AIMS/INTRODUCTION: As the extensor digitorum brevis muscle is a small muscle in the most distal part of the legs, its atrophy (EDBA) might reflect symmetric polyneuropathy (SPN). We aimed to clarify the EDBA-related factors and the usefulness of bilateral EDBA detection for diagnosing SPN, especially diabetic SPN (DSPN). MATERIALS AND METHODS: In 1,893 participants from the Japanese general population (investigation I) and 133 established diabetes patients (investigation II), relationships between EDBA and various factors including the traditional sitting style called "seiza'" (kneeling and sitting on one's heels) were investigated. Analyses were carried out by univariate and multivariate analysis, and SPN or DSPN was diagnosed by the criteria of "Probable DSPN" of the Toronto Consensus. The validity of EDBA detection for diagnosing SPN/DSPN was also evaluated. RESULTS: Investigation I: EDBA was more prevalent in women than men (44% vs 20%). Significant EDBA-related factors were aging and seiza habit regardless of sex. Male-specific EDBA-related factors were SPN and known diabetes. In men without seiza habit, EDBA was significantly associated with SPN regardless of diabetes, so EDBA seemed to be a useful sign for diagnosing SPN/DSPN. Investigation II: In men, DSPN was more prevalent in the EDBA group than the non-EDBA group (71% vs 33%). Sensitivity, specificity, positive predictive value and kappa coefficient of EDBA detection for diagnosing DSPN were 44, 87, 67% and 0.323, showing fair agreement. CONCLUSIONS: EDBA detection might be a useful method to screen for distal symmetric polyneuropathy, such as DSPN in men, although the exclusion of individuals with seiza habit is necessary to improve accuracy.

AIM/INTRODUCTION: Studies on a novel point-of-care device for nerve conduction study called DPNCheck have been limited to Westerners. We aimed to clarify Japanese normal limits of nerve action potential amplitude (Amp) and conduction velocity by DPNCheck (investigation I), and the validity of DPNCheck to identify diabetic symmetric sensorimotor polyneuropathy (DSPN; investigation II). MATERIALS AND METHODS: For investigation I, 463 non-neuropathic Japanese participants underwent DPNCheck examinations. Regression formulas calculating the normal limits of Amp and conduction velocity (Japanese regression formulas [JRF]) were determined by quantile regression and then compared with regression formulas of individuals from the USA (USRF). For investigation II, in 92 Japanese diabetes patients, 'probable DSPN' was diagnosed and nerve conduction abnormalities (NCA1: one or more abnormalities, and NCA2: two abnormalities in Amp and conduction velocity) were determined. Validity of NCAs to identify 'probable DSPN' was evaluated by determining sensitivity, specificity, reproducibility (kappa-coefficient) and the area under the curve of receiver operating characteristic curves. RESULTS: For investigation I, JRF was different from USRF, and normal limits by JRF were higher than that of USRF. The prevalence of Amp abnormality calculated by JRF was significantly higher than that of USRF. For investigation II, the sensitivity, specificity and reproducibility of NCA1 and NCA2 judged from JRF were 85%, 86% and 0.57, and 43%, 100% and 0.56, respectively. These values of JRF were higher than those of USRF. The area under the curve of JRF (0.89) was larger than USRF (0.82). CONCLUSIONS: A significant difference in the normal limits of nerve conduction parameters by DPNCheck between Japanese and USA individuals was suggested. Validity to identify DSPN of NCAs might improve by changing the judgment criteria from USRF to JRF.

UNLABELLED: Aims/Introduction:  In order to diagnose diabetic symmetric polyneuropathy (DSPN) more simply and accurately, we identified symptoms that correlated with neurological functions and existed more frequently in diabetic than non-diabetic subjects. MATERIALS AND METHODS:   The relationships between 10 symptoms (numbness or paresthesia in toe and sole, numbness in hand, pain in foot or hand, coldness in legs, painful leg cramp, dizziness on standing, sweating restricted to face/trunk and frequent constipation/diarrhea) and clinical background, defined as DSPN and cardiovascular autonomic neuropathy (CAN) by the criteria proposed in the statement of the American Diabetes Association, and seven quantitative nerve function data were evaluated in 593 diabetic patients in Wakayama Medical University Hospital (WMUH). Furthermore, the prevalence of various symptoms was examined by three questionnaires: a WMUH survey (999 diabetic outpatients), a Nationwide survey (1524 male diabetic outpatients under a primary-care physician) and a Control survey (501 non-diabetic subjects). RESULTS:   Bilateral 'numbness in toe and sole', 'paresthesia in toe and sole', 'pain in foot' and 'sweating restricted to face/trunk' were significantly associated with diabetes duration, retinopathy, probable and confirmed DSPN, possible and advanced CAN, and all or six nerve functions. Questionnaire surveys clarified that symptoms that are not rare (>15%) and more frequent in diabetic than non-diabetic subjects were bilateral 'numbness in toe and sole', 'paresthesia in toe and sole', 'coldness in legs', 'dizziness on standing' and 'sweating restricted to face/trunk'. CONCLUSIONS:   Therefore, bilateral 'numbness in toe and sole', 'paresthesia in toe and sole' and 'sweating restricted to face/trunk' are suitable symptoms useful for the diagnosis of DSPN. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00124.x, 2011).

