Comparison of pregnancy outcomes between women with gestational diabetes and overt diabetes first diagnosed in pregnancy: a retrospective multi-institutional study in Japan

AIMS

To determine differences in pregnancy outcomes including diabetic complications, maternal and perinatal complications between gestational diabetes mellitus and overt diabetes in pregnancy in Japan.

METHODS

A multi-institutional retrospective study compared pregnancy outcomes between gestational diabetes mellitus and overt diabetes in pregnancy. We examined pregnant women who met the former criteria for gestational diabetes mellitus and received dietary intervention with self-monitoring of blood glucose with or without insulin. Overt diabetes in pregnancy was defined as ≥2 abnormal values on 75-g oral glucose tolerance test, fasting glucose ≥126 mg/dl (7.0 mmol/l) and 2-h postprandial glucose ≥200 mg/dl (11.1 mmol/l), or glycated hemoglobin levels ≥6.5% (48 mmol/mol).

RESULTS

Data were collected on 1267 women with gestational diabetes and 348 with overt diabetes in pregnancy. Pregestational body mass index was higher (26.2 ± 6.1 vs. 24.9 ± 5.7 kg, P<0.05) and gestational age at delivery was earlier (37.8 ± 2.5 weeks vs. 38.1 ± 2.1 weeks, P<0.05) in overt diabetes than in gestational diabetes. Glycated hemoglobin (6.8 ± 1.1% [51 mmol/mol] vs. 5.8 ± 0.5% [40 mmol/mol], P<0.05) and glucose on 75-g oral glucose tolerance test and prevalence of retinopathy (1.2% vs. 0%, P<0.05) and pregnancy-induced hypertension (10.1% vs. 6.1%, P<0.05) were higher in overt diabetes than in gestational diabetes. Pregnancy-induced hypertension was associated with pregestational body mass index, gestational weight gain, chronic hypertension, and nulliparity but not with 75-g oral glucose tolerance test.

CONCLUSIONS

Overt diabetes in pregnancy is significantly associated with maternal complications such as retinopathy and pregnancy-induced hypertension.

Familial clustering in subgroups of gastric cancer stratified by histology, age group and location

AIM

To assess the risk of gastric cancer in a Japanese patient population with the disease by stratification with histology, age, tumour location and the association with family history of gastric or non-gastric tumours.

METHODS

A retrospective analysis of 1400 consecutive patients with gastric cancer and 13,467 age- and gender-matched controls from a pre-recorded database using conditional logistic regression models.

RESULTS

Young patients (< or = 43 years of age) with gastric cancer of intestinal type had a strong association with family history of gastric cancer in first degree-relatives (OR=12.5). Moreover, when a history of gastric cancer was observed in both parents, there was an increased risk of gastric cancer intestinal type (OR=7.8), more commonly in the proximal and mid-stomach. In contrast, there was an increased risk of diffuse-type cancer when both parents suffered non-gastric cancers (OR=2.1).

CONCLUSION

These data suggest that the degree of familial clustering differ in gastric cancer subgroups stratified by histology, age, and stomach location in this Japanese population.

[Development of quality of life questionnaire for patients with colorectal cancer in surgical area--a study of reliability and validity of Tokyo Yamabuki Forum Version]

We developed a new questionnaire in the surgical area based on a core quality of life (QOL) questionnaire for patients with gastrointestinal cancer. In this study, we investigated the validity and reliability of a QOL questionnaire (Tokyo Yamabuki Forum Version) for patients with colorectal cancer. The questionnaire was composed of 17 items including 5 scales (basic sensory scale, psychological scale, physiological scale, defection-related scale and active scale) and a face scale as an global scale. The time needed to answer questionnaires was expected to be around 7 minutes and the questionnaires should basically be answered by the patients themselves everyday in the hospital. The study was performed in 10 hospitals in the Tokyo area, and 394 samples collected from 21 patients with rectal and colonic cancers were analyzed. A number of respondents failed to answer the question "Do you feel your foods tasty?", so we judged this item inappropriate and deleted it from the analysis. Fifteen items, including 5 scales showed satisfactory internal consistency and construct validity in correlation and factor analyses. Performance status showed a low correlation between each item, each scale and the global scale, while SDS and STAI showed an inordinately negative correlation with the fundamental and physical scales. Especially, SDS revealed an extremely close correlation with the active scale, and STAI showed an excessive correlation with the psychological scale. In the time course of QOL under chemotherapy, reductions (aggravations) were observed in both the total score of 15 items and global scale within one week postoperatively, but after that recovered to preoperative levels at 2 weeks postoperatively. A tendency to QOL improvement was observed 2 weeks after starting chemotherapy or chemoimmunotherapy. QOL of 13 patients was measured over 3 months, and the longest term was 8 months. The results suggested that this QOL questionnaire has sufficient reliability and validity to be usable for patients with colorectal cancer in the surgical area and that this model is applicable for long-term QOL surveys and frequent measurement.

Rationale for extent of lymph node dissection for right colon cancer

PURPOSE

The extent of lymph node dissection optimal for the prognosis of right colon cancer is investigated.

METHODS

Between 1946 and 1991, 275 patients had curative operation for right colon cancer. A retrospective analysis of rate and degree of lymph node metastasis was performed in each of the 275 patients, and survival rate was estimated in 197 patients who could be followed over a period of three years or more.

