No abstract available.
Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Inflammation

Syndrome of inappropriate antidiutetic hormone(SIADH) secretion is the most common cause of hyponatremia in clinical medicine. Before diagnosis of the SIADH is made, other causes for a decreased diluting capacity and nonosmotic stimuli for AVP release need to be rule out. Disorders associated with SIADH can be divided into 4 major etiologic groups: malignancies, pulmonary diseases, central nervous disorders, and drugs. A 45-year-old woman was admitted due to maculopapular skin eruption and fever after taking medications for fever and myalgia. Generalized tonic clonic seizure was developed nine days later, and laboratory results showed marked hyponatremia. During the evaluation, treatment, and subsequent follow-up, the diagnosis of SIADH was confirmed, but the definitive cause was obscure. With fluid restriction, sodium replacement and demeclocycline therapy, she recovered completely 6 months later. We suggest that the SIADH might be related to drug-induced generalized maculopapular rash via menmgitis-like reaction in CSF as one of systemic adverse side effects to drugs rather than direct effect of related drugs.
Clinical Medicine ; Demeclocycline ; Diagnosis ; Exanthema* ; Female ; Fever ; Follow-Up Studies ; Humans ; Hyponatremia ; Inappropriate ADH Syndrome* ; Lung Diseases ; Middle Aged ; Myalgia ; Seizures ; Skin ; Sodium

No abstract available.
Diabetes Insipidus* ; Pregnancy*

BACKGROUND: Carolic restriction as a treatment for obesity causes catabolism of body protein stores and produces negative nitrogen balance. GH administration causes acceleration of lipolysis and promotion of nitrogen conservation. We evaluated the effects of GH treatment and caloric restriction on lipolysis, anabolic effects and body composition in obese subjects. METHODS: 24 obese (20% over IBW) subjects (22 women and 2 men; 22-46yr old) were fed a diet of 25kcal/kg IBW with 1.2g protein/kg IBW daily during treatment. The subjects were assigned at random to either treatment with recombinent human GH (n=12, 0.06U/kg IBW every other day) or placebo (n 12, vehicle injection) for 12 weeks. Body fat was assessed by impedence and abdominal fat, visceral fat area at the umbilicus level and muscle area of mid thigh level were measured using computed tomography. RESULTS: Fraction of body weight lost as fat lost was significantly greater in GH treatment than in placebo group (1.21+-0.48%/kg, vs 0.52+-0.28%/kg, p0.05). GH treatment caused significant decrease in visceral fat area (35.3% vs 28.5%, p<0.05). In placebo group, there were significant loss of muscle area (-4.8 +-2.6cm ) and lean body mass (-2.62 +-1.51kg) after treatment. In contrast, GH treatment group had more increase in muscle area (3.5+-2.3cm ) and lean body mass (1.13 +-1.04kg) and positive nitrogen balance (1.81+-4.06g/day). GH injections cuased a 1.6-fold increase in IGF-I, despite caloric restriction. GH responses to L-dopa stimulation were blunted in all subjects and GH responses were increased after treatment. Both group showed hyperinsulinemia during oral glucose tolerance test (OGTT), and after treatment, they had decreased in insulin secretion. However, GH treatmnent group had not significant decrease, because GH might induce insulin resistance. FFA response areas during OGTT markedly decreased after treatment in both group. In GH treatment group, more decrease of FFA responses might result from the antilipolytic effect by higher level of insulin or more decrease in amount of fat. CONCLUSION: This study has demonstrated that in obese subjects fed hypocaloric diet, GH accelerates body fat loss and exerts anabolic effects.
Abdominal Fat ; Acceleration ; Adipose Tissue ; Adult* ; Anabolic Agents ; Body Composition ; Body Weight ; Caloric Restriction ; Diet* ; Female ; Glucose Tolerance Test ; Growth Hormone* ; Humans ; Hyperinsulinism ; Insulin ; Insulin Resistance ; Insulin-Like Growth Factor I ; Intra-Abdominal Fat ; Levodopa ; Lipolysis ; Male ; Metabolism ; Nitrogen ; Obesity ; Thigh ; Umbilicus

