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

To clarify the influence of elevated serum lipoprotein (a) (Lp(a)) concentration on ischemic heart disease (IHD) and the perforating artery occlusion type of cerebral infarction (CI) in elderly patients with type 2 diabetes, we measured the serum levels of Lp(a) of type 2 diabetic patients (n = 158, 81 men and 77 women). The group was followed up prospectively for 4 years and the incidence of IHD or CI was monitored. The diagnosis of CI was confirmed by computed tomography and that of IHD, which includes myocardial infarction and angina pectoris, was diagnosed by electrocardiogram and blood chemistry examination, Lp(a) concentrations of 20 mg/dl or more were identified as elevated Lp(a) levels and Lp(a) concentrations of less than 20 mg/dl were identified as normal Lp(a) levels. A Kaplan-Meier survival analysis (log-rank test) assessed the time to event rate stratified by an Lp(a) cutoff point of 20 mg/dl. The predictive value for CI or IHD events was assessed by multiple logistic regression analysis. The probability of IHD events was significantly higher in the elevated Lp(a) group than in the normal Lp(a) group without a history of IHD but was similar in the two groups for those patients with a history of IHD. There was no significant difference between the elevated Lp(a) group and the normal Lp(a) group with regard to CI events in patients without a history of CI and with a history of CI. On multiple logistic regression analysis, Lp(a), hyperlipidemia and a history of IHD were significant predictors of IHD and hypertension, hyperlipidemia and a history of CI were significant predictors of CI. These results show that elevated serum Lp(a) concentrations is an independent risk factor for IHD, but not for the perforating artery occlusion type of CI in type 2 elderly diabetic patients.

An elderly patient with gastric carcinoma developing multiple metastasis in skeletal muscle.

We present a 70-year-old man with gastric carcinoma developing multiple metastasis in skeletal muscle. He had a right supraclavicular lymph node swelling. Brain, chest and abdomen CT scans revealed metastatic lesions in the brain, lung, liver and bilateral adrenal glands. Further, CT showed a ring enhanced soft-tissue mass in the left lumbar muscle. Needle aspirate of the mass in both the left lumbar muscle and the right enlarged supraclavicular lymph node revealed cells suggestive of poorly differentiated adenocarcinoma. Upper gastrointestinal endoscopic evaluation demonstrated an advanced gastric carcinoma. Two months after admission, the tumor in the left lumbar muscle had grown and some new lesions in the left iliopsoas muscles appeared. Intramuscular metastasis from gastric carcinoma is an extremely rare phenomenon.

Ileus after administration of cold remedy in an elderly diabetic patient treated with acarbose.

A 69-year-old type 2 diabetic man was admitted due to diabetic gangrane. He had a history of subtotal gastrectomy. During hospitalization, he was treated with regular insulin and 300 mg/day of acarbose. He developed a low grade fever, cough and nasal discharge, and was given a compound "cold" remedy with anticholenergic properties. The next day, he suffered from a paralytic ileus. Oral intake and acarbose were withheld and the ileus spontaneously resolved after 2 days. These finding indicate the possibility that the ileus was triggered by drugs with anticholinergic properties in this elderly diabetic patient treated with alpha-glucosidase inhibitors.

Two cases of acute myositis associated with influenza A virus infection in the elderly.

During the influenza epidemic of 1998-1999, we observed two elderly patients with influenza-like symptoms who had evidence of acute myositis with elevated serum enzymes. Influenza A infection was confirmed serologically in either case. The present cases suggest that it is important to distinguish influenzal myositis from other forms of myopathy in the elderly patients.

[Sulfonylureas and daily blood glucose profiles in elderly diabetics].

The aim of this study is to clarify the relationship between the efficacy of sulfonylureas and duration of diabetes in elderly diabetics. Daily blood glucose profiles were measured in 87 Type 2 elderly diabetic patients on sulfonylureas (tolbutamide, gliclazide or glibenclamide). Plasma glucose concentrations were determined at 08.00 (before breakfast), 10.00, 12.00 (before lunch), 14.00, 18.00 (before dinner), 20.00, 24.00, 03.00, 06.00, 08.00 hours. The subjects were divided into 4 sub-groups, according to their duration of the diabetes (< 10, 10-14, 15-19, 20 or more years). Mean plasma glucose values at 08.00, 10.00, 20.00, 03.00 and 06.00 hours were not significantly different among the four groups. However, mean plasma glucose values at 12.00, 14.00, 18.00, 00.00 hours and mean total blood glucose area under the daily profile (total BG) were significantly different among the four groups and the values in patients with a history of diabetes of 15 years or more increased. Duration of diabetes positively correlated with blood glucose values at 12.00, 14.00, 18.00, 00.00, 03.00 hours and total BG, and the dose of sulfonylureas positively correlated with blood glucose values at 12.00, 14.00, 18.00, 00.00 hours and total BG in multiple regression analysis. These results suggest that duration of diabetes and dose of sulfonylureas are important determinants of blood glucose control with sulfonylureas in elderly diabetic patients.

