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Increased oxidative stress has been paid attention to as an important causative factor for diabetic cardiovascular complications. Hyperglycemic state are supposed to induce the overproduction of reactive oxygen species (ROS) through various mechanisms including increased non-enzymatic glycation end products (AGEs) formation, increased polyol pathway flux, increased O2-production from mitochondrial and protein kinase C (PKC)-dependent NAD (P) H oxidase activation in cardiovasucular tissues. Oxidative modification of lipoprotein is critical for atheromatous lesion formation. O2- reacts with nitric oxide (NO), resulting in loss of NO's anti-atherogenic properties. Thus, the causative role of oxidative stress in diabetic cardiovascular complications has been implicated, but there has been little human evidence showing the beneficial effect of antioxidants. Here we introduce our human study showing that congenital hyperbilirubinemia in diabetic patients with Gilbert's syndrome protects against cardiovascular events as well as microangiopathy along with the amelioration of enhanced oxidative stress in diabetes, implicating the causative role of oxidative stress.

A 32-year-old female complained of a headache persisting for approximately one week. She was emergently brought to the hospital for sudden consciousness disorder early in the morning. Her neurological state was JCS 200 and WFNS Grade V. CT scan demonstrated a subarachnoid hemorrhage. 3D-CTA and DSA showed a right true posterior communicating artery fusiform aneurysm. We performed open surgery the same day, and found that the aneurysmal wall had thinned markedly. The aneurysm ruptured, and trapping was performed. A perforating artery from the aneurysm was sacrificed, but there was no apparent neurological deficit. The patient was ambulatory when discharged after a VP shunt was implanted, and she has returned to normal daily life. True posterior communicating artery fusiform aneurysm is very rare, and has been reported in detail in only 6 cases to date. A brief clinical review of the literature is presented. Since this type of aneurysm enlarges rapidly in some patients, and the possibility of re-rupture in the acute period is high, prompt trapping after onset is recommended.