No abstract available.

The aim of this study was to investigate the relationship between somatostatinergic tone (SST) and the size of growth hormone (GH)-producing pituitary tumors. GH levels of 29 patients with newly diagnosed acromegaly were measured using a 75-gram oral glucose tolerance test (OGTT), an insulin tolerance test (ITT), and an octreotide suppression test (OST). Differences between GH levels during the ITT and the OGTT (DeltaGH(IO)), and between the OGTT and the OST at the same time point (DeltaGH(OS)) were compared according to the size of the tumor and the response pattern to the OST. DeltaGH(IO) of macroadenomas (n=22) was non-significantly higher than those of microadenomas while DeltaGH(OS) of macroadenomas were significantly higher than those of microadenomas. According to further analyses of macroadenomas based on the response pattern to the OST, GH levels during the ITT were significantly higher in non-responders. DeltaGH(OS) showed near-significant differences between responders and non-responders. In conclusion, as the size of the pituitary tumor increases, the effect of glucose on SST appears to be attenuated. Macroadenomas that are non-responders to the OST possess a portion of GH secretion exceeding the range of regulation by SST.
Acromegaly/*diagnosis/*pathology ; Adenoma/drug therapy/*pathology ; Adult ; Aged ; Antineoplastic Agents, Hormonal/therapeutic use ; Female ; Glucose Tolerance Test ; Human Growth Hormone/*blood/secretion ; Humans ; Insulin/blood ; Insulin-Like Growth Factor I/analysis ; Male ; Middle Aged ; Octreotide/therapeutic use ; Pituitary Neoplasms/drug therapy/*pathology

BACKGROUND: Recently, a hemoglobin A1c (HbA1c) level of 6.5% has been determined to be a criterion for diabetes mellitus (DM), and it is a widely used marker for the diagnosis of DM. However, HbA1c may be influenced by a number of factors. Anemia is one of the most prevalent diseases with an influence on HbA1c; however, its effect on HbA1c varies based on the variable pathophysiology of anemia. The aim of this study was to determine the effect of anemia on HbA1c levels. METHODS: Anemic subjects (n=112) and age- and sex-matched controls (n=217) who were drug naive and suspected of having DM were enrolled. The subjects underwent an oral glucose tolerance test and HbA1c simultaneously. We compared mean HbA1c and its sensitivity and specificity for diagnosing DM between each subgroup. RESULTS: Clinical characteristics were found to be similar between each subgroup. Also, when glucose levels were within the normal range, the difference in mean HbA1c was not significant (P=0.580). However, when plasma glucose levels were above the diagnostic cutoff for prediabetes and DM, the mean HbA1c of the anemic subgroup was modestly higher than in the nonanemic group. The specificity of HbA1c for diagnosis of DM was significantly lower in the anemic subgroup (P<0.05). CONCLUSION: These results suggest that the diagnostic significance of HbA1c might be limited in anemic patients.
Anemia ; Blood Glucose ; Diabetes Mellitus* ; Glucose Tolerance Test ; Hemoglobin A, Glycosylated* ; Humans ; Prediabetic State ; Reference Values ; Sensitivity and Specificity

BACKGROUND: Recently, a hemoglobin A1c (HbA1c) level of 6.5% has been determined to be a criterion for diabetes mellitus (DM), and it is a widely used marker for the diagnosis of DM. However, HbA1c may be influenced by a number of factors. Anemia is one of the most prevalent diseases with an influence on HbA1c; however, its effect on HbA1c varies based on the variable pathophysiology of anemia. The aim of this study was to determine the effect of anemia on HbA1c levels. METHODS: Anemic subjects (n=112) and age- and sex-matched controls (n=217) who were drug naive and suspected of having DM were enrolled. The subjects underwent an oral glucose tolerance test and HbA1c simultaneously. We compared mean HbA1c and its sensitivity and specificity for diagnosing DM between each subgroup. RESULTS: Clinical characteristics were found to be similar between each subgroup. Also, when glucose levels were within the normal range, the difference in mean HbA1c was not significant (P=0.580). However, when plasma glucose levels were above the diagnostic cutoff for prediabetes and DM, the mean HbA1c of the anemic subgroup was modestly higher than in the nonanemic group. The specificity of HbA1c for diagnosis of DM was significantly lower in the anemic subgroup (P<0.05). CONCLUSION: These results suggest that the diagnostic significance of HbA1c might be limited in anemic patients.
Anemia ; Blood Glucose ; Diabetes Mellitus* ; Glucose Tolerance Test ; Hemoglobin A, Glycosylated* ; Humans ; Prediabetic State ; Reference Values ; Sensitivity and Specificity

