小谷 和彦

Background. A silent cerebral infarction (SCI) is often found in the elderly. However, studies on SCIs focusing on an elderly population are sparse. Our objective was to evaluate risk factors of SCIs in healthy elderly individuals. Methods. One hundred seventy-five neurologically normal community-dwelling Japanese people aged greater than or equal to65 years (128 men and 47 women 77.5 +/- 8.7 years) were studied. Among them we assessed the demographic data and detected SCIs on brain magnetic resonance imaging scans. Results. Eighty four subjects had at least one SCI. Hypertension and low body mass index (BMI) were the significant risks for SCIs in multivariate analysis adjusted for age, sex and other risk factors. Mean BMI in subjects with SCIs was significantly lower than those without SCIs (20.8 +/- 3.2 kg/m(2) vs. 22.1 +/- 3.2 kg/m(2)). In the subgroup analysis by age stratum regarding hypertension and BMI, hypertension was a significant risk factor in subjects aged 65-75 years. Lower BMI had a significant risk in subjects aged greater than or equal to81 years. Conclusions. Hypertension and increasing age have been recognized as risk factors for SCIs, and low BMI might be a significant risk especially in superelderly subjects. Further data with a larger sample size is needed to confirm the relationship between BMI and SCIs among the elderly. (C) 2004 IMSS. Published by Elsevier Inc.

Recently, many cancer patients have been cared for at home in Japan. Cancer pain control is one of the most important factors for terminal cancer patients to maintain functional lives at home. Morphine has long been the gold standard in the control of cancer pain. This paper examined the present status of the frequency of morphine use and its prescribing route for pain control in cancer patients at home monitored by doctors offering home care medicine in Japan. We reviewed the data based on the replies to questionnaires about morphine use in a textbook edited in 2001 by the doctors supportive of home care medicine nationwide in Japan. 301 (92.9%) among 324 doctors administered morphine for at-home cancer patients. 257 doctors' replies were analyzed as to the prescribed pattern of morphine after excluding data without information on the administration route. The oral administration was most frequently used in 247 (96.1%) doctors and rectal administration was used in 217 (84.4%) doctors, while intravenous injection and epidural infusions were less common. The pattern of morphine administration was similar between doctors who worked at hospitals and clinics, except that doctors who worked at hospitals administered subcutaneously more frequently than doctors who worked at clinics (69.2% in the hospital vs. 39.4% in the clinic setting). This study has revealed that morphine is commonly prescribed to control pain in at-home cancer patients by doctors who support home care medicine in Japan. The restricted administration routes of morphine among the doctors and less prevalent use of the subcutaneous routes in doctors who work at clinics are also shown in the home cancer care setting. These findings might result from mutual relationship between the thought and experience of doctors and clinical characteristics of patients under home care medicine.

The discriminating abilities of fasting plasma glucose (FPG) and HbA1c were compared on screening tests for impaired glucose tolerance (IGT) and IGT plus diabetes mellitus by the receiver operating characteristic (ROC) curve analysis. Furthermore, effects of sex, age and BMI were examined on sensitivity and specificity of the optimal cutoff points. This study included 997 subjects who were recruited for 75 g OGTT after the first screening of the Japan Diabetes Prevention Program. According to the 1997 criteria of the American Diabetes Association (ADA), 140 subjects were classified as diabetic and 256 as IGT. The areas under the ROC curves of FPG were significantly larger than those of HbA1c. The optimal cutoff points of FPG were 102 mg/dl for IGT and 105 mg/dl for IGT plus diabetes mellitus. Those of HbA1c were both 5.3%. In screening with FPG, females had significantly lower sensitivity and higher specificity than males, and the specificity for IGT plus diabetes mellitus was the lowest in the obese group. In screening with HbA1c, the specificity was low in the older and the obese groups. We concluded that FPG was superior to HbA1c for screening of IGT and IGT plus diabetes mellitus and the optimal cutoff point of FPG would be 102 mg/dl or greater.

Nitric oxide (NO) is a candidate as a causative molecule in migraine. We determined nitrite, total nitrate/nitrite, and cyclic guanosine 3',5'-monophosphate (cGMP) concentrations in platelets from 30 migraine without aura (MwoA) patients and 17 migraine with aura (MwA) patients. All migraine patients were studied during their migraine attacks. The control group consisted of 28 healthy volunteers. Concentrations of platelet nitrite and total nitrate/nitrite were determined using simple and sensitive nitrate/nitrite fluorometric assay techniques. High concentrations of platelet nitrite and total nitrate/nitrite were found in patients with MwoA and MwA when compared with healthy controls. High concentrations of platelet cGMP were also found in patients with MwoA and MwA. The levels of platelet total nitrate/nitrite significantly decreased in headache-free periods after treatment with oral propranolol. These findings suggest that NO is produced in platelets during migraine attacks. It maylilso be related to the migrainous pain and the changes in cerebral blood flow experienced during migraine attacks. These data may provide new strategies for the treatment of migraine.