Managing type 2 diabetes has become more complex as pharmacotherapy has expanded. Therapies for type 2 diabetes can be divided into drugs facilitating supply of endogenous insulin or those enhancing insulin actions. Successful treatment of type 2 diabetes combines approaches to lifestyle modification frequently in conjunction with use of pharmacologic therapy. The dual aspects of type 2 diabetes, insulin resistance and insulin deficiency, are important factors in therapy selection and the subsequent reponse to therapy. Most patients have gradually increasing needs for additional therapy. Some patients require combination pharmacologic therapy at the time of initial treatment, especially if they have a markedly elevated HbA1c. We describes combination pharmacologic therapy in type 2 diabetes, recent evidence and opinions on sequences for type 2 diabetes.
Humans ; Insulin ; Insulin Resistance ; Life Style

Heterotopic pregnancy is the coexistency of intrauterine and extrauterine pregnancy. The incidence of heterotopic pregnancy is about 1 to 30,000 pregnancy in a natural cycle. However, the frequency of heterotopic pregnancy has steadily increased because of rising incidence of pelvic inflammatory disease, pelvic surgery and the development of ovulation induction and assisted reproduction. Because heterotopic pregnancy is difficult to diagnose and it has high morbidity and mortality rate, one should always take this into consideration and should conduct careful and thorough gynecologic evaluation. We have experienced a case of heterotopic pregnancy in a 29-year old woman who presented with acute abdominal pain in a natural cycle and report this case with a brief review of literature.
Abdominal Pain ; Adult ; Female ; Humans ; Incidence ; Mortality ; Ovulation Induction ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Heterotopic* ; Reproduction

No abstract available.
Apgar Score* ; Humans

No abstract available.
Apgar Score* ; Humans

Thyroid anomaly are rare embryological condition. The failure of the development of one lobe leading to unilateral agenesis is the rarest of all the thyroid anomalies, The cause of unilateral agenesis is unknown. Thyroid hemiagenes is common in females (3: 1) with the left lobe being absent. The common disease in the remaining lobe is a benign adenoma, a multinodular goiter, hyperthyroidism, chronic thyroiditis, and rarely carcinoma. The most common pathology involved in thyroid hemiagenesis is hyperthyroidism. This report the case of a 57-year-old woman with a right thyroid hemiagenesis.
Adenoma ; Female ; Goiter ; Humans ; Hyperthyroidism ; Middle Aged ; Pathology ; Thyroid Gland* ; Thyroiditis

Systolic time interval measurements were made sequentially during second, third trimesters and postpartum period. Recordings were made in the supine position after bed rest for at least five minutes in order to obtain a steady state. In second trimester, pre-ejection period index (PEPI) was significantly shortened and left ventricular ejection period index(LVETI) remained normal while PEP/LVET decreased. Four possible mechanisms may be involved to account for the alterations in hemodynamic changes during this period(late stage of second trimester) : (1) increased metabolic demands of pregnancy: (2) hemodynamic effects of hypervolemia: (3) circulatory adjustments secondary to an arteriovenous shunt-like effect of the placental circulation: (4) cardiovascular effect of steroid hormone. The third trimester was characterized-by a markedly shortened LVETI, a prolonged PEPI and PEP/LVET. This findings are consistent with impaired left ventricular performance and are probably due to decreased left ventricular preload resulting from diminished venous return secondary to inferior vena caval obstruction by the large gravid uterus. In the postpartum period, the PEPI and PEP/LVET remained elevated and the LVETI shortened in the supine position. It is concluded that alterations in systolic time intervals occur normally during the course of uncomplicated pregnancy and persist into the postpartum period.
Bed Rest ; Female ; Hemodynamics ; Humans ; Placental Circulation ; Postpartum Period* ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third* ; Supine Position ; Systole* ; Uterus

