Sleep Duration and Glycemic Control in Patients with Diabetes Mellitus: Korea National Health and Nutrition Examination Survey 2007-2010

Short sleep duration has been reported to increase the risk of diabetes. However, the influence of sleep duration on glycemic control in diabetic patients has not been clarified. In this study we evaluated the association between sleep duration and glycemic control in diabetic patients. We analyzed the data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2007-2010. Sleep duration was classified into five groups: or =9 h/day. Fasting blood glucose and HbA1c showed a U-shaped trend according to sleep duration. Sleep duration of 7 h/day had the lowest HbA1c (7.26%) among the subjects (P=0.026). In the older age group (> or =65 yr), a sleep duration of 6 h/day was associated with the lowest HbA1c (7.26%). The adjusted odds ratio (OR) with a 95% confidence interval (CI) of worse glycemic control (HbA1c > or =7.0%) in group of sleep duration of > or =9 h/day was 1.48 (1.04-2.13) compared with the group of 7 h/day. This relationship disappeared after adjusting duration of diabetes (OR, 1.38; 95% CI, 0.93-2.03). Our results suggest that sleep duration and glycemic control in diabetic patients has U-shaped relationship which was mainly affected by duration of diabetes.

Letter: Basal C-peptide Level as a Surrogate Marker of Subclinical Atherosclerosis in Type 2 Diabetes Patients (Diabetes Metab J 2011;35:41-9)

No abstract available.

The Relationship between Diabetes Mellitus and Health-Related Quality of Life in Korean Adults: The Fourth Korea National Health and Nutrition Examination Survey (2007-2009)

BACKGROUND: Diabetes is a major health problem in Korea. However, interest in the quality of life in patients with diabetes is low. We examined the effects of diabetes on health-related quality of life (HRQoL) and compared it with HRQoL in the general Korean population using the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) (2007-2009). METHODS: Using KNHANES IV data, we compared EuroQol (EQ)-5D and EQ-visual analogue scale (VAS) scores after adjusting for sociodemographic and psychosocial factors as well as for comorbidities (hypertension, heart disease, stroke, arthritis, and chronic renal disease). Logistic regressions were used to explore determinants for the lowest quintile HRQoL scales in the diabetes group. RESULTS: The mean age of the 14,441 enrolled subjects (6,129 men and 8,312 women) was 52.5+/-14.5 years. The mean EQ-5D and EQ-VAS scores were significantly lower in the diabetes group (EQ-5D. 0.87; EQ-VAS, 71.94) than in the non-diabetes group (EQ-5D, 0.94; EQ-VAS, 77.40) (P<0.001). Self-reported depressive symptom had a significant effect on lowering the EQ-VAS (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.1 to 2.6) in the diabetes group. Stress level had a significant effect in lowering both the EQ-5D (OR, 2.0; 95% CI, 1.3 to 2.9) and the EQ-VAS (OR, 1.9; 95% CI, 1.3 to 2.9). HbA1c, diabetes duration, and treatment modalities had no significant effect on lowering HRQoL. CONCLUSION: Diabetes was clearly associated with impaired HRQoL compared with the non-diabetic population regardless of comorbidities. Therapeutic approaches should focus much more on the subjective perception of health in patients with diabetes.

A Case of Acute Renal Failure Complicated by the Poisoning of Amanita virgineoides / 대한신장학회지

Mushroom poisonings are potentially fatal. Most fatalities are due to the amatoxin that causes fulminant hepatic failure and acute renal failure. We report a patient who developed acute renal failure after ingesting Amanita virgineoides, which required renal replacement therapy, despite recovery of liver injury. A kidney biopsy showed acute tubular necrosis. The patient was recovered with the supportive care and temporary hemodialysis.

