Clinical Characteristics of Intermittent Exotropia Patients who Have Improved due to Corrected Refractive Errors

PURPOSE: To evaluate clinical features of patients who have experienced decreased exodeviation after refractive error correction. METHODS: Thirty-four patients who experienced decreased exodeviation after refractive error correction between 2003 and 2010 were evaluated. Visual acuity, refractive errors, reported age at onset, duration of wearing glasses, stereopsis, and function of fusion were evaluated. RESULTS: The present study included 34 patients with intermittent exotropia. Before correcting refractive errors, the mean visual acuity was 0.34 +/- 0.27 for the right eye and 0.37 +/- 0.27 for the left eye according to log MAR. After refractive error correction, mean visual acuity improved to 0.12 +/- 0.11 for the right eye and 0.11 +/- 0.11 for the left eye according to log MAR. Before correcting refractive errors, the amount of deviation was 18.1 +/- 7.4 PD at near and 13.5 +/- 8.4 PD at far. However, after correcting refractive errors, the amount of deviation decreased to 5.8 +/- 8.6 PD at near and 4.5 +/- 7.6 PD at far (p < 0.05). CONCLUSIONS: The clinical characteristics of children who have decreased exodeviation after correcting refractive errors is shown by a greater amount of deviation at near than at distance and good fusional vergence and stereoacuity. Because correcting refractive errors by wearing appropriate glasses can decrease exodeviation, the authors of the present study recommend correcting refractive errors as the initial management for exotropia.

Prevalence of Diabetes Mellitus and Prediabetes in Dalseong-gun, Daegu City, Korea

BACKGROUND: The aim of the present study was to determine the population-based prevalence of diabetes mellitus (DM) and prediabetes in a rural district of Daegu City, Korea. METHODS: Between August and November 2003, a community-based health survey of adults aged 20 years and older was performed in the rural district of Dalseong-gun in Daegu City. A total of 1,806 of all eligible individuals agreed to participate. Fasting plasma glucose was measured in all participants. Two hour oral glucose tolerance was measured in the 1,773 participants for whom there was neither an established diagnosis of DM nor evidence of DM according to fasting glucose levels. The prevalence of DM and prediabetes was determined according to the 2003 criteria of the American Diabetes Association. Subjects with prediabetes were classified into one of three categories of glucose intolerance: isolated impaired fasting glucose (IFG); isolated impaired glucose tolerance (IGT); or combined IFG and IGT. RESULTS: The prevalence of DM was 12.2%. The highest prevalence rates were observed in subjects in their seventies. A total of 34.7% of all subjects who were assigned a diagnosis of DM in the present study had not been diagnosed previously. The prevalence of prediabetes was 22.7%. The highest prevalence rates were observed in subjects in their fifties. CONCLUSION: The present study identified prevalence rates of 12.2% for DM (age-standardized prevalence rate [ASR], 6.8%), and 22.7% for prediabetes (ASR 18.5%). These results emphasize the need for community health promotion strategies to prevent or delay the onset of DM in individuals with prediabetes.

Factors Affecting the Long-term Outcome of Silicone Tube Intubation in Patients With Nasolacrimal Duct Obstruction

PURPOSE: To evaluate factors affecting the outcome of silicone tube intubation in patients with nasolacrimal duct obstruction. METHODS: A retrospective study of the outcome of silicone tube intubation performed from August 2001 to August 2009 in 98 patients (132 eyes) with nasolacrimal duct obstruction was conducted. Improvement was defined as the disappearance of epiphora after silicone tube intubation and success was defined as maintenance of improvement by the time of the final patient follow-up. Recurrence was also defined as appearance of epiphora after silicone tube extubation. RESULTS: The success rate was 76.5% (101 eyes), failure rate was 8.3% (11 eyes), and recurrence rate was 15.2% (20 eyes). Preoperative canaliculus irrigation test was significantly correlated with symptomatic improvement and recurrence after silicone tube intubation (p = 0.003 and 0.045, respectively). The mean time that patients experienced recurrence was 43.7 months after silicone tube intubation, according to Kaplan-Meier survival analysis. CONCLUSIONS: Preoperative canaliculus irrigation test is a simple and effective tool to estimate the outcome of silicone tube intubation. This outcome should be considered in the stage of planning treatment in nasolacrimal duct obstruction patients.

