The effect of statins on HDL-cholesterol in type 2 diabetic patients / 대한내과학회지

BACKGROUND/AIMS: Statins have been a mainstay of treatment for primary and secondary prevention of coronary heart disease through their beneficial effect on lipid profile. However, their effect on the HDL cholesterol level has been determined to be equivocal or unclear. This study sought to investigate HDL cholesterol response to statin treatment in type 2 diabetic patients. METHODS: We retrospectively assessed the effect of statins in 217 patients with type 2 diabetes and dyslipidemia through chart review. Patients who were using medications such as fibrates, niacin, or thiazolidinediones, or had a plasma creatinine concentration greater than 1.5 mg/dL, a fasting triglyceride level greater than 300 mg/dL, or chronic liver disease, were excluded from the study. RESULT: The mean level of LDL cholesterol was significantly decreased, and the percentage of patients who achieved the normal LDL cholesterol level was increased in this study. The mean HDL cholesterol level after statin treatment was decreased by 2.3%. The percent change of HDL cholesterol was affected by baseline HDL cholesterol level, percent change of total cholesterol, percent change of LDL cholesterol, and baseline total cholesterol level. When subjects were divided into quintiles according to baseline HDL cholesterol, HDL cholesterol level was found to be increased in the lowest two quintiles while it was decreased in the highest two quintiles. CONCLUSIONS: There were some patients whose HDL cholesterol level was decreased after statin treatment, depending on their baseline HDL cholesterol level. We think further study on the effect of statins on HDL level will be needed in the future.

Cloning of a Family of Serine Protease Genes Expressed in German Cockroach(Blattella germanica) and Possibility as Allergens / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The serine protease allergens have been known as one of the most important inhalent allergens of insects as well as house dust mites. There is no known serine protease allergen of German cockroach, which is a well-known etiological agent of allergic diseases. We identified the serine protease genes of cockroach, Blattella germanica, and examined its possibility as an allergen. MATERIALS AND METHOD: We have isolated three partial genes, Bg3, Bg5 and Bg6, of serine protease from the Blattella germanica cDNA library using the degenerate oligonucleotide PCR primers specific for the conserved regions. RESULTS: The genes, Bg3, Bg5 and Bg6, were composed of 396 bp 131 amino acids, 513 bp 170 amino acids, and 410 bp 136 amino acids, respectively. Northern hybridization analysis indicated that the size of Bg5 and Bg6 transcripts was approximately 0.7 kb. The gene, Bg5, was also identified as a multiple gene by the Southern blot analysis. The gene, Bg3, showed significant homology to trypsin-like serine protease of various insects. The deduced amino acids sequence of the gene Bg5 was matched to the mite group III allergen as well as various species of insect serine protease sequences. The gene Bg6 also showed high homology to the amino acids sequences of insect serine proteases and mite group III allergens. Three Blattella germanica serine protease gene fragments revealed close genetic relationships with Dermatophagoides farinae group III allergen in the phylogenetic analysis. CONCLUSION: The high homology and close phylogenetic relationship raise the possibility of three serine protease genes as being an allergen of German cockroach.

Comparison of the Efficacy of Systemic and Intratympanic Steroid Treatment on Sudden Sensorineural Hearing Loss with Diabetes / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: High dose systemic steroid therapy is currently the mainstay of the treatment for sudden sensorineural hearing loss (SSNHL). However, it makes a glycemic control worse in patients with diabetes. Intratympanic steroid injection (ITSI) can result in reduced systemic steroid toxicity and higher perilymph steroid level selectively. The purpose of this study is to compare the efficacy of ITSI (IT group) with that of systemic steroid (IV group) on SSNHL with diabetes. SUBJECTS AND METHOD: Thirty eight SSNHL patients who were diagnosed with diabetes were divided into the IV group (19 patients) and the IT group (19 patients). In the IV group, prednisolone was administrated intravenously for 7 days followed by tapered doses orally for 7 days. In the IT group, dexamethasone was administrated 4 times within a 2 week-period. Hearing outcome was assessed before and after treatment. RESULTS: In the IV group, 10 patients (58.8%) showed an improvement in the pure tone audiogram (PTA), with a mean improvement of 17.6 dB (p=0.023). In the IT group, 16 patients (84.2%) showed improvement in the PTA, with the mean improvement of 25.1 dB (p=0.000). But there was no significant difference in hearing gain and the recovery rate between the two groups. And it is more difficult to control blood sugar in the IV group rather than in the IT group. CONCLUSION: ITSI treatment is as effective as the systemic steroid treatment for SSNHL patients with diabetes and it can avoid a significant side effect of systemic steroids. So it could be considered as an initial treatment for the SSNHL patient with diabetes.

