Hepatic Actinomycosis with Abdominal Wall and Paracolic Gutter Involvement / 이화의대지

A 53-year-old female with intrauterine contraceptive device insertion was admitted for painful abdominal mass on the left upper quadrant abdomen. Abdominal computed tomography scan showed multiple enhancing masses on the right lobe of liver, left abdominal wall and right paracolic gutter. We performed incisional biopsy on the left abdominal wall lesion. Although microorganisms were not identified, the histopathologic result was consistent with actinomycosis which contained sulfur granules within the chronic granulomatous inflammation. She was treated with penicillin agents for 6 months. We report a case of hepatic actinomycosis with abdominal wall and paracolic gutter involvement.

Glycemic Effects of Rebaudioside A and Erythritol in People with Glucose Intolerance

BACKGROUND: Rebaudioside A and erythritol are nonnutritive sweeteners. There have been several studies of their glycemic effects, but the outcomes remain controversial. The purpose of this study was to evaluate the glycemic effects of rebaudioside A and erythritol as a sweetener in people with glucose intolerance. METHODS: This trial evaluated the glycemic effect after 2 weeks of consumption of rebaudioside A and erythritol as sweeteners in a pre-diabetic population. The patients were evaluated for fructosamine, fasting plasma glucose, C-peptide, insulin, and 2-hour plasma glucose before and after consumption of sweetener. The primary outcome was a change in fructosamine levels from the baseline to the end of treatment. Secondary outcomes were the changes in levels of fasting plasma glucose and 2-hour plasma glucose. RESULTS: From the baseline to the end of experiment, the changes in fructosamine levels after consumption of rebaudioside A and erythritol, did not differ significantly (244.00±19.57 vs. 241.68±23.39 µmol/L, P=0.366). The change in levels from the baseline to end of the study for rebaudioside A and erythritol were fasting plasma glucose (102.56±10.72 vs. 101.32±9.20 mg/dL), 2-hour plasma glucose (154.92±54.53 vs. 141.92±42.22 mg/dL), insulin (7.56±4.29 vs. 7.20±5.12 IU/mL), and C-peptide (2.92±1.61 vs. 2.73±1.31 ng/mL), respectively, and also did not differ significantly (P>0.05 for all). CONCLUSION: Our study suggests that consumption of rebaudioside A and erythritol does not alter the glucose homeostasis in people with glucose intolerance.

Dietary Sodium Intake in People with Diabetes in Korea: The Korean National Health and Nutrition Examination Survey for 2008 to 2010

BACKGROUND: Diabetics are likely to receive advice from their physicians concerning lifestyle changes. To understand how much sodium is consumed by diabetics in Korea, we compared the average daily sodium intake between diabetics and non-diabetics after controlling for confounding factors. METHODS: We obtained the sodium intake data for 13,957 individuals who participated in the Korean National Health and Nutrition Examination Survey (KNHANES), 2008 to 2010, which consisted of a health interview and behavioral and nutritional surveys. The KNHANES uses a stratified, multistage, probability-sampling design, and weighting adjustments were conducted to represent the entire population. RESULTS: Our analysis revealed that, overall, diabetics tended to have lower sodium intake (4,910.2 mg) than healthy individuals (5,188.2 mg). However, both diabetic and healthy individuals reported higher sodium intake than is recommended by the World Health Organization (WHO). Stratified subgroup analyses revealed that the sodium intake (4,314.2 mg) among newly diagnosed diabetics was higher among women when compared to patients with known diabetes (3,812.5 mg, P=0.035). Female diabetics with cardiovascular disease had lower average sodium intake compared to those without cardiovascular disease after adjusting for sex, age, body mass index, and total energy intake (P=0.058). Sodium intake among male diabetics with hypercholesterolemia (P=0.011) and female diabetics with hypertriglyceridemia (P=0.067) tended to be higher than that among those who without dyslipidemia. CONCLUSION: The average sodium intake of diabetics in Korea was higher than the WHO recommends. Sodium intake in newly diagnosed diabetics was significantly higher than that in non-diabetics and previously diagnosed diabetics among females. Prospective studies are needed to identify the exact sodium intake.

Management of Diabetic Peripheral Neuropathy / 대한내과학회지

Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus. The prevalence of neuropathic pain is estimated to occur in about 30-50% of all diabetic patients. Clinical symptoms vary depending on the nerves affected, and may include both positive and negative symptoms. Many patients with DPN experience pain or discomfort, anxiety, depression, and limitations in activity, which can significantly impact their physical, emotional, and social well-being. Early diagnosis is essential for the successful management of DPN. Routine management consists of glucose and risk factor control, and symptomatic relief, along with therapies designed to target the underlying disease pathology. Pharmacological treatment of DPN includes tricyclic compounds, serotonin noradrenalin reuptake inhibitors, the antioxidant alpha-lipoic acid, anticonvulsants, opiates, membrane stabilizers, topical capsaicin, and other drugs. Management of DPN must be tailored to each individual, and depends on a variety of factors, including disease severity and response to treatment.

A Case of Pheochromocytoma Presenting as Stress-Induced Cardiomyopathy with Large Left Ventricular Thrombus / 대한내과학회지

The clinical presentation of pheochromocytoma is variable. The classic symptoms are headache, diaphoresis, and tachycardia, with paroxysmal hypertension. Other less common cardiovascular manifestations, such as arrhythmias, angina pectoris, acute myocardial infarction, dilated cardiomyopathy, and acute heart failure, have been reported occasionally. We present the case of a middle-aged woman who had stress-induced cardiomyopathy with a left ventricular thrombus, due to the pheochromocytoma. The thrombus was embolized to the aorto-iliac bifurcation during hospitalization. We removed the thrombus by a catheter thromboembolectomy and performed a surgical left adrenalectomy. After the operation, all of her symptoms and the underlying diseases (hypertension, hyperglycemia, heart failure, dyslipidemia) resolved.