Study on Survey of Knowledge and Awareness Level of Diabetic Retinopathy in Type 2 Diabetes Patients: Results from Seoul Metro-City Diabetes Prevention Program Survey

PURPOSE: To investigate the knowledge and awareness level of diabetic retinopathy (DR) in type 2 diabetes patients. METHODS: A total of 437 participants with diabetes were recruited in the Seoul Metro-City Diabetes Prevention Program (SMC-DPP). Participants underwent clinical and laboratory examinations and questionnaire survey to evaluate diabetes complications. The DR was diagnosed by grading fundus photographs 5 standard fields taken per eye. RESULTS: The overall prevalence of any DR was 20.4% and only 6.6% of patients were aware of their DR. The DR patients who underwent an eye examination within the previous year were 42.3%, and 50.3% out of 437 patients enrolled were educated on diabetes. Of the survey participants, 83.8% answered positive to 'Evaluation of diabetes mellitus complication must be performed every year', 61.1% answered positive to 'Must control blood pressure and lipid level for diabetes management' and 28.4% believed 'It takes a long time for complications of diabetes to develop'. The DR self awareness was 14.6% and an eye examination within the previous year was 50.6% among the 89 DR participants. CONCLUSIONS: Results of the survey with SMC-DPP type 2 diabetes participants showed a low knowledge and awareness level of chronic complications such as DR.

A Case of Acute Gastric Anisakiasis Causing Massive Hematemesis / 대한소화기내시경학회지

Acute gastric anisakiasis is caused by gastric mucosal penetration from an Anisakis larvae. It occurs with those who ingest raw or inadequately cooked saltwater fish or squid containing anisakis. The clinical symptoms are severe abdominal pain, nausea, vomiting, diarrhea, and so on. A case of acute gastric Anisakiasis with massive hematemesis was presented. Initial endoscopic examination revealed an edematous or raised erosive lesion with a small blood clot-covered vessel in the fundus which was thought to be a stigmata of recent bleeding. The lesion was treated with an epinephrine-hypertonic saline injection, electrocoagulation, and an ethanol injection. A follow-up gastroscopy revealed an artificial coagulation-induced ulcer at the previous bleeding site. At the ulcer margin, a whitish linear worm was found with half of its body penetrating the gastric mucosa. The worm was removed using biopsy forceps and the patient was subsequently placed on a soft diet. The next day however, hematemesis recurred. Gastroscopic band ligation of the vessel was performed with a cessation of bleeding. Three weeks later, a gastroscopy determined that the ulcer had completely healed.

Relationship between the Expression of Growth Hormone-Releasing Hormone Receptor Gene and Endocrinologic Profiles in GH-Secreting Pituitary Adenomas / 대한내분비학회지

BACKGROUND: Growth hormone-releasing hormone (GHRH) plays a key role in the regulation of the proliferation and differentiation of somatomammotroph cells as well as secretion of GH. The actions of GHRH are mediated through the GHRH receptor (GHRH-R) that is a G protein coupled receptor with seven transmembrane domains. It has been demonstrated that alternative splicing occurs in the third cytoplasmic domain of rat and human GHRH-R mRNA, However, the clinical significance of the altemative splicing remains to be unsolved. To find an insight into the clinical significance, we investigate the correlation between the GHRH-R gene expression and a variety of clinical clinical and endocrinological findings in 11 acromegalic patients. METHODS: Eleven acromegalic patients (3 males and 8 females, mean age 43.5 years) were included in this study. Six endocrine tests were carried out to evaluate the GH seeretory function of tumors. Invasiveness of tumors were evaluated by preoperative MRI findings on the basis of Hardys classification. Sequence the gsp oncogene and estimate the GHRH-R gene expression by RT-PCR and in vitro transcription. RESULTS: Three different sized cDNA fragments, 250 bp, 700 bp and 810 bp, were found after RT-PCR. The amount of 250 bp fragment was higher than those of the other two fragments. The clinical findings (age, size, GH level, frequency of paradoxical response to TRH or GnRH, octreotide response, hypothalamic somatostatinergic activity) of the group with high expression of the 250 bp fragment did not significantly differ from those of the group with low expression. The GHRH-R gene expression of tumors with gsp oncogene did not significantly differ from that of tumors without gsp oncogene. CONCLUSION: These results suggest that the expression of GHRH-R gene may not be an important determinant for tumor growth, and the lower GH response to GHRH of tumors with gsp oncogene may not be attributed to the lower expression of GHRH-R gene. The expression of GHRH-R is likely to be regulated by a certain property of tumors for GH secretion and growth.

