Patients with type 2 diabetes who require insulin therapy are commonly elderly and have poor visual acuity. In this study, we examined the clinical usefulness of the indicator magnifying window (IMW) for elderly patients with type 2 diabetes. We recruited 50 patients with type 2 diabetes over the age of 60 who had used insulin pens for glucose control. They were asked to set the insulin pen at randomly selected doses with or without an IMW. We assessed dosing accuracy, convenience, self-confidence, need for eyeglasses, preference, and willingness to recommend the IMW to other patients. Although the IMW did not improve the dosing accuracy or convenience, it significantly decreased the need for eyeglasses. Overall, the clinical usefulness of the IMW is quite limited in elderly patients with type 2 diabetes.
Aged ; Diabetes Mellitus ; Eyeglasses ; Glucose ; Humans ; Insulin ; Visual Acuity

Mediastinal ectopic thyroid is a very rare condition, with few reported cases in the literature and no reported cases in Korea. This report describes an asymptomatic 65-year-old man with a right paratracheal mass compressing the superior vena. Additionally, the epidemiology, clinical manifestation, diagnosis, and management of mediastinal ectopic thyroids are discussed. A mediastinal ectopic thyroid should be considered in the differential diagnosis of all mediastinal masses. Surgical excision is recommended for both the diagnosis and treatment of this condition, because of its potential for malignancy and compression of mediastinal structures. This case demonstrates the clinical importance of mediastinal etopic thyroid.
Aged ; Choristoma/*diagnosis ; Humans ; Incidental Findings ; Male ; Mediastinal Diseases/*diagnosis ; *Thyroid Gland

BACKGROUND: Measurement of the plasma adrenocorticotropic hormone (ACTH) level has been recommended as the first diagnostic test for differentiating between ACTH-independent Cushing syndrome (CS) and ACTH-dependent CS. When plasma ACTH values are inconclusive, a differential diagnosis of CS can be made based upon measurement of the serum dehydroepiandrosterone sulfate (DHEA-S) level and results of the high-dose dexamethasone suppression test (HDST). The aim of this study was to assess the utility of plasma ACTH to differentiate adrenal CS from Cushing' disease (CD) and compare it with that of the HDST results and serum DHEA-S level. METHODS: We performed a retrospective, multicenter study from January 2000 to May 2012 involving 92 patients with endogenous CS. The levels of plasma ACTH, serum cortisol, 24-hour urine free cortisol (UFC) after the HDST, and serum DHEA-S were measured. RESULTS: Fifty-seven patients had adrenal CS and 35 patients had CD. The area under the curve of plasma ACTH, serum DHEA-S, percentage suppression of serum cortisol, and UFC after HDST were 0.954, 0.841, 0.950, and 0.997, respectively (all P<0.001). The cut-off values for plasma ACTH, percentage suppression of serum cortisol, and UFC after HDST were 5.3 pmol/L, 33.3%, and 61.6%, respectively. The sensitivity and specificity of plasma ACTH measurement were 84.2% and 94.3%, those of serum cortisol were 95.8% and 90.6%, and those of UFC after the HDST were 97.9% and 96.7%, respectively. CONCLUSION: Significant overlap in plasma ACTH levels was seen between patients with adrenal CS and those with CD. The HDST may be useful in differentiating between these forms of the disease, especially when the plasma ACTH level alone is not conclusive.
Adrenocorticotropic Hormone* ; Cushing Syndrome* ; Dehydroepiandrosterone Sulfate ; Dexamethasone ; Diagnosis, Differential ; Diagnostic Tests, Routine ; Humans ; Hydrocortisone ; Pituitary ACTH Hypersecretion* ; Plasma* ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND: We investigated whether patients' perceived glycemic control and self-reported diabetes self-care correlated with their actual glycemic control. METHODS: A survey was administered among patients with diabetes mellitus at an outpatient clinic with structured self-report questionnaires regarding perceived glycemic control and diabetes self-management. Actual glycemic control was defined as a change in glycated hemoglobin (A1C) or fasting plasma glucose (FPG) since the last clinic visit. RESULTS: Patients who perceived their glycemic control as "improved" actually showed a mild but significant decrease in the mean A1C (-0.1%, P=0.02), and those who perceived glycemic control as "aggravated" had a significant increase in the mean FPG (10.5 mg/dL or 0.59 mmol/L, P=0.04) compared to the "stationary" group. However, one-half of patients falsely predicted their actual glycemic control status. Subjective assessment of diabetes self-care efforts, such as adherence to a diet regimen or physical activity, correlated positively with perceived glycemic control but showed no association with actual glycemic control. CONCLUSION: Patients should be encouraged to assess and monitor diabetes self-care more objectively to motivate behavioral modifications and improve their actual glycemic control.
Ambulatory Care ; Ambulatory Care Facilities ; Blood Glucose ; Diabetes Mellitus ; Diet ; Fasting ; Hemoglobin A, Glycosylated ; Humans ; Motor Activity ; Self Care* ; Surveys and Questionnaires

