Relationship between plasma homocysteine levels and chronic diabetic complications in NIDDM patients / 대한내과학회지

BACKGROUND: Elevated plasma homocysteine is a recently-recognized independent risk factor for cardiovascular disease. In patients with non-insulin dependent diabetes mellitus (NIDDM), plasma homocysteine concentration was reported to be elevated in association with nephropathy. However, inconsistent results were reported about the association with other microvascular complications. METHODS: To determine the relationship between plasma homocysteine and the development of chronic diabetic microvascular complications, fasting plasma homocysteine, glycemic control, lipid and lipoprotein levels, vitamin status, renal function test, and chronic diabetic microvascular complications were assessed in 101 patients with NIDDM in the present study. RESULTS: There was no difference in the plasma levels of homocysteine by sex, age, status of sugar control, duration of diabetes, other cardiovascular risk factors. Patients with diabetic microangiopathy had higher plasma homocysteine concentrations than those without diabetic microangiopathy. Moreover, there was a significant correlation between amount of urinary albumin excretion and plasma homocysteine level (p=0.004, r=0.357). However, multivariate analysis showed that only serum creatinine (beta=0.635) was independently associated with plasma homocysteine level in NIDDM patients. The increase in plasma homocysteine was not shown to increase the risk of diabetic microvascular complications independently on multiple logistic regression analysis. CONCLUSION: In conclusion, decrease of renal function is an independent determinant of plasma homocysteine level and higher plasma homocysteine is associated to diabetic microangiopathy. But an increase in plasma homocysteine in patients with NIDDM is not independently associated with diabetic microvascular complications considering renal function. Therefore, the renal function should be considered in study about relationship between plasma homocysteine level and the development and/or progression of chronic diabetic microvascular complications in diabetic patients.

Lack of integrative control of body temperature after capsaicin administration

BACKGROUND: Body temperature is usually regulated by opposing controls of heat production and heat loss. However, systemic administration of capsaicin, the pungent ingredient of hot peppers, facilitated heat production and heat loss simultaneously in rats. We recently found that the capsaicin-induced heat loss and heat production occur simultaneously and that the biphasic change in body temperature is a sum of transient heat loss and long-lasting heat production. Moreover, suppression of the heat loss response did not affect capsaicin-induced heat production and suppression of heat production did not affect capsaicin-induced heat loss. These observations suggest the independent peripheral mechanisms of capsaicin-induced thermal responses. Thus, the capsaicin-induced thermal responses apparently lack an integrated control. METHODS: Male Wistar rats were maintained at an ambient temperature of 24 1 degrees C on a 12 h on-off lighting schedule at least for two weeks before the experiments. They were anesthetized with urethane (1.5 g/kg, i.p.) and placed on a heating pad, which was kept between 29 and 30 degrees C. Skin temperature(Ts) was measured with a small thermistor, which was taped to the dorsal surface of the rat's tail, to assess vasoactive changes indirectly. Colonic temperature(Tc) was measured with another thermistor inserted about 60 mm into the anus. O2 consumption was measured by the open-circuit method, and values were corrected for metabolic body size (kg0.75). Capsaicin (Sigma) was dissolved in a solution comprising 80+ACU- saline, 10+ACU- Tween 80, and 10+ACU- ethanol, and injected subcutaneously at a dose of 5 mg/kg. Each rat received a single injection of capsaicin because repeated administration of capsaicin renders an animal insensitive to the subsequent administration of capsaicin. Laminectomy was performed at the level of the first and second cervical vertebrae to expose the cervical spinal cord for sectioning. The brain was transected at 4-mm rostral from the interaural line with an L-shaped knife. RESULTS: After administration of capsaicin, O2 consumption increased from 13.5 0.4 mL/min/kg0.75 at 0 min to a peak of 15.9 0.4 mL/min/kg0.75 at 71 min and gradually declined but remained higher than the basal value until the end of the 4-h observation period. Ts also immediately increased from 27.7 0.2 degrees C to 31.9 0.3 degrees C at 39 min, and it returned to the baseline level within 90 min after the capsaicin administration. Tc initially decreased from 37.1 0.1 degrees C to 36.8 0.2 degrees C at 43 min and then gradually increased over the baseline level and remained at 37.6 0.2 degrees C until the end of the experiment. In spinalized rats, the capsaicin-induced increases in O2 consumption was largely attenuated, while the basal O2 consumption was similar to that of control rats. The basal Ts of spinalized rats was 32.4 0.3 degrees C, which was higher than that of control rats. Capsaicin increased Ts by less than 1 degree C, and Tc did not change after the capsaicin administration. O2 consumption of decerebrated rats was statistically higher than that of control rats after the injection of capsaicin. However, capsaicin did not increase Ts, showing a lack of a vasodilatory response. Decerebration between the hypothalamus and midbrain prevented the capsaicin-induced heat loss but not the heat production response. CONCLUSION: These results show that the capsaicin-induced heat production and heat loss are controlled separately by the brainstem and by the forebrain, respectively, and suggest that the body temperature regulation is performed without an integrative center.

