The association between non-islet cell tumors and fasting hypoglycemia has been recognized since 1929. The humoral mediator of this non-islet cell tumor hypoglycemia(NICTH) is now known as IGF-II. Hypoglycemia develops commonly in the course of hepatocellular carcinoma(HCC), mostly late in the course and usually mild to moderate in severity. Rarely, severe hypoglycemia occurs early in the course of HCC, suggesting NICTH. We report a case of HCC in which hypoglycemic coma due to NICTH was the presenting symptom.A 52-year-old man developed mental confusion and seizures in the early morning. At emergency room, he was found to have severe hypoglycemia. Circulating levels of insulin, C-peptide, insulinlike growth factor-I(IGF-I) and growth hormone were reduced during hypoglycemia. Diagnostic work-up revealed that he had unresectable HCC. During admission, infusion of more than 400g of dextrose per day in addition to meals was required to prevent hypoglycemia. Because the chemotherapy was refused, he was transferred to a local hospital to receive infusions of dextrose.
Adenoma, Islet Cell ; C-Peptide ; Coma ; Drug Therapy ; Emergency Service, Hospital ; Glucose ; Growth Hormone ; Humans ; Hypoglycemia ; Insulin ; Insulin-Like Growth Factor II ; Islets of Langerhans ; Meals ; Middle Aged ; Seizures

Bilateral coronoid hyperplasia causes painless progressive trismus, resulting from coronoid process impingement on the posterior aspect of the zygomatic bone. The etiology of coronoid hyperplasia is unclear, with various theories proposed. An endocrine stimulus, increased temporalis activity, trauma, genetic inheritance and familial occurrence have all been proposed, but no substantive evidence exists to support any of these hypotheses. Multiplanar reformatting of axial scans and 3-dimensional reconstruction permit precise reproduction of the shape and size of the coronoid and malar structures, and relationships of all structures of the temporal and infratemporal fossae. This case shows remarkably increased mouth opening by coronoidectomy in a patient who complained of trismus due to hyperplasia of coronoid process.
Humans ; Hyperplasia* ; Mandible ; Mouth ; Reproduction ; Trismus* ; Wills

The authors would like to delete the acknowledgement part.

BACKGROUND: The average duration of diabetes and predictive factors of macrovascular complications in Korean diabetic patients remain to be elucidated. This study examines the average duration of diabetes up to the onset of macrovascular complications and clinically important factors of early development of these complications in Korean type 2 diabetic patients. METHODS: Clinical characteristics in type 2 diabetics with (n = 121) and without macrovascular complications (n = 115) were analyzed. In addition, early onset (< or = 5 years, n = 54) and late onset groups (> 5 years, n = 67) were compared, as were the clinical characteristics between male and female patients in the macrovascular complications group. RESULTS: The average duration of diabetes was 8.7 +/- 7.8 years in the macrovascular complications group. Average age, systolic and diastolic blood pressures and smoking history were all higher in the macrovascular complications group than the control group. However, HbA1c levels and prevalence of microvascular complications were higher in the controls. Average age was lower in the early onset group and many more patients of that group had a smoking history. In the analysis based on sex, marcrovascular complications developed earlier in male patients. In addition, the prevalence of family history of diabetes was higher in males and 77.8% of male patients had a smoking history (female: 3.4%). CONCLUSION: Our study confirms that older age, high blood pressure and smoking history are major risk factors for the development of macrovascular complications. Moreover, a smoking history in males can be both risk and predictive factors for earlier development of macrovascular complications in Korean type 2 diabetic patients. We also found that several clinical characteristics including age, family history of diabetes, hypertension and smoking history, vary between the sexes, and these findings can provide useful indices for the prevention of macrovascular complications.
Diabetes Complications ; Diabetes Mellitus, Type 2 ; Female ; Humans ; Hypertension ; Male ; Prevalence ; Risk Factors ; Smoke ; Smoking

Acute coronary closure occurs 2-10% during the procedure of PTCA, 50-80% of those events are in the catheterization room. The causes of acute coronary closure are mainly due to dissection, thrombosis or spasm. We recently experienced a case of acute left main coronary artery closure due to guiding catheter induced embolization in the 56 year-old female, unstable angina patient complicated by diabetes mellitus and chronic renal failure. The patient received cardiopulmonary resuscitation shortly after acute closure because of cardiac arrest. During the resuscitation, we performed PTCA at the site of acute closure. The blood pressure maintained normaly after successful recanalization. And then we inserted IABP(intraaortic balloon pump) balloon and did PTCA of original stenosis sites. The patient removed IABP 24 hours later and discharged a month later without complication.
Angina, Unstable ; Blood Pressure ; Cardiopulmonary Resuscitation* ; Catheterization ; Catheters* ; Constriction, Pathologic ; Coronary Vessels ; Diabetes Mellitus ; Female ; Heart Arrest ; Humans ; Kidney Failure, Chronic ; Middle Aged ; Resuscitation ; Spasm ; Thrombosis

