BACKGROUND: Diabetic patients develop hypoaldosteronism which frequently caused hyperkalemia and metabolic acidosis and diabetic hypoaldosteronism is associated with selective unresponsiveness of aldosterone to angiotensin A-II, but mechanism of defect in A-II stimulated aldosterone response still remain unclear. METHODS: To elucidate the mechanism of defect in A-II stimulated aldosterone response, author evaluated the responses of aldosterone production to A-II, K+, and ACTH in adrenal glomerulosa cells prepared from streptozotocin induced diabetic rats, Inositol triphosphate (IP3) generated by activation of phospholipase C (PLC) and arachidonic acid and lysophospholipids generated by activation of phospholipase A2 (PLA2) were measured in A-II stimulated glomerulosa cells. Radiocalcium efflux and aldosterone response to second messenger of A-II such as PLC, IP3, PLA, AA and protein kinase C activator, 12-o-tetradecanoylphorbol 13 acetate (TPA). RESULTS: 1. Plasma renin activity and aldosterone levels were not different among control rats, untreated and insulin treated diabetic rats. 2. Basal, ACTH and K+ -stimulated aldosterone production were similar in cells from the three groups (p<0.05), but A-II stimulated aldosterone production was significantly decreased in cells from untreated diabetic rats compared with control and insulin treated diabetic rats (p0.05). 4. Aldosterone responses to PLC, IP3, AA and TPA were significantly decreased in glomerulosa cells from diabetic rats compared with control and insulin treated diabetic rats (p<0.05), but aldosterone response to PLA2 was similar among the three groups (p>0.05). 45Ca efflux to PLC, IP3 PLA2 and AA were similar among the three groups (p>0.05). CONCLUSION: These results suggested that decreased A-II-stimulated aldosterone response was present in glomerulosa cells from streptozotocin induced diabetic rats and reversed by insulin treatments. The main defect of altered A-II response of zona glomerulosa might be located in the step after activation of phospholipase and increase of intracellular calcium, and activation of PKC, or distal to that could be one of the causative mechanism.
Acidosis ; Adrenocorticotropic Hormone ; Aldosterone* ; Angiotensin II ; Angiotensins* ; Animals ; Arachidonic Acid ; Calcium* ; Diabetes Mellitus ; Humans ; Hyperkalemia ; Hypoaldosteronism ; Inositol ; Insulin ; Lysophospholipids ; Phospholipases A2 ; Phospholipases* ; Plasma ; Protein Kinase C ; Rats* ; Renin ; Second Messenger Systems ; Streptozocin ; Type C Phospholipases ; Zona Glomerulosa*

The author analyzed 231 patients of congestive heart failure which was confirmed by the clinical symptoms and the laboratory findings among the patients admitted to Ewha Womans University Hospital between the begining of 1974 and the end of 1978. The result were as follow; 1. In sex distribution, the female was predominant. Male to female ratio is 1:2.45. The most common incidence by age group was sixth decade. 2. Regarding the underlying disease, there were hypertensive heart disease(27.3%), post-partum heart disease(19.5%), rheumatic heart disease(16.0%) and arteriosclerotic heart disease(15.6%) in order. 3. The precipitating factors were observed in 77.5% of total cases and the order of frequency was pregnancy and delivery(26.4%), infection(19.1%), arrhythmia(12.6%) and physical exertion(12.1%). 4. On admission, patients usually complained of dyspnea, cough, right upper quadrant pain and the physical examination revealed moist rales, hepatomegaly etc. 5. The laboratory findings were anemia(19.0%), increased E.S.R.(33.8%) and leukocytosis (34.2%). 6. The blood chemistry showed increased level of creatinine(24.5%), S.G.O.T. (20.9%), B.U.N.(20.0%) and decreased albumin(15.5%), increased S.G.P.T.(15.0%) in order. 7. The X-ray films of chest on admission revealed increased vascular marking and pulmonary congestion(85.7%), cardiomegaly(80.0%) and pleural effusion(21.4) etc. 8. The E.C.G. findings showed(205 cases among 231 cases) LVH 56.6%, atrial fibrillation 26.3% etc. 9. The echocardiography perfomed in 59 cases among 231 cases gave valvular heart disease (28.9%), atrial fibrillation (11.9%) arteriosclerotic heart disease(8.5%), ventricular hypertrophy (6.8%) and atrial enlargement(5.1%) in order of frequency.
Atrial Fibrillation ; Chemistry ; Cough ; Dyspnea ; Echocardiography ; Estrogens, Conjugated (USP)* ; Female ; Heart ; Heart Failure* ; Heart Valve Diseases ; Hepatomegaly ; Humans ; Hypertrophy ; Incidence ; Leukocytosis ; Male ; Physical Examination ; Precipitating Factors ; Pregnancy ; Respiratory Sounds ; Sex Distribution ; Thorax ; X-Ray Film

