Relationship between serum osteoprotegerin levels and bone mineral metabolism in women / 대한내과학회지

BACKGROUND: Osteoprotegerin (OPG) is a recently identified cytokine that acts as a decoy receptor for the RANK ligand. OPG has been shown to be an important inhibitor of osteoclastogenesis in animal models. The relationship between circulating OPG levels and female bone status in human populations is unclear. Thus, the aim of this study was to investigate the relationship between circulating OPG levels and bone mineral metabolism in Korean women. METHODS: ubjects were 287 women aged 37~73 (mean age, 51.5 yr). Serum concentrations of OPG were determined by ELISA. Biochemical markers of bone turnover and follicle stimulating hormone (FSH) were measured by standard methods. Bone mineral density at lumbar spine and femur neck were measured by dual energy X-ray absorptiometry. RESULTS: e observed a significant positive association between circulating OPG levels and urine calcium excretion (r=0.128; p<0.05). Although circulating OPG levels were not significantly correlated to urine deoxypyridinoline levels (r=0.105; p=0.076), but there was a weak trend in it. We found that mean OPG levels were about 11% greater in postmenopausal women (mean +/- SD, 1358.5 +/- 380.0 pg/mL) than in premenopausal women (1228.8 +/- 407.7 pg/mL; p<0.001). There was a significant positive relationship between circulating OPG levels and serum FSH levels (r=0.172; p<0.01). There was a non-significant relationship between circulating OPG levels and bone mineral density at lumbar spine and femur neck. CONCLUSION: In conclusion, our data shows that the circulating OPG levels are associated with urine calciumexcretion and serum FSH levels in Korean women. These data suggest that OPG may be an important paracrine mediator of female bone metabolism in human populations.

The effects of C161->T polymorphisms in exon 6 of peroxisome proliferator-activated receptor-gamma gene on insulin resistance and the prevalence of metabolic syndrome in healthy korean subjects / 대한내과학회지

BACKGROUND: Peroxisome proliferator-activated receptor (PPAR)gamma is a member of nuclear receptor family, known to be involved mainly in adipocyte differentiation and suggested to play an important role in the pathogenesis of insulin resistance and diabetes. Although PPAR gamma Pro12Ala polymorphism has been massively studies under the hypothesis that it could have a protective effect against the development of diabetes, studies on the association of other PPAR gamma polymorphisms with insulin resistance and diabetes are scarce. We investigated the frequencies of PPAR gamma exon 6 C->T substitution in healthy Koreans and the correlations between different genotypes and insulin resistance and the prevalence of metabolic syndrome. METHODS: In total 335 Korean adults (37-73 years, mean age 52 +/- 7 years, 72 males, 263 females), body mass indices (BMI, Kg/m2) were calculated from height and weight measurements and blood pressure, fasting blood glucose, fasting insulin, serum lipid profiles were measured. Homeostatic model assessment (HOMA) and Quantitative Insulin Sensitivity Check Index (QUICKI) were calculated as insulin resistance indices. Metabolic syndrome was diagnosed according to Adult Treatment Panel (ATP) III guidelines, substituting waist circumference with BMI. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was done in all blood samples and statistical analysis were performed among different genotypes CC, CT and TT. RESULTS: The frequency of CC genotype was 64.5%, 31.6% for CT and 3.9% for TT genotype and the frequency of C allele was 0.803 and 0.197 for T allele, which was in Hardy-Weinberg equilibrium (p>0.05). There were no differences in the mean values of age, percent body fat (%), blood pressure, fasting blood glucose level, fasting insulin levels and HOMA, QUICKI and lipid battery among different genotypes (p>0.05). The prevalences of metabolic syndrome were not different among different genotypes, however, when prevalences of each components of metabolic syndrome was compared individually, the prevalence of fasting hyperglycemia (>or=110 mg/dL) was higher in group with T allele than group with CC genotype (pT polymorphism in Korean people was similar to that in caucasians. Although insulin resistance indices, BMI, prevalence of metabolic syndrome were not different among different genotypes, the fact that the prevalence of fasting hyperglycemia was higher and that of low HDL-C was lower in group with T allele suggests the role of this polymorphism in negative way in glucose metabolism and in positive way in atherosclerosis, which needs further investigation.

