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Volume 59, Issue 6
Displaying 1-7 of 7 articles from this issue
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Case Reports
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Toshio Hosaka, Yui Nagase, Azusa Sawai, Minori Ishitobi, Mai Ishimoto, ...2016 Volume 59 Issue 6 Pages 401-406
Published: June 30, 2016
Released on J-STAGE: June 30, 2016
JOURNAL FREE ACCESSThe percent of hemoglobin A1c (HbA1c) is one of the criteria to diagnose the presence of diabetes or to indicate the need for blood glucose control during treatment. Recently, the method of high performance liquid chromatography (HPLC) has been commonly used to analyze the percent of HbA1c. The glycated Hb of hemoglobinopathy has a different electrical charge and eluates at a different phase from normal HbA1c in the HPLC column. Thus, almost all hemoglobinopathy patients, similar to this case of a mixed Asian-Caucasian American patient have been found to have low HbA1c levels compared to those patients that are indicated to undergo blood glucose control by the HPLC method. The HbA1c levels of this patient were high and so were the average of blood glucose levels according to the latex coagulating method. A genetic analysis showed presence of a heterozygous β-globin miss-sense mutation [121Glu→Gln] which is designated as hemoglobin D (HbD) Los Angeles. In Japan, the number of cases of with abnormal HbD patients have been rare until now. However, they are more commonly observed in Western countries and thus such cases are expected to increase due to the progress of internationalization. We have to evaluate the treatment of abnormal HbD patients not based on the levels of HbA1c, but instead based on the levels of glycoalbumin or the blood glucose.View full abstractDownload PDF (476K) -
Tadamasa Ohashi, Yuri Ariyama, Eri Hayakawa, Miki Nagasawa, Toru Sugiy ...2016 Volume 59 Issue 6 Pages 407-413
Published: June 30, 2016
Released on J-STAGE: June 30, 2016
JOURNAL FREE ACCESSA 49-year-old male with an impaired consciousness was transported to our emergency department 14 days after undergoing acupuncture therapy. He was found to have a trapezius abscess and diabetic ketoacidosis (Glu 643 mg/dL, pH 6.916, total ketone body 20600 μmol/L). Rehydration and intravenous insulin infusion restored his consciousness. The abscess was effectively treated with intravenous antibiotics, debridement, and negative pressure wound therapy. The blood glucose levels were maintained by intensive insulin therapy, followed by a combination of basal insulin and oral hypoglycemic agents. In this case, an immunocompromised state due to untreated diabetes (HbA1c 15.1 %) was considered to be the cause of a trapezius abscess that had been induced by acupuncture, and which triggered the onset of diabetic ketoacidosis. All health professionals, including acupuncturists, should therefore consider the risk of infection from invasive medical practices, such as acupuncture, in patients suffering from poorly controlled diabetes.View full abstractDownload PDF (647K) -
Rie Murakami, Toshikatsu Shigihara, Tomoyuki Uchida, Keishi Tsuzuki, T ...2016 Volume 59 Issue 6 Pages 414-420
Published: June 30, 2016
Released on J-STAGE: June 30, 2016
JOURNAL FREE ACCESSA 49-year-old man was found to have type2 diabetes mellitus two years previously. However, he had not received any treatment for this condition. He underwent the extraction of his left maxillary canine due to dental caries. Two weeks after the extraction, he visited our hospital complaining of swelling of his left eye. The laboratory data showed poor blood glycemic control (HbA1c 15.3 %). Magnetic resonance angiography and computed tomography showed left orbital cellulitis and septic pulmonary embolus and vision impairment (left 0.1). Since K. Pneumoniae was detected from his blood and the sputum culture, and from the culture of the abscess collected from the tooth extraction wound, we considered that odontogenic orbital cellulitis had led to the development of sepsis. Continuous insulin infusion and antibiotic therapy in addition to respiratory and circulatory management improved his general condition, and his vison recovered to 1.2. Orbital cellulitis is associated with a high risk of vision loss; thus an early diagnosis and prompt treatment are essential. This is the only published report of odontogenic orbital cellulitis caused by K. Pneumoniae in a patient with diabetes. We herein report the case of a type2 diabetes mellitus patient with orbital cellulitis whose eyesight recovered due to early treatment.View full abstractDownload PDF (1320K) -
