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Guido Menzinger

Dear all,

It is with great sadness that we announce to all of you that our beloved Founding Father Prof. Dr. Guido Menzinger passed away peacefully on November 11, 2018. Prof Menzinger recently attended NeuroDIAB 2018 in Rome where he met old friends and colleagues. It was clear, that even in retirement, he was still committed to the existence and success of NeuroDIAB

There are a limited number of clinician scientists who have contributed as much to the field of diabetic neuropathy. Amongst these there are even fewer whose interests spans such wide fields, whose inheritance is his great example and whose legacy will inspire future generations – this is Prof Menzinger’s contribution to diabetic neuropathy.

Prof P Kempler

Chairman of NeuroDIAB

 

Obituary: Guido Menzinger

Guido Menzinger 12.2.1934 – 11.11.2018

On Sunday morning on 11 November, when my flight from Kiev to Rome was about to take off, I received a call from Anna with the terribly sad news that Professor Guido Menzinger had passed away during the night.

Many Neurodiab members had the opportunity to meet him in Rome at Neurodiab’s social dinner just two months earlier. He was determined to attend the dinner to meet old friends and younger participants, and to underline his continuing commitment to the existence of Neurodiab that he had founded, promoted throughout the years and continued to follow even after his retirement.

A few days before he died, he also had shared a dinner with some members of his old team, who had enjoyed, as always, his sharp wit and intelligence, warm humanity and friendship. In the last few days, his cardiovascular condition had given him some cause for complaint but without ever suggesting such an imminent conclusion.

I would like to remember Guido Menzinger by referring to the words and messages that, in the days around his passing, many colleagues and friends from Italy and other parts of Europe and indeed the world have sent, and in this way to depict moments and aspects of his professional life and personality through their voices like in a choral tale.

A true European

Guido Menzinger was born in Perugia from Italian father and English mother.

His international vocation was perhaps family-driven: “He was a great man – the best that Italy and Manchester (via his mother) could produce – a formidable combination.” (David Tomlinson). “I was fascinated by his family history, which he told me with unexpected simplicity: he was learned in his mind but simple with his words.” (Federico Bellavere). “Borges wrote that when a man dies it is like a library that burns: with the passing of Professor Menzinger, more than one library has been burnt. He was a polyglot, spoke English, French and German, the prototype of a true European. He was the representative of a multicultural Europe open to innovation and to the needs of poorer parts of the world, and always young inside.” (Pino Bax).

Care as responsibility

I met Guido Menzinger in 1976, when I was a student. He was Assistant Professor of Internal Medicine and then of Endocrinology from 1968 to 1979 at the University of Rome La Sapienza. That is when I became one of his Endocrinologist trainees. I remember the large open ward, the beginning of modern research, an extraordinary cluster of senior doctors and researchers under the management of Professor Domenico Andreani. That was a wonderful environment for young doctors to learn clinical methodology, observation, and attention to detail: care as one’s own life responsibility. In his whole career, Guido Menzinger was greatly appreciated by students and colleagues alike for his professional qualities: “He was an outstanding physician and teacher.” (Lucio Gaspari). “In the long time that we’ve known each other, I could only increase my admiration for him as a person and his high professional worth.” (Luca Bianchi). “Passionate about his work as a clinician first and then as a scientist.” (Fausto Santeusanio).

Patients hold a deep sense of gratitude towards him: “My retinal haemorrhages taught me to recognize his steps, so distinct and so uniform… Many times, during the night at the hospital, my hypoglycaemias coincided with his call to the duty nurse, around 1.30, to ask for ward news, and then I found that infinite man in his green loden coat and his scarf at the foot of my bed: ‘Lucy, how are you? How do you feel?’. I also remember him, with the simplicity that marked him, running to his office and coming back with the book that described how to open the vancomycin capsule to allow better adhesion to my intestine walls and to be more effective against pseudo-membranous colitis due to Clostridium.” (Lucia Cifani). “He will always be among my dearest memories” (Antonio Rispoli).

