In the treatment of hyperlipidemia, when to begin and end therapy is important. In recent years, potent anti-hyperlipidemia drugs have been widely used, and the results of many intervention trials have shown that combinations of diet, exercise and drug therapies are effective for the primary and secondary prevention of coronary heart disease. The present paper summarizes these trials; introduces the therapy guidelines for adult hyperlipidemia established by Japan Atherosclerosis Society in 1997; and discusses the drugs for hyperlipidemia.
(Internaml Medicine 39: 765-772, 2000)

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Hypertension is the most common complication of chronic renal insufficiency (CRI) and it accelerates the rate of progression of most forms of CRI. Several large clinical trials have clearly demonstrated the efficacy of antihypertensive treatment for prevention of progression of renal failure. Angiotensin-converting enzyme (ACE) inhibitors may have therapeutic advantages. However, large scale trials include a variety of chronic renal diseases, and the origins of renal diseases are quite diverse. Moreover, the differences in sex, age, race have not been considered. Based on these trials, it was concluded that blood pressure control is the most effective means for the prevention of deterioration of renal dysfunction. Consistent with this view, our recent preliminary data provide evidence that aggressive blood pressure control using self-reported blood pressure values measured by a home blood pressure device is promising to arrest the progression of renal failure in Japanese patients with CRI.
(Internal Medicine 39: 773-777, 2000)

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Objective This prospective pilot study was conducted to compare the usefulness of measuring fecal lactoferrin (Lf) to that of fecal occult blood (FOB) test for detection of colorectal diseases.
Patients and Methods The subjects were 351 patients who underwent colonoscopy. A fecal sample was obtained on the day before colonoscopy. Fecal Lf was measured by enzyme-linked immunosorbent assay. The FOB test was performed by combined assay (latex agglutination) of hemoglobin and transferrin.
Results The specificities of the fecal Lf and FOB tests were the same (88.7%). For patients with colorectal cancer (13), colorectal polyp (69), ulcerative colitis (18), Crohn's disease (13), non-specific colitis (8), internal hemorrhoids (60), colon diverticulum (27), and miscellaneous diseases of the colon (10), the rates of positivity for fecal Lf were 7/13, 14/69, 12/18, 7/13, 4/8, 22/60, 8/27, and 6/10, respectively. The corresponding rates for FOB were 8/13, 12/69, 11/18, 4/13, 4/8, 9/60, 2/27, and 1/10. For patients with internal hemorrhoids, the rate of positivity for fecal Lf was significantly higher than that for FOB. In other disease groups, there was no significant difference in the rate of positivity between fecal Lf and FOB.
Conclusion These findings suggest that measurement of fecal Lf is as useful as FOB in detecting colorectal diseases.
(Internal Medicine 39: 778-782, 2000)

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Objective Evaluation of metabolic states and chronic complications is essential for maintaining a high quality of care for diabetic patients. We have assessed the quality of care in routine outpatient clinics for diabetic subjects in our university hospital, and compared with those in a newly introduced standardized clinic to evaluate the new care system.
Methods The quality of care was assessed by the chart review in 1995, and compared with those from 1996-1997 in the "Diabetes Follow-up Clinic" which is systematically designed for the standardized care.
Patients The subjects were recruited among 860 patients who visited the outpatient clinic in July and August of 1995 with a diagnosis of diabetes or glucose intolerance. Six hundred seventy-two patients whose follow-up period had been more than 6 months with clinically diagnosed dia