PURPOSE: The purpose of this study was to evaluate the utility of two-phase dynamic CT, early and equilibrium pahse, in the preoperative staging of rectal cancers. MATERIALS AND METHODS: We performed incremental dynamic CT after rectal infusion of water in 34 patients with pathologically proved rectal cancers. Two-phase dynamic CT findings were prospectively analyzed and correlated with surgical and histopathologic findings. A total of 150ml of nonionic contrast medium was intravenously administered with a power injector at a flow rate of 5ml/sec for 30 sec, and two-phase images were obtained at 30 sec(early phase) and 2 min (equilibrium phase) after bolus injection. Local tumor staging and regional lymph node were classified by TNM staging. RESULTS: All 34 rectal cancers showed a moderate to marked enhancement in the early phase and a homogeneous and prolonged enhancement of the entire lesion in the equilibrium phase. T-staging of primary tumors were 85.3%(29/34) in early phase and 70.6%(24/34) in equilibrium phase. The accuracy in determining the perirectal fat invasion of rectal cancer was 92%(23/25) in early phase, and 72%(18/25) in equilibrium phase. The sensitivity & specificity of the regional lymph node metastasis were 63.6% and 79.1% in early phase, and 54.5% and 65.2% in equilibrium phase, respectively. CONCLUSION: Early phase dynamic CT was more accurate for the preoperative staging of rectal cancer than that at equilibrium phase.
Humans ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm Staging ; Prospective Studies ; Rectal Neoplasms* ; Sensitivity and Specificity ; Water

We aimed to estimate the cutoff value of glycated hemoglobin (HbA1c, A1c) for fasting plasma glucose (FPG) of 126 mg/dL in the Korean adult population, using the 2011 Korea National Health and Nutrition Examination Survey. A total of 5,421 participants without a history of diabetes and over 19 years of age were included in the analysis. A point-wise area under the receiver operating characteristic curve was used to estimate the optimal A1c cutoff value. A1c threshold of 6.1% produced the highest sum of sensitivity (85.2%) and specificity (90.5%) for FPG of 126 mg/dL (area under the curve, 0.941, P<0.001). A1c of 6.5% produced a sensitivity of 67.7% and specificity of 98.0% for FPG of 126 mg/dL. Considering A1c as one of three criteria for the diagnosis of diabetes and the specificity of an A1c cutoff of 6.5%, the current diagnostic criteria of A1c> or =6.5% might be acceptable in the Korean adult population.
Adult ; Blood Glucose* ; Diabetes Mellitus ; Diagnosis ; Fasting* ; Hemoglobin A, Glycosylated* ; Humans ; Korea ; Nutrition Surveys* ; ROC Curve ; Sensitivity and Specificity

Tracheal bronchus is an aberrant bronchus that arises most often from the right tracheal bronchial wall above the carina and is the result of an additional tracheal outgrowth early in embryonic life. Its incidence ranges from 0.1 to 5%. This anomaly is usually diagnosed incidentally during bronchoscopy or bronchography in patients with various respiratory problems. Tracheal bronchus may be associated with other bronchopulmonary anomalies such as tracheal stenosis, pulmonary agenesis, pulmonary sequestration, abnormal lobulation, and Down's syndrome. In patients without specific clinical symptoms, a incidentally diagnosed tracheal bronchus does not require any treatment. We report a case of 59-year-old man incidentally detected accessory tracheal bronchus associated with bronchial asthma with review of literatures.
Asthma* ; Bronchi* ; Bronchography ; Bronchopulmonary Sequestration ; Bronchoscopy ; Down Syndrome ; Humans ; Incidence ; Middle Aged ; Tracheal Stenosis

A 48 year-old man was referred to our Department with a headache, and also presented with an elevated serum ACTH level, but without an elevated serum cortisol. Although there was no clinical evidence of Cushing's syndrome, a brain CT and MRI showed a 4x4.5 cm sized pituitary mass, which was successfully removed by a transsphenoidal approach (TSA). A histopathological examination revealed the mass to have an ACTH positive reaction. Therefore, through hormonal and pathological evaluation, a silent corticotroph-cell adenoma (SCCA), with an elevated serum ACTH level, was diagnosed. Although reports on SCCA have been recently increased, this case is reported because these kinds of tumor are still rare, and those SCCA with an elevated serum ACTH even more so
Adenoma* ; Adrenocorticotropic Hormone* ; Brain ; Cushing Syndrome ; Headache ; Humans ; Hydrocortisone ; Magnetic Resonance Imaging ; Middle Aged ; Pituitary Neoplasms