[An elderly case of giant infected liver cyst that decreased dramatically without percutaneous aspiration].

A 70-year-old woman was referred to our hospital for treatment of cholelithiasis. A giant liver cyst (6 cm in diameter) had been diagnosed three years earlier. On admission, she had low grade fever and hepatomegaly. High values were observed for WBC (9900/microliter), CRP (8.9 mg/dl), GPT (45 IU/l), ALP (1399 IU/l), gamma-GTP (333 IU/l) and LAP (249 IU/l). The diagnosis of infected liver cyst (8 cm in diameter) was made based on contrast-enhanced CT scan. Endoscopic retrograde cholangiopancreaticography showed no communication between the cyst and the intrahepatic bile duct. She was successfully managed with antibiotics and discharged without percutaneous aspiration the cyst. On abdominal CT scan 4 months after the discharge, the liver cyst had decreased dramatically in size (1 cm in diameter). The patient remains healthy without symptoms.

Effect of age on urinary excretion of N-acetyl-beta-D-glucosaminidase.

To examine the relationship between the concentrations of urinary NAG and age, we measured ratios of urinary N-acetyl-beta-D-glucosaminidase (NAG) to urinary creatinine (NAG index) in 137 healthy subjects, aged from 19 to 88 years. The study is also designed to evaluate the relationship between urinary NAG and blood pressure. The subjects were divided into 7 subgroups, according to their age (< 30, 30-39, 40-49, 50-59, 60-69, 70-79, 80 or more years). There was a positive correlation between NAG index and age (r = 0.36; P < 0.001). The regression equation relating NAG index (y) to age (x) was y = 0.065x + 0.97. The mean NAG indexes for the 7 subgroups divided by age were significantly different (P < 0.01). There was a positive correlation between NAG index and systolic blood pressure (r = 0.18; P < 0.05), but was not between diastolic blood pressure and NAG index. In multiple regression analysis, age and BUN significantly correlated with NAG index (r = 0.32; P < 0.01, r = 3.3; P = 0.07, respectively), although there was no correlation between systolic blood pressure and NAG index. This cross-sectional study showed a clear elevation in NAG index with age. The rate of elevation was 0.65 per decade. Urinary excretion of NAG may be unrelated to blood pressure.

[Effect of age, gender, and body fat distribution on serum leptin concentrations].

The aim of this study was to clarify the relationship between serum leptin concentration and age, gender and body fat distribution. Serum leptin concentrations were determined 267 subjects (138 men and 129 women), aged 30 to 91. The thicknesses of the preperitoneal fat layer (Pmax) and subcutaneous fat layer (Smin) in the abdomen were measured by ultrasonography. Fat mass and percent fat were measured by the bioelectrical impedance analysis method. Women had higher leptin and leptin/fat mass values than men in all BMI groups (BMI < 20, 20-23.9, 24-25.9, > or = 26). The leptin concentration correlated significantly with BMI, fat mass, percent fat, waist, hip, waist/hip ratio (W/H), Pmax, Smin and serum Cr in both men and women. The leptin concentration correlated significantly with age in men only and P/S in female only. Leptin/fat mass values significantly correlated with age, fat mass, and percent fat, but not with BMI, waist, hip, W/H, Pmax, Smin and P/S in men. In women, leptin/fat mass values significantly correlated with BMI, fat mass, percent fat, waist, hip, Pmax, Smin and P/S, but not with age or W/H. Multiple regression analysis showed that fat mass and serum creatinine were significant determinants of the leptin and leptin/fat mass values both in men and women, but that age was a significant determinant of these values only in men. These results suggest that the influence of aging on serum leptin concentration exists only in men.

[High levels of serum ferritin in elderly patients with non-insulin-dependent diabetes mellitus].

We studied concentrations of serum ferritin, glycosylated ferritin, and non-glycosylated ferritin in elderly patients with diabetes. The subjects were 111 people who were at least 60 years old: 54 healthy controls, 14 diabetic patients without retinopathy, and 43 diabetic patients with retinopathy. The mean levels of ferritin, glycosylated ferritin, and non-glycosylated ferritin in serum were significantly higher in the patients with retinopathy than in healthy controls. The mean percent glycosylated ferritin did not differ between patients with retinopathy and healthy controls. The mean levels of serum ferritin, glycosylated ferritin, and non-glycosylated ferritin, and the percent glycosylated ferritin did not differ significantly between patients without retinopathy and health controls. None of these values differed between subjects with macroangiopathy and those without macroangiopathy, in both groups of patients. In patients with diabetes, none of the values measured was significantly related to fasting plasma glucose, HbA1c, or the duration of diabetes. These results suggest that diabetic microangiopathy is associated with abnormally high levels of ferritin in serum.

