Heterotopic Ossification in the Gallbladder

No abstract available.

Nodular Fasciitis of External Auditory Canal

Nodular fasciitis is a pseudosarcomatous reactive process composed of fibroblasts and myofibroblasts, and it is most common in the upper extremities. Nodular fasciitis of the external auditory canal is rare. To the best of our knowledge, less than 20 cases have been reported to date. We present a case of nodular fasciitis arising in the cartilaginous part of the external auditory canal. A 19-year-old man complained of an auricular mass with pruritus. Computed tomography showed a 1.7 cm sized soft tissue mass in the right external auditory canal, and total excision was performed. Histologic examination revealed spindle or stellate cells proliferation in a fascicular and storiform pattern. Lymphoid cells and erythrocytes were intermixed with tumor cells. The stroma was myxoid to hyalinized with a few microcysts. The tumor cells were immunoreactive for smooth muscle actin, but not for desmin, caldesmon, CD34, S-100, anaplastic lymphoma kinase, and cytokeratin. The patient has been doing well during the 1 year follow-up period.

A Case of Teriparatide on Pregnancy-Induced Osteoporosis

Pregnancy-induced osteoporosis is a rare disorder characterized by fragility fracture and low bone mineral density (BMD) during or shortly after pregnancy, and its etiology is still unclear. We experienced a case of a 39-year-old woman who suffered from lumbago 3 months after delivery. Biochemical evidence of increased bone resorption is observed without secondary causes of osteoporosis. Radiologic examination showed multiple compression fractures on her lumbar vertebrae. We report a case of patient with pregnancy-induced osteoporosis improved her clinical symptom, BMD and bone turnover marker after teriparatide therapy.

Nutritional Status and Cardiac Autophagy

Autophagy is necessary for the degradation of long-lasting proteins and nonfunctional organelles, and is activated to promote cellular survival. However, overactivation of autophagy may deplete essential molecules and organelles responsible for cellular survival. Lifelong calorie restriction by 40% has been shown to increase the cardiac expression of autophagic markers, which suggests that it may have a cardioprotective effect by decreasing oxidative damage brought on by aging and cardiovascular diseases. Although cardiac autophagy is critical to regulating protein quality and maintaining cellular function and survival, increased or excessive autophagy may have deleterious effects on the heart under some circumstances, including pressure overload-induced heart failure. The importance of autophagy has been shown in nutrient supply and preservation of energy in times of limitation, such as ischemia. Some studies have suggested that a transition from obesity to metabolic syndrome may involve progressive changes in myocardial inflammation, mitochondrial dysfunction, fibrosis, apoptosis, and myocardial autophagy.

A Case of Diabetic Mastopathy

Diabetic mastopathy is an unusual fibroinflammatory breast lesion that is characteristically presented in premenopausal women with long-standing diabetes with multiple microvascular complications. This patient was a 49-year-old postmenopausal woman with diabetic nephropathy, neuropathy, and retinopathy. Although palpable mass was detected on the left breast, an ultrasonography could not distinguish it from breast cancer. Excisional biopsy was conducted. Histological findings indicated diabetic mastopathy with keloid-like fibrosis, perivascular lymphocytic infiltration, and lymphocytic lobulitis without evidence of malignancy. After excision, there has been no recurrence until now.

The Peroxisome Proliferator-Activated Receptor delta Agonist, GW501516, Inhibits Angiogenesis through Dephosphorylation of Endothelial Nitric Oxide Synthase