A bridge-builder, educator, and “patients first”

His academic career led him to Naples as a Full Professor of Constitutional Medicine from 1980 to 1983. There, he promoted the initiative of inter-regional meetings between the regions of Rome and Naples, Lazio and Campania (“Incontri Endocrino-Metabolici Campano-Laziali”). He had the aptitude to build bridges and occasions for scientific and cultural exchange, together with an interest in the education of young people. He followed this vocation until the end: “He still tried his best to attend the meetings of the Collegium of Endocrinology Roman Schools, to which he had given significant input from the very beginning.” (Paolo Pozzilli).

Guido Menzinger joined the University of Rome Tor Vergata in 1983 as a Full Professor of Metabolic Diseases, and then of Endocrinology until his retirement in 2005. He promoted new educational pathways in the field of clinical nutrition. He was Director of the Postgraduate School on Nutrition, the Coordinator of the Doctorate Course on Clinical and Preventive Nutrition, and the Chairman of the University Course for Dieticians from 1993 to 2005. These academic paths provided an opportunity for the watchful education of many young people who retain a grateful memory. Parallel to this, there was the foundation of the new University Hospital of Tor Vergata and the effort to provide modern and effective clinical assistance. Throughout his career, his priority was always to focus on patient needs and patient care. 

Research achievements

The author of more than 300 papers, among which approximately 100 original papers, his research dealt with insulin-like activity, insuloma, glucagon secretion, cholesterol synthesis in diabetes, and from 1980 was more focused on diabetic neuropathy and its complications.

Original contributions in this field were made on the relationship between glycaemic control and nerve conduction velocity, the impact of autonomic dysfunction on blood pressure circadian pattern and sympathovagal activity, the relationship between autonomic neuropathy and diabetic nephropathy, the evidence of early dysregulation of EPO control related to diabetic neuropathy, the early autonomic dysfunction in the nondiabetic offspring of patients with diabetes, abnormalities in body sway, postural instability, and biomechanical foot alterations linked to diabetic neuropathy and involved in foot ulceration, and the role of manufactured shoes in the prevention of diabetic foot ulcers.

Service for scientific societies

His service for scientific societies was another aspect of his many-sided activities. He was member of the EASD Committee for Postgraduate Education from 1983 to 1989. He was member of the Executive Committee of the Italian Society of Endocrinology from 1992 to 1997 and from 2001 to 2003, the President of the same Society from 2003 to 2005, and then Honorary President. He dedicated specific energies to the editorial activities of the Society, i.e. the Journal of Endocrinological Investigation and L’Endocrinologo, to relationships with international endocrine societies, i.e. Endocrine Society and EFES, and to the activities of the Study Groups. “He was a true Master, a person of science with great balance.” (Francesco Giorgino). “He played a fundamental role in the world of Italian Endocrinology.” (Paolo Vitti).

He was the Chairman of the Italian Diabetic Neuropathy Study Group in the Italian Society of Diabetology from 1979 to 1988 and from 1998 to 2000. In cooperation with other noteworthy Italian researchers, he led a growing awareness of diabetic neuropathy resulting in a higher level of expertise among Italian diabetologists, which in turn generated general interest in this diabetic complication. He also raised attention on diabetic foot in Italy. “Guido was a very esteemed friend with whom I shared a long journey, very often full of satisfaction.” (Domenico Fedele). “He was a historical reference figure of Italian diabetology.” (Francesco Giorgino). He received a career award for professional and scientific merit from the Italian Society of Diabetology in 2015.

International vocation

A privileged relationship with the United Kingdom was a constant thread throughout his life: his time spent in 1961-1962 as a British Council Scholar in the Endocrinology Department of Guy’s Hospital under the supervision of Henry Keen and Lord Butterfield, the foundation and chairmanship for almost 20 years from 1985 to 2003 of the Italo-British Association for the Study of Diabetes, then called Centre of International Studies on Diabetes, his election as a Fellow of the Royal College of Physicians in recognition of his international achievements. Thus, the link with English colleagues was a constant source of initiatives, research stimuli, and also solid friendship.

Role in Neurodiab

In a meeting on neuropathy organized by Jean-Raymond Attali in 1989 in Versailles, Guido Menzinger and John Ward discussed the idea of an EASD study group on neuropathy and asked Arnold Gries to come in on the project. It was the birth of Neurodiab. In 1990 Arnold Gries hosted a preliminary meeting in Düsseldorf: Peter Watkins and Jannik Hilsted joined the organization. Guido Menzinger was the first Chairman of Neurodiab from 1991 to 1994, and then became Secretary from 1994 to 1998.

