H Hamada

Okayama University, Okayama, Okayama, Japan

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Publications (33)43.79 Total impact

  • K Hamazaki · H Sakai · T Amano · K Ichiki · H Hamada · T Yamauchi
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    ABSTRACT: A 79 year-old woman was admitted to Aioi City Hospital for a closer examination of hepatic dysfunction. A filling defect was observed at the distal end of the intrapancreatic common bile duct by computed tomography combined with drip infusion cholangiography. The diagnosis of adenoma with dysplasia at the papilla of Vater was obtained by a biopsy performed during duodenoscopy. As a result, we performed an ampullectomy. Histologic examination revealed a papillary adenocarcinoma which partly extended just beyond the muscle of Oddi. The patient made an uneventful recovery and was discharged on the 35th postoperative day. Here, based upon our experience, we discuss such problems as the accuracy of preoperative diagnosis and the indications for ampullectomy.
    No preview · Article · Oct 2000 · Hiroshima journal of medical sciences
  • S Okada · K Ishii · H Hamada · S Tanokuchi · K Ichiki · Z Ota
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    ABSTRACT: Studies were carried out to assess various ways of improving glycaemic control and lipid profiles of patients with noninsulin-dependent diabetes mellitus (NIDDM) in whom glucose metabolism was poor. Part or all of the dose of the sulphonylurea that had been used to treat patients in Group 1 (n = 8) was replaced by an alpha-glucosidase inhibitor. Symptoms related to hypoglycaemia disappeared and the postprandial blood glucose level was significantly increased (P < 0.043) but serum lipid levels were not significantly altered and the mean glycosylated haemoglobin level was unchanged. In Group 2 (n = 10) patients, a large part of the insulin dose was replaced by an alpha-glucosidase inhibitor. Hypoglycaemia-related symptoms disappeared but there were no significant changes in lipid profiles, postprandial blood glucose or glycosylated haemoglobin levels. The third group of patients (n = 9) had been treated with insulin alone and were given additional alpha-glucosidase inhibitor without changing their insulin dose. This did not significantly change their lipid profiles, postprandial blood glucose or glycosylated haemoglobin levels. In Group 4 (n = 9) the addition of an alpha-glucosidase inhibitor to the initial sulphonylurea did not produce any significant changes in mean postprandial blood glucose or glycosylated haemoglobin levels. The results for individual patients indicated that the glycosylated haemoglobin levels had improved after the change of treatment only in those patients whose connective peptide immunoreactivity was > or = 6.0 ng/ml.
    No preview · Article · Sep 1996 · The Journal of international medical research
  • S Okada · K Ishii · H Hamada · S Tanokuchi · K Ichiki · Z Ota
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    ABSTRACT: The effect of adding a very low dose of a sulphonylurea (tolbutamide) to the treatment of 10 patients with noninsulin-dependent diabetes mellitus (NIDDM) was investigated. Patients took 0.1 mg tds of an alpha-glucosidase inhibitor orally for 8 weeks, and 50 mg tds of the sulphonylurea, tolbutamide, for the last 4 weeks of this period. The glycosylated haemoglobin level was significantly reduced during the combined treatment period compared with the level after treatment with alpha-glucosidase inhibitor alone (P = 0.035), although not compared with the pretreatment level. There were no significant changes in post-prandial blood glucose, serum lipid levels or connective peptide immunoreactivities. These preliminary results indicate that the addition of a very low dose of tolbutamide to a recommended diet and treatment with an alpha-glucosidase inhibitor, may improve glucose metabolism without raising insulin secretion or influencing lipid metabolism.
    No preview · Article · Sep 1996 · The Journal of international medical research
  • S Okada · K Ishii · S Tanokuchi · H Hamada · K Ichiki · Z Ota
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    ABSTRACT: The case of a 67-year-old women with non-insulin-dependent diabetes mellitus is described. Diabetes was first diagnosed when the woman was aged 55; a diet of 1440 kcal daily was recommended and 500 mg tolbutamide daily was prescribed. Hypoglycaemia was improved for a while but the blood-sugar concentration gradually increased until a tolbutamide dose of 2000 mg/day was needed. The patient eventually came to an out-patient clinic for diabetes control due to continuous hyperglycaemia. Her diabetes proved difficult to control, probably due, in part, to excessive eating and lack of exercise, despite appropriate education and glibenclamide treatment. After 15 months, an alpha-glycosidase inhibitor, at a dosage of 0.75 mg/day, was added to the treatment with glibenclamide at 7.5 mg/day and the glycosylated haemoglobin level was reduced to normal levels within 2 months. After a further 6 months the glibenclamide dose was reduced to 3.75 mg/day with no ill effects during the subsequent 4 weeks, up to the present day.