Daisuke Sanoyama, Yuji Yamaguchi, Mototsugu Nagao, Akane Nogami, Naomi ...2016 Volume 59 Issue 6 Pages 421-428
Published: June 30, 2016
Released on J-STAGE: June 30, 2016
JOURNAL FREE ACCESSMitochondrial diabetes mellitus (MDM) presenting with a mitochondrial DNA 3243 (A-G) mutation is most frequently observed in patients with diabetes caused by a genetic defect. Clinical manifestations include short stature, the absence of obesity, young-onset, and the maternal inheritance of diabetes. MDM is strongly associated with neurosensory deafness, which is often overlooked during routine medical care. In this study, we reviewed three cases of MDM presenting with a mitochondrial DNA 3243 (A-G) mutation. All three patients had mild to severe neurosensory deafness. However, the clinical manifestations in these patients were not consistent, with ambiguity in regard to the maternal inheritance of diabetes in some and the absence of obesity. The clinical manifestations of MDM are varied; thus, a through examination, such as a mitochondrial DNA mutation test, seems desirable in cases where diabetes is complicated with neurosensory deafness or in which there is a family history of deafness.View full abstractDownload PDF (858K) -
Hiromi Hamamoto, Ikki Shimizu, Motoaki Sasaki2016 Volume 59 Issue 6 Pages 429-434
Published: June 30, 2016
Released on J-STAGE: June 30, 2016
JOURNAL FREE ACCESSTwo women developed autoimmune type 1 diabetes with ketoacidosis concomitant with pregnancy. Patient 1 was in her teens and was found to be pregnant several weeks after beginning to experience excessive thirst and polydipsia. She had lost weight, and given her laboratory findings (hemoglobin A1c (HbA1c) 12.5 %, plasma glucose 790 mg/dL, positivity for anti-glutamic acid decarboxylase (GAD) antibody, and ketoacidosis), we diagnosed her with autoimmune type 1 diabetes. Patient 2 was in her 30s and was diagnosed with type 1 diabetes based on her laboratory findings (HbA1c 10.1 %, plasma glucose 599 mg/dL, and positivity for GAD antibody). Her pregnancy was discovered three months after this diagnosis. Both patients developed autoimmune type 1 diabetes concomitant with pregnancy, and interestingly, they both had the HLA-DR9 allele. Since most cases of acute-onset type 1 diabetes during pregnancy are the fulminant type and develop in the third trimester, we considered these cases to be rare. Care must be taken when diagnosing type 1 diabetes in pregnant patients, as the symptoms of morning sickness and ketoacidosis are very similar.View full abstractDownload PDF (531K) -
Daigo Suemaru, Jun Maruyama, Takahiro Ishizuka, Tetsu Hashida, Yasuko ...2016 Volume 59 Issue 6 Pages 435-442
Published: June 30, 2016
Released on J-STAGE: June 30, 2016
JOURNAL FREE ACCESSAn 86-year-old woman was admitted to our hospital in an emergent condition due to repeated vomiting and hematemesis. She had been diagnosed with diabetes mellitus at 64 years of age. She had an HbA1c level of 12.4 % with glimepiride (2 mg), pioglitazone (30 mg), and sitagliptin (100 mg), and her body mass index was 17.3 kg/m2. Four days prior to her admission, glimepiride and pioglitazone had been exchanged for dapagliflozin (5 mg). The laboratory findings at admission were as follows: plasma glucose, 299 mg/dL; arterial blood gas, pH 7.093; HCO3-, 8.1 mmol/L; and 3-hydroxybutyric acid, 15420 μmol/L. She was diagnosed with diabetic ketoacidosis (DKA), and continuous venous insulin infusion was started for treatment. Her excretion of urinary C-peptide was decreased (2.2 μg/day). She also had an acute myocardial infarction (AMI), and percutaneous coronary intervention was performed on the day of admission. Given these observations in the present case, physicians should carefully take into consideration the patients' pathological condition and lifestyle before prescribing novel selective inhibitors of sodium glucose co-transporter 2 (SGLT2 inhibitor).View full abstractDownload PDF (675K)
Proceeding of the Local Societies
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2016 Volume 59 Issue 6 Pages 443-461
Published: June 30, 2016
Released on J-STAGE: June 30, 2016
JOURNAL FREE ACCESSDownload PDF (807K)
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