Kazuhiko Yoshinaga

A follow-up study of 201 children with autism in Kyushu and Yamaguchi areas, Japan.

A follow-up survey was conducted on 201 young adults with autism who were 18 or older (mean age, 21.5). All had participated previously in intensive therapeutic camping or had therapeutic involvement at medical consultation agencies to evaluate their outcome. Their social outcome was better than that previously reported in Japan. Although 31.5% had shown marked deterioration during adolescence, 43.2% had shown marked improvement during that period. Possible factors contributing to these results are discussed.

Intestinal and extraintestinal complications of Crohn's disease: Predictors and cumulative probability of complications

Of 238 patients with Crohns disease seen at our clinics from April 1973 to August 1988, 203 patients were selected for this study, since they fulfilled the following criteria: they had been followed up for more than 6 months as outpatients or had been treated as inpatients for more than 1 month. They were studied to elucidate: (a) the different types and indidence of various complications, (b) the factors related to complications present at the time of diagnosis, (c) predictors of new complications arising after diagnosis, and (d) the cumulative incidence of complications occurring during the course of the disease from the times of onset and diagnosis. Of the intestinal complications, perianal fistula was most common (33%), followed by strictures with dilatations of the proximal bowel (21%), and internal fistula (14%). Of the extraintestinal complications, menstrual disturbance was the most common (18% of the female patients), followed by arthritis (10%), and aphthous stomatitis (10%). As for the factors influencing complications present at the time of diagnosis, the pattern of bowel involvement was significantly correlated with the presence of intestinal stricuture, while the erythrocyte sedimentation rate was significantly correlated with the presence of perianal fistula. A significant predictor of new complications arising after diagnosis was the general well-beling of patients at the time of diagnosis. Patients who, at diagnosis, already have complications such as stricture, absominal abscess, internal or external fistula, massive hemorrhage, and free perforation or anal lesions are more likely to develop new complications in addition to those present at diagnosis, compared with patients without any complications at diagnosis (P=0.055).

Reduction of charge-modified LDL by statin therapy in patients with CHD or CHD risk factors and elevated LDL-C levels: the SPECIAL Study.

Various forms of atherogenic modified low-density lipoprotein (LDL) including oxidized LDL and small, dense LDL have increased negative charge as compared to normal LDL. Charge-modified LDL (electronegative LDL) and normal LDL subfractions in plasma are analyzed by capillary isotachophoresis (cITP) as fast-migrating LDL (fLDL) and slow-migrating LDL (sLDL). We examined the effects of pravastatin and simvastatin on charge-based LDL subfractions as determined by cITP in patients with hypercholesterolemia. Patients (n=72) with CHD or CHD risk factors and elevated LDL cholesterol (LDL-C) levels were randomly assigned to receive pravastatin or simvastatin. After treatment with statins for 3 and 6 months, both cITP fLDL and sLDL were reduced (p<0.05) from the baseline, but the effects did not differ between treatment with pravastatin and simvastatin. At baseline and after treatment for 3 months, cITP sLDL was correlated with LDL-C, but fLDL was correlated with inflammatory markers, high-sensitive C-reactive protein and LDL-associated platelet-activating factor acetylhydrolase, and atherogenic lipoproteins, remnant-like particle cholesterol and small, dense LDL cholesterol. In conclusion, cITP fLDL was related to inflammatory markers and atherogenic lipoproteins and was reduced by treatment with statins. Charge-modified LDL subfraction could be a potential marker for atherosclerosis and a target for therapy.

Hyperinsulinemic hypoalphalipoproteinemia as a new indicator for coronary heart disease

OBJECTIVES The purpose of this study was to investigate the association among insulin resistance, high density lipoprotein cholesterol (HDL-C) and coronary heart disease (CHD), and to test the hypothesis that HDL-C may ameliorate the adverse effects of insulin. BACKGROUND Serum low HDL-C (hypoalphalipoproteinemia) and hyperinsulinemia are independent predictors for CHD, but a strong negative correlation exists between them, as in patients with syndrome X. METHODS Fifty-four pairs of cases (M/F: 49/5), defined as patients with angiographically proved CHD, and control subjects (M/F: 49/5) matched with cases with regard to gender and age were included. Insulin resistance was assessed by the homeostasis model assessment (HOMA). RESULTS Cases had increased HOMA insulin resistance and lower serum levels of HDL-C than controls. A receiver operating characteristic (ROC) curve analysis indicated that HDL-C and insulin resistance were significant discriminators of CHD (area under ROC curve: 0.72 and 0.69, respectively). The interaction between HDL-C and the association of insulin resistance with CHD was significant: subjects with hyperinsulinemia and high HDL-C had no increased risk of CHD. Multivariate conditional logistic regression analysis showed that hyperinsulinemic hypoalphalipoproteinemia was a stronger indicator for CHD than either HDL-C or insulin resistance alone (-2 log likelihood: 19.0 vs. 12.6 or 15.7). CONCLUSIONS Hyperinsulinemic hypoalphalipoproteinemia was a more potent indicator for CHD than either insulin resistance or low serum HDL-C levels alone, and the adverse effects of hyperinsulinemia seem to be ameliorated by high HDL-C levels.

Clinical course and long-term prognosis of Crohn's disease in Japan

The long-term outcome of Crohns disease was reviewed in 74 patients who had a history of more than 10 years (range 10.8–27.3) since disease onset. The observation period was between 4.3 and 18.5 years, the mean and SD being 10.6±3.1 years. The means and SD of age at onset and final observation were 21±7 and 37±8 years, respectively. Fifty-eight of the 74 patients had not undergone bowel resection at the time of diagnosis; of these 58, 31 (53.4%) had an operation for the disease during the follow-up period. Thus, of the 74 patients, 47 (63.5%) (these 31, plus the 16 who had undergone bowel resection at the time of diagnosis) had an operation at least once during a follow-up period of 10 years or more. The cumulative operation rates 5, 10, and 15 years after onset in the 74 and 58 patients above were 18.9%, 6.9%, and 40.8%, and 34.8%, 49.1%, and 46.0%, respectively. The corresponding figures 5 and 10 years after diagnosis in all 74 patients and the 58 patients were 32.3% and 28.6% and 47.3% and 46.3%, respectively. There were no significant differences in the incidence of operation rate in relation to anatomical involvement. Cumulative reoperation rates 1, 3, 5, and 10 years after the first operation in the 31 patients who were operated on during the follow-up period were 3.4%, 6.9%, 25.5%, and 51.7%, respectively. Three patients died, the causes of death in one being directly related to Crohns disease. The cumulative survival rate in all patients was compared with the expected survival rate in a sex- and age-matched general population. There was no significant difference between the two groups in survival rates in the-year period since onset. When the degree of satisfaction with quality of life in the previous 1 month and 1 year was evaluated by the patients themselves on an 11-point scale, in which a higher score indicated a better quality of life, about 30% of the patients had scores of 8–10. In the previous 1 year, 53% of the patients had been able to continue the same work, whereas 17% of the patients were not able to work. In conclusion, the prognosis for survival in Crohns disease was very good; however, about 50% of patients required at least one surgical treatment during the 15-year followup period since onset, and about 70% of patients had some bowel or systemic symptoms, or emotional or social problems.