Primary biliary cirrhosis (PBC) is an idiopathic chronic non-suppurative destructive inflammation of intrahepatic bile ducts and rare in Korea. Although its pathogenesis is not fully understood, immunologic dysregulation is suspected because of presence of antimitochondrial antibody (AMA) and association with other autoimmune disease, such as autoimmune thyroid disease. Evidence of hypothyroidism in PBC is relatively common in western countries, however it has not been reported in Korea. And it is uncertain whether the reason is ethnic factor or unawareness of the disease. Recently, we experienced a 50-year-old women with hypothyroidism who had elevated alkaline phosphatase and gamma glutamyl transpeptidase. This is the first case of hypothyroidism associated with PBC in Korea.
Alkaline Phosphatase ; Autoimmune Diseases ; Bile Ducts, Intrahepatic ; Female ; gamma-Glutamyltransferase ; Humans ; Hypothyroidism* ; Inflammation ; Korea ; Liver Cirrhosis, Biliary* ; Middle Aged ; Thyroid Diseases

No abstract available.
Pregnancy*

No abstract available.
Glucagon-Like Peptide 1* ; Thyroid Neoplasms* ; Glucagon-Like Peptide-1 Receptor

BACKGROUND: Incretin-based therapies are rapidly becoming one of the main glycemic control strategies in diabetes. Considering the large numbers of papillary thyroid carcinomas (PTCs) and possible effects of glucagon-like peptide-1 (GLP-1) on cell proliferation, the expression of GLP-1 receptor (GLP-1R) in PTC is likely to have clinical significance. We performed this study to evaluate the expression of GLP-1R in PTC and the clinical meaning of GLP-1R expression in PTC. METHODS: Fifty-six cases of PTC, four cases of medullary thyroid cancer (MTC), seven cases of nodular hyperplasia and 56 normal thyroid tissue samples were selected for immunostaining for GLP-1R. Clinical parameters were obtained by retrospective review of medical records. RESULTS: Immunohistochemical staining for GLP-1R showed immunoreactivity in 18 of 56 cases of PTC (32.1%). All four cases of MTC exhibited cytoplasmic GLP-1R expression. Nodular hyperplasia exhibited immunoreactivity in two of seven cases (28.6%). All normal thyroid follicular cells showed negative immunoreactivity. In univariable and multivariable analyses, tumor multifocality was negatively correlated with GLP-1R expression. Extrathyroidal extension showed positive association with GLP-1R expression that was almost significant. Sex, age, tumor size, and lymph node metastasis were not significantly associated with GLP-1R expression. CONCLUSION: Some parts of PTC tissues express GLP-1R, and GLP-1R expression in PTC was negatively correlated with tumor multifocality. The long-term influence of pharmacologically increased GLP-1 on thyroid follicular cells and development and progression of tumors originating from thyroid follicular cells should be investigated.
Cell Proliferation ; Cytoplasm ; Glucagon-Like Peptide 1* ; Hyperplasia ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms* ; Glucagon-Like Peptide-1 Receptor

