Objective: To examine the potential for mealtime boluses of biphasic insulin aspart 70 (BIAsp70); 70% rapidacting fraction and 30% intermediate-acting fraction, in reducing the subsequent increase of blood glucose (BG) after a meal rich in protein and fat. Materials and Methods: The subjects were 25 children with type 1 diabetes mellitus (T1DM) who were currently on multiple daily injections. They were divided into two groups based on lunchtime insulin use, i.e. 20 using rapid acting insulin (group Ra) and 5 using BIAsp70 (group BIAsp70). The BG profiles before and up to 6 hours after taking the two types of lunch were compared between the two groups. Results: The postprandial changes of the BG concentrations (Δ%) 1, 2, 3 and 6 hours after Japanese-style meals in the Ra group were 14, 15, 10 and -8%, and those in the BIAsp70 group were -8, 62, -11 and -30%. The Δ% reduction after 3 and 6 hours were greater in the BIAsp70 group than in the Ra group. On the other hand, the Δ% after the protein- and fat-rich meals in the Ra group after 1, 2, 3 and 6 hours were 97, 63, 49 and 34%, compared with 69, 43, 40 and -24%, respectively, in the BIAsp70 group. BG decreased to below the preprandial level and the Δ% was negative after 6 hours in the BIAsp70 group compared with the Ra group. Conclusions: Mealtime boluses of BIAsp70 might be useful to control postprandial glycemia after 3 hours or more, in children with T1DM, especially after a protein- and fat-rich meal.
Purpose. To retrospectively investigate the usefulness of various types of reinforcement materials on reoperation for spontaneous pneumothorax. Patients and Methods. From October 2002 to November 2012, 325 cases of spontaneous pneumothorax, who were under the age of 40, underwent video assisted thoracic surgery (VATS). We used a single type of reinforcing material in 241/325 cases. Fleece-coated fibrin glue, PGA sheet and oxidized cellulose were used in 168, 66 and 7 cases, respectively. Re-operation was carried out in 15 cases and fleece-coated fibrin glue, PGA sheet and oxidized cellulose were used in 8, 5 and 2 cases, respectively. Results. Using the fleece-coated fibrin glue, adhesion was possible for mild to moderate, re-operation with VATS. Strong adhesion was achieved using the PGA sheet. However, adhesiolysis was difficult with the VATS. One case of oxidized cellulose melted during the early postoperative period. Re-operation using VATS was possible. Conclusion. Fleece-coated fibrin glue is useful as a reinforcing material in consideration of re-operation for spontaneous pneumothorax.
We encountered a patient with posterior fossa arachnoid cyst-induced dizziness. The patient was a 72-year-old female who visited the internal medicine department with the chief complaints of persistent dizziness and vomiting for one month. Subdural hygroma was noted in the cerebellopontine angle on head CT, but it was considered an age-related change after surgery for an aneurysm, and the cause of the complaints could not be identified. Thus, the patient was referred to the otolaryngology department on the 22nd day after the first examination at the internal medicine department. On the first examination at the otolaryngology department, leftward spontaneous nystagmus was observed in the primary gaze, and bilateral fixation nystagmus was noted. Direction-changing upbeat nystagmus was noted on a head nystagmus test, and vertical downbeat nystagmus was noted when the head position was changed from recumbency to sitting in a positional nystagmus test. On head MRI, the brain stem and vermis were compressed by a cyst. Compression by an arachnoid cyst was identified as the cause based on close neurological and neurotological examinations.
Between December 2008 and October 2012, four consecutive patients with spontaneous esophageal rupture underwent surgery at Nihon University Itabashi Hospital (Tokyo, Japan). All 4 patients were treated by anterolateral thoracotomy with video-assisted thoracoscopic surgery in the right half lateral decubitus position. Three patients underwent intraoperative placement of a thoracostomy tube in the right-side thoracic cavity. We administered sivelestat sodium hydrate from the intraoperative period for all cases, and also administered carperitide postoperatively in one case. All of the patients underwent the surgery safely with no serious postoperative complications. Anterolateral thoracotomy with video-assisted thoracoscopic surgery in the right half lateral decubitus position helps to reduce the operative time and ensures a good view of the surgical field. In addition, we considered this to be a useful method in promoting quick recovery from advanced invasive surgery to the use of sivelestat sodium hydrate, carperitide and insertion of a contralateral thoracostomy tube.