Biomedical subjects
Publications and source records attributed to G Inoue.
The case of a 15-year-old boy, a high-performance motocross rider, who developed bilateral osteochondritis dissecans of the elbow is described. Both lesions were successfully treated by Herbert screw internal fixation.
Changes in insulin-stimulated glucose metabolism were studied in young and aged subjects, subjects with impaired glucose tolerance, and patients with NIDDM by means of the glucose clamp technique. The diabetic group includes obese and non-obese patients treated without insulin and non-obese patients treated with insulin. The glucose disposal rate (GDR) was decreased in aged subjects (5.8 +/- 0.4 mg/kg/min) compared with young controls (7.4 +/- 0.3 mg/kg/min). In patients with IGT, it was further decreased to 3.6 +/- 0.5 mg/kg/min, which was comparable to the rate in NIDDM without insulin treatment (3.3 +/- 0.4 mg/kg/min). There were no differences in the GDR between obese (3.0 +/- 0.3 mg/kg/min) and non-obese (3.4 +/- 0.6 mg/kg/min) diabetic patients. In insulin-treated diabetic patients, GDR ranged widely, but the mean value was partially normalized (5.2 +/- 0.9 mg/kg/min). In the diabetic group, no correlation was observed between fasting blood glucose and GDR. These results suggest that in the course of developing NIDDM, a decrease in insulin-stimulated glucose uptake precedes a rise in fasting blood glucose. Thus, as previously reported for Caucasian NIDDM patients, resistance to insulin-stimulated glucose uptake may be one of the basic defects in Japanese patients with NIDDM. The degree of glycemia, however, is not directly related to the magnitude of the defect in insulin action.
Two patients with a dorsal transscaphoid perilunate dislocation with a dorsal dislocation of the proximal fragment of the scaphoid are described. Our 2 cases demonstrate that there can be a simultaneous fracture of the scaphoid and rupture of the scapholunate ligaments, which require open reduction and internal fixation.
Since dry cough has recently been recognized as a side effect of angiotensin converting enzyme (ACE) inhibitors employed in the treatment of hypertension or congestive heart failure, the incidence of dry cough in elderly patients receiving ACE inhibitors was investigated. There were 237 out-patients on either captopril, enalapril, or delapril, in August and November 1989. Questionnaires concerning dry cough and smoking were completed by 184 patients. Patients either less than 50 years of age, or with chronic pulmonary disease were excluded. The remaining 168 patients, 63 males, 105 females, with a mean age of 73 years were analyzed for the incidence of a dry cough in relation to age, sex, smoking, and type of drugs. The overall incidence of a dry cough was 21/168 (12.5%), 7/63 (11.1%) for males and 14/105 (13.3%) for females, and was less frequent with advancing age; in the 51-60 age group 4/11 (36.4%), in the 61-70 age group 5/39 (12.8%), in the 71-80 age group 9/75 (12.0%), in the 81-90 age group 3/40 (7.5%), in the 91- age group 0/3 (0%). Enalapril showed significantly higher incidence of dry cough than captopril (16/93, 17.2% vs 7/88, 8.0%, p less than 0.05). Delapril showed an incidence 4/11, 36.4%, however, 9 out of the 11 patients who were given delapril had had a history of a dry cough with captopril or enalapril, and in 4 out of these 9 patients the dry cough disappeared by replacement of captopril or enalapril by delapril.(ABSTRACT TRUNCATED AT 250 WORDS)
To evaluate the efficacy of the single dose chemoprophylaxis of recurrent urinary tract infection (UTI) in the elderly, 20 female inpatients (mean age 81.4) who had one or more culture documented UTIs in the past 12 months were studied. They were randomly assigned to be treated for 6 months either with chemoprophylaxis (200 mg of norfloxacin) or conventional therapy (without any antimicrobials except when overt UTI occurred). After a 4 months of washout period, the protocols were exchanged with each other and next 6 months of trial was carried out. All cases were followed at least 4 months after the discontinuance of the chemoprophylaxis. The difference of efficacy between the two modalities was evaluated by periodical examinations of urine cultures, urinalysis and inflammatory markers. During chemo-prophylaxis, the frequency of the symptomatic UTI (bacteriuria greater than 10(4)/ml, pyuria greater than 5/HPF, CRP greater than +) was 0.267/patient.year which was significantly lower than during conventional therapy (2.97/patient.year, p less than 0.01). This prophylactic effect remained 4 months after the discontinuance of the drug. On the other hand, bacteriuria was persistent in more than half of patients with chemoprophylaxis. Minimal inhibitory concentration of norfloxacin for separated bacteria revealed that the resistant species steeply increased from 4 to 6 months after the beginning of chemoprophylaxia. These species disappeared 4 months after the drug was discontinued. Optimal durations of chemoprophylaxis and drug-holidays were discussed.
