Yoshiaki Kigawa

A CHINESE HERBAL MEDICINE, CHOTO‐SAN, IMPROVES COGNITIVE FUNCTION AND ACTIVITIES OF DAILY LIVING OF PATIENTS WITH DEMENTIA: A DOUBLE‐BLIND, RANDOMIZED, PLACEBO‐CONTROLLED STUDY

CASE REPORT This 81-year-old man presented in January 2004 at the emergency department for a first episode of acute abdominal distension. He had been hospitalized 8 years earlier for a myocardial infarction and atrial fibrillation. He lived at home with his wife. His treatment included aspirin (75 mg/d), an angiotensin-converting enzyme inhibitor, and digoxin. Initial electrolyte analysis showed severe hypokalemia, at 2.0 mmol/L. Natremia, urea nitrogen, and creatinemia were in the normal range. The electrocardiogram showed atrial fibrillation, with a ventricular rate of 92 beats per minute. A plain abdominal ray showed a gaseous distension of the right colon and of the rectum without sigmoid volvulus or fecal impaction. The diagnosis of acute colonic pseudoobstruction was made, and a colonoscopic exsufflation was performed. Kaliuresis was low (18 mmol/L). The patient was given 40 mEq potassium chloride intravenously. Because of the atrial fibrillation, thyroid function tests were performed, which showed latent hyperthyroidism with low thyroid-stimulating hormone (0.015 mUI/mL (normal range 0–15.4)) and normal peripheral hormones (T4, 19.4 pmol/L (normal range 10–25); T3, 5.23 pmol/L (normal range 4.5–9.2)). Clinically, the thyroid was normal. A second exsufflation was performed the day after admission. Kalemia was measured at 2.9 mm/L. The patient was given potassium supplementation orally (20 mEq/d). He was discharged on the tenth day. Kaliemia was 3.9 mmol/L. The abdomen was normal. A beta-blocker was added to his treatment because of the history of myocardial infarction, and potassium supplementation was stopped. The patient was rehospitalized 3 months later, in April 2004, with the same presentation: acute colonic pseudoobstruction and hypokalemia (1.9 mmol/L) with a low kaliuresis (11 mmol/L). Potassium supplementation was given intravenously initially and then orally. Two colonic exsufflations were necessary. The patient was discharged 10 days after admission. Kalemia was measured at 4.9 mmol/L. A third attack of acute colonic pseudoobstruction occurred 1.5 months later, in May 2004. Kalemia was measured at 2.5 mmol/L. The hypothesis of a relationship between hypokalemia and hyperthyroidism was formulated. Thyroid-stimulating hormone was undetectable (0.005 mUI/L (normal range 0.15–4), and free T4 was elevated (33 pmol/L (normal range 10–25)). Treatment with NeoMercazole (40 mg/d) was initiated. Radioactive iodine uptake was 30% at 4 hours, and the patient was treated with 7 milli Curie of 131 Iodine at the beginning of June 2004. Three months later, kalemia remained in the normal range, no colonic pseudoobstruction occurred, and thyroid function had normalized. DISCUSSION This observation of TPP is unusual in two aspects: the age of the patient and the type of paralysis. TPP usually occurs in young Asian men. To our knowledge, it has never been described in an elderly person. The most frequent clinical presentation is recurrent attacks of flaccid weakness, predominantly involving the lower limbs. Bulbar, ocular, cardiac, and respiratory muscles are rarely involved. Smooth-muscle paralysis has never been described. The cardinal biochemical abnormality during an attack is hypokalemia, which is the result of an intracellular shift of potassium, the total body potassium store being normal. The relationship between thyrotoxicosis and hypokalemia is based on the fact that thyroid hormone has been shown to increase sodium/potassium ATPase activity in skeletal muscle, the liver, and the kidneys, resulting in increased intracellular transport of potassium in the setting of hyperthyroidism, but the pathogenic mechanisms of TPP are not totally explained. A defect in the neuromuscular junction, classically suggested, may explain the colonic paralysis observed. As in classical TPP, recurrent attacks of colonic pseudoobstruction occurred until correction of the hyperthyroid status. Hyperthyroidism must be excluded in older people who present with a hypokalemic colonic pseudoobstruction.

Effects of bile-acid-binding resin (colestimide) on blood glucose and visceral fat in Japanese patients with type 2 diabetes mellitus and hypercholesterolemia: an open-label, randomized, case-control, crossover study.

