Effects of Diabetes Education on Diabetic Management in Non-Insulin-Dependent Diabetics Mellitus Patients

The purpose of this study was to examine the effect of diabetes education on diabetic management by determining the changes of the knowledge and practice for diet therapy and blood glucose level pre-training and post-training. Statistical data analyses were completed using the SPSS 11.0 program. The results can be summarized as follows : The average age of the subjects was 52.8 years old, the period of suffering from diabetes was 7.9 years and 31% of the patients had a history of diabetes in their family members. In life style for self-management, they showed lower levels in drinking post-training, and significantly higher exercise levels post-training (P<0.05). Regarding the level of knowledge for diet, they showed significantly higher levels post-training in eight items such as importance of diet therapy for diabetes (p<0.005), principle of diet therapy (p<0.005), nutrient composition of foods (p<0.005), carbohydrate composition of foods (p<0.005), calorie prescribed to themselves (p<0.001), exchange units prescribed to themselves (p<0.005), exchange food items and exchanges units of cereal & grains (p<0.005) and exchange food items and exchanges units of fruit & juices (p<0.005). Regarding the practices of diet, they showed significantly higher levels of practice in keeping permitted meal size (p<0.005), using food exchange list (p<0.005), keeping exact meal times (p<0.001) and restricting most foods to eat (P<0.01) post-training. When measuring their bodies, average weight was lower post-training. Obesity was significantly lower post-training (p<0.01), and blood pressure both in systolic and diastolic was lower. Postcardinal-2hour blood glucose level decreased significantly from 268.4+/-98.9 pre-training to 180.9+/-48.4 post-training (p<0.001).

Identification of Patients More Susceptible to Severe Anal Pain after Colonoscopy and Effect of Topical Treatment of Lidocaine Gel in Reducing the Anal Pain: A Prospective, Randomized, Controlled Study (Identification and Management of Patients Susceptibl / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of this study was to identify which patients are more susceptible to severe anal pain after colonoscopy and to determine the usefulness of lidocaine gel in reducing the anal pain. METHODS: A prospective trial was performed with 150 consecutive outpatients who underwent a colonoscopic examination. The patients were randomized into three groups: they received topical treatment of lidocaine gel (n=48) or lubricant gel (chlorhexidine gluconate) (n=48), or no treatment (n=54) just after the procedure. Data regarding the procedures were collected and the patients were phone-interviewed on the next day. RESULTS: Seventy of 150 (46.7%) had moderate to severe pain (VAS score>or=4). A multiple regression analysis found that the presence of hemorrhoid was significantly (p<0.05) associated with severe anal pain after colonoscopy. Among three groups, there was no significant difference of the pain scores on the procedure day on the next day. However, patients' subjective evaluation about the usefulness of the gel was significantly better in the lidocaine group than in the placebo group in patients who had moderate to severe pain (79.2% vs. 43.5%, p<0.05). CONCLUSIONS: A palliative management is more required for patients who complain moderate to severe pain just after colonoscopy or those with hemorrhoid

A Case of Ischemic Colitis in a Young Woman with Chronic Obstructive Type Constipation / 대한소화관운동학회지

Although ischemic colitis is often considered to be a condition occurred in elderly patients or in patients with vascular diseases, it also can occur in younger healthy persons. Some drugs, such as oral contraceptives, may play an important role in the development of ischemic colitis in young women. However, constipation also can play an important role in this condition. We recently experienced a case of reversible ischemic colitis of a young woman, who had been suffered from obstructive type of chronic constipation, after taking a laxative and enema. We report this case with literature review. Proper managements and educations in patients with chronic constipation should be emphasized.

A Case of Cowden's Syndrome / 대한소화기내시경학회지

A 17-year-old man was referred to our hospital because of dizziness and mild dyspnea. He had a history of partial thyroidectomy due to benign mass when he was 10 year-old. His conjunctiva was anemic and acral keratosis was noted. He had a goiter and a previous surgical scar on the anterior neck just below the thyroid cartilage. Blood counts were as follows; Hb was 4.3 g/dL, WBC 5,500/mm3, PLT 366,000/ mm3. Esophagogastroduodenoscopy and colonoscopy showed esophageal acanthosis and numerous variable sized polyps in the stomach, duodenum and colon. The small bowel series showed numerous polypoid lesions in the entire small bowel. Gastric polyps revealed hamartoma and colon polyps revealed inflammatory polyp with lymphoid hyperplasia by pathologic examination. Thyroid ultrasonograph showed multiple nodules and cysts and I131 scintigraphy showed multiple cold and hot nodules in his remnant thyroid gland. We diagnosed the patient as Cowden's syndrome.

