Successful resection of rectal carcinoma in an Evans' syndrome patient followed by predonisolone and high-dose immunoglobulin: report of a case.

A 69-year-old woman was admitted to our hospital because of anal bleeding and fatigue. The patient was previously diagnosed as having Evans' syndrome on the basis of hematological examination and had been treated with predonisolone for 8 years. On admission, severe anemia and thrombocytopenia were noted. Colonoscopy and Barium enema studies demonstrated an irregular tumor with hemorrhagic ulceration in the rectum, which was histopathologically confirmed as an adenocarcinoma. After red blood cells and platelets were transfused, and the patient was treated with high-dose gammaglobulin, predonisolone, and camostat mesylate, the platelet count gradually increased and hemolysis was well controlled. The patient then underwent Hartmann's operation and splenectomy without any postoperative complications. Predonisolone and high-dose immunoglobulin therapy in a rectal cancer burdened patient with Evans' syndrome is considered useful in combination with surgical treatment. This is the first case report of rectal carcinoma resection in a patient with Evans' syndrome.</p

Familial Case of Type 1 Diabetes Mellitus (T1DM) with Similar Onset and HLA Analysis

Subjects: Cases are two patients with type 1 diabetes mellitus (T1DM), with the characteristic relationship and onset situation. Case 1 is 46-year-old daughter and case 2 is 69-year-old mother. They have been living apart and they rarely meet together. Twenty-two months after the onset of T1DM case 1, case 2 also developed T1DM. They did not notice clinical manifestation of upper respiratory infection, or they did not have any stressful matters before the onset of T1DM. Results: Their data in case 1 vs 2 were as follows: BMI 21.3 vs 19.8, HbA1c 10.3% vs 9.8%, anti-IA-2 antibody (IA-2 Ab) 2.1 vs 6.0 (<0.4), anti-GAD antibody (GAD Ab) 24 vs 10000 (<1.5), HLA-DR type DR9 / DR13 vs DR4/DR13. Discussion and conclusion: These 2 cases have characteristic mode for the onset of T1DM. In Japanese race, DR4 and DR9 have rather high sensitivity for T1DM, DR15 (DR2) has resistance for T1DM and DR13 has unremarkable influence. From these, HLA-DR type would be possible involved in the onset of T1DM, and further investigation would be expected

Association of clinical findings in Yusho patients with serum concentrations of polychlorinated biphenyls, polychlorinated quarterphenyls and 2,3,4,7,8-pentachlorodibenzofuran more than 30 years after the poisoning event

<p>Abstract</p> <p>Background</p> <p>The Yusho poisoning incident, which was caused by rice bran oil contaminated with polychlorinated biphenyls (PCBs), polychlorinated quarterphenyls (PCQs) and polychlorinated dibenzofurans (PCDFs) generated by heat denaturation of PCB, occurred in 1968 in western Japan. Annual physical, dermatological, dental, ophthalmological and laboratory examinations were conducted for Yusho patients after the incident. From 2001, blood levels of individual PCDF congeners were also measured. The blood levels of 2,3,4,7,8-pentachlorodibenzofuran (2,3,4,7,8-PeCDF), PCBs and PCQs in Yusho patients were found to be significantly higher than those of the general population. We investigated the relationships between blood concentrations of 2,3,4,7,8-PeCDF, PCBs and PCQs in Yusho patients and the items measured in the annual medical examination.</p> <p>Methods</p> <p>Medical and laboratory examination data from 501 Yusho patients enrolled in the study from 2001 to 2004 were analyzed. The relationships between blood 2,3,4,7,8-PeCDF, PCB and PCQ concentrations and medical/laboratory examination data were investigated using principal components and logistic regression analyses.</p> <p>Results</p> <p>Serum Concentrations of 2,3,4,7,8-PeCDF, PCBs and PCQs in blood tended to correlate with either acneform eruptions, black comedones, cutaneous and mucosal pigmentation, and hypersecretion of meibomian glands as well as general fatigue, headaches, cough/sputum, abdominal pain, arthralgia, increased blood sugar, increased serum γ-GTP and decreased total bilirubin. The majority of these signs and symptoms are included in the diagnostic criteria for Yusho.</p> <p>Conclusion</p> <p>After Yusho patients had suffered chronic exposure to these chlorinated compounds for more than 35 years, the serum concentration of 2,3,4,7,8-PeCDF in blood was significantly related to arthralgia and decreased albumin/globulin (A/G) ratio; the serum concentration of PCBs was significantly related to ophthalmologic symptoms; and the serum concentration of PCQ to increased total cholesterol. These findings suggest that the co-contaminants may affect other functions than those originally associated with Yusho.</p

血中の2,3,4,7,8-五塩化ダイベンゾフラン(PeCDF)の個人の半減期：油症患者における臨床症状並びに検診結果との関係

BACKGROUND: In 1968, many people developed dioxin poisoning (Yusho) in Japan. Ingestion of 2,3,4,7,8-pentachlorodibenzofuran (2,3,4,7,8-PeCDF) was considered to be the cause of this poisoning. Although some patients had high concentrations of 2,3,4,7,8-PeCDF in their blood, individuals' half-lives of 2,3,4,7,8-PeCDF were long. OBJECTIVES: To evaluate the relationship between clinical and laboratory parameters and the individual half-life of 2,3,4,7,8-PeCDF in blood. METHODS: Clinical and laboratory data were collected during annual check-ups from 2001 to 2008. We enrolled 71 patients, who were measured more than 3 times, and who had 2,3,4,7,8-PeCDF concentrations in blood >50pgg(-1) lipid. The half-life of 2,3,4,7,8-PeCDF for each patient was estimated using linear regression. Moreover, relationships between clinical and laboratory parameters and individual half-life were investigated by linear regression. RESULTS: A shortened individual half-life for 2,3,4,7,8-PeCDF was significantly correlated with an increased red blood cell count, increased viscous secretions from the meibomian glands, existing black comedones, and severe cedar pollen allergy. CONCLUSIONS: Symptoms that accelerate excretion of lipids from the body, such as viscous secretions from the meibomian glands, may lead to a shorter half-life of 2,3,4,7,8-PeCDF. Red blood cells are related to the half-life of 2,3,4,7,8-PeCDF. However, further studies are required to investigate the excretory mechanism of 2,3,4,7,8-PeCDF.博士（医学）・乙1325号・平成26年3月17

