Longitudinal Changes of High Molecular Weight Adiponectin are Associated with Postpartum Development of Type 2 Diabetes Mellitus in Patients with Gestational Diabetes Mellitus

Background@#The influence of serial changes of adipokines on maternal glucose metabolism from pregnancy to postpartum periods in women with previous gestational diabetes mellitus (pGDM) has not been thoroughly explored. We tried to examine the relationship between the serial changes of adipokines and the development of diabetes mellitus (DM) in women with pGDM. @*Methods@#We longitudinally measured following adipokines: high molecular weight (HMW) adiponectin, retinol-binding protein-4 (RBP-4), lipocalin-2, and chemerin, during pregnancy, and at 2 months and 3 years after delivery. Based on glucose status at postpartum 3 years, we divided into three groups: normal glucose tolerance (GDM-NGT, n=20), impaired glucose tolerance (GDM-IGT, n=23), and GDM-DM (n=22). We analyzed the correlations between adipokines and various metabolic parameters. @*Results@#Plasma HMW adiponectin levels were not different among the three groups during pregnancy. However, HMW adiponectin levels increased at 3 years after the delivery in women with GDM-NGT compared with women with GDM-DM. In the GDM-IGT group, HMW adiponectin levels increased at 2 months postpartum compared to pregnancy period. In contrast, HMW adiponectin levels showed no alternation after parturition in women with GDM-DM. HMW adiponectin was negatively correlated with body mass index and a homeostasis model assessment of insulin resistance. Other adipokines such as RBP-4, lipocalin-2, and chemerin neither showed any differences among the groups nor any significant correlations with 3 years postpartum status of glucose intolerance. @*Conclusion@#Serial changes of HMW adiponectin are associated with the maintenance of glucose metabolism in women with pGDM after delivery.

Contralateral Suppression at Adrenal Venous Sampling Is Associated with Renal Impairment Following Adrenalectomy for Unilateral Primary Aldosteronism

Background@#Adrenal venous sampling (AVS) is performed to distinguish the subtype of primary aldosteronism (PA). The clinical implication of contralateral suppression (CS; aldosterone/cortisolnondominant0.26 after adjusting for other factors. @*Conclusion@#CS may not predict postoperative clinical and biochemical outcomes in subjects with unilateral aldosterone excess, but it is associated with postsurgical deterioration of renal function in subjects over 50 years with CSI ≤0.26.

Contralateral Suppression at Adrenal Venous Sampling Is Associated with Renal Impairment Following Adrenalectomy for Unilateral Primary Aldosteronism

Background@#Adrenal venous sampling (AVS) is performed to distinguish the subtype of primary aldosteronism (PA). The clinical implication of contralateral suppression (CS; aldosterone/cortisolnondominant0.26 after adjusting for other factors. @*Conclusion@#CS may not predict postoperative clinical and biochemical outcomes in subjects with unilateral aldosterone excess, but it is associated with postsurgical deterioration of renal function in subjects over 50 years with CSI ≤0.26.

Associations between the HaeIII Single Nucleotide Polymorphism in the SLC2A1 Gene and Diabetic Nephropathy in Korean Patients with Type 2 Diabetes Mellitus

BACKGROUND: Diabetic nephropathy (DN) is the most serious microvascular complication of diabetes mellitus and is one of the leading causes of end stage renal failure. In previous studies, the contribution of genetic susceptibility to DN showed inconsistent results. In this study, we investigated the association between the solute carrier family 2 facilitated glucose transporter member 1 (SLC2A1) HaeIII polymorphism and DN in Korean patients with type 2 diabetes mellitus (T2DM) according to disease duration. METHODS: A total of 846 patients with T2DM (mean age, 61.3 ± 12.3 years; mean duration of T2DM, 10.3 ± 7.9 years; 55.3% men) who visited the Chungbuk National University Hospital were investigated. The HaeIII polymorphism of the SLC2A1 gene was determined by the real time polymerase chain reaction method. Genotyping results were presented as GG, AG, or AA. A subgroup analysis was performed according to duration of T2DM (≤ 10 years, < 10 years). RESULTS: The AG + AA genotype showed a significantly higher risk of DN compared with the GG genotype in patients with a type 2 DM duration less than 10 years (12.4% vs. 4.2%; P < 0.001). No significant differences were observed in terms of other diabetic complications, including retinopathy, peripheral neuropathy, cardiovascular disease, cerebrovascular disease or peripheral artery disease, according to the genotypes of the SLC2A1 HaeIII polymorphism. CONCLUSION: The SLC2A1 HaeIII polymorphism was associated with DN in Korean patients with T2DM, particularly in the group with a relatively short disease duration.

