Case of Acute Methemoglobinemia Caused by Nitrobenzene Ingestion / 대한내과학회지

Nitrobenzene is a poisonous agent, not commonly encountered in clinical practice, which belongs to the aniline dyes. Ingestion of nitrobenzene may cause methemoglobinemia, a condition in which the iron in hemoglobin is oxidized from the ferrous state to the ferric state, resulting in the inability to transport oxygen. A 41-year-old man presented with the clinical features of methemoglobinemia after drinking nitrobenzene. The patient was treated conservatively with intravenous methylene blue. We report a case of acute methemoglobinemia due to ingestion of nitrobenzene.

Diabetes Educator Training Module (DETM) / 임상당뇨병

The Diabetes Educator Training Module (DETM), which was developed in 2011, contained more than 900 slides. The purpose of the DETM is to help Korean diabetes educators develop programs for diabetic patients and health professionals. In this paper, we present information regarding the history, the principles of development, the contents, and the use of the DETM program. We hope that the DETM will be a useful tool for helping diabetic patients to understand their disease and to improve their glycemic control and treatment adherence.

Diabetes Education Recognition Program / 임상당뇨병

The Committee of Education of the Korean Diabetes Association discussed the need to develop the Diabetes Education Recognition Program. In 2011, the current certification program was reviewed and a survey was conducted to improve the Diabetes Education Recognition Program. This improved program will be a standard for qualified diabetes education for diabetes educators and institutes, and will ultimately become a national standard for diabetes education.

Current Status of Self-management and Barriers in Elderly Diabetic Patient / 당뇨병

BACKGROUND: Diabetes has a critical effect on elderly diabetic patients' quality of life. Elderly diabetic patients have many difficulties in diabetes self-management because their physical, psychological and social functions are decreased as a result of the aging process. Therefore, we evaluated the current status of self-management and barriers in elderly diabetic patients METHODS: The sample was 124 elderly diabetic patients (over 61 years) who visited a hospital and two senior welfare centers in Seoul from July to August 2006. The results of the study were analyzed by descriptive statistics, ANOVA, T-test, and hierarchical regression. RESULTS: 1) Diabetes self-management was composed of insulin injection, diet, exercise, foot management, smoking and drinking alcohol. An average score of self-management in the elderly diabetic patients was 4.5784. In demographic variables, only job status showed a significant effect on self-management. 2) Barriers such as 'forgetting taking diet and medication', 'being interrupted by others', and 'lack of family and social support' were significant factors in diabetes self-management. 3) These barriers for diabetes self-management were still significant in the case of controlling demographic and clinical variables. CONCLUSION: Diabetic educator should identify the significant factors that affect patient's self-management such as whether they have a full-time job, or the type of their job. In addition, diabetes education should focus on assertiveness training to deal with various interpersonal barriers and empowerment for enhancing patient's self-efficacy. These approaches would benefit patients who experience barriers of diabetes self-management

Pheochromocytoma in pregnancy: A case report / 대한내과학회지

Pheochromocytoma during pregnancy is very rarely discovered, and this condition is life threatening to both mother and fetus. Maternal and fetal survival depend a lot on an early diagnosis, a correct medical therapy and a correct timing of delivery and surgery. We describe a case of pheochromocytoma during pregnancy. A patient was transferred to our hospital during gestational week 24 with severe hypertension, generalized edema. Pheochromocytoma caused by a left adrenal mass was diagnosed. The patient was treated with titrated dose of phenoxybenzamine, propranolol, and intravenous nicardipine, but intermittent severe hypertension was developed. At 33 weeks gestation, fetal distress was developed, and emergent cesarean section was done. Two weeks after delivery, she underwent a successful left adrenalectomy. Two months after surgery, all antihypertensive medications were discontinued and her blood pressure have remained normal range.

The Expression of L-type Calcium Channel mRNA by the Concentrations of Glucose on the Cell Proliferation in Cultured OLETF Rat Aortic Vascular Smooth Muscle Cells