A Case of a Huge Duodenal Brunner's Gland Hyperplasia / 대한소화기내시경학회지

So called Brunner's gland hyperplasia is characterized by a nodular proliferation of histologically normal Brunner's gland, accompanied by ducts and scattered stromal element. The clinical presentation vary from vague epigastric disomfort to obstruction and gastrointestinal bleeding. We experienced a case of huge Brunner's gland hyperplasia presented as a huge duodenal polyp. A 28-year-old woman was refered to our hospital because of suspicious ampulla of Vater cancer or duodenal cancer in abdominal CT scan. The patient complained of dizziness and intermittent melena. The side view duodenoscopic examination revealed a huge pedunculated mass originated from the posterior wall of the duodenal bulb. The head of the polyp was placed on the ampulla of Vater with several erosions suggesting recent bleeding. Resection of duodenal polyp was performed by laparoscopic duodenotomy and Brunner's gland hyperplasia was revealed on pathologic examination.

Angiographic Differences Analysis of Coronary Artery Lesions in Patients with Stable and Unstable Angina Pectoris

BACKGROUND AND OBJECTIVES: As previously reported, unstable angina is usually related to characteristic coronary artery lesion's morphology analyzed by coronary angiogram. This takes the form of an eccentrically placed convex stenosis with a narrow neck due to one or more overhanging edges or irregular, scalloped borders, or both. Although most studies were done for lesions with high degree stenosis(>50%), recent studies emphasized the role of vulnerability of plaque in acute coronary syndrome and even mild degree stenotic lesions may progress rapidly to evoke acute coronary syndrome. Therefore in this study, we analyzed the morphological characteristics of coronary artery lesions with mild degree stenosis as well as severe stenosis. MATERIALS AND METHODS: We conducted a retrospective study of 96 patients with angina pectoris (42 of stable patients and 54 of unstable patients) who underwent coronary angiography. Each lesions with 25% or greater diameter stenosis were categorized into simple and complex lesion(convex intraluminal obstruction with a narrow neck or irregular borders, diffuse irregularities, ulceration, thrombus). Calcification of coronary artery, extents of lesions were analyzed and stenosis grade and location were categorized by AHA classification. RESULTS: There were no significant differences between the stable angina and unstable angina in risk factors and vessel involvement, numbers of lesions, calcification and total obstruction. In morphologic analysis, complex lesions were more frequent in unstable angina than stable angina (49% vs 33%, p<0.05). The mean of percent diameter stenosis was not signigicantly different between two groups, but severe stenotic lesions with 90% or more stenosis were more frequent in unstable angina (34% vs 22%, p<0.05). Locations of involved vessels were similar between the angina groups. Complex lesions were distributed more frequent in RCA and simple lesions were more in LAD and LCX (p<0.05). CONCLUSIONS: The lesions with both complex morphology and severe degree stenosis are closely implicated in unstable angina.

A Case of Pheochromocytoma Manifested by Generalized Seizure / 대한내분비학회지

Pheochromocytoma is originated from chromaffin cells of sympathetic nervous system and clinical symptoms are caused by catecholamine released from tumor. In typical cases, periodic attacks of hypertension, palpitation, headache, and sweating are main symptoms. But, the diagnosis of pheochromocytoma is sometimes difficult since its clinical presentation is quite variable. We evaluated a 25-year-old woman who was admitted because of left flank pain and seizure. She had a history of hemoptysis and toxemia. During the hospitalization, she experienced generalized seizure once more. The clinical diagnosis of pheochromocytoma was proven by highly elevated urinary catecholamines and confirmed histologically after operation. We think it is the first case report of pheochromocytoma manifested by seizure in korea, so we report this case with literature review.