Control of the blood sugar level is the fundamental treatment for diabetes mellitus. However, it is extremely difficult to effectively control the blood sugar level over a long period, during which complications such as neuropathy, retinopathy and nephropathy may develop. Impaired polyol (sorbitol) metabolism is considered to be a cause of neuropathy among these complications of diabetes. Diabetic neuropathy occurs in a relatively early stage. Its incidence increases with the prolongation of the diabetic condition, and the plight of the patients suffering from extensive tissue damage is profound. In this study, assessment was made regarding the effects of the aldose reductase inhibitor epalrestat, which is expected to reverse the pathogenic mechanism of diabetic neuropathy, on symptoms of neuropathy, erythrocyte sorbitol level, and threshold of vibratory sensibility.
[Subjects] The subjects were 7 male and 4 female outpatients who consistently exhibited spontaneous pain, dysesthesia, and autonomic disorders, or showed abnormalities in the erythrocyte sorbitol level and threshold of vibratory sensibility, and were taking 50 mg of epalrestat (1 tablet) before each meal for at least 6 months. The period of investigation was from October 1992 to March 1993.
[Methods] The subjects were explained about the aim of the study and their informed consents were obtained. They were inquired about symptoms while they were waiting for medicine in the Drug Information Management Office. Data concerning the erythrocyte sorbitol level and threshold of vibratory sensibility were obtained from charts.
[Results and Conclusions] 1) Improvement rates by subjective symptom: 75.0% for spontaneous pain; concerning dysesthesia, 57.1% for numbness of hands and feet, 40.0% for coldness of extremities, 33.3% for hot flushes, 75.0% for hypoesthesia, and 50.0% for itching; concerning autonomic disorders, 75.0% for dizziness on standing up, and 33.3% for abnormal perspiration. 2) Effects by the duration of illness: Improvements were greater as the duration of illness was shorter. 3) Erythrocyte sorbitol level: Improvements were generally unremarkable. 4) Threshold of vibratory sensibility: Fair improvements were observed in general. Neuropathy occurs from a relatively early stage of diabetes, and chronic hyperglycemia is considered to be the most important factor. Regulation of the blood sugar level is essential for the treatment, but if it is impossible, the pain and discomfort of patients may be alleviated by epalrestat, and the administration should be started as early as possible since, in this study, the drug was more effective as the duration of illness was shorter.

[Introduction] Fluticasone propionate (FP), an inhaled corticosteroid, has almost twice as much clinical efficacy as Beclomethasone dipropionate (BDP) in the management of asthma. The inhalation of FP dry powder by using a handy and portable inhalator is effective for young and middle-aged patients with bronchial asthma. However, the inhalator are not always easy for elderly patients to operate because it requires some manual dexterity and a knack for quick inhalation.
[Methods] A total of 47 outpatients aged 65 years or above who had achieved a stable asthmatic condition were enrolled for this study, and changed the drugs from BDP to FP. The amount of FP to be taken at one time was equivalent to half the dose of BDP. Twelve check points of inhalation skills were repeatedly taught until patients understoodfully. We checked these points after 2-4 weeks and 8 weeks. We used a questionnaire to survey the patients' impression of FP and its adverse effects. We also evaluated peak flow values (PEF) in the morning and at night, results of pulmonry function tests and asthmatic grades.
[Results] We found clear weak points for the 12 skills in the elderly patients. PEF both in the morning and at night significantly improved after 2-4 week treatment with FP, but pulmonary function tests found no statistically significant change. Eventually 71.4% of the patients in the 65-74 year age range and 50.0% of those of 75 years or above hoped to continue to receive FP therapy. The total number of the patients with adverse effects was 14 (29.8%): These were 7 cases of dryness in the mouth, 5 cases of hoarseness and 2 cases of nausea and vomiting.
[Discussion] Although we confirmed the clinical usefulness of FP in elderly patients with asthma, we must recognize that it requires much time and labor for the eldrely to get used to FP inhalation and that it is important to give them repeated instruction.