Effective Xultophy administration to stable blood glucose profile by Continuous Glucose Monitoring (CGM)

Type 2 diabetes mellitus (T2DM) need adequate diet, exercise and pharmacotherapy. Authors have continued diabetic practice and research on low carbohydrate diet (LCD), calorie restriction (CR), continuous glucose monitoring (CGM), and so on. The case is 50-year-old female patient with T2DM for 10 years. She has received insulin treatment with recent HbA1c 7.4 – 8.7%, then her glucose profile was studied on CGM by FreeStyle Libre. Treatment was changed from Glargine 15 units (until day 5) to Zultophy10-12 doses (after day 6), then her glucose variability showed remarkably improved. The average blood glucose on day 3, 5, 6, 8,10,13 was 174, 164, 125, 111, 101, 98 mg/dL, respectively. FreeStyle Libre showed estimated HbA1c as 6.2% and 44 mmol/mol

Daily improvement of glucose variability by Continuous Glucose Monitoring (CGM)

Continuous Glucose Monitoring (CGM) has been recently applied in the clinical diabetic practice. Authors have continued research of glucose variability. In this study, 51 year-old female patient with Type 1 diabetes mellitus (T1DM) was investigated. She has given multiple daily insulin injection (MDI) for long and her recent daily glucose profile was unstable. After applied with FreeStyle Libre, her blood variability was improved with the average glucose from 222 mg/dL to 135 mg/dL, which was partly from her motivation for better diabetic control. Thus, CGM may become a trigger to give beneficial influence for regular lifestyle of the patients

Significant weight reduction by super low carbohydrate diet with improved lipid profiles

The case was a 41-year-old male patient with obesity and hypertension until 2015. He became 102 kg with body mass index (BMI) of 32.5 and HbA1c value increased to 6.6% in January 2016. Then, he started a low carbohydrate diet (LCD) and continued successfully. His body weight was decreased to 77 kg within nine months with 5.7% in HbA1c. His lipid profiles were improved as follows: triglyceride 143 to 33 mg/dL, LDL-C 130 to 102 mg/dL, HDL-C 40 to 76 mg/dL. After that, he has continued LCD but has always meals with excess calories. Then, his weight became 88 kg in January 2020 with 6.4% in HbA1c. During three years, values of HbA1c and lipid profiles became gradually worse. He has been prescribed for antihypertensive drugs and not for an oral hypoglycemic agent (OHA) so far. The adequate treatment would be discussed from now

Cutaneous symptoms such as acneform eruption and pigmentation are closely associated with blood levels of 2,3,4,7,8-penta-chlorodibenzofurans in Yusho patients, using data mining analysis

<p>Abstract</p> <p>Background</p> <p>Yusho an intoxication caused by oral dioxins and polychlorinated biphenyls occurred in 1968. Patients suffered from various systemic symptoms, including general fatigue, nausea, muscular and articular pain, acneform eruptions, black comedones, cutaneous and oral pigmentation, and increased eye discharge. The major causative factor was the contamination of rice oil with 2,3,4,7,8-penta-chlorodibenzofuran (PeCDF). Recent technical advances have allowed us to measure blood levels of PeCDF. However, there is little information on which symptoms and laboratory data are directly associated with PeCDF levels.</p> <p>Methods</p> <p>Yusho patients underwent annual medical check-ups from 2001 to 2003. Blood PeCDF levels were correlated with the presence or absence of symptoms in medical, hematological, dermatological, dental and ophthalmological examinations. This study analyzed all combinations by using the association analysis. This is the most suitable method to evaluate all combinations of the data comprehensively. This method was used to determine the rate of patients with high PeCDF level in the population with each symptom, and to extract combinations of three symptoms which were strongly associated with high PeCDF level.</p> <p>Results and Conclusion</p> <p>The rate of the patients with high PeCDF level was high in populations with high uric acid, black comedones (face), second highest quartile of age, or high urea nitrogen. The combination of three symptoms associated with the highest rate of patients with high PeCDF level was "high uric acid, female sexuality, and history of acneform eruptions", followed by "history of Yusho in and after 1968, high cholesterol level, and subjective symptoms." This analysis newly suggested that PeCDF concentration may be associated with history of dermatological symptoms, high uric acid, and elevated erythrocyte sedimentation rate.</p

Glucose-lowering efficacy of Xultophy with low doses by FreeStyle Libre as continuous glucose monitoring (CGM)

The daily profile of blood glucose can be detected by continuous glucose monitoring (CGM) using FreeStyle Libre. The case was a 51-year-old female with type 2 diabetes mellitus (T2DM) for uncontrolled glucose variability as HbA1c 10.3%. During CGM measurement, diabetic treatment was changed from multiple daily insulin injections (MDI) to Xultophy (insulin degludec and liraglutide). Xultophy starting from 10 to 18 doses has brought the improvement of glucose variability, such as decreased pre-prandial glucose from 268 mg/dL to 101 mg/dL. Consequently, detailed data of glucose variability on Xultophy using CGM would be beneficial and become some reference for further clinical diabetic research