Effect of Nonalcoholic Fatty Liver Disease on the Development of Type 2 Diabetes in Nonobese, Nondiabetic Korean Men

BACKGROUND/AIMS: We have a limited understanding of the effect of nonalcoholic fatty liver disease (NAFLD) on the development of type 2 diabetes. METHODS: The study subjects included male who had received biennial medical check-ups between 2005 and 2009 and who had been diagnosed with fatty liver disease. The subjects with sustained NAFLD (FL, n=107) and sustained non-NAFLD (NFL, n=1,054) were followed to determine the development of type 2 diabetes. RESULTS: In the FL group, there were more subjects with impaired fasting glucose (IFG), type 2 diabetes and high HOMA-IR than there were in the NFL group during the 5-year follow-up period (32.7 vs. 17.6%, 1.9 vs. 0.3%, 17.9 vs. 5.2% respectively, p<0.05). The FL group showed a higher risk than NFL group for abnormal glucose metabolism as determined using IFG (odds ratio [OR], 2.13; confidence interval [CI], 1.36 to 3.35), type 2 diabetes (OR, 7.63; 95% CI, 1.03 to 56.79) and high HOMA-IR (OR, 3.25; 95% CI, 1.79 to 5.91) and metabolic parameters such as body mass index (OR, 3.35; 95% CI, 1.87 to 6.02), triglyceride (OR, 3.05; 95% CI, 1.92 to 4.86) and fasting blood sugar (OR, 2.18; 95% CI, 1.39 to 3.41). CONCLUSIONS: Sustained NAFLD appears to be associated with an increased risk for the development of type 2 diabetes and deterioration of metabolic parameters in non-obese, non-diabetic Korean men.

Is there any vindication for low dose nonselective beta-blocker medication in patients with liver cirrhosis?

BACKGROUND/AIMS: Nonselective beta-blockers (NSBBs), such as propranolol, reportedly exert a pleiotropic effect in liver cirrhosis. A previous report suggested that survival was higher in patients receiving adjusted doses of NSBBs than in ligation patients. This study investigated whether low-dose NSBB medication has beneficial effects in patients with liver cirrhosis, especially in terms of overall survival. METHODS: We retrospectively studied 273 cirrhotic patients (199 males; age 53.6+/-10.2 years, mean+/-SD) who visited our institution between March 2003 and December 2007; follow-up data were collected until June 2011. Among them, 138 patients were given a low-dose NSBB (BB group: propranolol, 20-60 mg/day), and the remaining 135 patients were not given an NSBB (NBB group). Both groups were stratified randomly according to Child-Turcotte-Pugh (CTP) classification and age. RESULTS: The causes of liver cirrhosis were alcohol (n=109, 39.9%), hepatitis B virus (n=125, 45.8%), hepatitis C virus (n=20, 7.3%), and cryptogenic (n=19, 7.0%). The CTP classes were distributed as follows: A, n=116, 42.5%; B, n=126, 46.2%; and C, n=31, 11.4%. Neither the overall survival (P=0.133) nor the hepatocellular carcinoma (HCC)-free survival (P=0.910) differed significantly between the BB and NBB groups [probability of overall survival at 4 years: 75.1% (95% CI=67.7-82.5%) and 81.2% (95% CI=74.4-88.0%), respectively; P=0.236]. In addition, the delta CTP score did not differ significantly between the two groups. CONCLUSIONS: Use of low-dose NSBB medication in patients with liver cirrhosis is not indicated in terms of overall and HCC-free survival.

Gastroduodenal Intussusception Due to Pedunculated Polypoid Gastrointestinal Stromal Tumor / 대한소화기학회지

The gastrointestinal stromal tumor (GIST) is a mesenchymal tumor of the digestive tract showing differentiation along the line of interstitial cell of Cajal. The most GISTs in the stomach generally show the appearance of submucosal tumors. It is rare for GISTs to appear as a pedunculated polypoid lesion on endoscopy. We experienced a case of a 51-year-old man who had a pedunculated polypoid GIST. He was admitted to our hospital for nausea, vomiting, melena and severe anemia (hemoglobin 3.4 g/dL, hematocrit 10.8%). An upper endoscopy showed gastroduodenal intussusception due to a pedunculated polypoid mass. This report presents a rare case of endoscopically proven gastroduodenal intussusceptions due to pedunculated polypoid GIST in the stomach.

Pregnancy-Induced Hypertension, But Not Gestational Diabetes Mellitus, Is a Risk Factor for Venous Thromboembolism in Pregnancy

BACKGROUND AND OBJECTIVES: The aim of this study was to identify the association of pregnancy-induced hypertension (PIH) or gestational diabetes mellitus (GDM) with the development of venous thromboembolism (VTE). SUBJECTS AND METHODS: This was a retrospective study of 57,009 pregnancies during 2002-2008 at Cheil General Hospital, Kwandong University. The diagnosis of VTE {deep vein thrombosis or pulmonary embolism (PE)} was based on clot visualization via ultrasound or computed tomography. RESULTS: In total, 27 cases (PE, 20 cases) were detected. The incidence of VTE was 0.47 per 1,000 pregnancies. To determine risk factors associated with pregnancy-induced VTE, univariate analysis using a chi-square test was performed. Cesarean (C)-section, multiple pregnancy, PIH, placenta previa, and assisted reproduction technique (ART) were statistically significant compared to the controls (all, p=0.000). However, age, premature rupture of membrane, and GDM were not statistically related to VTE. Logistic regression analysis was used to calculate the odds ratios for the risk factors. Placenta previa showed a 12.6-fold higher risk, while PIH had a 9.8-fold higher risk for the occurrence of VTE. C-section and ART procedures increased the risk of VTE by 4.2 times compared to that of the controls. CONCLUSION: Placenta previa and PIH were significant risk factors for VTE, whereas the known traditional risk factors of increased age and GDM were not found to be associated with VTE.