“No one has done more to further the cause of Neurodiab than Guido.” (Solomon Tesfaye). “Not only Guido was the founder but he was also the father of Neurodiab. With his inspiration, he made an invaluable contribution to the Diabetic Neuropathy Community, and this will never be forgotten.” (Dan Ziegler). “He was a monument in diabetic neuropathy.” (Geert-Jan Biessels).

Specific legacies of his Chairmanship include: to safeguard a format for presentations with ample space for discussion, to preserve overall autonomy in the choice of topics, and to guarantee balance between experimental and clinical presentations.

After the fall of the Berlin Wall, Guido Menzinger had an important role in endorsing Eastern European colleagues inside Neurodiab. Thanks partly to his contacts and initiatives (he had personal relationships with some Romanian diabetologists and had been since 1992 an Honorary Member of the Romanian Society for Diabetes Nutrition and Metabolism), Neurodiab was able to facilitate the participation of colleagues from Eastern Europe, which has become one of the cornerstones of Neurodiab’s identity.  He will be remembered as a bridge-builder: “Guido was especially supportive and helpful to Eastern European members of Neurodiab.” (Peter Kempler). “A long-standing mentor and friend even for members from the far-east.” (Soroku Yagihashi).

Together with the other founders, he received the Neurodiab Lifetime Achievement Award in 2008 in Orvieto.

Mentorship

In addition to mentorship to his close colleagues, he was also a mentor to many young people in Neurodiab. “As a young researcher I greatly appreciated his kindness and sound advice. Guido had a warm smile, a friendly disposition and always encouraged me to do neuropathy research.” (Solomon Tesfaye). “I remember well how much support he provided to the very young scientists like me in the mid-1990s” (Tamás Várkonyi). “He was an instrumental in Neurodiab and kind and supportive to many of us” (Gerry Rayman).

“I first met Guido in 1993 at Neurodiab in Istanbul and ever since he was a true inspiration for me.” (Henning Andersen). “…the privilege to meet Guido and learn from his so many accomplishments and vision.” (Rodica Pop-Busui).

His socio-ethical interests and activities

He also paid attention to the ethical and social aspects of medicine, including his heartfelt participation as a Visiting Professor of Endocrinology in a training programme for doctors in Somalia in 1976, 1977, and 1984, his activity as a member of a Task Force on Insulin in the International Diabetes Federation, where he was involved in initiatives about access to insulin in Developing Countries, his activity as a volunteer doctor from 2003 in the Multispecialty Outpatient Clinic of Istituto di Medicina Solidale in the outskirts of Rome. This latter aimed to treat immigrants and other potentially disadvantaged and vulnerable people, including among others an educational prevention campaign on eating habits conducted in the local Nigerian community.

Three weeks before his death, he told me and other friends over dinner that if someone has skills and knowledge, he or she cannot avoid using them to address people’s needs. He did exactly that until the very end.

His style and grace

“He was always an example of not just great scientist and doctor but great person in all aspects.” (Boris Mankovsky). He was “a kind, dignified gentleman, who was generous with his time.” (Dinesh Selvarajah). “I will always remember his wonderful and gentle soul.” (Dan Ziegler).

“I appreciated his cleverness, kindness, his respect for others, his culture and humanism. I’ll also remember his wonderfully warm smile.” (Paul Valensi). “He had great knowledge not only of medicine, but also of classical music, arts, literature and architecture. Knowing Guido has no doubt enriched all of our lives.” (Andrew Boulton) “His enthusiasm and grace were always so evident, as was his wonderful sense of humour and fun.” (Mary Cotter and Norman Cameron).

His legacy

“In many respects he was the Father of Neurodiab and I hope the Society can honour him by going from strength to strength.” (David Tomlinson).

His brilliant intelligence, his incredible memory, his ability to grasp the point immediately, his open mind, and a continuous curiosity for knowledge always followed – including when it was not-for-profit.

We can share that “We will all fill his absence in future meetings with the memory of his gracious face.” (Soroku Yagihashi).

Guido wrote in his contribution for the 25th Neurodiab Anniversary Commemorative Book in 2015: “I now feel a great sense of achievement, seeing how active and flourishing Neurodiab is in its 25th year and how the atmosphere of friendly cooperation, integrity and dedication to our basic and clinical scientific goals, which we worked for at its foundation, is still unchanged.”

