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Hayashi T.,Nagoya University | Kawashima S.,Nakatsu Saiseikai Hospital | Nomura H.,Nagoya University | Itoh H.,Tokyo Metropolitan Geriatric Hospital | And 8 more authors.
Cardiovascular Diabetology | Year: 2011

Background: We analyzed the effects of insulin therapy, age and gender on the risk of ischemic heart disease (IHD) and cerebrovascular accident (CVA) according to glycemic control.Methods and Results: We performed a prospective cohort study (Japan Cholesterol and Diabetes Mellitus Study) of type 2 diabetes patients (n = 4014) for 2 years. The primary endpoint was the onset of fatal/non-fatal IHD and/or CVA, which occurred at rates of 7.9 and 7.2 per 1000 person-years, respectively. We divided diabetic patients into four groups based on age (≤ 70 and > 70) and hemoglobin A1C levels (≤ 7.0 and > 7.0%). Multiple regression analysis revealed that IHD was associated with high systolic blood pressure and low HDL-C in patients under 70 years of age with fair glycemic control and was associated with low diastolic blood pressure in the older/fair group. Interestingly, insulin use was associated with IHD in the older/poor group (OR = 2.27, 95% CI = 1.11-5.89; p = 0.026) and was associated with CVA in the older/fair group (OR = 2.09, 95% CI = 1.06-4.25; p = 0.028). CVA was associated with lower HDL-C and longer duration of diabetes in younger/poor glycemic control group. Results by stepwise analysis were similar. Next, patients were divided into four groups based on gender and diabetic control(hemoglobinA1C < or > 7.0%). Multiple regression analysis revealed that IHD was associated with high systolic blood pressure in male/fair glycemic control group, age in male/poor control group, and short duration of diabetic history in females in both glycemic control groups. Interestingly, insulin use was associated with IHD in the male/poor group(OR = 4.11, 95% CI = 1.22-8.12; p = 0.018) and with CVA in the female/poor group(OR = 3.26, 95% CI = 1.12-6.24; p = 0.02). CVA was associated with short duration of diabetes in both female groups.Conclusions: IHD and CVA risks are affected by specific factors in diabetics, such as treatment, gender and age. Specifically, insulin use has a potential role in preventing IHD but may also be a risk factor for CVA among the diabetic elderly, thus revealing a need to develop improved treatment strategies for diabetes in elderly patients. The Japan Cholesterol and Diabetes Mellitus Study was formulated to evaluate them(Umin Clinical Trials Registry, clinical trial reg. no. UMIN00000516; http://www.umin.ac.jp/ctr/index.htm). © 2011 Hayashi et al; licensee BioMed Central Ltd.

Mizuki A.,Saiseikai Central Hospital | Tatemichi M.,Saiseikai Central Hospital | Tatemichi M.,Showa University | Tsukada N.,Saiseikai Central Hospital | And 9 more authors.
Oncology Letters | Year: 2010

To assess the efficacy of the additional treatment of transcatheter arterial chemoembolization (TACE) to percutaneous ethanol injection (PEI) therapy for relatively small hepatocellular carcinomas (HCCs), a multicenter randomized control study (RCT) was performed. We conducted an RCT and follow-up study during the enrollment period from 1997 to 1999. Newly diagnosed patients with one to three HCC tumors measuring from 2 to 4 cm (4 cm maximum) in diameter were enrolled. A total of 30 patients initially underwent a combination TACE-PEI or PEI-alone therapies at eight randomly assigned Japanese hospitals. However, 3 patients withdrew. Of the 27 remaining patients, 13 were treated with the combination TACE-PEI therapy and 14 with PEI therapy alone. The patients were observed over several months [median (interquartile range) 33.2 (24.6) months]. There were no significant differences in the background of the patients between the two groups. Among the patients treated with TACE-PEI, the development of a local residual tumor was of significantly lower occurence, compared to the group receiving PEI alone (7.6 and 42.9%, respectively; P=0.024). However, the mean cancer-free time (absence of local or multiple nodule recurrence) or patient survival time was not significantly different between the two groups [PEI alone vs. TACE-PEI: cancer-free time 16.7 (95% CI 7.3-26.0) vs. 22.9 months (95% CI 12.4-33.4); survival time 57.2 (95% CI 37.2-77.2) vs. 42.4 months (95% CI 29.2-55.6)]. Although the combination of TACE and PEI had significant effects on the local tumor control, no efficacy of the addition of TACE to PEI was noted in the prognosis among patients with relatively small HCC tumors.

Hamada S.,Nakatsu Saiseikai Hospital | Azuma H.,Osaka Medical College | Inamoto T.,Osaka Medical College | Katsuoka Y.,Osaka Medical College
Asian Journal of Surgery | Year: 2010

OBJECTIVE: To assess the feasibility of minimum-incision endoscopic radical prostatectomy (MIERP) in the management of localized prostate cancer. METHODS: We conducted clinical evaluations of mean blood loss, operation time, and postoperative course in 50 cases of MIERP performed at Osaka Medical College Hospital from June 2006 to October 2009. The operations were performed according to the MIERP development protocol at our department, with incisions of 10 cm or less in the early cases and 6-7 cm in later cases. RESULTS: In all 50 cases, average bleeding was significantly shortened compared with 19 cases by the conventional method at our institution. The postoperative start of oral intake, start of ambulation, use of analgesics, timing of catheter removal, and duration of hospitalization were all significantly improved with MIERP compared with the conventional method. MIERP patients were divided into 3 consecutive groups (initial 16 cases, midterm 17 cases, and latest 17 cases); mean operation time/mean blood loss were 253 min/1,485 mL, 253.4 min/2,340.9 mL, and 177 min/1,274 mL, respectively. CONCLUSION: Surgical experience involving approximately 30 cases was required to achieve stable clinical results. MIERP is less invasive than conventional retropubic radical prostatectomy and may be safely introduced to resident urologists. © 2010 Asian Surgical Association.

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