BACKGROUND : There are various factors affecting the nutritional status of the elderly. Depression has been known as an important factor of malnutrition in them. We had already reported the poor nutritional status of elderly diabetics [J Kor Diabetes Association 22(1):71, 1998]. We investigated to document the prevalence of malnutrition and its relationship to depression in elderly diabetic patients. METHODS : We studied 52 patients aged 65 and over (65-00 y, mean 76.7 y; 22 men, 30 women) with diabetes mellitus admitted during from 1996 through 1997. Malnutrition was diagnosed on presence of 1 or more criteria; 10% weight loss in last 3 months, serum albumin <3.3 g/dL, serum transferrin <200 mg/dL, and blood total lymphocyte<1,800/mm3. There was no significant differences between depressed Group and non-depressed Group in duration of diabetes, body mass index, fasting plasma glucose, HbA1c, and number of complication including hypoglycemic episodes. Depression was assessed on Hamilton Depression Scale score of 16 or more. Data were analyzed by Chi square test. RESULTS : 28/52 (53.9%) were malnourished, 12/52 (23.1%) having depression. Of the 12 patients with depression, only 5 had malnutrition. No significant relation between depression and malnutrition was found (Chi squre=2.689, p=0.992). CONCLUSION : Depression might have no significant relationship to malnutrition in the elderly diabetic in-patients.
Aged* ; Blood Glucose ; Body Mass Index ; Depression* ; Diabetes Mellitus ; Fasting ; Humans ; Male ; Malnutrition* ; Nutritional Status ; Prevalence ; Serum Albumin ; Transferrin ; Weight Loss

PURPOSE: The purpose of our study was to describe the clinical and radiological mani-festations of tuberculosis in patients with end-stage renal disease. MATERIALS AND METHODS: The medical records, chest radiographs, and CT scans of 42 patients with tuberculosis among 871 consecutive patients with end-stage renal disease were reviewed. Patterns of initial chest radiographs were categorized as primary, postprimary, miliary, or atypical, according to the predominant radiologic findings. RESULTS: Chest radiographs and CT scans revealed pulmonary tuberculosis in 28 patients and extrapulmonary tuberculosis in 15. The pattern of chest radiographs indicative of pulmonary tuberculosis was primary in 12 cases, postprimary in 11, miliary in one, demonstrated atypical infiltrates in three, and was normal in one. Tuberculosis involved the extrathoracic lymph nodes in six cases, the peritoneum in four, the spine in three, and the bone marrow in two. The primary pattern, seen in 12 patients, manifested as pleural effusion or segmental consolidation, and in ten of the twelve the former was dominant. CONCLUSION: The radiological pattern of pulmonary tuberculosis in end-stage renal disease is often primary, and extrapulmonary involvement is frequent.
Bone Marrow ; Humans ; Kidney Failure, Chronic* ; Lymph Nodes ; Medical Records ; Peritoneum ; Pleural Effusion ; Radiography, Thoracic ; Spine ; Tomography, X-Ray Computed ; Tuberculosis* ; Tuberculosis, Pulmonary

Erdheim-Chester disease (ECD) is a rare form of non-Langerhans cell histiocytosis with multi-organ involvement. Bones, cardiovascular system, central nervous system, kidney, skin and many different organs can be involved but laryngeal involvement has not been reported in literatures. The diagnosis of ECD was based on clinical manifestations and immunohistochemical findings including CD68(+), CD1a(-) and S100(-). Currently, Interferon-a is the most extensively studied agent in the treatment of ECD and serves as the 1st line of treatment. Surgical resection of involved lesions can be tried but it leads to temporary improvement. A 60-year-old man visited with respiratory symptoms because of ECD with laryngeal involvement. We resected the obstructive lesion to relieve the symptoms. Tissue biopsy gave a diagnosis of ECD. As it is rare to encounter ECD involving the larynx, we report this case with a review of literatures.
Biopsy ; Cardiovascular System ; Central Nervous System ; Diagnosis ; Epiglottis ; Erdheim-Chester Disease* ; Histiocytosis ; Humans ; Kidney ; Larynx ; Middle Aged ; Skin

Adrenergic Fibers ; Humans ; Male ; Mandibular Condyle ; Regeneration ; Sweat ; Sweat Glands ; Sweating ; Sweating, Gustatory ; Young Adult

Human chorionic gonadotropin(HCG) is a member of the glycoproteins family synthesized by the placenta, which consists of 2 noncovalently joined subunits(alpha(alpha) and beta(beta)). The alpha- and beta-subunits have a structural homology with the alpha- and beta-subunits of TSH and LH. The thyrotropic action of HCG results from its structural similarity to TSH, so beta-HCG can bind to the TSH receptor in the thyroid gland. A high level of HCG accompanied by an increased thyroid hormone level, can be observed in gestational trophoblastic disease (GTD), such as a hydatidiform mole or a choriocarcinoma, but the clinical symptoms of hyperthyroidism are rarely observed. We experienced a case of Hashimoto's thyroiditis, where the patient was diagnosed with T3-thyrotoxicosis, which had initially been induced by excess beta-HCG due to an H-mole; after evacuation of the H-mole, the condition was diagnosed as hypothyroidism. It has been speculated that a patient with Hashimoto's thyroiditis could have hyperthyroidism, induced by beta-HCG, due to an H-mole
Choriocarcinoma ; Chorion ; Female ; Gestational Trophoblastic Disease ; Glycoproteins ; Humans ; Hydatidiform Mole* ; Hyperthyroidism ; Hypothyroidism ; Placenta ; Pregnancy ; Receptors, Thyrotropin ; Thyroid Gland* ; Thyroiditis*