Disseminated Cryptococcosis with Adrenal Insufficiency and Meningitis in an Immunocompetent Individual.

We present a case of cryptococcosis with adrenal insufficiency and meningitis in a healthy host without any risk factors. Antifungal therapy did not reduce the cryptococcal antigen titers of the cerebrospinal fluid and serum or the bilateral adrenal gland enlargement. It was suggested that the adrenal glands were the focus of persistent fungemia. Removal of both adrenal glands brought about a response to antifungal therapy. We conclude that if antifungal therapy is ineffective, bilateral adrenalectomy is an effective measure for treatment of such patients. Cryptococcosis is a possible cause of primary adrenal insufficiency in immunocompetent patients.

Severity of measles among patients with incidental postexposure vaccination.

It has not been well elucidated whether patients with measles who have undergone postexposure prophylaxis (PEP) exhibit milder clinical symptoms than would be expected in the absence of PEP. In the present study, we compared the severity of measles of patients who had undergone incidental PEP to those of patients who had not received such prophylaxis. An outbreak of measles occurred among the personnel of the Japan Self-Defense Forces (SDF) between 7 May and 14 June 2007 at 3 camps in or near Sendai City. All patients were admitted to SDF Sendai Hospital for isolation and care. Measles was confirmed in 21 patients (age: 21.9 +/- 5.9 years). Of the 15 ill recruits (persons who had just joined SDF), 8 underwent incidental PEP on 10 May, 3 days after the onset of the prodromal symptoms in the first patient. The vaccination was not originally intended as PEP and was administered within the framework of a routine vaccination program. Compared to recruits without PEP (n = 7), the admission period was 5.6 days shorter, the period with high fever (39C or more) was 2.7 days shorter, and the maximum body temperature was 1.1C lower in the recruits with PEP (n = 8). These results suggest that PEP ameliorates the clinical symptoms of measles.

Overweight male personnel of the Japan Self-Defense Forces with body mass indices of 23.0-24.9 and obesity-related metabolic disorders.

OBJECTIVES: To assess the validity of the criterion of overweight for Asian people that is recommended by Western Pacific Region of the World Health Organization. METHODS: We carried out a cross-sectional analysis of the association between the criterion of overweight for ethnic Asian people--body mass indices (BMI) of 23.0-24.9 kg/m(2)--and the presence of obesity-related metabolic disorders among middle-aged Japanese men (n = 974, age range 51-59). RESULTS: The odds ratios (95% confidence interval) of overweight to those with normal weight (BMI < 23.0 kg/m(2)) were 1.61 (1.11-2.33) for the presence of impaired glucose tolerance, 1.95 (1.30-2.93) for hypertension, 2.22 (1.63-3.03) for hypercholesterolemia, 2.83 (2.02-3.97) for hypertriglyceridemia, and 2.06 (1.06-4.00) for hyperuricemia. Overweight was not associated with the presence of type 2 diabetes or with high gamma-glutamyl transferase in the present study (odds ratios: 1.09 and 1.05, respectively). Adjustment for age, rank, and lifestyle factors affected the results only slightly. CONCLUSIONS: Based on these results, we conclude that the Asian criterion of overweight appears to be rational in terms of its association with obesity-related metabolic disorders in male personnel of the Japan Self-Defense Forces in their fifties.

Serum gamma-glutamyl transferase is associated with plasma total homocysteine in Japanese patients with type 2 diabetes.

Serum gamma-glutamyl transferase (gamma-GT), a marker of oxidative stress, predicts morbidity and mortality from cardiovascular disease. Plasma total homocysteine (tHcy), a pro-oxidant and also an independent risk factor for cardiovascular disease, correlates with gamma-GT among some populations. It is not known whether tHcy correlates with gamma-GT among type 2 diabetic patients in whom oxidative stress is increased and implicated for the development of diabetic complications. In the present study, we analyzed the association between gamma-GT, tHcy and related vitamins cross-sectionally among patients with type 2 diabetes without overt nephropathy (age range 17-76 years; n = 110). In a univariate regression analysis model, gamma-GT (logarithm) was positively associated with tHcy (beta = 0.288, P = 0.002) but not with folate or vitamin B(12). The association between tHcy and gamma-GT (logarithm) remained significant in a multivariate analysis model including age, lifestyle factors, folate, vitamin B(12), creatinine, HbA(1c) and medical history (beta = 0.219, P = 0.027). These results suggest that tHcy generates oxidative stress among type 2 diabetic patients and may partly explain the reported association between gamma-GT and cardiovascular disease.