    No preview · Article · Jan 1996 · The Journal of international medical research
  • S Okada · K Ichiki · H Hamada · N Matsuo · Z Ota
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    ABSTRACT: This study examined factors contributing to the development of microalbuminuria in diabetic patients. A total of 236 patients with Type 2 diabetes were studied: 143 were normoalbuminuric and 86 were also normotensive. Multiple regression analysis was used to identify factors influencing the urinary albumin index (UAI), an index of proteinuria based on urinary albumin adjusted for urinary creatinine. Significant factors (retinopathy, systolic blood pressure, and glycosylated haemoglobin) were used to generate a formula for estimating the log(e) UAI. Target values for systolic blood pressure and glycosylated haemoglobin to maintain the urinary albumin index at or below 22 were determined for different degrees of retinopathy. Normoalbuminuric patients were followed for 3 years to evaluate their progression to microalbuminuria. Each month, blood pressure, urinary albumin and creatinine, and glycosylated haemoglobin were measured. In normotensive, normoalbuminuric patients, initial urinary albumin index and log(e) UAI were significantly higher in patients who subsequently developed microalbuminuria. Patients with initial log(e) UAI > 3.09 or initial glycosylated haemoglobin > 6.0% also showed greater progression to microalbuminuria. Hyperglycaemia was an independent factor for the development of microalbuminuria in Type 2 diabetes. The urinary albumin index was most significantly affected by retinopathy, systolic blood pressure, and glycosylated haemoglobin. The estimated loge UAI calculated from these factors is a useful predictor of progression to microalbuminuria.
    No preview · Article · Jan 1996 · The Journal of international medical research
  • S Okada · K Ishii · H Hamada · S Tanokuchi · K Ichiki · Z Ota · M Shimizu · Y Hiraki
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    ABSTRACT: The relationship between cardiac autonomic neuropathy and diabetic microangiopathies and macroangiopathy was investigated in 103 patients with non-insulin-dependent diabetes mellitus. Cardiac autonomic nerve function was assessed by determining the uptake of [123I]metaiodobenzyl-guanidine into the myocardium. Cardioparasympathetic nerve function was assessed by comparing electrocardiographically the expiratory and inspiratory respiratory rate (RR) interval ratios, during a period of deep breathing, and the coefficients of variation of the RR intervals. Nerve conduction velocity measurements were used to assess diabetic somatic neuropathy, and measurement of pulse-wave velocity provided an indication of the extent of aortic sclerosis. The only correlations between the parameters of cardiac autonomic neuropathy and parameters of diabetic microangiopathies and macroangiopathy were between the expiratory to inspiratory RR interval ratio and both the conduction velocity of the tibial nerve and pulse-wave velocity, and between the heart to lung ratio (cardiac autonomic nerve function) and nephropathy. These correlations may have occurred by chance; alternatively they may indicate a difference in the onset mechanisms of cardiac parasympathetic and sympathetic neuropathies in diabetics.
    No preview · Article · Jan 1996 · The Journal of international medical research
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    ABSTRACT: The relationships between cardiac autonomic neuropathies, diabetic somatic neuropathy, metabolic parameters, general parameters (such as age and duration of illness) and diabetic microangiopathy and macroangiopathy were investigated in 103 patients with non-insulin-dependent diabetes mellitus (NIDDM). Spearman's correlation coefficients were calculated for the comparisons of all the parameters of the neuropathies with all the other parameters. Variables were selected using a stepwise procedure and multiple regression analysis was carried out using these variables. The results of the regression analysis show that diabetic neuropathy is correlated with vascular parameters including blood pressure and pulse-wave velocity, as well as with parameters of sugar and lipid metabolism. The results confirm the diversity of the clinical characteristics of the neuropathies in patients with NIDDM and confirm that these neuropathies do not always occur in parallel.