OBJECTIVE: Peroxisome proliferator-activated receptor delta (PPAR-delta) is an ubiquitously expressed nuclear receptor that has been implicated in adipose tissue formation, brain development, and atherosclerosis. Despite mouse studies demonstrating that PPAR-delta activation has favorable anti-atherogenic properties by improving systemic lipid profiles, the relationship between PPAR-delta agonist and angiogenesis is unknown. We hypothesized that PPAR-delta ligands modulate the angiogenesis. METHODS: To test this hypothesis we treated primary cultures of bovine aortic endothelial cells with PPAR-delta specific ligand, GW501516 (50-800 nM) for 6 h. RESULTS: GW501516 dose-dependently decreased nitric oxide production without alteration in endothelial nitric oxide synthase (eNOS) expression. Analysis with phospho-specific antibodies against eNOS demonstrated that GW501516 significantly decreased the phosphorylation of eNOS at Serine1179 (eNOS-Ser1179). Concurrently, GW501516 also decreased the Akt phosphorylation. GW501516 did not affect endothelial cell proliferation or induce apoptosis. However, GW501516 inhibited endothelial cell migration, and tube formation in a high nanomolar concentration. The inhibition of endothelial cell tube formation by GW501516 was prevented by addition of the nitric oxide donor, DETA NONOate (5 microM). GW501516 was also found to inhibit angiogenesis in vivo in the chicken chorioallantoic membrane assay. CONCLUSION: These results provide that high nanomolar range of GW501516 inhibits angiogenesis by a mechanism involving dephosphorylation of eNOS-Ser1179.

Letter: Higher Glycated Hemoglobin Level Is Associated with Increased Risk of Ischemic Stroke in Non-Diabetic Korean Male Adults (Diabetes Metab J 2011;35:551-7)

No abstract available.

Medical Therapy in Pregnant Women with Diabetes / 임상당뇨병

Pregnant women with diabetes are at greater risk for adverse outcomes, such as miscarriage, macrosomia, and preterm birth. Advances in the care of diabetes have reduced maternal and perinatal mortality rates to the levels expected in nondiabetic pregnancies. Lifestyle modification such as medical nutritional therapy and exercise is a first step in therapy for gestational diabetes. Rapid-acting insulin analogs (lispro, aspart) are comparable in safety and superior in glucose control to regular human insulin. Because the safety of long-acting insulin analogs (glargine, detemir) in pregnancy has not firmly established, the use of human insulin is preferred over basal insulin. Among the oral hypoglycemic agents, metformin and glyburide might be considered as alternative therapies.

Exercise in Patients with Advanced Diabetic Complications / 임상당뇨병

Structured exercise is considered as an important cornerstone to achieve good glycemic control and improve cardiovascular risk profile in diabetes. Both aerobic and resistance training improve insulin action and can assist with management of blood glucose levels, lipids, and blood pressure. However, exercise must be undertaken regularly to have continued benefits and include regular training varying types. Most persons with diabetic complication such as vascular disease, peripheral neuropathy, autonomic neuropathy, retinopathy, and nephropathy can perform exercise safely as long as certain precautions are taken.

The significant role of the National Health Information Portal, http://health.mw.go.kr

The National Health Information Portal (http://health.mw.go.kr), a collaborative project by the Ministry of Health and Welfare and the Korean Academy of Medical Sciences, was officially launched in January 2011. In the modern society, the internet and smart phones have been flooded with health information, in addition to the information available through traditional media such as newspapers, television, and radio broadcasting. The Korean Medical Association and the Korean Academy of Medical Sciences have expanded their work in several directions, including a monitoring project to correct wrong health information that is commonly used. Nevertheless, they are confronted with the fundamental problem that they are unable to keep up with the speed of production and diffusion of health information in modern society. This initiative of the National Health Information Portal led by the Ministry of Health and Welfare and the Korean Academy of Medical Sciences is significant in that anyone with internet access can easily find proven health information. Unlike existing health information, the National Health Information Portal is structured to help improve understanding by presenting a variety of materials, such as cartoons, pictures, photos, and videos, as compared to simple documents or texts. In addition, it is constructed with a feedback system so that the consumer of the health information can directly and easily access specific content. Furthermore, the National Health Information Portal continues to strive to provide practical contents with mobile services like smart phone applications. We expect the National Health Information Portal to make a contribution to the prevention and treatment of disease by reducing unnecessary medical expenditures, and providing quality health information to society.