Beer ethanol consumption and plasma homocysteine among patients with type 2 diabetes.

We analyzed the association between beer and other type of ethanol consumption and tHcy levels among type 2 diabetic patients. Male type 2 diabetic patients without overt nephropathy were studied (n=242). Ethanol consumptions of the patients were 35.1+/-37.8mL/day for total ethanol, 13.9+/-15.2mL/day for beer ethanol and 21.2+/-32.1mL/day for non-beer ethanol. Both, total and non-beer ethanol consumption correlated with tHcy, whereas beer ethanol consumption showed a trend to inverse association with tHcy (standard regression coefficient, 0.184, 0.283 and -0.110, respectively). Each intake of 30mL/day ethanol consumption was associated with an increase of tHcy of 0.6micromol/L for total ethanol and 1.1micromol/L for non-beer ethanol and a decrease of tHcy of 0.7micromol/L for beer ethanol. Similar trend was observed in the analysis model which included only drinkers, and also in an adjusted analysis model. Plasma tHcy of beer only drinkers was lower than that of non-beer alcohol only drinkers (8.9+/-1.9micromol/L versus 11.5+/-5.5micromol/L, P=0.003). Non-beer ethanol consumption might be less healthy compared with beer ethanol consumption among type 2 diabetic patients in terms of the effects on tHcy.

Type 2 diabetes and hearing loss in personnel of the Self-Defense Forces.

The association of type 2 diabetes with hearing loss was evaluated in middle-aged male personnel of the Self-Defense Forces (SDFs). Hearing loss was defined as the pure-tone average (PTA) of the thresholds frequency at 0.5, 1, 2, and 4 kHz greater than 25 dB hearing levels (HL) in the worse ear. Diabetes status was determined by self-report of physician-diagnosed diabetes or by oral glucose tolerance test (OGTT). Of 699 subjects studied (age 52.9+/-1.0 years), 103 subjects were classified as having type 2 diabetes. Fasting plasma glucose of diabetic subjects was 120+/-19 mg/dl. Hearing loss levels were (worse) higher among diabetic subjects compared with subjects with normal glucose tolerance (NGT) (30.7+/-13.0 dB versus 27.4+/-12.3 dB, P=0.014). Hearing loss was more prevalent among diabetic subjects than among subjects with normal glucose tolerance (60.2% versus 45.2%, P=0.006). The odds ratio (OR) of type 2 diabetes for the presence of hearing loss was 1.87 (95% confidence interval 1.20-2.91, P=0.006) in a logistic regression analysis adjusted for age, rank, cigarette smoking and ethanol consumption. These results suggest that type 2 diabetes is associated with hearing loss independently of lifestyle factors in middle-aged men.

Prevalence rates of type 2 diabetes and hypertension are elevated among middle-aged Japanese men with colonic diverticulum.

OBJECTIVE: To elucidate the prevalence rate of metabolic disorders among subjects with asymptomatic colonic diverticulum. METHODS: We carried out a cross-sectional analysis of the association between colonic diverticulum and selected metabolic disorders among the male personnel of the Self-Defense Forces who underwent total colonoscopy as part of their retirement check-up (age range, 51-59 years). RESULTS: The prevalence rate of colonic diverticulum was 10.2% among the population studied. The scores of lifestyle factors including those of cigarette smoking and alcohol consumption were similar between the subjects with colonic diverticulum and those without it. Type 2 diabetes (21.6% vs 14.0%, P=0.047) and hypertension (30.9% vs 19.8%, P=0.011) were more prevalent among the subjects with colonic diverticulum than those without it. The prevalence rates of obesity, dyslipidemia, hyperuricemia, and impaired glucose tolerance were similar between the two groups. CONCLUSION: The prevalence rates of type 2 diabetes and hypertension are elevated among the middle-aged male subjects with asymptomatic colonic diverticulum. The results may partly explain the reported association between colonic diverticulum and cardiovascular disease.

