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Santo T.,Osaka Saiseikai Noe Hospital | Yano H.,Hikone Municipal Hospital
Journal of the Japan Diabetes Society | Year: 2015

A 55-year-old man visited a general practitioner due to a 3 day history of rigor and elevated temperature. Oral antipyretic medicines were administered. The next day he presented to our hospital with an erythematous skin rash. The patient's blood glucose was 113 mg/dl. On the sixth day the papules and erythematous areas became larger and began to merge. His blood glucose level increased to 200 mg/dl on the seventh day. On the ninth day, no deterioration in hepatic function was found but an abdominal CT scan revealed the significant enlargement of the pancreas, liver, and spleen. The patient complained of increased thirst, polyuria and general fatigue from day 11 and he was transferred to our department on the thirteenth day after the onset of symptoms. He was diagnosed with acute diabetic ketoacidosis. His blood glucose level was 807 mg/dl, his arterial blood pH was 7.285 and he was positive for both urine and blood ketones, however, his HbA1c was 6.9% and he was negative for autoantibodies. A glucagon loading test showed a decrease but not a complete exhaustion in his insulin secretion at onset. Here, we report a case of fulminant type 1 diabetes-like disease and the details of the patient's pancreatic size, blood glucose levels and insulin secretion in response to a glucagon stimulation test before and after the onset of symptoms. © Japan Diabetes Society. All rights reserved.

Nishimura K.,National Center for Geriatrics and Gerontology | Oga T.,Kyoto University | Tsukino M.,Hikone Municipal Hospital | Hajiro T.,Tenri Hospital | And 2 more authors.
Respiratory Investigation | Year: 2014

Background: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 consensus report proposed a new classification system, incorporating symptoms with future risk, in subjects with chronic obstructive pulmonary disease (COPD). We hypothesized it could be applied to Japanese COPD patients. Methods: We previously analyzed clinical factors related to 5-year mortality in 150 male outpatients with COPD. We reviewed the data and reanalyzed the relationships between the new GOLD classification and various outcomes including mortality. Results: There were 51 (34.0%), 12 (8.0%), 57 (38.0%), and 30 (20.0%) patients in GOLD A (forced expiratory volume in 1s [FEV1]≥50% predicted and modified Medical Research Council [mMRC] 0-1), GOLD B (FEV1≥50% predicted and mMRC≥2), GOLD C (FEV1<50% predicted and mMRC 0-1), and GOLD D (FEV1 <50% predicted and mMRC≥2), respectively. The GOLD 2011 classification correlated significantly with exercise capacity and multi-dimensional disease staging. Cox proportional hazards analysis revealed that, among several methods categorizing symptoms, the GOLD A-D classification was significantly associated with mortality (p=0.0055). Conclusion: Although the relative number of patients in each category of the combined COPD assessment classification depended on the choice of symptom measures, the categories defined by the mMRC scale (score 0-1 versus ≥2) were most useful for future risk assessed as mortality. GOLD A had the lowest mortality, followed by GOLD B and C, and D had the highest mortality. Exercise capacity was also stratified by the new GOLD classification. © 2013 The Japanese Respiratory Society.

Oga T.,Kyoto University | Tsukino M.,Hikone Municipal Hospital | Hajiro T.,Tenri Hospital | Ikeda A.,Nishi Kobe Medical Center | Nishimura K.,Takanohara Central Hospital
Respiratory Research | Year: 2012