Utility of Quantitative Parameters from Single-Photon Emission Computed Tomography/Computed Tomography in Patients with Destructive Thyroiditis

OBJECTIVE: Quantitative parameters from Tc-99m pertechnetate single-photon emission computed tomography/computed tomography (SPECT/CT) are emerging as novel diagnostic markers for functional thyroid diseases. We intended to assess the utility of SPECT/CT parameters in patients with destructive thyroiditis. MATERIALS AND METHODS: Thirty-five destructive thyroiditis patients (7 males and 28 females; mean age, 47.3 ± 13.0 years) and 20 euthyroid patients (6 males and 14 females; mean age, 45.0 ± 14.8 years) who underwent Tc-99m pertechnetate quantitative SPECT/CT were retrospectively enrolled. Quantitative parameters from the SPECT/CT (%uptake, standardized uptake value [SUV], thyroid volume, and functional thyroid mass [SUVmean × thyroid volume]) and thyroid hormone levels were investigated to assess correlations and predict the prognosis for destructive thyroiditis. The occurrence of hypothyroidism was the outcome for prognosis. RESULTS: All the SPECT/CT quantitative parameters were significantly lower in the 35 destructive thyroiditis patients compared to the 20 euthyroid patients using the same SPECT/CT scanner and protocol (p < 0.001 for all parameters). T3 and free T4 did not correlate with any SPECT/CT parameters, but thyroid-stimulating hormone (TSH) significantly correlated with %uptake (p = 0.004), SUVmean (p < 0.001), SUVmax (p = 0.002), and functional thyroid mass (p < 0.001). Of the 35 destructive thyroiditis patients, 16 progressed to hypothyroidism. On univariate and multivariate analyses, only T3 levels were associated with the later occurrence of hypothyroidism (p = 0.002, exp(β) = 1.022, 95% confidence interval: 1.008 – 1.035). CONCLUSION: Novel quantitative SPECT/CT parameters could discriminate patients with destructive thyroiditis from euthyroid patients, suggesting the robustness of the quantitative SPECT/CT approach. However, disease progression of destructive thyroiditis could not be predicted using the parameters, as these only correlated with TSH, but not with T3, the sole predictor of the later occurrence of hypothyroidism.

Validity and Reliability of the Korean Version of the Hyperthyroidism Symptom Scale

BACKGROUND: Thyrotoxicosis is a common disease resulting from an excess of thyroid hormones, which affects many organ systems. The clinical symptoms and signs are relatively nonspecific and can vary depending on age, sex, comorbidities, and the duration and cause of the disease. Several symptom rating scales have been developed in an attempt to assess these symptoms objectively and have been applied to diagnosis or to evaluation of the response to treatment. The aim of this study was to assess the reliability and validity of the Korean version of the hyperthyroidism symptom scale (K-HSS). METHODS: Twenty-eight thyrotoxic patients and 10 healthy subjects completed the K-HSS at baseline and after follow-up at Seoul National University Bundang Hospital. The correlation between K-HSS scores and thyroid function was analyzed. K-HSS scores were compared between baseline and follow-up in patient and control groups. Cronbach's α coefficient was calculated to demonstrate the internal consistency of K-HSS. RESULTS: The mean age of the participants was 34.7±9.8 years and 13 (34.2%) were men. K-HSS scores demonstrated a significant positive correlation with serum free thyroxine concentration and decreased significantly with improved thyroid function. K-HSS scores were highest in subclinically thyrotoxic subjects, lower in patients who were euthyroid after treatment, and lowest in the control group at follow-up, but these differences were not significant. Cronbach's α coefficient for the K-HSS was 0.86. CONCLUSION: The K-HSS is a reliable and valid instrument for evaluating symptoms of thyrotoxicosis in Korean patients.