BACKGROUND: The proliferation of vascular smooth muscle cell(VSMC) is a part of the major pathogenic mechanism for atheroscle- rosis. It has been reported that L-type calcium channel plays a role in the VSMC proliferation in diabetic rats. But there is a little study results about the association between L-type calcium channel and VSMC proliferation by glucose concentrations in culture media. So we examined the association between voltage-dependent L-type calcium channel of VSMCs and the proliferative activity of vascular smooth muscle cells. METHODS: Rat aortic VSMCs were isolated from the aorta of OLETF rat by enzyme method. VSMCs were cultured in various concentrations of glucose(5.5, 25 mM). The VSMCs(1x104 cells in 24-well plates) were incubated in the presence of Bay K 8644 (10-6M) with/without verapamil(10-6M) for 48 hours. Then the proliferation was assessed by MTT(methylthiazole tetrazolium) assay and expression of L-type calcium channel mRNA was measured by RT-PCR. RESULTS: The proliferative ability and the expression of L-type calcium channel of cultured VSMCs were increased dose-dependently by the glucose concentrations(p<0.05). Bay K 8644 enhanced the proliferation of VSMC and verapamil blocked the incremental effects induced by Bay K 8644. CONCLUSION: These results suggest that L-type calcium channel may play a role in VSMC proliferation of OLETF rat.

Metabolic Syndrome and Steroid: 11 -Hydroxysteroid Dehydrogenases (11 -HSDs) / 대한내분비학회지

No abstrat available.

Metabolic Syndrome and Steroid: 11 -Hydroxysteroid Dehydrogenases (11 -HSDs) / 대한내분비학회지

No abstrat available.

Relationship between Metabolic Syndrome and Coronary Heart Disease in Elderly

BACKGROUND: Metabolic syndrome, a concurrence of disturbed glucose and insulin metabolism, over- weight and abdominal fat distribution, dyslipidemia and hypertension, is associated with subsequent de- velopment of type 2 diabetes mellitus and cardiovascular disease, especially coronary heart disease. The aim of the study is to assess the relationship between metabolic syndrome and coronary heart disease in elderly greater than 65 years old. METHODS: Eighty two elderly patients greater than 65 years old who underwent coronary angiography were divided into two groups with metabolic syndrome or without metabolic syndrome, and assessed the association with coronary angiographic finding. The metabolic syndrome factors and cardiovascular risk factors of JNC 7 were investigated to assess the relationship with coronary heart disease in elderly. Coronary heart disease was defined as 50% or greater diameter in stenosis of coronary artery in coronary angiography. RESULTS: In elderly patients with metabolic syndrome, coronary angiographically abnormal findings(p<0.05) and multi vessel disease findings(p<0.05) were presented significantly higher than non metabolic syndrome patients. In elderly patients with 3 and more cardiovascular risk factors of JNC 7, coronary angiographically abnormal findings(p<0.05) and multi vessel disease findings(p=0.059) were presented more than the other patients. Diabetes mellitus was related significantly with coronary heart disease(p value 0.044). CONCLUSION: In elderly patients, metabolic syndrome was significantly related with coronary heart disease and diabetes mellitus had strong relationship with coronary heart disease. Metabolic syndrome and cardiovascular risk factors of JNC 7 should be further evaluated to assess the relationship with coronary heart disease in the future.

Analysis of Elderly Patients who visited Emergency Room

BACKGROUND: Recently elderly people have increased in Korea and increased demands of medical service. To solve the problem of emergency medical service in elderly patients, it is very important to analyze the emergency patients who visit medical service and to accumulate date bases of various hospitals. So the purpose of this study is to evaluate the use of emergency services by the elderly to provide better understanding of the emergency care needs of this specialized populations and provide a basis planning to meet the needs of the expanding geriatric population. METHODS: We performed a retrospective study of 2380 elderly patients who visited Emergency room of national medical center, from August 1, 1999 to July 31, 2000. We analyzed the patients gender, age, arrival time, final diagnosis, admission rate, mortality, ects. RESULT: Male to female ratio is 1:1.29, and most common age group was between 65 and 69 years old. The peak time of patients entrance was between 10 AM and 11AM, in a week monday was most crowding day. The most predomint monthly distribution of visit was January. The respiratory disease are most common problem (14.7%), and cardivascular disease (12.01%) are next, and cerebrovascular disease (11.17%) are following. Diabetic complication (7.53%) are common problems and hypoglycemia and diabetic foot infection are frequent. Admission rates was 32.53%. ICU admission rate is 2.77%. Emergency operation rate is 5.91%. During admission, mortality case was 127 patients. The cause of death were cerebrovascular disease (16.94%) and advanced respiratory disease (15.43%). CONCLUSION: The results show that cerebrovascular disease and respiratory disease and cardiovascular disease that needed prompt medical service are major problem who visit emergency room. And diabetic complications that are prevented by proper educations are common. So more concentrated medical service and preventive effort focused on these disease.

