No abstract available.

Hypoparathyoidism is rarely reported during pregnancy or the puerperium. Since hypocalcemia during pregnancy increases the mortality and morbidity of fetus, neonate, and mother, the early diagnosis and treatment of hypocalcemia, especially hypocalcemic crisis, might be very important to reduce severe complications. We experienced a case of hypocalcemic crisis induced by hypoparathyroidism developed after Cesarean section. This case represents symptoms and signs of hypocalcemia such as dyspnea, tingling sensation of upper and lower limbs, chest pain during hypocalcemic crisis. Physicians should be aware of the symptoms and signs, and treatment of hypocalcemic crisis.
Cesarean Section* ; Chest Pain ; Dyspnea ; Early Diagnosis ; Female ; Fetus ; Humans ; Hypocalcemia ; Hypoparathyroidism ; Infant, Newborn ; Lower Extremity ; Mortality ; Mothers ; Postpartum Period ; Pregnancy ; Sensation

BACKGROUND: There have been many reports that 1,5-Anhydroglucitol (1,5-AG) was a better marker than the hemoglobin A1c (HbA1c) or fructosamine for monitoring the control of glucose in patients with Diabetes Mellitus (DM). However, there was difficulty in performing the tests on the patient's samples in the hospital laboratory because the measurement was possible only with gas chromatog-raphy or high performance chromatography. Recently, a reagent that can measure 1,5-AG on the automatic chemistry analyzer was introduced. We evaluated the analytical and clinical characteris-tics of the reagent. METHODS: We measured the 1,5-AG with the Lana(TM) (Japan Chemistry Medicine, Tokyo, Japan) on the automatic chemistry analyzer, TBA-30FR (Toshiba, Otawara, Japan). We evaluated the pre-cision, the recovery rate, the lower detection limit, the reference value, and the correlation with other clinical markers for glucose control of the DM patient. RESULTS: The within-run precisions of abnormal and normal samples were 1.27% and 1.41%. The between-day precisions were 2.34% and 4.56%, respectively. The recovery rate was 100.1% and 100.7% in abnormal and normal samples, respectively. The lower detection limit was 0.05 mg/L. The reference value from the healthy people was from 12.7 to 50.9 mg/L. The correlation coefficients of the 1,5-AG with glucose and HbA1c were -0.45 and -0.63, respectively. CONCLUSIONS: The newly introduced reagent for 1,5-AG that could be applied with the automatic chemistry analyzer was enough to satisfy the analytical features and it showed better correlation with HbA1c than with the fasting blood glucose. We expect that the Lana(TM) can be used in hospital lab-oratories to monitor the blood glucose control of DM patients and more studies on the clinical value of the 1,5-AG can be done with the convenient reagent such as this.
Biomarkers ; Blood Glucose ; Chemistry ; Chromatography ; Diabetes Mellitus ; Fasting ; Fructosamine ; Glucose ; Humans ; Laboratories, Hospital ; Limit of Detection ; Reference Values

BACKGROUND: Glucocorticoid-induced osteoporosis is characterized by decreased osteoblastic activity and replacement of bone marrow with adipocytes. Since osteoblast and adipocytes are derived from the same mesenchymal stem cell, one might speculate that there is an interaction between these two cells types. In fact, leptin that is secreted from adipocytes is known to stimulate differentiation of osteoblasts, while it inhibits the differentiation of adipocytes. Furthermore, it has been demonstrated that PPAR is present in osteoblasts and it is increased by leptin in adipocytes. However, the role of PPAR and leptin remains unknown in glucocorticoid-induced osteoporosis. The aims of this study are to investigate the effect of glucocorticoid on bone mineral density and gene expression in osteoblasts and adipocytes, and to study the role of PPAR and leptin in the mechanism of glucocorticoid-induced osteoporosis. METHODS: Methylprednisolone, 1 mg/200 g-weight, was injected into five rats (steroid group) and saline was given to five rats (control group) for eight weeks. The bone mineral density was determined by dual energy X-ray absoptiometry. Gene expression of osteocalcin, alkaline phosphatase, lipoptrotein lipase, and PPAR -2 was assessed by RT-PCR. Serum leptin level was measured using a commercial radioimmunoassay kit. RESULTS: 1) The body weight of the steroid group was significantly lower than that of the control group (451.4+/-12.9 g vs. 247.6+/-19.8 g, p<0.05). The bone mineral density of the steroid group tended to be lower than that of the control group (0.27+/-0.01 g/cm2 vs. 0.26+/-0.01 g/cm2, p>0.05). 2) In the steroid group, the gene expressions of osteocalcin (1.00+/-0.08 vs. 0.23+/-0.16, p<0.05) and alkaline phosphatase (0.47+/-0.07 vs. 0.33+/-0.18, p<0.05) were decreased significantly compared to those in controls. 3) In the steroid group, the gene expression of lipoprotein lipase (0.23+/-0.06 vs. 0.39+/-0.12, p>0.05) and+/-PAR 2 (0.17+/-0.08 vs. 0.22+/-0.12, p>0.05) tended to be increased compared to that in the contol group. 4) The serum leptin level of the steroid group tended to be lower than that of the control group (0.20+/-0.12 g/L vs. 0.10+/-0.09 g/L, p>0.05). CONCLUSION: These data suggest that long-term administration of a large dose of glucocorticoid suppresses differentiation of osteoblasts and enhances the differentiation of adipocytes, which may be mediated by increased expression of PPAR and decreased synthesis of leptin.
Adipocytes ; Alkaline Phosphatase ; Animals ; Body Weight ; Bone Density ; Bone Marrow* ; Gene Expression ; Leptin ; Lipase ; Lipoprotein Lipase ; Mesenchymal Stromal Cells* ; Methylprednisolone ; Osteoblasts ; Osteocalcin ; Osteoporosis ; Peroxisome Proliferator-Activated Receptors ; Radioimmunoassay ; Rats