Factors associated with liver stiffness in chronic liver disease / 대한간학회지

BACKGROUND/AIMS: Transient elastography is a new noninvasive tool for measuring liver stiffness that accurately predicts significant fibrosis and cirrhosis. However, several studies have indicated that liver stiffness can be significantly influenced by major changes in aminotransferase in patients with chronic viral hepatitis. The aim of this study was to determine the factors influencing liver stiffness in patients with chronic liver disease. METHODS: We studied 158 patients with chronic liver disease who underwent transient elastography and liver biopsy sampling. Histologic findings on fibrosis and necroinflammatory activity in the biopsy specimens were evaluated according to the Korean Society of Pathologists Scoring System. Routine biochemical tests were performed according to standard methods. RESULTS: Liver stiffness was strongly correlated with liver fibrosis stage (Spearman coefficient=0.636, P<0.001), lobular activity (Spearman coefficient=0.359, P<0.001), and portoperiportal activity grade (Spearman coefficient=0.448, P<0.001). Liver stiffness was significantly associated with serum levels of total bilirubin (P=0.025), direct bilirubin (P=0.049), gamma-glutamyl transpeptidase (P=0.014), platelet count (P=0.004), albumin (P<0.001), and international normalized ratio (P<0.001). Multivariate analysis showed that fibrosis stage (B 3.50, P=0.009) and lobular activity grade (B 3.25, P=0.047) were independently associated with liver stiffness. CONCLUSIONS: Liver stiffness as measured by transient elastography is associated with the grade of necroinflammatory activity and the stage of fibrosis, irrespective of serum ALT levels.

Comparison of radiofrequency ablation and transarterial chemoembolization for the treatment of a single hepatocellular carcinoma smaller than 4 cm / 대한간학회지

BACKGROUND/AIMS: Radiofrequency ablation (RFA) is an established curative therapeutic modality for unresectable hepatocellular carcinoma (HCC), and transarterial chemoembolization (TACE) has been used as a palliative treatment for inoperable HCC. It is still unknown whether RFA and TACE are equally effective for improving the survival of patients with unresectable HCC that is amenable to either treatment. The aim of this retrospective study was to compare the clinical impacts of two treatments, and analyze the prognostic factors for recurrence and survival. METHODS: Ninety-three patients with a single HCC smaller than 4 cm who showed complete responses (complete ablation or complete lipiodol tagging) after treatment with RFA (n=43) or TACE (n=50) between January 2002 and February 2009 were investigated. Univariate and multivariate analyses were performed for 13 potential prognostic factors using the Cox proportional-hazards model. RESULTS: The time-to-recurrence rates at 1, 2, and 3 years after treatment were 32.9%, 44.3%, and 55.4%, respectively, for the RFA group, and 42%, 68.3%, 71.7% for the TACE group. The probability of survival at 1, 2, and 3 years was 97.7%, 77.4%, and 63.1%, respectively, for the RFA group, and 95.9%, 76.1%, and 60.2% for the TACE group. The time-to-recurrence and overall survival rates did not differ significantly between the two treatment groups. A multivariate Cox proportional-hazards model revealed that a tumor size larger than 3 cm and lower serum albumin levels were independent risk factors for recurrence, and that being male, being seropositive for hepatitis B surface antigen, and having a higher serum albumin level were independent favorable prognostic factors for survival. CONCLUSIONS: TACE and RFA exhibited similar therapeutic effects in terms of recurrence and survival for patients with a single HCC smaller than 4 cm, if they could exhibited complete responses.

A Case of Seborrheic Keratosis Distributed as an Agminated form / 대한피부과학회지

Seborrheic keratosis is a common skin disease in the elderly, and when multiple lesions are present, scattered distribution is the rule. Herein, we report an interesting case of agminated form seborrheic keratosis distributed as an agminated form. A 56-year-old female presented with 2-3mm sized multiple brownish papules on the left-cheek. The small papules were scattered in a small area as a shape of coin. To the best of our knowledge, this type of distribution of seborrheic keratosis has not so far been reported.

Therapeutic Effect of Intra-lesional Triamcinolone Injection on Idiopathic Onychodystrophy / 대한피부과학회지

BACKGROUND: Intra-lesional triamcinolone injection is a widely used treatment modality of onychodystrophy. However, clinical evaluation has rarely been performed for the therapeutic effect of intra-lesional triamcinolone injection in the treatment of idiopathic onychodystrophy, except for psoriatic nail. OBJECTIVE: The purpose of this study was to investigate the therapeutic effect of intra-lesional triamcinolone injection on idiopathic onychodystrophy. METHODS: A total of 43 patients diagnosed as idiopathic onychodystrophy were enrolled in this study. At first 2 visits, triamcinolone acetonide (2.5mg/ml) was injected into the proximal nail fold of each nail using the dermo-jet. Thereafter, intra-lesional injection was performed at 4-week intervals with two-fold increased concentration of triamcinolone acetonide (5mg/ml). After a total of 7 treatments, the treated nails were scored by both doctor and patient between 0 and 10 according to the severity. RESULTS: In 26 patients treated for more than 12-weeks, 189 nails were eventually assessed by four grade scale. Therapeutic effects were as follows; excellent improvement in 19.8%, good in 28.8%, moderate in 11.6%, and poor in 38.6%. Onycholysis responded well to this treatment, with 81.1% of good to excellent improvement, whereas trachyonychia was resistent with 78.1% of poor to moderate improvement. There was no significant side effect, except pain on the injection site. CONCLUSION: According to our results, intra-lesional injection of triamcinolone acetonide is an effective and safe treatment modality of idiopathic onychodystrophy. It is suggested that, with intra-lesional triamcinolone injection, the morphologic classification is an important prognostic factor in the treatment of idiopathic onychodystrophy.

