Association of obesity and visceral fat distribution with intima-media thickness of carotid arteries in middle-aged and older persons.

OBJECTIVE: The association between obesity and atherosclerotic disease is controversial. We examined whether common carotid intima-media thickness (IMT), a precursor to preclinical atherosclerosis, was associated with total body fatness or the accumulation of fat mass in the abdominal region in middle-aged and older persons. METHODS: Participants were consecutively enrolled from patients aged >or=50 years, and were 623 men aged 73+/-10 (mean+/-standard deviation) years and 835 women aged 76+/-10 years. Demographic data were collected and maximal preperitoneal fat thickness (PFT(max)) and carotid intima-media thickness (IMT) were evaluated on B-mode ultrasonography. Subjects were divided into 3 groups on the basis of body mass index (BMI), a marker of general obesity. RESULTS: It was shown by multiple regression analysis for IMT that age, smoking status, hypertension and uric acid were significantly associated with IMT in subjects in the lowest BMI group (<20 kg/m(2)), and age, hypertension, dyslipidemia and uric acid in middle BMI group (20-22.9 kg/m(2)). Moreover, man sex, age, BMI, PFT(max), smoking status, hypertension and uric acid were significantly associated with IMT in subjects with highest BMI group (>or=23 kg/m(2)). Analysis of covariance showed that interaction between BMI and visceral obesity (f=7.202, p=0.007) was significantly associated with IMT, in addition to age, visceral obesity, smoking status, hypertension, dyslipidemia and uric acid. CONCLUSION: The present study indicates a graded and independent association between general and visceral obesity and preclinical carotid artery changes in patients aged >or=50 years with a BMI >or=23 kg/m(2).

Carotid atherosclerosis in normal-weight metabolic syndrome.

OBJECTIVE: To examine whether or not individuals with a normal body mass index (BMI) (18.5 kg/m(2)-24.9 kg/m(2)), but who also fulfill the criteria for the metabolic syndrome (MetS) class, can be associated with carotid atherosclerosis. METHODS: The subjects were consecutive in-patients with a normal BMI (18.5 kg/m(2)-24.9 kg/m(2)) in the Medical Department of Seiyo Municipal Nomura Hospital enrolled between September 1996 and February 2006. The subjects were 452 men aged 69+/-15 (mean+/-standard deviation) years and 542 women aged 74+/-13 years. Carotid atherosclerosis was assessed by carotid intima-media thickness (IMT) on B-mode ultrasonography. RESULTS: Compared with men with BMI 18.5 kg/m(2) to 20.9 kg/m(2), the odds ratios of the MetS were 2.83 (95% confidence interval [CI], 1.69-4.76) for men with BMI 21 kg/m(2) to 22.9 kg/m(2) and 6.13 (95% CI, 3.57-10.5) for men with BMI 23.0 kg/m(2) to 24.9 kg/m(2) after controlling for age, smoking status, high low-density lipoprotein cholesterol, and uric acid. Using the same regression model and BMI categories in women, the odds ratios were 2.52 (95% CI, 1.42-2.83) and 4.38 (95% CI, 2.42-7.92), respectively. Multivariate-adjusted carotid IMT was significantly greater in men with than without MetS, especially in patients with BMI 23.0 kg/m(2) to 24.9 kg/m(2). Although in women, there were no inter-group differences in categories of normal BMI and MetS. CONCLUSION: Individuals in the upper normal BMI range have a relatively high prevalence and are at increased risk of having metabolic syndrome. Therefore, screening of individuals with normal or slightly elevated BMI is important in preventing atherosclerosis.

[Elements necessary for end-of-life care for terminal cancer patients and standardization of discharge planning].

AIM: Unitil now, most terminal cancer patients have received end-of-life care service in a hospital. How, recently, home health care services have received much attention instead of the hospital care. In this study, we investigated important factors affecting smooth transition to home health care from hospital care. METHODS: We examined the records of 66 deceased subjects with terminal cancers who received medical care by staff of home heath care agency "Yunomori Tnapopo clininc" were included in this study. METHODS: The categories evaluated were: 1) general condition, 2) breakdown of family caregivers, 3) rate of application for care insurance, 4) the percentage of cases with a discharge planning conference, 5) the time of death and, 6) frequency of visiting care in the first 1 week and the last 1 week. RESULTS: The 66 subjects consisted of 38 men (58%) and the average age of the group was 71.1 2.0. 1) Dementia was indicated in 20 (30%) patients and 23% of the patients were reliant on intravenous nutrition. Oxygen treatment was required for 45% of the patients. Some help for excretion was required by 70% of the patients. 2) 70% of a main care giver were woman and the average number of persons per household was 2.0. 3) 50% of the patients did not apply for care insurance. 4) Discharge planning conferences between the hospital and the clininc were held in only 21% of the case. 5) over 70% of the patients died outside duty hours (between 8AM and 6PM). 6) Although the average duration of stay at home was 62.5 days, 10% of the cases died or had to leave their home due to worsening condition during the first 2 weeks. Vsits by medical doctor in the last 1 week significantly increased in frequency compared to that in the last 1 week. (5.0 0.2 vs. 3.9 0.2, p<0.01). In addition, frequency of care visits by nurses increased significantly as well (3.2 0.2 vs. 2.4 0.2, p<0.01). Overall the number of care visits in the last 1 week was more than once a day. CONCLUSION: 1. A home-health care clinic which gives 24-hour care is necessary so that the patients receive end-of-life care as well as hospital care. 2. Earliest possible transfer to the home health care setting is needed so trhat the patients could have enough time to live in their hom with their family. On this account, it is most important to convene a conference co-organaized by the home health care adjusytment. In addition, the patients or their family need to apply to the munided office for care insurance. Medical staff should provide information and help them.

[A case of Werner syndrome with chromosomal abnormality].

A 52-year-old woman with diabetes mellitus (DM) complained of weakness of the arms and legs. She was referred to our hospital in November 2002 because of anemia, thyroid tumor and meningioma including DM. She was short in stature, juvenile bilateral cataract, intractable skin ulcers, clavus on the sole of her foot, a bird-like face and high-pitched voice. Typical physical features led to the final diagnosis of Werner's syndrome. Although the myelogram revealed no abnormal findings except erythroid hypoplasia, cytogenetic analysis of bone marrow cells showed deletion of chromosome 20 in 10% of the analyzed cells, which suggested the possibility of that myelodysplastic syndrome (MDS) or acute myeloblastic leukemia (AML) could occur. She had a thyroidectomy because both lobes of the thyroid gland were enlarged and caused hoarseness, In addition, it is common knowledge that the goiter could become malignant. We need to follow her carefully because she might be vulnerable to malignant disease, including leukemia and malignant meningioma.