Effect of Isoproterenol on the Glucose-induced Hypothalamin Somatostatin Release / 대한내분비학회지

BACKGROUND: Acute hypoglycemia stimulates somatostatin (SRIH) release from the hypothalamus, and which in turn suppress growth hormone (GH) secretion from the anterior pituitary gland. However, the exact mechanism of glucose increases the hypothalamic SRIH secretion is not well known. Beta-adrenergic pathway is known to stimulate the hypothalamus SRIH release. We, therefore, hypothesized that the glucose-induced SRIH release may be mediated by the stimulation of the central beta-adrenergic system, and investigated to determine whether a beta-adrermgic aganist, isoproterenol, contribute the suppressive effect of glucose on the GHRH-induced GH secretian. METHODS: Ten healthy young men, aged 23 to 26 years, were studied. Four endocrinological tests were carried out. (Test 1) GHRH (Bachem, CA, U.S.A.), 100pg bolus, was given intravenously at 0 minute. (Test 2) Glucose 100 gm dissolved in water, was given orally at -30 minute and GHRH was administered as Test 1. (Test 3) Isoproterenol (Isuprel, Sanofi Winthrop, USA), 0.012 mg/kg, wasinfused continuously between 0 minute and 120 minute, and GHRH was administered as Test 1. (Test 4) Isoproterenol, 0.012 mg kg was infused continuously between 0 minute and 120 minute, and glucose and GHRH were administered as Test 2. RESULTS: Oral glucose ingestion significantly suppressed the GHRH-induced GH secretion. The acute hyperglycemia significantly suppressed GHRH-induced GH secretion. The pretreatments with isoproterenol significantly suppressed the GHRH-induced GH levels. The pretreatment with glucose and isoproterenol suppressed the GHRH-induced GH levels more compared to those induced by glucose in Test 2. The GH levels in Test 4 did not significantly differ from those in Test 3. CONCLUSION: The results of this study suggests that the hypothalamic somatostatinergic activity induced by the oral glucose administeration is not mediated by the beta-adrenergic pathway in normal men. (J Kor Soc Endocrinool 14:255-264, 1999)

A Case of Congenital Bronchial Atresia with Mucocele / 결핵

Bronchial atresia is a rare congenital anomaly characterized by a bronchocele resulting from a mucus-filled, blindly-terminating segmental or lobal bronchus, and hyperinflation of the obstructed segment of lung. Characteristically, the patient is young and asymptomatic but has an abnormal chest roentgenogram. The only physical finding may be decreased breathing sounds over the affected parenchyma. We experienced a case of bronchial atresia with mucocele in adult. So we report it with a review of the literature.

A Case of Portal Hypertension Secondary to Intrahepatic Arterioportal Fistula / 대한내과학회지

Intrahepatic arterioportal fistulae are rare, but can induce serious complications such as portal hypertension. We present a patient who developed portal hypertension secondary to an intrahepatic arterioportal fistula which was successfully embolized with occlusive balloon and microcoils. A 47-year-old previously healthy male was admitted to our hospital following an episode of melena and abdominal distension. The noteworthy feature in his previous medical history was a hepatic injury caused by a traffic accident when he was aged 9. He didn't drink liquor at all. General appearance was pale and acutely ill. The abdomen was markedly distended and a very noisy bruit over the liver area was continously heard. Laboratory findings, including liver function tests were completely normal except for anemia (Hb 5.7g/dL) and hepatitis viral markers were all negative. Endoscopy demonstrated gastroesophageal varices as the source of bleeding which was treated with variceal ligation. Computed tomography showed a dilated vascular structure in the periphery of the liver at the arterial phase, which suggested a intrahepaic arterioportal fistula. The fistula was also subsequently identified with duplex ultrasound and angiography. Occlusion of the right hepatic artery was performed with occlusive balloon and microcoils. Ascites was rapidly corrected in accordance with a large amount of diuresis and gastroesophageal varices were also completely disappeared whithin a month. On follow-up examination 18 months after hepatic embolization, duplex ultrasound and selective angiography revealed a minute flow of blood through this fistula, but the patient remains well with no recurrence of signs of portal hypertension.

Finding and significance of C.T. in petersen's hernia

No abstract available.