Non-Hodgkin's lymphoma of the thyroid and adrenal glands

We report a case of non-Hodgkin's lymphoma(NHL) with simultaneous involvement of both thyroid and bilateral adrenal glands. Literature review on a computerized search showed that this is an extremely rare condition. The final diagnosis of diffuse large B cell lymphoma was confirmed by biopsies of thyroid gland, enlarged cervical lymph node, and adrenal gland. The significant endocrine dysfunction of the thyroid, adrenal or other endocrine glands was absent in our case. The patient responded dramatically to three cycles of chemotherapy with no complication or endocrine dysfunction and continues to be followed.

A case of acromegaly associated with moyamoya disease, coronary arterial stenosis, and dilated cardiomyopathy / 대한내과학회지

A 19-year-old girl with typical features of acromegaly, duration of which was thought to be above 10 years, presented with dyspnea. After serial studies, dilated cardiomyopathy and critical stenosis of left anterior descending coronary artery were demonstrated. Brain MRI revealed the following changes: the pituitary gland was enlarged and its upper margin was upwardly convex; severe cerebral atrophy and multiple signs of vascular abnormalities were present. Cerebral angiographic studies demonstrated the presence of complete occlusion of left carotid artery and severe stenosis of right carotid artery with the formation of collateral networks of vessels. The patient was thus diagnosed as having moyamoya disease that was thought to be congenital according to her past histories. Her cardiac function was slightly improved after percutaneous transluminal coronary angioplasty. Operation for the pituitary lesion and moyamoya disease was not performed due to poor general condition, but serum growth hormone concentration was adequately suppressed after octreotide therapy. We consider that this is a very rare case of acromegaly associated with moyamoya disease, coronary arterial disease and dilated cardiomyopathy.

Changes of glomerular basement membrane components in Vacor-induced diabetic nephropathy

OBJECTIVES: The thickening of the glomerular basement membrane in rats after Vacor ingestion was examined by electron microscopy. This study was performed to elucidate which biochemical components changed in the glomerular basement membrane after Vacor-induced diabetic glomerulopathy. METHODS: Immunohistochemical analyses of type IV collagen, laminin, fibronectin and chondroitin sulfate proteoglycan were performed. A single dose of Vacor (molecular weight 272), 80 mg/kg, was administered to adult male Wistar rats by orogastric canule, and the animals were sacrificed at 0.5, 1, 3, 7, 14, 28 and 56 days after administration. RESULTS: Mild thickening of the glomerular basement membrane was evident 7 days after Vacor administration, and the width of the glomerular basement membrane was more than twice that of normal controls at 28 and 56 days. Significantly increased expressions of type IV collagen, laminin, fibronectin and neutral polysaccharide in the thickened glomerular basement membrane were noted 14 to 56 days after administration, and a mildly increased expression of chondroitin sulfate proteoglycan appeared between 3 to 7 days. CONCLUSION: These abnormally increased glomerular basement membrane components might be part of what causes diabetic nephropathy after Vacor administration.

