We studied exercise endurance (anaerobic threshold; AT) in type 2 diabetic patients in relation to atherosclerotic change measured as intima-media thickness (IMT) of the carotid artery and other parameters such as the coexsistence of hypertension (HT), body mass index (BMI), glycemic control, fasting serum insulin, and C-peptide (sCPR) concentration. A strong negative correlation was observed between AT and HT, BMI, and s-CPR through multiple regression analysis. IMT was correlated with HT, HbA_1c or s-CPR except for age. In patients with AT exceeding 4 Mets (n=54), IMT was significantly (p<0.05) lower than in other patients with AT less than 4 Mets (n=48). This data suggests that a lack of exercise is related to atherosclerosis, probably through the existence of hypertension, obesity, and/or insulin resistance.

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We have reported that blood interleukin-6 (IL 6) and interleukin-8 (IL 8) are increased in diabetes ketoacidosis. Recently, hepatocyte growth factor (HGF) has been structurally analyzed as a factor in promoting regeneration of the liver. HGF was also resolved to be cytokine with various functions.
We considered the potential of blood HGF increase in diabetic ketoacidosis and blood HGF for ketoacidosis patients. HGF of hyperglycemia patients not presenting ketosis in their serum was measured as a control.
HGF of 12 hospitalized diabetic ketoacidosis patients and 8 hyperglycemia patients was measured from frozen stored serum 6, 12, 24, and 48 hours after insulin treatment using enzyme immunoassay (EIA).
HGF of 12 hospitalized diabetic ketoacidosis patients, was 1.29±0.99ng/ml on admission, significantly higher (p<0.05) than HGF of hyperglycemia patients at 0.35±0.15ng/ml. HGF in the serum of ketoacidosis patients 6, 12, and 24 hours after insulin treatment was also significantly higher (p<0.05) than HGF of hyperglycemia patients. HGF gradually decreased after ketoacidosis treatment, compared to HGF from the serum of hyperglycemia patients where there was no significant difference between admission and 6, 12, 24, and 48 hours after treatment.
High HGF was detected in the serum of 12 diabetes ketoacidosis patients on admission. Considering that HGF of hyperglycemia patients was 0.39 or under, which is normal, we suppose that ketoacidosis increased blood HGF. Although the mechanism of this increase HGF is not clear, acute failure of metabolism produces HGF from endothelial cells.

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A 73-year-old man admitted for right eyeball swelling, high fever, and systemic edema had experienced symptoms from 3 days after admission to another hospital due to resupination and appetite loss, after which he was transferred to our hospital. He refused treatment for diabetes mellitus for 8 years. Laboratory data on admission examination revealed increased white blood cells and serum C-reactive protein, decreased platelets, and high blood glucose.
Although antibiotics (CFPM 4g/day, CLDM 1200mg/day) administration improved the number of white blood cells and C-reactive protein concentration, they did not become normal. Ophthalmectomy of the right eyeball was conducted on day 10 after admission because abscess formation in the eyeball was found by ultrasonography. Enterobacter agglomerans was detected from the vitreous humor of the extracted eye. Inflammation improved after surgery and the patient was discharged on day 38 after admission. This is, to our knowledge, the first report of panophthalmitis caused by Enterobacter agglomerans.

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We report 2 patients with hypercortisolism, 1 induced by Cushing's syndrome and the other by preclinical Cushing's syndrome.
Case 1: A 65-year-old woman admitted for evaluation of a left adrenal tumor discovered by computed tomography (CT) for the further study of hypertension showed no clinical evidence of Cushing's syndrome.
Case 2: A 66-year-old woman admitted for leg fatigue and edematous face had moon face, central obesity, and ecchymosis.
In both patients, the diurnal rhythm of plasma cortisol was absent, an overnight 8 mg dexamethasone test showed no suppression of the plasma cortisol level, and plasma ACTH was supressed. From these findings and imaging examinations, we diagnosed the patients as preclinical Cushing's syndrome (Case 1) and Cushing's syndrome (Case 2) due to left adrenal adenoma. In both patients, 75g OGIT administered before and after surgical treatment showed improved glucose tolerance from DM to IGT. In the insulin resistance evaluation with euglycemic hyperinsulinemic glucose clamping, the metabolic clearance rate (MCR) for glucose improved from 4.2 to 10.1ml/kg/min (Case 1) and from 3.8 to 5.4ml/kg/min (Case2).

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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