[Recurrent idiopathic cerebral infarction in a 5-year-old boy, with emphasis on the importance of platelet aggregation analysis for appropriate selection of anti-platelet drugs].

We present a 5-year-old boy with recurrent idiopathic cerebral infarction in which analysis of platelet hyperaggregability was useful in choosing appropriate anti-platelet drugs. The patient presented with gait disturbance at the age of 5 years and 1 month. Brain MRI demonstrated multiple infarctions in the right thalamus and left cerebellum. There were no apparent underlying diseases including hematological, cardiac and vascular abnormalities. He was diagnosed as idiopathic cerebral infarction. First, we administered ticlopidine and he remained stable with persistent mild intention tremor in the left upper extremity for 4 months. Then he developed the second stroke at the age of 5 years and 5 months, and multiple infarctions in the right celebellum and cerebellar vermis were demonstrated. On platelet aggregation analysis, adenosine diphosphate (ADP)-induced aggregation was inhibited, probably due to ticlopidine administration. Collagen- and epinephrine-induced platelet aggregation showed hyperaggregation, so we started to administer cilostazol, which inhibits only epinephrine-induced hyperaggregation. We also added aspirin, which inhibits collagen-induced hyperaggregation. The combination of anti-platelet drugs inhibited epinephrine-, collagen- and ADP-induced hyperaggregation in this patient. He has been stable on the triple combination of anti-platelet drugs without further episodes of cerebral infarction or transient ischemic attack for 4 years to date. Appropriate selection of anti-platelet therapy was achieved by the simple and repeatable platelet aggregation analyses, which must be considered even in pediatric patients with cerebral infarction.

Effects of pre-germinated brown rice on blood glucose and lipid levels in free-living patients with impaired fasting glucose or type 2 diabetes.

White rice (WR) is made by polishing brown rice (BR) and has lost various nutrients; however, most people prefer it to BR, maybe because of the hardness of BR. Pre-germinated brown rice (PGBR) improves the problem of BR. It is made by soaking BR kernels in water to germinate and becomes softer than BR. In this study we compared the effects of WR and PGBR on blood glucose and lipid concentrations in the impaired fasting glucose (IFG) or type 2 diabetes patients. Six men and 5 women with impaired fasting glucose (IFG) or type 2 diabetes were randomly allocated to 6 wk on WR or PGBR diet separated by a 2 wk washout interval in a crossover design. Each subject was instructed to consume 3 packs of cooked WR or PGBR (180 g/pack) daily in each intervention phase. Blood samples were collected 4 times (in study weeks 0, 6, 8 and 14) for biochemical examination. Blood concentrations of fasting blood glucose, fructosamine, serum total cholesterol and triacylglycerol levels were favorably improved on the PGBR diet (p<0.01), but not on the WR diet. The present results suggest that diets including PGBR may be useful to control blood glucose level.

Postprandial blood glucose and insulin responses to pre-germinated brown rice in healthy subjects.

Effects of pre-germinated brown rice (PGBR) on postprandial blood glucose and insulin concentrations were compared with brown rice (BR) and white rice (WR) in two studies. In the first study, we investigated the time course of postprandial blood glucose and insulin concentrations after ingesting 25% (W/V) glucose solution, PGBR, BR or WR in 19 healthy young subjects. In the second study, dose-dependent effect of PGBR on the time course of postprandial blood glucose concentrations was compared among 4 different mixtures of PGBR and WR in 13 healthy young subjects. They were solely PGBR, 2/3 PGBR (PGBR: WR = 2 : 1), 1/3 PGBR (PGBR : WR = 1 : 2) and solely WR. Each sample was studied on a different day. The samples were selected randomly by the subjects. All the rice samples contained 50 g of available carbohydrates. The previous day the subjects ate the assigned dinner by 9:00 pm and then were allowed only water until the examination. The next morning, they ingested each test rice sample with 150 ml of water in 5-10 min. Blood was collected into capillary tubes from finger at 0, 30, 60, 90 and 120 min after the ingestion. The incremental areas under the curve (IAUC) of blood glucose concentrations (IAUC-Glc) for 120 min after the administration of PGBR and BR were lower than those after WR. In contrast the IAUC-Glc of BR and PGBR were not different (Study 1). The higher the ratio of PGBR/WR, the lower the glycemic index became (Study 2). These results suggest that intake of PGBR instead of WR is effective for the control of postprandial blood glucose concentration without increasing the insulin secretion.