    No preview · Article · Jan 1996 · The Journal of international medical research
  • S Okada · K Ichiki · S Tanokuchi · K Ishii · H Hamada · Z Ota
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    ABSTRACT: We are actively seeking methods to prevent and to limit the progression of angiopathy in patients with non-insulin-dependent diabetes mellitus (NIDDM). In the present study, we conducted a clinical and epidemiological survey to clarify the clinical factors responsible for the development and progression of diabetic microangiopathy (MI) and macroangiopathy (MA). A total of 107 patients (58 female and 49 male) were randomly selected from 145 NIDDM patients. Twenty-four patient variables were selected for analysis. We identified PWV, UAI, RETINOP, MCV-T, SCV-S, MCV-P, SBP, and DBP as responsible factors and carried out stepwise multiple regression analyses. The following explanatory variables were found to be significant: age > SCV-S (P < 0.0001) for the criterion variable PWV, BUN > HbA1c > MCV-P > HT-drug > HDL-C (P < 0.0001) for log(e) UAI, DM-thera > SBP (P < 0.0001) for RETINOP, MCV-P (P < 0.0001) for MCV-T, IRI > SBP > MCV-P > S-CR (P < 0.0002) for SCV-S, MCV-T > SCV-S > DM-thera (P < 0.0001) for MCV-P, DBP > HT-drug > BUN > MCV-P (P < 0.0001) for SBP, and SBP > PWV > sex (P < 0.0001) for DBP. In summary, responsible factors for MI and MA in NIDDM had metabolic and blood pressure factors in common. Moreover, MI was a responsible factor for MA, which becomes a responsible factor for MI because it is a responsible factor for blood pressure factors. Thus, all the responsible factors for MA represented by MI and PWV had metabolic and blood pressure factors in common. The results of this study suggest that metabolic and blood pressure factors must be controlled to prevent and to limit the progression of diabetic MI and MA in NIDDM patients.
    No preview · Article · Jan 1996 · The Journal of international medical research
  • S Okada · K Ichiki · S Tanokuchi · H Hamada · N Matsuo · Z Ota
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    ABSTRACT: This study was intended to clarify the factors associated with the development and progression of diabetic retinopathy in patients with Type 2 diabetes. A total of 107 patients with Type 2 diabetes underwent fundoscopic examination by an ophthalmologist, and the factors that might be associated with the severity of retinopathy were investigated. Analysis of variance and the chi 2 test were performed to determine whether 22 separate factors were associated with the severity of diabetic retinopathy. There were significant associations between retinopathy and duration of disease, systolic blood pressure, urinary albumin index, and blood urea nitrogen. Multiple regression analysis with retinopathy as the criterion variable and 20 other factors as explanatory variables revealed that, of those explanatory variables showing statistical significance, the strongest associations were with duration of disease and type of diabetic therapy, in that order. The chi 2 test also revealed significant associations between retinopathy and both the type of diabetic therapy and the use of anti-hypertensive therapy. The results suggest that the duration of illness and the type of diabetic therapy are strongly related to the development and progression of retinopathy in patients with Type 2 diabetes. These findings suggest that insulin deficiency in patients with Type 2 diabetes should be corrected as early and as vigorously as possible, and that modification of daily activities to achieve a more nearly non-diabetic state should be instituted first, with supplementary drug therapy added as required.
    No preview · Article · Jan 1996 · The Journal of international medical research
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    ABSTRACT: The relationship between cardiosympathetic neuropathy and cardioparasympathetic neuropathy was investigated in 103 patients with non-insulin-dependent diabetes mellitus. Cardioparasympathetic nerve function was assessed by comparing electrocardiographically the expiratory and inspiratory R-R interval ratios, during a period of deep breathing, and the coefficients of variation of the R-R intervals. Cardiosympathetic nerve function was assessed by determining the uptake of [123I]metaiodobenzyl guanidine into the myocardium. The results indicate that there is no significant correlation between cardioparasympathetic and cardiosympathetic nerve function.
    No preview · Article · Jan 1995 · The Journal of international medical research
  • S Okada · K Ishii · H Hamada · S Tanokuchi · K Ichiki · Z Ota
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    ABSTRACT: For 10 patients (three women and seven men) with noninsulin-dependent diabetes mellitus, who had been given insulin (22.6 +/- 19.6 U/day) and had frequently shown hypoglycaemia, the insulin dose was slightly reduced and the administration of an alpha-glucosidase inhibitor was simultaneously started. Hypoglycaemic symptoms disappeared immediately and completely, and sugar metabolism immediately before the withdrawal of treatment was not aggravated: the glycosylated haemoglobin level was unchanged and the post-prandial blood glucose level was increased though not significantly. The results of the present study indicate that the combined used of an alpha-glucosidase inhibitor with a reduced insulin dose improves the quality of life of patients and may improve hyperinsulinaemia.