Reconstruction of the Posterior Canal Wall with Mastoid Obliteration after Canal Wall Down Mastoidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There have been heated controversies over the choice of the canal wall down mastoidectomy (CWD) and canal wall up mastoidectomy (CWU), which are operational methods used to eliminate the lesion of cholesteatoma. Combining the advantages of both methods, we reconstructed the posterior canal wall with conchal cartilage plate and obliterated mastoid cavity with bone chips (group I), or hydroxyapatite mixed with bone chips (group II) since 2001. This study was designed to evaluate the surgical outcomes of posterior canal wall reconstruction with mastoid obliteration in the treatment of cholesteatoma. SUBJECTS AND METHOD: From January of 2001 to March of 2007, the posterior canal wall reconstruction with mastoid obliteration was conducted on 66 patients. There were 30 cases of cholesteatoma and 36 cases of old radical cavity. The postoperative observation period ranged from 5 to 74 months, with the average period of 34.7 months. We analyzed the postoperative complications, and hearing results of the 33 ossicular reconstruction cases. RESULTS: There was 1 case of residual cholesteatoma in the middle ear cavity, but no recurrent cholesteatoma. In most cases, reconstructed canal wall was maintained well, but partial canal wall resorption and postauricular dimpling occurred in 5 cases of group I. On the other hand, the epithelization of posterior canal wall was incomplete in 4 cases of group II. After surgery, no patients complained any cavity problems at all. CONCLUSION: The present study suggests that this procedure can prevent cavity problems and reduce the recurrence of cholesteatoma with destructed canal wall.

A Case of a Gastric Gastrointestinal Stromal Tumor with a Fistula and Gastrointestinal Bleeding / 대한소화기내시경학회지

There has been much debate on the origin, differentiation and prognosis of gastrointestinal stromal tumors (GIST). Based on recent studies, we consider Cajal interstitial cell as the origin of a GIST. The common symptoms of a GIST are abdominal pain, hemorrhage, and the presence of a mass. However, there are few reported cases of a GIST with abscess pockets that communicate with the lumen of the stomach via a fistula. We report a case of a GIST of the stomach presenting with an abscess and a fistula communicating with the lumen of the stomach. An 84-year-old man presented with continuous fever and general weakness. We were able to diagnose the disease by an endoscopic examination, CT scan, biopsy and by cellular immunohistochemical staining.

Dry eye in patients with fibromyalgia / 대한내과학회지

BACKGROUND: Dry eye is a disorder of the tear film caused by reduced tear production or excessive tear evaporation. A high incidence of sicca symptoms has been noted in fibromyalgia (FM) patients resulting in serious complications. This study was conducted to evaluate the incidence of dry eye by pathogenic mechanisms and to investigate the relationship between dry eye and symptom severity in FM patients. METHODS: Fifty patients that visited Maryknoll Hospital between March 2006 and December 2006 were included in the study. Enrolled patients underwent a Korean fibromyalgia impact questionnaire (KFIQ), ocular surface disease index (OSDI), Schirmer test and tear break up test (TBUT). The KFIQ and OSDI are used to assess the severity of fibromyalgia symptoms and dry eye symptoms, respectively. The Schirmer test and TBUT are used to assess reduced tear production and excessive tear evaporation, respectively. We assessed the OSDI, Schirmer test, TBUT, age and disease duration in terms of the KFIQ. RESULTS: The incidence of dry eye was high in FM patients (12.0% by the Schirmer test and 92.0% by the TBUT test). The OSDI positively correlated with the KFIQ (p=0.006). A positive correlation was observed between the Schirmer test and the KFIQ (p=0.024), but not between the TBUT and the KFIQ. CONCLUSIONS: In this study, dry eye was found to be common in FM patients. Excessive tear evaporation was a more common cause of dry eye than reduced tear production. The patients with more severe dry eye symptoms tend to have more severe FM symptoms.

