Macrovascular dysfunction detected by comparison of serum FDP detected by simplified venous occlusion test in patients with NIDDM and CVA / 대한내과학회지

OBJECTIVES: In diabetic patients, the incidence of atherosclerotic disease are increased, which may be due to decreased fibrinolytic activity. The aim of study is to elucidate the relationship between angiopathies and vascular function evaluated by simplified venous occlusion test in patients with non-insulin dependent diabetes mellitus (NIDDM) and cerebrovascular accident (CVA). METHODS: The study was conducted on 63 patients who were hospitalized during the period from March 1, 1994 to May 30, 1997. The serum concentration of fibrinogen degradation products (FDP) was measured before and 5 min after venous occlusion in 31 NIDDM patients, 16 CVA patients and 16 age-matched control subjects. FDP was measured with the anti-fibrinogen- coated latex particle agglutinin assay system. RESULTS: 1) The basal serum FDP level was higher in diabetic patients with macroangiopathy (12.3+/-5.8 ug/ml) and patients with CVA (11.2+/-5.1 ug/ml) than in control subjects (5.7+/-1.8 ug/ml) (p<0.05). 2) The increment of serum FDP level after venous occlusion in diabetic patients with microangiopathy (6.6+/-2.2 to 10.3+/-4.1 ug/ml) and control subjects (5.7+/-1.8 to 11.4+/-4.3 ug/ml) was significantly higher than basal serum FDP level (p<0.05). But the increment of serum FDP level after venous occlusion in diabetic patients with macroangiopathy (12.3+/-5.8 to 15.2+/-5.1 ug/ml) and patients with CVA (11.2+/-5.1 to 13.7+/-4.8 ug/ml) wasn't significantly higher than basal serum FDP level. 3) The increment rate of serum FDP after venous occlusion in diabetic patients with macroangiopathy (24.4+/-29.3%) and patients with CVA (29.4+/-34.5%) was significantly lower than diabetic patients with microangiopathy (66.3+/-71.7%) and control subjects (84.1+/-69.3%) (p<0.05). CONCLUSION: The responsiveness of fibrinolytic activity to venous occlusion was significantly lower in diabetic patients with macroangiopathy, as in patients with CVA, compared with that in control subjects. We conclude that measurement of the increase in serum FDP concentration 5 min after venous occlusion may be useful to detect vascular dysfunction in patients with macrovascular disease caused by atherosclerosis.

A Case with Primary Biliary Cirrhosis / 대한내과학회지

Primary biliary cirrhosis (PBC) is a chronic progressive disease, more often affecting women, characterised by progressive destruction of the small intrahepatic bile ducts with portal inflammation leading to fibrosis and cirrhosis. There is a close association between PBC and antibodies to antimitochondrial antibodies (AMA). The pathogenesis of PBC remains uncertain. The disease has been considered as an example of autoimmunity. Estimates of disease prevalence vary between 20 and 240 cases per milion per year. PBC is a extremely rare liver disease in Asia. There is no definitive drug treatment, liver transplantation is indicated for patients with intractable symptoms and for end-stage disease. The authors have experienced a case of PBC in 66 year-old female who suffered from lethargy, pruritus and dry mouth since 2 years ago. We report a case of PBC with a review of literatures.