The author analyzed 231 patients of congestive heart failure which was confirmed by the clinical symptoms and the laboratory findings among the patients admitted to Ewha Womans University Hospital between the begining of 1974 and the end of 1978. The result were as follow; 1. In sex distribution, the female was predominant. Male to female ratio is 1:2.45. The most common incidence by age group was sixth decade. 2. Regarding the underlying disease, there were hypertensive heart disease(27.3%), post-partum heart disease(19.5%), rheumatic heart disease(16.0%) and arteriosclerotic heart disease(15.6%) in order. 3. The precipitating factors were observed in 77.5% of total cases and the order of frequency was pregnancy and delivery(26.4%), infection(19.1%), arrhythmia(12.6%) and physical exertion(12.1%). 4. On admission, patients usually complained of dyspnea, cough, right upper quadrant pain and the physical examination revealed moist rales, hepatomegaly etc. 5. The laboratory findings were anemia(19.0%), increased E.S.R.(33.8%) and leukocytosis (34.2%). 6. The blood chemistry showed increased level of creatinine(24.5%), S.G.O.T. (20.9%), B.U.N.(20.0%) and decreased albumin(15.5%), increased S.G.P.T.(15.0%) in order. 7. The X-ray films of chest on admission revealed increased vascular marking and pulmonary congestion(85.7%), cardiomegaly(80.0%) and pleural effusion(21.4) etc. 8. The E.C.G. findings showed(205 cases among 231 cases) LVH 56.6%, atrial fibrillation 26.3% etc. 9. The echocardiography perfomed in 59 cases among 231 cases gave valvular heart disease (28.9%), atrial fibrillation (11.9%) arteriosclerotic heart disease(8.5%), ventricular hypertrophy (6.8%) and atrial enlargement(5.1%) in order of frequency.
Atrial Fibrillation ; Chemistry ; Cough ; Dyspnea ; Echocardiography ; Estrogens, Conjugated (USP)* ; Female ; Heart ; Heart Failure* ; Heart Valve Diseases ; Hepatomegaly ; Humans ; Hypertrophy ; Incidence ; Leukocytosis ; Male ; Physical Examination ; Precipitating Factors ; Pregnancy ; Respiratory Sounds ; Sex Distribution ; Thorax ; X-Ray Film

No abstract available.
Fasting* ; Female ; Humans

OBJECTIVES: Subacute thyroiditis is a nonsuppurative inflammation of thyroid gland and is probably caused by a cytopathic virus. Typical clinical symptoms and features of subacute thyroiditis vary widely during the course of illness. It has a clinical course, evolving from hyperthyroidism through a temporary hypothyroidism to recovery. However, the final outcome of this disease remains unpredictive in some patients. Permanet hypothyroidism occurs infrequently. METHODS: Thirty-three patients proven to have subacute thyroiditis at the Ewha Womans University Hospital from September 1993 to November 1995 were studied. We analyzed their clinical features, laboratory findings, and duration of recovery to cha- racterize the course of the disease. RESULTS: 1) Total 33 patients were studied: 31 patients were female and 2 patients were male. Their mean age was 42.6+/-8.3 years old. The peak months were August through October in this study. 2) Initial mean ESR was 73.0+/-35.2mm/hr, mean T3 was 217.3+/-73.9ng/dl, mean T4 was 15.2+/-8.5microgram/ dl, and TSH was 0.06+/-0.09microIU/ml. The positive rates of antithyroglobulin and anitmicrosomal antibodies were 31% and 6% respectively, and TSH receptor antibody was elevated in one patient. 3) In the thyroid scan, 91% showed both lobes nonvisualisation, and 9% showed one lobe nonvisualization. Radioactive iodine uptake(RAIU) at 24 hour was 2.4+/-3.3%. 4) With the predisolone therapy, 90% of patients completely recovered, 57% of these patients had no hypothyroid phase and remaining 33% of them had hypothyroid phase during course of the disease. Three of the patients had permanent hypothyroidim. 5) The average duration of recovery was 3.2+/-1.4 months and it has no correlation with initial thyroid hormone levels, antithyroid antibodies and duration of steroid administration. CONCLUSION: There was no historical, physical, laboratory findings that help us predict those patients likely to have an exacerbation of the disease.
Antibodies ; Female ; Humans ; Hyperthyroidism ; Hypothyroidism ; Inflammation ; Iodine ; Male ; Prednisolone ; Receptors, Thyrotropin ; Thyroid Gland ; Thyroiditis, Subacute