INTRODUCTION: This study examined the effect of the application of low intensity pulsed ultrasound on bone healing after an injection of adipose tissue-derived stem cells (ADSCs) during the implantation of a titanium implant in the tibia of diabetes-induced rats. MATERIALS AND METHODS: Twelve Sprague-Dawely rats were used. After inducing diabetes, the ADSCs were injected into the hole for the implant. Customized screw type implants, 2.0 mm in diameter and 3.5 mm in length, were implanted in both the tibia of the diabetes-induced rats. After implantation, LIPUS was applied with parameters of 3 MHz, 40 mW/cm2 , and 10 minutes for 7 days to the left tibiae (experimental group) of the diabetes-induced rats. The right tibiae in each rat were used in the control group. At 1, 2 and 4 week rats were sacrificed, and the bone tissues of both tibia were harvested. The bone tissues of the three rats in each week were used for bone-to-implant contact (BIC) and bone area (BA) analyses and the bone tissues of one rat were used to make sagittal serial sections. RESULTS: In histomorphometric analyses, the BIC in the experimental and control group were respectively, 39.00+/-18.17% and 42.87+/-9.27% at 1 week, 43.74+/-6.83% and 32.27+/-6.00% at 2 weeks, and 32.62+/-11.02% and 47.10+/-9.77% at 4 weeks. The BA in experimental and control group were respectively, 37.28+/-3.68% and 31.90+/-2.84% at 1 week, 20.62+/-2.47% and 15.64+/-2.69% at 2 weeks, and 11.37+/-4.54% and 17.69+/-8.77% at 4 weeks. In immunohistochemistry analyses, Osteoprotegerin expression was strong at 1 and 2 weeks in the experimental group than the control group. Receptor activator of nuclear factor kB ligand expression showed similar staining at each week in the experimental and control group. CONCLUSION: These results suggest that the application of low intensity pulsed ultrasound after an injection of adipose tissue-derived stem cells during the implantation of titanium implants in the tibia of diabetes-induced rats provided some positive effect on bone regeneration at the early stage after implantation. On the other hand, this method is unable to increase the level of osseointegration and bone regeneration of the implant in an uncontrolled diabetic patient.
Animals ; Bone and Bones ; Bone Regeneration ; Hand ; Humans ; Immunohistochemistry ; Nitrogen Mustard Compounds ; Osseointegration ; Osteoprotegerin ; Rats ; Stem Cells ; Tibia ; Titanium