One Case of Linear Lichen Planus / 대한피부과학회지

Linear lichen planus, a variant of lichen planus, accounts for 0.24-0.62% of all patients with lichen planus. Clinically, it consists of itchy linearly distributed violaceous papules, usually lasts for more than 1 year and the mucous membranes may also be affected. This disorder shows the same histologic findings of lichen planus, which is characterized by a band like dermal inflammatory cell infiltration with hyperkeratosis, focal hypergranulosis, acanthosis, excytosis and the presence of Civatte body. We report a 66-year-old man showing typical clinical and histological features of linear lichen planus with pruritus.

Glue Embolization of Aneurysm after Stenting in Canine Carotid Arteries - Technical Feasibility

PURPOSE: Coiling or infusion of embolic materials into a wide necked aneurysm can be performed with stenting. The purpose of our study is to assess the technical feasibility of aneurysm treatment with glue embolization after stenting. MATERIALS AND METHODS: We used four Wallstents for surgically repairing eight canine carotid aneurysms. After confirmation of the aneurysms on the angiogram, we introduced a 6-7 F guiding catheter in order to deploy the stents. After stenting, we passed a microcatheter into the aneurysm lumen through the stent mesh. 28% glue was slowly injected until the glue cast completely filled the lumen. We evaluated the passage of a microcatheter through the stent meshwork, formation of the glue cast and the stents' ability to protection for any leakage of glue. The follow-up angiogram was obtained for two dogs, one to three times until 8 weeks, and then we sacrificed the dogs and performed pathologic examinations. RESULTS: Stenting was successful in all cases except one in which the vessel was occluded because the stent was not completely expanded within the lumen. The microcatheter could not pass through the stent mesh in one aneurysm. The two week follow-up angiogram showed complete occlusion of the aneurysm and a patent carotid lumen in a case after successful stenting and glue embolization without distal migration of glue. Tungsten in the glue was noted to migrate out of aneurysm into the soft tissue of the neck. Histopathologic examination showed successful obliteration and stable organization of the aneurysmal lumen with ingrowth of fibroblasts and a foreign body reaction. In contrast, the aneurysms without the glue embolization being performed showed partially thrombosed aneurysmal lumens that became smaller and indistinct on the 8 week follow-up angiograms. Histopathologic examination showed a disorganized thrombus with numerous recanalizations. CONCLUSION: Glue embolization after stenting could be performed for aneurysm without distal migration of the glue or gluing of the catheter. This concept appears to be useful for applications to the further research and the treatment of aneurysm.

A Case of Balloon Cell Melanoma / 대한피부과학회지

Balloon cell melanoma, an uncommon histopathological variant of malignant melanoma was first described by Gardner and Vazquez in 1970. This is histopathologically characterized by the presence of balloon cells with varying sizes and atypical nuclei. A 45-year-old man presented with asymptomatic, solitary, dome shaped, 1.5 cm-diameter black nodule on the left upper arm for 7 years. Histopathologically, lobulated tumor mass revealed copious melanin pigments and many balloon cells with clear cytoplasm, atypical nucleic and variable size. Immunohistochemically the tumor mass showed positive reaction to S-100 protein and HMB 45 staining. Chest CT, MRI for the extremities, bone scan, bone marrow biopsy and routine laboratory tests were within normal limit or negative. Gallium scan showed increased density only on the skin lesion. There was no evidence of lymphadenopathy and metastasis. We herein report a typical case of balloon cell melanoma, which developed primarily on the skin.