Von Hippel-Lindau (VHL) disease is an autosomal dominant disorder that results from a germline mutation of the VHL gene. The affected individuals might develop several benign or malignant tumors such as central nervous system or retinal haemangioblastomas, endolymphatic sac tumors, renal cell carcinomas, pheochromocytomas or pancreatic cysts and neuroendocrine tumors. We report here on a case of a 21 year old female with von Hippel-Lindau disease and she presented with only pancreatic neuroendocrine tumor and no evidence of haemangioblastomas or other visceral complications. Further, direct sequencing of the VHL gene reveals a novel germline frameshift mutation of codon 198 from the deletion of nucleotide 592 (cytosine), leading to truncation of the VHL protein.
Carcinoma, Renal Cell ; Central Nervous System ; Codon ; Endolymphatic Sac ; Female ; Frameshift Mutation ; Germ-Line Mutation ; Humans ; Neuroendocrine Tumors ; Pancreas ; Pancreatic Cyst ; Pheochromocytoma ; Retinaldehyde ; von Hippel-Lindau Disease

Allergy diagnosis and immunotherapy in Korea rely mostly on imported allergen extracts. However, some allergens that are not important in Western countries are not commercially available, and even the same species of allergen source often displays differences in allergenicity due to amino acid sequence polymorphisms. Therefore, it is essential to prepare allergen extracts that reflect regional characteristics. Allergen standardization has been performed since 2009 with the support of the Korea Center for Disease Control and Prevention. Here, we summarize the current status of allergen standardization, focusing on the house dust mite and cockroach. Pollen allergens that are under investigation are also briefly described.
Allergens ; Amino Acid Sequence ; Centers for Disease Control and Prevention (U.S.) ; Cockroaches ; Diagnosis ; Hypersensitivity ; Immunotherapy ; Korea ; Pollen ; Pyroglyphidae

Herpes simplex encephalitis (HSE) is a rare viral encephalitis in adults. A high (70%) mortality rate with serious complications has been reported even after active, appropriate management. The association between HSE and immune suppression is unclear, but there are case reports of cancer patients in which HSE concomitantly developed after whole brain radiation or high-dose steroid treatment. The clinical manifestations and laboratory findings of these patients are atypical compared to the general population. Although brain magnetic resonance images reveal typical HSE findings, cerebrospinal fluid (CSF) analysis might be normal in cancer patients. We report a case of HSE in a 48-year-old male diagnosed with nasopharyngeal cancer and treated with concurrent chemoradiation. This patient had a normal cell count in CSF, but HSE was finally diagnosed from positive polymerase chain reaction test results. After administration of acyclovir and systemic steroid treatment, the patient had a good clinical course with few neurologic sequelae.
Acyclovir ; Adult ; Brain ; Cell Count ; Cerebrospinal Fluid ; Chemoradiotherapy* ; Encephalitis, Herpes Simplex* ; Encephalitis, Viral ; Humans ; Male ; Middle Aged ; Mortality ; Nasopharyngeal Neoplasms* ; Polymerase Chain Reaction

BACKGROUND: Dipeptidyl peptidase-4 (DPP-4) inhibitor add-on therapy is a new option for patients with inadequately controlled type 2 diabetes who are taking combined metformin and sulfonylurea (SU). We evaluated the efficacy and safety of this triple therapy and the characteristics of rapid responders and hypoglycemia-prone patients. METHODS: We included 807 patients with type 2 diabetes who were prescribed a newly added DPP-4 inhibitor to ongoing metformin and SU in 2009 to 2011. Glycemia and other metabolic parameters at baseline, 12, 24, and 52 weeks, as well as episodes of hypoglycemia were analyzed. Rapid responders were defined as patients with > or =25% reduction in glycosylated hemoglobin (HbA1c) within 12 weeks. RESULTS: At baseline, while on the submaximal metformin and SU combination, the mean HbA1c level was 8.4%. Twelve weeks after initiation of DPP-4 inhibitor add-on, 269 patients (34.4%) achieved an HbA1c level < or =7%. Sixty-six patients (8.2%, 47 men) were rapid responders. The duration of diabetes was shorter in rapid responders, and their baseline fasting plasma glucose (FPG), HbA1c, C-peptide, and homeostasis model assessment of insulin resistance were significantly higher. Patients who experienced hypoglycemia after taking DPP-4 inhibitor add-on were more likely to be female, to have a lower body weight and lower triglyceride and FPG levels, and to have higher homeostasis model assessment of beta-cells. CONCLUSION: An oral hypoglycemic triple agent combination including a DPP-4 inhibitor was effective in patients with uncontrolled diabetes. Proactive dose reduction of SU should be considered when a DPP-4 inhibitor is added for rapid responders and hypoglycemia-prone patients.
Blood Glucose ; Body Weight ; C-Peptide ; Diabetes Mellitus, Type 2 ; Dipeptidyl-Peptidase IV Inhibitors ; Fasting ; Female ; Hemoglobin A, Glycosylated ; Homeostasis ; Humans ; Hypoglycemia ; Insulin Resistance ; Metformin* ; Sulfonylurea Compounds ; Triglycerides