The effects of angiotensin converting enzyme ingibitors on proteinuria and lipoprotein(a) in non-insulin dependent diabetic patients / 대한내과학회지

BACKGROUND: We determined the serum Lipoprotein(a) [Lp(a)] level in patients with NIDDM and evaluated the relationship between serum Lp(a) level and proteinuria, and the efficacy of angiotensin converting enzyme inhibitor(ACEI) in reducing serum Lp(a) level in NlDDM patients. METHOD:A total of 86 patients with NlDDM(age: 61.2 +/- 1.2 years) was divided into ACEI treatment group (n=45) and control group(n=41). The changes of the amount of proteinuria and serum Lp(a) were analyzed in both groups. Mean duration of follow-up in control group or ACEI administration in ACEI group was 8.4 months. RESULTS: 1) Befare ACEI treatment, the positive correlation between serum Lp(a) level and amount of proteinuria was present in ACEI group, but not in total subjects and control group. ACEI treatment was associated with decrease in serum Lp(a) level, but not with change in the amounts of proteinuria. 2) Serum Lp(a) levels decreased significantly by ACEI treatment, not only in patients whose diastolic blood pressure(DBP) decreased by more than 10mmHg, but also in patients whose DBP did not response to ACEI administration. 3) Patients with overt proteinuria(> 500rng/day) had higher serum Lp(a) level than patients without overt proteinuria before ACEI treatment. After ACEI treatment, serum Lp(a) levels and amount of proteinuria decreased significantly in patients with overt proteinuria, but not in patients without overt proteinuria. 4) In both subgroups of patients with serum Lp(a) level 30mg/dl and patients with serum Lp(a) level <30mg/dl, serum Lp(a) levels decreased significantly after ACEI treatment, but the amount of proteinuria did not change in both subgroups. 5) In the analyses of subgroups of patients whose amounts of proteinuria definitively decreased (responder group) or increased (non-responder group) after ACEI, serum Lp(a) levels decreased even in the non-responder group. CONCLUSION: NIDDM patients with overt proteinuria have higher level of serum Lp(a) than patients without overt proteinuria, and ACEI treatment could reduce serum Lp(a) level as well as proteinuria. Although decrease in Lp(a) is thought to be associated with decreased proteinuria, there may be another effect of ACEI that should be clarified further.

Serum Lipids and Lipoproteins in Patients with Chronic Renal Failure / 대한신장학회잡지

We measured serum lipoprotein (a) [Lp (a)] concentrations in 304 uremic patients treated on predialysis, hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD), and compared them with those in 43 normal controls. The mean values were 46.1mg/dl in predialysis, 35.7mg/dl in HD, 54.7mg/dl in CAPD patients and 17.0mg/dl in controls, respectively. Serum Lp (a) levels were elevated both in the predialysis patients (P<0.001) and in the CAPD patients (P<0.001) compared with those in controls, and were also elevated in the CAPD patients (P<0.01) compared with HD patients. Serum Lp (a) levels tended to be higher in HD patients compared with controls, although these differences did not reach statistical significance. We observed statistically significant positive correlations of Lp (a) to serum levels of total cholesterol (TC) (r=0.279, P<0.01), LDL-cholesterol (r=0.335, P<0.01), and Apo (B) (r=0.352, P<0.01), and significant negative correlation of Lp (a) to serum level of albumin (r=-0.278, P<0.01) in 304 CRF patients. CAPD patients had a more atherogenic lipoprotein profile than did HD patients; besides significantly higher Lp (a) levels (P<0.01), total (P<0.001) and LDL (P<0.001) cholesterol, triglycerides (P<0.05), and apo (B) (P<0.001) were significantly elevated in comparison to HD patients. The marked elevation of serum Lp (a) in patients on CAPD may be due to increased hepatic synthesis as a consequence of the substantial amounts of plasma proteins lost in the dialysate. The increased serum concentrations of Lp (a) may contribute to the high risk for atherosclerosis in end stage renal disease, especially in patients treated by CAPD.