Vincenza Spallone

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Contribution of Guido Menzinger for the 25th Neurodiab Anniversary Commemorative Book

In a very hot summer as Neurodiab Chairman I laboured to produce a draft of the bye-laws, which was approved with minor changes by the Executive Committee and sent to the EASD for approval. The name (Neurodiab – Diabetic Neuropathy Study Group of EASD) and various drafts of the logo were suggested by my co-worker Luigi Uccioli. I submitted the name and the chosen logo to the Executive Committee. The Neurodiab study group was then approved by the EASD.

The first official meeting was in Cork 9-10 September 1991 at the Silver Springs Hotel. There were 100 participants and the meeting was very lively and successful. Among the participants I remember P.K. Thomas and David Tomlinson from London, Jean-Raymond Attali and Paul Valensi form Paris, Andrew Boulton from Manchester, Norman Cameron and Mary Cotter from Aberdeen, Solomon Tesfaye from Sheffield, Aristides Veves and Rayaz Malik from Manchester, Bernhard Neundörfer from Nürnberg, Dan Ziegler from Düsseldorf, Peter Kempler from Budapest, Göran Sundkvist from Malmö, Jonescu Tirgoviste from Bucharest, Boris Mankovski from Kiev, Anders Sima from Michigan, Nicola Canal and Luigi Comi from Milan, Vincenza Spallone and Luigi Uccioli from Rome, Domenico Fedele and Federico Bellavere from Padua and Luciano Bernardi from Pavia.

In this first meeting I insisted that the discussion times should be equal to the times of presentations in order to ensure a lively interchange and encourage the younger members to join in. This rule was approved by the Executive Committee and observed in all subsequent meetings, contributing to the success of the Study Group.

It was also decided that members of Neurodiab and presenting authors should receive free registration and accommodation from the organizing committee; this encouraged younger members and those from less affluent countries to participate.

The subsequent meeting was held in Bratislava in order to favour attendance from Eastern European Countries; there were in fact presentations from the Ukraine, Russia, Poland, Czechoslovakia, Hungary, and Romania. Also we had Nigishi Hotta from Japan and a gradually increasing attendance from the USA. The latter was subsequently to become very significant as the lack of a neuropathy study group in the American Diabetes Association made Neurodiab a sort of regular meeting for neuropathy researchers from the US.

An interesting episode occurred when the bus from Prague to Bratislava passed the town of Brno, and I noticed that we were near the notorious prison of Spielberg. All members from the East and Italy appeared well acquainted with it, while it had no echo in the western countries like France or England. The Spielberg was in fact a sort of university for all patriots of the different nationalities of the Austrian Empire.

The third meeting under my chairmanship was held in Istanbul and was a cause of considerable anxiety for the Executive Committee, and me, because during the organization of the meeting the pharmaceutical firm, which had agreed to be the chief supporter, suddenly collapsed. We had previously decided to have a rotation of pharmaceutical firms as main sponsors of the meetings, so as to ensure a maximum of independence, the firm in question (Fidia) would have come in rotation from the previous one Pfizer. During the spring of 1993 we had to find quickly a substitute, as many arrangements and economical engagements had already been take. Fortunately Pfizer was asked to come in and very generously supported us.

The meeting was held in a beautiful site, the Tarabya Hotel where from our rooms we could admire the ships coming through the Bosporus. The social evening  – thanks to the generous cooperation of the Italian Ambassador and Consul – was held in the Italian Consulate, Palazzo Venezia, originally the Venetian Embassy to the Sultan of Istanbul.   

For some organizational reason I was asked to chair Neurodiab until the meeting in Düsseldorf where I left the chairmanship in the very prestigious and efficient hands of Arnold Gries while I was elected Secretary and so continued to have a full involvement in the running of the Group, always helped by the very dedicated work of my co-worker Vincenza Spallone.

On leaving the chair I was happy to leave a very lively scientific group, with a solid structure and a particularly open and friendly atmosphere. For all this I was most grateful to the Executive Committee within which we had a most satisfactory cooperation through all the most rewarding, if occasionally difficult, years, and especially to the constant lucid, support and encouragement of John Ward, the very friendly and illuminating cooperation of Peter Watkins, Janik Hilsted, and the solid authority of Arnold Gries (a curious note in the composition of the Executive Committee was the presence of two English catholics, one Danish catholic, one Italian catholic and a German lutheran).

