We analyzed the causes of death in 74 non-insulin-dependent diabetes mellitus (NIDDM) patients who died in Koseiren Takaoka hospital between 1982 and 1988 and compared with 334 non-diabetic dead patients.
The first cause of death in NIDDM was malignant neoplsma (35.1% of NIDDM). The second was ischemic heart disease (17.6%). The third was infection (12.2%). The ratios of cerebral infarction and diabetic nephropathy were 9.5% each. The ratios of ischemic heart disease and cerebral infarction in diabetics were twice those in non-diabetics. The tratio of uremia in diabetics wassix-fold. In patients over 61 years old, the ratios of ischemic heart disease and diabetic nephropathy were large. Nevertheless, in patients under 60 years old, the proportion of cerebral infarction was higher. The proportions of cerebral infarction and ischemic heart disease were higher in the group of long diabetic duration than in group of short duration.
Compared with past Japanese reports, the proportions of malignant neoplasma and ischemic heart disease in diabetics increased and the proportions of diabetic nephropathy and coma decreased.
This study concluded that not only the control of diabetes mellitus but also the examination of malignant neoplasma was important in management of diabetes mellitus. The proportion of the causes of death in diabetics will change with changes of the circumstances and the progress of medical treatment.

The patient was a 56-year-old male. He had a history of alcoholism since 1975 and diabetes mellitus since 1978. He was treated with insulin therapy. But the control of diabetes mellitus was very poor and he had six hypoglycemic comas attacks. He had diabetic triopathy but no symptoms of gait disturbance, dementia and incontinence. Brain computerized tomography and magneting resonance imaging revealed severe communicating hydrocephalus with mild brain atrophy.¹¹¹In-DPTA cisternography revealed retension of isotope in the ventricle after 48 hours. The pressure of cerebrospinal fluid was normal.
This case report is interesting as it suggests the relationship between normal pressure hydrocephalus and hypoglycemia.

Medical therapies, adapted to local requirements, are necessary in the field of community medicine. Generalized medical treatment is often all there is in Japan's Konsen Area, due to the large number of elderly people and a paucity of medical institutions. Kampo medical treatment is useful for elderly patients with plural diseases, and the demand for such treatment has been increasing. Therefore, we collected data on Kampo prescriptions prescribed by the doctors at the Nakashibetsu Municipal Hospital, which is the main local hospital in the Konsen Area, from 2010 to 2013. We conducted similar investigations at the Kushiro Red Cross Hospital in Kushiro city, which is centrally located in the Konsen Area, and at Asahikawa Medical University Hospital in Asahikawa, central Hokkaido. The aim of these investigations was to compare Kampo medicine use based on hospital location and size. The results can be used in community medicine to enhance the use of Kampo medicine with increase for its demand. Medical students and doctors should be educated in Kampo medicines, since their prescriptions have a significant impact on community health.

We report a case of reactive hypoglycemic coma in a 77-year-old man. Seven months after partial gastrectomy for early gastric cancer, he presented with syncopal attacks and seizure. His plasma glucose and insulin levels at coma were 18 mg/dl and 27μU/ml. Insulinoma was neglected with computerized tomography, magnetic resonance imaging and angiography. Because dietary control was insufficient, oral diazoxide therapy was done. But diazoxide did not protectthe overresponse of the insulin and reactive hypoglycemia in 75 g GTT. Octreotide (100 micrograms IM) inhibited insulin release and prevented hypoglycemia. Acarbose delayed the response of insulin butdid not inhibited insulin release. However, acarbose also prevented reactive hypoglycemia. We concluded that acarbose is an effective therapy for reactive hypoglycemic coma.

Background : This study was performed to evaluate surgical outcomes after cardiovascular surgery (including urgent surgery) in patients 85 or older. Methods : A retrospective analysis was performed on 39 patients (mean age, 86.3 years ; age range, 85-90 years) who underwent total arch replacement (n=4), ascending aorta replacement (n=4), descending aorta replacement (n=1), aortic valve replacement (AVR ; n=13), mitral valve replacement or valvuloplasty (n=3), coronary artery bypass grafting (CABG ; n=9), CABG+AVR (n=4), tumor resection (n=1) between June 2008 and December 2012 at Dokkyo Medical University Hospital. Results : Six hospital deaths occurred. One patient died due to bleeding from a ruptured descending thoracic aortic aneurysm, and another patient died due to gastrointestinal perforation from non-occlusive mesenteric ischemia (NOMI) after urgent AVR. The other deaths were related to various complications, including lung cancer, cholecystitis, myocardial infarction, and Takotsubo cardiomyopathy, during the postoperative period. Overall 30-day mortality was 2.6%, hospital mortality was 12.8%, duration of hospital stay after surgery was 41.3 days, duration of intensive care unit (ICU) stay was 3.8 days and ventilator time was 49.1 h. Twenty patients underwent elective surgery, and 19 patients underwent urgent surgery. The two groups had similar preoperative characteristics, except for the number of patients with aortic disease. No significant difference was evident in hospital mortality (26.3% vs. 5%, p=0.065) or 30-day mortality (0% vs. 5.3%, p=0.3) when comparing the two groups. However, the duration of hospital stay (58.9 days vs. 27.5 days, p=0.049), ICU stay (6.74 days vs. 1.05 days, p=0.002) and ventilator time (89.9 h vs. 8.2 h, p=0.006) was significantly longer in the urgent surgery group than in the elective surgery group. Fourteen patients (70%) in the elective surgery group and four patients (21.1%) in the urgent surgery group were able to be discharged from the hospital to their homes within 30 days after surgery. These data demonstrated that cardiovascular surgery in patients 85 years of age or older was associated with satisfactory outcomes, and outcomes associated with elective surgery were even better than those associated with urgent surgery. Conclusions : Therefore, advanced age does not represent a contraindication of conventional cardiovascular surgery. Rather, the decision for surgery should take the patient's preoperative condition, the severity of concurrent medical disease, the wishes of the patient, and the predicted functional outcomes into account.

