Rheumatoid arthritis in patients aged above 75 years old at onset]

Elderly onset rheumatoid arthritis (RA) is difficult to diagnose definitively when the patients note their first symptoms of arthritis above the age of 75 years old. In this report, we reviewed the clinical features of elderly onset RA and its diagnosis. The subjects included 4 females, aged 78, 83, 84 and 93 years, respectively. The onsets were abrupt in 2 cases and more slowly arriving in the other 2. Shoulder joints and wrist joints were involved in all cases. Knee joints, finger joints and foot joints were involved in 3 cases and the elbow was involved in one case. Anti-RA treatment quickly attenuated the acute and severe arthritis and brought down the high CRP level associated with vivid inflammatory activity of RA. The RAPA value was very high in all but one of the cases. Severe destructive findings in radiography was undetectable in the major joints (e.g. shoulder, hip and knee joints). Radiographic findings in wrist and finger joints were also very difficult to differentiate from arthrosis and osteoporosis. On the other hand, RA involvement in the cervical spine was certain in the radiographs; 1 case had anterior atlantoaxial subluxation and 2 cases had subaxial intervertebral erosion. Pathological radiographic findings in the cervical spine are useful for the diagnosis of elderly onset RA.     

Operation for polysyndactyly of the fifth toe using Z-plasty.

A new operative procedure was devised to treat polysyndactyly of the fifth toe. This procedure, which consists of removal of the fifth toe, correction of the alignment of the preserved sixth toe by arthroplasty and construction of an interdigital space by Z-plasty, is technically simple and produces good results, both functionally and aesthetically.     

Direct effect of cadmium on citrate uptake by isolated rat renal brush border membrane vesicles

High incidence of multiple kidney stone formation has been observed among workers exposed to cadmium (Cd). Citrate is known to be a protective factor against renal stone formation. To study the direct effect of cadmium on citrate uptake by the renal brush border membrane, we exposed isolated rat renal brush border membrane vesicles (BBMV) to cadmium and determined their citrate uptake characteristics. BBMV were prepared by the divalent cation precipitation method. Citrate uptake was measured by the Millipore rapid membrane filtration technique. Preincubation of BBMV with 2 and 10 mM CdCl₂ for 1 min significantly inhibited citrate uptake compared with that of BBMV without Cd. Analysis of the time course of citrate uptake during 30-min preincubation of BBMV with 0.5 mM Cd also revealed significant reduction of the uptake compared with that of the control BBMV without preincubation. These findings indicate that preincubation of BBMV with cadmium results in time-dependent and concentration-dependent inhibition of citrate uptake.     

Fecal stream is essential for adaptive induction of glucose-coupled sodium transport in the remnant ileum after total proctocolectomy

Our previous studies demonstrated that sodium glucose cotransporter 1 (SGLT-1) was induced in the remnant ileum of total colectomized rats via the action of factors other than hyperaldosteronism. The aim of the present study was to clarify whether fecal stream is required for the enhancement of SGLT-1-mediated sodium transport. Twenty-seven pairs of ileal tissues were obtained from the proximal and distal side, respectively, of loop ileostomy after total proctocolectomy. Mucosae were mounted in an Ussing chamber to evaluate glucose-coupled sodium transport. Levels of SGLT-1 mRNA in proximal and distal mucosae were compared by Northern blotting. Villous height and crypt depth were measured to test for correlations between mucosal structure and SGLT-1-mediated sodium transport or mRNA expression levels. Both glucose-coupled sodium transport and expression of SGLT-1 mRNA were significantly lower in distal mucosae relative to proximal mucosae. In distal mucosae, villous height, but not crypt depth, was significantly lower than in proximal mucosae, demonstrating a positive correlation between villous height and SGLT-1 function and expression. Comparative studies of proximal and distal mucosae demonstrated that in addition to hormonal changes, fecal stream is required for full induction of the sodium transport system (which includes SGLT-1-mediated transport) in the remnant ileum following total proctocolectomy. Presented in part at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–19, 2005 (poster presentation). This work was supported by Grants-in-Aid for Scientific Research 10557118 and 14657295 from the Ministry of Education, Science and Culture of Japan to K. Fukushima, and by Kanae Foundation to K. Fukushima.     

Relationship between the number of steps taken and body mass index for male workers in the metropolitan area]

The present study examined the relationship between number of steps and body mass index (BMI) among male workers in the metropolitan area. The number of subjects were 310 (aged 30-59) and they were studied for seven consecutive days. The number of steps was measured by a pedometer. Energy expenditure was assessed by the activity record method. Energy intake was assessed by a food frequency questionnaire. Height and body weight were examined by a self-administered questionnaire. BMI of 81 subjects (26.1%) was greater than 25 kg/m2. The number of steps was 10,682 +/- 4,365 on working days, and 7,135 +/- 4,536 on holidays. Average energy expenditure in seven days was 2,259 +/- 378 kcal/d. The physical activity level (PAL) was 1.5 +/- 0.1. There was a significant correlation between BMI and the number of steps in a working day (r=-0.188, p<0.01). In addition, there were significant correlations between PAL and daily steps on working days (r=0.301, p<0.001), and on holidays (r=0.296, p<0.001). Subjects were divided into four groups according to the median number of steps on working days and energy intake (I; > or =9,894 steps, <1,901 kcal, II; > or =9,894 steps, > or =1,901 kcal, III; <9,894 steps, <1,901 kcal, IV; <9,894 steps, > or =1,901 kcal). BMI of Group IV (24.7 kg/m2) was significantly higher than that of the other Groups. Group III had the highest proportion of subjects (15.7%) with lifestyle related diseases.