Parameters of Glucose and Lipid Metabolism Affect the Occurrence of Colorectal Adenomas Detected by Surveillance Colonoscopies

PURPOSE: Limited data are available regarding the associations between parameters of glucose and lipid metabolism and the occurrence of metachronous adenomas. We investigated whether these parameters affect the occurrence of adenomas detected on surveillance colonoscopy. MATERIALS AND METHODS: This longitudinal study was performed on 5289 subjects who underwent follow-up colonoscopy between 2012 and 2013 among 62171 asymptomatic subjects who underwent an initial colonoscopy for a health check-up between 2010 and 2011. The risk of adenoma occurrence was assessed using Cox proportional hazards modeling. RESULTS: The mean interval between the initial and follow-up colonoscopy was 2.2±0.6 years. The occurrence of adenomas detected by the follow-up colonoscopy increased linearly with the increasing quartiles of fasting glucose, hemoglobin A1c (HbA1c), insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and triglycerides measured at the initial colonoscopy. These associations persisted after adjusting for confounding factors. The adjusted hazard ratios for adenoma occurrence comparing the fourth with the first quartiles of fasting glucose, HbA1c, insulin, HOMA-IR, and triglycerides were 1.50 [95% confidence interval (CI), 1.26–1.77; p(trend)<0.001], 1.22 (95% CI, 1.04–1.43; p(trend)=0.024), 1.22 (95% CI, 1.02–1.46; p(trend)=0.046), 1.36 (95% CI, 1.14–1.63; p(trend)=0.004), and 1.19 (95% CI, 0.99–1.42; p(trend)=0.041), respectively. In addition, increasing quartiles of low-density lipoprotein-cholesterol and apolipoprotein B were associated with an increasing occurrence of adenomas. CONCLUSION: The levels of parameters of glucose and lipid metabolism were significantly associated with the occurrence of adenomas detected on surveillance colonoscopy. Improving the parameters of glucose and lipid metabolism through lifestyle changes or medications may be helpful in preventing metachronous adenomas.

Associations between White Blood Cell Count and Features of the Metabolic Syndrome

BACKGROUND AND OBJECTIVES: The proinflammatory state is considered to be a risk factor for develop atherosclerosis. Recently, certain components of the metabolic syndrome have been related to inflammatory markers. The purpose of this study was to assess the association of white blood cell (WBC) count with different components of the metabolic syndrome (MS). SUBJECTS AND METHODS: We performed this study to investigate the relationships of white blood cell count, uric acid, and C-reactive protein (CRP) to components of metabolic syndrome (MS), such as abdominal obesity, elevated triglyceride, low high-density lipoprotein cholesterol (HDL), high blood pressure, and impaired fasting glucose in 3134 koreans. RESULTS: WBC count, uric acid, and CRP were associated with several components of MS. WBC count increased, as did the number of MS. CONCLUSION: Our data suggests an association between the metabolic syndrome and WBC count.

Plasma CRP, apolipoprotein A-1, apolipoprotein B and Lp(a) according to thyroid function status / 대한내과학회지

