Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant tumor syndrome. Thymic carcinoid tumors in MEN1 are not common and their natural history is little known. But development of thymic carcinoid tumors is important because in 1993, they were identified as a frequent case of death. There has not been a report of case in Korea so far. We encountered a case of thymic carcinoid in MEN1. A 42 year old man was referred presenting with diabetes of 12 years duration. Abnormal findings in his blood chemistry were hypercalcemia and hyperprolactinemia. 99mTc- sestamibi scintigraphy showed parathyroid adenoma and hyperplasia. Sella MRI showed pituitary macroadenoma. Abnormal CT scan demonstrated multiple pancreas islet cell tumors, bilateral adrenal tumor and thymoma. Subtotal parathyroidectomy with thymectomy was perfomed and thymic carcinoid was confirmed. This is the first report of thymic carcinoid with MEN1 in Korea.
Adenoma, Islet Cell ; Adult ; Carcinoid Tumor* ; Chemistry ; Humans ; Hypercalcemia ; Hyperplasia ; Hyperprolactinemia ; Korea ; Magnetic Resonance Imaging ; Multiple Endocrine Neoplasia Type 1* ; Multiple Endocrine Neoplasia* ; Natural History ; Pancreas ; Parathyroid Neoplasms ; Parathyroidectomy ; Radionuclide Imaging ; Thymectomy ; Thymoma ; Tomography, X-Ray Computed

BACKGROUND: Previous studies showed 'treatment gap' phenomenon in the treatment of hyperlipidemia, meaning failure to adhere to the recommendation in the treatment guideline. In Korea, systematic research on this issue has never been done. This investigation was to estimate the hypercholesterolemia treatment gap in coronary artery disease (CAD) patients in tertiary care centers according to NCEP ATP-III guideline. METHODS: Ten Korean educational hospital participated in the survey, reviewing medical record of 1,048 patients. Patients were enrolled when they were documented as having coronary artery disease by coronary angiography or stress tests or medical history of myocardial infarction, percutaneous coronary intervention or bypass surgery. Thirty or more medical records per each of 3 or more cardiologists were reviewed in each hospital. Sampling was done sequentially based on outpatient or inpatient list. Pharmacological treatment for hyperlipidemia included the first and last records of prescription. Baseline and the most recent lipid profiles were collected. RESULTS: Findings from the survey was summarized as '10 to 50% rule': 10%: mean LDL-cholesterol reduction without lipid-lowering drug, 20%: LDL-cholesterol level at the treatment goal before any treatment, 30%: mean LDL-cholesterol reduction with lipid-lowering drug treatment, 40%: proportion of CAD patients without lipid-lowering drug, 50%: treatment goal achievement after treatment. CONCLUSIONS: Significant treatment gap exists in Korean cardiology practice in tertiary care centers. Systematic approach to reduce this gap is warranted.
Cardiology ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Exercise Test ; Guideline Adherence ; Humans ; Hypercholesterolemia* ; Hyperlipidemias ; Inpatients ; Korea ; Medical Records ; Myocardial Infarction ; Outpatients ; Percutaneous Coronary Intervention ; Prescriptions ; Tertiary Care Centers

BACKGROUND AND OBJECTIVES: Ex vivo expansion of endothelial cells is important when applying cell therapy to therapeutic angiogenesis in ischemic tissues. Endothelial precursor cells (EPCs) from the umbilical cord blood are one of adult stem cell. In order to establish the culture system for EPCs, we examined the effects of the media and matrix on the differentiation of a subset of mononuclear cells to endothelial cells, and analyzed their endothelial-lineage phenotype. MATERIALS AND METHODS: Mononuclear cells isolated from human umbilical cord blood were cultured in a chamber slide coated with fibronectin or gelatin in a M199 medium supplemented with 10% fetal bovine serum (FBS) (the normal medium) or with 20% FBS and ECGS (the rich medium). Changes in the morphology and the attainment of DiI-ac-LDL uptake ability were examined during a 7 day period. The attached cells were immunostained for CD31, KDR, and vWF. RESULTS: The fibronectin matrix gave rise to more attached cells than the gelatin matrix (about 1.5 fold). The numbers of attached cells were no different between the normal medium and the rich medium at day 3 and 7, and were about 12% of the seeded mononuclear cells. However, the cell size and the numbers of longer spindle-shaped cells increased with the rich medium. Moreover, there was no increase in cellular population, but a 2-3 fold increase in the cellular size between day 3 and 7. About 20-40% of the attached cells acquired the DiI-ac-LDL uptake ability at day 3, whereas more than 85% of the attached cells could be stained with fluorescent DiI-ac-LDL at day 7 (p<0.001). The attached cells after being cultured for 7 days were stained moderately with the antibodies of CD31, or KDR. However, the cells at day 7 were only weakly immunostained with the vWF antibody, whereas more than 90% of cells were strongly stained at day 14. CONCLUSION: These results suggest that a subset of mononuclear cells derived from cord blood cells can give rise to cells with an endothelial cell-like phenotype, in vitro, at high percentages, which could be applied to in vivo vasculogenesis.
Adult Stem Cells ; Antibodies ; Cell Size ; Cell- and Tissue-Based Therapy ; Electrocardiography ; Endothelial Cells ; Endothelium, Vascular ; Fetal Blood* ; Fibronectins ; Gelatin ; Humans ; Phenotype ; Stem Cells ; Umbilical Cord*