RESULTS

In most of the curative operative cases of right colon cancer, metastasis to epicolic and paracolic nodes was restricted up to 10 cm proximal or distal to the tumor margin, and metastasis in the central direction was restricted up to main nodes. When cancer metastasized to infrapyloric lymph nodes, dissection of the nodes resulted in a higher rate of long-term prognosis. The five-year cumulative survival rates showed no statistically significant difference between any two of the N0 to N3 lymph node metastasis groups.

CONCLUSION

The dissection procedure for right colon cancer involved removal of 10 cm of normal bowel both proximal and distal to the lesion and, in the central direction, dissection of regional lymph nodes along the main trunk artery up to main nodes, i.e., nodes situated anterior to the surgical trunk, which was confirmed to have a therapeutically satisfactory benefit. Infrapyloric lymph nodes must be dissected when metastasis to the nodes is suspected. In cases of cecal or ascending colon cancer in which the middle colic artery is no longer the main trunk artery, a right hemicolectomy with resection of only the right branch of the middle colic artery will usually suffice.

Outcome of peristomal skin management by long-term use of skin barrier

Peristomal skin status was retrospectively evaluated in group of patients who routinely used skin barriers as a part of their pouching system. Three hundred forty-four photographs were obtained for 113 patients who used skin-barrier products continuously for periods ranging from 1 to 10 years. Changes in the peristomal skin were evaluated according to severity and three qualitative characteristics: inflammatory changes, pigmentary alterations, and macroscopic evidence of relief from the chronic effects of skin barrier. Of the 344 photographs reviewed, only 7.4% were free from any skin change. The incidence of inflammatory change peaked at 38% before 3 months and varied from 5% to 20% after this riod. The incidence of pigmentary change was 86% at 9 months after operation and 85% to 95% during later periods. Macroscopic evidence of skin relief was observed in 75% to 95% of the photographs across time. This investigation demonstrates that peristomal skin changes among patients who use skin barriers as a routine part of the pouching procedure are dynamic and complex. These products exhibit both skin-protective and skin-irritating properties.

[Mastopathy associated with early breast cancer]

Using 436 cases of infiltrating ductal carcinoma less than 2.0 cm in diameter mastectomized at the Cancer Institute Hospital, Tokyo, during 9 years from 1965 to 1973, association of mastopathy with breast cancer were analysed. Out of 436 cases, 128 (29.4%) were associated with mastopathy, and the association of mastopathy varied according to histologic type of breast cancer. The highest incidence was observed in carcinoma of papillotubular prototype and the lowest in carcinoma of medullary tubular prototype. Pure scirrhous carcinoma came between them. No correlationship was recognized between the grade of scirrhous stromal infiltration and incidence of mastopathy.

Impaired vibratory perception as a criterion of diabetic neuropathies

Among neurological findings in diabetics, increased vibratory perception threshold (VTP) and abnormal ankle jerks are thought to be two of the most common. This study aims to determine the diagnostic value of VPT by C128-vibrometer. Mean VPT in a reference group composed of 278 non-diabetics showed regression with age, so the normal range was determined as lying below M + 2SD for each 10 year age range in the reference group. The mean VPT in each age group of 667 diabetic subjects was found to be approximately equal to M + 1SD of the values for the non-diabetics. After 10 days on a proper diet in the hospital, VPT showed a marked improvement in well controlled cases. In a 3 year follow up study, it was found that constant impairment of vibratory perception was common in the group with a high prevalence of microangiopathies. Though impaired VPT is reversible, it is useful as a diagnostic aid for diabetes.

Role of acetaldehyde in the pathogenesis of alcoholic cardiomyopathy

Rats given both ethanol and tolbutamide showed decreased oxidative phosphorylation of the myocardial mitochondria as compared with rats given only ethanol. There were no differences in ethanol consumption and blood ethanol levels between the two groups. The concentration of acetaldehyde tended to be higher in rats given both ethanol and tolbutamide than in rats given ethanol alone. It is concluded that acetaldehyde plays a more important role in the production of alcoholic cardiomyopathy than does ethanol itself.

Myocardial metabolism of spontaneously hypertensive rat

Oxidative phosphorylation of myocardial mitochondria isolated from spontaneously hypertensive rats (SHR) was determined polarographically. The concentrations of high-energy phosphate compounds, the concentrations of intermediate metabolites, and the activities of the enzymes within the metabolic systems of glycolysis, the pentose phosphate (PPh) cycle, and the tricarboxylic acid (TCA) cycle of the myocardium of SHR were determined. The gradual development of cardiac hypertrophy was observed in SHR in comparison with normotensive Wistar rats. There were no significant differences in the function of oxidative phosphorylation of the mitochondria, in concentrations of high-energy phosphate compounds and carbohydrate metabolites, or in activities of glycolytic enzymes between SHR and normotensive Wistar rats.

Metabolic effect of pH on myocardium of heart-lung preparation

Cardiac performance and metabolism of heart-lung preparation of rat were studied with acid, normal, and alkali perfusions. Cardiac output, glucose uptake, and myocardial content of lactate, malate, glycerophosphate, and CP were increased in alkali and decreased in acid perfusion of 20 min. On the other hand, when pH of the perfusate was abruptly changed, CP and ATP were decreased independent of the performance. FDP was high and PEP was low in acute acidifying experiments. From these findings it is concluded that cardiac performance and carbohydrate metabolism are accelerated in alkali and depressed in acid perfusion, and that myocardial metabolism could be affected by pH not only secondary to the change of performance but also by itself.