Association of Endotoxins and Colon Polyp: A Case-Control Study

Endotoxins are known to be associated with the occurrence of various chronic diseases. This study was conducted to investigate the role of endotoxins in the pathogenesis of colon polyps through a case-control study. A total of 145 subjects (74 subjects in the polyp group and 71 subjects in the control group) had undergone a colonoscopy. Age, body mass index (BMI) and endotoxin levels were found to be significantly higher in the polyp group than in the control group. The endotoxin level was still significantly higher in the polyp group than in the control group, even after age and BMI had been adjusted (polyp group 0.108 +/- 0.007 EU/mL, control group 0.049 +/- 0.008 EU/mL, P < 0.001). In subgroup analysis, the endotoxin level significantly increased in accordance with the number of colon polyps (one-polyp group, 0.088 +/- 0.059 EU/mL; two-polyp group, 0.097 +/- 0.071 EU/mL; three-or-more-polyp group, 0.149 +/- 0.223 EU/mL). The endotoxin levels also significantly increased in groups with tubular adenoma with high-grade dysplasia (hyperplastic polyp group, 0.109 +/- 0.121 EU/mL; tubular adenoma with low grade dysplasia group, 0.103 +/- 0.059 EU/mL; tubular adenoma with high grade dysplasia group, 2.915 +/- 0.072 EU/mL). In conclusion, the serum level of endotoxins is quantitatively correlated with colon polyps.

Cut-Off Values of Visceral Fat Area and Waist-to-Height Ratio: Diagnostic Criteria for Obesity-Related Disorders in Korean Children and Adolescents

PURPOSE: The aim of this study was to study the appropriate cut-off value of visceral fat area (VFA) and waist-to-height ratio (WTHR) which increase the risk of obesity-related disorders and to validate the diagnostic criteria of abdominal obesity and metabolic syndrome in Korean children and adolescents. MATERIALS AND METHODS: A total 314 subjects (131 boys and 183 girls) were included in this study. The subjects were selected from Korean children and adolescents who visited three University hospitals in Seoul and Uijeongbu from January 1999 to December 2009. All patients underwent computed tomography to measure VFA. RESULTS: The cut-off value of VFA associated with an increase risk of obesity-related disorder, according to the receiver operating characteristics curve, was 68.57 cm2 (sensitivity 59.8%, specificity 76.6%, p=0.01) for age between 10 to 15 years, and 71.10 cm2 (sensitivity 72.3%, specificity 76.5%, p<0.001) for age between 16 to 18 years. By simple regression analysis, the WTHR corresponding to a VFA of 68.57 cm2 was 0.54 for boys and 0.61 for girls, and the WTHR corresponding to a VFA of 71.10 cm2 was 0.51 for boys and 0.56 for girls (p=0.004 for boys, p<0.001 for girls). CONCLUSION: Based on the results of this study, VFA which increases the risk of obesity-related disorders was 68.57 cm2 and the WTHR corresponding to this VFA was 0.54 for boys and 0.61 for girls age between 10-15 years, 71.70 cm2 and the WTHR 0.51 for boys and 0.56 for girls age between 16-18 years. For appropriate diagnostic criteria of abdominal obesity and obesity-related disorders in Korean children and adolescents, further studies are required.

Lifestyle and Health State in Individuals with Frequent Nocturnal Sleep Interruption

BACKGROUND: Many studies have demonstrated that excessively long or short sleep duration and insomnia are associated with high risk of mortality. We intended to investigate the lifestyle and the state of health in frequently sleep interrupted people. METHODS: We have examined 2,540 subjects who visited a comprehensive medical testing center from January 2001 to June 2003. We divided into two groups of sleep disturbance into frequently interrupted group (two or more times per night) and infrequently interrupted group (less than twice per night). After frequency matching by age and sex, 1,900 subjects (each group of 950 subjects) were selected. Lifestyle, self-health perception, symptoms, clinical laboratory data and past history were compared by chi-square test and student's t-test. To identify the factors that influenced on sleep interruption, multiple logistic regression analysis was done. RESULTS: Sleep duration was not significantly different in both groups (P=0.486). The frequently interrupted group were likely to perceive themselves as bad state of health being in a (P=0.008) and to complain of various symptoms, i.e., fatigue (P<0.001), headache (P= 0.001), etc. Also, they had more incidence of mood disorders (P= 0.002), fatty liver (P=0.008), and arthritis (P=0.001) than the other group. By multiple logistic regression analysis, alcohol consumption (OR: 1.344, P= 0.007), irregular diet (OR: 1.325, P=0.003), and coffee intake (OR: 0.786, P= 0.013) were significantly different between the frequently interrupted group and the other group. CONCLUSION: Patients who complain of insomnia should be evaluated on both sleep duration and interruption. The evaluation of sleep interruption is needed in patients who perceive themselves as being in a bad state of health, who complain of various symptoms (fatigue, headache, etc.), or have a history of mood disorder, fatty liver, or arthritis.