BACKGROUND: Prenatal tongue development may affect oral-craniofacial structures, but this muscular organ has rarely been investigated. METHODS: In order to document the physiology of prenatal tongue growth, we histologically examined the facial and cranial base structures of 56 embryos and 106 fetuses. RESULTS: In Streeter's stages 13-14 (fertilization age [FA], 28 to 32 days), the tongue protruded into the stomodeal cavity from the retrohyoid space to the cartilaginous mesenchyme of the primitive cranial base, and in Streeter's stage 15 (FA, 33 to 36 days), the tongue rapidly swelled and compressed the cranial base to initiate spheno-occipital synchondrosis and continued to swell laterally to occupy most of the stomodeal cavity in Streeter's stage 16-17 (FA, 37 to 43 days). In Streeter's stage 18-20 (FA, 44 to 51 days), the tongue was vertically positioned and filled the posterior nasopharyngeal space. As the growth of the mandible and maxilla advanced, the tongue was pulled down and protruded anteriorly to form the linguomandibular complex. Angulation between the anterior cranial base (ACB) and the posterior cranial base (PCB) was formed by the emerging tongue at FA 4 weeks and became constant at approximately 124degrees-126degrees from FA 6 weeks until birth, which was consistent with angulations measured on adult cephalograms. CONCLUSIONS: The early clockwise growth of the ACB to the maxillary plane became harmonious with the counter-clockwise growth of the PCB to the tongue axis during the early prenatal period. These observations suggest that human embryonic tongue growth affects ACB and PCB angulation, stimulates maxillary growth, and induces mandibular movement to achieve the essential functions of oral and maxillofacial structures.
Adult ; Axis, Cervical Vertebra ; Embryonic Structures* ; Fetus* ; Humans ; Mandible ; Maxilla ; Mesoderm ; Parturition ; Physiology ; Skull Base ; Tongue*

Diabetic insipidus may first present before, during or immediately after pregnancy. Pregnancy serves as a physiologic provocation test that unmasks latent diabetes insipidus. It may explain the very rare first occurrence of diabetes insipidus in the pureperium. Central diabetes insipidus occurring after delivery associated with a catastrophic delivery and postpartum hypopituitarism is more frequent entity. We recently experienced central diabetes insipidus patient, aggrevated polyuria and polydipsia after total hysterectomy due to cervical carcinoma, who had interesting past history of severe polyuria and polydipsia developed during puerperium of 1st pregnancy, 14 years ago. She have had quiet normal pregnancy and there was no definite postpartum complication of pregnancy at that time. There were no change of polyuria and polydipsia during and after second pregnancy and 2 another pregnancy terminated artificially compare to puerperium of 1st delivery. She has intact anterior pituitary gland functinally and anatomically, but the posterior pituitary hyperintense signal with pre-enhance Tl-weighted imaging was absent on MRI.
Diabetes Insipidus ; Diabetes Insipidus, Neurogenic* ; Humans ; Hypopituitarism ; Hysterectomy ; Magnetic Resonance Imaging ; Pituitary Gland, Anterior ; Polydipsia ; Polyuria ; Postpartum Period* ; Pregnancy

