fibrin and Diabetic-Neuropathies

Data from the literature concerning the frequent lack of correlation between the clinical manifestations of diabetic neuropathy on the one hand and the morphofunctional status of the appropriate nerves, disorders in carbohydrate and lipid metabolism, and the influence of antidiabetic therapy on metabolism and the clinical picture of diabetic neuropathy on the other, are presented. In this connection, abundant evidence of frequent affection of various blood vessels, particularly small and smallest, in diabetic neuropathy is considered. But even these data attest to a non-infrequent lack in diabetic neuropathy of the involvement of the appropriate vessels, particularly the lack of basal membrane thickening which is a most common indication to the diabetic involvement of capillaries. Attention is drawn to the possible role of genetic heterogeneity of people with regard to the development of various forms of diabetic neuropathy.

Topics: Adult; Aged; Basement Membrane; Blood Vessels; Chronic Disease; Diabetic Angiopathies; Diabetic Neuropathies; Diabetic Retinopathy; Endothelium; Fibrin; Gangrene; Humans; Microcirculation; Middle Aged; Nerve Fibers; Nervous System

Sural nerve biopsy was performed in twenty-four diabetic patients, with clinical and electrophysiological evidence of diabetic neuropathy. Material from an autopsy case was also examined. Vessels plugged with fibrin were seen within nerve in nine cases. In three cases fibrin was observed tracking into the vessel wall and in four, older thrombus was observed in vessels. Areas of necrosis in nerve bundles were seen in two of the latter. In two patients there had been a preceding episode of intravascular coagulation. Fibrin deposition within small vessels could well play a part in damaging the diabetic nerve and a disturbance of the balance between deposition and removal by fibrinolysis could explain phasic variation in the symptoms of neuropathy.

Topics: Adult; Aged; Blood Vessels; Demyelinating Diseases; Diabetic Neuropathies; Female; Fibrin; Fibrinolysis; Humans; Male; Middle Aged; Neural Conduction; Peripheral Nerves; Sural Nerve