial coronary artery stenosis in women].

Among 6,200 patients undergoing coronary arteriography using the Sones technique at the Juntendo University Hospital and the Juntendo Urayasu Hospital from 1975 to 1988, 121 patients (1.95%, 111 males and 10 females) were found to have significant (> or = 50%) stenosis in their left main trunks (LMT). Patients with systemic inflammatory disease such as syphilis or Takayasu's arteriitis, aortic valvular disease, or a history of mediastinal irradiation were excluded from this study. Stenotic lesions of the LMT were categorized into 7 types according to their locations and appearances. 1. The most common type was stenosis localized just before the branching from the left circumflex artery (42 patients or 34.7%). 2. Although the incidence of left coronary ostial stenosis was not very high (13 patients, 10.7%) as a whole, that for the female patients was the highest (30.8%) of the 7 types. Nine patients showed atherosclerotic irregularities with or without significant stenosis in the distal coronary arterial trees. Four patients, including 3 women, were diagnosed as "primary solitary ostial stenosis" of which the cause is unknown. All of the 3 women were premenopausal, and their clinical profiles were as follows: Case 1 (45-year-old): She was hospitalized because of anterior chest pain during exertion or at rest. Her electrocardiogram (ECG) showed severe ischemic ST-T changes. Coronary cineangiography disclosed a 95% stenosis in the left coronary ostium, and the distal portion of the coronary artery was normal. She had not experienced angina after her coronary artery bypass operation. Case 2 (45-year-old): She was hospitalized because of exertional chest pain.(ABSTRACT TRUNCATED AT 250 WORDS)