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Volume 46, Issue 2
Displaying 1-11 of 11 articles from this issue
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[in Japanese]2003 Volume 46 Issue 2 Pages 101-105
Published: February 28, 2003
Released on J-STAGE: March 02, 2011
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Lessons from the Okamoto Diabetes StudyYasuo Kida, Yoshiko Murata, Jirou Ooi, Masayoshi Sakaguchi, Masayuki T ...2003 Volume 46 Issue 2 Pages 107-115
Published: February 28, 2003
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSThe role of diabetic macrovascular complications of the heart, brain and lower extremities on the prognosis and cause of death were investigated in 1, 122 type-2 diabetes patients enroled in the Okamoto Diabetes Study. Using noninvasive examinations and the same diagnostic criteria, ischemic heart disease (IHD), cerebral infarction (CI) and arteriosclerosis obliterans (ASO) were evaluated upon enrollment in this study. The number of macroangiopathies present (MA score) was used as a marker of generalized atherosclerosis. Life prognosis and cause of death were analyzed as of Jun, 2001. Of the 1, 122 subjects, 129 subjects died within a mean observation period of 5.2 years. Cardiovascular disease (28.7%), cancer (26.4%) and infection (11.6%) were the three major causes of death. Using the Cox regression model, adjusted for age and duration of diabetes, each macroangiopathy was found to be an independent determinant of life prognosis. The prognosis was poor, especially in subjects associated with IHD and/or ASO. The MA score was also closely correlated with cardiovascular-related death. The mortality rate per 1, 000 person-years in subjects with all three macroangiopathies was 23-fold higher than that of macroangiopathy-free cases. In addition, the contribution of both HbA1c levels and gender patient prognosis was suggested. Macroangiopathy complications were a predictor of patient outcome in type-2 diabetes. These results indicate glycemic control, risk factor control and the evaluation of systemic macroangiopathy using noninvasive techniques is important for the initial management of diabetes to reduce the risk of death from cardiovasclular disease.View full abstractDownload PDF (1498K) -
Haruyuki Takama, Hisako Nagasawa, Shuichi Tohyou, Takuyuki Katabami, N ...2003 Volume 46 Issue 2 Pages 117-123
Published: February 28, 2003
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSA 70-year-old woman hospitalized for muscular weakness in the extremities was found in electrocardiography on admission to have ST-segment elevation in leads II, III, aVF and V1 through V4, and inverted Twaves were seen in II, III, aVF and V2 to V6. Although no stenotic lesion was detected in emergency coronary angiography, left ventriculography showed a hypokinetic area around the apex with an ejection fraction of 31%. 123I-MIBG myocardial scintigraphy showed an extensive defect around the apex. These findings supported a diagnosis of “Takotsubo” -like cardiomyopathy.
Forty days after admission, albuminocytogenic dissociation of cerebrospinal fluid led us to diagnose Guillain-Barré syndrome as responsible for the weakness in the extremities.
