Relationship between body fat distribution and atherosclerotic risk factors in Korean populations / 대한내과학회지

BACKGROUND: Obesity is an independent risk factor for the development of coronary artery disease and associated with insulin resistance, hyperlipidemia and hypertension. In many studies, visceral adipose tissue is highly correlated with adverse coronary risk profile. Left ventricular (LV) hypertrophy also is an independent risk factor for cardiovascular mortality and morbidity. However, few data are available concerning the relations of LV hypertrophy to body fat composition, especially in Korean subjects. Therefore, this study was intended to evaluate the relation between body fat distribution and atherosclerotic risk factors including metabolic parameters and LV mass. METHODS: Total 138 subjects who visited the healthy promotion center in Kangbuk Samsung hospital (97 men, 41 women) were to recruited to the study. Body fat distribution was assessed by Abdomial CT (computer tomography) and Bioelectrical impedance analysis (Body Composition Analyzer Inbody 2.0, Biospace, Seoul, Korea) RESULTS: Visceral adipose tissue volume was higher in male subjects while subcutaneous adipose tissue volume and % body fat were higher in female subjects (p<0.05). Serum triglyceride and uric acid level were elevated in male subjects but HDL-cholesterol level was elevated in female subjects (p0.05). Increasing age was correlated with waist-hip ratio, visceral adipose tissue volume, abdominal fat/total body fat ratio, LV mass (p0.05). Visceral adipose tissue volume was positively correlated with body mass index, waist-hip ratio, blood pressure, total cholesterol, triglyceride, uric acid and negatively correlated with HDL-cholesterol (p0.05). After adjustment for age and sex, this correlation was significantly remained. LV mass was positively correlated with body mass index, waist-hip ratio, visceral adipose tissue volume, abdominal fat/total body fat ratio (p0.05). In the multiple regression analysis, the independent predictor for LV mass was visceral adipose tissue volume (beta=0.252, p0.05). CONCLUSION: Body fat distribution is associated with traditional cardiovascular risk factors. Especially, visceral adipose tissue is correlated with the components of metabolic syndrome and LV mass which is independent risk factor of cardiovascular morbidity and mortality.

A Case of Secondary Achalasia due to Recurrence of Stomach Cancer / 대한소화관운동학회지

Achalasia can be provoked by organic causes, and it is called secondary achalasia. Sometimes it is very difficult to distingush secondary achalasia from primary achalasia. We report a case of secondary achalasia due to recurrence of stomach cancer. A 45-year-old man came to our hospital due to three months history of dysphagia and regurgitation. Barium esophagogram showed concentric narrowing at the distal esophagus and dilatation of proximal esophagus. The esophagogastroduodenoscopy showed stenosis of gastroesophageal junction and the endoscope could not pass through it, but there was no evidence of malignancy. Esophageal manometry showed aperistalsis, compatible with achalasia. Abdominal CT showed soft tissue density near the gastroesophageal junction. However it was not possible to differentiate whether it was due to adhesion or malignancy. For correct diagnosis and treatment, explorolaparotomy was performed and it was diagnosed as secondary achalasia due to recurrence of stomach cancer.

Some obstacles to hormone replacement therapy for postmenopausal osteoporosis

BACKGROUND: Osteoporosis after menopause is known as a disease that needs preventive measures before medical treatment. Many patients, however, do not undergo hormone therapy to prevent it. This paper investigates some obstacles to hormone replacement therapy (HRT). METHOD: A total of 85 menopausal women who under went bone-mineralodensitometry (BMD) examination at Chuncheon Sungshim Hospital Health Care Clinic from May, 1995 to April, 1997 were the subjects of our study. We interviewed them by telephone, examined their medical records including their BMD results. We also examined what the obstacles were for them to receive HRT for osteoporosis. RESULTS: The average age of the subjects was 55.8years. Only 40 women (47%) replied that they knew beforehand the purpose of the BMD examination. The rest of the subjects replied that they simply went through the examination because it was inclusive to health items. Those who had heard of HRT for osteoporosis were only 43 people because(50.1%), and those who did not currently receive HRT amounted to 32 (74.4%). The reasons why they do not undergo the therapy were fear of cancer, no symptoms related to osteoporosis, financial difficulty, and weight gain. Among the 32 subjects, only 1 person replied that she would not receive the HRT even if the above obstacles were removed. Therefore, it seems that most of our subjects would receive HRT if such obstacles removed. Those who were currently receiving HRT were 11 people(12.9%). According to the open questionnaire, many of them replied that they do not feel any inconvenience while receiving the HRT, but some of them complained of epigastric pain, dysmenorrhea, or mastalgia. They replied that after the HRT they felt no arthralgia and felt far better in body and mind than before treatment. All the 11 people replied that they will continue to receive the HRT. CONCLUSION: The main reason why so few people received HRT for osteoporosis proved to be the lack of knowledge of the therapy. Even those who had heard of HRT complained about the negative aspects, which in fact can be overcome, and as a result a considerable number of them do not receive HRT. Therefore we conclude that in order to increase the number of patients who will undergo HRT for osteoporosis after menopause we need to strengthen education about the merits of this therapy rather than just performing BMD examination.