BACKGROUND AND OBJECTIVES: The overriding influence of physical activity and the diurnal variation during ambulatory blood pressure monitoring (ABPM) has been well demonstrated. We prospectively evaluated the usefulness of electronic activity monitoring for deriving the actual physical activity and the diurnal variation of ABPM. SUBJECTS AND METHODS: 24-hour ABPM with using an electronic activity monitor was performed on ten normotensive volunteers and fifteen hypertensive subjects. To interpret the ABPM results of the fifteen hypertensive subjects, we obtained the actual awake/sleep periods of every subject with using an electronic activity monitor. RESULTS: The activity values obtained from the ten normotensive volunteers correlated well with the values of the blood pressure (BP) and the heart rate. In the hypertensives, the nocturnal mean BP derived by the actual period was significantly lower than that derived by the arbitrary period (130+/-16/81+/-13 mmHg versus 124+/-13/77+/-12 mmHg, respectively, p<0.05). The nocturnal BP fall derived by the actual period was significantly larger than that derived by the arbitrary period (14.9+/-8.7/11.6+/-7.5 mmHg versus 21.1+/-8.6/16.2+/-7.4 mmHg, respectively, p<0.01). Four among the 7 non-dippers determined by the arbitrary period were re-classified as dippers when the actual period was used. One among the 13 hypertensives, as determined by the arbitrary period, was also re-classified as a non-hypertensive. CONCLUSION: The electronic activity monitor was able to determine the actual activity level. The interpretation of ABPM may be altered by the use of the electronic activity monitor. These results suggest that the accuracy and reproducibility of the 24-hour ABPM will be improved by using an electronic activity monitor.
Blood Pressure ; Blood Pressure Monitoring, Ambulatory* ; Heart Rate ; Motor Activity ; Prospective Studies ; Volunteers

BACKGROUND: Minimal invasive gynecologic surgery usually requires pneumoperitoneum and Trendelenburg positioning, which results in adverse effects on respiratory and hemodynamic parameters. The aim of this study was to investigate the effects of volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) introduced sequentially in patients who underwent gynecological laparoscopy on respiratory mechanics, cardiovascular responses, and gas exchange. METHODS: Forty patients who were scheduled for gynecologic laparoscopic surgery were enrolled. Baseline ventilation of their lungs was performed with VCV with a tidal volume (TV) of 8 ml/kg ideal body weight (IBW). Forty minutes after pneumoperitoneum and Trendelenburg positioning, the ventilation mode was changed to PCV, and airway pressure was set to provide a TV of 8 ml/kg IBW without exceeding 35 cmH2O. Respiratory mechanics and hemodynamic and gas exchange parameters were recorded at 10 minutes after induction, 30 minutes after CO2 pneumoperitoneum and Trendelenburg positioning, 30 minutes after PCV, and 30 minutes after desufflation and supine position. RESULTS: After pneumoperitoneum and Trendelenburg positioning, there were significant increases in systolic blood pressure, diastolic blood pressure, central venous pressure, peak airway pressure (PAP), mean airway pressure (Pmean), whereas lung compliance and PaO2 significantly decreased. The decrease in PAP and increases of Pmean, lung compliance and PaO2 were observed during PCV compared with VCV (P < 0.05). There were no differences in hemodynamic parameters between VCV and PCV. CONCLUSIONS: Our results demonstrated that PCV may be an effective method of ventilation during gynecologic laparoscopy in terms of improved oxygenation and minimizing adverse respiratory mechanics.
Blood Pressure ; Central Venous Pressure ; Female ; Gynecologic Surgical Procedures ; Head-Down Tilt* ; Hemodynamics ; Humans ; Ideal Body Weight ; Laparoscopy* ; Lung ; Lung Compliance ; Oxygen ; Pneumoperitoneum ; Respiratory Mechanics ; Supine Position ; Tidal Volume ; Ventilation*

Celiac disease is an intestinal autoimmune disorder, triggered by ingestion of a gluten-containing diet in genetically susceptible individuals. The genetic predisposition is related to human leukocyte antigen (HLA) class II genes, especially HLA-DQ2-positive patients. The prevalence of celiac disease has been estimated to be ~1% in Europe and the USA, but it is rarer and/or underdiagnosed in Asia. We report a case of celiac disease in a predisposed patient, with a HLA-DQ2 heterodimer, and Graves' disease that was treated successfully with a gluten-free diet. A 47-year-old woman complained of persistent chronic diarrhea and weight loss over a 9 month period. Results of all serological tests and stool exams were negative. However, the patient was found to carry the HLA DQ2 heterodimer. Symptoms improved after a gluten-free diet was initiated. The patient has been followed and has suffered no recurrence of symptoms while on the gluten-free diet. An overall diagnosis of celiac disease was made in a genetically predisposed patient (HLA-DQ2 heterodimer) with Graves' disease.
Asia ; Celiac Disease* ; Diagnosis ; Diarrhea ; Diet ; Diet, Gluten-Free ; Eating ; Europe ; Female ; Genes, MHC Class II ; Genetic Predisposition to Disease ; Graves Disease* ; Humans ; Leukocytes ; Middle Aged ; Prevalence ; Recurrence ; Serologic Tests ; Weight Loss

