Reference values of carotid artery intima-media thickness and association with atherosclerotic risk factors in healthy subjects in Korea / 대한내과학회지

BACKGROUND: Atherosclerosis is an important cause of cardiovascular and cerebrovascular diseases, which are the major cause of death in middle-aged and older adults. However atherosclerotic lesions are not easily detected before they cause symptoms and signs which means that early detection is important. In Korea it has been reported that the carotid artery intima-media thickness (IMT) correlates well with the atherosclerotic risk factors in type 2 diabetes mellitus, but there is little data available on the carotid artery IMT in healthy subjects. Therefore, the aims of this study were to determine the reference values of the carotid artery IMT in healthy subjects and to investigate the associations of the carotid artery IMT with the atherosclerotic risk factors. METHODS: Ultrasound high-resolution B-mode imaging of the carotid arteries was conducted in 757 healthy subjects (385 men, 372 women) in order to determine the mean and maximal carotid artery IMT and the presence of carotid artery atherosclerotic plaques. RESULTS: The mean carotid artery IMT values with respect to gender were 0.69+/-0.18 mm in men and 0.67+/-0.16 mm in women (NS). The mean carotid artery IMT values with respect to age in men and women were 0.57+/-0.09 mm vs 0.57+/-0.10 mm in those aged 30 to 39, 0.61+/-0.11 mm vs 0.60+/-0.10 mm in those aged 40 to 49, 0.72+/-0.21 mm vs 0.67+/-0.12 mm in those aged 50 to 59, 0.77+/-0.15 mm vs 0.71+/-0.13 mm in those aged 60 to 69 and 0.88+/-0.18 mm vs 0.76+/-0.20 mm in those aged 70 to 79, respectively. The mean carotid artery IMT was significantly greater with increasing age (p<0.001), particularly between those aged 40 to 49 and 50 to 59 (p<0.001). The maximal carotid artery IMT values for men (0.72+/-0.22 mm) were significantly greater than women (0.69+/-0.15 mm). The maximal carotid artery IMT values with respect to age in men and women were 0.60+/-0.10 mm vs 0.61+/-0.12 mm in those aged 30 to 39, 0.65+/-0.11 mm vs 0.64+/-0.11 mm in those aged 40 to 49, 0.79+/-0.29 mm vs 0.71+/-0.14 mm in those aged 50 to 59, 0.83+/-0.20 mm vs 0.77+/-0.18 mm in those aged 60 to 69 and 0.97+/-0.29 mm vs 0.80+/-0.22 mm in those aged 70 to 79. The mean carotid artery IMT was significantly greater with increasing age (p<0.001), particularly between those aged 40 to 49 and 50 to 59 (p<0.001). Age, systolic and diastolic BP, body mass index, waist/hip ratio, total cholesterol, LDL cholesterol correlated with the mean and maximal carotid artery IMT, and smoking, serum glucose, triglyceride, and HDL cholesterol levels were not correlated with the mean and maximal carotid artery IMT. Being male correlated with the maximal carotid artery IMT, but not correlated with the mean carotid artery IMT. CONCLUSION: This study suggested reference values for the mean and maximal carotid artery IMT in healthy subjects, which can be an index for the carotid artery IMT of Koreans. Furthermore, there were significant correlations between the carotid artery IMT and the atherosclerotic risk factors in healthy subjects.

The comparison of intra-abdominal fat distance (I-A Fat Distance) and visceral adipose tissue area (VAT) or visceral fat to skeletal muscle area ratio (VMR) measured by computed tomography (CT) / 대한내과학회지

BACKGROUND: Visceral fat accumulation plays a major role in metabolic syndrome and increased cardiovascular risks. Clinical evaluation of visceral fat by CT is not widely used because of high cost, low availability, and ionizing radiation risk, and alternative means are required. To assess the usefulness of ultrasound measurement of I-A fat distance for the evaluation of visceral obesity, we compared several length-associated parameters (I-A fat distance, I-A fat distance to thigh muscle length ratio, and I-A fat distance to abdominal subcutaneous fat length ratio) with area-associated parameters (VAT, visceral fat to subcutaneous fat area ratio [VSR] and VMR) measured by CT. METHODS: We evaluated 65 patients with type 2 diabetes (34 men and 31 postmenopausal women). CT scans were obtained at the L4-5 level and the mid-portion between greater trochanter and upper margin patella. I-A fat distance was defined as the distance between the internal face of rectus muscle and the anterior wall of the aorta. Also ultrasonography for measurement of I-A fat distance was performed in 20 men of subjects. RESULTS: Of the various parameters examined, I-A fat distance was most closely correlated with the VAT (r=0.76, p<0.001) and VMR (r=0.71, p<0.001) but not VSR (r=0.18, p=0.22). This distance positively correlated with serum triglyceride and free fatty acids in men (r=0.56 and r=0.59, p<0.05, respectively), and with uric acid (r=0.70, p<0.05), fasting insulin levels (r=0.70, p<0.001), insulin resistance index by HOMA (r=0.69, p<0.001), systolic blood pressure (SBP) (r=0.73, p<0.05), and diastolic blood pressure (DBP) (r=0.85, p<0.001) in women. When the clinical and laboratory data was considered by tertiles of I-A distance, serum uric acid, fasting insulin levels, insulin resistance index (HOMA), BMI, waist or hip circumference, SBP, and DBP were significantly higher in the top tertile, but not WHR. I-A fat distance measured by ultrasonography significantly correlated with VAT, VSR, and VMR (r=0.79, r=0.71, and r=0.79, p<0.05, respectively). CONCLUSION: These results suggest that 1) I-A fat distance may substitute for the VAT in assessment of visceral fat content and may be relatively good parameter indicative of visceral obesity and/or insulin resistance, and 2) several parameters (e.g., VAT, VSR, and VMR) related with visceral fat by CT may be replaced with ultrasonographic I-A fat distance.