BACKGROUND/AIMS: Our previous studies of ionization and solubility of unconjugated bilirubin (UCB) yielded inappropriately large differences between the two carboxylic pK'a values of UCB. These data, however, were not ideal due to crystal effects, matastability, impurities of the bilirubin, and imprecision of analyses at low UCB. METHODS: The sodium salt of taurocholate (TC) was purified and dissolved in water to 100 mM. Chloroform (CHCl3) was purified by vacuum distillation. Buffers used were: citrate from pH 4 to 6, phosphate from pH 6 to 8, and borate above pH 8. All had an ionic strength of 0.10. The problems were minimized by rapid solvent partition of UCB from CHCl3 into buffered aqueous NaCl, and a new, accurate assay of low UCB in the aqueous phase which was achieved by concentrating the UCB through back extraction into small volumes of CHCl3. RESULTS: In contrast with the crystal dissolution studies, the two pK'a value were similar. H2B0, not HB-, was the dominant UCB species in the pH range of bile (6.0 to 8.0). The aqueous solubilities of UCB were 90 to 98% less. Less than 0.01% of the bile salt partitioned into the CHCl3 phase and self-association of B= was negligible. UCB solubilities in 50 mM TC were 2 to 10% of those obtained by crystal dissolution, and, up to pH 7.9, were below the maximum UCB concentration in normal human bile. CONCLUSIONS: We suggest that the markedly increased binding of UCB with each ionization step is due to the disruption of the internal hydrogen bonds of the ionized carboxyl groups on interaction with the bile salt. We propose to extend the study of partition to determine the activity and the degradation products of calcium salts of unbound bilirubin fractions.
Bilirubin/*chemistry ; Chloroform ; English Abstract ; Hydrogen-Ion Concentration ; In Vitro ; Solubility ; Solvents ; Taurocholic Acid/*chemistry

Although tubercrlosis is one of the recognized causes of adrenal insufficiency, little is known about adrenal function in patients with active pulmonary tuberculosis. Patients with active pulmonary tuberculosis are at risk from sudden and unexpected death which can occur during the first few weeks of treatment. There are many reports that patients who received rifampicin as a part of their treatment appeared to show impairment in adrenocortical function when compared to a group who received anti-tuberculosis chemotherapy which did not include rifampicin. Adrenocortical function was studied in 15 patients(7 males, 8 females) with active pulmonary tuberculosis, before and 2-weeks after the anti-tuberculosis chemotherapy including rifampicin. At 08: 00 hour a base-line sample of venous blood was taken. One hour after the administration of 0.25mg of Synacthen, a further blood specimen was taken. The base-line and 1-hour specimens were analysed for plasma cortisol and electrolytes.All were initially found to have a normal cortisol response to rapid ACTH stimulation test. Following a 2-week course of anti-tuberculosis chemotherapy including rifampicin there was 1 case(6.6%) of a suboptimal response.Rifampicin, a powerful anti-tuberculosis drug, is a known inducer of the hepatic microsomal enzyme system and has been shown to cause an enhanced clearance of endogenous cortisol. Findings reported in this paper suggest that the adrenocortical function is compromised in some case(6.6%) of tuberculosis patients. It will therefore be necessary to undertake detailed investigations on the effect of treatment with daily and fully intermittent regimens containing rifampicin on the function of this endocrine gland.
Adrenal Insufficiency ; Adrenocorticotropic Hormone ; Drug Therapy ; Endocrine Glands ; Gonadotropin-Releasing Hormone ; Humans ; Hydrocortisone ; Male ; Plasma ; Puberty, Precocious ; Rifampin ; Tuberculosis ; Tuberculosis, Pulmonary

