A 75-year-old man with type 2 diabetes and a history of previous empyema surgery was admitted to our hospital due to difficulty moving caused by chronic obstructive pulmonary disease and dehydration. ...During the first two days of hospitalization, intestinal myiasis was diagnosed after maggots were found in his diapers. After the maggots disappeared, he developed a fever, prompting antibiotic therapy for a suspected secondary infection, resulting in clinical improvement. Despite thorough home cleaning, no flies or maggots were found, and the source of infection and the fly species remained unknown. Recent reports suggest a higher prevalence of myiasis among the elderly, even with overall improvement in hygiene. While myiasis is typically mild, it is a condition that requires consideration in an aging society. Myiasis is a disease that should be considered in the differential diagnosis of the elderly, especially in people who are bedridden or frail.
Background: Urinary N‐acetyl‐β‐D‐glucosaminidase (NAG) has been suggested as a marker for diabetic nephropathy. A prospective study has therefore been performed to compare albuminuria and urinary ...NAG activities in type 2 diabetic patients.
Methods: Forty‐one patients (23 men and 18 women) with type 2 diabetes between 40 and 78 years of age were selected for a 5‐year follow‐up study. The urinary activities of NAG to creatinine ratios (NAG index) and albumin to creatinine ratios (albumin index) were measured in random spot urine samples. All patients were normoalbuminuric (albumin index < 30 mg/g Cr) at the beginning of the study. The mean NAG indexes and albumin indexes were calculated yearly.
Results: During the observation period, 15 patients developed diabetic nephropathy (albumin index ≥ 30 mg/g Cr). Significantly higher mean NAG index and albumin index were found at the beginning of the study in patients who later developed diabetic nephropathy in comparison with those who did not (5.5 ± 2.0 vs 10.6 ± 4.2 U/g Cr, 11.0 ± 5.0 vs 17.8 ± 5.7 mg/g Cr, respectively). A gradual increase of the NAG index was found during the study in both patients who developed diabetic nephropathy and those who did not. On multiple logistic regression analysis, the NAG index at the beginning of the study was an independent predictor for the development of diabetic nephropathy.
Conclusions: These results suggest that the NAG index may serve as an early functional indicator of diabetic nephropathy.
The present study was designed both as a cross-sectional and longitudinal follow-up study to evaluate the association between pulse wave velocity (PWV) and cardiovascular disease. The subjects in ...this study included a total 260 patients (134 men and 126 women) ranging from 25 to 91 years (mean, 67.6±11.0 years). Carotid to femoral PWV was measured in all patients. The subsequent development of a cerebrovascular or coronary event was defined as a cardiovascular event. The longitudinal follow-up study was conducted with the occurrence of a cardiovascular event as the endpoint. The patients were classified into two groups: an L group with a PWV of less than 10 m/sec and an H group with a PWV of 10 m/sec or higher. Cross-sectional study at baseline: The H group patients were significantly older than the L group patients. The prevalence of hypertension, cardiovascular disease, ischemic heart disease, and cerebrovascular disease were significantly higher in the H group. Systolic blood pressure and serum uric acid were significantly higher in the H group than in the L group. However, there were no significant differences between the two groups with respect to other risk factors. Multivariate analysis using the prevalence of cardiovascular disease as the dependent variable showed "age" and "H group" to be independent variables. When the prevalence of ischemic heart disease or cerebrovascular disease was used as dependent variable, only "age" was an independent variable. Longitudinal follow-up study: The prevalence of cardiovascular event and cerebrovascular event were significantly higher in the H group than in the L group. The prevalence of coronary event in the H group tended to be higher than in the L group, but the difference was not statistically significant. Multivariate analysis using the cardiovascular event rate or coronary event rate as the dependent variable showed only "age" to be an independent variable. When the cerebrovascular event rate was used as the dependent variable, "uric acid" and "H group" were independent variables. The results of this study suggest a higher rate of cerebrovascular disease in patients with high PWV.
The aim of this study was to clarify the relationship between apolipoprotein (a) (apo (a) ) phenotypes and diabetic retinopathy in elderly type 2 diabetes. Serum Lp (a) concentrations and apo (a) ...phenotypes were analyzed in 250 diabetic patients aged 60 to 88 years old. Apo (a) phenotypes were classified into 7 subtypes (F, B, S1, S2, S3, S4, O (Null) ) by the method SDS electrophoresis with Western blotting. Patients were divided into two groups according to their apo (a) phenotypes:a low molecular weight (LMW) Lp (a) group, and a high molecular weight (HML) Lp (a) group. Patients were classified as having one of 4 types of diabetic retinopathy: no retinopathy (R0), simple retinopathy (R1), pre-proliferative retinopathy (R2), and proliferative retinopathy (R3). There was a significant association between serum Lp (a) levels and severity of diabetic retinopathy (p<0.001). A gradual trend toward increasing serum Lp (a) levels was observed across the groups (from R0 to R3). A significantly greater percentage of LMW Lp (a) was observed in the R1, R2, and R3 groups than in the R0 group (42.9% (p<0.001), 27.0% (p<0.01), and 27.3% (p<0.05) vs. 10.4%). Multiple logistic regression analysis revealed that duration of diabetes and LMW Lp (a) are independent risk factors for diabetic retinopathy. These results provide significant evidence that LMW Lp (a) contributes to an increased risk of diabetic retinopathy in elderly type 2 diabetes.