Histopathologic Properties of Eyelid Skin and Conjunctiva in Patients with Dermatochalasis

PURPOSE: To evaluate histopathologic properties of eyelid skin and conjunctiva and the association between clinical manifestation and histopathologic findings. METHODS: A prospective study was conducted on the histologic findings of the upper eyelid skin and conjunctiva performed from November 2009 to February 2010 in 27 patients for upper eyelid blepharoplasty procedures. Histopathologic studies were performed for specimens collected from the upper eyelid skin and inferotemporal bulbar conjunctiva. Preoperative photographs of the upper eyelid and conjunctiva were taken to grade clinical severity of dermatochalasis and conjunctivochalasis. RESULTS: Decrease of collagen density and elastic degeneration in the eyelid skin and conjunctiva were significantly associated with aging (p < 0.001, p = 0.001, p = 0.001, p < 0.001). Clinical severity of dermatochalasis was correlated with a decrease of collagen density and elastic degeneration in the eyelid skin, and clinical severity of conjunctivochalasis was associated with a decrease of collagen density, elastic degeneration and lymphangiectasia in conjunctiva (p < 0.001). CONCLUSIONS: Change of collagen fiber and elastic fiber in the eyelid skin and conjunctiva was observed with aging. Relaxation of the eyelid skin and conjunctiva was correlated with histologic findings.

Clinical Outcomes of Conjunctiva-Muller Muscle Resection and Factors Which Affect Success

PURPOSE: To investigate clinical outcomes and to analyze the factors of successful treatment of conjunctiva-Muller muscle resection (CMMR) in patients with mild to moderate ptosis. METHODS: The medical records of 22 patients (30 eyes) with upper lid ptosis were retrospectively reviewed. All patients underwent conjunctiva-Muller muscle resections, and four patients (seven eyes) underwent concurrent upper lid blepharoplasty. The mean follow-up period was 81.62 +/- 21 days. Pre- and post-operative MRD1, IPF and pupil to brow distance were measured using the Image J program. A preoperative phenylephrine test and a pathologic examination were performed to analyze the presence of Muller's muscle and the tear secreting glands from the CMMR specimens. RESULTS: The overall success rate of the procedure was 93%. Postoperatively, the MRD1 increased on average by 1.47 mm (p = 0.00) and increased by an average of 1.72 mm when the phenylephrine test response was greater than 2 mm and by 0.99 mm when the response less than 2 mm. The Muller muscle was observed in every specimen. CONCLUSIONS: Conjunctiva-Muller muscle resection is an effective and safe method for treating mild to moderate ptosis, for which the preoperative phenylephrine test result is the most important factor for surgical success.

Analysis of Factors Affecting the Change in Axial Length of Premature Infant's Eye

PURPOSE: To analyze the effect of presence with or absent of retinopathy of prematurity (ROP) and its stage, birth weight, conceptual age and associated diseases on the axial length of premature infants' eye. METHODS: A total of 102 eyes of 51 premature infants less than 36 weeks of conceptual age were evaluated in this study. Fundus examination for ROP and axial length measurement were conducted at 40, 52 and 64 weeks of postconceptual age. The medical records were reviewed retrospectively. Independent t-test analysis, simple regression analysis, and one-way ANOVA were performed to assess the influence of each factor on axial length. RESULTS: The mean axial length at 40, 52 and 64 weeks were 17.35, 18.80 and 19.78 mm, respectively. The mean axial length with and without ROP at 40 weeks were 17.10 mm and 17.54 mm, respectively, which were statistically significant (p=0.000). There was a significant decrease in axial length at 40 weeks in the higher ROP stage (p<0.05). Axial length and birth weight showed positive correlation with statistical significance at 40 weeks, while these parameters showed no significant correlation at 64 weeks. Axial length and conceptual age showed a positive correlation with statistical significance at 40 weeks (p=0.000), yet a negative correlation at 64 weeks with no statistical significance (p=0.306). A significant difference was not observed between sex and the associated diseases. CONCLUSIONS: The factors that affect the axial length of an infants'eye at 40 weeks were ROP and its stage, birth weight, and conceptual age. Additionally, there was no significant relationship between sex and the associated diseases.