BACKGROUND: Angiogenesis is essential for tumor growth and metastasis. Vascular endothelial growth factor(VEGF), also known as vascular permeability factor(VPF), is an angiogenic factor that plays important roles in tumor growth. Angiogenesis studies on VEGF deal with various types of malignant tumors, but little is known about the role or significance of VEGF in human thyroid neoplasms. Therefore, this study was performed to determine whether the VEGF expression in different histological types of thyroid tumors is altered and to see if there was a relationship between the expression of VEGF and either metastasis or the invasiveness of thyroid carcinomas. METHODS: Forty-two cases that underwent thyroidectomy at Kosin Medical Center, between March, 1999 and February, 2000, were included in this study. Of the 42 cases, 27 were malignant(26 papillary carcinoma, 1 Hurthle cell carcinoma) and 15 were benign lesions. The expression of VEGF was determined by immunohistochemistry using paraffin embedded thyroid tissue blocks, and was quantified as negative(absent), +(1~24%), ++(25~49%), +++(50~74%) and ++++(> or =75%), according to the extent of positive cells. RESULTS: VEGF was stained with red-brown colored granules in the cytoplasm of the thyroid tumor epithelium and was expressed in 27 of the 42 cases(+1, ++8, +++5, ++++13). Most malignant tumors(24 of 27 cases) were stained with VEGF, but only 3 of the 15 benign tumors cases were stained(P<0.001). When the VEGF expression was divided into ++ or below and +++ or above groups, the expression of VEGF was much more extensive in the malignant than benign tumors(P<0.001). Of the 27 malignant tumors cases, lymph node metastasis and/or invasion was noted in 13. VEGF expression was more extensive in malignant tumors with lymph node metastasis and/or invasion than in those without(P<0.001). CONCLUSION: In this study, the rate and extent of VEGF expression were greater in the malignant than the benign thyroid tumors, and also the extent of VEGF expression was the extent of VEGF greater in the malignant tumors with lymph node metastasis and/or invasion than those without
Angiogenesis Inducing Agents ; Capillary Permeability ; Carcinoma, Papillary ; Cytoplasm ; Epithelium ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Paraffin ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy ; Vascular Endothelial Growth Factor A*

The internal biliary fistula between the gallbladder or bile duct and intestinal tract is a rare disease. Because symptoms and signs of biliary fistula are not specific, these patients are commonly investigated with computed tomography, endoscopic retrograde cholangiopancreatography (ERCP) and barium study. Among them, a cholecystogastric fistula is a very rare type of biliary fistula. We recently experienced a case of cholecystogastric fistula and transmigration of the gallstone to the stomach. A 53-year-old woman was transferred with the impression of gallbladder cancer. On evaluating the cause of right upper abdominal pain and nausea, we confirmed the cholecystogastric fistula with gastroscopy, upper GI series and ERCP. Cholecystectomy and the repair of the fistula was done.
Abdominal Pain ; Barium ; Bile Ducts ; Biliary Fistula ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Female ; Fistula* ; Gallbladder ; Gallbladder Neoplasms ; Gallstones* ; Gastroscopy ; Humans ; Middle Aged ; Nausea ; Rare Diseases ; Stomach

BACKGROUND: Many epidemiologic studies have shown that women with type 2 diabetes have an increased risk of developing cardiovascular disease compared with men with diabetes. The aim of this study is to elucidate whether disparities of adiposity, age and insulin resistance (IR) at the time of diabetes diagnosis exist between women and men in the adult Korean population. METHODS: Data from The Korea National Health and Nutrition Examination Survey, performed in Korea from 2007 to 2010, were used. In the survey, anthropometric data and blood samples were obtained during a fasting state. IR and beta-cell function were calculated using the homeostasis model assessment (HOMA-IR and HOMA-beta, respectvely). RESULTS: The mean age of diabetes diagnosis was 58.5 years in women and was 55.1 years in men (P=0.015). The mean body mass index (BMI) of newly diagnosed diabetes subjects was 26.1 kg/m2 in women and 25.0 kg/m2 in men (P=0.001). The BMI was inversely related to age in both genders, and the higher BMI in women than men was consistent throughout all age groups divided by decade. The HOMA-IR in women with diabetes is higher than in men with diabetes (7.25+/-0.77 vs. 5.20+/-0.32; P=0.012). CONCLUSION: Korean adult women are diagnosed with type 2 diabetes at higher BMI and older age than men and are more insulin-resistant at the time of diabetes diagnosis. This may help explain why women with diabetes have an increased risk of developing cardiovascular disease after the diagnosis of diabetes, compared to men.
Adiposity ; Adult ; Body Mass Index ; Cardiovascular Diseases ; Diagnosis ; Epidemiologic Studies ; Fasting ; Female ; Homeostasis ; Humans ; Insulin Resistance ; Korea* ; Male ; Nutrition Surveys*

