The Relationship between Dehydroepiandrosterone sulfate and Insulin Resistance Syndrome in Women / 대한내분비학회지

BACKGROUND: Dehydroepiandrosterone (DHEA) is an androgen precursor, and is known to be decreased by the aging process. DHEA has been known to have a protective effect on insulin resistance and cardiovascular disease in men, but remains controversial in women. The aim of this study was to elucidate the role of DHEA on insulin resistance, and the risk for cardiovascular disease, in women. METHODS: We analyzed the relationship between DHEA sulfate (DHEAS), known to have a longer half-life and less diurnal variation than DHEA, and insulin resistance syndrome (IRS) in 471 non-diabetic women from an urban community diabetes prevalence study. Serum DHEAS concentrations were measured using a commercially available radioimmunoassay kit. RESULTS: 1. The frequencies of obesity, impaired glucose tolerance, hypertension and dyslipidemia were 25.3, 8.5, 21.9 and 6.2%, respectively, and the frequency of IRS was 16.5%. 2. DHEAS was significantly inversely correlated with age (r=-0.47, p<0.001), systolic blood pressure (r=-0.18, p<0.001), diastolic blood pressure (r=-0.10, p<0.05), fasting serum glucose (r=-0.10, p<0.05), postchallenge 2 hour glucose (r=-0.12, p<0.01) and triglycerides (r=-0.16, p<0.01). 3. As serum DHEAS concentrations, by quartiles, were decreased, the age-adjusted frequency of hypertension was significantly increased (p<0.05). 4. A Multiple linear regression analysis revealed that DHEAS was significantly associated with age (p<0.0001) and BMI (p<0.05). 5. A Logistic regression analysis showed that DHEAS was not associated with IRS after adjustment for age. CONCLUSION: DHEAS is inversely associated with age. DHEAS has no harmful effect, and may even have a protective role, on insulin resistance syndrome. Prospective examinations of DHEAS and insulin resistance syndrome in women are needed to confirm the mechanism for the association between DHEAS and the development of cardiovascular disease.

Aortic Saddle Embolism Caused by Mitral Valve Vegetation

Aortic saddle embolus accounts for approximately 10% of all peripheral arterial emboli. The most common sources of emboli are left atrial thrombi associated with atrial fibrillation and vegetation. A 22-year-old male patient was admitted due to acute onset of orthopnea, tachypea and cough. Transthoracic and transeophageal echocardiography showed huge vegetation (3X2cm) of the posterior mitral valve leaflet which was associated with severe mitral regurgitation. On 14th hospital day, he suffered from sudden onset of weakness, pain, and coldness on both lower extremities. Follow-up echocardiography showed marked size reduction of the original mitral valve vegetation. Angiography showed aortic saddle embolus. The embolectomy of aortic saddle embolus was performed through the transfemoral approach with a Forgarty catheter. At the same time, removal of the infected mitral valve and mitral valve replacement were performed.

A Case of Drug-Induced Acute Interstitial Nephritis Accompanying Prominent Neutrophil Infiltration / 대한내과학회지

Drug-induced acute interstitial nephritis, induced by unknown immunologic mechanisms, is inflammatory lesions of the tubulointerstitial area due to several kinds of drugs as hapten and a rare, but increasingly recognized cause of acute renal failure. Drugs implicated include not only methicillin and other penicillins but also diuretics and nonsteroidal anti-imflammatory agents. Diagnosis of acute interstitial nephritis is important, because withdrawal of the offending agent will usually result in rapid improvement in renal function, and steroid therapy may reduce residual chronic renal damage. We are reporting a case of diuretic-induced acute interstitial nephritis in a 49 year-old female patient, who was given hydrochlorothiazide to treat hypertension. A percutaneous biopsy showed tubulointerstitial nephritis accopanying prominent neutrophil infiltration without glomerulitis. Withdrawal of the drug and use of corticosteroid led to remarkable improvement with renal function returning to normal.

Changes in Plasma and Urine Endothelin Levels During Acute Exacerbation of Asthma / 결핵

BACKGROUND: Recent studies have documented increased release of endothelin(ET) during acute attack of asthma. The purpose of this study is to observe the link between plasma level and urinary excretion of each and changes during acute exacerbation. METHOD: Plasma and 24 hour urine were collected from sixteen asthmatics during acute exacerbation, twice ; first day of symptomatic exacerbation and two weeks after treatment. Controls were ten healthy normal subjects. All patients were treated with corticosteroid and beta-2 adrenergic agonist on admission. ET was determined by radioimmmunoassay and had 100% cross reactivity with ET-1, 67% with ET-2, 84% with ET-3, and 8% with Big-ET. RESULTS: Plasma ETs were significantly elevated during acute attack of asthma compared with those in remission and controls. However, there was no significant changes in urine ET concentrations or total ET amounts in 24 hour urine during exacerbation upto two weeks. Those levels of urine ET in asthmatics were still higher than controls. ET concentrations in plasma or urine were not correlated with pulmonary functional parameters and hypoxemia. CONCLUSION: The findings suggests that increased plasma ETs are related with exaggerated release during acute asthma. Urinary ET excretion is increased in asthma. However, urine ET changes during exacerbation should be observed in a larger and longer scale.