Nobuyuki Furutani

The underlying mechanisms for development of hypertension in the metabolic syndrome

High blood pressure is an important constituent of the metabolic syndrome. However, the underlying mechanisms for development of hypertension in the metabolic syndrome are very complicated and remain still obscure. Visceral/central obesity, insulin resistance, sympathetic overactivity, oxidative stress, endothelial dysfunction, activated renin-angiotensin system, increased inflammatory mediators, and obstructive sleep apnea have been suggested to be possible factors to develop hypertension in the metabolic syndrome. Here, we will discuss how these factors influence on development of hypertension in the metabolic syndrome.

Diacylglycerol oil for the metabolic syndrome

Excess adiposity has been shown to play a crucial role in the development of the metabolic syndrome. The elevated fasting and postprandial triglyceride-rich lipoprotein levels is the central lipid abnormality observed in the metabolic syndrome. Recent studies have indicated that diacylglycerol (DAG) is effective for fasting and postprandial hyperlipidemia and preventing excess adiposity by increasing postprandial energy expenditure. We will here discuss the mechanisms of DAG-mediated improvements in hyperlipidemia and in postprandial energy expenditure, and effects of DAG oil on lipid/glucose metabolism and on body fat. Further, the therapeutic application of DAG for the metabolic syndrome will be considered.

Physician perspectives on the ethical aspects of disability determination

OBJECTIVE: To evaluate physician’s attitudes and responses to the ethical conflicts involved in certifying patients for welfare disability.DESIGN: A mailed questionnaire survey that used case scenarios and general questions.SETTING: Massachusetts.PARTICIPANTS: A random sample of 347 internists and family practitioners and a convenience sample of 100 neighborhood health center physicians from three large cities (NHC sample). The response was 53% and 76%, respectively.MEASUREMENTS AND MAIN RESULTS: Physician responses to case scenarios representing difficult decisions about patient requests for welfare disability determination and general questions about the welfare disability system. Physicians reported a willingness to exaggerate clinical data to help a patient they thought deserving of welfare disability benefits (39% random sample; 56% NHC sample). Physicians did not report confidence in their ability to determine who was disabled as measured by a visual analog scale (4.4 cm random sample, 4.6 cm NHC sample; 0=very confident, 10=very uncertain). They did feel burdened by their participation in welfare disability determinations when compared with other administrative chores as measured on a visual analog scale (2.8 cm random sample, 2.5 cm NHC sample; 0=more burdensome, 10=less burdensome). Eighty-two percent of the random sample physicians and 86% of the NHC sample physicians thought that filling out a disability form could adversely affect the physician-patient relationship, and 62% of physicians in each sample thought that it represented a conflict of interest. Eighty percent of physicians in both samples thought that it would be better if an independent group of physicians were designated to determine disability.CONCLUSIONS: Physicians perceive an ethical bind as they try to satisfy the conflicting demands of patients and the welfare disability system. They will frequently decide in favor of their patient’s interests. This has implications for welfare policy planners.

Myositis, Vasculitis, Hepatic Dysfunction in Adult-Onset Still's Disease.

Although hepatic dysfunction is common in adult-onset Stills disease (AOSD), sometimes it is difficult to differentiate hepatic dysfunction due to AOSD itself from drug-induced hepatic dysfunction. Further, myalgia often occurs in patients with AOSD; however, AOSD patients complicated with myositis are rare. We report a 43-year-old Japanese man with AOSD who developed myositis and hepatic dysfunction which were deteriorated by multiple nonsteroidal antiinflammatory drugs (NSAIDs) and were dramatically ameliorated by a low-dose steroid therapy. A skin biopsy of salmon pink rash which is characteristic for AOSD showed leukocytoclastic vasculitis, and the markers for vasculitis, plasma von Willebrand factor, and vascular endothelial growth factor levels were elevated in this patient, suggesting an association between AOSD and systemic vasculitis.

Aseptic spondylodiscitis in a patient with polymyalgia rheumatica.

An 85-year-old man was admitted to the Department of Orthopaedics with fever, polyarthralgia and back pain. Laboratory evaluation was notable for a C-reactive protein (CRP) level of 21.2 mg/dl (normal range, <0.3 mg/dl) and a leukocyte count of 13 400 cells/μl, however, no bacteria were detected in his blood culture. T2-weighted MRI of the lumbar spine revealed a high intensity in the L2–L3 disc (fig 1), and he was …

Mediastinal abscess and suppurative thrombophlebitis possibly because of an accidental inhalation of paraquat

A 62-year-old man presented with a sudden onset of fever and left neck pain. Laboratory evaluation on admission was notable for a C-reactive protein level of 178 mg/l and a leucocyte count of 11.8×109/l, and Staphylococcus aureus was detected in his blood culture. A CT scan of the neck and chest after the administration of intravenous contrast …