The Change of Urine Deoxypyridinoline in a Patient with Symptomatic Hypercalcemia associated with Hyperthyroidism / 대한골다공증학회지

Malignancy and primary hyperparathyroidism are the common causes of hypercalcemia. Although hyperthyroidism may induce mild asymptomatic hypercalcemia, it is very rare that hyperthyroidism causes symptomatic hypercalcemia with a serum calcium concentration > or = 11 mg/dL. A 47-year-old woman visited our hospital for evaluation of nausea, vomiting, and urinary frequency. Her corrected total calcium level was 12.0 mg/dL. She was diagnosed with hyperthyroidism. We excluded the common causes of hypercalcemia by measurements of serum intact parathyroid hormone and a diagnostic work-up for malignancy. She was treated with propranolol and methimazole. The serum calcium and urine deoxypyridinoline, as a bone resorption marker, decreased and hypercalcemic symptoms resolved completely after restoration of the biochemical euthyroid state. In case of difficulty in excluding other causes of hypercalcemia in hyperthyroid patients, the follow-up of changes of bone turnover marker and level of serum calcium can be helpful.

A Case of Disseminated Melioidosis in a Migrant Worker from Thailand / 대한진단검사의학회지

With globalization, foreign patients are frequently encountered at the clinical practice in Korea. As the number of migrant workers from Southeast Asia has been notably rising since the late 1990's, unfamiliar tropical infectious diseases that they bring out, may give great challenges to the routine clinical practice in Korea. Melioidosis is a community-acquired infection caused by a gram-negative bacillus, Burkholderia pseudomallei. It has been endemic in Southeast Asia and Northern Australia, where B. pseudomallei is a soil saprophyte and invades the host through inoculation or inhalation. It frequently presents as an acute septicemia with a high mortality rate of 40%, mainly in patients with chronic underlying diseases, such as diabetes mellitus. Recently, we encountered a case of fatal disseminated melioidosis in a migrant worker from Thailand. We suggest an importance of melioidosis as a cause of community-acquired sepsis in migrant workers from Southeast Asia.

Prevalence of the Metabolic Syndrome in Type 2 Diabetic Patients / 당뇨병

BACKGROUND: The aim of this study was to analyze the prevalence of metabolic syndrome in Korean type 2 diabetic patients. METHODS: A total of 4,240 diabetic patients (male 2,033, female 2,207; mean age 58.7 +/- 11.3 years; DM duration 8.9 +/- 7.6 years) were selected from the data of endocrine clinics of 13 university hospitals in 2006. Metabolic syndrome was defined using the criteria of the American Heart Association/National Heart Lung and Blood Institute and the criteria of waist circumference from the Korean Society for the Study of Obesity. RESULTS: The prevalence of metabolic syndrome was 77.9% (76.7% of males, 78.9% of females). The average number of the components of metabolic syndrome was 2.4 +/- 1.1. Abdominal obesity was seen in 56.8% of the patients, hypertriglyceridemia in 42.0%, low HDL cholesterol in 65.1%, and high blood pressure in 74.9%. Abdominal obesity and high blood pressure were much more prevalent among females than males, and low HDL cholesterol was much more prevalent among males than females. The prevalence of metabolic syndrome was not different according to the duration of diabetes. Metabolic syndrome was strongly related with obesity (odds ratio, 6.3) and increased age (odds ratio in the over 70 group, 3.4). CONCLUSION: The prevalence of metabolic syndrome was 77.9% in Korean type 2 diabetic patients. Its prevalence was greater in obese patients and in those over 40 years of age.