Background: Guidelines recommend that symptoms as well as lung function should be monitored for the management of patients with chronic obstructive pulmonary disease (COPD). However, limited data are available regarding the longitudinal change in dyspnea, and it remains unknown which of relevant measurements might be used for following dyspnea.Methods: We previously consecutively recruited 137 male outpatients with moderate to very severe COPD, and followed them every 6 months for 5 years. We then reviewed and reanalyzed the data focusing on the relationships between the change in dyspnea and the changes in other clinical measurements of lung function, exercise tolerance tests and psychological status. Dyspnea with activities of daily living was assessed with the Oxygen Cost Diagram (OCD) and modified Medical Research Council dyspnea scale (mMRC), and two dimensions of disease-specific health status questionnaires of the Chronic Respiratory Disease Questionnaire (CRQ) and the St. George's Respiratory Questionnaire (SGRQ) were also used. Dyspnea at the end of exercise tolerance tests was measured using the Borg scale.Results: The mMRC, CRQ dyspnea and SGRQ activity significantly worsened over time (p < 0.001), but the OCD did not (p = 0.097). Multiple regression analyses revealed that the changes in the OCD, mMRC, CRQ dyspnea and SGRQ activity were significantly correlated to changes in forced expiratory volume in one second (FEV1) (correlation of determination (r2) = 0.05-0.19), diffusing capacity for carbon monoxide (r2 = 0.04-0.08) and psychological status evaluated by Hospital Anxiety and Depression Scale (r2 = 0.14-0.17), although these correlations were weak. Peak Borg score decreased rather significantly, but was unrelated to changes in clinical measurements.Conclusion: Dyspnea worsened over time in patients with COPD. However, as different dyspnea measurements showed different evaluative characteristics, it is important to follow dyspnea using appropriate measurements. Progressive dyspnea was related not only to progressive airflow limitation, but also to various factors such as worsening of diffusing capacity or psychological status. Changes in peak dyspnea at the end of exercise may evaluate different aspects from other dyspnea measurements. © 2012 Oga et al.; licensee BioMed Central Ltd.

Oga T.,Kyoto University | Tsukino M.,Hikone Municipal Hospital | Hajiro T.,Tenri Hospital | Ikeda A.,Nishi Kobe Medical Center | Nishimura K.,Rakuwakai Otowa Hospital
International Journal of COPD | Year: 2011

Background: Chronic obstructive pulmonary disease (COPD) is considered to be a respiratory disease with systemic manifestations. Some multidimensional staging systems, not based solely on the level of airflow limitation, have been developed; however, these systems have rarely been compared. Methods: We previously recruited 150 male outpatients with COPD for an analysis of factors related to mortality. For this report, we examined the discriminative and prognostic predictive properties of three COPD multidimensional measurements. These indices were the modified BODE (mBODE), which includes body mass index, airflow obstruction, dyspnea, and exercise capacity; the ADO, composed of age, dyspnea, and airflow obstruction; and the modified DOSE (mDOSE), comprising dyspnea, airflow obstruction, smoking status, and exacerbation frequency.Results: Among these indices, the frequency distribution of the mBODE index was the most widely and normally distributed. Univariate Cox proportional hazards analyses revealed that the scores on three indices were significantly predictive of 5-year mortality of COPD (P, 0.001). The scores on the mBODE and ADO indices were more significantly predictive of mortality than forced expiratory volume in 1 second, the Medical Research Council dyspnea score, and the St. George's Respiratory Questionnaire total score. However, peak oxygen uptake on progressive cycle ergometry was more significantly related to mortality than the scores on the three indices (P, 0.0001). Conclusion: The multidimensional staging systems using the mBODE, ADO, and mDOSE indices were significant predictors of mortality in COPD patients, although exercise capacity had a more significant relationship with mortality than those indices. The mBODE index was superior to the others for its discriminative property. Further discussion of the definition of disease severity is necessary to promote concrete multidimensional staging systems as a new disease severity index in guidelines for the management of COPD. © 2011 Oga et al, publisher and licensee Dove Medical Press Ltd.

Morimoto A.,Jichi Medical University | Shimazaki C.,Social Insurance Kyoto Hospital | Takahashi S.,University of Tokyo | Yoshikawa K.,Hikone Municipal Hospital | And 7 more authors.
International Journal of Hematology | Year: 2013

Little information is available regarding effective systemic therapies for adult Langerhans cell histiocytosis (LCH). The Japan LCH Study Group has formulated an ambulatory treatment regimen for adult patients with LCH. In total, 14 patients (median age 43 years, range 20-70 years) with multifocal LCH with biopsy-confirmed histology were enrolled. None had received cytoreductive agents for LCH previously. Four had single system (SS) and ten had multi system (MS) disease. All were treated with the Special C regimen, which consists of vinblastine/prednisolone and methotrexate with daily 6-mercaptopurine for 36 weeks. At the end of the therapeutic regimen, all SS patients achieved no active disease (NAD), and six of the ten MS patients showed a response (NAD in two, partial response in four). At the last follow-up (median 34 months), 11 patients were alive (NAD in eight and active disease in three). Of the three deceased, one died of hemorrhage during the Special C treatment, and two of infections during subsequent therapy. Although this study is limited by the small sample size, this ambulatory regimen shows signs of efficacy for adult LCH. This was particularly evident for patients with multifocal SS disease, but half of those with MS disease also benefited. © 2012 The Japanese Society of Hematology.

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