The Effects of C161-->T Polymorphisms in Exon 6 of Peroxisome Proliferator-Activated Receptor- Gene on Bone Mineral Metabolism and Serum Osteoprotegerin Levels in Healthy Korean Middle-aged Men / 대한내분비학회지

BACKGROUND: The peroxisome proliferator-activated receptor (PPAR) is a member of the nuclear receptor family known to be involved in adipocyte differentiation. Recent studies have revealed the inhibitory role of PPAR in osteoblastogenesis, which suggests its possibility as a candidate gene for osteoporosis. The frequency of C161-->T substitution in exon 6 of PPAR was observed in Korean men and the association of different genotypes with bone turnover markers, bone mineral density (BMD) and serum osteoprotegerin (OPG), which play inhibitory roles in osteoclastogenesis, examined. METHODS: In 72 healthy Korean men (mean age 54.5 6.4 yrs; range 42~69 yrs), anthropometric measurements, and lumbar spine and femoral neck BMD, and bone turnover markers, such as alkaline phosphatase (ALP), serum calcium, phosphorus, osteocalcin and cross-linked C-telopeptides of type I collagen (ICTP) measurements were performed. The levels of serum testosterone, estradiol and insulin-like growth factor (IGF-I), and those of serum OPG levels, were measured with a sandwich enzyme-linked immunosorbent assay (ELISA) method. The DNAs were extracted from the samples, and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and the sequencing of the products were performed to confirm the substitution. RESULTS: The allele frequencies were 0.799 and 0.201 for the C and T allele, respectively, which were in Hardy-Weinberg equilibrium (p=0.80). Subjects with the CT genotype were older and those with the T allele showed higher blood pressure levels and lower body mass indices (p0.05). The levels of serum testosterone, estradiol, IGF-I and OPG were not different among the different genotype groups (p>0.05). The lumbar, femoral neck BMD (g/cm2) and T scores were significantly lower in subjects with T alleles, and those with CT genotypes showed the lowest BMD values (pT substitution in exon 6 of the PPAR gene in Korean men were similar to those observed in other races, and those with the T alleles showed significantly lower BMD values. These data imply the PPAR gene might be a candidate gene for the pathogenesis of osteoporosis

Lipoma of the transverse colon with intussusception: A case report / 대한내과학회지

Colonic lipomas represent the most frequent mesenchymal benign tumors of the large intestine after hyperplastic polyps and adenomatous polyps, but the pathogenesis is unclear. These tumors are composed of mature fatty tissue and usually arise in the submucosa. They are usually solitary and small, and may be sessile or pedunculated. Most patients are asymptomatic and their tumors are often detected incidentally, but tumors larger than 2 cm tend to produce change in bowel habit, abdominal pain, rectorrhagia and complications such a luminal obstruction or intestinal intussusception. Diagnosis may be aided by colonoscopy with biopsy, barium enema and computed tomography. Colonic lipomas occur most often in the right colon, particularly in the ileocecal valve. Some cases of such lipoma of transverse colon have been reported in Europe and the United States, but rare in Korea. We report a case of lipoma of the transverse colon that was originated in subserosa and presented as a intussusception in a 63-year-old woman with brief review of literatures.

Recurrent Pulmonary Thromboembolism Treated with Urokinase

The symptoms and signs of acute pulmonary arteries thrombosis are nonspecific. So clinical suspicion is the most important in the diagnosis. Treatment of pulmonary thromboembolism include anticoagulant, thrombolytic agent, or surgical intervention. We experienced a case of recurrent pulmonary thromboembolism without coagulation defect and any risk factor except old age and obese. Initially we treated with heparin, but clinical symptoms were aggravated. After we changed to urokinase (total 330 million IU/2 days), the pulmonary arteries obstruction were resolved and clinical symptoms were improved without any complications. So we report this clinical experience with review of articles.