The Effect of Minocycline Sclerosing Therapy on Cystic Thyroid Nodules / 대한내과학회지

OBJECTIVES: We studied the efficacy and safety of repeated aspiration therapy and minocycline sclerotherapy for cystic thyroid nodules in the euthyroid patients and the factors which might appear to influence the outcome of therapy. SUBJECT AND METHODS: 114 patients with predominantly cystic thyroid nodules were studied. All of the patients underwent the first aspiration therapy, and patients with recurrent cystic lesions after the first aspiration treatment underwent repeated aspiration therapy or additive minocycline sclerotherapy. The patients were followed up ultrasonically 1 and 3 months, and every three month thereafter after the treatments. RESULTS: In 106 patients of 114 patients, cumulative success rate of the treatments was 54.6%. Cumulative success rate of only aspiration treatments(n=81) was 45.1%. 83 patients of 114 patients was recurred after the first aspiration therapy. In these patients, Cumulative success rate of repeated aspiration treatments(n=58) was 24.1%, Cumulative success rate of additive minocycline sclerotherapy(n=25) was 88.0%. Treatment modalities and longest diameter of the lesions significantly influenced the outcome of the trea tments. The effect of the larger longest diameter of cystic thyroid nodule would tend to reduce the cummulative success rate, and the cutoff point of the longest diameter was 4.5 cm. There were no significant adverse effects except for transient pain around the injection site in 12 patients (46%). Cytologic study showed 4 (3.5%) of 114 patients to be malignant. CONCLUSION: Minocycline sclerotherapy of cystic thyroid nodules is a useful and tolerable non-operative therapeutic method in patients with recurrent cystic thyroid nodules after repeated aspiration therapy. The size of a cystic thyroid nodule influence the outcome of aspiration therapy but may not inflcence the outcome of minocycline sclerotherapy.

Ultrastructure of neuromuscular junction in vacor-induced diabetic rats

OBJECTIVES: Rodenticide Vacor causes a severe peripheral neuropathy in humans. Electrophysiologic studies on a peripheral motor nerve-skeletal system of Vacor-treated rat showed decreased amplitude of muscle action potential without conduction velocity abnormalities. The ultrastructural studies of the neuromuscular junction were performed to clarify the anatomic site of the Vacor-induced peripheral neuropathy in male Wistar rats. METHODS: After oral administration of a single dose of Vacor, 80 mg/kg of body weight, to the experimental animals, neuromuscular junctions within the interosseous muscles of the hind foot were observed in time. RESULTS: No axon terminal change was noted until 24 hours after the administration of Vacor. Remarkable loss of presynaptic vesicles and swollen endoplasmic reticulum in the axon terminal were developed at 3 days after Vacor treatment. Progressive degenerative changes consisting of marked loss of presynaptic vesicles, focal disruption of membrane in the axon terminal with disappearance of the number of the damaged axon terminal appeared, and flattening of postsynaptic folds was also seen. CONCLUSIONS: These results suggest that degenerative changes in axon terminal at neuromuscular junction may contribute to the peripheral neuropathy developed in the early phase of Vacor poisoning.

Changes in Insulin Sensitivity and Insulin Secretory Function in Hyperthyroid Patients / 대한내분비학회지

The impairement of glucose metabolism is frequently associated in hyperthyroidism. The present study was performed to determine the effect of the thyroid hormone excess on insulin sensitivity and on insulin secretory function in vivo. Ten newly diagnosed hyperthyroid patients and fifteen healthy control subjects were subjected to frequently sampled intravenous glucose tolerance tests(FSIGT) after an overnight fast. Insulin sensitivity, represented by the insulin sensitivity index(S_1), was assessed by minimal model analysis of FSIGT data. Insulin secretion was measured by the total area under the insulin curve after glucose load.The results were as follows.1) The K_G values, which represent glucose tolerance, were not different between the hyperthyroid patients and the normals(2.2+-0.3 vs. 2.5+-0.3%/min, p>0.05).2) S_1 was significantly decreased in the hyperthyroid patients in comparison to the normals(7.5+-1.4 vs. 2.6+-0.3X10

Body fat, bone mineral density and therapeutic agents in postmenopausal women / 대한내분비학회지

No abstract available.

Glomerulopathy in vacor-induced diabetic mongolian gerbil

No abstract available.