OBJECTIVES: The American Diabetes Association (ADA) recommends hepatitis-B virusVIruS vaccination for unvaccinated adults with diabetes. However, the Korean Diabetes Association (KDA) did not recommend hepatitis-B vaccination for unvaccinated adults with diabetes. This study was performed to assess the differences in hepatitis-B virus antigen and antibody status between Korean patients with diabetes and those without by using national survey data. METHODS: We analyzed hepatitis-B virus antigen and antibody status in 9,771 South Korean people from the general population based on the Korean National Health and Nutrition Examination Survey. Diabetes patients were defined as those with a measured fasting plasma glucose over 126 mg/dL or those who had been previously diagnosed with diabetes by other health care centers. RESULTS: Subjects with diabetes accounted for 812 (8.3%) among the 9771 study subjects. The prevalence ofhepatitis-B (HBsAg) seropositive subjects was not significantly different (3.9% vs. 4.6%, P = 0.09) between subjects with diabetes and those without. The prevalence of hepatitis-B antibody (HBsAb) positive subjects and unimmunized subjects was not significantly different (55.2% vs. 58.2%, P = 0.09, 40.9% vs. 37.2%, P = 0.09) between the two groups. The prevalence of unimmunized subjects decreased by age ( < 20 years 33.3 % vs. 33.0%, 20~29 years 49.1% vs. 41.2%, 30~39 years 41.9% vs. 37.7%, 40~49 years 35.1% vs. 33.5%, 50~59 years 39.0% vs. 38.0%, 60~69 years 41.2% vs. 39.8%, > 70 years 48.5% vs. 42.8%) but was not significantly different between the 2 groups. CONCLUSIONS: From this study, we conclude that there are not sufficient grounds to recommend routine hepatitis-B virus vaccination for unvaccinated Korean subjects with diabetes at this point in time in Korea. Further prospective studies will be needed.
Adult ; Blood Glucose ; Delivery of Health Care ; Fasting ; Hepatitis B ; Humans ; Immunization* ; Korea* ; Nutrition Surveys ; Prevalence ; Prospective Studies ; Vaccination

Calcium plays a critical role in neuromuscular excitement and other cellular functions. Therefore, extracellular calcium concentration is maintained within a very narrow range through interaction of calcium regulating hormones such as parathyroid hormone, calcitonin, and vitamin D. Thus, symptomatic severe hypercalcemia has rarely occurred in a clinical situation, particularly in patients with hypoparathyroidism. In general, a large amount of calcium and vitamin D should be supplied in order to avoid hypocalcemia in hypoparathyroid patients. A 63-year old female patient was admitted suffering from nausea, vomiting, and weakness for two weeks. She had a history of total thyroidectomy and subsequent permanent hypoparathyroidism and long-term calcium and vitamin D supplementation. For over 10 years she had not changed her daily amount of calcium and vitamin D intake. Her initial serum calcium was 17.5 mg/dL, creatinine was 2.57 mg/dL, and total CO2 was 33.1 meq/L. After thorough examination, we concluded that milk-alkali syndrome was the cause of severe hypercalcemia. Therefore, special pay attention should be paid to aged patients on calcium supplementation in situations of increased risk of dehydration and renal insufficiency, even though the usual amount of calcium intake was unchanged for several years.
Calcitonin ; Calcium* ; Creatinine ; Dehydration ; Female ; Humans ; Hypercalcemia* ; Hypocalcemia ; Hypoparathyroidism* ; Nausea ; Parathyroid Hormone ; Renal Insufficiency ; Thyroidectomy ; Vitamin D ; Vomiting

Biliary-enteric fistula is a rare disease, and the common causes of biliary-enteric fistula are gallstone, peptic ulcer, malignancy and trauma. It is known that the most common type of biliary-enteric fistula is the cholecysto-duodenal fistula, yet the combination of choledocho-duodeno-colonic fistula is a rare finding. A 78-year-old woman was admitted because she had suffered with right upper quadrant pain, a febrile sense and chills for 2 days. We confirmed the choledocho-duodeno-colonic fistula by performing gastroduodenoscopy, abdominal CT and an upper GI series. So, we report here on an usual case of choledocho-duodeno-colonic fistula, along with a review of the relevant literatures.
Aged ; Biliary Fistula ; Chills ; Female ; Fistula* ; Gallstones ; Humans ; Peptic Ulcer ; Rare Diseases ; Tomography, X-Ray Computed