Pathophysiologic Approach by Proximal Peroneal Nerve Conduction Study in Diabetic Neuropathy

BACKGROUND AND OBJECTIVES: Diabetes mellitus is known as a common cause of peripheral neuropathy. However, there is a continuous argument about the pathophysiologic mechanism of diabetic polyneuropathy : axonal degeneration versus segmental demyelination. We studied the patients with diabetic polyneuropathy by peroneal nerve conduction study using identical segments recording from proximal and distal peroneal muscles. METHODS: We studied 18 diabetic patients who were confirmed to have diffuse symmectrical sensorimotor polyneuropathy by conventional nerve conduction study. We also studied 18 healthy subjects. We measured peroneal motor conduction velocities across the same nerve segment, recording from proximal and distal muscles in both lower extremities. Compound muscle action potentials(CMAP) were simultaneously recorded from extensor digitorum brevis(EDB) and tibialis anterior(TA) muscles using the tendon-belly method. RESULTS: There was no significant difference in conduction velocities recorded from proximal and distal muscles in healthy subjects(EDB 50.5 m/s, TA 53.3 m/s). However, in patients with diabetic polyneuropathies, there was a significant decrease in conduction velocity obtained from distal recording, compared with that from proximal recording(EDB 36.8 m/s, TA 47.0 m/s, p<0.05, paired t-test). CONCLUSION: These results of proximal peroneal nerve conduction study are considered as another supporting evidence that axonal degeneration is the main pathomechanism of diabetic polyneuropathy.

Guillain-Barre syndromes accompanied by optic neuritis

Although Guillain Barre sydrome(GBS) is known to be a demylinating disease of the peripheral nervous system, it has been rarely repored that GBS was accompanied by demyelinating disease of the central nervous system such as multiple sclerosis, optic neuritis or acute disseminated encephalomyelitis. We experienced a patients with GBS who developed unilateral opticneuritis. A 19-year-old male patient was presented with ascending weakness. A few days later, he complained of decreased visual acuity and pain on the right eye. Cerebrospinal fluid findings were compatible with GBS and serial visual evoked potential studies were indicative of optic neuritis. This case suggests common pathogenesis between central and peripheral demyelinating diseases.

A Case of Thrombotic Thrombocytopenic Purpura(TTP), Presenting Multiple Gross Infarction

Thrombotic thrombocytopenic purpura (TTP) is an uncommon disorder, frequently fatal, characterized by a pentad of thrombocytopenia, microangiopathic hemolytic anemia, fluctuating neurologic symptoms, fever, and renal disease. TTP is characterized by widespread noninflammatory thrombotic occlusions of arterioles and capillaries with material containing fibrin and platelets. Generally, gross infarct is rare in the patient with TTP. We present a case of TTP with multiple gross infarcts on brain CT scan. A 53-year-old-man was presented with left hemiparesis and confused mentality. On laboratory study, he had microangiopathic hemolytic anemia & thrombocytopenia. Brain CT showed multiple gross infarct areas in the right basal ganglia, right parietal lobe and right cerebellar hemisphere. When managing the patient with acute stroke syndrome, we should consider TTP as a diagnostic possibility for early proper treatment, even if CT scan of brain show multiple gross infarctions.

Pathophysiologic Approach by Blink Reflex and EMG Studies in Essential Blepharospasm Comparison with Other Facial Involuntary Movement

Background and objectives: Blepharospasm (BS) is best categorized as focal dystonia, but the biochemical and neuroanatomical mechanisms are poorly understood. We performed this study in order to postulate the pathophysiologic mechanism of essential BS, using blink reflex test and EMG studies. METHODS: We studied 24 patients with essential BS and 51 normal adults. Blink reflex tests and EMG on orbicularis oculi muscle were performed in all patients. We evaluated our electrophysiological data, comparing with those obtained from other studies, in which bulbocavernosus reflex, H-reflex, and T-reflex tests were done. We also compared our EMG data with those of hemifacial spasm and facial myokymia in other studies. Results: 1. Rl response latency of blink reflex test in 24 patients with essential BS was not changed, but R2 latency in the papient group was significantly shortened, comparing with those of normal control group. These results can be explained by overexcitability of the interneuron with polysynaptic pathway. Another supporting evidence is the fact that the latency of polysynaptic bulbocavernous reflex test in upper motor neuron lesion is shorter than normal control, although the latency of monosynaptic H-reflex and T-reflex test are not changed. 2. EMG on orbicularis oculi muscle in patients with essential BS showed spontaneous MUPs at irregular intervals at rest, while those in patients with hemifacial spasm and facial myokymia, known to be caused by overexcitability of facial nucleus, showed spontaneous MUPs at regular intervals. EMG in patients with essential BS, during the period of spasm, showed relatively long brief bursts at irregular intervals from 30 to 100 ms, lasting inconstant duration ranging from 30 to 300 ms. CONCULSIONS: It is suggested that the pathophysiology of essential BS is overexcitability of interneuron due to disinhibition in inhibitory interneuron, and that EMG findings of essential BS are remarkably different from those of hemifacial spasm and facial myokymia.

A Case of Paramyotonia Congenita

Paramyotonia congenita (PMC), an autosomal dominant non-progressive muscle disorder, is characterised by cold-induced stiffness followed by muscle weakness. The weakness is considered to be caused by a dysfunction of the sodium channel in muscle fiber. We report a 37-year-old male patient with PMC, complaining of episodic myotonia and motor weakness on cold exposure. In this patient, we performed clinical and neurological examination, electrophysiologic examination and muscle biopsy. On electrophysiologic study, needle EMG showed spontaneous myotonic discharges at room temperature but disappeared after cooling. Amplitude of compound action potential in abductor pollicis brevis muscle decreased significantly after cooling the tested extremity. Muscle biopsy showed a minimal variation of muscle fiber diameters, internal nuclei, chained nuclei, occasional atrophic fibers in vastus lateralis muscle. His mother, his son, three of six siblings, and five of eleven nephewes are affected with same symptomes.