A Nationwide Survey about the Current Status of Glycemic Control and Complications in Diabetic Patients in 2006: The Committee of the Korean Diabetes Association on the Epidemiology of Diabetes Mellitus / 당뇨병

BACKGROUND: The Committee of the Korean Diabetes Association on the Epidemiology of Diabetes Mellitus performed a nationwide survey about the current status of glycemic control and diabetic complications in 2006. METHODS: The current study included 5,652 diabetic patients recruited from the rosters of endocrinology clinics of 13 tertiary hospitals in Korea. Age, gender, height, weight, waist circumference and blood pressure were investigated by standard method. Fasting and postprandial 2 hour glucose, glycosylated hemoglobin (HbA1c), lipid profiles, fasting insulin and c-peptide levels were measured. Microvascular (microalbuminuria, retinopathy and neuropathy) and macrovascular (coronary artery disease [CAD], cerebrovascular disease [CVD] and peripheral artery disease [PAD]) complications were reviewed in their medical records. RESULTS: Mean age of total subjects was 58.7 (+/- 11.6) years and duration of diabetes was 8.8 (0~50) years. Mean fasting and postprandial 2 hour glucose levels were 145.9 +/- 55.0 and 208.0 +/- 84.4 mg/dL, respectively. Their mean HbA1c was 7.9 +/- 1.9%: the percentage of patients within target goal of glycemic control (< 7% of HbA1c) was 36.7%. In this study, 30.3%, 38.3% and 44.6% of patients was found to have microalbuminuria, retinopathy and nephropathy, respectively. Prevalence of CAD, CVD and PAD was 8.7%, 6.7% and 3.0%, respectively. Diabetic complications were closely related with age, duration of diabetes and glycemic control, and this relationship was stronger in microvascular complications than macrovascular ones. CONCLUSION: Only about one third of patients with diabetes was found to reach target glycemic control in tertiary hospitals of Korea. More tight control is needed to reduce deleterious complications of diabetes in Korea.

A Long-term Study On Changes of Serum Middle Molecules Concentration according to the Frequency of On-line Hemodiafiltration :A Comparison between 1/week and 3/week On-line Hemodiafiltration / 대한신장학회지

PURPOSE:The purpose of this study was to assess the effect of long-term and differing frequency of on-line hemodiafiltration (OL-HDF) on changes in degree of hemoglobin, albumin level, serum small and middle molecules concentration in stable patients with undergoing high-flux hemodialysis (HF-HD). METHODS:Twenty five patients with more than 3 months of HF-HD were divided into two groups and followed for more than 36 months. Group 1 was treated once with OL-HDF and twice with HF-HD per week. Group 2 was treated three times with OL-HDF per week. Analysis was performed to compare hemoglobin, biochemical parameters, serum beta-microglobulin, leptin, alpha-microglobulin levels in both groups. RESULTS:There were significant improvements in hemoglobin and albumin level in group 2 compared to group 1. After receiving OL-HDF for a mean of 24 months, patients on both groups had the significantly reduced predialysis level of beta-microglobulin compared to baseline level. However, there is no significant difference in beta-microglobulin level between both groups. The predialysis level of leptin and alpha-microglobulin with relatively large molecular weight was not significantly reduced during observational period and was not significantly different between both groups. CONCLUSION:There were improvements in hemoglobin and albumin level according to the frequency of OL-HDF. The predialysis level of beta-microglobulin was significantly reduced after receiving even once with OL-HDF per week for long-term. Therefore, our study can suggest that there is no correlation between the frequency of OL-HDF and the predialysis level of beta-microglobulin.

A case of papillary thyroid cancer and pheochromocytoma with ganglioneuroma / 대한내과학회지

Composite tumors containing pheochromocytoma and ganglioneuroma are very rare. We report a 70-year-old female with papillary thyroid carcinoma and a compound adrenal medullary tumor, composed of pheochromocytoma/ ganglioneuroma. She had complained of epigastric discomfort 2 months earlier. Chest computed tomography and pancreatic magnetic resonance imaging revealed an intrathoracic goiter and pancreatic cystic tumor. She underwent an explorative laparotomy, and a left adrenalectomy was done because of an adrenal mass, not the pancreatic mass. The pathological diagnosis was a compound adrenal medullary tumor, composed of pheochromocytoma and ganglioneuroma. Although there was no evidence of thyroid cancer on fine needle aspiration cytology, a total thyroidectomy was done because of the neck discomfort. The pathological diagnosis was a papillary thyroid carcinoma, and she underwent radioactive iodine therapy.