BACKGROUND: Cleft lip and palate repair requires a deep and small surgical field and is usually performed by surgeons wearing surgical loupes. Surgeons with loupes can obtain a wider surgical view, although headlights are required for the deepest procedures. Surgical microscopes offer comfort and a clear and magnification-adjustable surgical site that can be shared with the whole team, including observers, and easily recorded to further the education of junior surgeons. Magnification adjustments are convenient for precise procedures such as muscle dissection of the soft palate. METHODS: We performed a comparative investigation of 18 cleft operations that utilized either surgical loupes or microscopy. Paper-based questionnaires were completed by staff nurses to evaluate what went well and what could be improved in each procedure. The operating time, complication rate, and scores of the questionnaire responses were statistically analyzed. RESULTS: The operating time when microscopy was used was not significantly longer than when surgical loupes were utilized. The surgical field was clearly shared with surgical assistants, nurses, anesthesiologists, and students via microscope-linked monitors. Passing surgical equipment was easier when sharing the surgical view, and preoperative microscope preparation did not interfere with the duties of the staff nurses. CONCLUSIONS: Surgical microscopy was demonstrated to be useful during cleft operations.
Cleft Lip* ; Cleft Palate ; Education ; Humans ; Microscopy ; Palate* ; Palate, Soft ; Surgeons ; Surgical Equipment

BACKGROUND: Cleft lip and palate repair requires a deep and small surgical field and is usually performed by surgeons wearing surgical loupes. Surgeons with loupes can obtain a wider surgical view, although headlights are required for the deepest procedures. Surgical microscopes offer comfort and a clear and magnification-adjustable surgical site that can be shared with the whole team, including observers, and easily recorded to further the education of junior surgeons. Magnification adjustments are convenient for precise procedures such as muscle dissection of the soft palate. METHODS: We performed a comparative investigation of 18 cleft operations that utilized either surgical loupes or microscopy. Paper-based questionnaires were completed by staff nurses to evaluate what went well and what could be improved in each procedure. The operating time, complication rate, and scores of the questionnaire responses were statistically analyzed. RESULTS: The operating time when microscopy was used was not significantly longer than when surgical loupes were utilized. The surgical field was clearly shared with surgical assistants, nurses, anesthesiologists, and students via microscope-linked monitors. Passing surgical equipment was easier when sharing the surgical view, and preoperative microscope preparation did not interfere with the duties of the staff nurses. CONCLUSIONS: Surgical microscopy was demonstrated to be useful during cleft operations.
Cleft Lip* ; Cleft Palate ; Education ; Humans ; Microscopy ; Palate* ; Palate, Soft ; Surgeons ; Surgical Equipment

OBJECTIVE: To assess the use of colony-stimulating factors (CSFs) in patients with ovarian cancer who receive adjuvant paclitaxel and carboplatin chemotherapy in clinical practice and to assess whether the frequency of CSF use differs among hospitals in Japan. METHODS: CSF use in patients with ovarian cancer who received first-line paclitaxel and carboplatin was analyzed retrospectively using data from the Japanese hospitalization payment system. RESULTS: A total of 1,050 patients at 104 hospitals were identified. The median age was 60 years (range, 22 to 88 years). Of these, 163 patients (15.5%) were diagnosed with neutropenia and 134 patients (12.8%) received CSFs. Among the patients who received CSFs, 125 (93%) received them for the treatment of neutropenia without fever and 1 received them for febrile neutropenia. In total, CSFs were administered for 272 cycles of chemotherapy. Among them, CSFs were used as treatment for neutropenia without fever in 259 cycles (95%), as prophylaxis (primary or secondary) in 12 cycles (4%), and as treatment for febrile neutropenia in 1 cycle. Among hospitals, a median of 4.0% of patients received CSFs with an interquartile range of 25% (Q1, 0%; Q3, 25%). A logistic random effects model showed that the variation in the proportion of patients receiving CSFs among the 104 hospitals was 2.0 (p<0.001), suggesting that the use of CSFs varied across hospitals. CONCLUSION: Most patients received CSFs for neutropenia without fever. Standardized and evidence-based use of CSFs is critically required among hospitals in Japan.
Asian Continental Ancestry Group ; Carboplatin* ; Colony-Stimulating Factors* ; Drug Therapy ; Febrile Neutropenia ; Fever ; Hospitalization ; Humans ; Japan* ; Neutropenia ; Ovarian Neoplasms* ; Paclitaxel* ; Retrospective Studies

