Masafumi Katakura

ACUTE EFFECTS OF COLD ON BLOOD PRESSURE, RENIN-ANGIOTENSINALDOSTERONE SYSTEM, CATECHOLAMINES AND ADRENAL STEROIDS IN MAN

1. In an attempt to study effects of cold on blood pressure and the reninangiotensin‐aldosterone system, 34 healthy young subjects with or without a family history of essential hypertension were exposed to moderate cold (4°C for 1 h) or severe cold (immersion of the hands to 0°C for 10 min). Moderate cold elevated blood pressure, aldosterone, cortisol and noradrenaline when the subjects wore summer clothing but not when the subjects wore winter clothing. Regardless of the clothing worn, skin blood flow and plasma renin activity decreased significantly in response to moderate cold but angiotensin II decreased insignificantly.

Ketoacidosis-Onset Noninsulin Dependent Diabetes in Japanese Subjects

In 5 patients (2 women and 3 men, aged 16–36 years), diabetic ketoacidosis developed without precipitating illness. Pancreatic islet cell antibody was negative, and the duration of insulin dependency was shorter than 4 weeks. Hemoglobin A1c was ≤ 6.3% for the mean period of 2.8 years thereafter, with diet therapy alone in 4 and with 5 mg glyburide in 1. Four were overweight before the development of diabetes, and 3 of them positive for family history of adult-onset, non-ketotic diabetes. Frequency of human leukocyte antigen B61 was increased significantly in the patients. In a patient not previously overweight, family history of diabetes was negative, and human leukocyte antigen haplotypes common in insulin-dependent diabetes mellitus were accumulated. Serum immunoreactive insulin was within normal range or supranormal with normal glucose tolerance after recovery. The patients closely resemble black Americans with ketoacidosis-onset non-insulin dependent diabetes.

Diminution of early insulin response to glucose in subjects with normal but minimally elevated fasting plasma glucose. Evidence for early beta-cell dysfunction

Aim Systematic analysis of β‐cell function in Japanese health examinees.

Development, worsening, and improvement of diabetic microangiopathy in older people : Six-year prospective study of patients under intensive diabetes control

OBJECTIVES: To examine retinopathy and nephropathy in elderly patients with diabetes mellitus (DM) under intensive multifactorial DM control.

POSTPRANDIAL HYPERGLYCEMIA IS AN INDEPENDENT RISK FOR RETINOPATHY IN ELDERLY PATIENTS WITH TYPE 2 DIABETES MELLITUS, ESPECIALLY IN THOSE WITH NEAR‐NORMAL GLYCOSYLATED HEMOGLOBIN

To the Editor: Data on the risk of retinopathy with high postprandial glucose (PPG) in patients with type 2 diabetes mellitus are controversial. It was found that PPG was significantly related to incidence of retinopathy and was a significant risk for worsening of retinopathy. A 6-year prospective study also found that PPG is a significant predictor for development of retinopathy in elderly patients. In these studies, PPG was significantly related to retinopathy even after adjustment for glycosylated hemoglobin (HbA1c), indciating that it is a risk for retinopathy in addition to high mean glucose. One study reported that PPG was significantly related to incidence of retinopathy, and PPG was a significant risk for development of retinopathy in the Kumamoto Study, but its independence from HbA1 as a risk was not examined in these studies. Two other studies found that PPG was not significantly related to incidence, development, or worsening of retinopathy. Levels of glycemic control have tended to be low in the studies with positive results, except for one, in which duration of diabetes mellitus was short as a group. Although duration of diabetes mellitus was long in the cohort in the 6-year prospective study, glycemic and blood pressure control was strict, and the patients were elderly. Good glycemic control as indexed according to lower HbA1c, short duration of diabetes mellitus, and older onset age of diabetes mellitus are all protective factors for retinopathy. Thus, it can be hypothesized that high PPG is a significant risk for retinopathy, especially in the patients with low risk of it. As far as the authors are aware, the cohort in the 6-year prospective study was an invaluable one, in which the relationship between PPG and risk of retinopathy in elderly patients can be analyzed in detail. Based on these considerations, and in view of recent attention to the detrimental effect of PPG on complications of diabetes mellitus, a focused analysis was performed on the relationship between PPG and retinopathy in the previously reported cohort. The characteristics of the patients (N 5 413) have been previously reported. Briefly, of 413 participants, 312 survived, and 168 (male/female 82/86, mean age 72, duration of diabetes mellitus 13 years, PPG 9.3 mmol/L, HbA1c 6.6%, use of oral hypoglycemic agents 58%, use of insulin 25%) had no retinopathy upon entry. Retinopathy developed in 45 (27%) during a 6-year observation. At baseline, the mean from two PPG (plasma glucose 2–4 hours after breakfast) values obtained at an outpatient clinic 1 to 2 months apart was calculated and recorded as a PPG for each patient. Glycemic control had been satisfactory for 6 years; the mean interim and closing HbA1c were both 6.7%. PPG was more significantly related to retinopathy than HbA1c (P 5.01 for PPG, P 5.03 for HbA1c). 3

Sarcomatoid renal cell carcinoma with widespread metastases to liver and bones in a kidney transplant recipient.

A case of sarcomatoid renal cell carcinoma with widespread metastases to liver and bones in a cadaver renal transplant recipient is reported in this article. The patient underwent a kidney transplant at the age of 43 and was treated with various immunosuppressive agents after surgery. Twelve months after the transplantation, multiple tumors were found in the liver, and the patient died 8 months later. Pathological examination at autopsy revealed renal cell carcinoma with a sarcomatoid component in the right native kidney and metastases to liver and bones. It is unusual for renal cell carcinoma to undergo sarcomatous transformation and to metastasize to the liver before reaching other organs. We speculate that immunosuppressants may have altered malignant cell proliferation, invasion, and the form of metastasis in this case.

