Rapid improvement of severe fatty liver in a case of fulminant type 1 diabetes following insulin treatment.

A 36-year-old woman presented to the emergency room with a consciousness disorder after developing abdominal pain with diarrhea for 2 days. She presented with marked hyperglycemia, ketoacidosis, and increased serum free fatty acid (FFA) levels; however, no elevation in the glycated hemoglobin (HbA1c) levels was observed. Based on the marked depletion of insulin secretion, the patient was diagnosed as diabetic ketoacidosis attributed to fulminant type 1 diabetes (FT1D). Computed tomography on admission revealed severe fatty liver (FL), which improved 17 h following insulin treatment. Insulin treatment also suppressed the serum FFA levels. Some cases of FT1D with FL and liver dysfunction have been reported previously; however, its pathogenesis and clinical course remain unclear. Compared to previous reports, this case reported the shortest time for FL improvement. In this case, rapid and severe insulin deficiency led to a markedly high FFA level and significant accumulation of triglycerides in the hepatocytes, resulting in severe FL. A rapid and large dose of insulin was administered when systemic insulin sensitivity was nearly maximal owing to insulin deficiency, increased insulin efficacy, early reduction of FFA, suppressed triglyceride accumulation in the hepatocytes, and increased triglyceride excretion from the liver. All these factors could have contributed to the rapid improvement in FL.

A Clinical Case of Insulinoma Presenting with Postprandial Hypoglycemia in a Patient with a History of Gastric Bypass Surgery.

A 61-year-old man with a history of total gastrectomy for cancer with Roux-en-Y reconstruction showed severe postprandial hypoglycemia accompanied by endogenous hyperinsulinemia. Abdominal ultrasonography and contrast-enhanced computed tomography showed no abnormal findings in the pancreas. A selective arterial secretagogue injection test showed the marked induction of serum immunoreactive insulin when calcium was injected into the splenic artery. A pathological analysis following distal pancreatectomy with splenectomy revealed a pancreatic neuroendocrine microadenoma containing insulin-producing cells in the resected pancreas. This case highlights the importance of carefully evaluating refractory and severe hypoglycemia in patients with a history of gastric surgery to exclude insulinoma.

Acute Kidney Injury with Hemolysis after Glycerin Enema-induced Rectal Injury in a Patient with Type 2 Diabetes.

A 66-year-old man with type 2 diabetes was admitted for glycemic control and weight loss. The rectal mucosa was unfortunately injured during glycerin enema administration in preparation for colonoscopy, after which dark red urine and renal dysfunction were observed. Considering the clinical diagnosis of glycerol-induced hemolysis and acute kidney injury, intravenous hydration and haptoglobin administration were started, which successfully treated the dark red urine and renal dysfunction. This case highlights the importance of appropriate glycerin enema administration and emphasizes the need to recognize glycerol-induced hemolysis and acute kidney injury as complications of glycerin enemas. This case also provides insight into glycerol-induced hemolysis and acute kidney injury as complications of glycerin enemas.

Fluorometric determination of heparin based on self-quenching of fluorescein-labeled protamine.

A new signaling technique for a fluorometric heparin assay has been developed using the self-quenching of fluoresceinisothiocyanate-labeled protamine (F-protamine). The binding between F-protamine and heparin led to a significant fluorescence quenching due to enhancing the proximity of the F-protamine molecules. The fluorescence of F-protamine (5.9 microg/mL) decreased to 13% in the presence of 2.0 microg/mL heparin. An advantage of this self-quenching system is that the detection can be carried out without using other indicators. With the present system, we could monitor the therapeutic level of heparin in bovine plasma, and the response was quick. These properties of the self-quenching system are suitable for practical use.

pH-induced interconversion between J-aggregates and H-aggregates of 5,10,15,20-tetrakis(4-sulfonatophenyl)porphyrin in polyelectrolyte multilayer films.

We fabricated a layer-by-layer (LbL) film composed of 5,10,15,20-tetrakis(4-sulfonatophenyl)porphyrin (TPPS) and poly(allylamine) (PAA) and investigated its pH response by UV-visible spectrometry. When the (PAA/TPPS)5PAA film was immersed in a pH 1.5 solution, J-aggregate bands were observed at 484 and 691 nm. Above pH 3.0, the J-aggregates were completely dissociated and an H-aggregate band was observed at 405 nm. The interconversion between the J-aggregates and H-aggregates in the LbL film was repeatable and controllable by changing the pH of the solutions.

Multilayered assemblies composed of brilliant yellow and poly(allylamine) for an optical pH sensor.

Multilayered thin films containing poly(allylamine) (PAA) and brilliant yellow (BY) were prepared on a quartz slide by a layer-by-layer (LBL) deposition technique. The UV-visible spectra of the PAA/BY films were sufficiently changed depending upon the pH value of the solution in which the film was immersed. The response of the PAA/BY films was very fast (within a second) upon pH change from 9.0 to 5.0, while the response time was ca. 100 s upon pH change from 5.0 to 9.0.