Although the mortality has been reduced with aggressive approach, thyrotoxic storm or crisis is still a life-threatening condition and usually triggered by preeclampsia, placenta previa, congestive heart failure, infections and induction of labor during pregnancy. We report here a 28-year-old pregnant woman suspicious of placenta previa without a previous history of hyperthyroidism was admitted to the hospital with vaginal spotting and labor. After receiving a Cesarean section, thyrotoxic manifestations were developed and she became stable with antithyroid therapy. The second attack of thyrotoxic storm was presented after a thyroid ultrasonographic study. It appears that the vigorous examination of thyroid gland carries a significant risk of thyrotoxic crisis in poorly controlled hyperthyroidism.
Adult ; Cesarean Section ; Female ; Heart Failure ; Humans ; Hyperthyroidism ; Metrorrhagia ; Mortality ; Palpation* ; Placenta Previa ; Pre-Eclampsia ; Pregnancy ; Pregnant Women ; Thyroid Crisis* ; Thyroid Gland*

BACKGROUND/AIMS: Low-dose aspirin therapy is widely used to prevent cardiovascular thrombotic events. However, the safety of low-dose aspirin therapy in the gastrointestinal tract is uncertain. Our aim was to evaluate endoscopic findings in patients taking low-dose aspirin. METHODS: Sixty-two patients who received 100 mg enteric coated aspirin daily more than 30 days were included in this study. Patients' medical records and endoscopic data were reviewed retrospectively. As controls, 70 of age- and gender-matched patients who received an endoscopy without gastrointestinal symptoms were employed. RESULTS: The overall prevalence of gastroduodenal mucosal injury was higher in the aspirin group than in the control group. Erosive gastritis was noted more frequently in the aspirin group than in the control group. However, the prevalence of ulcer was not different between the aspirin group and the control group. CONCLUSIONS: Patients treated with low-dose aspirin therapy are more likely to have endoscopic evidence of mucosal damage. Our study suggests that even a low-dose aspirin therapy can induce a gastroduodenal mucosal injury. In the future, a prospective randomized control study is needed.
Aged ; Aspirin/administration & dosage/*adverse effects ; Cardiovascular Diseases/prevention & control ; Esophagitis/chemically induced ; Female ; Gastritis/chemically induced ; Gastrointestinal Diseases/*chemically induced ; Humans ; Male ; Middle Aged ; Platelet Aggregation Inhibitors/administration & dosage/*adverse effects ; Tablets, Enteric-Coated/adverse effects

Anticonvusant therapy with any of several agents, especially phenytoin, phenobarbital, and primidone causes disturbances in bone mineral metabolism. Anticonvulsants stimulate the hepatic microsomal mixed-oxidase enzymes and hence increase the rate of clearance of vitamin D and its metabolism. The severity of clinical manifestations in any given individual appears to be a function of the combined effects of variety of factors including drug type and total drug dose, dietary vitamin D intake, sunlight exposure, and physical activity level. We report a case of osteomalacia associated with long term carbamazepine therapy in a 21-year-old male with less exposure to sunlight.
Anticonvulsants ; Carbamazepine* ; Humans ; Male ; Metabolism ; Motor Activity ; Osteomalacia* ; Phenobarbital ; Phenytoin ; Primidone ; Sunlight ; Vitamin D ; Young Adult

BACKGROUND/AIMS: Type 2 diabetes with microvascular complications is often accompanied by macrovascular complications. However, the relationship between the two complications is unclear. In this study, we determined the relationship between diabetic retinopathy and morphological changes of the carotid artery. METHODS: We analyzed the presence of plaque and mean carotid intima-media thickness (CIMT) in patients with type 2 diabetes (n = 133) using high-resolution ultrasound. The presence and severity of retinopathy were graded according to fundus photographs. RESULTS: The mean CIMT of the diabetic retinopathy (DR) group (0.111 +/- 0.048 cm) was significantly greater than that of the nondiabetic retinopathy (No DR) group (0.074 +/- 0.039 cm, p = 0.007). An abnormal mean CIMT (> 0.08 cm) was more frequently observed in the DR group (76%) than that in the No DR group (23.1%; odds ratio, 10.609; 95% confidence interval, 3.072-36.639; adjusted by age, body mass index, hypertension, and diabetes duration). Although the mean CIMT in patients with plaque was significantly greater than that of patients without plaque, no significant difference was observed between the DR (36%, 17 patients) and NoDR (18.5%, 20 patients) groups in the presence of plaque. CONCLUSIONS: Diabetic retinopathy was associated with an increased CIMT but not with atherosclerotic plaques. However, the increases in IMT were associated with the presence of plaques, which predispose patients to cardiovascular disease. These results imply that the microvascular complications of diabetes have indirect relationships with the cardiovascular complications of diabetes.
Atherosclerosis ; Body Mass Index ; Cardiovascular Diseases ; Carotid Arteries ; Carotid Intima-Media Thickness ; Diabetes Mellitus ; Diabetic Retinopathy ; Humans ; Hypertension ; Odds Ratio ; Plaque, Atherosclerotic