A macroinvasive pituitary adenoma with plurihormonality usually causes acromegaly and hyperprolactinemia, and also accompanies with neurologic symptoms such as visual disturbances. However, its concurrent presentation with a rectal carcinoid tumor is rarely observed. This study reports the history, biochemical, colonoscopic and immunohistochemical results of a 48-year-old female with acromegaly and hyperprolactinemia. Despite the large size and invasive nature of the pituitary adenoma to adjacent anatomical structures, she did not complain of any neurologic symptoms such as visual disturbance or headache. Immunohistochemical staining of the surgical specimen from the pituitary adenoma revealed that the tumor cells were positive for growth hormone (GH), prolactin (PRL), and thyroid stimulating hormone (TSH). Staining for pituitary-specific transcription factor-1 (Pit-1) was shown to be strongly positive, which could have been possibly contributing to the plurihormonality of this adenoma. Colonoscopy found a rectal polyp that was identified to be a carcinoid tumor using immunohistochemical staining. A macroinvasive pituitary adenoma with concomitant rectal carcinoid tumor was secreting GH, PRL, and TSH, which were believed to be in association with over-expression of Pit-1. This is the first case report of double primary tumors comprising a plurihormonal pituitary macroadenoma and rectal carcinoid tumor.
Acromegaly* ; Adenoma ; Carcinoid Tumor* ; Colonoscopy ; Female ; Growth Hormone ; Headache ; Humans ; Hyperprolactinemia ; Middle Aged ; Neurologic Manifestations ; Pituitary Neoplasms* ; Polyps ; Prolactin ; Thyrotropin

BACKGROUND: Despite the expected high prevalence of several infectious diseases among the homeless, a majority of them have not received screening test and early treatment. MATERIALS AND METHODS: The subjects of this study were 269 homeless patients who had been hospitalized in the National Medical Center (Korea) between January 2002 and August 2004. Their medical histories and records were reviewed to analyze the prevalence and clinical characteristics of hepatitis B and C, syphilis, tuberculosis and HIV infection among them. RESULTS: The entire 269 homeless patients being hospitalized during the period of this study consist of 249 male patients and 19 female patients. For the prevalence of infectious diseases, HBV was seen in 15 of 228 patients (6.6%); HCV in 8 of 113 patients (7.1%); VDRL positive in 25 of 234 patients (10.7 %); HIV antibody positive in 2 of 130 (1.5%); and tuberculosis in 19 of 269 (7.1%). The number of patients who had the antibody to hepatitis B was 118 (51.7%). Of 28 patients hospitalized with the chief complaints of liver diseases and/or their complications, the number of cases infected with hepatitis B and C viruses was only 5 (17.9%). On the other hand, for patients with tuberculosis, 13 of 19 cases (68.4%) were hospitalized with the chief complaints associated with symptoms of pulmonary tuberculosis or enlarged lymph nodes. The number of patients with multiple infectious diseases was 9 in total. CONCLUSION: As expected, the prevalence of some infectious diseases were higher among the homeless inpatients, than non-homeless population. Proper screening tests in order to determine the presence of any infectious diseases among the patients and protect involved medical staff are necessary. Further, the government should take proactive measures to prevent the spread of infectious diseases in the aspect of public health.
Communicable Diseases* ; Female ; Hand ; Hepatitis B ; HIV ; HIV Infections ; Humans ; Inpatients ; Liver Diseases ; Lymph Nodes ; Male ; Mass Screening ; Medical Staff ; Prevalence* ; Public Health ; Syphilis ; Tertiary Care Centers* ; Tertiary Healthcare* ; Tuberculosis ; Tuberculosis, Pulmonary