BACKGROUND: Alterations of lipid profiles are well known in thyroid dysfunction. Hypothyroidism is associated with premature atherosclerosis. This relation has been attributed to increased levels of total cholesterol, low density lipoprotein cholesterol and apolipoprotein B. However, there have been dissenting reports of abnormalities in serum lipid concentrations in patients with subclinical hypothyroidism. Serum Lp(a), an independent risk factor of atherosclerosis, is predicted according to thyroid function status. C-reactive protein (CRP) is very sensitive acute phase reactant and independently associated with the occurrence of atherosclerosis. Overt hypothyroidism is a cause of atherosclerosis, so it is expected that serum level of CRP may be related with thyroid dysfunction. However, no study has been performed about it. The objective of the study was to evaluate the relation of plasma CRP, apo A1, apo B and Lp(a) with thyroid function. METHODS: We undertook this study in 54 patients with hyperthyroidism, 35 patients with subclinical hyperthyroidism, 29 patients with overt hypothyroidism, 194 patients with subclinical hypothyroidism and 100 age and sex matched healthy control subjects. Serum CRP and Lp(a) were measured by immuno-nephelometry. RESULTS: There were no significant differences of serum CRP, Lp(a), HDL-C and apo A1 according to thyroid dysfunction. Serum total cholesterol level was lower in hyperthyroidism than in overt hyperthyroidism, subclinical hypothyroidism, subclinical hyperthyroidism and healthy control subjects (p<0.05). Serum LDL-C level was lower in hyperthyroidism than overt hypothyroidism (p<0.05). Serum triglyceride level was higher in overt hypothyroidism than in hyperthyroidism and healthy control subjects (p<0.05). Serum apo B level was lower in hyperthyroidism than in overt hyperthyroidism, subclinical hypothyroidism and healthy control subjects (p<0.05). CONCLUSION: Serum CRP and Lp(a), risk factors of atherosclerosis, were not significantly different according to thyroid dysfunction. Increased risk for atherosclerosis in overt hypothyroidism seems not to be associated with serum CRP level.

Optimal midazolam dose, factors affecting midazolam dose and proper timing of flumazenil injection during esophagogastroduodenoscopy / 대한내과학회지

BACKGROUND: Intravenous administration of midazolam is widely used as a premedication for esophagogastroduonenoscopy. However, there are individual differences in midazolam doses for premedication and controversies for starting point of esophagogastroduonenoscopy after midazolam injection. There are also controversies for flumazenil injection time after esophagogastroduonenoscopy. The aims of this study were to determine the proper doses of midazolam for esophagogastroduonenoscopy and factors which affect midazolam doses. Also we evaluated the proper timing of flumazenil injection to increase patient's satisfaction according to sedation status. METHODS: 126 patients who were supposed to be taken diagnostic esophagogastroduonenoscopic exam were enrolled in this study. We evaluated the difference of patient's age, sex, alcohol consumption, sedation score, cooperation score, and satisfaction score according to midazolam doses. The relation between midazolam doses and agitation score, insomnia score, and somatic preoccupation score were checked. We evaluated the relation between midazolam doses and age, sex, alcohol consumption, amnesia, sedation, cooperation and satisfaction. RESULTS: There were no relationship between age, sex and midazolam doses. Alcoholics needed larger amount of midazolam than non-alcoholics. No differences in satisfaction were observed according to sedation status. There were significant relationship between midazolam doses and sedation score but not with satisfaction, cooperation, amnesia, agitation, insomnia and somatic preoccupation score. Patients who were injected flumazenil 20 minutes after esophagogastroduonenoscopy were more satisfied than patients who were injected flumazenil immediately after esophagogastroduonenoscopy. CONCLUSION: Minimal doses of midazolam that could induce mild sedation was enough and safe. Flumazenil injection 20 minutes after esophagogastroduonenoscopy was more efficacious than immediate injection.

Circulating IL-8 and IL-10 in Euthyroid Sick Syndromes following Bone Marrow Transplantation

It is generally agreed that euthyroid sick syndromes (ESS) are associated with an increased production of cytokines. However, there has been scarce data on the relationship thyroid hormone changes and cytokines among the patients undergoing bone marrow transplantation (BMT). Because interleukin-8 (IL-8) has been identified as a potent proinflammatory and interleukin-10 (IL-10) as an antiinflammatory cytokine, we studied the relation between thyroid hormone parameters and these cytokines following BMT. We studied 80 patients undergoing allogeneic BMT. Serum T3 decreased to nadir at post-BMT 3 weeks. Serum T4 was the lowest at the post-BMT 3 months. Serum TSH sharply decreased to nadir at 1 week and gradually recovered. Serum free T4 significantly increased during 3 weeks and then returned to basal level. Mean levels of serum IL-8 significantly increased at 1 week after BMT. Mean levels of serum IL-10 significantly increased until 4 weeks after BMT. No significant correlation was found between serum thyroid hormone parameters and cytokines (IL-8, IL-10) after adjusting steroid doses during the entire study period. In conclusion, ESS developed frequently following allogeneic BMT and cytokine levels were increased in post-BMT patients. However, no significant correlation was found between serum thyroid hormone parameters and these cytokines.