Infective Endocarditis with Systemic Septic Emboli

Infective endocarditis is still one of the important fatal diseases, especially with systemic embolic manifestations. Infective endocarditis is often misdiagnosed because of variability of systemic embolic manifestations. We have experienced 3 cases of infective endocarditis with systemic embolic manifestations who were initially misdiagnosed as other infectious diseases. Case 1 is a 66 year-old man, who was admitted to our hospital with dyspnea , fever and petechia. His chest X-ray showed rapid decrease of cardiomegaly and pulmonary congestion in two days. At 1 week after discharge he was readmitted for recurrent fever. On the follow-up echocardiography, mitral regurgitation was newly detected. Case 2 is a 75 year-old man, who was admitted to neurology department with sudden left hemiplegia and headache, in whom it was initially difficult to differentiate from ischemic brain infarction. Case 3 is a 29 year-old man, who was admitted to neurosurgery department with fever and back pain, in whom it was initially difficult to diffrentiate from tuberculous spondylitis in early radiologic study. All 3 cases were treated effectively with appropriate antibiotic therapy and discharged with improvement of symptoms. We report 3 cases of systemic embolic manifestations complicated by infective endocarditis with a brief review of literatures.

A case of diabetic hyperosmolar coma treated successfully with conversion to hemodialysis in a chronic renal failure patient on CAPD treatment / 대한내과학회지

Continuous ambulatory peritoneal dialysis(CAPD) is now the most important and effective therapeutic modality as well as hemodialysis(HD) and renal transplantation in patients with chronic renal failure. It is frequently recommended to diabetic renal failure patients because of poor, athersclerotic vascularity of them. Hyperglycemia and obesity are not uncommon complications of CAPD therapy. But there were only few reports of very severe hyperglycemia or hyperosmolar coma in CRF patients on CAPD therapy, especially with 7% dextrose CAPD dialysate in foreign countries in the past. Moreover, no specific management for hyperosmolar coma is established in those situations yet. In Korea, only three cases of hyperosmolar coma in non diabetic renal failure patient on CAPD therapy have been reported in one case report. And only one case among them whose CAPD therapy was changed to HD survived. Authors also experienced a case of diabetic hyperosmolar coma treated successfully with conversion to HD in chronic renal failure patient on CAPD therapy. So we report this case with a review of literature. Taken together with this case and review of literature, changing CAPD therapy to HD is regarded to be an important part of treatment when hyperosmolar coma develops in chronic renal failure patients.

A case of diabetic hyperosmolar coma treated successfully with conversion to hemodialysis in a chronic renal failure patient on CAPD treatment / 대한내과학회지

Continuous ambulatory peritoneal dialysis(CAPD) is now the most important and effective therapeutic modality as well as hemodialysis(HD) and renal transplantation in patients with chronic renal failure. It is frequently recommended to diabetic renal failure patients because of poor, athersclerotic vascularity of them. Hyperglycemia and obesity are not uncommon complications of CAPD therapy. But there were only few reports of very severe hyperglycemia or hyperosmolar coma in CRF patients on CAPD therapy, especially with 7% dextrose CAPD dialysate in foreign countries in the past. Moreover, no specific management for hyperosmolar coma is established in those situations yet. In Korea, only three cases of hyperosmolar coma in non diabetic renal failure patient on CAPD therapy have been reported in one case report. And only one case among them whose CAPD therapy was changed to HD survived. Authors also experienced a case of diabetic hyperosmolar coma treated successfully with conversion to HD in chronic renal failure patient on CAPD therapy. So we report this case with a review of literature. Taken together with this case and review of literature, changing CAPD therapy to HD is regarded to be an important part of treatment when hyperosmolar coma develops in chronic renal failure patients.