A Case of Actinomycosis of the Vocal Cord / 대한이비인후과학회지

Actinomycosis is a chronic granulomatous infective disease caused by microaerophilic gram-positive bacteria of the genus Actinomyces. It presents a challenging clinical diagnostic dilemma because of variable presentations in the head and neck. It involves the upper airway and gastrointestinal tract. Actinomycosis of the larynx is rare, especially in vocal cord. Here, we report a rare case of actinomycosis presenting as a vocal cord nodule in a healthy 45-year-old woman with a review of the literature.

Serum lipid profile in patients with fibromyalgia / 대한내과학회지

BACKGROUND: Fibromyalgia syndrome (FMS) is a chronic musculoskeletal disorder that's characterized by widespread bodily pain, chronic fatigue, irritable bowel syndrome and increased tenderness at specific anatomic sites. This study was undertaken to compare the serum lipid profiles in patients with FMS and the healthy controls, and we also wanted to investigate relationship between the serum lipid levels and the symptoms in FMS patients. METHODS: Fifty three patients who visited Maryknoll Hospital between March 2001 and March 2005 were included; they were compared with 53 age & gender matched healthy adults. We assessed the serum lipid profile of the FMS patients in terms of the tender points, the Korean Fibromyalgia Impact Questionnaire (KFIQ) scores and the Korean Center for Epidemiologic Studies Depression (KCES-D) scores. RESULTS: Total cholesterol (208.9+/-38.5 vs 194.2+/-37.1, respectively, p=0.047) and LDL cholesterol (low density lipoprotein cholesterol, 121.9+/-31.0 vs 109.3+/-32.2, respectively, p=0.043) were significantly higher in the FMS patients than in the controls. The tender points and KCES D scores were inversely influenced by the total cholesterol, and there was a statistically significant difference. The KFIQ score was inversely influenced with the lipid profile, but there was no statistically significant difference. CONCLUSIONS: The results showed significant differences in the lipid levels of FMS patients and the controls. More extensive investigation of the lipid levels is required to determine whether the lipid levels are associated with FMS.

Assessment of Left Ventricular Function in Symptomatic Patients with Myocardial Bridge using Two-Dimensional Strain

BACKGROUND AND OBJECTIVES: We wanted to perform quantitative echocardiographic assessment of myocardial function in the patients with myocardial bridge by measuring 2-dimensional strain with using newly developed software. SUBJECTS AND METHODS: Novel computer software was used for tracking heart tissue on echocardiography, and we conducted an advanced wall-motion analysis for 18 symptomatic patients (mean age: 57.1+/-9.7 years, 10 female) with myocardial bridging of the left anterior descending coronary artery and also 20 age-matched healthy controls. The conventional wall-motion scoring was normal in all the patients, and the software was able to adequately track their heart tissue. RESULTS: The maximal angiographic systolic lumen diameter reduction within the myocardial bridges was 71+/-12.6% at rest, with a persistent diameter reduction of 31.2+/-11.3%. The radial strain and displacement of the anterior segments were more significantly reduced than that of the posterior segments at the level of the papillary muscle (30.9+/-13.8% vs. 51.8+/-17.3% and 4.8+/-0.9 vs. 5.9+/-1.5, respectively, all p<0.05), and this showed a plateau (39% and 33%, respectively) or biphasic (50% and 56%, respectively) pattern. The time from the R wave on electrocardiography to the transition from regional systole to early diastolic lengthening (Tr) was significantly delayed in the patients with myocardial bridge more than that for the controls (497+/-20.4 ms vs. 348+/-12.5 ms, respectively, p<0.05). CONCLUSION: Delayed systolic contraction and diastolic relaxation are important mechanisms that contribute to ischemia in the patients with myocardial bridge. 2-dimensional strain can be used to achieve real-time wall-motion analysis, and it has the potential to improve the identification and functional quantification of myocardial Bridge.