The accuracy and convenience of continuous glucose monitoring (CGM), which efficiently evaluates glycemic variability and hypoglycemia, are improving. There are two types of CGM: professional CGM and personal CGM. Personal CGM is subdivided into real-time CGM (rt-CGM) and intermittently scanned CGM (isCGM). CGM is being emphasized in both domestic and foreign diabetes management guidelines. Regardless of age or type of diabetes, CGM is useful for diabetic patients undergoing multiple insulin injection therapy or using an insulin pump. rt-CGM is recommended for all adults with type 1 diabetes (T1D), and can also be used in type 2 diabetes (T2D) treatments using multiple insulin injections. In some cases, short-term or intermittent use of CGM may be helpful for patients with T2D who use insulin therapy other than multiple insulin injections and/or oral hypoglycemic agents. CGM can help to achieve A1C targets in diabetes patients during pregnancy. CGM is a safe and cost-effective alternative to self-monitoring blood glucose in T1D and some T2D patients. CGM used in diabetes management works optimally with proper education, training, and follow up. To achieve the activation of CGM and its associated benefits, it is necessary to secure sufficient repetitive training and time for data analysis, management, and education. Various supports such as compensation, insurance coverage expansion, and reimbursement are required to increase the effectiveness of CGM while considering the scale of benefit recipients, policy priorities, and financial requirements.

BACKGROUND: Iodine is an intrinsic element of thyroid hormone, which is essential for childhood growth and development. The Ideal Breast Milk (IBM) cohort study aims to evaluate the effects of maternal iodine status during pregnancy and lactation on maternal thyroid function, offspring growth and development, and offspring thyroid function. METHODS: The IBM cohort study recruited pregnant women from Seoul National University Hospital between June 2016 and August 2017, followed by enrollment of their offspring after delivery. For the maternal participants, iodine status is evaluated by urinary iodine concentration (UIC) and dietary records in the third trimester and at 3 to 4 weeks and 12 to 15 months postpartum. For the child participants, cord blood sampling and UIC measurements are performed at birth. At 3 to 4 weeks of age, UIC and breastmilk iodine concentrations are measured. At 12 to 15 months of age, growth and development are assessed and measurements of UIC, a thyroid function test, and ultrasonography are performed. RESULTS: A total of 198 pregnant women in their third trimester were recruited. Their mean age was 35.1±3.5 years, and 78 (39.4%) of them were pregnant with twins. Thirty-three (16.7%) of them had a previous history of thyroid disease. CONCLUSION: Korea is an iodine-replete area. In particular, lactating women in Korea are commonly exposed to excess iodine due to the traditional practice of consuming brown seaweed soup postpartum. The study of the IBM cohort is expected to contribute to developing guidelines for optimal iodine nutrition in pregnant or lactating women.
Breast* ; Child ; Cohort Studies* ; Cordocentesis ; Diet Records ; Female ; Growth and Development* ; Humans ; Infant ; Iodine* ; Korea ; Lactation* ; Milk, Human* ; Parturition ; Postpartum Period ; Pregnancy Trimester, Third ; Pregnancy* ; Pregnant Women ; Prospective Studies* ; Seaweed ; Seoul ; Thyroid Diseases ; Thyroid Function Tests ; Thyroid Gland* ; Twins ; Ultrasonography

Familial isolated primary hyperparathyroidism(FIPH) is associated with multiple endocrine neoplasia type 1 (MEN1) syndrome, primary hyperparathyroidism accompanied by jaw-tumor syndrome, and familial hypocalciuric hypercalcemia. FIPH may be an early stage of MEN1 or an allelic variant of MEN1. Thymic carcinoid tumor is a rare tumor in MEN1 syndrome. Here, the authors report the case of a 40-year-old man diagnosed with recurrent thymic carcinoid tumor and FIPH. Both the patient and his elder sister had been previously diagnosed to have FIPH with a novel frameshift mutation in the MEN1 gene. Initially, the patient underwent thymectomy because of an incidental finding of a mediastinal mass in his chest X-ray, and had remained asymptomatic over the following 4 years. Pancreas computed tomography conducted to evaluate MEN1 syndrome revealed anterior and middle mediastinal masses, and resultantly, massive mass excision was performed. Histological findings disclosed atypical carcinoids with infiltrative margins. In view of the thymic carcinoid tumor relapse that occurred in this patient, the authors recommend that regular pancreas and pituitary imaging studies be conducted for FIPH associated with a MEN1 gene mutation.
Adult ; Carcinoid Tumor* ; Frameshift Mutation ; Humans ; Hypercalcemia ; Hyperparathyroidism ; Hyperparathyroidism, Primary* ; Incidental Findings ; Multiple Endocrine Neoplasia Type 1 ; Pancreas ; Recurrence ; Siblings ; Thorax ; Thymectomy