There was some discussion on whether to have a Neurodiab meeting in 1994 as the third International Meeting on Neuropathy was to be held in Japan in 1994. I strongly insisted the Neurodiab meeting should be held, both because many people would not be able to go to Japan and because our members expected it and should not be discouraged in their allegiance. The proposal was accepted by the Executive Committee.

The fourth meeting was thus held in Düsseldorf, perfectly organized by Arnold Gries and Dan Ziegler and was very well attended and a great success. The four lectures of the meeting were published as a Mini-Symposium in the journal Diabetic Medicine, through the offices of Andrew Boulton then Editor of the Journal.

The status of Neurodiab was increasing and we were asked to produce a State of the Art Symposium for the EASD Meeting in Düsseldorf in 1994. The main lines were discussed at the Istanbul EASD meeting by myself with Arnold Gries and Michael Berger of the EASD Organizing Committee. The Symposium included after my introduction, presentations by David Tomlinson on the biochemical pathogenesis of diabetic neuropathy, by Dan Ziegler on diagnosis, staging and epidemiology, by me and Simona Frontoni on the symptomatic treatment of autonomic neuropathy, by P.K. Thomas on painful diabetic neuropathy, and a round table on diabetic neuropathy treatment with John Ward, K.F. Hansen, H.M.J. Krans, and Solomon Tesfaye. The Symposium was very well received, to the satisfaction of the EASD. The Editor of Diabetes Nutrition and Metabolism, the official journal of the Italian Society of Diabetology, accepted to publish the Symposium in full.

The fifth meeting was held in Stockholm in 1995, organized locally by Göran Sundkvist, always a very active and friendly Neurodiab member, in a very pleasant location in a thermal hotel in Salstjobaden. The meeting was introduced by a lecture by Peter Watkins on autoimmunity of diabetic neuropathy and featured an ample Symposium on nerve regeneration. It proved a particularly agreeable and successful meeting.

The sixth Neurodiab meeting was held in Baden near Vienna with an increasing number of papers from the US and a large presence of eastern Europeans. On the suggestion of John Ward, who had heard from Peter Watkins of a Symposium in London of non diabetologist scientists on pain, we organized a Mini Symposium on pain chaired by P.K. Thomas and delivered by S.P. Hunt from Cambridge, C. Stucky from Wurtzburg, and D. Yarnitsky from Boston.

The seventh Neurodiab was held in conjunction with the 4th International Meeting on Neuropathy in Noordwijkerhout (The Netherlands). Neurodiab was very amply represented both in the Organizing and the Scientific Committees, being the Chairman of Neurodiab, David Tomlinson, also the Chairman of the Scientific Committee.

The eight Neurodiab meeting was held in Sitges near Barcelona. I was asked to keep the role of Secretary for a further year, and so I was engaged in the meeting organization. This was opened by a Mini-Symposium on the evaluation of reinnervation given by J. Jacobsen from Aarhus, Vera Bril from Toronto, and Henning Andersen from Aarhus.

With this Meeting I concluded my 8 years engagement in the founding and running of Neurodiab, with a feeling of gratitude to all members of the Executive Committees and all members of this brilliant scientific group. I feel now a great sense of achievement, seeing how active and flourishing Neurodiab is in its 25th year and how the atmosphere of friendly cooperation, integrity and dedication to our basic and clinical scientific goals, which we worked for at its founding, is unchanged.

Among the US scientists who were a regular and important presence in Neurodiab there was Peter Dick a sort of father figure probably the highest authority in neuropathy in his country, Aaron Vinik whose imaginative and brilliant contributions animated our discussions, Anders Sima, and Vera Bril from Canada. One should also note the constant significant contributions from Nigishi Hotta from Japan.

In the course of my engagement in Neurodiab I could follow the rise and fall of a number of promising drugs for the pathogenetic treatment of diabetic neuropathy like aldose reductase inhibitors. We would all have liked to see some form of effective pharmacologic treatment of diabetic neuropathy but this was not to be and we leave it to our successors to find it…. perhaps”.

Guido Menzinger