Clinical Analysis of Malarial Infections between January and September 1998 / 대한내과학회지

OBJECTIVE: Annually, the prevalence of indigenous and imported malarial infections is steadily increasing since 1993 in Korea. In order to understand the current characteristics of malarial infections and to prevent, the present research reviewed twenty-seven cases between January and September 1998. METHOD:In this study, all the twenty-seven (twenty- six patients) cases were obtained from admitted patients between January and September 1998. We had performed routine blood chemical studies, peripheral blood thin and thick smear, physical examination and abdominal sonography. Any patient with a previous history of a narcotic drug injection or had blood transfusion was excluded. RESULTS: Twenty cases (74.1%) were indigenous and seven (25.9%) were imported malaria. Yeonchon-Gun (nine cases) was the most prevalent area in the indigenous cases; Cambodia (three cases) were the most one in the imported cases. Peripheral blood thin smear revealed Plasmodium vivax in all (100%) indigenous malaria, while four cases (57.1%) were P. vivax and one (14.3%) was P. falciparum and two (28.6%) were mixed infections with P. vivax and P. falciparum in the imported cases. In a 3-month period between July and September, peak prevalence (80.4%) was observed. The negative conversion of peripheral blood smear was achieved much earlier in the indigenous (3.9+/-1.4day) than in the imported (5.7+/-1.9day) after the treatment but, was not statistically signifcant. CONCLUSION: Plasmodium ovale was the only unique causative species in the indigenous malaria. Also Yeonchon-Gun and Cheolwon-Gun had been the most important endemic areas as previous reports. One relapse case had been occurred in the imported malaria. On the basis of our data, more efforts for control of malaria should be necessary for eradication and prevention of indigenous and imported malarial infections in Korea.

Diabetes mellitus in the elderly

No abstract available.

Age-related trend of diseases distribution in the elderly aged 60 years and older / 대한내과학회지

With increasing life expectance and improvement of the overall health of the elderly, the understanding of geriatric disease becomes an important aspect of medical services. In the elderly, the frequencies of hypertension, DM, & anemia are increased according to aging and renal function is decreased progressively. As screening test for cervical cancer Papanicolaou smear is recommended due to its cost-effective benefits in females. In age-adjusted elderly male and female study populations, authors investigated the alterations of the above diseases, hypercholesterolemia, liver disease, obesity, & proteinuria distributions. METHODS: This study included 1,181 aged 40 years (600 males, 581 females) visitors between January 1, 1997 and December 31, 1997 in National Medical Center, Seoul, South Korea. Authors divided these populations into two large groups such as group A and B. Group A was composed of 40-59 years, group B 60 years and older. Group A and B were subdivided into 4 subgroups each other, such as A-1, A-2, A-3 and A-4, B-1, B-2, B-3 and B-4 by means of age-adjusted dividing scale. We used our inclusion criteria to define each disease. RESULTS: Hypertension was the most common disease in males of group B, but obesity was in females. The age-adjusted frequencies of hypertension, anemia, obesity & proteinuria were increased according to aging in the elderly aged 60 years and older. Though hypercholesterolemia revealed non-specific distribution in each group, increased frequency was observed in females compared to males in group B. With increasing their age, abnormal findings of Papanicolaou smear were found in females of group B. CONCLUSIONS: As the frequencies of hypertension, anemia, obestiy, proteinuria & abnormal findings of Papanicolaou smear were increased in the elderly aged 60 years and older as increasing their age. Much more attentions and follow up plans for these disease should be needed in the elderly.

A Case of Mixed Malarial Infection with Plasmodium falciparum and Plasmodium vivax / 감염

We experienced a case of mixed infection with Plasmodium falciparum and P. vivax in a 48-year old Korean man. He returned to Korea from Papua New Guinea, where he worked for 20 days. Approximately one month after return to Korea, he developed high fever and myalgia. Malaria was suspected and he was admitted to our hospital. The peripheral blood smear demonstrated ring forms of P. falciparum. He was treated with quinine and doxycycline successfully. However, fever and myalgia reappeared five months later. This time, the peripheral blood smear showed gametocytes of P. vivax, while indirect immunofluorescence antibody test revealed high titers to both P. vivax and P. falciparum. He was treated with chloroquine and primaquine. Three months later, vivax malaria recurred again; he was treated with chloroquine and higher dose of primaquine. The patient was well after 6 months of follow-up. We hereby report a case of mixed malarial infections with a review of literatures.

