Evaluation of new criteria for diagnosis of diabetes mellitus based on follow-up study of borderline diabetes

In order to evaluate the validity of recently proposed criteria for diagnosis of diabetes mellitus, a retrospective study was performed in 315 patients with borderline diabetes, who were selected from approximately 4,000 outpatients under treatment for more than three years. They were divided into two groups, BI and BII, according to the 2-hr blood glucose level in the 50 g glucose tolerance test (GTT): BI between 100 and 135 mg/100 ml and BII between 135 and 195 mg/100 ml. In group BI, glucose tolerance was deteriorated in 38 of 75 patients (51%) and converted to diabetes mellitus in 21 patients (28%). In group BII, 78 among 232 patients (34%) developed diabetes mellitus. Furthermore, in 85% of the 99 cases of the conversion to diabetes mellitus from borderline diabetes, it occurred within 5 years. Diabetic retinopathy was observed in 25 of 72 patients (35%) in group BI and in 60 of 212 patients (28%) in group BII. More than two thirds of the patients with diabetic retinopathy observed in the borderline diabetes developed their retinopathy within 5 years. Normal insulin response during GTT was proved only in 21% and 17% among groups BI and BII, respectively. These results indicate that the patients with borderline diabetes BI as well as BII, are closely related with diabetes mellitus, and that the patients with impaired glucose tolerance should be treated with diet restriction as in diabetes mellitus.     

Aneurysmal bone cyst arising in fibrous dysplasia during pregnancy

A case of two secondary aneurysmal bone cysts arising in fibrous dysplasia during pregnancy is reported. Marked radiographic changes were seen in one lesion over a 3-week period. The development of these cysts during pregnancy strongly suggests that the hemodynamic and/or hormonal changes of pregnancy were responsible for their formation.     

Molecular changes in glutamatergic synapses induced by Pb2+: association with deficits of LTP and spatial learning.

What are the molecular bases for the neurotoxicity that occurs after developmental exposure to low levels of Pb2+, and are these effects persistent and detrimental in adults? Our inability to understand specific mechanisms behind Pb2+ neurotoxicity has long been one of many problem areas of this preventable childhood disease. The sensitivity of the developing brain to Pb2+-induced neurotoxicity is an outcome of the many unique characteristics that comprise the developing central nervous system. The developing brain can be exposed to significant concentrations of Pb2+ during vulnerable periods of development such as synapse formation, gene and protein expression, and other diverse molecular changes associated with these processes. Recently, changes in NMDA receptor subunits were identified in animals that showed cognitive deficits induced by exposure to Pb2+. This molecular association is important because it provides new evidence in the characterization of developmental Pb2+ neurotoxicity that supports physiological findings of impairments in synaptic plasticity and behavior. This review updates information from molecular studies that can be directly associated with impairments of behavior and synaptic plasticity, and outlines the functional consequences of molecular differences in Pb2+-exposed animals that illuminate potential mechanisms of Pb2+-induced neurotoxicity.     

Effect of post-transplant double filtration plasmapheresis on recurrent focal and segmental glomerulosclerosis in renal transplant recipients

In the present study, we reviewed the effect of post-transplant double filtration plasmapheresis (DFPP) on recurrent focal segmental glomerulosclerosis (FSGS) in the transplanted kidney allograft. Sixteen patients with post-transplant recurrent FSGS were enrolled in this study. Out of 16 patients with recurrent FSGS after transplantation, five did not receive DFPP and lost their grafts, while 11 did receive DFPP and four of these patients lost their grafts. Seven patients were able to maintain normal renal function for an average observation period of 57.1 +/- 40.7 months (range 7-125 months). In five patients who had a significant reduction in urinary protein after DFPP, the urinary protein level decreased from 26.60 +/- 23.05 g/day (range 3.34-62.6 g/day) to 2.95 +/- 3.42 g/day (range 0.02-8.64 g/day) and renal function was maintained. The beneficial effects of DFPP on graft outcome were more likely to occur if the patients experienced a marked drop in urinary excretion. Thus, post-transplant DFPP appears to be effective for reducing urinary protein levels and improving long-term graft survival. With the small numbers in this trial, however, none of the findings were statistically significant. We recommend the use of post-transplant DFPP to prevent the progression of recurrent FSGS.     

A phase I/II study of nedaplatin and 5-fluorouracil with concurrent radiotherapy in patients with T4 esophageal cancer: Japan Clinical Oncology Group trial (JCOG 9908)

Background Nedaplatin is an analogue of cisplatin with less nonhematologic toxicity. The combination of nedaplatin and 5-fluorouracil showed a promising response rate in a previous phase II study for metastatic esophageal cancer. The purpose of this study was to determine a recommended dose and to evaluate the efficacy of nedaplatin and 5-fluorouracil combined with concurrent radiotherapy.Methods Eligibility criteria included squamous cell carcinoma of the thoracic esophagus; T4 disease without distant organ metastasis; age 20–70 years; performance status 0–2; and adequate organ functions. Patients received two cycles of nedaplatin (80 mg/m² or 90 mg/m²) on day 1 and continuous infusion of 5-fluorouracil 800 mg/m²/day on days 1–5, every 5 weeks with concurrent radiotherapy 60 Gy in 30 fractions.Results Between December 1999 and April 2002, 26 patients were accrued. The recommended dose of nedaplatin was 90 mg/m². Common grade ≥3 toxicities included leukopenia 9, neutropenia 5, thrombocytopenia 4, esophagitis 4, and esophageal fistula 3. Three of 26 patients achieved complete response (12%; 95% confidence interval, 2%–30%). With a minimum follow-up of 26 months for surviving patients, the median survival time was 12 months (95% confidence interval, 9–22 months), and the 2-year overall survival was 31% (95% confidence interval, 13%–49%).Conclusions This combined therapy is active with acceptable toxicity, however, the survival figure remains poor. Further investigation into more effective treatment is needed.