[Microalbumin and N-acetyl-beta-D-glucosaminidase in random spot urine samples as predictors of diabetic nephropathy in the elderly non-insulin dependent diabetic patients].

To determine whether urinary albumin to creatinine ratio (Albumin index) and urinary N-acetyl-beta-D-glucosaminidase (NAG) to creatinine ratio (NAG index) in random spot urine samples can be sued to predict the early stage of diabetic nephropathy in the elderly non-insulin dependent diabetic patients, we measured these concentrations in 150 non-diabetics, 61 diabetics without retinopathy and 56 diabetics with retinopathy. All patients with Albustix-positive urine were excluded. Subjects divided into two groups according to whether they were < 60 years (adult group) or > or = 60 years old (old group). Multiple regression analysis was used to investigate the relationship between NAG index or Albumin index (dependent variable) and independent variables (age, systolic blood pressure, duration of diabetes. HbA1c) in diabetic patients. Diabetic patients with retinopathy showed the highest mean Albumin index, followed by diabetic patients without retinopathy and then non-diabetic patients both in adult group and in old group (p < 0.001, p < 0.001, respectively). Diabetic patients with retinopathy showed the highest mean NAG index, followed by diabetic patients without retinopathy and then non-diabetic patients both in adult group and in old group (p < 0.001, p < 0.001, respectively). Albumin index positively correlated with systolic blood pressure, duration of diabetes and HbA1c (r = 0.18, r = 0.35, r = 0.18, respectively). NAG index positively correlated with age, duration of diabetes and HbA1c (r = 0.18, r = 0.25, r = 0.29, respectively). These results suggest that both NAG index and Albumin index in random spot urine samples may serve as early functional indicators of diabetic nephropathy in elderly diabetics.

[Age-related changes in concentrations of ferritin, glyeosylated ferritin, and non-glycosylated ferritin].

We studied age-related changes in the concentrations in serum of ferritin, glycosylated ferritin, and non-glycosylated ferritin. The concentrations were determined in 95 healthy subjects: 39 men and 56 women, aged from 22 to 94 years. In the men, age correlated significantly with serum ferritin (r = 0.332, p < 0.05) and non-glycosylated serum ferritin (r = 0.628, p < 0.001) but not with glycosylated serum ferritin. In the women, age correlated significantly with serum ferritin (r = 0.456, p < 0.001), non-glycosylated serum ferritin (r = 0.439, p < 0.001), and glycosylated serum serum ferritin (r = 0.415, p < 0.01). The ratio of glycosylated serum ferritin to serum ferritin correlated negatively with age both in men and in women (men: r = -0.661, p < 0.001; women: r = -0.411, p < 0.01). Serum non-glycosylated ferritin levels were higher in older men. Both serum glycosylated ferritin and non-glycosylated ferritin levels were higher in older women, but this phenomenon was more pronounced with respect to the non-glycosylated form. These results suggest that hyperferritinemia in the elderly is mainly caused by an increase in the concentration of non-glycosylated ferritin, both in men and in women.

[Oral glucose tolerance test using a continuous blood sampling technique for analysis of the blood glucose curve].

Blood glucose levels were continuously monitored in 70 subjects during a 75 g oral glucose tolerance test (OGTT). Subjects were divided into normal (N = 15), borderline (N = 31), diabetes with fasting glucose levels below 140 mg/dl (DM1) (N = 15) and diabetes with levels above 140 mg/dl (DM2) (N = 9). Three patterns of blood glucose curves were observed in each subject group; domed, biphasic and upward. The frequency of blood glucose patterns in each class of glucose tolerance group was as follows: in the normal group; domed 33.3%, biphasic 66.7%; in the borderline group; domed 67.7%, biphasic 29.0%, upward 3.2%; in the DM1 group; domed 66.7%, biphasic 13.3%, upward 20.0%; in the DM2 group; domed 77.8%, upward 22.2%. The frequency of patients with a biphasic pattern was significantly higher in the normal group than in the other groups. In the borderline group, almost all patients with a biphasic pattern were young or middle aged (< 60 years old). When the patients with fasting glucose levels below 140 mg/dl were analyzed, the mean peak time and peak value of blood glucose levels were significantly higher in patients with domed patterns than those with biphasic patterns. Indices of early insulin response to glucose load were significantly lower in patients with domed patterns than in those with a biphasic pattern. In conclusion, the pattern of the glucose curve in an OGTT is mainly dependent on the patient's early insulin response. Glucose intolerance with aging resembles diabetes from the standpoint of the pattern of glucose tolerance curves.