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.

A 60-year-old woman visited our hospital, complaining of hyperpigmentation and itching of the skin. The case was histologically diagnosed as acanthosis nigricans by skin biopsies. It is usually associated with malignancies, of which gastric cancer is by far the most common. Upper endoscopy revealed advanced gastric cancer (Borrmann type 3). Total gastrectomy was performed, but the patient died of peritonitis carcinomatosa 21 months after resection. It is important to examine the upper GI tract periodically when acanthosis nigricans is present from the early stage.

［Purpose］This study aimed to evaluate the differences in the immediate postoperative muscle strength around the hip and knee joints, joint range of motion, pain, and mobility between the anterolateral-supine (AL-S) approach, as a form of minimally invasive total hip arthroplasty (THA), and the posterior approach (PA), as a form of small-incision THA.

［Methods］The subjects were 68 patients with hip osteoarthritis who underwent unilateral THA for the first time. Maximal isometric muscle strength around the hip and knee joints, joint range of motion, walking ability, and pain were measured before surgery, and on Day 10, Day 21, and 2 months after surgery.

［Results］Significant interactions were found between the time and the type of surgery for hip abduction, external rotation, and extension strength. Interaction was also found between the surgical approach and the time required to achieve optimal hip extension range of motion.

［Conclusion］The differences in the functional recovery after AL-S approach and PA were most likely caused by differences in muscle damage. Therefore, it is necessary to customize rehabilitation programs according to the characteristics of each approach.

In Mongolian gerbils, bilateral common carotid artery occlusion (BCCAO) for several minutes induces ischemia, due to an incomplete circle of Willis, resulting in delayed neuronal cell death in the Cornet d'Ammon 1 (CA1) region of the hippocampus. Neuronal cell death in the hippocampus and changes in behavior were examined after BCCAO was performed for 5 min in the gerbils. One day after BCCAO, the pyramidal neurons of the CA1 region of the hippocampus showed degenerative changes (clumped chromatin in nuclei). At 5 and 10 days after BCCAO, extensive neuronal cell death was observed in the hippocampal CA1 region. Cognitive performance was evaluated by using the radial maze and passive avoidance tests. In the radial maze test, which examines win-stay performance, the number of errors was significantly higher in ischemic gerbils than in sham-operated gerbils on days 1 and 2 post-operation. In the passive avoidance test, the latency and freezing times were significantly shorter in ischemic gerbils than in sham-operated gerbils on the days 1, 2, and 4–6 post-operation. These results indicate that transient forebrain ischemia impairs cognitive performance, even immediately after the ischemic insult when there are only subtle signs of neuronal cell death.
CA1 Region, Hippocampal ; Carotid Artery, Common ; Cell Death ; Chromatin ; Circle of Willis ; Freezing ; Gerbillinae ; Hippocampus ; Ischemia ; Neurons ; Prosencephalon ; Pyramidal Cells

Coronavirus disease 2019 (COVID-19) has spread rapidly in Japan. The purpose of this study was to report the clinical experience of our COVID-19 patients early in the pandemic and lessons from our experience. An outpatient fever clinic was established on April 7. Admission of COVID-19 patients was started on July 23. Between April 7 and September 30, there were 364 walk-in outpatients and emergency patients with fever. Polymerase chain reaction test for SARS-CoV-2 RNA or COVID-19 antigen test were performed in all patients, and all results were negative. Twenty patients with COVID-19 were admitted to a newly established dedicated COVID-19 ward. They were discharged well. There were no cases of nosocomial infection at our hospital. Length of hospitalization was correlated with serum ferritin level at admission, serum CRP level at admission, and age. More than half the patients experienced psychological stress, and COVID-19 specialized nurses experienced some stress. It is essential to set up the medical system for COVID-19 according to the trends of the disease. Creation of our original database and our “problem notebook” were useful for treatment and care of COVID-19 patients as well as for mental care of nurses.