PURPOSE: We evaluated the prognostic factors, survivals and patterns of failure of the patients with locally advanced cervical cancer who received radical radiotherapy alone and induction chemotherapy followed by radiotherapy respectively. MATERIALS AND METHODS: Between May 1985 to December 1992, one hundred and sixty three patients with locally advaneed cervical cancer received curative radiotherapy. Patients were divided into two groups: control group included 69 patients who received curative radiotherapy and combined group included 94 patients who received induction chemotherapy followed by curative radiotherapy. The curative radiotherapy consisted of external pelvic radiotherapy and intracavitary brachytherapy. Induction chemotherapy was delivered in VBP (vincristine, bleomycin, cisplatin) and FP (5-FU, cisplatin). Follow up period ranged from 2 months to 99 months with median of 50 months. RESULTS: The overall response rate was 94.2% in the control group and 89.4% in the combined group. The response rate by control group was 66.7% for CR (complete response), 27.5% for PR (partial response), 5.8% for NR (no response). The response rate by combined group of CR, PR, NR were 64.9%, 24.5%, 10.6%, respectively. There was no difference in response for control group and combined group (p> 0.05). The 5-year overall survival had no significant difference in between control group and combined group (54.6% vs. 57.3%). The 5-year disease free survival also had no significant difference (52.9% vs. 55.0%). In the control group, 23 patients (33.3%) had treatment failure: twelve (17.4%) at a local recurrence, 9 (13.0%) as distant metastasis, and 2 (2.9%) with both local recurrence and distant metastasis. In the combined group, Thirty patients (31.9%) failed therapy, with local recurrence in 21 patients (22.3%), distant metastasis in 7 patients (7.5%), and both in 2 patients (2.1%). The difference between the two groups was not significant in view of patterns of failure. The major toxicities were nausea/ vomiting, leukopenia, anemia, and diarrhea. The prognostic factors affecting were hemoglobin level, KPS (karnofsky performance status), and treatment response in both group by multivariate analysis. CONCLUSION: This study did not prove the efficacy of induction chemotherapy followed by radiotherapy in locally advanced cervical cancer.
Anemia ; Bleomycin ; Brachytherapy ; Diarrhea ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Induction Chemotherapy* ; Leukopenia ; Multivariate Analysis ; Neoplasm Metastasis ; Radiotherapy* ; Recurrence ; Treatment Failure ; Uterine Cervical Neoplasms* ; Vomiting

Parathyroid cysts, which can be divided into functional and non-functional cysts, are rare causes of primary hyperparathyroidism. A technetium-99m-methoxyisobutylisonitrile (99mTc-sestamibi) parathyroid scan is a sensitive diagnostic tool for the localization, although it sometimes shows a false-negative result. Here we report a case of presumed cystic parathyroid adenoma based on clinical findings and analysis of cystic fluid with negative findings in a parathyroid scan. A 44-year-old male patient visited the hospital due to leg pain and compressive symptoms (dysphagia, hoarseness) that had started 4-5 months before. His serum calcium level was 14.4 mg/dL and his intact parathyroid hormone (iPTH) had increased to 478.1 pg/mL. On neck computed tomography, a cystic nodule measuring 6.2 cm was detected in the inferior part of the right thyroid gland. Sestamibi uptake for this nodule was not detected on 2-h delayed imaging, and fluorodeoxyglucose positron emission tomography showed only subtle uptake. Fine-needle aspiration was performed and intracystic iPTH had increased to 61,600 pg/mL. Focused parathyroidectomy guided by intraoperative iPTH monitoring led to successful enucleation of the right inferior parathyroid gland. A parathyroid adenoma was confirmed, and his laboratory results had normalized. This study shows that cystic parathyroid adenoma can sometimes be difficult to detect on a 99mTc-sestamibi parathyroid scan.
Adult ; Biopsy, Fine-Needle ; Calcium ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Primary ; Leg ; Male ; Neck ; Parathyroid Glands ; Parathyroid Hormone ; Parathyroid Neoplasms ; Parathyroidectomy ; Positron-Emission Tomography ; Technetium Tc 99m Sestamibi ; Thyroid Gland