PURPOSE: Interferon gamma release assays (QuantiFERON-TB Gold in Tube test [QFT-GIT]); Cellestis Limited, Victoria, Australia) have been studied for diagnosing pulmonary tuberculosis (TB) or latent TB but there have been no reports on the usefulness of this assay in diagnosing tuberculous anal fistula in actual clinical practices. In this study, we evaluated its diagnostic usefulness in patients with suspected tuberculous anal fistula. METHODS: We conducted a retrospective analysis of 119 patients with suspected tuberculous anorectal fistula from May 2007 to May 2009. Diagnosis of tuberculous fistula was concluded by identification of acid-fast bacilli, typical caseating granuloma and successful clinical response to anti-TB chemotherapy. All patients underwent the QFT-GIT and all patients diagnosed with tuberculous anal fistula were analyzed. RESULTS: Of the 119 patients with suspected TB fistula, 51 (43%) patients were classified as having TB fistula, including 31 with confirmed tuberculosis and 20 with probable tuberculosis, and other 68 (57%) were classified as not having tuberculosis. Among the 51 patients with TB fistula, Chronic caseating granuloma, acid-fast bacilli stain, and successful clinical response to anti-TB treatment were positive in 27 (52.9%), 4 (7.8%), and 20 (39.2%), respectively. Of the 51 with TB fistula, 44 had positive QFT-GIT results and 7 had negative results. The sensitivity and specificity of the assay were 86% and 85%, and positive predictive value (PPV) and negative predictive value (NPV) were 81% and 89%, respectively. CONCLUSION: QFT-GIT is a simple, sensitive, and specific method for the diagnosis of clinically highly suspected TB fistula.
Diagnosis* ; Drug Therapy ; Fistula* ; Granuloma ; Humans ; Interferon-gamma ; Interferon-gamma Release Tests* ; Rectal Fistula ; Retrospective Studies ; Sensitivity and Specificity ; Tuberculosis ; Tuberculosis, Pulmonary ; Victoria

A 65-year-old woman was admitted due to poor oral intake and a dry cough over the previous 3 months. The physical examination was remarkable for bibasilar crackles, and plain chest radiography showed reticulation in both lower lung fields. A pulmonary function test demonstrated a restrictive pattern with a reduced diffusing capacity of the lung for carbon monoxide. High resolution computed tomography showed reticulation and honey-combing in both peripheral lung zones, which was consistent with usual interstitial pneumonia pattern. Her skin showed livedo reticularis. The erythrocyte sedimentation rate and C-reactive protein level were elevated, and hematuria was noted on urinary analysis. A serologic test for auto-antibodies showed seropositivity for Myeloperoxidase-Anti-neutrophil cytoplasmic antibody (MPO-ANCA). A kidney biopsy was performed and showed focal segmental glomerulosclerosis. She was diagnosed as having pulmonary fibrosis with microscopic polyangiitis (MPA) and treated with high dose steroids. Here we report a case of pulmonary fibrosis coexistent with microscopic polyangiitis.
Aged ; Antibodies, Antineutrophil Cytoplasmic ; Biopsy ; Blood Sedimentation ; C-Reactive Protein ; Carbon Monoxide ; Cough ; Cytoplasm ; Female ; Glomerulosclerosis, Focal Segmental ; Hematuria ; Humans ; Idiopathic Pulmonary Fibrosis ; Kidney ; Livedo Reticularis ; Lung ; Microscopic Polyangiitis ; Physical Examination ; Pulmonary Fibrosis ; Respiratory Function Tests ; Respiratory Sounds ; Serologic Tests ; Skin ; Steroids ; Thorax

We experienced a case of middle cerebral artery-distal internal carotid artery bypass surgery for treating a ruptured cerebral aneurysm in a 50-year-old female who also had a descending aortic dissection and a past history of receiving a Bentall operation for an ascending aortic dissection 7 years previously. The patient successfully underwent surgery and we report on this experience along with a brief review of the relevant literature.
Anesthesia ; Anesthesia, General ; Carotid Artery, Internal ; Female ; Humans ; Intracranial Aneurysm ; Middle Aged