OBJECTIVE The objective was to examine the effects of colestimide on blood glucose, visceral fat, adipocytokines, and bile acid conjugate fractions in Japanese patients. METHODS This study was an open-label, randomized, case-control, crossover study of colestimide 3 g/day in 40 Japanese patients with type 2 diabetes mellitus (T2D) and hypercholesterolemia. Patients were assigned to the colestimide group in which pravastatin and colestimide were administered orally and to the statin group in which pravastatin alone was administered orally. The principal outcome measures were serum lipid levels, fasting plasma glucose level in the early morning, hemoglobin A1c (HbA(1c)), visceral fat area (VFA), and serum 1,5-anhydroglucitol (1,5-AG) level. RESULTS Serum low-density lipoprotein cholesterol levels significantly decreased from 113±38 mg/dl at baseline to 90±20 mg/dl (P=.009) at week 12 of colestimide administration. HbA(1c) significantly decreased from 7.4%±0.9% at baseline to 6.9%±0.9% (P=.001) at week 12 of colestimide administration. Serum 1,5-AG levels increased from 9.4±10.1 μg/ml to 12.4±9.5 μg/ml (P=.05) at week 12 of colestimide administration. The statin group showed no significant changes in lipids and 1,5-AG. However, ΔVFA was inversely correlated with Δcholic acid, and multivariate analysis revealed that ΔVFA was a significant explanatory variable. CONCLUSIONS Colestimide holds promise not only for the treatment of hypercholesterolemia but also for the possible improvement of T2D and visceral fat obesity.

Low-molecular-weight lipoprotein (a) and low relative lymphocyte concentration are significant and independent risk factors for coronary heart disease in patients with type 2 diabetes mellitus: Lp(a) phenotype, lymphocyte, and coronary heart disease

BackgroundThe aim of the present prospective study was to examine whether lipoprotein (a) [Lp(a)] phenotypes and/or low relative lymphocyte concentration (LRLC) are independently associated with coronary heart disease (CHD) in patients with type 2 diabetes mellitus (T2DM).MethodsSerum Lp(a) concentration, Lp(a) phenotypes, and RLC were analyzed in 214 subjects. Lp(a) phenotypes were classified into 7 subtypes according to sodium dodecyl sulfate-agarose gel electrophoresis by Western blotting. Subjects were assigned to the low-molecular-weight (LMW (number of KIV repeats: 11–22) ) and high-molecular-weight (HMW( number of KIV repeats: >22 )) Lp(a) groups according to Lp(a) phenotype and to the LRLC (RLC: <20.3%) and normal RLC (NRLC; RLC: ≥20.3%) groups according to RLC. A CHD event was defined as the occurrence of angina pectoris or myocardial infarction during the follow-up period.ResultsDuring the follow-up period, 30 cases of CHD events were verified. Neutrophil count showed no correlation with CHD, while relative neutrophil concentration and RLC showed positive and negative correlations, respectively, with CHD. The Cox proportional hazard model analysis revealed the following hazard ratios adjusted for LMW Lp(a), LRLC, and LMW Lp(a) + LRLC: (4.31; 95% confidence interval [CI], 1.99-9.32; P < 0.01, 3.621; 95% CI, 1.50-8.75; P < 0.05, and 7.15; 95% CI, 2.17-23.56; P < 0.01, respectively).ConclusionsOur results suggest that both LMW Lp(a) and LRLC are significant and independent risk factors for CHD and that the combination thereof more strongly predicts CHD in patients with T2DM.

Four-year prospective study of the influence of elevated serum lipoprotein (a) concentration on ischemic heart disease and cerebral infarction in elderly patients with type-2 diabetes

Background:  The purpose of the present paper was to elucidate the influence of an elevated serum lipoprotein (a) (Lp(a)) concentration on the incidence of ischemic heart disease (IHD) and perforating artery occlusion‐type cerebral infarction (CI) in elderly patients with type‐2 diabetes.

Daily blood glucose profiles of glibenclamide and gliclazide taken once or twice daily in elderly type 2 diabetic patients

Aim:  The aim of this study was to evaluate the difference in daily blood glucose profiles between once‐ and twice‐daily regimens of a moderate daily dose of glibenclamide or gliclazide in elderly patients with type 2 diabetes.