Evidence of characteristics of Japanese patients with diabetes from a large-scale population is necessary. Few studies have compared glycaemic controls, complications and comorbidities between type 1 ...and 2 diabetic patients. This paper focuses on illustrating a clinical picture of Japanese diabetic patients and comparing glycaemic control and prognoses between type 1 and 2 diabetes using multi-institutional data.
The BioBank Japan Project enrolled adult type 1 and 2 diabetic patients between fiscal years 2003 and 2007. We have presented characteristics, controls of serum glucose, cholesterol and blood pressure, prevalence of complications and comorbidities and survival curves. We have also shown glycaemic controls according to various individual profiles of diabetic patients.
A total of 558 type 1 diabetic patients and 30,834 type 2 diabetic patients participated in this study. The mean glycated haemoglobin A1c was higher in type 1 diabetes than in type 2 diabetes. In the type 1 diabetic patients, the glycated haemoglobin A1c had no consistent trend according to age and body mass index. The Kaplan–Meier estimates represented a longer survival time from baseline with type 1 diabetes than with type 2 diabetes. Compared with type 1 diabetic patients, type 2 diabetic patients had double the prevalence of macrovascular complications.
This work has revealed detailed plasma glucose levels of type 1 and 2 diabetic patients according to age, body mass index, blood pressure, serum cholesterol levels and smoking and drinking habits. Our data have also shown that the prognosis is worse for type 2 diabetes than for type 1 diabetes in Japan.
•Detailed glycaemic control data of diabetic patients are necessary.•Few studies have compared the survival times between type 1 and 2 diabetes.•Higher glycated HbA1c was observed in type 1 than in type 2 diabetes.•Data showed higher hazard ratio of mortality in type 1 than in type 2 diabetes.•Fewer macrovascular complications accompany type 1 than type 2 diabetes.
Abstract Background Electron-beam tomography (EBT) may provide useful information about characterization and morphology of atherosclerotic plaque of coronary arteries. Materials and methods ...Twenty-six subjects (20 male, 6 female) with suspected coronary heart disease had two routine (r) and one enhanced (e) EBT scans to detect non-calcified plaque (NCP) in the coronary arterial lumen, and were compared with conventional coronary angiograms (CAG) and intravascular ultrasound (IVUS). Results Three had the sites, which did not have high CT values suggesting calcification in rEBT, nor which was not enhanced by contrast material in eEBT. One had the site with positive CT values that were supposed to be the proliferation intima or organized thrombus and at the corresponding site mixed plaque was observed in the IVUS image. The other two had the site with negative CT values that were supposed to be fat tissue with significant stenosis in CAG. We also made the cross-sectional images of the vessel and the morphology of the NCP, which projected into the lumen, could be evaluated. Conclusions We could detect the NCP, differentiate fat tissue from soft tissue and evaluate the morphology of the plaque in EBT.
A 56-year-old woman was treated for rheumatoid arthritis for 17 years with methotrexate (MTX). Night sweats, fever and weight loss made her visit our hospital. Although levofloxacin failed to resolve ...her fever, she was suspected of having sepsis because of pancytopenia, elevated procalcitonin and a nodular lesion in the lung. After urgent hospitalization, she was diagnosed finally with the methotrexate-related lymphoproliferative disorder (MTX-LPD) associated with macrophage activation syndrome (MAS). Her general condition was improved with MTX withdrawal and 5-day high-dose glucocorticoid administration. Thus, even when the patient was critically ill with MAS, no cytotoxic agents were required to control MTX-LPD.
We report two cases where carotid artery stenting (CAS) and percutaneous coronary intervention (PCI) were performed at the same time on patients with advanced carotid artery stenosis, with impending ...symptoms of transient ischemic attack (TIA) complicated by advanced coronary artery stenosis. Case 1 was a 78-year-old male suffering from frequent occurrence of intermittent paralysis of the right upper and lower extremities. Advanced stenosis of his left internal carotid artery and left anterior descending (LAD) coronary artery was demonstrated in catheter angiography. Semi-urgent treatment of carotid artery stenosis was deemed necessary and, as the subject's coronary artery stenosis was also advanced, CAS was performed immediately following PCI. Case 2 was a 77-year-old female whose angina symptoms persisted despite undergoing PCI at another hospital. She visited our hospital after she began to experience amaurosis fugax. Advanced bilateral carotid stenosis and lesions in three coronary artery vessels were observed in catheter angiography. PCI and CAS were performed on three coronary artery vessels and her right internal carotid artery on the same day. CAS was performed on her left internal carotid artery at a later date, and her treatment was completed with no sequellae. We believe that the aforementioned method should be selected in the treatment of advanced carotid artery stenosis complicated by severe coronary artery disease if the patient's background and situation of the facility renders it appropriate.
A 57-year-old female was admitted to Chiba-nishi General Hospital complaining of exertional dyspnea. Severe hypoxemia and right ventricular dilatation were observed, which were consistent with acute ...pulmonary thromboembolism. Multiple large thrombi were detected in the bilateral main pulmonary arteries by angiography. Both thrombolytic therapy with urokinase and transcatheter suction maneuver were unsuccessful. An insertion of percutaneous cardiopulmonary support system (PCPS) was attempted only to fail because of peripheral vascular disease and her further deterioration, which resulted in sudden cardio-pulmonary arrest. The patient was immediately transferred to the operating room under cardiopulmonary resuscitation, and emergency open-heart thrombectomy was successfully performed. The postoperative recovery was uneventful and she discharged without any clinical sequellae following six weeks admission.
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