Physical activity and selected cardiovascular risk factors in middle-aged male personnel of self-defense forces.

We cross-sectionally analyzed the association between duration of physical activity and the presence of selected cardiovascular risk factors in the middle-aged male personnel of the Self-Defense Forces who underwent retirement check-up (n = 974). In a univariate regression analysis, duration of high intensity physical activity but not that of moderate or low intensity physical activity inversely correlated with body mass index (BMI), triglyceride, fasting plasma glucose, white blood cell (WBC) count and systolic blood pressure. No intensity categories of physical activity correlated with total cholesterol. In a multivariate logistic regression analysis adjusted for lifestyle factors and the rank, the odds ratio per 1 h/wk increase in high intensity physical activity was .88 (95% confidence interval (CI) .80-.97; P=.007) for the presence of obesity (BMI 25.0 kg/m2), .88 (95% CI .81-.95; P = .002) for hypertrigly ceridemia, .87 (95% CI .76-.99; P=.034) for type 2 diabetes, and .90 (95% CI .82-.99; P=.037) for hypertension. Neither hypercholesterolemia nor high WBC count (> or = 6,900/microl) was associated with high intensity physical activity. High intensity physical activity inversely correlated with traditional cardiovascular risk factors in the middle-aged men.

Plasma total homocysteine and gallstone in middle-aged Japanese men.

BACKGROUND: We wished to determine whether selected coronary risk factors correlated with the presence of gallstone (GS) in middle-aged Japanese men. METHODS: We carried out a cross-sectional study of 974 male Self-Defense officials. The odds ratio of a 1-SD increment in levels of coronary risk factors for the presence of GS was calculated in a logistic regression analysis. RESULTS: Nine subjects had undergone cholecystectomy. Gallstone was detected in 39 subjects and not in 926 subjects. The presence of GS was associated with total homocysteine (tHcy), but not with total cholesterol, triglyceride, gamma-glutamyl transferase, glucose, or folate. The odds ratio of a 2.8-micromol/l increase (1 SD) in tHcy levels for the presence of GS was 1.34 (95% confidence interval [CI], 1.05-1.69; P = 0.017), and the ratio was 1.33 (95% CI, 1.04-1.70; P = 0.025) after being adjusted for lifestyle factors, including cigarette smoking, vegetable intake, physical activity, and abstention from alcohol. CONCLUSIONS: Plasma tHcy, but not the other coronary risk factors, correlated with the presence of GS in middle-aged Japanese men. This association may partly explain the reported high prevalence rate of coronary heart disease in subjects with GS.

Gamma-glutamyl transferase and airflow obstruction in middle-aged men.

BACKGROUND: A relationship between pulmonary dysfunction and cardiovascular mortality has been described. The mechanism responsible for the relationship remains largely unknown. METHODS: The association between airflow obstruction and selected cardiovascular risk factors including gamma-glutamyl transferase (gamma-GT) and total homocysteine was analyzed cross-sectionally in 954 middle-aged men. Airflow obstruction was assessed with %FEV(1) (FEV(1)/FVC). RESULTS: Serum gamma-GT and white blood cell (WBC) count were higher in subjects with airflow obstruction (%FEV(1)<70%) than in those without it (76.9+/-164.3 IU/L vs. 55.9+/-67.9 IU/L, P=0.030; 6290+/-1590/microL vs. 5590+/-1410/microL, P<0.001). Airflow obstruction was not associated with body mass index, total cholesterol, triglycerides, fasting glucose, or systolic blood pressure, but there was a marginal association with total homocysteine. In a logistic regression analysis adjusted for smoking status and alcohol consumption, the odds ratios (95% confidence interval) of Delta100 IU/L increase in gamma-GT and Delta1000/microL increase in WBC count for the presence of airflow obstruction were 1.20 (0.97-1.48, P=0.090) and 1.21 (1.02-1.44, P=0.036), respectively. CONCLUSIONS: Airflow obstruction was associated with gamma-GT. The association was independent of alcohol consumption category, but was attenuated by the addition of cigarette smoking status.

