Inferior petrosal sinus sampling (IPSS) plays an important role in the assessment of patients with ACTH-dependent Cushing's syndrome. IPSS has been described as an innocuous, essentially risk-free procedure. Neurological complications associated with IPSS are rare. Previously reported neurological complications include brain stem infraction, pontine hemorrhage and subarachnoid hemorrhage. A 26-year-old woman was admitted to the hospital because of a moon face and a buffalo hump. A MRI showed a suspicious, but uncertain, area on the left side of the sella turcica. IPSS was performed as an appropriate means of providing more information about the side of the ACTH source. Immediately after the procedure, the woman experienced double vision, caused by a complete sixth nerve palsy of the left eye, together with a contralateral hemiparesis. From a clinical point of view, abducens nerve palsy and contralateral hemiparesis corresponded to Raymond-Cestan syndrome. I report a case of Raymond-Cestan syndrome, following petrosal sinus sampling in a female patient with ACTH-dependent Cushing's syndrome. To the best of our knowledge, this complication associated with petrosal sinus sampling has only been described in one previous case report. Although IPSS may provide essential information in the investigation of Cushing's syndrome, the possibility of very occasional but devastating complications should be remembered.
Abducens Nerve Diseases ; Adrenocorticotropic Hormone ; Adult ; Brain Stem ; Buffaloes ; Cushing Syndrome ; Diplopia ; Female ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Paresis ; Petrosal Sinus Sampling* ; Sella Turcica ; Subarachnoid Hemorrhage

No abstract available.
Carotid Intima-Media Thickness ; Diabetic Nephropathies ; Humans

Obesity is becoming increasingly prevalent worldwide. It is linked to health problems including cardiovascular disease, diabetes, cancer, musculoskeletal problems and even psychiatric problems. Intermittent fasting is an interventional strategy wherein individuals are subjected to varying periods of fasting. Intermittent fasting has recently attracted attention because experimental studies have highlighted its potential for correcting metabolic abnormalities. Preliminary findings indicate that intermittent fasting may be associated with increased lifespan, decreased mortality from cancers and cardiovascular diseases, improved insulin sensitivity, and reduced oxidative stress and inflammation. However, some of the data still remain controversial. No human studies have examined the effects of intermittent fasting in diabetics. Studies examining intermittent fasting in diabetic patients have encountered problems with compliance, malnutrition, and hypoglycemia rather than seeing benefits of weight loss. Regular meals (at least three meals each day) and a balanced diet are crucial in the management of blood sugar levels in diabetic patients.
Blood Glucose ; Caloric Restriction ; Cardiovascular Diseases ; Compliance ; Diabetes Mellitus ; Diet ; Fasting* ; Humans ; Hypoglycemia ; Inflammation ; Insulin Resistance ; Malnutrition ; Meals ; Mortality ; Obesity ; Oxidative Stress ; Weight Loss

No abstract available.

The antinuclear antbody (ANA) test have been used to screen the patients with systemic lupus erythematosus (SLE) and other autoimmune diseases. We had retrospectively reviewed the 263 records of pediatric patients with doing ANA tests who admitted at Department of Pediatrics, Kyung Hee University Hospital, from January 1988 to May 1993. The following results were obtained. 1) The positive rate of ANA test in patients with connective tissue diseases is 16 out of 40(40%).In patients with SLE, the positive rate of ANA test is 9 out of 11 (82%). 2) The positive predictivity for SLE is 9 out 36 (25%). 3) The positive predictivity for connective tissue disease and possible immune disease is 28 out of 36 (78%). 4) The false positive rate is 8 0ut of 36 (22%), Thus, the pediatric patients with positive ANA test should be applicable for diagnosis with prudence. 5) The positive anti-dsDNA in patients with the positive ANA is shown in 4 cases and these patients are all SLE. In conclusion, the patients who had repeated positive ANA should be tested Anti-dsDNA antibody, and further clinical and diagnostic evaluation of other ANA associated diseases.
Autoimmune Diseases ; Connective Tissue Diseases ; Diagnosis ; Humans ; Immune System Diseases ; Lupus Erythematosus, Systemic ; Pediatrics ; Retrospective Studies

Alcohol influences glucose metabolism in both diabetic and non-diabetic individuals. Moderate alcohol consumption significantly decreases fasting glucose levels, but does not affect postprandial glucose levels. However, acute alcohol intake without food may provoke hypoglycemia. Moderate alcohol consumption may inhibit gluconeogenesis and enhance insulin sensitivity, but excessive alcohol intake (three or more drinks per day) may contribute to hyperglycemia. Daily alcohol intake in diabetics should be limited to a moderate amount (one drink per day or less for women and two drinks per day or less for men). Moderate alcohol intake may have cardiovascular benefits for patients with diabetes, but the trade-off between the cardiovascular benefits versus the potential risk of lower adherence associated with self-care behaviors should be considered.
Alcohol Drinking ; Blood Glucose ; Diabetes Mellitus ; Fasting ; Female ; Gluconeogenesis ; Glucose ; Humans ; Hyperglycemia ; Hypoglycemia ; Insulin Resistance ; Self Care