Six men and two women (aged 37 to 50) with traumatic axial-ulnar disruption of the carpus were evaluated at an average of 34 months following treatment. The injuries were caused by a broad, anteroposterior crushing force to the hand and wrist resulting from, in most cases, an industrial accident. Our treatment began 2 weeks postinjury in five patients and more than 1 month postinjury in three patients. Treatment techniques included closed or open reduction and plaster immobilization, primary or delayed skin grafting, immediate revascularization, and secondary techniques. Cooney's criteria rated treatment results as excellent in one patient, good in two, fair in two, and poor in three. Although four variations of this injury were identified, the pattern of disruption appeared to have no influence on the results. An early surgical procedure seems to be most effective.
Twenty-one patients who had received treatment for a locked metacarpophalangeal joint of an index finger were reviewed. Five cases were successfully treated with manipulation after an intra-articular injection of a local anesthetic, while the remaining 16 required open reduction. In the vast majority (15 of the 16 operated patients), the locking was attributed to catching of the radial accessory collateral ligament on a bony prominence of the metacarpal head of the finger. All patients who underwent manipulation, and 14 of the 16 patients who were operated on, regained full range of motion of the metacarpophalangeal joint with no pain. Our experience suggests that manipulation is the treatment of choice. However, if it is unsuccessful, it should be followed by surgical exploration to avoid further damage to the joint.
In 22 patients an arterialised venous flap, with arterial blood only flowing through the vein of the flap, was used to cover skin defects of the hand. There were 17 complete successes, four partial successes and one complete failure. The main indications for use of the arterialised venous flap are to cover extensive skin loss with exposed bone or tendon where conventional flaps cannot be applied and to reconstruct the digital arterial defect where both revascularisation and skin coverage are needed.
Thirteen patients with 14 dorsal trans-scaphoid perilunate dislocations were treated by open reduction and internal fixation of the scaphoid using a Herbert screw. The follow-up evaluations took place after a mean of 18 months. These perilunate dislocations were only trans-scaphoid in ten wrists, trans-radial styloid and trans-scaphoid in three and trans-scaphoid and trans-capitate in one. Based on Cooney's clinical scoring system, the scores of our series were two excellent, six good, five fair and one poor. This suggests that the Herbert screw can offer satisfactory results in the management of trans-scaphoid perilunate dislocations, despite its technical difficulties.
A case of isolated dorsal dislocation of the scaphoid is reported. The patient was treated surgically with a good result.
Three patients with palmar dislocations of the proximal interphalangeal joints are described. The causes of irreducibility were the interposition of one lateral band about the condyle of the middle phalangeal head in two patients and the interposition of the central slip in one patient.
To see if insulin receptor kinase activity alters with aging, the activity of wheat germ agglutinin-purified receptor preparations from liver and skeletal muscle was compared in 2-, 4-, 10-, and 20-mo-old rats. Basal and insulin-stimulated autophosphorylation of liver insulin receptor and its kinase activities toward histone 2b and poly(Glu4Tyr1) did not alter with aging. On the other hand, the muscle insulin receptor showed different results. Insulin-stimulated increases of autophosphorylation and the kinase activity toward histone 2b above basal were comparable in the four groups. However, insulin-stimulated phosphorylation of poly(Glu4Tyr1) was decreased in 20-mo-old rats compared with 10- and 4-mo-old rats. These results indicate that insulin receptor kinase activity could vary under certain conditions, depending on the substrate used to measure the activity. It is concluded that insulin receptor kinase activity does not change markedly during the process of aging, although subtle changes seem to exist.
