The results of studies that evaluated predictive factors for rebleeding in non-variceal upper gastrointestinal bleeding are inconsistent. The aim of this study was to investigate predictive factors for 30-day rebleeding in these patients. A consecutive 312 patients presenting symptoms and signs of gastrointestinal bleeding were enrolled in this prospective, observational study. Clinical and demographic characteristics and endoscopic findings were evaluated for potential factors associated with 30-day rebleeding using logistic regression analysis. Overall, 176 patients were included (male, 80.1%; mean age, 59.7+/-16.0 yr). Rebleeding within 7 and 30 days occurred in 21 (11.9%) and 27 (15.3%) patients, respectively. We found that chronic kidney disease (CKD) (OR, 10.29; 95% CI, 2.84-37.33; P<0.001), tachycardia (pulse>100 beats/min) during the admission (OR, 3.79; 95% CI, 1.25-11.49; P=0.019), and Forrest classes I, IIa, and IIb (OR, 6.14; 95% CI, 1.36-27.66; P=0.018) were significant independent predictive factors for 30-day rebleeding. However, neither Rockall nor Blatchford scores showed statistically significant relationships with 30-day rebleeding in a multivariate analysis. CKD, hemodynamic instability during hospitalization, and an endoscopic high-risk appearance are significantly independent predictors of 30-day rebleeding in patients with non-variceal upper gastrointestinal bleeding. These factors may be useful for clinical management of such patients.
Adult ; Aged ; Endoscopy, Digestive System/adverse effects ; Female ; Gastrointestinal Hemorrhage/*etiology ; *Hemodynamics ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Prospective Studies ; Recurrence ; Regression Analysis ; Renal Insufficiency, Chronic/*complications ; Risk Factors ; Severity of Illness Index ; Tachycardia/complications

Growth hormone (GH) and thyroid stimulating hormone (TSH)-secreting pituitary adenomas are very rare and they account for only 0.5% for all pituitary adenomas. These adenomas are usually treated with surgery, but this surgery is not easy because the tumor is usually huge and invasive. We reported here on a case of a GH-TSH-secreting adenoma in a 23-year-old male patient who was initially treated with octreotide LAR. He presented with symptoms of headache, palpitation and a visual defect that he had for the 3 months. He had hypertrophy of the frontal bone and enlargement of both the hands and feet. The visual field test showed bitemporal hemianopsia. The laboratory examinations showed high serum levels of free T4, TSH and free alpha-subunit. Additionally, the serum levels of GH and insulin-like growth factor-I (IGF-I) were increased. GH was not suppressed below 1microg/L by an oral 75g glucose loading test, and TSH was not stimulated by thyrotropin-releasing hormone (TRH). Because sellar MRI showed invasive macroadenoma encasing the vessels, we initially tried octreotide LAR for treatment. A year later, the IGF-I and thyroid function tests were normalized and the size of the tumor was reduced with cystic change. The symptoms of palpitation and headache were improved without a change of the visual field defect.
Acromegaly ; Adenoma ; Foot ; Frontal Bone ; Glucose ; Growth Hormone ; Hand ; Headache ; Hemianopsia ; Humans ; Hypertrophy ; Insulin-Like Growth Factor I ; Male ; Octreotide ; Pituitary Neoplasms ; Thyroid Function Tests ; Thyrotropin ; Thyrotropin-Releasing Hormone ; Visual Field Tests ; Visual Fields ; Young Adult

PURPOSE: This study evaluates the long-term results of definitive radiotherapy (RT) for early glottic cancer. Clinical and treatment factors related to local control and patterns of failure are analyzed. MATERIALS AND METHODS: We retrospectively reviewed 222 patients with T1-2N0 squamous cell carcinoma of the glottic larynx treated with definitive RT from 1981 to 2010. None of the patients received elective nodal RT or combined chemotherapy. The median total RT dose was 66 Gy. The daily fraction size was < 2.5 Gy in 69% and 2.5 Gy in 31% of patients. The RT field extended from the hyoid bone to the cricoid cartilage. RESULTS: The median age was 60 years, and 155 patients (70%) had T1 disease. The 5-year rates of local recurrence-free survival (LRFS) and ultimate LRFS with voice preservation were 87.8% and 90.3%, respectively. T2 (hazard ratio [HR], 2.30; 95% confidence interval [CI], 1.08 to 4.94) and anterior commissural involvement (HR, 3.37; 95% CI, 1.62 to 7.02) were significant prognostic factors for LRFS. In 34 patients with local recurrence, tumors recurred in the ipsilateral vocal cord in 28 patients. There were no contralateral vocal cord recurrences. Most acute complications included grade 1-2 dysphagia and/or hoarseness. There was no grade 3 or greater chronic toxicity. CONCLUSION: Definitive RT achieved a high cure rate, voice preservation, and tolerable toxicity in early glottic cancer. T2 stage and anterior commissural involvement were prognostic factors for local control. Further optimization of the RT method is needed to reduce the risk of ipsilateral tumor recurrence.
Carcinoma, Squamous Cell ; Cricoid Cartilage ; Deglutition Disorders ; Drug Therapy ; Glottis ; Hoarseness ; Humans ; Hyoid Bone ; Laryngeal Neoplasms ; Larynx ; Neoplasm Recurrence, Local ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Risk Factors ; Vocal Cords ; Voice

