BACKGROUND: Type 2 diabetes is usually preceded by a long and clinically silent period of increasing insulin resistance. The purpose of this study is to demonstrate that rosiglitazone and metformin fixed-dose combination therapy (RSG/MET) will safely and effectively control glycemia as a first line of oral therapy, better than rosiglitazone (RSG) or metformin (MET) monotherapy in Korean type 2 diabetes patients. METHODS: This study was a 32-week, multicenter, randomized, double-blind study. Twenty-seven type 2 diabetes patients (males 14; females 13) were included and randomly divided into the rosiglitazone, metformin group, or rosiglitazone /metformin combination groups. The primary objective of this study was to determine the change in HbA1c from baseline (week 0) to week 32. The secondary end-points were to determine changes in fasting plasma glucose (FPG) and homeostasis model assessment insulin resistance (HOMA-IR), from baseline to week 32. Other cardiovascular risk markers were also assessed. RESULTS: At week 32, there were significant reductions in HbA1c and FPG, in all three treatment groups. There was no statistical difference in HbA1c among the three groups, but the decrease in FPG in the RSG/MET group was statistically significant compared to the MET group (P < 0.05). RSG/MET significantly reduced HOMA-IR at week 32 compared to baseline, but there was no difference among the three groups. RSG/MET significantly decreased high-sensitive C-reactive protein (hs-CRP) value at week 32, compared to baseline. There were increases in adiponectin from baseline to week 32 in the RSG and RSG/MET groups, and the increase in the RSG/MET group was statistically significant compared to that of the MET group (P < 0.05). At week 32, there was a significant decrease in plasminogen activator inhibitor-1 (PAI-1) in all three treatment groups, but no statistically significant difference among them. The RSG/MET group significantly decreased in terms of urinary albumin-creatinine ratio at week 32, compared to baseline. CONCLUSIONS: In this study, rosiglitazone and metformin combination therapy was effective in glycemic control as an initial therapy, and it improved cardiovascular risk markers in Korean type 2 diabetes patients.
Adiponectin ; C-Reactive Protein ; Diabetes Mellitus, Type 2 ; Double-Blind Method ; Fasting ; Female ; Glucose ; Homeostasis ; Humans ; Insulin Resistance ; Metformin ; Plasma ; Plasminogen Activators ; Thiazolidinediones

Hyalinizing trabecular adenoma is an uncommon benign thyroid tumor that is recently described in the literature. This tumor is easily confused with medullary carcinoma on surgical specimens and with papillay carcinoma on cytologic specimens. Herein we report the cytologic characteristics of a case of histologically proven hyalinizing trabecular adenoma of the thyroid gland. Cytologically, the aspirate showed trabecular or individually dispersed polygonal cells with finely stippled chromatin pattern, nuclear grooves, and eosinophilic nuclear pseudoinclusions. No colloid materials were noted in the background.
Adenoma ; Animals ; Carcinoma, Medullary ; Chromatin ; Colloids ; Eosinophils ; Hyalin ; Mediastinum ; Puromycin Aminonucleoside* ; Puromycin* ; Rats* ; Thyroid Gland