Characterization of Patients with Type 2 Diabetes according to Body Mass Index: Korea National Health and Nutrition Examination Survey from 2007 to 2011

BACKGROUND: The present study aimed to investigate the clinical characteristics of type 2 diabetes mellitus (T2DM) in Korean adults according to body mass index (BMI) and to analyze the association with cardiovascular disease (CVD). METHODS: We conducted a cross-sectional study of data from the Korea National Health and Nutrition Examination Survey from 2007 to 2011. A total of 3,370 patients with T2DM were divided into categories according to BMI. We conducted a comparison of the T2DM patient population composition by BMI category between different countries. We investigated the prevalence of awareness, treatment, and target control of T2DM according to BMI. RESULTS: Patients with T2DM had a higher BMI, and were more likely to have a history of CVD than healthy controls. For Korean adults with T2DM, 8% had BMI > or =30 kg/m2. By contrast, the population of patients with T2DM and BMI > or =30 kg/m2 was 72% in patients in the USA and 56% in the UK. The rate of recognition, treatment, and control has worsened in parallel with increasing BMI. Even in patients with BMI 25 to 29.9 kg/m2, the prevalence of CVD or high risk factors for CVD was significantly higher than in patients with BMI 18.5 to 22.9 kg/m2 (odds ratio, 2.07). CONCLUSION: Korean patients with T2DM had lower BMI than those in Western countries. Higher BMI was associated with lower awareness, treatment, and control of diabetes, and a positive association was observed between CVD or high risk factors for CVD and BMI, even for patients who were overweight but not obese.

Renal Expression of an Ammonia Transporter in Rats with a Unilateral Ureteral Obstruction / 대한내과학회지

BACKGROUND/AIMS: Urinary tract obstruction induces a form of renal tubular acidosis with a urinary acidification defect caused by decreasing net acid excretion, which is predominantly due to a decrease in urinary ammonia excretion. The present study examined whether this decrease is associated with changes in the renal expression of an ammonia transporter family member, Rh C glycoprotein (Rhcg), in rats with a unilateral ureteral obstruction. METHODS: Male Sprague-Dawley rats underwent a 24-h unilateral ureteral obstruction. Rhcg expression was then evaluated by immunoblotting and immunohistochemistry. Cell height, total cellular expression, expression in the apical 25% of the cell, and % of total expression in the apical region were quantified by immunohistochemistry with quantitative morphometric analysis. RESULTS: After 24 h of unilateral ureteral obstruction, the serum bicarbonate level and total urinary ammonia excretion were decreased. Both light microscopy and immunohistochemistry with quantitative morphometric analysis demonstrated that the total intensity of Rhcg expression was decreased in the obstructed kidneys, whereas Rhcg expression did not change in the cortical collecting duct (CCD) and outer medullary collecting duct (OMCD) of nonobstructed kidneys in rats with a 24-h unilateral ureteral obstruction. CONCLUSIONS: The rats with a unilateral ureteral obstruction showed decreased urinary ammonia excretion associated with decreased Rhcg expression in the CCD and OMCD. These changes suggest that the ammonia transporter Rhcg mediates a urinary acidification defect associated with unilateral ureteral obstruction.

A Case of Choledocholithiasis and Intestinal Malrotation in an Adolescent with Repaired Gastroschisis

Most infants with repaired gastroschisis develop normally and remain in good health. About 10% of patients with gastroschisis have other malformations. We report a case of choledocholithiasis and intestinal malrotation in an adolescent with repaired gastroschisis. A 17-year-old girl presented with fever, jaundice, and abdominal pain. She had undergone an operation to repair gastroschisis at birth. Physical examination revealed icteric sclera, a tight abdominal wall, and a longitudinal surgical scar at the midline. An abdominal computed tomography scan revealed a round calcifying lesion near the pancreas and a midline-positioned liver and gallbladder. Absence of the retroperitoneal duodenum and the anterior and left-sided position of the superior mesenteric vein compared with the superior mesenteric artery were observed. Results of abarium examination revealed intestinal malrotation. Endoscopic retrograde cholangiopancreatography revealed diffuse dilatation of the biliary trees and a malpositioned gallbladder. A single stone was removed by using a basket. The clinical symptoms improved after the patient underwent endoscopic retrograde cholangiopancreatography.

The Usefulness of a Colonoscopy with Biopsy in the Early and Accurate Diagnosis of Ischemic Colitis

