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Yokono K.,Kita Harima Medical Center
Nihon rinsho. Japanese journal of clinical medicine

Both decreased insulin secretion and insulin resistance are two major factors of impaired glucose tolerance (IGT) in the elderly. Up to now, decreased lean body mass and relatively increased fat mass, so-called sarcopenia or sarcopenic obesity, contribute to insulin resistance in the elderly. However, recent reports indicate that muscle mitochondrial function is reduced in aging, and this age-associated decline in mitochondrial function contributes to insulin resistance in the elderly. In addition, exercise intervention to IGT in the elderly is more effective to reduce in the incidence of type 2 diabetes than in younger people. Exercise seems to improve insulin resistance through mitochondrial function by activating AMP-activated protein kinase(AMPK) and PPARgamma coactivator-1alpha (PGC-1alpha). Because cognitive impairment is a most crucial factor plunging into frailty in diabetic elderly, diabetic control would be very important in preventing cognitive decline as well as vascular events. However, comprehensive management of diabetes, including dyslipidemia and hypertension, might contribute to the prevention of declines in cognitive function in older diabetic patients. Source

Uenaka T.,Kobe University | Hamaguchi H.,Kita Harima Medical Center | Sekiguchi K.,Kobe University | Kowa H.,Kobe University | And 2 more authors.
Clinical Neurology

A 76-year-old female was referred to our department because of diplopia for two months and intermittent claudication for five months. She showed medial longitudinal fasciculus (MLF) syndrome. Brain MRI (T2WI) showed multiple infarctions in the right pontine tegmentum and left paramedian midbrain. A biopsy of superficial temporal artery showed the characteristic findings of glanulomatous inflammation indicative of giant cell arteritis. We thought the mechanism of this cerebral infarction as artery to artery embolization or intracranial arteritis. Treatment with oral prednisolone (1 mg/kg/day) improved her limb claudication and normalized serum C-reactive protein level. Source

Suzuki S.,Kobe University | Nakamura T.,Kobe University | Imanishi T.,Kobe University | Kanaji S.,Kobe University | And 7 more authors.
Annals of Surgical Oncology

Background: Our purpose was to evaluate the perioperative safety of laparoscopic-assisted distal gastrectomy (LADG) in elderly patients with clinical stage I gastric cancer. Methods: From 527 consecutive patients who underwent distal gastrectomy for gastric cancer from 2000 to 2011, 38 elderly patients (aged 75 years or older) with clinical stage I disease who underwent LADG were compared with 28 elderly patients who underwent open distal gastrectomy (ODG) and with 41 nonelderly patients (younger than aged 65 years) who underwent LADG. Intraoperative cardiopulmonary changes following pneumoperitoneum and surgical outcomes were analyzed. Results: A significant elevation in mean blood pressure (MAP) (by 44 %) and slight increase in heart rate (HR) (by 13 %) were observed 5 min after the beginning of pneumoperitoneum in the elderly LADG group, although they tended to remain stable since 30 min. The elevation of end-tidal CO2 (ETCO2) in the elderly LADG group remained at 8 % and did not differ from that in the nonelderly LADG group who were 20.5 years (median) younger, whereas percutaneous oxygen saturation (SpO2) did not worsen. Compared with the elderly ODG group, the elderly LADG group did not increase intraoperative cardiopulmonary impairment or complication, had lower incidence of postoperative medical complication (7.9 vs. 32.1 %, p = 0.012) and shortened postoperative recovery course (25 vs. 15 days, p < 0.001). Pneumoperitoneum did not necessarily impair cardiopulmonary dynamics or prognosis for elderly patients with declining cardiopulmonary function. Conclusions: Cardiopulmonary impairment caused by pneumoperitoneum was not critical but transitory. LADG led to superior perioperative course for elderly patients with early gastric cancer. © 2014, Society of Surgical Oncology. Source

Matsumoto M.,Kita Harima Medical Center | Nakayama T.,Kinki University | Inoue D.,Kitano Hospital | Takamatsu K.,Kitano Hospital | And 8 more authors.
BMC Cancer

Background: Lung cancer cells have been reported to produce cytokines, resulting in systemic reactions. There have been few reports showing that these cytokines induced the formation of an inflammatory mass around lung cancers.Case presentation: We encountered a patient with a pleomorphic carcinoma of the lung. This tumor produced interleukin (IL)-8, granulocyte colony-stimulating factor and IL-6, which in turn recruited inflammatory cells, such as CD8 positive lymphocytes, around the tumor, resulting in a rapidly growing tumor shadow.Conclusion: 18 F-fluoro-deoxy-glucose positron emission tomography, in addition to a conventional radiological approach such as computed tomography, may detect immunological responses around a tumor. © 2014 Matsumoto et al.; licensee BioMed Central Ltd. Source

Matsuda T.,Kobe University | Iwasaki M.,Kobe University | Yoshioka N.,Kobe University | Hirota Y.,Kobe University | And 4 more authors.
Diabetology International

Fear of iatrogenic hypoglycemia associated with insulin therapy or oral hypoglycemic agents may prevent patients from achieving appropriate control of blood glucose levels. Such episodes also often impair quality of life and can be fatal. Hypoglycemia-induced hemiplegia is a neurological sign that is thought to result from selective neuronal vulnerability to low blood glucose and is readily reversed by glucose administration. A differential diagnosis of such hypoglycemia-induced hemiplegia relative to ischemic cerebrovascular conditions is important given the substantial differences in prognosis. We now report a case of hemiplegia induced by hemodynamic change in association with hypoglycemia, with this condition being differentiated clinically from typical hypoglycemia-induced hemiplegia. An 85-year-old woman presented with left-sided hemiplegia that was rapidly resolved by intravenous glucose administration. Magnetic resonance imaging revealed no acute changes in the brain parenchyma, whereas diffusion-weighted images typically show high-intensity areas in cases of hypoglycemia-induced hemiplegia. Magnetic resonance angiography revealed advanced stenosis of the right internal carotid artery. Furthermore, whereas single-photon emission computed tomography showed no abnormality in blood flow at rest, it revealed marked impairment of blood flow in the right hemicerebrum after loading with acetazolamide, consistent with the advanced arteriosclerosis. The impaired cerebral flow reserve was thus likely exacerbated by hypoglycemia and evoked transient hemiplegia. As far as we are aware, this is the first report of a hypoglycemia-induced transient ischemic attack in the presence of underlying arteriosclerosis. The cerebrovascular state of patients with hemiplegia and hypoglycemia should thus be appropriately assessed to prevent future cerebral infarction. © 2014, The Japan Diabetes Society. Source

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