The Association of Interleukin-4 Promoter Gene and Receptor alpha Gene Polymorphisms with Atopic Dermatitis / 대한피부과학회지

BACKGROUND: Several investigators have linked the interleukin-4(IL-4) gene nearby markers located on chromosome 5 to atopy and demonstrated that the T allele of a polymorphism in the IL-4 gene promoter region -590C/T is associated with elevated levels of total serum IgE. IL-4 receptor alpha gene has been also reported to be involved in the development of atopy. Recently, the R allele of a polymorphism in the IL-4 receptor alpha gene (IL4R*A) has been reported to be associated with atopy. OBJECTIVE: The purpose of our study is to investigate the association of IL-4 promoter gene C-590T polymorphism and receptor alpha gene (-1902) IL4R*A polymorphism with atopic dermatitis in Korea. MATERIAL AND METHODS: Seventy one Korean patients with atopic dermatitis and one hundred and sixty six normal subjects participated in this study with the analysis of polymorphism of IL-4 promoter (-590C/T) gene and IL-4 receptor alpha(-1902) gene by using PCR-SSCP. RESULTS: The frequency of IL-4 promoter (-590) genotypes (T/T, T/C, C/C), genes (T, C), alleles (T, C) did not show any significant difference between atopic dermatitis patients and normal controls (p>0.05). There were weak associations in the frequency of IL-4 receptor alpha(-1902) genotypes (IL4R*G/IL4R*G) and genes (IL4R*A) in patients of atopic dermatitis and normal controls (p=0.05). But, the frequency of IL-4 receptor alpha(-1902) genotypes (IL4R*A/IL4R*G, IL4R*A/IL4R*A), genes (IL4R*G), alleles (IL4R*A, IL4R*G) did not show any significant difference between atopic dermatitis patients and normal controls (p>0.05). CONCLUSION: These data show that IL-4 promoter polymorphism (-590C/T) and IL-4 receptor alpha polymorphism (-1902) IL4R*A are not associated with atopic dermatitis in Korean. It is suggested that the difference between our results and previous reports means racial difference, cooperation of -590C/T or IL4R*A polymorphism with the other gene, and the existence of another polymorphism.

A Case of Membranous Fat Necrosis with Calcification in Lipoma / 대한피부과학회지

Membranous fat necrosis, an uncommon disorder, was first described by Nasu et al. in 1973. This is characterized by the presence of membranocystic foci in which cysts are lined by an eosinophilic homogeneous membrane with pseudo papillary luminal projections. We, herein, report a case of membranous fat necrosis with calcification in lipoma which developed on the abdomen of a 47-year-old woman. To our knowlege, this is the first report on membranous fat necrosis with calcification in lipoma, in Korea.

A Case of Progressive Zosteriform Macular Pigmented Lesion / 대한피부과학회지

Progressive zosteriform macular pigmented lesion (PZMPL) is a rare pigmentary disorder characterized by uniformly tanned macular pigmented lesions in a zosteriform distribution preceded by multiple pruritic macular pigmentation in a part of the dermatome for a period. We herein report a case of PZMPL which has developed along the left T3-5 dermatome in a 48-year-old man. The histological findings revealed increased melanin pigments in the basal layer and focal pigmentary incontinence in the upper dermis. PZMPL may be differentiated from progressive cribrifom and zosteriform hyperpigmentation in the clinical and histological manifestations.

A Case of Subungal Abscess And Onycholysis Related to Docetaxel / 대한피부과학회지

Docetaxel is a new taxoid antineoplastic drug widely used for advanced breast cancer, lung cancer, and head and neck cancer. Skin and nail change is one of the most frequent nonhematologic adverse reactions. Nail changes include dark pigmentation, subungal hemorrhage, acute paronychia, onycholysis and Beau's line. A 43-year-old woman with metastatic stomach cancer developed painful subungal abscess and secondary onycholysis of all fingernails after three courses of docetaxel chemotherapy(cumulative dose: 360mg). Puncturing under the nail plate expressed a purulent serous fluid. Microbiological cultures revealed heavy growth of Staphylococcus aureus. The docetaxel therapy was discontinused and 3rd generation cephalosporin was started. After 3-weeks antibiotic therapy, subungal abscess was improved. To our knowlege, this is the second case report of subungal abscess related to docetaxel chemotherapy.

A Case of Giant Premature Sebaceous Gland Hyperplasia Clinically Simulating Nevus Sebaceus / 대한피부과학회지

The occurrence of sebaceous gland hyperplasia commonly develops in elderly individuals. Clinical appearance is a papule with a central umbilication corresponding to the histological opening of sebaceous duct in the center. The usual size is 2 to 3mm in diameter. The histological features include hyperplastic mature sebaceous lobules grouped around a widely dilated sebaceous duct. We report a case of a 7-year old child with mental retardation and giant size of sebaceous gland hyperplasia which lead us to such clinical impressions as a nevus sebaceus

A Case of Steatocystoma Simplex on the Scalp / 대한피부과학회지

A 63-year-old man presented with an asymptomatic, solitary, yellowish papule on the scalp for one year. There was no family history of similar lesions. A punch biopsy taken from the papule Showed an oily yellowish discharge. Histopathological findings showed a thin-walled cyst lined by a stratified squamous epithelium with hyaline cuticle and no granular layer. Based on this histologic finding, we diagnosed this case as a steatocystoma simplex occurring on the scalp, an unusual site.