Prevalence of Helicobacter pylori infection and its association with cardiovascular risk factors in Korean adults / 대한내과학회지

BACKGROUND: Chronic inflammation plays an important role in the pathophysiology of atherosclerosis. Among the many pathogens causing chronic inflammation, Helicobacter pylori is the major pathogen for gastric diseases in Korean people. The purpose of this study is to evaluate the prevalence of Helicobacter pylori infection and its association with cardiovascular risk factors in healthy Korean adults. METHODS: In 32,998 healthy subjects, the proportion of seroposive subjects for H. pylori and its association with cardiovascular risk factors were evaluated in participants in health screening program. H. pylori infection status was tested with serum IgG antibody test with ELISA and blood pressure, body mass index, serum lipid profiles, hsCRP were tested. RESULTS: 67% of participants were infected with H. pylori serologic test. Seropositivity was highest in age group of over sixty and male subjects tended to be more infected with H. pylori (p0.05). In multiple logistic regression models, adjusted by age, sex and other variables, total cholesterol was associated with H. pylori seropositivity (odds ratio 1.004, 95% confidence intervals 1.002~1.006, p<0.001) and HDL was inversely related with H. pylori independently (odds ratio 0.990, 95% confidence intervals 0.987~0.992, p<0.001). Age and sex was also positively associated with H. pylori (odds ratio for age 1.029, 95% confidence intervals 1.026~1.032, p<0.001, odds ratio for women to men 0.818, 95% confidence intervals 0.750~0.893, p<0.001). CONCLUSION: The results of this study is that H. pylori infection is prevalent in Korean adults and is independently correlated with cardiovascular risk factors such as total cholesterol and HDL in atherogenic way in healthy subjects. This may support the previous hypothesises that H. pylori might be one of the atherosclerotic pathogens.

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.

A Case of Congenital Nephrogenic Diabetes Insipidus with Megaureter and Megabladder / 대한신장학회잡지

A case of a 37 year-old man of congenital diabetes insipidus is reported. He complained of polydipsia, which began from his youth, drinking about 10 L of water every day. He didn't look ill or mentally retarded. In his family, his only brother has shown similar symptoms and his older sister had no symptom. On radiologic study, both kidneys showed severe hydronephrosis and the bladder was markedly distended. Water deprivation test was performed. The result was consistent with diabetes insipidus and the urine osmolality didn't respond to antidiuretic hormone injection, and he was diagnosed as nephrogenic diabetes insipidus. We began to treat him with thiazide and amiloride. The amount of water he's been drinking daily has decreased to 3-4 L per day. We discuss this case with a brief review of literature.

Etoposide and cisplatin combination chemotherapy in extensive stage small cell lung cancer / 대한내과학회지

BACKGROUND: Small cell lung cancer (SCLC) disseminates early and has poor prognosis. However, SCLC is highly chemosensitive, thus chemotherapy has been established as the primary mode of treatment. This study evaluated the efficacy and toxicity of etoposide in combination with cisplatin in the treatment of extensive stage small cell lung cancer. METHODS: Thirty four patients (28 males, 6 females) with previously untreated extensive stage small cell lung cancer were treated with etoposide at a dose of 100 mg/m2, IV on days 1-3 with cisplatin at 100 mg/m2, IV on day 1. The median age was 63 (range 41~80). This combination chemotherapy was administered every 3-4 weeks. Response rate, response duration, survival, and toxicity were evaluated. RESULTS: The response rate was 50%. The median survival time was 29 weeks. The median response duration was 17.2 weeks in responders. The toxicity was acceptable. CONCLUSION: This study illustrated that the combination of etoposide and cisplatin is effective in the treatment of extensive stage small cell lung cancer, and can be administered with acceptable toxicity. Although this study was not designed to be a formal comparative trial, the efficacy and toxicity observed with this regimen were found to be comparable to previous reports.