Effects of the Serum Adiponectin to Tumor Necrosis Factor-alpha (TNF-alpha) Ratio on Carotid Intima-Media Thickness in Newly Diagnosed Type 2 Diabetic Patients

OBJECTIVES: Type 2 diabetes, a leading cause of cardiovascular disease, is well known for its association with accelerated atherosclerosis. Adiponectin and tumor necrosis factor - alpha (TNF-alpha), which are produced and secreted in adipose tissue, have been suggested as predictors for cardiovascular disease. However, little is known about the influence of adiponectin and TNF-alpha ratio on the progression of carotid atherosclerosis in newly diagnosed type 2 diabetic patients. This study was conducted to evaluate the influence of serum adiponectin/TNF-alpha levels on the progression of carotid atherosclerosis. METHODS: One hundred eleven newly diagnosed type 2 diabetes patients were enrolled. Anthropometric and biochemical data including serum adiponectin, TNF-alpha were measured for each participant. Also we measured carotid intima-media thickness (CIMT) at baseline and at 1 year follow-up (n=81). We finally examined the relationship among serum adiponectin over TNF-alpha levels (ADPN/TNF-alpha), baseline CIMT, and progression of CIMT at 1 year. RESULTS: ADPN/TNF-alpha negatively correlated with baseline CIMT (r=-0.231, p=0.025). Moreover, progression of CIMT was significant at 1 year (0.011+/-0.138 mm). There was a negative correlation between ADPN/TNF-alpha and progression of CIMT at 1 year (r=-0.172, p=0.038). In multiple regression analysis, age and HbA1c were found to be independent risk factors for baseline CIMT. However, only HbA1c was an independent risk factor for the progression of CIMT. CONCLUSION: ADPN/TNF-alpha was negatively associated with baseline CIMT and the progression of CIMT at 1 year. Overall glycemic control is the most important factor in the progression of CIMT in patients with type 2 diabetes.

Opportunistic lung infections as a manifestation of Good's syndrome

Good's syndrome is an acquired immunodeficiency state associated with thymoma. It is characterized by recurrent infection, autoimmune disease, and immunologic abnormality. The insufficient immunity can be managed by intravenous immunoglobulin (IVIG) replacement therapy. We describe 2 patients who presented with Pneumocystis jiroveci pneumonia and Cytomegalovirus pneumonia after thymectomy for a thymoma. Immunologic study revealed hypogammaglobulinemia with very low B-cell count, consistent with Good's syndrome. They were successfully treated with trimethoprim/sulfamethoxazole and gancyclovir respectively, and they are all well without additional infections, receiving regular IVIG replacement.

Simple Congenital Lymphedema: A Case Report / 대한정형외과학회잡지

Simple congenital lymphedema is a congenital form of chronic lymphedema of unknown etiology which affects a part or all of the one extremity, especially the lower extremities, at or immediately after birth. A clinical classification of lymphedema was offered by Allen and Ghormley in 1935, based on a study of 300 cases of lymphedema of which 12 cases are simple congenital lymphedema. They classified the cases of lymphedema into two divisions: noninflammatory and inflammatory, with a tabulation of primary and secondary causes. One caes I reporting is classified as being of congenital origin and naturally comes under the noninflammatory group. On May 1960, a 3 year old girl entered to the Department of Orthopaedic Surgery, Kyungpook National University Hospital because of lymphedema of right leg. Since at birth, there were no history of skin infection, cellulitis and lymphangitis etc. Gross appearance of the skin of the affecte leg revealed leather like consistency and thickening. One week of preoperative preparation of the patient was sustained absolute bed rest with elevation of affected limb to ease drainage of lymphatic fluid. The two staged operation of Homans procedure were performed under general anesthesia, first to medical half and second to remaining lateral half of the affected leg. The end result was relatively good in decreasing the circumfence of affected leg but it was not quite acceptable in its cosmetic effect. The literature on primary lymphedema is reviewed.

Heterotropic Ossification in Paraplegia: Report of of 4 Cases / 대한정형외과학회잡지

Heterotropic ossifications have been known to occur around joints in many pathological conditions of the nervous system mostly in paraplegia and is affects most of the hip joint. Recently, 4 cases of heterotropic ossification in 18 cases of traumatic paraplegia have been reviewed at the orthopedic department of Kyungpook National University Hospital from April 1965 to July 1968 and the results obtained were as follows: 1. All cases were found in male of 3rd to 4th decade. 2. Heterotropic ossification affectected around the hip joint in 3 cases and in the other one case around the medial femoral condyle of knee joint. 3. Three cases affecting around hip joint expressed pressure sores on ipsilateral great trochanteric area, but the other one case affecting around medial femoral condyle had not any pressure sore. 4. In all cases, the heterotropic ossification was noted on X-ray film within 4 to 6 months after paraplegia.

Gastric Carcinoma(An eleven year review of 792 cases)

Statistical analysis of 792 cases of gastric carcinoma is reported. Materials were collected from the medical record room during the 11 year period from Jan. 1955 to Dec. 1965. Diagnosis of gastric carcinoma was established by pathologic examination of the resected specimen, by lymph node biopsy, and by physical and X-ray findings. The age of peak incidence was in the 5th decade. The male to female ratio was 3:1. In the order of frequency, the symptoms and signs which were the most prominent and common were epigastric pain or discomfort, indigestion, anorexia, a palpable mass, weight loss, and epigastric tenderness. More than 50% of the patients had symptoms for less than 6 months. About 70% of the patients and hypochlorhydria on gastric analysis. More than 60% of the carcinomas were located in the prepyloric region. Regional lymph-node metastasis was present in 76% of the cases. In order of frequency this occurred in the omentum, celiac nodes, liver, pancreas, and mesocolon. There was a 56.4% operability and 58.8% resectability. The most common postoperative complication was wound infection. There were 9 operative deaths which made a 3.4% mortality for cases resected, and 2% mortality for all cases coming to surgery. The five year survival rate was 12.9% for all cases coming to surgery, but was increased to 22.2% for patient having a total gastrectomy and 24.2% for patients having a subtotal gastrectomy. 12.0% of patients having gastrectomy in which there were positive nodal metastases survived five years, but, when metastasis was not noted the patients who had had a gastrectomy survived at a rate of 45.5% for five years. The surgical result was influenced by several fastors other than the presence or absence of metastases to the lymph nodes. These factors included the grade of the tumor microscopically, the presence or absence of serosal involvement, and the pathologic type of the tumor. It is our opinion that our surgical results, which are poor when compared with those in the literature, are due mainly to the fact of a late diagnosis. Some of the patients were so far-advanced as to be questioned as to their being candidates for surgery. Most of the patients come to the surgeon simply because of their symptoms and signs which have developed beyond the point of tolerance, or because of family pressures to come for treatment. This study revealed that the resectability rate, and the surgical results improved year by year. This fact explains why the early diagnosis is so very important. It is felt keenly that education of the public and increased alertness on the part of both patients and physicians is needed. This is particularly true when the patient is over 40 years of age, complains of indigestion, epigastric pain or discomfort. Each of these patients should have a complete check-up. Once the chance for cure of the disease has passed it is difficult to do more than a palliative procedure.