Advanced glycation endproducts (AGEs) have been reported to play a role in neointimal formation and increase the rate of in-stent restenosis (ISR) in the diabetic coronary artery disease patients treated with stents, but the potential pathogenic mechanisms of AGEs in vascular smooth muscle cell proliferation remain unclear. We sought to determine the AGEs related pathobiological mechanism of diabetic vasculopathy. Rat aortic smooth muscle cell (RAoSMC) culture was done with different concentrations of AGEs and proliferation was assessed. Immunohistochemistry for receptor of AGEs (RAGE) was performed with human carotid atheroma. Western blotting was performed to assess the activation of MAP kinase system in the cultured RAoSMC. AGEs increased RAoSMC proliferation and were associated with increased phosphorylation of ERK and p38 kinase by time and dose dependent manner. The MAP kinase activity was decreased by RNA interference for RAGE. AGEs stimulation increased reactive oxygen species (ROS) generation in cultured RAoSMC. From this study it is concluded that AGEs played a key role in RAoSMC proliferation via MAP kinase dependent pathways. Activation of vascular smooth muscle cell (VSMC) proliferation by MAP kinase system and increased formation of ROS may be the possible mechanisms of AGEs induced diabetic vasculopathy.
Animals ; Carotid Artery Diseases/metabolism/pathology ; Cell Proliferation/drug effects ; Cells, Cultured ; Diabetic Angiopathies/*etiology/metabolism/pathology ; Extracellular Signal-Regulated MAP Kinases/metabolism ; Glycosylation End Products, Advanced/adverse ; Humans ; MAP Kinase Signaling System/drug effects/*physiology ; Phosphorylation/drug effects ; RNA, Small Interfering/pharmacology ; Rats ; Rats, Sprague-Dawley ; Reactive Oxygen Species/metabolism ; Receptors, Immunologic/antagonists & inhibitors/metabolism

Insulin-induced allergy is a rare adverse drug reaction since the introduction of recombinant human insulin. However, recombinant insulin-induced allergy is still being reported in 0.1% to 2% of all patients treated with insulin. This allergic reaction varies from mild localized skin reactions to life-threatening anaphylaxis. It has been shown that one-third of insulin allergy cases is related to insulin itself and the remaining occur due to preservatives contained in the insulin preparations, such as protamine, zinc, or metacresol. This case report describes a 75-year-old woman with poorly controlled diabetes who experienced insulin allergy. She complained of urticaria with itching after the injection of insulin. Allergic skin tests showed positive responses to all available human insulin preparations, and specific IgE to human insulin was also detected, which suggested that her urticaria was developed by insulin itself. This is the first case of insulin allergy that was sensitive to all available human insulin preparations and confirmed by the presence of specific IgE to human insulin. It is important to remember that allergic reactions to insulin may be directly associated with adherence and can be the reason of poor glucose control.
Aged ; Anaphylaxis ; Drug-Related Side Effects and Adverse Reactions ; Female ; Glucose ; Humans* ; Hypersensitivity* ; Immunoglobulin E ; Insulin Antibodies ; Insulin* ; Pruritus ; Skin ; Skin Tests ; Urticaria ; Zinc

The purpose of this study was to examine the urban-rural differences in the prevalence and associated factors with type 2 diabetes mellitus (T2DM) in Korean adults. A total of 1,060 adults >30 yr of age from urban (189 males and 331 females) and rural districts (219 males and 321 females) were recruited. Anthropometric measures, blood pressure, lipid profiles, and fasting and 2-hr after 75-g oral glucose load blood glucose were obtained. The crude- and age-standardized prevalence of T2DM was 15.4% and 14.5%, and 11.7% and 8.6% in urban and rural districts, respectively. Diabetic subjects were older and obese, and had a higher triglyceride level, and systolic blood pressure compared to non-diabetes in both population. Multivariate regression analysis revealed that older age, high triglyceride levels, central obesity, and hypertension were significantly associated with T2DM in both areas. Low monthly incomes were significantly associated with T2DM in urban population, while a family history of T2DM was significantly associated with T2DM in rural area. T2DM is more prevalent in urban than in rural population, and low economic status or genetic factor is differently associated with T2DM in both population, respectively.
Adult ; Age Factors ; Aged ; Diabetes Mellitus, Type 2/complications/*epidemiology ; Female ; Humans ; Hypertension/complications ; Male ; Middle Aged ; Obesity/complications ; Prevalence ; Regression Analysis ; Republic of Korea/epidemiology ; Risk Factors ; Rural Population ; Socioeconomic Factors ; Triglycerides/blood ; Urban Population