BACKGROUND: Chemerin is a novel adipokine that is associated with inflammation and adipogenesis. However, it remains unclear whether chemerin is involved in patients with cardiovascular disease. We investigated whether the serum chemerin levels of Korean patients with coronary artery disease correlated with specific cardiometabolic parameters. METHODS: In total, 131 patients, all of whom had coronary artery stenosis exceeding 50%, participated in this study. Their serum chemerin levels and cardiometabolic parameters were measured. The serum chemerin levels of two groups of patients were compared; those with one stenotic vessel (n=68) and those with multiple stenotic vessels, including left main coronary artery disease (n=63). RESULTS: Serum chemerin levels correlated positively with the degree of coronary artery stenosis and fasting glucose, triglyceride, total cholesterol, low density lipoprotein cholesterol, and high sensitive C-reactive protein levels. The group with multiple stenotic vessels, including left main disease, had higher chemerin levels than the group with one stenotic vessel (t=-2.129, P=0.035). Multiple binary logistic regression showed chemerin was not an independent risk factor of multiple vessel disease (odds ratio, 1.018; confidence interval, 0.997 to 1.040; P=0.091). CONCLUSION: Serum chemerin levels have a significant correlation with several cardiometabolic risk factors and the degree of coronary artery stenosis in Korean patients with coronary artery disease. However, multiple binary logistic regression showed chemerin was not an independent risk factor of multiple vessel disease. Additional investigations are necessary to fully elucidate the role of chemerin in cardiovascular disease.
Adipogenesis ; Adipokines ; C-Reactive Protein ; Cardiovascular Diseases ; Cholesterol ; Cholesterol, LDL ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Fasting ; Glucose ; Glycosaminoglycans ; Humans ; Inflammation ; Lipoproteins ; Logistic Models ; Risk Factors

Growth hormone (GH) and thyrotropin (TSH)-secreting pituitary adenomas are very rare and account for only 0.5% of all pituitary adenomas. We report a case of a GH/TSH-secreting pituitary adenoma in a 53-year-old male patient. He presented with symptoms of thyrotoxicosis, clinical features of acromegaly, and diabetes mellitus. The laboratory examinations showed high serum levels of free T4, TSH, and free alpha-subunit. Additionally, serum levels of GH and insulin-like growth factor (IGF-1) wereincreased. GH was not suppressed below 1 microgram/L by an oral 75 g glucose loading test, and TSH was not stimulated by thyrotropin- releasing hormone. A sellar MRI showed a large lobulated mass on the pituitary gland, so transcranial surgery was performed. Immunohistochemical staining showed anti-GH and anti-TSH positive tumor cells in the cytoplasm. Serum GH, IGF-1, free T4, and TSH levels normalized after surgery.
Acromegaly ; Cytoplasm ; Diabetes Mellitus ; Glucose ; Growth Hormone ; Humans ; Insulin-Like Growth Factor I ; Male ; Middle Aged ; Pituitary Gland ; Pituitary Neoplasms ; Thyrotoxicosis ; Thyrotrophs ; Thyrotropin

BACKGROUND: The highly developed endoplasmic reticulum (ER) structure is one of the characteristic features of pancreatic beta-cells. Recent study showed that ER stress causes beta-cell dysfunction. However, little is known about the effects of high glucose concentration on induction of ER stress in pancreatic beta-cells. Therefore, this study was designed to evaluate whether exposure of high glucose concentration in rat insulinoma cell line, INS-1 cell induces ER stress and whether ER stress decreases insulin gene expression. METHODS: The effect of 30 mM glucose on insulin expression and secretion in INS-1 cells was evaluated by Northern blot analysis and glucose-stimulated insulin secretion (GSIS). Cell viability was evaluated by XTT assay. The effect of 30 mM glucose on phosphorylation of eIF2alpha and CHOP expression, which are markers of ER stress were evaluated by Western blot analysis. RT-PCR analysis was performed to determine whether high glucose concentration induces XBP-1 splicing. To investigate whether ER stress decreases insulin gene expression, the effect of tunicamycin on insulin mRNA expression was evaluated by Northern blot analysis. RESULTS: The prolonged exposure of INS-1 cells with the 30 mM glucose concentration decreased insulin mRNA expression in a time dependent manner and impaired GSIS while did not influence on cell viability. 30 mM glucose increased phosphorylation of eIF2alpha, XBP-1 splicing and CHOP expression in INS-1 cells. Tunicamycin-treated INS-1 increased XBP-1 splicing and decreased insulin mRNA expression in a dose dependent manner. CONCLUSION: This study showed that prolonged exposure of INS-1 with high glucose concentration induces ER stress and ER stress decreases insulin gene expression. Further studies about underlying molecular mechanism by which ER stress induces beta-cell dysfunction are needed.
Animals ; Blotting, Northern ; Blotting, Western ; Cell Line ; Cell Survival ; Endoplasmic Reticulum ; Endoplasmic Reticulum Stress ; Gene Expression ; Glucose ; Hyperglycemia ; Insulin ; Insulinoma ; Phosphorylation ; Rats ; RNA, Messenger ; Tunicamycin