Emphysematous pyelonephritis and cystitis concurrence; A case report

We report a case of emphysematous pyelonephritis coexisting with emphysematous cystitis. A 57-year-old woman seen for abdominal pain, diarrhea, and high fever had been referred after computed tomography (CT) elsewhere had shown an air density mass in the left kidney and pelvis. Abdominal CT on admission showed emphysematous change in the left renal parenchyma and intramural bladder. Serum analysis results showed disseminated intravascular coagulation (DIC) and uncontrolled diabetes. Klebsiella pneumoniae was isolated in the blood. She was diagnosed with sepsis based on these findings due to concurrent emphysematous pyelonephritis and cystitis caused by K. pneumoniae. She was treated conservatively with meropenem, intravenous immunoglobulin, and gabexate mesilate and cured. Concurrent emphysematous cystitis and pyelonephritis is rare., with ours only the fourth case reported in Japan.     

Low-carbohydrate diet by staple change attenuates postprandial GIP and CPR levels in type 2 diabetes patients

AimsThe aim of this study is to investigate the effects of a low-carbohydrate staple food (i.e., low-carbohydrate bread) on glucose and lipid metabolism and pancreatic and enteroendocrine hormone secretion in comparison with meals containing normal-carbohydrate bread, without consideration of the carbohydrate content of the side dishes.MethodsT2DM patients (n = 41) were provided meals containing low-carbohydrate bread (LB) together with side dishes or normal-carbohydrate bread (NB) together with side dishes every other day as a breakfast. Blood glucose levels were evaluated by using a continuous glucose monitoring system; blood samples were collected before and 1 and 2 h after the breakfast.ResultsPostprandial blood glucose levels, plasma insulin, plasma glucose-dependent insulinotropic polypeptide (GIP) and plasma triglyceride were significantly lower and plasma glucagon levels were significantly higher in LB compared with those in NB. Plasma glucagon-like peptide-1 (GLP-1) levels did not differ in the LB and NB groups.ConclusionsThese results indicate that changing only the carbohydrate content of the staple food has benefits on glucose and lipid metabolism in T2DM patients concomitant with the decrease of insulin and GIP secretion, which ameliorate body weight gain and insulin resistance.     

Effect of mild exercise on glycemic and bodyweight control in Japanese type 2 diabetes patients: A retrospective analysis

We retrospectively evaluated the effects of mild physical exercise (P) in a routine clinical setting on glycemic and bodyweight control in Japanese type 2 diabetes patients with and without individualized nutritional therapy (D). We analyzed 49 patients who participated in P that measured 2.5 metabolic equivalents and was held once every 2 weeks, compared with 83 non‐participant controls, followed over a period of approximately 1.6 years. With a Cox model, the adjusted hazard ratio for improved glycated hemoglobin by numerical count of P was 1.03 (95% confidence interval [CI] 1.00–1.07; P = 0.025). Among four categories – with neither P nor D, only P, only D, and both P and D – the hazard ratios for reduced body mass index were 1.0, 0.87 (95% CI 0.46–1.67), 0.58 (95% CI 0.25–1.30) and 2.17 (95% CI 1.03–4.59), respectively. Even mild physical exercise contributed to glycemic control. The combination of P and D exerted beneficial effects on bodyweight control.     

Complete response of lung metastasis to interferon-alpha therapy after radical nephrectomy for sarcomatoid renal cell carcinoma with Stauffer syndrome: a case report

A 75-year-old man was admitted to our hospital with liver dysfunction and elevated C-reactive protein level. He was diagnosed with renal tumor by ultrasonography. Computed tomography revealed a renal cell carcinoma (cT3aN0M0) with Stauffer syndrome. Laparoscopic radical nephrectomy was performed. Histological findings indicated clear cell carcinoma with a sarcomatoid component. After 1 month, lung metastasis was detected on an X-ray film. Interferon-α was administered, and complete response was achieved 2 months later. He has shown no evidence of recurrence in 27 months.