UNLABELLED: Aims/Introduction:  We have previously reported that the Pro198Leu missense polymorphism in the glutathione peroxidase 1 (GPx-1) gene was associated with frequent macrovascular disease (MVD). Our goal was to examine whether the GPx-1 genotype is associated with diabetic neuropathy. MATERIALS AND METHODS:   We determined the GPx-1 genotype in 173 Japanese type 2 diabetic patients who received medical interviews, physical examinations, nerve conduction studies, quantitative vibratory perception (QVP), head-up tilt and heart rate variability tests by polymerase chain reaction-restriction fragment-length polymorphism. Diabetic sensorimotor distal symmetric polyneuropathy (DSPN) and diabetic autonomic neuropathy (DAN) were evaluated separately. DSPN and DAN were defined by two or more abnormalities of neuropathic leg symptoms, diminished Achilles tendon reflexes or impaired QVP in toes, and two autonomic dysfunctions, respectively. The association of the GPx-1 genotype with DSPN, DAN, MVD and other clinical manifestations was analyzed. RESULTS:   The prevalence of DSPN, impaired QVP and painful leg cramps in patients having a genotype with Pro/Leu at the codon 198 (Pro/Leu type) was significantly higher than those with Pro/Pro type. As a result of multivariate analyses that contained the GPx-1 genotype as an independent variable, the Pro/Leu type was extracted as a significant risk factor of DSPN, QVP impairment and MVD. The statistical significance did not disappear, even after proteinuria, retinopathy and a history of MVD were introduced as independent variables. In contrast, the GPx-1 genotype was not associated with DAN. CONCLUSIONS:   The Pro198Leu missense polymorphism of the GPx-1 gene might have a common genetic predisposition to DSPN and MVD. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00127.x, 2011).

Prevalence, clinical characteristics and risk factors of orthostatic hypotension (OH) were assessed in 600 diabetic patients aged 20 to 65 years.<BR>The influence of OH on mortality was also examined in 320 diabetic patients, who were followedup 1 to 15 years (average 5.1 years) later with nerve function testing. OH was judged by an orthostatic fall in systolic blood pressure of 30 mmHg or more, or by a systolic pressure of less than 80mmHg after standing. The results were as follows:(1) The prevalence of OH was 18%.(2) Half of the patients with OH were asymptomatic.(3) OH was observed more frequently in patients with long duration diabetes, severe microangiopathy, low body mass index, high blood pressure and imparired nerve functions, including nerve conduction slowing, decreased heart rate variability and an increased vibratory perception threshold.(4) The prevalence of OH in males was higher than in females especially in patients more than 50 years old.(5) The mortality of the OH patients (29.2/ 1, 000 person-year) was significantly higher than that of the non-OH patients (4.4/1, 000 personyear), and was significantly higher than that of the microangiopathic non-OH patients (4/1, 000 person-years), whose severities of retinopathy and nephropathy were equal to OH patients.(6) Half of the OH patient mortalities had suffered sudden unexpected deaths.

透析管理医

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透析管理医

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内科診察医、透析管理医

本クリニックにおいて内科診察および人工透析の管理を行う。

透析管理医

本クリニックにおいて人工透析の管理を行う。

透析管理医

本クリニックにおいて人工透析の管理を行う。

糖尿病

日本糖尿病学会の評議員として、学会の運営および糖尿病の予防・治療、合併症余郷・治療、指導などを行う。

糖尿病

日本糖尿病学会の腎症重症化予防担当医として、地域住民に対する腎症重症化予防に対する啓蒙、治療に努める。

糖尿病、患者会

糖尿病の患者会である日本糖尿病協会の和歌山支部において、糖尿病患者・家族への療養支援、地域への啓蒙・教育活動、和歌山糖尿病療養指導士の育成などに関わっている。

糖尿病

日本病態栄養学会の評議員としいて、学会の運営に協力し、病態栄養の解明に取り組む。