Severe hypoglycemia in the elderly diabetes

BACKGROUND: Hypoglycemia is the most common therapeutic complication of diabetes mellitus and especially in elderly diabetic patients with diminished cardiac and cerebral circulation can cause serious tissue damage. Though many studies have attempted to evaluate hypoglycemia in IDDM or adult diabetic patients, few studies in the elderly. We have compared clinical characteristics of severe hypoglycemia in elderly diabetes with adult diabetes. METHODS: This study include 56 severe hypoglycemic patients who have admitted to emergency department of National Medical Center from march 1, 1992 to december 31, 1997. they are divided two group (adult group; 21, elderly group; 35) and authors investigate the cause, the symptom, the time of severe hypoglycemia, degree of education, treatment method in each group. RESULTS: 1) DM education was not well done in severe hypoglycemic patients. 2) The frequency of severe hypoglycemia in the elderly was more than adult (adult: 21 (38%), elderly 35 (62%)). 3) In both population, the most common symptom of severe hypoglycemia was neuroglycopenic symptom, especially in the elderly (adult: 57%, elderly: 77%). 4) Decreased food intake (49%) in the elderly and overdose of insulin (38%) in the adult were the most common cause of severe hypoglycemia. 5) Severe hypoglycemia occurred more often between midnight and 6 AM in the adult, between noon and 6 PM in the elderly. 6) The treatment of diabetes mellitus is insulin (71%) and oral hypoglycemic agent (29%) in the adult, oral hypoglycemic agent (51%) and insulin (49%) in the elderly. CONCLUSION: For prevention of severe hypoglycemia, we should emphasize the importance of DM education and especially elderly diabetic patients should be educated about the symptoms of hypoglycemia, the self-management of hypoglycemia, the need for a regular carbohydrate intake and more easy and effective diet program is require in elderly diabetes.

Barriers to dietary practice adherence among the elderly diabetes

BACKGROUND: Some research viewed that effective dietary therapy was enough to control proper blood glucose level, but in the most patient, dietary therapy was not practiced and the most difficult part of managing their diabetes. The purpose of this research study was to investigate dietary practice adherence and perceived barriers among the elderly diabetes. METHODS: The survey was mailed to 852 persons with diabetes member via diabetic educator of 156 hospitals or clinics and 24 health centers. Questionnaire had background information of patients, meal regularity, food intake as a dietary practice adherence, barriers of 36 items which have 3 areas such as motive/attitude, knowledge, authority/resource. We asked the person with diabetes to rate barrier to dietary practice adherence. 432 questionnaire were returned the response. we selected 69 persons who were over 65 year old. RESULTS: 1) meal regularity was more satisfactory than food intake. 2) deficit of meal regularity were evening snack and resonable spacing between evening meal and evening snack. 3) deficit of food intake was serving of milk. 4) main barrier to dietary practice adherence was that of knowledge. CONCLUSION: For practice effectively dietary therapy to elderly diabetes, individual consultation or small group education must be pursued and more easily educational skills should be required.

Utility of Serum Fructosamine as a Measure of Glycemia in Elderly Diabetic Patients

BACKGROUND: Glycemic profile has traditionally been with the use of HbAlc over a 2 to 4 month period. Recently, serum fructosamine is highly sensitive to acute metabolic deterioration(period 2 to 3 weeks), and is suitable for automation, allowing multiple assays with minimal effort. In some report, despite evidence suggesting a reduction in serum albumin level with increasing age, serum fructosamine was strongly correlated with HbAlc in elderly diabetic patients. This study was conducted to define the correlation between fructosamine and other parameters in elderly diabetic patients. METHODS: The study group consisted of 56 elderly patients(age range : 66-85 years, group A) and 58 adult patients(age range: 18-64 years, group B), who were stable over recent 2 months in fasting glucose values and serum albumin levels. Fructosamine was measured in 114 diabetic patients. The measured levels were related to HbAlc and fructosamine/albumin index(FAI). RESULTS: 1) There was significant correlation between HbAlc and fructosamine in all diabetic patients(r=0.705, p=0.0001). The correlation between HbAlc and fructosamine was stronger in group A than in group B [group A: r=0.831, group B: r=0.367, p=0.0001](p<0.05). 2) The correlation between HbAlc and FAI was significantly stronger compared to that between HbAlc and fructosamine in elderly diabetic patients(p<0.05). 3) Glycation ratio provides a vector-like insight into the recent trend of glycemia, and Glycation ratio was stable in all diabetic patients. CONCLUSIONS: Our study suggests that correlation between HbAlc and fructosamine in elderly daibetic patients was significantly lower in adult diabetic patients. Further studies are needed to determine the ultimate values of this test in the clinical management of elderly patient with diabetes.