Factors that Affect Medication Adherence in Elderly Patients with Diabetes Mellitus / 당뇨병

BACKGROUND: This study was conducted to evaluate the factors affecting medication adherence in geriatric diabetic patients treated at private clinics and tertiary hospitals. We compared the factors affecting medication adherence between these two patient groups. METHODS: We included 108 diabetic patients older than 65 years treated at one tertiary hospital and 157 patients older than 65 years treated at two private clinics. We conducted an interview survey based on the Health Belief Model, and used a questionnaire that included the self-efficacy variable. For the medication adherence, Morisky's self-report was used. RESULTS: The medication adherence based on Morisky's self-report was significantly higher in tertiary hospital patients (61.1%) compared to private clinic patients (43.2%) (P < 0.01). The results showed that drug storage and self-efficacy were factors affecting adherence to medication in tertiary hospital patients (P < 0.05). The adherence was high in cases of proper drug storage (odds ratio [OR], 5.401) and in cases with high self-efficacy (OR, 13.114). In private clinic patients, financial level (P < 0.05), recognition of the seriousness of diabetes complications (P < 0.05) and self-efficacy (P < 0.01) were associated with medication adherence. The medication adherence was significantly lower in patients whose financial state were moderate than those with lower (OR, 0.410), and medication adherence was significantly higher in patients who had higher perceived severity (OR, 2.936) and in patients with higher self-efficacy (OR, 4.040). CONCLUSION: Different strategies should be used to increase medication adherence in geriatric diabetic patients, depending on institutions whether they are treated.

Two Cases of Lacrimal Drainage Obstruction Associated With S-1 Anticancer Treatment

PURPOSE: To report two cases of lacrimal drainage obstruction associated with the anticancer drug S-1 (tegafur, gimeracil, oteracil ; TS-1(R), Taiho Pharmaceutical, Japan). CASE SUMMARY: (Case 1) A 34-year-old male who had previously undergone a total gastrectomy for treatment of gastric cancer visited with epiphora in both eyes that had developed 6 months after S-1 treatment. On examination, a right canalicular obstruction and left punctal and nasolacrimal partial obstruction were noted. Endoscopic dacrycystorhinostomy with lacrimal trephinization was done in the right eye and punctoplasty with punctal membrane removal and silicone tube intubation were performed in the left eye and the epiphora were successfully treated. (Case 2) A 60-year-old male who was treated with S-1 for gastric cancer presented with tearing in both eyes that had developed 2 months after S-1 treatment. Ophthalmic examinations revealed a right nasolacrimal partial obstruction in the right eye and lacrimal sac obstruction in the left. Silicone intubations were performed on both sides and the epiphora were successfully treated. CONCLUSIONS: Lacrimal drainage obstructions may develop after S-1 treatment. Therefore, ophthalmologic evaluations should be performed in patients treated with S-1 to detect lacrimal drainage obstruction.

The Effect of Intravitreal Triamcinolone Acetonide and Bevacizumab Injection on Intraocular Pressure

PURPOSE: To compare intraocular pressure (IOP) changes after intravitreal triamcinolone acetonide versus bevacizumab injection. METHODS: IOP was measured in 40 patients who received an intravitreal injection of 0.1 ml triamcinolone and 40 patients who received 2 consecutive intravitreal injections of bevacizumab (0.05 ml and 0.1 ml). Patients were divided into three groups : 0.1 ml triamcinolone group (0.1 IVTA group), 0.05 ml bevacizumab group (0.05 IVB group), and 0.1 ml bevacizumab group (0.1 IVB group). IOPs were compared within groups at different time points (before, 1 day after, and 30 days after the injection) and between groups at the same time points. RESULTS: In the 0.05 IVB and 0.1 IVB groups, IOP at 1 day after injection was significantly lower than before injection (P< 0.01, P = 0.03), and IOP at 30 days after injection was significantly higher than IOP at 1 day after injection (P < 0.01, P < 0.01). In the 0.1 IVTA group, IOP at 30 days after injection was significantly higher than before injection (P = 0.01). Between groups, IOP at 1 day after injection in the 0.05 IVB group was significantly lower than IOP in the 0.1 IVTA group (P = 0.03). CONCLUSIONS: IOP was decreased at 1 day after intravitreal bevacizumab injection, whereas in intravitreal triamcinolone acetonide IOP elevation persisted after 1 month.