BACKGROUND: Core temperature decreases rapidly after the induction of general anesthesia, because the heat is redistributed to peripheral tissues. Thermoregulatory responses of volatile anesthetics have been tested, but their effects have not been directly compared. Therefore, we evaluated the thermoregulatory responses to sevoflurane, desflurane, and isoflurane. METHODS: Sixty healthy patients scheduled for laparoscopic myomectomy or radical hysterectomy were allocated into three groups; Group S (sevoflurane, n = 20), Group D (desflurane, n = 20), and Group I (isoflurane, n = 20). Anesthesia was maintained with 1 minimum alveolar concentration (MAC) of sevoflurane, desflurane, and isoflurane in a 50/50 mixture of N2O/O2. Patients were maintained in a normovolemic and normocapnic state. The core temperature and forearm minus fingertip skin-temperature gradient (an index of peripheral vasoconstriction) were monitored after the induction of general anesthesia. RESULTS: Each of the seven patients given sevoflurane, desflurane, and isoflurane vasoconstricted at a core temperature of 35.3 +/- 0.5degrees C, 33.6 +/- 0.4degrees C, and 35.2 +/- 0.4degrees C, respectively. The vasoconstriction threshold was the lowest in patients anesthetized with desflurane. The core temperature gradient (Ti-Tf) was significantly higher in patients that were anesthetized with desflurane than in those that were anesthetized with sevoflurane or isoflurane. The core temperature of desflurane was significantly lower than that of sevoflurane or isoflurane 15 minutes after the induction of anesthesia until 180 minutes of anesthesia. CONCLUSIONS: These results indicate that the core temperature is maintained at a higher level in patients that have been anesthetized with sevoflurane or isoflurane than in those that have been anesthetized with desflurane.
Anesthesia ; Anesthesia, General ; Anesthetics ; Forearm ; Hot Temperature ; Humans ; Hysterectomy ; Isoflurane ; Laparoscopy ; Methyl Ethers ; Vasoconstriction

BACKGROUND: The injection of rocuronium causes pain and withdrawal responses. This study was designed to determine an appropriate dose of remifentanil to prevent the withdrawal responses associated with injection of rocuronium in children. METHODS: Fourty five ASA physical status I and II pediatric patients were randomly allocated into three groups; Group I (placebo; normal saline 3 ml, n = 15), Group II (remifentanil 0.3microg/kg, n = 15), Group III (remifentanil 0.5microg/kg, n = 15). After the induction of anesthesia with 5 mg/kg of thiopental sodium, patients in groups I, II, and III received normal saline 3 ml, remifentanil 0.3microg/kg, and remifentanil 0.5microg/kg, respectively. After one minute, rocuronium 0.6 mg/kg was injected over 10 seconds. The patient's response after injection was graded using a four-point scale. The patient's heart rate (HR), mean arterial pressure (MAP) were measured at pre-anesthesia (T0), 1 minute after injection of thiopental sodium (T1), test drug (T2), and rocuronium (T3). RESULTS: The incidence of withdrawal responses was 100%, 66.7%, and 20% in groups I, II, and III, respectively. In addition, the severity of withdrawal responses was lowest in group III. CONCLUSIONS: Remifentanil 0.5microg/kg was an appropriate dose to prevent the withdrawal responses on injecting rocuronium.
Androstanols ; Anesthesia ; Arterial Pressure ; Child ; Heart Rate ; Humans ; Incidence ; Piperidines ; Thiopental

Ionizing radiation exerts harmful effect during the limb development, but the exact mechanism is still largely unknown. In this study, 2 Gy of X-ray irradiated to the rat fetuses on gestation day of 13.7 when the hindlimb buds appear, and sacrificed at GD 14.7, GD 15.7 and GD 16.7, respectively. To reveal the changes of apoptotic figures between control and experimental groups, TUNEL immunohistochemistry and confocal laser scanning microscopy were carried. Mean body weight of fetuses of irradiated groups were decreased significantly compared to the control group. Numerical digit anomalies and asymmetries between right and left sides were increased significantly in the irradiated group compared to control group. Some digit anomalies were increased significantly in the right side. Radiation-induced decrement of the density of apoptotic figures on GD 14.7 was presumed to be related with foot and digit anomalies.
Animals ; Apoptosis* ; Body Weight ; Extremities ; Fetus* ; Foot ; Hindlimb* ; Immunohistochemistry ; In Situ Nick-End Labeling ; Microscopy, Confocal ; Morphogenesis ; Pregnancy ; Radiation, Ionizing ; Rats*

OBJECTIVES: Obstructive sleep apnea (OSA) syndrome is diagnosed through history, physical examination, imaging studies and polysomnography. Clinical examination of this condition may point to hypertrophic tonsils and crowded oropharynx. The objective of this study is to investigate the usefulness of modified Mallampati grade (MMG) and tonsil grade (TG) in predicting the severity of obstructive sleep apnea. METHODS: MMG and TG were divided into 4 and 5 groups, respectively, according to their severity. Medical records were collected from 94 patients who had received polysomnography and otorhinolaryngologic examination for snoring and sleep apnea at Keimyung University Dongsan Medical Center from March 2002 through April 2004. Patients were divided into two groups according to the apnea-hypopnea index (AHI) : control (n=24), and patients with sleep apnea (n=70). RESULTS: Patients with higher MMG and TG had higher AHI, and MMG and TG proved to have a statistically significant correlation with AHI (p< 0.05) CONCLUSION: MMG and TG were reliable predictors of OSA and helpful parameters in deciding treatment method.
Humans ; Medical Records ; Oropharynx ; Palatine Tonsil ; Physical Examination ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Snoring