Background: Postpartum thyroiditis is a painless, destructive lymphocytic inflammation of the thyroid gland that occurs during the postpartum period and is associated with a high prevalence of serum thyroid autoantibodies. Clinical symptoms and laboratory fi#ndings of postpartum thyroiditis vary widely during the course of illness and the final outcome of this disease remains unpredictive in some patients. The purpose of this study is to investigate the clinical course and the predictors of the outcome of the disease. Methods: Thirty-eight patients proven to have postpartum thyroiditis at the Ewha Womans University Hospital were studied. We analyzed their clinical features, laboratory findings and duration of recovery to characterize the course of the disease. Results: Their mean age was 29.0±3.3 years and the time of diagnosis was 4.9±1.9 months after delivery. The prevailed months of delivery were November through January in this study. Twenty six patients were hypothyroid and 12 were thyrotoxic at initial thyroid function. The positive rates of antithyroglobulin and anitmicrosomal antibodies were 92%, 67% in the hypothyroid group and 75%, 67% in th thyrotoxic group respectively. TSH receptor antibodies were negative in all patients. In the hypothyroid group the titers of antimicrosomal antibodies were significantly higer than the thyrotoxic group. The titers of antimicrosomal antibodies were positively correlated with serum TSH and negatively correlated with serum T4. In all patients, the titers in thyroid function tests returned to the normal range without long-term hypothyroidism. Conclusion: The titers of antimicrosomal antibodies were significantly higher in the hypothyroid group than the thyrotoxic group. Thus the titers of antimicrosomal antibodies can help guide the physician in the care of patients with postpartum thyroiditis who will probably be hypothyroid. In this study, we were surprised that all patients became euthyroid without permanent hypothyroidism.
Antibodies ; Autoantibodies ; Clinical Study ; Diagnosis ; Female ; Humans ; Hypothyroidism ; Inflammation ; Postpartum Period ; Postpartum Thyroiditis ; Prevalence ; Receptors, Thyrotropin ; Reference Values ; Thyroid Function Tests ; Thyroid Gland ; Thyroiditis

BACKGROUND: Cardiovascular disease is the major cause of morbidity and mortality. It is well known that androgen and sex hormone-binding globulin(SHBG) in women were associated with risk factors for cardiovascular disease such as obesity, central fat accumulation and atherogenic lipid profile. High resolution B-mode ultrasonography can visualize directly both luminal and vessel wall characteristics, and ultrasonic measurement of carotid intima-medial thickness(IMT) can be used to investigate the atherosclerosis of coronary, cerebral and peripheral arteries. The aim of this study was to evaluate the relationship between the serum dehydroepiandrosterone sulfate(DHEA-S) and SHBG, and body fat distribution pattern, cardiovascular risk factor and carotid atherosclerosis in women. METHODS: Blood pressure, fasting serum glucose, insulin, lipid profile, SHBG and DHEA-S were measured. Body fat distribution pattern was assessed by waist to hip ratio, waist to thigh ratio and subscapular to triceps skin fold thickness ratio, faf mass measured by bioelectric impedance analyzer, subcutaneous fat area, visceral fat area, and visceral to subcutaneous fat area ratio(VSR) at the level of umbilicus using the computed tomography. The IMT of the carotid artery was measured by high resolution B mode ultrasound as a marker of atherosclerosis. RESULTS: 1) There was no significant difference of age-adjusted values of carotid IMT among subjects with NGT(0.426+/-0.09mm), IGT(0.46+/-10.09mm) and NIDDM(0.453+/-0.11mm). 2) In postrnenopausal women, carotid IMT was greater(0.484+/-0.11mm, p=0.05) than premenopausal women(0.426+/-0.08mm), but it was not significant after age adjustment. Serum SHBG and DHEA-S levels in postmenopausal women were significantly lower(p<0.05) than premenopausal women, but they were not significant after age adjustment. 3) Carotid IMT was significantly correlated with age(r=0.37, p<0.01), fasting serum glucose (r=0.32, p<0.01), total cholesterol(r= 0.25, p<0.05), LDL-cholesterol(r=0.26, p<0.05), visceral fat area(r=0.35, p<0.01) and VSR(r=0.31, p<0.05). 4) By the stepwise multiple regression analysis, carotid IMT was positively and significantly associated with age(p<0.01) and serum DHEA-S concentration(p<0.05) in dent of age, body mass index, waist to hip ratio, fasting serum glucose. CONCLUSION: Carotid IMT was associated with age and serum DHEA-S concentration in women without cardiovascular disease. Therefore, serum DHEA-S may be one of risk factors for cardiovascular disease in women. However, we could not conclude its cause-result relationship because of cross sectional nature of our study, and prospective study will be needed.
Arteries ; Atherosclerosis ; Blood Glucose ; Blood Pressure ; Body Fat Distribution ; Body Mass Index ; Cardiovascular Diseases ; Carotid Arteries ; Carotid Artery Diseases* ; Dehydroepiandrosterone Sulfate* ; Dehydroepiandrosterone* ; Electric Impedance ; Fasting ; Female ; Humans ; Insulin ; Intra-Abdominal Fat ; Mortality ; Obesity, Abdominal ; Phenobarbital ; Risk Factors ; Sex Hormone-Binding Globulin* ; Skin ; Subcutaneous Fat ; Thigh ; Ultrasonics ; Ultrasonography ; Umbilicus ; Waist-Hip Ratio

