ABSTRACT
Addison's disease is a rare disorder that is characterized by primary adrenal hypofunction and the underlying causes are various according to geographic regions. In order to establish an appropriate therapeutic regimen to treat adrenal insufficiency associated with Addison's disease, knowledge of the underlying adrenal abnormality is essential. We report a case of a 37-year-old man who showed biochemical evidence of adrenocortical insufficiency without signs of tuberculosis. Computed tomography showed bilateral adrenal enlargement and definitive diagnosis of adrenal tuberculosis was established by laparoscopic biopsy.
Subject(s)
Adult , Humans , Addison Disease , Adrenal Insufficiency , Biopsy , TuberculosisABSTRACT
BACKGROUND: To investigate the best surrogate marker for insulin resistance in the non-diabetic middle-aged population in Korea. METHODS: This study was performed from February to April 2003-2005 in adults over 40 years of age living in Chungju City, South Korea, selected by stratified random cluster sampling. We analyzed the data from a total 6,149 non-diabetic subjects that completed a survey consisting of anthropometric measurement and blood chemistry. We defined the highest quartile of the homeostasis model for insulin resistance (HOMA-IR) as the insulin resistant group in our study population. We also analyzed the correlation of various anthropometric (body mass index, waist circumference, waist to hip ratio, waist to height ratio) and biochemical parameters (total cholesterol to HDL cholesterol ratio, non-HDL cholesterol level, triglycerides to HDL cholesterol ratio and level of triglycerides) with insulin resistance using simple and multiple regression analysis for detecting the insulin resistance group. RESULTS: By simple regression analysis, among the anthropometric parameters including the body mass index, waist circumference, waist to hip ratio, waist to height ratio, and the biochemical parameters, including the total cholesterol to HDL cholesterol ratio, non-HDL cholesterol level, triglyceride to HDL cholesterol ratio and triglycerides level, the body mass index was the best surrogate marker for insulin resistance (95% CI 1.215-1.262). The cut-off value of the body mass index was 24.6 kg/m2 (male; 24.7, female; 24.6 kg/m2), with a sensitivity of 62.6% and specificity of 66.9%. Multiple logistic regression analysis for insulin resistance also gave the same results. Furthermore, the cut-off value of the body mass index for the metabolic syndrome as defined by NCEP-ATP III was also 24.1 kg/m2 (male; 24.0, female; 24.2 kg/m2). CONCLUSIONS: Our study results suggest that the body mass index was the best surrogate marker for insulin resistance of a non-diabetic population and its cut-off value was approximately 24 kg/m2.
Subject(s)
Adult , Female , Humans , Middle Aged , Biomarkers , Body Mass Index , Chemistry , Cholesterol , Cholesterol, HDL , Homeostasis , Insulin Resistance , Insulin , Korea , Logistic Models , Sensitivity and Specificity , Triglycerides , Waist Circumference , Waist-Hip RatioABSTRACT
BACKGROUNDS: Percutaneous radiofrequency neurotomy of posterior primary ramus has been in use as a treatment for persistent, mechanical low back pain for two decades. However, there has been limited studies regarding to prognostic factors related to outcome. We report our experience with at least 2-year follow up with special aftention on prognostic factors. METHODS: Of total 228 patients who underwent percutaneous radiofrequency neurotomy (PRN) of posterior primary ramus for refractory low back pain during last 3 years, 128 patients whose pain was considered to be originated from facets joints or their surrounding soft tissue and responded to temporary blocks were assigned to a group II. All patients had more than 6 months of pain. These patients were compared with 100 patients to whom PRN were provided for chronic nonspecific low back pain without all inclusion criteria (Group I). RF procedures were done under local anesthesia with C-arm intensifier guidance. Pain reliefs were estimated at 1week, 1month, 6months and 2 years using visual analog scale(VAS). For patients with more that 50% reduction of previous pain was regarded as positive responder. Various clinical variables such as age, sex, symptom duration, types of pain, bilaterality, and previous surgery were studied for prognostic factors. RESULTS: Positive responders were 56% at 1week, 46% at lmonth, 18% at 6months, and 13% at 2years after PRN in group I, and 78.9% at lweek, 75.4% at lmonth, 62.5% at 6months, and 54.7% at 2years in group II. Some variables were found to be significantly related to outcome including prominent local tenderness, percussion tenderness, combination of symptoms with pain on gefting up, extension, transitional movement, pain radiating to buttock and/or posterior thigh, and good immediate response. Age, sex, symptom duration, bilaterality, imaging study results, previous lumbar surgery, and degrees of pain relief from diagnostic block were not related to outcome. CONCLUSIONS: These results indicate that PRN of posterior primary ramus has a moderate overall long-term beneficial effect, with no morbidity in our series. But, the long-term good results will be anticipated only in properly selected patients with low back pain originating from facet joints and surrounding structures.
Subject(s)
Humans , Anesthesia, Local , Buttocks , Follow-Up Studies , Joints , Low Back Pain , Percussion , Thigh , Zygapophyseal JointABSTRACT
BACKGROUND: Alteration in plasma lipid levels during malaria attacks was studied to evaluate the diagnstic values in vivax malaria. METHODS: The plasma levels of total cholesterol, triglycerides, HDL-cholesterol (HDL-c), and LDL-cholesterol (LDL-c) were analyzed and compared in 32 patients with vivax malaria at presentation, in 10 patients after 17-days of treatment with anti-malaria drug, and in 40 control individuals. Interrelation of lipid profile with other parameters including parasitemia level, platelet count, hemoglobin and WBC counts were analysed. RESULTS: In patients with malaria, serum total cholesterol, triglycerides, HDL-c and LDL-c concentrations were significantly lower than those of control subjects. None of lipid profile showed any correlation with the parasitemia level. After treatment, HDL-c was significantly elevated. CONCLUSION: These results suggest that lipid profile, especially decreased of HDL-c, may be a valuable information in the diagnosis of the malaria.
Subject(s)
Humans , Cholesterol , Cholesterol, HDL , Cholesterol, LDL , Diagnosis , Malaria , Malaria, Vivax , Parasitemia , Plasma , Plasmodium vivax , Plasmodium , Platelet Count , TriglyceridesABSTRACT
BACKGROUND: Alteration in plasma lipid levels during malaria attacks was studied to evaluate the diagnstic values in vivax malaria. METHODS: The plasma levels of total cholesterol, triglycerides, HDL-cholesterol (HDL-c), and LDL-cholesterol (LDL-c) were analyzed and compared in 32 patients with vivax malaria at presentation, in 10 patients after 17-days of treatment with anti-malaria drug, and in 40 control individuals. Interrelation of lipid profile with other parameters including parasitemia level, platelet count, hemoglobin and WBC counts were analysed. RESULTS: In patients with malaria, serum total cholesterol, triglycerides, HDL-c and LDL-c concentrations were significantly lower than those of control subjects. None of lipid profile showed any correlation with the parasitemia level. After treatment, HDL-c was significantly elevated. CONCLUSION: These results suggest that lipid profile, especially decreased of HDL-c, may be a valuable information in the diagnosis of the malaria.