Gamma-glutamyl transferase and metabolic risk factors for cardiovascular disease.

OBJECTIVE: To elucidate the mechanism of the reported association between serum gamma-glutamyl transferase (GGT) activity and cardiovascular mortality. METHODS: Cross-sectional analysis of the relationship between serum GGT activity and the risk factors for cardiovascular disease was performed. PATIENTS AND MATERIALS: Middle-aged Japanese male personnel of the Self-Defense Forces who underwent retirement check-up. RESULTS: Serum GGT activity was associated with total cholesterol, triglyceride, fasting plasma glucose, total homocysteine and systolic blood pressure. The association remained in the analysis adjusted for possible confounders including cigarette smoking, ethanol consumption and body mass index. CONCLUSION: The observed association between serum GGT and cardiovascular risk factors may partly explain the reported relationship between serum GGT activity and cardiovascular disease. Serum GGT activity may be regarded as a marker of cardiovascular risk factors or oxidative stress rather than a mere indicator of excessive ethanol consumption or obesity.

Adiponectin levels and cardiovascular risk factors in Japanese men with type 2 diabetes.

Several cardiovascular risk factors correlate with adiponectin levels. It is not known whether total homocysteine, folate and gamma-glutamyl transferase levels correlate with adiponectin. We cross-sectionally analyzed the association between adiponectin and these cardiovascular risk factors in diabetic patients. One hundred and two male inpatients with type 2 diabetes without overt nephropathy or insulin use were studied. In a regression analysis of the quartiles of adiponectin, plasma levels of adiponectin were associated positively with HDL-cholesterol and age, and inversely with body mass index and HbA1c, but not with total homocysteine, folate or gamma-glutamyl transferase. Non-traditional cardiovascular risk factors such as homocysteine and folate levels were not associated with adiponectin levels in male type 2 diabetic patients who are not subject to insulin therapy.

Plasma vitamin B12, folate and homocysteine levels in gastrectomized men.

BACKGROUND & AIMS: Hyperhomocysteinemia is a risk factor for cardiovascular disease, dementia and depression. Prevalence rate of hyperhomocysteinemia in gastrectomized patients is not well elucidated. METHODS: We compared plasma total homocysteine, vitamin B12 and folate of gastrectomized male patients with those of control subjects. RESULTS: Total homocysteine was higher in gastrectomized patients than in control subjects (11.7 +/- 4.4 micromol/l vs. 9.3 +/- 2.4 micromol/l, P = .011), while vitamin B12 was lower in patients than in control subjects (382 +/- 211 pg/ml vs. 500 +/- 179 pg/ml, P = .020). Folate of the two groups was comparable (5.8 +/- 2.5 ng/ml vs. 5.9 +/- 2.2 ng/ml). Of 31 gastrectomized patients six (19.4%) showed low vitamin B12 (<233 pg/ml), four (12.9%) low folate (<3.0 ng/ml) and seven (22.6%) hyperhomocysteinemia (>14 micromol/l), whereas they were found in one (3.2%), none (0%) and one (3.2%) of 31 control subjects, respectively. Patients who had undergone gastrectomy because of cancer showed higher total homocysteine compared to patients who had undergone it because of peptic ulcer. Type of surgery did not correlate with total homocysteine in the present study. CONCLUSION: Hyperhomocysteinemia is not rare in male Japanese gastrectomized patients.

Alcohol consumption and plasma homocysteine.

