Hypophyseal Stalk Section in Rapidly Progressive Diabetic Retinopathy

Will be published extensively in this journal Discussion Binkhorst wonders if the impressive improvement in the fundus picture and visual function in the patient demonstrated should not be regarded more as the result of removal of the venous obstruction and congestion of the optic disc than as improvement in the diabetic retinopathy. Schlesinger replies that this possibility, considering the double indication of progressive exophthalmos and diabetic retinopathy, must certainly be considered. It was the opinion of the attendant ophthalmologist (Prof, ten Does-schate) that the fundus picture was more indicative of a rapidly progressive diabetic retinopathy than of venous congestion from another cause. Goldmann draws attention to the histological similarities and differences between the vascular abnormalities in the kidney (Kimmelstiel-Wilson syndrome) and those observed on pathological examination of the ocular blood vessels. He enquires if the division of the pituitary stalk has had any influence on the kidney condition. Schlesinger replies that the nodular glomerulo-sclerotic anomaly in the kidney, originally described by Kimmelstiel and Wilson, differs markedly from the pathological histology of the ocular blood vessels in diabetic retinopathy. Recently, however, in addition to the nodular Kimmelstiel-Wilson anomaly, attention has been drawn to a more diffuse anomaly of the glomerular capillaries, which is probably a forerunner of the Kimmelstiel-Wilson anomaly, and which resembles the condition of the ocular blood vessels much more closely. More precise knowledge of the resemblances and differences between the vascular condition in the eyes and the kidney may be expected to result from examination with the electron microscope. With reference to the influence of division of the pituitary stalk or hypophysectomy on the renal function, he refers to the observations of Luft and Oliυecrona, who reported that, after the operation, the concentration of protein excreted in the urine did not alter appreciably, the inulin clearance (measure of glo-merular filtration) diminished slightly, and the para-aminohippuric acid clearance (renal plasma flow) was unaltered. The filtration fraction (quotient Ophthalmologica, Vol. 146, No. 5 (1963) 31 362 Schlesinger of inulin clearance and para-aminohippuric acid clearance), in accordance with the above results, also diminished slightly. The recorded changes in the renal function are not significant. In the case of the patient operated upon by us, also no changes in the renal function were observed.