    No preview · Article · Jan 1995 · The Journal of international medical research
  • S Okada · K Ishii · H Hamada · S Tanokuchi · K Ichiki · Z Ota
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    ABSTRACT: Twenty patients with non-insulin-dependent diabetes mellitus whose glucose metabolism was unsatisfactory, even though they were receiving appropriate dietary therapy, were treated with an alpha-glucosidase inhibitor (0.6 mg/day) for 12 weeks. The connecting peptide immunoreactivity value (selected as the evaluation criterion of post-prandial endogenous insulin secretion) was compared in patients with and without improved glycosylated haemoglobin levels. A significant difference was found between the connecting peptide immunoreactivity value of the group with improved glycosylated haemoglobin levels (5.0 +/- 1.0 ng/ml) and that in the group without the improvement (2.7 +/- 0.9 ng/ml).
    No preview · Article · Jan 1995 · The Journal of international medical research
  • S Okada · K Ichiki · S Tanokuchi · K Ishii · H Hamada · Z Ota
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    ABSTRACT: The effects of reducing stress on blood pressure were investigated in 20 patients with non-insulin-dependent diabetes mellitus. An anxiolytic, fludiazepam, was administered to the patients for 12 weeks and their blood pressures and State Trait Anxiety Inventory scores at the beginning and end of treatment were compared. Systolic and diastolic blood pressures and trait and state anxiety scores were all significantly reduced during the treatment period. There was also a weak correlation between the extent of the improvement in the same anxiety score and the improvement in diastolic blood pressures.
    No preview · Article · Jan 1995 · The Journal of international medical research
  • S Okada · K Ichiki · S Tanokuchi · K Ishii · H Hamada · Z Ota
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    ABSTRACT: The effects of reducing stress on glucose metabolism in diabetics were evaluated in 20 patients with type 2 diabetes (10 of each sex) who were given an anxiolytic (fludiazepam) for 12 weeks. Patients were tested 4 weeks before the start of anxiolytic treatment (A), immediately before the first dose (B), and before the end of the study period (C) using the State-Trait Anxiety Index and glycosylated haemoglobin levels. There were no significant differences between the trait or state anxiety scores or the glycosylated haemoglobin levels at times A and B before treatment. However, for all three measurements, the values at time C, after treatment, showed significant improvements, compared with those at both times A and B (P < 0.05). The improvement in the trait anxiety score was weakly correlated with the decrease in the glycosylated haemoglobin level (r = 0.426, P < 0.01). No correlation was seen between state anxiety scores and glycosylated haemoglobin levels. The results suggest that suppressing anxiety in patients with type 2 diabetes reduces glycosylated haemoglobin levels.
    No preview · Article · Jan 1995 · The Journal of international medical research
  • S Okada · H Hamada · K Ishii · K Ichiki · S Tanokuchi · Z Ota
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    ABSTRACT: Stress was assessed using State-Trait Anxiety Inventory scores in 40 non-insulin-dependent diabetes mellitus (NIDDM) patients, and the results were compared with those for 40 sex- and age-matched healthy controls. Fludiazepam was administered to the patients for 12 weeks and stress was reassessed. The Manifest Anxiety Scale score correlated with Trait (r = 0.548, P < 0.0001) and State (r = 0.474, P = 0.0001) scores, validating the latter as measurements of stress. Both Trait (43.4 vs 35.8, P < 0.001) and State (41.6 vs 33.8, P < 0.001) scores were significantly higher in NIDDM patients than in healthy controls. Administration of an anxiolytic, fludiazepam (0.25 mg, three times daily, orally) for 12 weeks lowered Trait score (43.5 to 36.9, P < 0.0001), State score (41.6 to 35.8, P < 0.0002), glycosylated haemoglobin (8.4 to 7.3%, P < 0.0001), systolic blood pressure (151.2 to 143.4 mmHg, P < 0.0017) and diastolic blood pressure (84.2 to 77.7 mmHg, P < 0.0018). Multiple regression analysis revealed that the significant explanatory variables for the change in State score during anxiolytic administration were the changes in total cholesterol, high-density lipoprotein cholesterol, triglycerides, apolipoprotein B:A1 and glycosylated haemoglobin (R2 = 0.3224, P < 0.0022). The results indicate that stress is detected at a higher frequency in patients with NIDDM than in healthy controls, and that blood glucose and lipid metabolic factors are significant explanatory variables for this stress. This stress is correlated with glucose metabolism and blood pressure and, moreover, these factors could all be proved concomitantly by the administration of an anxiolytic.