Steroid-Responsive Recurrent Encephalopathy Associated with Subacute Thyroiditis

BACKGROUND: Steroid-responsive encephalopathy associated with subacute thyroiditis has, to our knowledge, not been reported previously. CASE REPORT: A 49-year-old woman was found collapsed and brought to our institution with decreased mentality, dysarthria, and gait disturbance. Brain magnetic resonance imaging and angiography were normal but blood tests revealed thyroid-autoantibody-negative thyrotoxicosis. Results of a (99m)technetium-pertechnetate scan were compatible with the thyrotoxic phase of subacute thyroiditis. 14-3-3 proteins were detected in cerebrospinal fluid. Her mental status began to improve from the day following steroid administration. Recurrent encephalopathy was found 2 months after the initial admission, which was also effectively treated with steroid. CONCLUSIONS:We speculate that steroid-responsive recurrent encephalopathy associated with subacute thyroiditis is a subtype of Hashimoto's encephalopathy, and consider that steroid treatment should not be delayed in suspected patients.

Historical Perspectives of the Treatment of Thyroid Disease / 의사학

Although several findings of historical writings have been made, the exact role of the thyroid was not known in the ancient times. From the middle of the nineteenth century, the anatomy and the physiological role of the thyroid were gradually elucidated, and diagnostic and therapeutic modalities were developed. It has been 100 years since Theodor Kocher was awarded the Nobel Prize for his work in pathophysiology and surgery of the thyroid. Fifty years have passed since radioactive iodine was first used for the diagnosis and the treatment of hyperthyroidism in Korea. Today, thyroid cancer is one of the most prevalent malignancy in Korean women. However, the detailed history of the thyroid disease has not been introduced in Korea. The aim of this paper is to describe the historical perspectives of the thyroid disease, especially focusing on the development of the treatment. The common thyroid disease ere named after their discoverers, such as Graves and Hashimoto. It is meaningful to understand the historical background of the thyroid gland, because the important concepts in the area of endocrinology such as hormone replacement therapy, feedback mechanisms, and the use of isotopes were first established based on the research of the thyroid.

Wernicke's encephalopathy in a patient with acute alcoholic pancreatitis / 대한내과학회지

Wernicke's encephalopathy is a serious neurological disorder caused by thiamine deficiency that is characterized by the triad of ocular abnormalities, ataxia, and global confusional state. It is most often seen in alcoholics, but it can be seen in disorders associated with malnutrition and with prolonged intravenous feeding without appropriate vitamin supplementation. We report the case of a 51-year-old man with acute alcoholic pancreatitis and chronic alcoholism with an intraperitoneal abscess, who presented with Wernicke's encephalopathy. He was initially treated by fasting, intravenous fluid replacement, and intermittent vitamin infusion for 3 weeks. After subsequently starting a high carbohydrate oral diet, the patient developed diplopia, orientation disturbance, ataxia, a confusional state, and nystagmus. His neurologic signs and symptoms normalized gradually after intravenous thiamine supplementation.

Ex utero intrapartum treatment (EXIT) for fetal intubation with giant neck mass: A case report / 대한마취과학회지

Large fetal neck masses can cause life threatening airway obstructions after delivery. The ex utero intrapartum treatment (EXIT) can be used to obtain a fetal airway while feto-maternal circulation is preserved. The relationship of neck mass to airway structures can be defined prenatally with ultrasound and magnetic resonance imaging (MRI). We present a successful EXIT case in which prenatally a large fetal neck mass was diagnosed on ultrasound and MRI at 35 weeks of gestation in 30 year-old paturient.