The present study evaluated the clinical usefulness of the measurement of common carotid artery blood flow velocity by an ultrasonic quantitative flow measurement system (QFM), and its correlation ...with the prevalence of ischemic heart disease (IHD). The subjects in this study included 287 patients (149 men and 138 women; mean age, 67.6±11.0 years) being treated as outpatients. Bilateral common carotid artery blood flow velocity was measured using a QFM-1100 (Hayashi Denki Co., Ltd.). The "high to low velocity ratio" (H/L ratio) was calculated by dividing the higher value by the lower value of the velocity of the common carotid artery. In 43 of 287 patients, we used an SSA-270 ACE (Toshiba Co., Ltd) to determine the presence of plaque and measure intimal-medial thickness (IMT) in the common carotid arteries. The mean H/L ratio was 1.45, with a median value of 1.25. The patients were stratified into subgroups based on H/L ratios from 1.0 and above in 0.1 increments in order to compare the prevalence rates of IHD. The prevalence rates in groups with H/L ratios of 1.3 and greater were significantly higher than those in the group with H/L ratios less than 1.3. In logistic regression analysis, the unadjusted H/L ratio was an independent risk factor for IHD at ratios from greater than 1.1 to greater than 1.6. The age-adjusted H/L ratio was an independent risk factor for IHD at ratios from greater than 1.1 to greater than 1.4. IMT was significantly higher in patients with a H/L ratio of 1.4 or greater versus patients with a ratio less than 1.4 (1.154±0.417 mm vs. 0.421±0.425 mm; p<0.05). The prevalence of carotid artery plaque was also significantly higher in patients with a H/L ratio of 1.4 or greater versus patients with a ratio of less than 1.4 (76.5% vs. 38.5%; p<0.03). Therefore, determination of the carotid artery H/L ratio by means of QFM may be clinically useful in screening patients for coronary artery lesions.
A 69-year-old type 2 diabetic man was admitted due to diabetic gangrane. He had a history of subtotal gastrectomy. During hospitalization, he was treated with regular insulin and 300 mg/day of ...acarbose. He developed a low grade fever, cough and nasal discharge, and was given a compound "cold" remedy with anticholenergic properties. The next day, he suffered from a paralytic ileus. Oral intake and acarbose were withheld and the ileus spontaneously resolved after 2 days. These finding indicate the possibility that the ileus was triggered by drugs with anticholinergic properties in this elderly diabetic patient treated with α-glucosidase inhibitors.
ivision of Geriatric Medicine, Nippon Medical School The present study evaluated the clinical usefulness of the measurement of common carotid artery blood flow velocity by an ultrasonic quantitative ...flow measurement system (QFM), and its correlation with the prevalence of ischemic heart disease (IHD). The subjects in this study included 287 patients (149 men and 138 women; mean age, 67.6 ± 11.0 years) being treated as outpatients. Bilateral common carotid artery blood flow velocity was measured using a QFM-1100 (Hayashi Denki Co. , Ltd.. The "high to low velocity ratio" (H/L ratio) was calculated by dividing the higher value by the lower value of the velocity of the common carotid artery. In 43 of 287 patients, we used an SSA-270 ACE (Toshiba Co., Ltd) to determine the presence of plaque and measure intimal-medial thickness (IMT) in the common carotid arteries. The mean H/L ratio was 1.45, with a median value of 1.25. The patients were stratified into subgroups based on H/L ratios from 1.0 and above in 0.1 increments in order to compare the prevalence rates of IHD. The prevalence rates in groups with H/L ratios of 1.3 and greater were significantly higher than those in the group with H/L ratios less than 1.3. In logistic regression analysis, the unadjusted H/L ratio was an independent risk factor for IHD at ratios from greater than 1.1 to greater than 1.6. The age-adjusted H/L ratio was an independent risk factor for IHD at ratios from greater than 1.1 to greater than 1.4. IMT was significantly higher in patients with a H/L ratio of 1.4 or greater versus patients with a ratio less than 1.4 (1.154 ± 0.417 mm vs. 0.421 ± 0.425 mm; p<0.05). The prevalence of carotid artery plaque was also significantly higher in patients with a H/L ratio of 1.4 or greater versus patients with a ratio of less than 1.4(76.5% vs. 38.5%;p<0.03). Therefore, determination of the carotid artery H/L ratio by means of QFM may be clinically useful in screening patients for coronary artery lesions. (J Nippon Med Sch 2001;68：482-489)
During the influenza epidemic of 1998-1999, we observed two elderly patients with influenza-like symptoms who had evidence of acute myositis with elevated serum enzymes. Influenza A infection was ...confirmed serologically in either case. The present cases suggest that it is important to distinguish influenzal myositis from other forms of myopathy in the elderly patients.
A 69-year-old type 2 diabetic man was admitted due to diabetic gangrane. He had a history of subtotal gastrectomy. During hospitalization, he was treated with regular insulin and 300 mg/day of ...acarbose. He developed a low grade fever, cough and nasal discharge, and was given a compound "cold" remedy with anticholenergic properties. The next day, he suffered from a paralytic ileus. Oral intake and acarbose were withheld and the ileus spontaneously resolved after 2 days. These finding indicate the possibility that the ileus was triggered by drugs with anticholinergic properties in this elderly diabetic patient treated with α-glucosidase inhibitors. (J Nippon Med Sch 2001;68：61-64).
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