Insulin autoimmune syndrome caused by an adhesive skin patch containing loxoprofen-sodium.

A 62-year-old woman complained of repeated hypoglycemic events. A 75 g oral glucose tolerance test (75 gOGTT) showed a marked increase in the plasma insulin level and impaired glucose tolerance. The patient exhibited a high titer of plasma anti-insulin autoantibodies. Her diagnosis was insulin autoimmune syndrome (IAS). Following the cessation of loxoprofen-sodium (LOXs), she experienced no further hypoglycemic episodes. However, the hypoglycemic attacks recurred following the accidental readministration of LOXs in an adhesive skin patch. Considering the changes in the titer of anti-insulin autoantibodies, the repeated 75 gOGTT and the repeated Scatchard analysis, we determined LOXs to be the cause of the IAS and evaluated the characteristics of the autoantibodies.

Template-based data entry for general description in medical records and data transfer to data warehouse for analysis.

General descriptions in medical records are so diverse that they are usually entered as free text into an electronic medical record, and the resulting data analysis is often difficult. We developed and implemented a template-based data entry module and data analyzing system for general descriptions. We developed a template with tree structure, whose content master and entered patient's data are simultaneously expressed by XML. The entered structured data is converted to narrative form for easy reading. This module was implemented in the EMR system, and is used in 35 hospitals as of October, 2006. So far, 3725 templates (3242 concepts) have been produced. The data in XML and narrative text data are stored in the EMR database. The XML data are retrieved, and then patient's data are extracted, to be stored in the data ware-house (DWH). We developed a search assisting system that enables users to find objective data from the DWH without requiring complicated SQL. By using this method, general descriptions in medical records can be structured and made available for clinical research.

Anomalous right coronary artery originating from the distal left circumflex artery: single coronary artery with choronic atrial fibrillation.

This report describes a patient with a single coronary artery in whom the right coronary artery originated from the distal left circumflex artery. Single coronary artery is a rare congenital anomaly of the coronary circulation which is often associated with other congenital cardiac malformations. This anomaly is thought to be clinically significant especially in patients with atrial fibrillation, although no other associated cardiac anomaly was detected.

Twice-daily administration of a long-acting angiotensin-converting enzyme inhibitor has greater effects on neurohumoral factors than a once-daily regimen in patients with chronic congestive heart failure.

Although many clinical trials have evaluated the use of long-acting angiotensin-converting enzyme (ACE) inhibitors in patients with chronic congestive heart failure (CHF), there are no data regarding whether a once-daily or twice-daily regimen is preferable with respect to effects on the neuroendocrine system. To address this issue, the authors evaluated the comparative effects of the administration schedule on neurohumoral factors and autonomic nervous activity in patients with CHF. Thirty-two patients with mild compensated CHF received lisinopril (5-20 mg/d) orally either once a day (n = 17) or twice a day (n = 15) for more than 3 months. After this initial therapy, patients receiving a once-daily regimen switched to a twice-daily regimen and vice-versa, and patients were followed for an additional 3 months. Neurohumoral factors and the coefficient of variance in the electrocardiographic R-R interval (CVRR) were measured. Hemodynamic parameters, renal function, plasma concentrations of brain natriuretic peptide and aldosterone, and CVRR did not differ between the two regimens. However, the plasma concentration of norepinephrine was significantly lower, and plasma renin activity tended to be lower with the twice-daily regimen. These findings suggest that twice-daily administration of long-acting ACE inhibitors may have better effects on the neuroendocrine system than a once-daily regimen in patients with mild CHF.