Comparison of Infliximab and Infliximab/Azathioprine for Maintenance Therapy in Korean Patients with Luminal Crohn's Disease

BACKGROUND/AIMS: The benefits and risks of concomitant immunomodulators with infliximab maintenance therapy in patients with luminal Crohn's disease (CD) have not been adequately evaluated. We studied the influence of immunomodulator discontinuation in patients in remission with infliximab therapy through a restrospective case-control study. METHODS: Medical records of 37 patients with luminal CD who received infliximab at four medical centers were retrospectively analyzed. We compared clinical and follow-up data of patients who were treated with infliximab alone with that of patients with combination therapy. RESULTS: Among 37 patients, 31 (83.7%) were treated with infliximab plus azathioprine and six (16.2%) were treated with infliximab alone. Of the 31 patients receiving combination maintenance therapy, 26 (83.9%) were in complete remission after 12 months, as compared with five of six patients (83.3%) receiving infliximab alone. No significant difference was observed in remission rate between two groups (P=0.735). In total, 16.1% of patients in combination therapy and 16.7% in infliximab alone group reported side effects (P=1.000), but serious adverse events such as reactivation of tuberculosis were noted in only one patient in combination therapy group. CONCLUSIONS: Concomitant immunomodulators did not improve efficacy in patients with luminal CD who received scheduled infliximab maintenance.

Role of B-type natriuretic peptide in the recurrence of atrial fibrillation after electrical cardioversion / 대한내과학회지

BACKGROUND/AIMS: No studies have conclusively determined whether the B-type natriuretic peptide (BNP) level measured before electrical cardioversion for atrial fibrillation (AF) is associated with the maintenance of sinus rhythm after the procedure. Therefore, we investigated whether the plasma BNP can predict AF recurrence in the short-term. METHODS: We prospectively recruited 20 consecutive patients with persistent AF, without symptomatic congestive heart failure. The plasma BNP was measured before and after electrical cardioversion. RESULTS: In all patients, AF was converted to normal sinus rhythm (NSR) after the procedure. NSR was maintained in 70.0% of the patients at 1 week and in 52.6% of the patients at 4 weeks. Of the patients with NSR at 1 week, five patients had relapsed by 4 weeks (4-week relapse group, 4WRG). The log BNP levels after cardioversion decreased significantly in all patients, except for the failed group at 1 week and the 4WRG. Multivariate analysis revealed that the maintenance of sinus rhythm was associated with body mass index at 1 week, and left atrial diameter (LAD) and left ventricular mass index (LVMI) at 4 weeks. 4WRG had a significantly higher baseline BNP. The baseline BNP was associated with the LVMI (R2=0.241, p=0.028) and tissue Doppler imaging (TDI) E' (R2=0.432, p=0.002). CONCLUSION: A higher plasma BNP at baseline in AF patients may help to predict the failure to maintain sinus rhythm 4 weeks after electrical cardioversion, but not the early recurrence at 1 week.

Gestational diabetes insipidus in the third trimester of pregnancy / 대한내과학회지

Gestational diabetes insipidus, which occurs rarely during late pregnancy, may injure the mother and fetus neurologically. It takes place in about 4 of every 100,000 pregnancies. Increased placental-derived vasopressinase in late pregnancy markedly degrades vasopressin. The decreased vasopressin activity causes hypotonic polyuria, polydipsia, and dehydration. We report a woman with gestational diabetes insipidus who had no abnormal laboratory tests before developing symptoms. The diabetes insipidus was controlled well by administering nasal desmopressin (1.desamino.8.D.arginine vasopressin, DDAVP) followed by resolution of the signs and symptoms after delivery. Although gestational diabetes insipidus is rare, a prompt diagnosis and appropriate treatment to reduce the risks of maternal and fetal injury are important.

Thromboembolism during pregnancy or postpartum / 대한내과학회지

BACKGROUND/AIMS: Venous thromboembolism (VTE) during pregnancy or postpartum is a major cause of maternal complications and death; however, the risk is uncertain. In this study, we sought to estimate the incidence of VTE during pregnancy and to identify risk factors for pregnancy-related VTE. METHODS: We retrospectively evaluated the incidence, risk factors, treatment, and prognosis for VTE based on 40,989 deliveries at Cheil General Hospital, Kwandong University College of Medicine, over a five-year period from February 2003 to January 2008. The risk factors were analyzed by chi-square-analysis and forward stepwise logistic regression, and are presented as crude and adjusted odds ratios (ORs) with a 95% confidence interval (CI). RESULTS: The incidence of VTE was 0.042% (17 patients, mean age 32.4+/-2.5 years), with deep venous thrombosis (DVT) in 0.01% of the patients (4 patients, mean age 31.5+/-2.9 years), and pulmonary embolism (PE) in 0.032% of the patients (13 patients, mean age 32.6+/-2.5 years). The postnatal incidence of VTE was higher than the antenatal incidence (2 vs. 15). The main manifestations at the time of diagnosis, in order of frequency, were: dyspnea in 8 patients (62%), chest pain in 4 patients (31%), cough in 2 patients (15%), and syncope in 1 patient (8%). The risk factors for VTE were Cesarean section (OR=7.4; 95% CI: 2.1-25.7, p=0.002) and preeclampsia (OR=12.0; 95% CI: 4.2-34.2, p<0.000). All cases showed clinical improvement spontaneously, or with anticoagulation and surgical thrombectomy, and caused no fetal or maternal mortality. CONCLUSIONS: The incidence of VTE during pregnancy was 0.042%; the independent risk factors were Cesarean section and preeclampsia.