Impact of one-hour postchallenge glucose on the relationship between insulin sensitivity and secretion

The impact of postchallenge glucose on the relationship between insulin sensitivity (SI) and secretion (β) is unknown. We analyzed data from 2,264 health examinees (male/female 1,524/740, median age 54 yrs) with normal glucose tolerance (NGT, n = 1,623), non-diabetic hyperglycemia (NDH, n = 555), or diabetes (DM, n = 86) using OGTT-derived indices of SI (insulin sensitivity index [ISI]-Matsuda, 1/HOMA-IR, and 1/fasting IRI) and β (δIRI0-30/δPG0-30, and Stumvoll 1st [Stumvoll-1] and 2nd [Stumvoll-2] phases). The combination of 1/HOMA-IR and Stumvoll-1 recapitulated the hyperbolic SI-β relationship with the slope of the fitted line -1.000 in NGT subjects, and therefore it was utilized in the following analysis of the SI-β correlation. In multiple regression analysis of the relationship between SI and β, an independent correlation was found for 1 h-plasma glucose (PG; PG60) but not for 2 h-PG. When the NGT subjects were grouped by PG60 quartile (Q), the fitted line was flat in Q1 but progressively steeper from Q2 to Q4, with a slope (95%CI) of -0.663 (-0.726~-0.605), -0.680 (-0.745~-0.622), -0.847 (-0.922~-0.779), and -1.259 (-1.370~-1.158) (P for trend < 0.05). The fitted line steepened further in the NDH and DM groups, with a slope of -1.545 and -1.915, respectively (P < 0.01 for the difference). The intercept of the fitted line for SI-β correlation was also progressively lower across the PG60 Q for NGT, NDH, and DM. In conclusion, using the 1/HOMA-IR-Stumvoll-1 pair for an analysis of the SI-β relationship, elevated PG60 was associated with steepening and downward shifting of the fitted line for the SI-β correlation. The finding suggests impaired beta cell function.

Partial resection of atrial septal aneurysm with multiple fenestrations: a case report

Aneurysms of the interatrial septum are uncommon lesions that are often accompanied by other cardiac anomalies or systemic thrombosis. The authors report 1 case of atrial septum aneurysm that was diagnosed by two-dimensional contrast echocardiography. At surgery a membrane-like, fenestrated aneurys mal protrusion to the right atrium without thrombosis was seen. The atrial septum was closed without using an artificial patch after some of the aneurysm with fenestrations was resected.

Unusual clinical presentation of malignant histiocytosis in a 70-year-old woman

Abstract. A 70‐year‐old woman was admitted for evaluation of hepatosplenomegaly, fever and elevated serum LDH levels. A biopsy specimen of the liver revealed histiocytic proliferation at the portal triad, and a mild degree of hepatitis. A bone marrow biopsy specimen showed proliferation of histiocytes with minimal immaturity and atypism, and haemophagocytosis by the proliferated histiocytes. Fever, hepatosplenomegaly and elevation of LDH levels all disappeared spontaneously, and presumptive diagnosis of benign reticulosis with haemophagocytosis was made. One year later, fever, hepatosplenomegaly and elevation of LDH levels redeveloped, and the liver and bone marrow biopsy specimen showed proliferation of unequivocally malignant histiocytes. The patient died as a result of disseminated intravascular coagulation with shock 20 d later. We concluded that, in this case, malignant histiocytosis first presented as benign haemophagocytic reticulosis and, 1 year later, there was a typical malignant presentation.

Equivocal Association Between Body Mass Index and Diabetes Mellitus in Elderly Adults

Conflict of Interest: The authors have no conflicts of interest to disclose. Supported in part by research grants from the Ministerio de Ciencia e Innovaci on (AGL2004–07907, AGL2006– 01979, AGL2009–12270), Ministerio de Ciencia y Competitividad (AGL2012–39615) to JL-M; FIS PI10/01041 to P P-M; FIS PI13/00023 to J D-L, Consejer ıa de Innovaci on, Ciencia y Empresa, Junta de Andaluc ıa (P06-CTS01425 and PI0193/09 to JL-M, PI-0252/09 to J D-L, PI0058/10 to P P-M), Proyecto de Excelencia, Consejer ıa de Econom ıa, Innovaci on, Ciencia y Empleo (CVI-7450 to J L-M); Merck Serono and Fundacion 2000 (Clinical research in Cardiometabolic to P P-M).The CIBEROBN is an initiative of the Instituto de Salud Carlos III, Madrid, Spain. Author Contributions: Lopez-Miranda, Perez-Jimenez: designed and conducted research. Delgado-Lista, DelgadoCasado, Garcia-Rios, Perez-Martinez, Lopez-Moreno: acquired data and participants. Lopez-Moreno, Camargo, Delgado-Casado, Quintana-Navarro, Yubero-Serrano: data collection. Lopez-Miranda, Yubero-Serrano: data analysis. Lopez-Moreno, Yubero-Serrano: writing the manuscript. Striker, Delgado-Lista, Tinahones, Perez-Martinez: significant advice and support in reviewing the drafting of the paper. Lopez-Miranda, Yubero-Serrano: primary responsibility for final content. All authors read and approved the final manuscript.