Guillain-Barré syndrome may damage the sympathetic nervous system, so we concluded that abnormality of the cardiac sympathetic nervous system due to Guillain-Barré syndrome and diabetic autonomic neuropathy caused cardiac dysfunction. Diabetes complicated “Takotsubo” -like cardiomyopathy followed by Guillain-Barré syndrome is extremely rare.View full abstractDownload PDF (2097K) -
[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...2003 Volume 46 Issue 2 Pages 125-128
Published: February 28, 2003
Released on J-STAGE: March 02, 2011
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Miho Tamura, Yasuyuki Kihara, Haruhiko Murakami, Yoshihisa Hatakeyama, ...2003 Volume 46 Issue 2 Pages 129-134
Published: February 28, 2003
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSA 58-year-old man with a 12-year history of poorly controlled diabetes mellitus admitted in October 1999 for left buttock pain and swelling had had multiple skin ulcers around the bilateral ankle joints for over 5 years. Methicillin-resistant Staphylococus aureus (MRSA) had been detected from the ulcer exudate. On admission, his leucocyte count was 16, 700/μl and serum C-reactive protein (CRP) 24.6mg/dl. Computed tomography (CT) showed multiple low-density areas in the left gluteus maximus muscle. We diagnosed gluteal abscesses and conducted surgical drainage. MRSA was cultured from a sample of pus from the left gluteal abscess, exudates from the right ankle, venous blood, and urine. Surgical drainage, antibiotic therapy, and strict glycemic control with combined to provide marked clinicalimprovement. We concluded that MRSA bacteremia caused abscesses in the left gluteus maximus muscle. Because diabetics are at risk for potentially adverse reactions to immunization, strict glycemic control is important.View full abstractDownload PDF (1421K) -
[in Japanese], [in Japanese]2003 Volume 46 Issue 2 Pages 135-138
Published: February 28, 2003
Released on J-STAGE: March 02, 2011
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Shigeki Yamamoto, Hiroshi Fujimoto, Isao Morimoto2003 Volume 46 Issue 2 Pages 139-144
Published: February 28, 2003
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSWe report the cases of a mother and daughter with type 1 diabetes mellitus (DM), rheumatoid arthritis (RA) and autoimmune thyroid disease (AITD).
Case 1: A 60-year-old mother with RA at age 40 was diagnosed with type 1 I) M at age 50 due to low 8μg/day urinary C-peptide (CPR) and a positive test for glutamic acid decarboxylase antibody (GADAb). She had diffuse goiter and her autoimmune thyroid antibodies were positive. She was diagnosed with chronic thyroiditis.
Case 2: The woman's 33-year-old daughter was diagnosed with Graves' disease at age 8, and took antithyroid drugs. She had euthyroid function due to medication but had positive TSH receptor antibody (TRAb). She was diagnosed with gestational DM at age 26 and treated with insulin. She was later diagnosed with type 1 DM due to undetectable urine CPR and positive GADAb. She was diagnosed with RA at age 30.
Few familial cases combining type 1 DM, RA, and AITD have been reported. These diseases may be associated with DR 4-DQB 1*0302 antigen, which was observed in both cases.View full abstractDownload PDF (1575K) -
Hideaki Miyoshi, Katsuyuki Yanagisawa, Nobuo Masauji, Shinji Obara, Ta ...2003 Volume 46 Issue 2 Pages 145-149
Published: February 28, 2003
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSA 72-year-old man was diagnosed as having cirrhosis of the liver in 1993 and diabetes mellitus in 1996. He was prescribed two doses of mixed human insulin (22 units at breakfast and 10 units at dinner) to maintain good glycemic control. However, the patient noted several diabetic symptoms, and his plasma glucose level increased to above 28 mmol/l in October 2001. Despite a decrease in his total insulin dose, the plasma glucose level did not respond. After admission to our divisionis, his prescription was changed to four doses per day of regular and NPH insulin (a total of 190 units per day), but his plasma glucose level remained at over 22 mmol/l. Investigations at the time of admission revealed a remarkably high titer of insulin antibody (96%). When we changed his insulin from regular human insulin to Lispro, his plasma glucose level improved. After three days, his plasma glucose level was around 5.5 mmol/l, and he sometimes felt hypoglycemic in the early morning. Eventually, he no longer needed NPH insulin and his dosage was reduced to only three doses per day of Lispro (a total of 120 units per day). Examination of the specific antibodies for both human insulin and Lispro suggested that some of his insulin antibodies had reacted with an epitope where two amino acids were replaced in the structure of insulin.View full abstractDownload PDF (813K) -
[in Japanese], [in Japanese], [in Japanese], [in Japanese]2003 Volume 46 Issue 2 Pages 151-153
Published: February 28, 2003
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESS -
[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...2003 Volume 46 Issue 2 Pages 155-159
Published: February 28, 2003
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESS -
2003 Volume 46 Issue 2 Pages 161-207
Published: February 28, 2003
Released on J-STAGE: March 02, 2011
JOURNAL FREE ACCESSDownload PDF (11754K)
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