Lack of Association Between Osteoarthritis of the Knee and Gene Polymorphisms of VDR in Korean Postmenopausal Women / 대한류마티스학회지

OBJECTIVE: To determine whether polymorphisms of the Vitamin D receptor (VDR)gene,known to be associated with osteoporosis and/or osteoarthritis (OA) in Caucasians,might also relate to the risk of OA and osteoporosis in Korean postmenopausal women METHODS: A population of 130 postmenopausal women,including 76 healthy controls and 54 knee OA patients,were studied using anteroposterior radiographs of the knee,which were graded for OA according to the Kellgren classification system.The VDR genotype was determined by using polymerase chain reaction and by digestion with the three restriction enzymes Taq I,Bsm I,and Apa I.Femoral neck bone mineral density (BMD)was assessed in all participants by dual energy X-ray absorptiometry . RESULTS: VDR genotype frequency distributions in Koreans were much different from Caucasian's both in the OA group and the control group.Especially, "t t", "B B" and "A A" genotype were very rare,prominently differentiating from Caucasians.But within Koreans,no significant differences in VDR genotype frequencies were observed between OA cases and controls.VDR genotype was not significantly associated with the radiographic grades of OA.And there were no significant relationships of VDR genotype with BMD scores in each group. CONCLUSION: In Korean postmenoposal women,the VDR gene polymorphisms do not significantly contribute to an increased prevalence of knee OA or to differences in BMD.VDR genotype analysis would not be helpful for assessing the risk of knee OA in Koreans because :(1)there is no correlation of VDR genotypes with the radiographic severity of OA ;and (2)there is a more skewed distribution of VDR genotypes in Korean population compared to the Caucasian's .

A Case of Primary Benign Histiocytosis X of the Stomach / 대한소화기내시경학회지

To our knowledge, there are only six cases of histiocytosis X confined to the stomach. A rare case of gastric polyposis caused by infiltration of histiocytes is reported. A 35-year-old Korean woman with no particular complaints was found to have numerous polyps all over the gastric wall revealed by radiographic and endoscopic examination. Endoscopic biopsy of polyps showed that there were diffuse solid infiltration of hidstiocytes with indistinct cytoplasmic membrane and an absence of phagocytosis in laminar propria mucosae. Immunohistiochemical stain showed positive reaction for S-100 and CD68 and a negative reaction for cytokeratin in the infiltrating histiocytes. Electron microscopic examination showed foamy vacuoles with digested debris around nucleus and displaced cellular organelles to periphery. Systemic examination showed no abonormalities outside the stomach.

A Case of the Membranous Glomerulonephritis Associated with Squamous Cell Lung Cancer / 결핵

The nephrotic syndrome that occurs in the absence of renal vein thrombosis, amyloidosis, neoplastic infiltration of the kidneys is an unusual but a well recognized paraneoplastic syndrome. The most frequently reported neoplasms associated with nephrotic syndrome are Hodgkin's disease and various carcinomas. The most common renal lesions are membranous glomerulonephritis(MGN) associated with carcinomas and minimal change lesions associated with Hodgkin's disease. Approximately 40% to 45% of patients clinically manifest the MGN symptoms prior to the diagnosis of the tumor, 40% simultaneously with the tumor and the remaining 15% to 20% following the tumor. Therefore, evaluating the underlying malignancy in patients with MGN is important. Here we report a patient with squamous cell lung cancer, which was detected 12 months after a MGN had been diagnosed, with a review of the relevant literature.

A Case of Heat Stroke in an Aluminium Utensil Plant / 대한산업의학회지

An 18-year-old man suffered heat stroke after continuous working for 26 hours on his first day in an aluminium utensil plant in August 1998. His job was to put a pressed aluminium utensil on the conveyer before the process of spray painting. The ranges of temperature and relative humidity measured at the local weather-station during the patient' s working period were 23.6-30.2 degrees C, 49-87 % respectively. On arrival the patient was comatose and suffered generalized seizure three times. His rectal temperature was 41.2 degrees C . blood pressure was 90/60 mmHg, pulse was 148 beats/minute and respiratory rate was 28 times/minute. The serum level of AST was 421 IU/L. ALT was 205 IU/L, LDH was 1,160 IU/L. myoglobin was higher than 500 ng/mL. OK was higher than 2,000 IU/L. He recovered consciousness 7th day of admission and discharged after 2 months but cerebellar dysarthria was remained. The patient felt himself several prodromal symptoms of heat stroke and he showed awkward behavior considered to be drowsiness, but the patient and his co-workers neglected them. This case report shows that heat stroke can be occurred in a condition that ambient temperature, humidity, and working load are not extreme. A thorough health education and management concerned with guidelines on salt and water intake, detection of early symptoms of heat-related illness, prompt body cooling and rapid transportation to a hospital is necessary.