Hashimotos thyroiditis has been associated with a various autoimmune disorders. The immunologic mechanisms involved in the pathogenesis of these disorders have not always been thought to be the same. Although it was demonstrated that there were high prevalence of abnormal thyroid function and autoantibody in autoimmune hemolytic anemia(AIHA) and Fisher-Evans syndrome(FES), AIHA combined with Hashimotos thyroiditis is rare in Korean literature. It was suggested that a common immunologic mechanism may be involved in the pathogenesis of both disease and the possibility of multiple autoimmune syndrome might present in autoimmune hematologic disorders. We experienced a 74-year old woman with a 12-year history of a hypothyroidism due to Hashimotos thyroiditis was hospitalized with sudden development of warm AIHA with positive Direct & Indirect Coombs test and pericardial effusion. Her thyroid function test showed subclinical hypothyroidism with the maintenance dosage of levothyroxine(100pg/day). With glucocorticoid and plasmapheresis, AIHA and pericardial effusion were corrected successfully. It is suggested that the prudent immunologic study is needed for the anemia developed in patients with Hashimotos thyroiditis with or without hypothyroidism.
Aged ; Anemia ; Anemia, Hemolytic, Autoimmune* ; Coombs Test ; Female ; Humans ; Hypothyroidism ; Pericardial Effusion* ; Plasmapheresis ; Prevalence ; Thyroid Function Tests ; Thyroid Gland* ; Thyroiditis*

BACKGROUND: Coal workers' pneumoconiosis(CWP) is a fibrotic lung disease resulting from the chronic inhalation of coal dust. Various cytokines and growth factors secreted from macrophages and monocytes play a key r ole in the pathogenesis of penumoconiosis. The platelet-derived growth factor (PDGF)-BB and the insulin-like growth factor(IGF)-1 secreted from the macrophages and monocytes are believed to stimulate the accumulation of mesenchymal cells and fibrosis of the lower respiratory tract that is observed in fibrotic lung disease. The serum concentration of PDGF-BB and IGF-1 in 30 CWP patients and 10 healthy controls were measured in order to determine if PDGF-BB and IGF-1 can be used as sensitive biomarkers in CWP. METHODS: Serum was collected from 30 patients with CWP (13 with simple CWP and 17 with complicated CWP) and 10 healthy controls. The serum concentrations of PDGF-BB and IGF-1 were measured using ELISA (RandD system, Minneapolis, MN). RESULTS: The serum PDGF-BB concentration in patients with complicated CWP (10083.76+/-639.07 pg/ml) was significantly higher than in the patients with simple CWP(8493.88+/-848.51 pg/ml) and the healthy controls (3726.17+/-292.20pg/ml)(p<0.05). Compared to the healthy controls (413.40+/-1.94ng/ml), there was no significant difference in the serum IGF-1 concentration in patients with simple (366.77+/-183.67ng/ml) and complicated CWP (403.18+/-15.39ng/ml)(p>0.05). CONCLUSIONS: These results show the important role of the PDGF-BB mediated pathways in the pathogenesis of CWP. These data suggests that the PDGF-BB serum concentration is a useful biomarkers of the fibrotic extent in CWP patients.
Biomarkers ; Coal* ; Cytokines ; Dust ; Enzyme-Linked Immunosorbent Assay ; Fibrosis ; Humans ; Inhalation ; Insulin-Like Growth Factor I* ; Intercellular Signaling Peptides and Proteins ; Lung Diseases ; Macrophages ; Monocytes ; Platelet-Derived Growth Factor ; Pneumoconiosis* ; Pulmonary Fibrosis ; Respiratory System

The adrenal glands are rarely injured by blunt trauma, because they are well protected by the ribs, paraspinal muscles, and the overlying abdominal contents. Although most of adrenal cysts are clinically silent, the number of incidentally detected adrenal cysts have increased due to advanced and widespread application of various sensitive imaging methods. Recently, we have encountered a case of a 62-year-old man who have developed a left adrenal pseudoeyst one and a half months after the blunt trauma from a pedestrian traffic accident. The pseudocyst was non-functional and measured about 5 * 4 cm in size with the same fluid density of a gall bladder in abdominal computerized tomography(CT). Turbid cystic fluid was aspirated by CT-guided method, and the aspirate was composed of degenerated old blood cells without any malignant cells. Since the cyst was developed following trauma and its microscopic content showed blood cells, impending rupture was anticipated. Hence, a laparoscopic adrenalectomy was performed.
Accidents, Traffic ; Adrenal Glands ; Adrenalectomy ; Blood Cells ; Humans ; Middle Aged ; Paraspinal Muscles ; Ribs ; Rupture ; Urinary Bladder