No abstract available.
Animals ; Captopril* ; Cisplatin* ; Nifedipine* ; Rats*

Although the mechanism of the development of hypertension has not been fully elucidated, abnormal ion transport across the cardiovascular musle membrance may play some role in this mechanism. The elevation of intraceular sodium by inhibition of the Na(+), K(+)-ATPase diminshes the sodium gradient for calcium extrusion and/or increase Na(+)/Ca(++) exchange across the cell membrance. In any event, contractility and vascular tone of cardiovascular system can be incresed as reslut of an increase of intracellular calcium. Recently it is reported that the defects of Na(+), K(+)-ATPase occur in spontaneously hypertensive rat(SHR) hearts, compared to control normotensive Spargue Dawley(SD) rat hearts. However, one missing, unresolved question arose in the previous reports in whether the reduced Na(+)-pump activity in the heart of SHR is associated with the development of hypertension itself in these animals or is a consequence of inhertied pathological features that later reslut in a reduced pump activity. In order to clearify this question it is attempted to measured to measure the change of the Na(+), K(+)-ATPase activities in cardiac sarcolemma purified from both the normotensive SD rats and SHR rats during growth ; Simultaneously the charge of cation concentration in both intracellular space(RBC) and extracelluar space(ECF) are measured to the erythrocyte test(Garay and Meyer) applied to the clinical investiation of hypertension. The results obtained are summarized as follows ; 1) The systolic blood pressure of 7 week old SHR was 120-130mmHg, which was not significantly different from that of the age-matched SD rats. However, the blood pressure was elevated to 160-170mmHg in 13-15 week old SHR, even elevated to 190mmHg in one of 19 week old SHR. On the other hand, SHR, in which hypertension was well established had pronounced cardiac hypertrophy. 2) The Na(+), K(+)-ATPase activities in cardiac sarcolemma of the SHR rats were decreased gradually as hypertension established.The decrease of Na(+), K(+)-ATPase was well associated with the increase of intracellular potassium concentration.By contrast, thr Na(+), K(+)-ATPase activities and cation transports og the normotensive SD rats were not significanlty chaged during growth. 3) The charges of Na(+), K(+)-ATPase activities in SHR were specific because the activities of Ca(++)-ATPase which is one of the membrance bound enzyme were not changed during growth appeared to be a major fator which generated hypertension in SHR rats. However, question on how the Na(+), K(+)-ATPase activities are decreased and which event is initiative between reduction of Na(+), K(+)-ATPase and development of hypertension are still remained unclear. Recent literature suggests the there might be a genetic factor, so-called Na(+)-pump inhibitor, involved in the meachanism.
Animals ; Blood Pressure ; Calcium ; Cardiomegaly ; Cardiovascular System ; Erythrocytes ; Hand ; Heart ; Hypertension ; Ion Transport ; Potassium ; Rats ; Rats, Inbred SHR* ; Sarcolemma ; Sodium

Mandibular retrusion showing the facial problem with a marked maxillarry incisors protrusion and chin deficiency, resulting in a highly convex profile is uncommon in Korea.. The large incisor overjet and deep-bite create functional limitations and unpleasing esthetic result. The majority of theses cases are susceptible to correction by orthodontic therapeutic methods. But severe Class II retrognathic cases in which orthodontic treatment alone has not been capable of achieving good results. Orthognathic surgery offers several approaches. In this case, mandibular advancement by bilateral sagittal split ramus osteotomy and augmentation genioplasty has a special surgical problems. The suprahyoid muscle gorup are lengthened if the body of the mandible is surgically repositioned anteriorly. Instability of results and relapse return to original position shoud predicted during post-surgical muscular readjustment.. To maintain maximum correction with this technique, it is suggested that the mandibular body be well rotated forward at time of surgical intervention and overcorrected anteriory as much as possible. So, the authors report the case with review of concerned literature.
Chin ; Genioplasty ; Incisor ; Korea ; Mandible ; Mandibular Advancement ; Orthognathic Surgery ; Osteotomy, Sagittal Split Ramus ; Overbite ; Recurrence ; Retrognathia*