【背景と目的】 脳血管障害に起因する片麻痺患者が多く入院しているリハビリテーション病院では, いかに転倒・転落事故を予防するかは重要な課題である. 【対象と方法】 2004年1月1日から6月末日までの半年間に当院に入院していた脳血管障害患者についてのインシデント, アクシデントレポートの中で, 54名, 合計75件の転倒・転落事故について検討した. 【結果】 ベッドサイドやトイレで転倒したり尻餅をつく事例が65%を占めており, 60歳代以上の高齢者に多い傾向がみられた. アセスメントスコアは危険度II, IIIと危険度の高い例が大半であった. 高次脳機能検査では78%で何らかの障害を有しており, 注意障害, 半側空間無視, 構成失行, 痴呆, 見当識障害, 動作維持困難が多かった. 左片麻痺例では, 2回以上転倒・転落する比率が右片麻痺例より有意に多かった. 【結語】 脳血管障害患者の転倒・転落の危険因子として高次脳機能障害は重要である.

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Backgrounds & Aims : Diabetic retinopathy is a major cause of new-onset blindness among diabetic adults that is characterized by increased vascular permeability, tissue ischemia, and neovascularization. To clarify the molecular mechanism responsible in the pathogenesis, it is important to understand the entire transcriptome of the retina tissue of multiple organisms. Methods : Since the genes responsible for the development of diabetic retinopathy might also be expressed in pancreatic β cells and play a crucial role in the regulation of insulin secretion, we compared the sequences with those identified in rat pancreatic islets after removal of house-keeping genes. Results : In the present study, we isolated and analyzed 1,000 cDNA sequences from rat retina as expressed sequence tags (ESTs). Nucleotide and peptide database searches found that 390 of the sequences represented known rat genes and an additional 266 sequences corresponded to ESTs identified in other tissues or cells. 141 of the sequences were not related to any of the sequences deposited in the databases. Conclusions : 123 commonly expressed genes were identified in the two tissues, all of which should be useful in studies of the development diabetes mellitus and retinal complications and possible therapeutic targets.

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Background and Aims : Although serum or plasma thrombomodulin (TM) was reported to be increased in various diseases with vascular injuries, blood TM was also shown to be influenced by renal function. In this study, we determined whether serum TM (sTM) could be a marker of vascular injury in patients with myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA)-associated vasculitis, in which kidneys are often affected. Methods : Thirteen patients with MPO-ANCA-associated vasculitis were investigated and 43 patients with chronic glomerulonephritis (CGN) served as a control. sTM was measured by one-step sandwich enzyme immunoassay method. Results : A significant positive correlation was found between sTM and serum creatinine (sCr) (sTM=2.24×sCr+2.16, r=0.91, P<0.001) in patients with CGN. In order to correct sTM for renal function, we calculated corrected sTM according to the following formula : corrected sTM (%)=[measured sTM/expected sTM at the measured sCr]×100=[sTM/(2.24×sCr+2.16)]×100. Patients with MPO-ANCA-associated vasculitis tended to have lower levels of corrected sTM before treatment compared to patients with CGN, but not significantly (86.8±23.2% vs. 98.7±18.3%, ANCA vs. CGN, P=0.12). Corrected sTM was increased significantly within 1 month after the beginning of treatment (145.7±46.9%, P=0.008, vs. before treatment in each patient). In remission, corrected sTM returned to the same levels of CGN (104.5±38.6%, P=0.03, vs. within 1 month in each patient). Conclusions : These results showed that sTM corrected for renal function does not simply reflect disease activity in MPO-ANCA-associated vasculitis.

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Background and Aims : The use of Complementary and Alternative Medicine (CAM) may increase the patient's will to fight the disease and has some advantageous effects. However, it may also have the disadvantages of financial burden and side effects. The purpose of this study was to clarify the use of CAM in Japanese patients with liver disease. Methods : An anonymous questionnaire was administered to 500 outpatients in the Liver Disease Department in Gunma prefecture in east Japan, from August to June 1999. Results : Among 405 patients, 267 (65.9%) had experienced CAM, with 153 patients (37.8%) using it at that time. Among 267 patients who had experienced CAM, only 16.5% patients had consulted a doctor or nurse about it. The subjective evaluation as “effective” of CAM was only 10-30% in each therapy. Seven of 267 patients (2.6%) reported that their physical condition deteriorated due to CAM. The maximum difficulty in using CAM was “expense”. Conclusion : Only a few patients consults a doctor or nurse about CAM. As for most CAM, the patients' subjective evaluations were low, and some side effects were reported. These suggests that patients with liver disease should learn the right and safe way to use CAM.

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Obstructive sleep apnea syndrome (OSAS) is a problem of obese patients. Leptin prevents fat deposition in adipose tissue and insulin reduces plasma glucose, but levels of these hormones are sometimes high in obese patients with OSAS. Thus, leptin and insulin do not function properly in OSAS, and increase resistance to leptin and insulin may cause paradoxical state, that is, leptin and insulin resistance. The present study investigates the rapid effect of nasal continuous positive airway pressure (nCPAP) ventilation on serum leptin and insulin levels in OSAS. Levels of plasma leptin and insulin at four sampling points a day decreased in OSAS patients (^*p<0.05, n=10) by nCPAP. Nocturnal mean-nadir arterial oxygen desaturation (nmSaO₂) correlated with plasma leptin levels in OSAS patients (^*p<0.05, n=10). Nasal CPAP did not affect circulating soluble leptin receptor levels in OSAS patients. These findings indicate that leptin and insulin are related to nocturnal hypoxia in OSAS patients, and that nCPAP have a possibility of improving leptin and insulin resistance.

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A 43-year-old diabetic woman was admitted in the 15th week of her first pregnancy. When HbAlc levels were 8.2%, we began diet therapy and continuous subcutaneous insulin infusion (CSII) therapy. The HbAlc levels subsequently ranged from 6.2 to 6.7%. She was delivered without complications of a healthy male infant (3120g) in the 38th week. Metformin was then administered. Six months later she was diagnosed as being in the 21st week of pregnancy. We changed from metformin to CSII therapy immediately. The HbAlc levels had ranged from 6.0 to 6.4% before the CSII therapy and from 5.8 to 6.3% after the CSII therapy during the entire second pregnancy. A macrosomia delivery (4070g) occurred in the 37th week. Although glycemic control was better during the 2nd pregnancy than the 1st pregnancy, metformin use until the 21st week may have induced macrosomia.

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A-67-year-old man developed severe hypoxemic pneumonia and acute renal failure with nephrotic syndrome, associated with Mycoplasma pneumoniae infection. Antibody- or immune complex-mediated mechanisms appeared likely, since there was apparent deposition of immunoglobulin (IgM) and complement components (Clq, C3) in the glomeruli, although light microscopy of renal biopsy tissue revealed minor glomerular abnormalities with tubulointerstitial change. The initial antibiotic treatment was not appropriated, therefore possibly allowed the progression of the disease. Early diagnosis and appropriate therapy are essential to the management of Mycoplasma pneumoniae infection

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