Large Vasopressin in SIADH

A 76-year-old man with small cell lung cancer associated with the syndrome of inappropriate secretion of ADH (SIADH) visited our hospital. The serum Na level was normal on the first visit, but 2 weeks later it decreased to 114 mEq/L with an extremely high plasma vasopressin (VP) level of 1520 pg/ml. Serum Na was normalized after the reduction of the tumor size by chemotherapy, but the plasma VP level remained between 150 to 600 pg/ml. On gel filtration of plasma VP two peaks of immunoreactive VP were eluted at the positions of a larger molecule than authentic VP and authentic VP, and VP in urine gave only one peak compared to that of authentic VP. The dilution curve of plasma VP was almost parallel and that of urine was completely parallel to the standard curve. These findings suggest that a larger VP with low physiological activity was predominantly secreted in the present patient and manifested relatively mild symptoms despite the extremely high plasma VP level

トクシマ コウケツアツ トウニョウビョウ study 2011 : コウケツアツ トウニョウビョウ ガッペイ レイ ニ カンスル タシセツ ケンキュウ

Cardiologists and diabetologists in Tokushima Prefecture investigated patients with hypertension and diabetes mellitus on treatment in２０１１. The findings were compared with our year‐２００４ data. The study population comprised ２３６ patients with hypertension and diabetes mellitus being treated by cardiologists（C２０１１group）, and ３９５ patients with the same condition being treated by diabetologists（D２０１１group）. The mean number of antihypertensives used per patient was１．９for the C２０１１group and１．６for the D２０１１group. In these two groups, calcium antagonists were the most frequently used drugs. Renin-angiotensin system（RAS）inhibitors were used in７１．５％ of the patients in the C２０１１group and７０．０％ in the D２０１１group. The ratio of patients meeting the blood pressure criteria of the Japan Hypertension Society Guidelines was ２１．６％ for the C２００４group,２２．９％ for the D２００４group,２９．１％ for the C２０１１group, and１８．２％ for the D２０１１group. The mean number of antidiabetics used per patient was１．３for the two groups, glimepiride being most frequently used（３８．５％ for the C２０１１group,５８．１％ for the D２０１１group）, followed by α-glucosidase inhibitors and pioglitazone. Frequency of use of biguanide increased compared with２００４. The ratio of patients with HbA１c＜６．５％ was４０．７％ for the C２００４group, ２１．９％ for the D２００４ group, ４６．５％ for the C２０１１ group, and ４９．０％ for the D２０１１ group ; a significant improvement was observed in the D２０１１group compared with the D２００４group. The serum cholesterol control rate was４９．７％ for the C２００４group,４５．０％ for the D２００４group,６０．９％ for the C２０１１group, and５６．５％ for the D２０１１group. The ratio of patients achieving good control for all three parameters（blood pressure, blood glucose level, serum lipid level）was low at７．６％ for the C２００４group,６．７％ for the D２００４group,９．４％ for the C２０１１group, and９．０％ for the D２０１１ group. This managerial situation for the condition is unsatisfactory, necessitating efforts for even better control

糖尿病患者の在宅ケア向上をめざしたTCDS育成の試み

The Tokushima City Medical Association has cultivated the talented persons of nursing care profession by both the education of diabetes and the instruction of medical treatments to secure the quality of home care for increasing diabetic patients. They are certified to be the Tokushima City Certified Diabetes Supporter（TCDS）. In Tokushima Prefecture, the rate of aging and the certification rate of care need are ranked high in Japan, and the medical measures should be provided for the aged diabetic patients utilizing team nursing care as well as team medical care, because many of these patients are obliged to receive home medical care owing to the introduction of community-based integrated care systems. Tokushima Prefecture kept the worst of age-adjusted diabetes mortality and also the worst of crude diabetes mortality in recent years. Therefore, the program for the TCDS was arranged by the staffs composed of board certified fellows of the Japan Diabetes Society, certified diabetes physicians of Tokushima, and Tokushima local certified diabetes educators （Tokushima LCDEs）. The program includes the lectures of diabetes and medical treatments, the practical training, and the group work by the World Café system collaborated with the medical staffs across many different fields, using the dramatic skit presented by the medical doctors and the LCDE staffs after narrating the scenario for the blood glucose control of diabetic patients to be treated. The persons who have completed the training course are certified as the TCDS by The Tokushima City Medical Association. The workshop is held twice a year and the certification is renewed every three years without examination. In conclusion, it is suggested that the development of TCDS leads to the improvement of the ability of nursing care staffs to support diabetic treatments and the advancement of the quality of home medical care for the aged diabetic patients

トクシマケン イシカイ トウニョウビョウ タイサクハン ダイ1ジ ダイ2ジ カツドウ ノ セイカ

Objective : The effectiveness of diabetes prevention programs for the general population in Tokushima Prefecture was investigated. The programs were designed by Tokushima Medical Association’ s（TMA’s）Steering Committee for Diabetes Prevention. Research design and methods : The committee promoted diabetes prevention by disseminating educational messages on diabetes to the general public and medical care providers, and establishing a referral system among public health centers and medical institutes throughout Tokushima Prefecture during the period from ２００４ to ２００９. The outcome of these activities were evaluated by analyzing data from the Prefectural Health and Nutrition Survey in Tokushima conducted in１９９７（n＝ ９９８）,２００３ （n＝１００８） and ２０１０ （n＝１１３０）, and then comparing these results with those of the national survey at the corresponding times. Results : The percentage of subjects with glucose intolerance at the time of initiation of the prevention program in Tokushima tended to increase from １９９７ to ２００３, but was slightly decreased in ２０１０, although the differences were not statistically significant. However, the percentage of subjects with glucose intolerance was significantly increased throughout Japan during the same period. Obesity parameters, physical activity evaluated by the number of steps and the average total energy intake changed favorably in parallel with changes in the prevalence of diabetes during the study period in Tokushima. Conclusion : The diabetes prevention programs initiated by the TMA’s committee may be useful in ameliorating the situation of diabetes in Tokushima Prefecture

トクシマシ イシカイ ノ トウニョウビョウ タイサク

Tokushima City Medical Association has founded the committee for the means to prevent diabetesmellitus, because the mortality rate by diabetes mellitus in Tokushima Prefecture remainedranked first for 14 years from 1993 to 2006. It has enlightened a large number of people, such asdiabetic patients and candidates for diabetes, and also healthy citizens in Tokushima for preventingdiabetes mellitus. For this aim, Tokushima City Medical Association has made the home pagenamed Tokushima City Diabetic Network to show clearly the means to prevent diabetes mellitusfor the citizens. By this Web site, the citizens can get a correct knowledge about diabetes mellitus,a useful information about the treatments including exercises, diets and medications, and an informationabout medical institutions by utilizing the search page to receive a proper diabetic treatment.Tokushima City Medical Association held several events, such as Tokushima citizens’extension courses and diabetes forums for the citizens to understand diabetes mellitus clearly.Fortunately, in 2007, Tokushima got out of the first rank of diabetic mortality rate. TokushimaCity Medical Association will continue efforts to prevent diabetes mellitus by approaching the citizensof all ages from various aspects