A few reports show that consumption of spirits and of wine correlate with elevated plasma total homocysteine (tHcy), which is associated with the risk of cardiovascular disease. We analyzed the relation between tHcy and current daily ethanol consumption cross-sectionally in middle-aged Japanese men (n = 974, age 51-59 years). Plasma tHcy was positively associated with consumption of whiskey but not with consumption of shochu (Japanese spirits), sake, beer, or wine. Odds ratios of an increase in daily intake of 30 ml ethanol (approximately 1 standard deviation) for hyperhomocysteinemia (>14.0 micromol/l) were 2.58 (95% confidence interval, 1.29-5.14) for whiskey, 1.08 (0.78-1.50) for shochu, 0.99 (0.59-1.66) for sake, 0.98 (0.58-1.63) for beer, and 1.70 (0.31-9.50) for wine in a multivariate logistic regression analysis adjusted for the daily number of cigarettes smoked, physical activity, vegetable consumption, and serum creatinine levels. After inclusion of plasma folate and vitamin B12 in the multivariate analysis model, the association between whiskey ethanol consumption and hyperhomocysteinemia remained significant with odds ratio of 2.79 (1.36-5.72). These results suggest that whiskey consumption correlates with hyperhomocysteinemia independently of plasma folate or vitamin B12 or lifestyle factors in the population studied.

Plasma folate levels in men with type 2 diabetes.

Limited data suggest that folate levels are higher in patients with type 2 diabetes than in subjects with normal glucose tolerance (NGT). We compared the fasting plasma folate, glucose (FPG), body mass index (BMI), and supplementary vitamin use among male subjects with NGT, those with impaired glucose tolerance (IGT), those with newly diagnosed type 2 diabetes, and those with previously diagnosed type 2 diabetes. Plasma folate of patients with newly diagnosed diabetes and that of patients with previously diagnosed diabetes was significantly higher than that of NGT subjects (p < 0.001). Prevalence of vitamin use was lower in newly diagnosed or previously diagnosed diabetic patients compared with non-diabetic subjects. Self-rated vegetable intake was similar among the four groups. FPG, BMI, triglycerides, and systolic blood pressure correlated with plasma folate levels independently of lifestyle factors studied. These results suggest that plasma folate levels are elevated in male diabetic patients independently of health-conscious behavior that is recommended for diabetic people.

Rank in Self-Defense Forces and risk factors for atherosclerotic disease.

Socioeconomic status is associated with prevalence of and risk for atherosclerotic disease. We investigated the relationship between rank in the Self-Defense Forces (SDFs) and risk factors for atherosclerotic disease among middle-aged, male, SDFs personnel. Subjects were classified into five groups according to their ranks in the SDFs, i.e., class 1 (lowest, n = 289), class 2 (low, n = 170), class 3 (middle, n = 229), class 4 (high, n = 197), and class 5 (highest, n = 89). Low rank was associated with current cigarette smoking, alcohol abstaining, and poorer vegetable consumption. It was also associated with prevalence of type 2 diabetes, elevated gamma-glutamyltransferase activity, and high white blood cell counts. Prevalence of obesity, hypertension, hypercholesterolemia, hypertriglyceridemia, or hyperuricemia was not associated with rank in this population. Rank may be regarded as one of the markers that reflect individual health states among middle-aged male personnel.

Newly identified steroid hormone in urine of patients with Cushing's syndrome: 3alpha,11 beta-dihydroxy-4-androsten-17-one.

We have previously reported that the urine of patients with Cushing's syndrome, including pituitary adenoma cases and adrenal adenoma cases, consistently show a conspicuous peak in the chromatographical analysis of 17-ketosteroid fraction but not in the urine of control subjects. The substance emerges just before 11beta-hydroxy-androsterone (11beta-OH-A) in capillary gas chromatography. In the present study, we have identified an "unknown peak substance" observed in the urine of Cushing's syndrome patients using gas chromatography-mass spectrometry (GC/MS). Trimethylsilylether (TMS)-derivative of the substance was found to have a molecular weight (MW) of 448, which is similar to that of 11-OH-A (MW: 450). From these findings, we hypothesized that the substance had the structure of a C-19 steroid with two hydroxyl groups at positions C-3 and C-11, one keto-group at C-17 and a double bond between C-4 and C-5 of the A ring. We hypothesized that the unknown peak substance was 3alpha,11beta-dihydroxy-4-androsten-17-one (3alpha,11beta-DH-A). To confirm this speculation we synthesized 3alpha,11beta-DH-A and compared the elution pattern of it with that of the "unknown peak substance" using GC and GC/MS. We found that both substances were indistinguishable by GC and GC/MS analysis. These results suggest that the unknown substance observed in the urine of patients with Cushing's syndrome is 3alpha,11beta-DH-A.