    No preview · Article · Jan 1995 · The Journal of international medical research
  • S Okada · K Ishii · S Tanokuchi · H Hamada · K Ichiki · Z Ota
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    ABSTRACT: The effects of treatment with an alpha-glucosidase inhibitor and a reduced dose of sulphonylurea were investigated in patients with non-insulin-dependent diabetes mellitus who had previously been treated with sulphonylurea compounds but who were hypoglycaemic at times. Treatment with a daily dose of 0.6 mg alpha-glucosidase inhibitor and a reduced dose of the previously used sulphonylurea compound for 4 weeks did not significantly affect the glycosylated haemoglobin level. The post-prandial blood-glucose concentration of the patients was unchanged after treatment compared with its value immediately before treatment but differed significantly compared with the value 4 weeks before treatment (P < 0.03); it was considered likely that this change was due to a seasonal increase in calorie intake at the end of the treatment period. Symptoms related to hypoglycaemia disappeared in all of the treated patients.
    No preview · Article · Jan 1995 · The Journal of international medical research
  • S Okada · K Ishii · S Tanokuchi · H Hamada · K Ichiki · Z Ota
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    ABSTRACT: The effects of administration of an alpha-glucosidase inhibitor and a sulphonylurea compound on lipid profile were investigated in patients with non-insulin-dependent diabetes mellitus, (NIDDM) previously treated with sulphonylurea compounds alone, but in whom metabolic control was inadequate. A group of patients (n = 10) were treated with the alpha-glucosidase inhibitor at a dose of 0.2 mg, three times daily, for 4 weeks. Treatment significantly reduced the post-prandial glucose level and the serum total cholesterol level. In addition, there were non-significant reductions in the triglyceride and very low density lipoprotein levels. These preliminary results suggest that administration of alpha-glucosidase inhibitors might improve the lipid profile of patients with NIDDM.
    No preview · Article · Nov 1994 · The Journal of international medical research
  • S Okada · K Ichiki · S Tanokuchi · K Ishii · H Hamada · Z Ota
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    ABSTRACT: The effects on serum lipid levels of reducing stress were examined in 20 patients with non-insulin-dependent diabetes mellitus. An anxiolytic, fludiazepam, was administered to the patients for 12 weeks and their lipid profiles and State-Trait Anxiety Inventory scores at the beginning and end of treatment were compared. The high-density lipoprotein cholesterol level increased significantly after the administration of anxiolytic, but other aspects of the lipid profile were unchanged. Both trait and state anxiety scores decreased significantly with the administration of anxiolytic. The results indicate that improvement of stress in patients with non-insulin-dependent diabetes mellitus increases high-density lipoprotein levels.
    No preview · Article · Jan 1994 · The Journal of international medical research
  • S Okada · Y Miyai · Y Masaki · K Ichiki · S Tanokuchi · K Ishii · H Hamada · Z Ota
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    ABSTRACT: The aim of this study is to obtain data for improving a training program for patients with diabetes mellitus. One hundred eighty-seven patients with non-insulin dependent diabetes mellitus were tested with 20 questions about their knowledge for self-management of diabetes mellitus. Then to draw out factors in their personal backgrounds relating to their correct answers, multiple regression analyses were conducted. As a result, four factors showed significant differences in the following order: Educational careers > ages > duration of disease > socioeconomic strata. The results of the present study have shown for the first time, that these four factors closely concern patients to acquire the necessary knowledge for their self-management of the disease. In addition, this study has raised some fundamental problems regarding the training program for patients: how education should be given to patients.
    No preview · Article · Apr 1993 · Acta medica Okayama
  • S Okada · K Ichiki · S Tanokuchi · K Ishii · H Hamada · Z Ota
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    ABSTRACT: The effect of prostaglandin E1 (PGE1) on the renin-aldosterone system was investigated in hospitalized patients with non-insulin-dependent diabetes mellitus presenting with continuous proteinuria but without nephrotic syndrome. Of the 20 patients studied, 10 had continuous positive proteinuria > or = 200 mg/day and 10 had continuous positive proteinuria < 200 mg/day. Prostaglandin E1 (40 micrograms in 100 ml normal saline) was infused intravenously over 2 h twice daily for 4 weeks. Plasma renin activity (PRA) and the plasma aldosterone concentration (PAC) were determined by radioimmunoassay at 0 and 120 min after a frusemide injection given before the start of PGE1 treatment and during administration of PGE1 in week 4. The patients who had proteinuria < 200 mg/day showed significant decreases in the PRA0 and the ratio of PRA120:PRA0 and a decrease in the PAC120 during prostaglandin PGE1 administration. When the results for the two patient groups were combined, both the PAC120 and the PRA120 were found to be significantly lowered during administration of PGE1. The results indicate that PGE1 may be valuable in the treatment of diabetic nephropathy, since the compound inhibited the increased reactivity of the renin-aldosterone system in patients with non-insulin-dependent diabetes mellitus.
    No preview · Article · Jan 1993 · The Journal of international medical research