Relationship between Serum Cystatin C and Arterial Stiffness in Type 2 Diabetes Patients with Normal Renal Function

OBJECTIVE: Several studies showed that increased arterial stiffness is an independent risk factor for cardiovascular disease. Pulse wave velocity (PWV) is known as a marker for large vessel stiffness. Recent studies show that serum cystatin C is associated with PWV and may predict future cardiovascular events, even in subjects with normal renal function. However, there have been few studies for the relationship between cystatin C and arterial stiffness in patients with type 2 diabetes (T2DM). In this study, we investigated the relationship between serum cystatin C and branchial-ankle PWV in T2DM patients with normal renal function. METHODS: Patients with urinary albumin/creatinine ratio (ACR) higher than 300 microg albumin/mg creatinine, estimated glomerular filtration rate (eGFR) less than 60 mL/min were excluded. A total of 88 patients (47 male/41 female; age, 59+/-2 years; ACR, 33+/-5 microg/mg) were included. Doppler-derived aortic PWV and serum cystatin C were measured. RESULTS: Cystatin C is significantly related to age (r=0.51, P<0.001), hemoglobin A1c (r=-0.23, P<0.05), high density lipoprotein-cholesterol (r=-0.22, P<0.05), apoprotein A (r=-0.22, P<0.05), and eGFR (r=-0.56, P<0.001). Aortic PWV is significantly associated with age (r=0.29, P<0.01), cystatin C (r=0.33, P<0.005), and eGFR (r=-0.24, P<0.05). In multiple regression analysis, there is significant association between aortic PWV and serum cystatin C levels. CONCLUSION: Serum cystatin C is significantly associated with arterial stiffness in T2DM patients with normal renal function. Our results suggest that cystatin C could be a marker for early atherosclerosis in T2DM patients.

Relationship between Serum Leptin Levels and Atherosclerosis in Type 2 Diabetes Patients

OBJECTIVE: Many studies have suggested that leptin is a possible cause of atherosclerosis and is proposed as a cardiovascular risk factor in obese patients. Several studies have shown that serum leptin is associated with pulse wave velocity (PWV) and carotid intima-media thickness (IMT). But the relevance of serum leptin levels for predicting incident cardiovascular disease is less clear. In this study, we investigated the relationship between serum leptin levels and aortic PWV, carotid IMT in type 2 diabetes (T2DM) patients. METHODS: Patients with end-stage renal disease or advanced atherosclerosis, systemic infection were excluded. A total of 116 patients (60 male/56 female; age, 59+/-14 years) were included. Serum leptin levels, aortic PWV and carotid IMT were measured. RESULTS: Aortic PWV was significantly associated with age (r=0.28, P<0.005). Carotid IMT was significantly related to age (r=0.46, P<0.001), low density lipoprotein (LDL) cholesterol (r=0.22, P<0.05), lipoprotein (a) (r=0.23, P<0.05) and estimated glomerular filteration rate (r=-0.348, P<0.01). There was no correlation between leptin and aortic PWV or carotid IMT. In multivariate analyses, aortic PWV was associated with age (P=0.007). Carotid IMT was significantly related to age (P<0.001), LDL cholesterol (P=0.01). CONCLUSION: Serum leptin was not associated with aortic PWV or carotid IMT in T2DM patients.

A Case of Pulmonary Sclerosing Hemangioma with an Increased Size and Chest Discomfort on 10 Years' Follow-up

Pulmonary sclerosing hemangioma is a relatively rare neoplasm of the lung with polymorphic histologic features of 2 unifying cellular components including surface cuboidal cells and interstitial round cells. Pulmonary sclerosing hemangioma typically occurs in middle aged women with asymptomatic, peripheral, solitary, well-circumscribed lesions. Although it is pathologically benign, it reveals size growing and chest symptom. We here report a case of pulmonary sclerosing hemangioma in a 72-year-old woman. She presented chest discomfort. A chest radiography and a chest computed tomography scan showed growing size from 3.2x3.1 cm to 6.0x5.3 cm in left upper lung during 10 years' follow-up period. Surgical resection of lung revealed a distinct constellation of findings including 2 epithelial cell types, surface cells, and round cells, which form 4 architectural patterns, papillary, sclerotic, solid, and hemorrhagic. She was diagnosed as pulmonary sclerosing hemangioma and chest discomfort disappeared.

Comparison of the Efficacy and Safety between Transradial and Transfemoral Percutaneous Coronary Intervention in Patients with Ischemic Heart Disease

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of transradial percutaneous coronary intervention (TRI) compared with transfemoral percutaneous coronary intervention (TFI) in patients with ischemic heart disease. METHODS: We reviewed retrospectively the medical records including imaging data of the patients with ischemic heart disease who underwent TRI or TFI from January 2007 to December 2009 in Soonchunhyang University Seoul Hospital. We compared major adverse cardiac and cerebrovascular events (MACCEs) including death, myocardial infarction, revascularization, stent thrombosis, and cerebrovascular accident during follow-up period. We also compared procedure related vascular complications including hematoma, arteriovenous fistula, pseudoaneurysm, and infection. RESULTS: Total number of patients was 347 (256 patients of TRI and 91 patients of TFI). There were no significant differences in the rate of MACCEs between two groups. There were significantly less procedure-related vascular complications in TRI group (3.1% vs. 11.0%, P=0.010). CONCLUSION: TRI is as effective as TFI with no difference in the rate of MACCEs in patients with ischemic heart disease. TRI is superior to TFI in safety with reduction of vascular complications.

A Case of ACTH-producing Pancreatic Neuroendocrine Tumor Presenting with Cushing Syndrome

Pancreatic neuroendocrine tumors are rare neoplasm arising from pancreatic islet cells. Occasionally they are functioning tumors secreting a variety of hormones such as insulin, gastrin, glucagon, and vasoactive intestinal peptides. Adrenocorticotropic hormone (ACTH) secreting pancreatic neuroendocrine tumors (ACTHomas) are very rare and there have been about 110 case reports worldwide. Due to excessive ectopic ACTH production and resulting hypercortisolemia, patients with ACTHoma usually present with Cushing syndrome. ACTHomas have a poor prognosis with severe and rapidly progressive clinical courses. They often present with unresectable liver metastases and there remains little consensus on its standard treatment. We report a 55-year-old female with ACTH-producing pancreatic neuroendocrine tumor, who was treated with surgical resection of pancreatic tail, spleen, and a portion of stomach. Sixteen months later, abdomen computed tomography scan showed multiple liver metastases, which were treated with transarterial chemoembolization.