Clinical Effects of Conjunctiva-Muller Muscle Resection in Anophthalmic Ptosis

PURPOSE: To evaluate the clinical effects of conjunctiva-Muller muscle resection through conjunctival incision in anophthalmic patients with mild ptosis. METHODS: Conjunctiva-Muller muscle resection was performed by one surgeon in 8 patients (8 eyes) who had received evisceration or enucleation and responded to 10% phenylephrine solution to correct ptosis. The average age of the patients was 35.87+/-13.4 years. Ptosis was seen from 1 to 34 months after evisceration or enucleation. The preoperative MRD 1 was -2 to 0.5 mm (average: -0.25+/-1.10 mm) and the difference of MRD 1 between before and after 10% phenylephrine use was 2.56+/-0.98 mm. The Muller muscle was resected 7.5 to 9 mm through conjunctival incision during surgery to match the MRD 1 of sound eye. Mean follow-up period after the operation was 2 to 16 months (average: 8.1 months). RESULTS: Postoperatively, the MRD 1 increased by 1.81+/-0.88 mm on the average, corresponding to the improvement in lid elevation after the use of 10% phenylephrine performed before resection. Surgery was successful in most patients, and postoperative difference in MRD 1 was less than 1 mm from the sound eye. No special postoperative complication was observed. CONCLUSIONS: Conjunctiva-Muller muscle resection is one of the effective methods of correcting mild ptosis in anophthalmic patients.

Clinical Effects of Conjunctiva-Muller Muscle Resection in Anophthalmic Ptosis

PURPOSE: To evaluate the clinical effects of conjunctiva-Muller muscle resection through conjunctival incision in anophthalmic patients with mild ptosis. METHODS: Conjunctiva-Muller muscle resection was performed by one surgeon in 8 patients (8 eyes) who had received evisceration or enucleation and responded to 10% phenylephrine solution to correct ptosis. The average age of the patients was 35.87+/-13.4 years. Ptosis was seen from 1 to 34 months after evisceration or enucleation. The preoperative MRD 1 was -2 to 0.5 mm (average: -0.25+/-1.10 mm) and the difference of MRD 1 between before and after 10% phenylephrine use was 2.56+/-0.98 mm. The Muller muscle was resected 7.5 to 9 mm through conjunctival incision during surgery to match the MRD 1 of sound eye. Mean follow-up period after the operation was 2 to 16 months (average: 8.1 months). RESULTS: Postoperatively, the MRD 1 increased by 1.81+/-0.88 mm on the average, corresponding to the improvement in lid elevation after the use of 10% phenylephrine performed before resection. Surgery was successful in most patients, and postoperative difference in MRD 1 was less than 1 mm from the sound eye. No special postoperative complication was observed. CONCLUSIONS: Conjunctiva-Muller muscle resection is one of the effective methods of correcting mild ptosis in anophthalmic patients.

The characteristics of non palpable thyroid nodule and relation to prediction of malignant nodule / 대한내과학회지

BACKGROUND: Thyroid nodules are commonly encountered in clinical practice and a p revalence of general population is 19~67% by ultrasonography. We made a study to investigate clinical characteristics, malignancy ratio of thyroid incidentalomas and predicting factors for diagnosis of malignancy, to provide recommendation for evaluation. METHODS: We retrospectively evaluated the medical records of 320 patients who visited Kyungpook National University Hospital from July 2001 to December 2003 with non palpable thyroid nodules. We reviewed physical examination, ultrasonographic findings, laboratory findings, histology of thyroid nodules and did statististic analysis to examine relationship to malignancy. RESULTS: 52 patients revealed papillary carcinomas and malignancy rate whin incidentalomas is 9.3%. Sonographic findings of solid structure, hypoechogenecity, punctate calcification, ill defined margin, irregular shape showed meaningful diagnostic value for malignancy. CONCLUSIONS: Combination of meaningful sonographic findings increased possibility of maliganancy and require active mangements including recurrent fine needle aspiration and surgery if needed.