BACKGROUND/AIMS: Ischemic colitis has a clinical spectrum ranging from mild reversible colitis to an acute fulminant course. Early and accurate diagnosis is therefore mandatory for a good clinical outcome. The aim of this study is to evaluate the efficacy and safety of a colonoscopy and histological examination with biopsy in the early and accurate diagnosis of ischemic colitis. METHODS: We investigated the clinical characteristics and endoscopic findings with the histopathology of 89 cases of ischemic colitis from October 2002 to August 2012 in a tertiary-care hospital. All patients underwent a colonoscopy with biopsy within a few days of the onset of symptoms, and the histological features from the biopsy specimens were reviewed. In addition, the occurrence of complications by colonoscopy with biopsy was evaluated. RESULTS: The mean age of the patients was 65.8+/-12.6 years (male:female, 1:2.2). The major combined disorders were hypertension (51.7%), diabetes (31.5%), and arrhythmia (19.1%). The clinical features usually presented with hematochezia (83.1%), abdominal pain (77.5%), and diarrhea (60.7%). The involved patterns were the left colon (56.2%), right colon (39.3%), and pancolon (4.5%). Based on the main histological features of ischemic colitis, including glandular atrophy (67.4%), hemorrhage (61.8%), capillary thrombi (42.7%), and coagulative necrosis of mucosa (29.2%), 67 of the 89 cases (75.3%) could be confirmed with ischemic colitis. There were no serious complications such as bowel perforation or major bleeding following the colonoscopy with biopsy. CONCLUSIONS: A colonoscopy with biopsy is beneficial and safe for the early and precise diagnosis of ischemic colitis.

A Case of Cystic Ectasia of the Rete Testis / 대한남성과학회지

The seminiferous tubules merge and connect with the tubuli recti that form the spaces known as the rete testis. Cystic ectasia of the rete testis is a rare benign testicular lesion. We report the cystic ectasia of the rete testis in a 66-year-old man.

A Case of Polyarteritis Nodosa Manifesting as a Neuropathy Following Influenza Infection

Polyarteritis nodosa (PAN) is a necrotizing vasculitis of the medium-sized arteries. The symptoms and signs of PAN include purpuric skin lesions, mononeuritis multiplex, symptoms of mesenteric ischemia, and renal involvement. We report the first case of PAN manifesting as a neuropathy after influenza infection in Korea. A 68-year-old woman had fever, myalgia, hyperesthesia of both hand and foot, and lower extremity weakness. EMG findings showed severe sensorimotor polyneuropathy, such as multiple mononeuritis. A sural nerve biopsy showed vasculitis and Influenza A (H1N1) were positive. Our patient was treated by glucocorticoid and oral cyclophosphamide, thereafter, symptoms and signs improved. No recurrence has been observed for five months.

Mechanoreceptors in the Remnants of Ruptured Anterior Cruciate Ligaments in Human Knees / 대한정형외과학회잡지

PURPOSE: This study was performed to identify the presence of mechanoreceptors in the tibial remnants of injured anterior cruciate ligaments (ACLs) in human knees by immunohistochemistry. MATERIALS AND METHODS: Twenty-one specimens of tibial remnants of ACLs from patients with ACL ruptures were obtained during arthroscopic ACL reconstruction procedures. As a control, two normal ACL specimens were taken from healthy men at the time of traumatic above the knee amputations. The ACL specimens were serially frozen-sectioned at a thickness of 40micrometer. The average number of sections from each specimen was 71.5 (total 1,502) in the remnant group and 132 (total 264) in the control group. Immunohistochemical staining was used for detection of the neural elements. The mechanoreceptors were identified under a light microscope and their locations and amounts were recorded. An independent sample t-test was used for analysis. RESULTS: In the remnants of the ACLs, ten mechanoreceptors were identified in 7 (33.3%) out of 21 cases. Nineteen mechanoreceptors were detected in the two normal ACLs, which demonstrated an even distribution at both the tibial and femoral attachments. There was no significant difference between the MR-present group (7 cases) and the MR-absent group (14 cases) with respect to the number of sections, age, and time from injury to surgery. CONCLUSION: The identification of mechanoreceptors in the remnants of ruptured ACL specimens could support the necessity for the preservation of the tibial remnant during ACL reconstruction to improve joint proprioception.

Bilateral Elastofibroma Dorsi in the Infrascapular Region: A case report / 대한흉부외과학회지

An 81-year-old woman was admitted to our hospital with bilateral chest wall mass in the infrascapular region. Considering the possible diagnosis of a malignant chest wall tumor at such location, we performed excision and biopsy. Both masses were histologically diagnosed as elastofibroma. We experienced this rare disease, bilateral elastofibroma, so we report this case with a bibliography.

Inverted Papilloma in the Prostatic Urethra / 대한비뇨기과학회지

Inverted papilloma of the urinary tract is a rare finding, and it is almost benign in its histologic morphology and clinical behavior. Despite several published reports, the prognostic significance and potential clinical behavior of this malady remains unclear. The most commonly associated clinical symptoms are hematuria and obstruction of the urinary tract. Most inverted papillomas of urinary tract occur in the bladder and only rarely in the ureter, renal pelvis and urethra. We report here on one case of inverted papilloma in the prostatic urethra. This was diagnosed by transrectal ultrasonography and confirmed by its histology.