BACKGROUND/AIMS: Infliximab (IFX), an antibody to tumor necrosis factor, (TNF)-alpha has efficacy in treating Crohn's disease (CD). However, knowledge of the potential effects of IFX on patients' immune profiles is lacking. The purpose of this study was to reveal the immunological effects of IFX. METHODS: Twenty-two patients with a CD activity index (CDAI) of 194.2+/-92.9 and an average duration of disease of 3.26 months and 21 healthy controls were included. Patients were to have their first IFX remission induction therapy with 3 infusions (5 mg/kg) at weeks 0, 2, and 6. Oral 5-aminosalicylic acid was the only ongoing medication in the patient population. Blood samples at baseline, 12 hours after the first infusion and at week 14 were labeled with anti-CD4/CD25 antibodies for immunohistochemical measurement of regulatory T-cells (Treg). Serum cytokines and chemokines were measured by suspension array and ELISA. RESULTS: CDAI significantly decreased prior to the second IFX infusion (p<0.001). Clinical remission rates were 77.3% and 91% by the second and third infusions, respectively. At baseline, interleukin (IL)-6 (p<0.03), IL-8 (p<0.03), IL-10 (p=0.050), IL-13 (p<0.01), transforming growth factor-beta1 (p<0.01), and 'regulated on activation, normal T cell expressed and secreted' (RANTES) (p<0.01) were elevated in patients. After the initial IFX infusion, TNF-alpha (p<0.04), IL-6 (p<0.03), interferon (IFN)-gamma (p<0.04), IFN-gamma-inducible protein-10 (p<0.01), monocyte chemoattractant protein-1 (p<0.01), macrophage inflammatory protein-1beta (p<0.01), and RANTES (p<0.01) were decreased. IFX infusion was associated with an increase in Treg (p<0.01) and a decrease in the Th1 (IFN-gamma)/Th2 (IL-4) ratio (p<0.03). CONCLUSIONS: IFX use was associated with restoration of the Th1/Th2 balance after a single infusion and seemed to promote induction of naive Th0 lymphocytes to Treg. This knowledge should have clinical relevance.
Antibodies ; Antibodies, Monoclonal ; Chemokine CCL2 ; Chemokine CCL5 ; Chemokines ; Crohn Disease ; Cytokines ; Humans ; Immune System ; Interferons ; Interleukin-10 ; Interleukin-13 ; Interleukin-6 ; Interleukin-8 ; Interleukins ; Lymphocytes ; Macrophages ; Mesalamine ; Remission Induction ; T-Lymphocytes, Regulatory ; Tumor Necrosis Factor-alpha ; Infliximab

Background/Aims: The precise incidence of symptomatic uncomplicated diverticular disease (SUDD) and its effects on the quality of life (QOL) remain unclear, particularly in Asian patients with right-sided SUDD. We assess the prevalence of SUDD and its impact on QOL in a real-world population. Methods: Five institutional cohorts of patients who received outpatient treatment for unexplained abdominal symptoms from January 15, 2020 to March 31, 2022, were included. All patients underwent colonoscopy. SUDD was defined as the presence of recurrent abdominal symptoms, particularly pain in the lower right or left quadrant lasting > 24 hours in patients with diverticulosis at the site of pain. The 36-item short-form health survey was used to assess QOL. Results: Diverticula were identified in 108 of 361 patients. Among these 108 patients, 31% had SUDD, which was right-sided in 39% of cases.Of the 50 patients with right-sided diverticula, 36% had SUDD, as did 15 of 35 patients with left-sided diverticula (43%). Among the 33 patients with SUDD, diverticula were right-sided, left-sided, and bilateral in 39%, 45%, and 15% of patients, respectively. Diarrhea was more frequent in the SUDD group than in the non-SUDD group. Patients with SUDD had significantly lower physical, mental, and role/social component scores than those without SUDD. Conclusions It is important to recognize that patients with SUDD account for as high as 31% of outpatients with unexplained abdominal symptoms; these patients have diarrhea and a low QOL. The presence of right-sided SUDD was characteristic of Asian patients.