Sodium glucose cotransporter-2 inhibitors (SGLT2i) block SGLT2 in the renal proximal tubule and increase the excretion of glucose into the urine, thereby decreasing serum glucose concentrations. These glucose-lowering effects are independent of insulin action. SGLT2i has been demonstrated to reduce cardiovascular complications and hospitalization for heart failure. SGLT2i has also shown remarkable inhibition effects on the progression of renal complications, decreasing serum creatinine, reducing albuminuria, and decreasing death from renal disease. These cardiorenal protective effects appear to be independent of glycemic control efficacy, and in view of these results, SGLT2i is recommended in type 2 diabetes patients at high risk of cardiovascular or renal disease. This review aims to provide an update on the mechanisms, efficacy, cardiorenal protective effects, and adverse effects of SGLT2i.

No abstract available.
Myofibroblasts* ; Thyroid Gland*

BACKGROUND/AIMS: Many studies have demonstrated an association between hemoglobin levels and cardiovascular disease in diabetic patients. The aim of this study was to determine whether there is an association between hemoglobin concentrations and various clinical parameters, including metabolic factors, plasma C-peptide response after a meal tolerance test, and microvascular complications, in Korean patients with type 2 diabetes. METHODS: In total, 337 male patients with type 2 diabetes were recruited. All subjects were subjected to a meal tolerance test and underwent assessment of hemoglobin levels, fasting and postprandial beta-cell responsiveness, and microvascular complications. RESULTS: Patients with lower hemoglobin concentrations had a longer duration of diabetes, a lower body mass index, and lower concentrations of total cholesterol, triglycerides, and low-density lipoprotein cholesterol. They also had lower levels of postprandial C-peptide, Delta C-peptide, and postprandial beta-cell responsiveness. They had a higher prevalence of retinopathy and nephropathy. In multivariate analyses, there was a significant association between nephropathy and hemoglobin concentration. Also, hemoglobin concentrations were independently associated with Delta C-peptide levels and postprandial beta-cell responsiveness. CONCLUSIONS: Hemoglobin concentrations are associated with postprandial C-peptide responses and diabetic nephropathy in patients with type 2 diabetes.
Aged ; Biological Markers/blood ; Blood Glucose/metabolism ; C-Peptide/blood ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/*blood/diagnosis/epidemiology ; Diabetic Nephropathies/*blood/diagnosis/epidemiology ; Diabetic Retinopathy/*blood/diagnosis/epidemiology ; Hemoglobins/*metabolism ; Humans ; Insulin-Secreting Cells/metabolism ; Linear Models ; Lipids/blood ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Postprandial Period ; Prevalence ; Republic of Korea/epidemiology ; Risk Assessment ; Risk Factors

BACKGROUND: Cardiovascular risk is higher among people with diabetic nephropathy than among those with normal renal function. Carotid intima-media thickness (IMT) is an independent predictor of cardiovascular mortality in type 2 diabetic patients. However, the relationship between carotid IMT and diabetic nephropathy is not well known. The aim of our study was to elucidate whether carotid IMT is associated with progression of diabetic nephropathy in type 2 diabetic patients. METHODS: We recruited a total of 354 type 2 diabetic patients with diabetic nephropathy. Renal function was evaluated by serum creatinine levels, estimated glomerular filtration rate (eGFR), and urinary albumin/creatinine ratio (ACR). Carotid IMT was assessed using B-mode ultrasound by measuring generally used parameters. Baseline-to-study end changes in eGFR were calculated, and the yearly change of eGFR (mL/min/yr) was computed. RESULTS: Age, diabetes duration, ACR, and eGFR were significantly correlated with mean or maximal carotid IMT; however, lipid profiles, HbA1c, and blood pressure were not correlated. The mean yearly eGFR change was -4.9 +/- 5.3 mL/min/yr. The yearly eGFR change was negatively correlated with mean and maximal carotid IMT. After adjusting for age and diabetes duration, the mean IMT is an independent predictor of yearly eGFR change. CONCLUSION: Carotid IMT may be a predictor of diabetic nephropathy progression in patients with type 2 diabetes.
Blood Pressure ; Carotid Intima-Media Thickness ; Creatinine ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Glomerular Filtration Rate ; Humans