Age-Related Differences of Optical Coherence Tomography Data in Koreans

PURPOSE: Optical coherence tomography (OCT) is a new imaging technique that can provide cross-sectional images of the retina. This study was designed to evaluate the thickness of the retinal nerve fiber layer (RNFL) and optic nerve head shape in normal eyes using OCT. METHODS: A total of 134 normal Korean volunteers in different age groups (age range, 10-50 years) were recruited for this study. Fifty-nine males and 75 females were enrolled. The mean age of the subjects was 24.0+/-12.91 years. RESULTS: At optic disc scan, the horizontal and vertical C/D ratios were 0.55 and 0.48, respectively, which were statistically significant (p<0.05). A significant positive correlation with increasing age was identified in the C/D area ratio and horizontal C/D ratio. According to the RNFL scan, the inferior and superior areas were significantly thicker than the nasal and superior areas. These areas were thinner with age. In addition, RNFL thickness in the superonasal, inferotemporal and superotemporal areas differed between subjects under 20 years old and those over 21 years old. CONCLUSIONS: We determined that RNFL thickness and optic nerve head shape in normal Koreans had age-related differences. These results could provide correctness with OCT scan in glaucoma patients.

Effects of Anti-thyroglobulin Antibody on the Measurement of Thyroglobulin: Differences Between Immunoradiometric Assay Kits Available / 대한핵의학회잡지

PURPOSE: Thyroglobulin (Tg) is a valuable and sensitive tool as a marker for diagnosis and follow-up for several thyroid disorders, especially, in the follow-up of patients with differentiated thyroid cancer (DTC). Often, clinical decisions rely entirely on the serum Tg concentration. But the Tg assay is one of the most challenging laboratory measurements to perform accurately owing to antithyroglobulin antibody (Anti-Tg). In this study, we have compared the degree of Anti-Tg effects on the measurement of Tg between availale Tg measuring kits. MATERIALS AND METHODS: Measurement of Tg levels for standard Tg solution was performed with two different kits commercially available (A/B kits) using immunoradiometric assay technique either with absence or presence of three different concentrations of Anti-Tg. Measurement of Tg for patient's serum was also performed with the same kits. Patient's serum samples were prepared with mixtures of a serum containing high Tg levels and a serum containg high Anti-Tg concentrations. RESULTS: In the measurements of standard Tg solution, presence of Anti-Tg resulted in falsely lower Tg level by both A and B kits. Degree of Tg underestimation by A kit was more prominent than B kit. The degree of underestimation by B kit was trivial therefore clinically insignificant, but statistically significant. Addition of Anti-Tg to patient serum resulted in falsely lower Tg levels with only A kit. CONCLUSION: Tg level could be underestimated in the presence of anti-Tg. Anti-Tg effect on Tg measurement was variable according to assay kit used. Therefore, accuracy test must be performed for individual Tg-assay kit.

Factors related to prevalence of colonic polyps in acromegalic patients / 대한내과학회지

BACKGROUND: It has been suggested that acromegalic patients are at increased risk of developing colonic neoplasia. We evaluated the prevalence of colonic neoplasia and the relationships of clinical parameters of acromegalic activity with presence of colonic neoplasia in Korean acromegalic patients. METHODS: In 30 patients with active acromegaly, colonoscopy was performed at the time of diagnosis. According to the endoscopic findings and histological classifications, the patients were grouped, and a number of clinical parameters of acromegalic activity were compared between those with and without colonic polyps. RESULTS: Colonic polyps were detected in 17 (56.7%) in the 30 acromegalic patients with colonoscopic examinations; 7 (23.3%) hyperplastic and 10 (33.3%) adenomatous polyps. Those with colonic polyps were significantly older (52.2+/-9.46 years vs. 42.2+/-12.97 years, p=0.02) and also had significantly longer disease duration (11.8+/-7.52 years vs. 5+/-2.20 years, p=0.004) than those without ones. In 21 patients who were more than 40 years old, significant differences were found in disease duration (12.7+/-7.54 years vs. 5.0+/-2.68 years, p=0.026) and serum IGF-1 level (1311.9+/-500.14 ng/mL vs. 715.9+/-330.58 ng/mL, p=0.015) between those with and without colonic polyps. CONCLUSION: These results suggest that screening colonoscopy should be recommended in acromegalic patients who are more than 40 year-old, have long disease duration or have high serum IGF-1 level.