A case of patent ductus arteriosus (PDA) in an 80 years old female is presented. This is the oldest case reported in Japan and the most elderly case of newly diagnosed PDA in the world. Features of PDA in the elderly are reviewed.
Proximal row carpectomy was performed in 13 wrists with old unreduced perilunate dislocations and in 4 wrists with Kienböck's disease. One failure was converted to wrist arthrodesis, and 2 patients were lost to follow-up. The remaining 14 patients were reexamined after 11 (3-19) years. Average ranges of wrist motion were 37 degrees of dorsiflexion, 30 degrees of palmar flexion, 5 degrees of radial deviation, and 24 degrees of ulnar deviation. Grip strength averaged two thirds of the uninvolved hand. Pain relief was achieved in 12 patients, who all returned to their previous occupations. The results according to Cooney's criteria were 1 good, 8 fair, and 5 poor.
Measurement of HbA1c is widely used to control diabetes mellitus (DM) and is one of the methods to diagnose DM. We adopted the measurement of HBA1c in the annual medical examination of residents at a nursing home for the elderly in order to obtain the normal serum level of HbA1c in the elderly and analyze the influence of aging on HbA1c. HbA1c and the body mass index (BMI) were measured in 968 elderly. HbA1c was distributed from 3.7 to 12.5%. Mean and SD, were 5.03 +/- 0.61% and there was no difference of the serum level of HbA1c between males and females. HbA1c was below 6.0% in 95% of all subjects. There was no correlation between age and HbA1c. To determine data trends, we divided the elderly into 4 age groups of 60 to 69 years, 70 to 79 years, 80 to 89 years and 90 or more. With advancing age, HbA1c gradually increased but there was no significant difference of HbA1c among the 3 groups which were younger than the group aged 90 or more. HbA1c was 5.51 +/- 1.06% in the group aged more than 90 years and there was a significant difference in the value of HbA1c between the group aged 90 or more and other groups. Inversely, BMI gradually decreased with age and there was also a significant difference of BMI between the group aged 90 or more and the other groups. These results suggest that there is a difference of metabolic condition between the group aged 90 or more and the other groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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To clarify the mechanism(s) responsible for the insulin resistance in streptozotocin (STZ)-treated diabetic rats, we studied insulin-induced glucose disposal by using the glucose clamp technique and measured insulin receptor and glucose transporter of muscles. The insulin dose-response curve of the metabolic clearance rate (MCR) of glucose revealed a decrease of the maximal response without a rightward shift in STZ rats. Maximal MCR was even lower when clamped at 300 rather than 150 mg/dl of blood glucose levels. Insulin binding to the crude plasma membrane of muscles from STZ rats was increased compared with controls. The number of glucose transporter of the plasma and microsomal membranes were significantly decreased in STZ rats. These in vivo and in vitro studies using skeletal muscles suggest that in STZ-treated diabetic rats 1) a defect or defects exist in the signal transduction mechanism of insulin in postbinding steps, 2) the decreased maximal MCR is related at least partly to the decrease of glucose transporter numbers, and 3) a defect in glucose metabolism (postglucose transport defect) is also present.
An 84-year-old woman was admitted to Tokyo Metropolitan Tama Geriatric Hospital because of knee pain, anemia and hyperglobulinemia. On physical examination, evidence of arthritis was observed in both knees. Nodular temporal arteries were palpable with hypertrophy and weak pulsation. The urine was normal except that the sediment contained 20-30 with blood cells per high power view. Laboratory data showed raised erythrocyte sedimentation rate of 150 mm per hour, elevation of beta and gamma globulin and mild anemia. Although the levels of serum IgG, IgA were markedly increased, there was no monoclonal component on immunoelectrophoresis. Light microscopy examination of an aspirated specimen of bone marrow showed slight hypocellularity and mild plasmacytosis. However, atypical plasma cells were not observed. Radiographs of the knee showed narrowing of the joint space and calcification of articular cartilage and meniscus. Biopsy of the left temporal artery revealed typical findings of giant cell arteritis. The administration of prednisolone resulted in rapid normalization of laboratory findings. But her arthralgia, which had been relieved by analgesics after admission, was worsened if she took prednisolone without analgesic. Therefore, analgesics were given again with prednisolone for the control of the arthralgia.