BACKGROUND: Obese type 2 diabetic subjects are recently increasing in Korea, indicating the importance of insulin resistance rather than insulin secretory defects in the pathophysioloy of type 2 diabetes. The purpose of this study is to evaluate the safety and efficacy of fixed dose rosiglitazone/metformin combination therapy in poorly controlled subjects with type 2 diabetes mellitus. METHODS: 12 type 2 diabetic subjects who had a HbA1c > 11% or fasting plasma glucose > 15 mmol/L were included. After a 2 week screening period, the subjected took the fixed does rosiglitazone/metformin for 24 weeks. The treatment with rosiglitazone/metformin began at week 0 with an initial dose of 4 mg/1000 mg and, unless tolerability issues arose, subjects would be increased to 6 mg/1500 mg at week 4 and at week 8 to the maximum dose of 8 mg/2000 mg. The primary object of this study was to characterize the magnitude of HbA1c reduction from baseline after 24 weeks of rosiglitazone and metformin treatment in poorly controlled type 2 diabetics. RESULTS: The mean age of the subjects was 48.9 +/- 10.6 years old, body mass index was 25.0 +/- 3.5 kg/m2, HbA1c was 12.0 +/- 1.0%, and fasting plasma glucose was 16.3 +/- 3.1 mmol/L. HbA1c was reduced to 7.54 +/- 1.45% and fasting plasma glucose reduced to 7.96 +/- 2.38 mmol/L at week 24. The proportion of HbA1c responder who showed the reduction from baseline of > or = 0.7% or HbA1c < 7% was 11 among 12 subjects (91.7%). 41% of the subjects (5 among 12 subjects) achieved HbA1c level < 7.0% and 75% (9 among 12 subjects) achieved HbA1c level < 8.0%. CONCLUSIONS: In this study, rosiglitazone and metformin combination therapy was effective in glycemic control in poorly controlled subjects with type 2 diabetes mellitus.
Body Mass Index ; Diabetes Mellitus, Type 2 ; Fasting ; Glucose ; Insulin ; Insulin Resistance ; Korea ; Mass Screening ; Metformin ; Plasma ; Thiazolidinediones

Objectives: This study was conducted to examine the obstacles in the use of healthcare from the perspective of family caregivers based on their experience of mental healthcare services and to identify practical recommendations according to the family’s needs. Methods: A focus group interview was conducted with 59 family caregivers of patients with mental disorders. They were asked about the first moment when they took the patient to a psychiatric hospital, their feelings, and experiences during the treatment, relapse or readmission, access to healthcare and obstacles. The results were analyzed in a three-step procedure using grounded theory analysis. Results: The results showed that the social prejudice and stigma toward mental disorders experienced by the family caregivers hindered the initial treatment approach. Discrimination and disadvantages in healthcare, and poor access to community mental healthcare services, lowered the reliability of institutions and services. A decrease in the sense of healing due to distrust in the treatment and disruption of family life can lead to a vicious circle that affects the continuity of treatment and could result in issues such as the stopping of treatment or difficulty in accessing treatment in case of relapse. Conclusion Based on these results, policy tasks were proposed to improve accessibility to mental health services according to the needs of the patient’s family.

Granulomatous vulvitis is a rare localized inflammatory disease characterized by a painless, swollen, indurated and distorted vulva. Histopathologically, it shows chronic non-necrotizing granulomatous inflammation with edema, fibrosis, and lymphangiectasia. Some cases are associated with granulomatous cheilitis or Crohn's disease. So far, only a few cases of idiopathic granulomatous vulvitis have been reported. A 43-year-old female presented with a 1-year-history of persistent swelling of the vulva. The lesion was enlarged, edematous, and indurated, and there were clustered vesicles and papules on the labia major. Histopathologic examination of the swollen labia major showed granulomatous inflammation composed of multinucleated giant cells and epithelioid cells, with numerous lymphocytes in the dermis. Another biopsy specimen obtained from the clustered vesicles showed lymphangiectasia with chronic inflammation. Based on these characteristic histopathologic features and clinical findings, the patient was diagnosed with idiopathic granulomatous vulvitis. Herein, we reported a rare case of idiopathic granulomatous vulvitis that developed in a healthy woman.
Adult ; Biopsy ; Crohn Disease ; Dermis ; Edema ; Epithelioid Cells ; Female ; Fibrosis ; Giant Cells ; Humans ; Inflammation ; Lymphocytes ; Melkersson-Rosenthal Syndrome ; Vulva ; Vulvitis*

Generalized granuloma annulare is a rare benign granulomatous dermatosis characterized by disseminated necrobiotic dermal papules forming an annular or nonannular configuration. It usually occurs in adults and rarely affects infants. Histologically, it presents as a lymphohistiocytic granuloma associated with varying degrees of connective tissue degeneration. Clinical associations between generalized granuloma annulare and diabetes mellitus, thyroid disease, malignancy, infection, and vaccination have been reported. There are a few cases reports of generalized granuloma annulare associated with Bacillus Calmette-Guerin (BCG) vaccination. Herein, we report three cases of generalized granuloma annulare following BCG vaccination in infants.
Adult ; Bacillus* ; BCG Vaccine ; Connective Tissue ; Diabetes Mellitus ; Granuloma ; Granuloma Annulare* ; Humans ; Infant ; Mycobacterium bovis ; Skin Diseases ; Thyroid Diseases ; Vaccination*