We describe a rare case of pseudopseudohypoparathyroidism (PPHP) with benign intracranial hypertension (BIH). A 16 year-old male presented with headache, vomiting, ocular pain, blurred vision, and diplopia following minor head trauma. He showed developmental delay, short stature and short metacarpals and phalanges, which suggested Albright's hereditary osteodystrophy. Neurologic examination revealed bilateral sixth cranial nerve palsy and bilateral papilledema. Lumbar puncure disclosed an elevated opening CSF pressure with normal biochemical and celluar find-ings. However, the levels of serum calcium, phosphorus and parathyroid hormone were within the normal limits and chromosomal analyses were normal. Brain MRI revealed normal ventricular size and no structural abnormality. We concluded that PPHP seemed to have a key role for the genesis of BIH in this case, although previous mild head trauma might have a precipitating effect.
Abducens Nerve Diseases ; Adolescent ; Brain ; Calcium ; Craniocerebral Trauma ; Diplopia ; Headache ; Humans ; Magnetic Resonance Imaging ; Male ; Metacarpal Bones ; Neurologic Examination ; Papilledema ; Parathyroid Hormone ; Phosphorus ; Pseudopseudohypoparathyroidism* ; Pseudotumor Cerebri* ; Vomiting

No abstract available.
Biomarkers* ; Blood Platelets* ; Diabetes Mellitus*

Oal contraceptives are one of the most frequently used methods of hormonal contraception. In general, oral contraceptives have proven to be safe for most women. However, the risk of deep vein thrombosis and pulmonary embolism are increased in women taking oral contraceptives. We have experienced a case of a woman who had superior mesenteric venous (SMV) and portal vein thromboses on taking oral contraceptives with antithrombin III, protein C, and protein S deficiencies.
Antithrombin III* ; Contraception ; Contraceptive Agents ; Contraceptives, Oral* ; Female ; Humans ; Portal Vein ; Protein C* ; Protein S Deficiency* ; Protein S* ; Pulmonary Embolism ; Thrombosis ; Venous Thrombosis*

PURPOSE: This study investigated the clinical features of patients with thyroid nodule combined with Hashimoto's thyroiditis, and the latter was incidentally detected after surgery. METHODS: The authors retrospectively evaluated 43 patients who were diagnosed with Hashimoto's thyroiditis after thyroidectomy between January 2001 and December 2006 at Chosun University Hospital. RESULTS: All patients underwent ultrasonography for the diagnosis of thyroid nodules. Ultrasonography revealed 16 calcified nodules with ill-defined margins, and these nodules were suspicious for malignancy. On performing preoperative fine needle aspiration, 37 cases were suspicious for malignancy or they were diagnosed as malignancies. All the thyroid nodules were taken for frozen section examination during surgery. On the frozen sections, 19 cases that were suspicious for malignant tumors underwent near total or total thyroidectomy along with central lymph node dissection, whereas 24 cases that were diagnosed as benign tumors underwent near total thyroidectomy or thyroid lobectomy. Based on the histopathological findings, 21 cases were diagnosed as Hashimoto's thyroiditis associated with papillary cancer; the nodules of these 21 cases were on average 0.75 cm, Twenty two cases were diagnosed as Hashimoto's thyroiditis associated with benign tumors, and the nodules of these cases measured on average 1.6 cm. CONCLUSION: Hashimoto's thyroiditis may present with a variety of clinical features, atypical ultrasonographic findings and a high false positive rate on fine needle aspiration. For the cases where Hashimoto's thyroiditis is suspected before surgery, serum antibody tests, ultrasonography and fine needle aspiration should be performed for making the accurate diagnosis of Hashimoto's thyroiditis. For the cases of suspicious malignant tumors, frozen section examination should be performed during surgery to decide on the correct operative procedure.
Biopsy, Fine-Needle ; Frozen Sections ; Humans ; Lymph Node Excision ; Retrospective Studies ; Surgical Procedures, Operative ; Thyroid Gland ; Thyroid Nodule ; Thyroidectomy ; Thyroiditis