A Case of Acute Generalized Exanthematous Pustulosis(AGEP), An uncommon Condition in Children / 대한피부과학회지

Acute generalized exanthematous pustulosis(AGEP) is characterized by acute onset of widespread pustular eruption in association of fever and leukocytosis. Most cases appear to be related to drugs, mainly antibiotics, but viral infections and hypersensitivity to mercury may cause AGEP. Histologically, AGEP is composed of neutrophilic subcorneal and spongiform pustules. A 4-year-old female, with no history of psoriasis, was given ampicillin for scarlet fever. One day after taking the medication, pustular eruptions appeared on the whole body. We describe a 4 year old girl with AGEP secondary to ampicillin. This is an uncommon condition in children.

Stent Placement in Arteriovenous Fistula: An Experimental study

PURPOSE: To determine the efficacy of metalic stents in the treatment of experimentally createdcarotid-jugular fistulas. MATERIALS AND METHODS: Carotid-jugular fistulas were constructed surgically in fourmongrel swines. Three Wallstents (Schneider, Bulbanch, Switzerland), 6mm in diameter and 23mm in length, and oneNir stent (Boston Scientific Corporation, Boston, U.S.A.), 3-5mm in diameter and 16mm in length, were placedendovascularly across the fistula holes within the carotid artery. Carotid angiography was performed before,immediately after, and 1-3 months after stent placement. Fistula specimens were ohtained after final angiographyand gross and microscopic examination was performed. RESULTS: Angiography demonstrated decreased flow through thefistula immediately after stent placement. During follow-up, flow through the fistula decreased progressively butcomplete closure did not occur. Carotid arteries p in which Wallstents were placed were patent throughout thefollow-up period. A carotid artery in which a Nir stent was used showed no decreased flow during follow-upangiography lasting two months. Pathologically, a thin layer of endothelium covered the stent wires;there was atransitional zone between the fibrous connective tissue of organizing thrombus, and endothelial proliferationoccurred in the overlying fistula hole. CONCLUSIONS: Stent placement effectively reduced flow through thefistulas but during the ensuing three months closure did not occur. Occlusion was then progressive.Pathologically, intimal proliferntion arose from the oranizing thrombus on the surface of the stent mesh.

Reaction Difference of Glue-Lipiodol Mixture According to the Different Lot Number

PURPOSE: We noted that in a catheter, glue-lipiodol mixtures (GLM) prematurely turned into a cast duringembolization of brain arteriovenous maliformation, and to avoid this problem, added tungsten to GLM. The reactiontime and hardness of GLM were then evaluated in vitro. MATERIALS AND METHODS: Six lots of Lipiodol (Nos.97LU009A, 96LU018A, 96LU017A, 96LUollA and 95Lu020A)(Laboratoire Guerbet, Cedex, France) and three lots HistoacrylBlue (2/7121, Ex. Date 03/99 (993);2/6263, 06/98 (986);2/6132 03/98 (983))(B. Brown, Melsungen, Germany) weremixed in a 5cc bottle at concentrations of 25-50%(glue:lipiodol=1:1 to 1:3) and observed for two weeks. Thehardness of polymerized GLM was classified as liquid, gel, semi-solid or solid. After the addition of tungsten ortantalum powder (0.2gm) and a drop of blood to GLM, different series of experiments were performed. pH wasmeasured in distilled water mixed with tungsten of tantalum(0.1 to 0.5 gm). RESULTS: At a concentration of 50%,most GLM turned into solid casts within 48 hours;at one of 25%, most GLM gelled within 24hrs. At concentrations of28 and 33%, hardness was between that of a solid and that of a gel. After the addition of tungsten to 50% and 25%GLM, this remained in a liquid state until two weeks later, regardless of lipiodol products. In 5cc distilledwater with 0.1 to 0.5 gm tungsten, pH changed from 3.5 to 2.6, and on the addition of tantalum from 6.4 to 5.7.The addition of blood to the mixture immediately turned the cast solid at a GLM concentration of 50%, andsemi-solid at one of 25%. CONCLUSION: The reaction time of GLM differed according to the lot number of lipiodol.The addition of tungsten seemed to prevent premature cast formation by decreasing pH;the mechanism was similar tothat observed when acetic acid was added.