Non-palpable and Asymptomatic Leydig Cell Tumor / 대한비뇨기과학회지

Leydig cell tumors are the most common non-germ cell tumors of the testis, and they account for 1-3% of all testicular tumors. They most commonly present as a testicular mass and/or with endocrine symptoms. This tumor is characterized by its endocrine manifestations, which are due to the tumor's capacity to secrete hormones. We report here on one case of a patient with Leydig cell tumor; the patient was without symptoms and the tumor was not detected on the physical examination.

Changes in the Mechanoreceptors of the Anterior Cruciate Ligament of Patients with Degenerative Arthritis / 대한정형외과학회잡지

PURPOSE: To clarify the morphologic and quantitative changes of mechanoreceptors of the human ACL with degenerative arthritis. MATERIALS AND METHODS: Eleven fresh specimens of anterior cruciate ligament (ACL) were obtained from patients with degenerative arthritis during TKA. As a control, two fresh specimens were taken from healthy men at the time of a traumatic above knee amputation. The whole ligaments were serially frozen and sectioned at a thickness of 40 mum. After immunohistochemical staining, the mechanoreceptors were observed under a light microscope. The ratios of sections showing mechanoreceptors were calculated. Statistical analyses were performed using the chi-square test. RESULTS: In the two control specimens, nineteen mechanoreceptors were found, evenly distributed at the femoral and tibial ends. However, the average number of mechanoreceptors was 1.4 (total 15) in the arthritic ligaments (p<0.05), and these were located near the femoral side rather than the tibial end. The percentage of sections showing mechanorecptors was 8.3% in the arthritic group and 40.2% in the control group (p<0.05). All receptors were round or fusiform shaped Ruffini corpuscles; Pacinian corpuscles could not be found in either group. Nine of 15 mechanoreceptors in the arthritic groups were "necrotic" in shape. CONCLUSION: Mechanoreceptors in arthritic ACL were significantly reduced in number and mainly necrotic in shape. Our findings suggest that the numerical and morphological changes of mechanoreceptors are closely related with reduced proprioception in degenerative arthritis.

A case report of Churg-Strauss syndrome / 천식및알레르기

The characteristic features of Churg-Strauss syndrome are vasculitis, both intra- and extravascular granuloma formation with eosinophilic tissue infiltration, and strong association with asthma and peripheral eosinophilia. Churg-Strauss syndrome with pleural effusion is relatively common and only a few cases have previously been reported in Korea. We report a case of Churg-Strauss syndrome with pleural effusion confirmed by VATS.

A Case of Esophageal Anisakiasis / 대한소화기내시경학회지

Anisakis is an accidental parasitic infection caused by the larvae of marine mammals. An individual becomes infected with a larval form of the nematode Anisakis by consuming raw or undercooked fish containing the parasite. Generally, the clincal symptoms are characterized by severe cramping abdomianl pain, nausea, vomiting, and an epigastric full sensation. A case was recently experienced by a patient who suffered acute esophageal anisakiasis, and had a history of eating raw sea fish. His symptoms included substernal chest pain and odynophagia. Early endoscopic examination revealed a whitish linear worm in the mid-esophagus, which was removed by biopsy forceps.

Endoscopic Release in Carpal Tunnel Syndrome / 대한정형외과학회잡지

Carpal tunnel syndrome is known as the most common peripheral nerve entrapment neuropathy which results from compression of the median nerve within the carpal tunnel. Recently, endoscopic carpal tunnel release was introduced as an alternative of open carpal tunnel release. The purpose of this study is to find out the clinical usefulness of endoscopic carpal tunnel release through analyzing results of symptom, physical sign and E.M.G. finding. We analyzed 20 patients (29 cases) who had been treated by endoscopic carpal tunnel release, and followed up over 6 mos at Department of Orthopedic Surgery, Bongseng Memorial Hospital from August 1994 to December 1996. The results were excellent or good in 27 cases (93%) in Cseuz criteria, poor in only 1 case. Grip strength recovered to preoperative strength level in 28 cases (96.6%) at 3 mos postoperatively. The EMG checked postoperatively demonstrated improvement in both sensory and motor function. In conclusion, although endoscopic carpal tunnel release is a technically demanding procedure and the learning curve in steep, it has the advantage of lesser palmar scarring, lesser ulnar pillar pain, rapid and complete return of strength and to work. Therefore, endoscopic carpal tunnel release can be a good method in the treatment of carpal tunnel syndrome.