Beta ig-h3 promotes renal proximal tubular epithelial cell adhesion, migration and proliferation through the interaction with alpha3beta1 integrin

Betaig-h3 (betaig-h3) is a secretory protein composed of fasciclin I-like repeats containing sequences that allows binding of integrins and glycosaminoglycans in vivo. Expression of betaig-h3 is responsive to TGF-beta and the protein is found to be associated with extracellular matrix (ECM) molecules, implicating betaig-h3 as an ECM adhesive protein of developmental processes. We previously observed predominant expression of betaig-h3 expression in the basement membrane of proximal tubules of kidney. In this study, the physiological relevance of such localized expression of betaig-h3 was examined in the renal proximal tubular epithelial cells (RPTEC). RPTEC constitutively expressed betaig-h3 and the expression was dramatically induced by exogenous TGF-beta1 treatment. betaig-h3 and its second and fourth FAS1 domain were able to mediate RPTEC adhesion, spreading and migration. Two known alpha3beta1 integrin-interaction motifs including aspartatic acid and isoleucine residues, NKDIL and EPDIM in betaig-h3 were responsible to mediate RPTEC adhesion, spreading, and migration. By using specific antibodies against integrins, we confirmed that alpha3beta1 integrin mediates the adhesion and migration of RPTECs on betaig-h3. In addition, it also enhanced proliferation of RPTECs through NKDIL and EPDIM. These results indicate that betaig-h3 mediates adhesion, spreading, migration and proliferation of RPTECs through the interaction with alpha3beta1 integrin and is intimately involved in the maintenance and the regeneration of renal proximal tubular epithelium.

Influence of Anti-thyroglobulin Antibody on the Measurement of Thyroglobulin using the Immunoradiometric Assay / 대한내분비학회지

BACKGROUND: Serum thyroglobulin(Tg) is a valuable and sensitive tool needed in the follow-up of patients with differentiated thyroid cancer(DTC), but antithyroglobulin antibody(Anti-Tg), common in patients with DTC, can interfere with the assay for Tg. In this study, we evaluated the influence of Anti-Tg on the measurement of Tg using the immunoradiometric assay(IRMA). METHODS: In using ELSA-hTg in vivo test(CIS international, Schering, France), a solid phase two-site IRMA was used to measure Tg(23.5ng/mL, 62.5ng/mL) under the absence or presence of three concentrations of Anti-Tg(25U/mL, 50U/mL, 100U/mL). We also performed Tg measurement using patients serum that was mixed with patients serum containing high Anti-Tg. ANOVA and Scheffe tests were performed to evaluate the effect of Anti-Tg on Tg IRMA, and an inverse regression was made to calculate the level of Tg from measured Tg and used Anti-Tg levels and also to assess the degree of effect of anti-Tg on Tg IRMA. RESULTS: In measuring Tg using the standard solution, the presence of Anti-Tg resulted in a falsely suppressed Tg value. The IRMAs for 23.5ng/mL of the standard Tg solution resulted in 24.5+/-.1 ng/mL under no Anti-Tg, 11.8+/-.4ng/mL under 25U/mL of Anti-Tg, 7.7+/-.1ng/mL under 50U/mL of Anti-Tg, and 4.5+/-.4ng/mL under 100U/mL of Anti-Tg. IRMAs 62.5ng/mL of the standard Tg solution resulted in 65.9+/-.7ng/mL under no Anti-Tg, 36.3+/-.2ng/mL under 25U/mL of Anti-Tg, 23.7+/-.7ng/mL under 50U/mL of Anti-Tg, and 14.0+/-.0ng/mL under 100U/mL of Anti-Tg. (ANOVA test, p=0.000). The degree of suppression of the measured Tg value was positively correlated with the Anti-Tg level (Quadratic model regression, Sig T=0.000). The presence of Anti-Tg also resulted in a falsely suppressed Tg value for the Tg measurement using patient's serum. CONCLUSION: The presence of Anti-Tg could consist of the use of Tg as a tumor, therefore Anti-Tg should be measured in all patients diagnosed with DTC. The interpretation of the Tg level must be performed with extreme caution in patients with Anti-Tg.