Partial unilateral lentiginosis is a rare pigmentary disorder which is characterized by multiple grouped lentigines in unilateral or segmental distributions. The ocular involvement of the disease is extremely rare and only four cases have been reported until today. The exact pathophysiology is still unknown. An 18-year-old woman is being presented with unilateral hyperpigmented macules on her left forehead, eyelid, cheek, lip and chin which all demarcated sharply at the midline of her face. The lesion has been presented since the age of 1. Also, there are discrete brownish pigmentations on her left bulbar conjunctiva. Biopsy specimen is being obtained from the left chin and the histopathological examinations revealed increasing basal layer of pigmentations and mild elongation of rete ridges. The histopathological features are also consistent with lentigo simplex. Herein, we present a rare case of partial unilateral lentiginosis with an ocular involvement. We have also proposed that the partial unilateral lentiginosis has a possibility of ocular involvements.
Adolescent ; Biopsy ; Cheek ; Chin ; Conjunctiva ; Eyelids ; Female ; Forehead ; Humans ; Lentigo* ; Lip ; Pigmentation

No abstract available.
Paraffin* ; Vitiligo*

This study was conducted to investigate the nutrient intakes of subjects by quartile of percent energy intake from cooked rice, consumption of cooked rice mixed with multi-grains and to evaluate rice consumption in relation to the risk of metabolic syndrome. The subjects were 5,830 males and females aged between 20~64 years based on 2007-2008 KNHNES data. Levels of percent energy intake from cooked rice were classified into 4 groups (Q1, Q2, Q3, Q4 groups: 25% of each) using data of 24-hour recall method from KNHNES. Using medical examination and questionnaire, subjects were classified according to diagnostic criteria of metabolic syndrome. The subjects with higher age, being married, lower education, lower economic level were more likely to take higher percent energy intake from cooked rice. Quartile Q3 of percent energy intake from cooked rice tended to show higher Index of Nutritional Quality (INQ) for fiber, calcium, iron, potassium and vitamin A. INQ of protein, dietary fiber, calcium, thiamin, phosphorus, potassium, riboflavin, niacin and vitamin C by consumption of cooked rice mixed with multi-grains was higher than that by consumption of cooked white rice when adjusted for age. No association with a risk for metabolic syndrome was found for quartile of percent energy intake from cooked rice or cooked rice mixed with multi-grains compared to cooked white rice after adjusting for energy, gender, age, BMI, alcohol, smoking, income and physical activity. In conclusion, consumption of over 54% energy intake from cooked rice or only cooked white rice showed relatively low INQs, but was not associated with a higher risk for metabolic syndrome.
Aged ; Ascorbic Acid ; Calcium ; Dietary Proteins ; Energy Intake ; Female ; Humans ; Iron ; Male ; Motor Activity ; Niacin ; Nutrition Surveys ; Nutritive Value ; Phosphorus ; Potassium ; Surveys and Questionnaires ; Riboflavin ; Smoke ; Smoking ; Vitamin A

Patients with C5 or C6 radiculopathy complain of shoulder area pain or shoulder girdle weakness. Typical idiopathic neuralgic amyotrophy (INA) is also characterized by severe shoulder pain, followed by paresis of shoulder girdle muscles. Recent studies have demonstrated that magnetic resonance neurography (MRN) of the brachial plexus and magnetic resonance imaging (MRI) of the shoulder in patients with INA show high signal intensity (HSI) or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle. We evaluated the value of brachial plexus MRN and shoulder MRI in four patients with typical C5 or C6 radiculopathy. HSI of the brachial plexus was noted in all patients and intramuscular changes were observed in two patients who had symptoms over 4 weeks. Our results suggest that HSI or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle on MRN and MRI may not be specific for INA.
Brachial Plexus Neuritis ; Brachial Plexus* ; Denervation ; Humans ; Magnetic Resonance Imaging ; Muscles ; Paresis ; Radiculopathy* ; Shoulder ; Shoulder Pain