Dendritic cells (DCs) play a role in natural killer (NK) cell activation, while NK cells are also able to activate and mature DCs. Toll-like receptors (TLRs) on the surface of DCs and NK cells induce the maturation and activation of these cells when engaged with their cognate ligand. We investigated to generate potent DCs by maturation with NK cells in the presence of TLR agonist in vitro and tested the efficacy of these DC vaccinations in mouse colon cancer model. The optimal ratios of DCs versus NK cells were 1:1 to 1:2. Immature DCs were mature with NK cells in the presence of lipopolysaccharide, which is TLR4 agonist, and further addition of IL-2 induced phenotypically and functionally mature bone marrow-derived DCs. These potent DCs exhibited not only high expression of several costimulatory molecules and high production of IL-12p40 and IL-12p70, but also high allogeneic T cells stimulatory capacity, and the induction of the high activities to generate tumor-specific CTLs. Consistently, vaccination with these DCs efficiently inhibited CT-26 tumor growth in mouse colon cancer model when compared to other vaccination strategies. Interestingly, combination therapy of these DC-based vaccines and with low-dose cyclophosphamide showed dramatic inhibition effects of tumor growth. These results suggest that the DCs maturated with NK cells in the presence of TLR agonist are potent inducer of antitumor immune responses in mouse model and may provide a new source of DC-based vaccines for the development of immunotherapy against colon cancer.
Animals ; Cancer Vaccines/immunology/metabolism ; Carcinoma/immunology/pathology/*therapy ; Cell Line, Tumor ; Cells, Cultured ; Colonic Neoplasms/immunology/pathology/*therapy ; Dendritic Cells/*drug effects/*immunology/transplantation ; Female ; Immunotherapy, Adoptive/*methods ; Killer Cells, Natural/*immunology/physiology ; Lipopolysaccharides/pharmacology ; Mice ; Mice, Inbred BALB C ; Toll-Like Receptor 4/agonists ; Toll-Like Receptors/*agonists

BACKGROUND: This study compared the bronchodilator efficacy and safety of tiotropium inhalation capsules (18microgram once daily) with a ipratropium metered dose inhaler (2 puffs of 20microgram q.i.d.) in patients with chronic obstructive pulmonary disease (COPD). METHOD: After the initial screening assessment and a two-week run-in period, patients received either tiotropium 18microgram once daily or ipratropium 40microgram four times daily over a period of 4 weeks in a double blind, double dummy, parallel group study. The outcome measures were the lung function, the daily records of the peak expiratory flow rate (PEFR), the patients' questionnaire, and the use of concomitant salbutamol. The forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) were measured 5 minutes before inhalation, and 0.5, 1, 2 and 3 hours after inhaling the study drug on days 0, 14 and 28. RESULT: In 16 centers, 134 patients with a mean (SD) age of 66 (7) years and a predicted FEV1 of 42 (12)% were analyzed. The trough FEV1 response was significantly higher in the tiotropium group than in the ipratropium group after a four-week treatment period. The weekly mean morning PEFR of the tiotropium group was consistently higher than that of the ipratropium group during the 4-week treatment period with differences ranging from 12.52 to 13.88 l/min, which were statistically significant. Tiotropium was well tolerated by the COPD patients during the 4-week treatment period and had a similar safety profile to ipratropium. CONCLUSION: This study shows that tiotropium administrated once daily has a superior bronchodilator effect with a similar safety profile in treating COPD patients compared with ipratropium, inhaled four times daily.
Adult* ; Albuterol ; Bronchodilator Agents ; Capsules ; Forced Expiratory Volume ; Humans ; Inhalation ; Ipratropium* ; Lung ; Mass Screening ; Metered Dose Inhalers ; Outcome Assessment (Health Care) ; Peak Expiratory Flow Rate ; Pulmonary Disease, Chronic Obstructive* ; Surveys and Questionnaires ; Vital Capacity ; Tiotropium Bromide