A case of metastatic malignant pheochromocytoma response to high dose 131I-MIBG treatment after surgery / 대한내과학회지

Approximately 10% of pheochromocytomas are malignant and its major criteria are tumor invasion of capsular blood vessel as well as metastatic invasion of other tissues. It is general rule that all resectable masses have to be removed surgically. However, there is no definite treatment modality about unresectable masses or microinvasive lesions. We experienced a case of 45 year-old male patient who was referred to our hospital for treatment of hypertension and headache. The plasma and urine catecholamine were increased above normal values and its metabolites also were increased. 131I-metaiodobenzylguanidine (MIBG) scan showed right adrenal mass and metastatic lesion of left iliac bone. This lesion was consistent with findings of the abdomen computed tomography (CT) and electron beam tomography (EBT) scan. We diagnosed this case as malignant pheochromocytoma. We removed primary tumor mass by wide excision and treated this patient with high dose 131I-MIBG. We report this case who shows good response to the high dose 131I-MIBG after surgery.

A Case of Acute Adrenal Insufficiency with Bilateral Adrenal Hemorrhagic Infarction due to Ebstein-Barr Virus Infection in a Patient with Asymptomatic Chronic Adrenal Insufficiency / 대한내분비학회지

Acute adrenal insufficiency may result from adrenal crisis, hemorrhagic destruction, or the rapid withdrawal of steroids from patient with chronic steroid medication, congenital adrenal hyperplasia or those on other drugs. Acute hemorrhagic destruction of both adrenal glands can occur due to infection, trauma, anticoagulant therapy, antiphospholipid syndrome or a coagulation disorder. However, there have been no reports on acute hemorrhagic adrenal insufficiency due to the Ebstein-Barr virus (EBV). Herein, a case of acute adrenal insufficiency, with bilateral adrenal hemorrhagic infarction, is reported in a patient with asymptomatic chronic adrenal insufficiency. A 42-year-old man presented with general weakness, weight loss and hyperpigmentation of several months duration. He suffered from a sore throat, general myalgia and a headache on admission. The laboratory findings were lymphocytosis, positive EBV IgM antibody, low cortisol level and a high level of adrenocorticotropic hormone (ACTH). Adrenocortical autoantibody and PCR for Mycobacterium tuberculosis showed negative findings. The serologic findings for CMV and HIV were negative. Fine needle aspiration of the adrenal gland revealed a hemorrhagic infarction and positive staining for the anti-EBV antibody. Acute adrenal insufficiency was then diagnosed with a bilateral adrenal hemorrhagic infarction due to the EBV infection in the patient, also with asymptomatic chronic adrenal insufficiency. This is the first case of acute adrenal insufficiency with bilateral hemorrhagic infarction, due to an EBV infection

Association of Polymorphism in beta3-Adrenergic Receptor Gene with Fat Distribution / 대한내분비학회지

BACKGROUND: Reasons for obesity include environmental factors and, more largely so, genetic factors. There have been many studies on these genetic factors. So far, genes related to obesity such as Leptin, Uncoupling Protein(UCP), Peroxisome proliferator activated receptor-gamma(PPAR-gamma), and Beta3-adrener-gic receptor(beta3-AR) gene have been discovered. Among these, beta3-AR is expressed in visceral adipose tissue and is thought to contribute to the regulation of resting metabolic rate and lipolysis. The missense mutation of beta3-AR gene, resulting in replacement of tryptophan by arginine at position 64(Trp64Arg), is associated with decreased resting metabolic rate and weightgain. We performed this study to determine if Trp64Arg polymorphism of beta3-AR gene is associatedwith obesity in Koreans. METHOD: We investigated the relationship between the beta3-AR gene mutation and body mass index (BMI), waist circumference, hip circumference, waist to hip ratio(WHR), area of subcutaneous fat, area of visceral fat, visceral to subcutaneous fat ratio(VSR), and lipid profile. 198 subjects were included in this study of which 97 were of normal weight and 101 were obese. Anthropometric data was obtained from physical examination and medical records. RESULT: In the cases of beta3-AR gene mutation of the obese group, the ratio of Trp/Arg and Arg/Arg are 43% and 5%, respectively, which were higher than the normal group(36%, 1%), although a statistical significant was not found. There was significant difference in the are of subcutaneous fat. Normal group(Trp/Trp) measured at 213.9+/-109.6cm2 versus 244.0+/-127.7cm2 (Trp/Arg) and 323.9+/-189.9cm2(Arg/Arg) for the mutation groups. Circumference of waist, circumference of hip, WHR, area of visceral fat, and VSR were higher in the mutation groups than in normal subject, but not significantly different. CONCLUSION: These results suggest that a genetic mutation in the beta3-AR gene can affect body fat composition, and is associated with obesity in Korean adults.