BACKGROUND: There have been recent reports that the fat distribution within skeletal muscle and the amount of muscle mass are associated with insulin resistance and the development of type 2 diabetes mellitus (T2DM). This study evaluated the impacts of visceral fat and thigh muscle from patients with T2DM and healthy subjects on atherosclerosis and insulin resistance. METHODS: Forty-two patients with newly-developed T2DM and 11 healthy subjects were selected for the study. The diabetic patients were subdivided into two groups, those under 40 years of age, as the young T2DM (n=21) group, and 40 years-old or greater, as the old T2DM (n=21) group. CT scans were obtained for all patients at the L4-L5 level and at the mid-portion between the greater trochanter and upper margin patella. The carotid intima-media thickness (IMT) was also measured using high resolution B-mode ultrasonography. RESULTS: The mean visceral fat area (VFA) in the old T2DM group was 169.4+/-13.2cm2, which was significantly greater than that found in the healthy subjects (67.9+/-7.92cm2, P<0.001) and young T2DM group (127.1+/-10.4cm2, P<0.05). The mean visceral fat to normal density muscle area ratio (VMNR) in the old T2DM group was 1.50+/-0.19, which was greater than in the healthy subjects (0.46+/-0.52, P<0.001) and young T2DM group (1.01+/-0.10, P<0.05). The total thigh muscle areas in the young and old T2DM groups were smaller than that in the healthy subjects, but without statistical significance. VMNR showed a positive correlation with the IMT and HOMA-IR. However, the total thigh muscle area was negatively correlated with the IMT. The normal density muscle area also showed significant negative correlations with the IMT and HOMA-IR. In a multiple regression analysis, age and VMNR were the most important independent risk factors of an increased carotid IMT. CONCLUSION: This study showed that the role of thigh muscle, as well as that of visceral fat, played a very important role in the occurrence of atherosclerosis. VMNR was found to be an especially important independent factor for an increased carotid IMT.
Adult ; Atherosclerosis ; Carotid Arteries* ; Carotid Intima-Media Thickness ; Diabetes Mellitus, Type 2 ; Femur ; Humans ; Insulin Resistance* ; Insulin* ; Intra-Abdominal Fat ; Muscle, Skeletal ; Patella ; Risk Factors ; Thigh* ; Tomography, X-Ray Computed ; Ultrasonography

Kikuchi's disease usually occurs in young women and is characterized by localized lymphadenitis (mostly cervical) usually associated with fever. It is considered a self-limited disease and most patients recover spontaneously within a few weeks to 6 months without any serious sequelae. However, patients with Kikuchi's disease require a systemic survey and regular follow-up for several years because it may be associated with other diseases such as systemic lupus erythematosus. To our knowledge, there are very few reports of Kikuchi's disease accompanied by hemophagocytic lymphohistiocytosis. Biopsy of a right cervical lymph node in a 35-year-old female who presented with fever and masses in the right cervical region showed necrotizing lymphadenitis and a diagnosis of Kikuchi's disease was reached. She was started on methylprednisolone pulse therapy (500 mg for 3 days) but developed generalized rash and fever. Laboratory data showed pancytopenia, elevation of serum transaminase and ferritin levels. Bone marrow and liver biopsy showed proliferation of histiocytes and Kupffer's cells engulfing lymphocytes, platelets and red blood cells, respectively. We report a case of Kikuchi's disease accompanied by hemophagocytic lymphohistiocytosis.
Adult ; Biopsy ; Bone Marrow ; Diagnosis ; Erythrocytes ; Exanthema ; Female ; Ferritins ; Fever ; Follow-Up Studies ; Histiocytes ; Histiocytic Necrotizing Lymphadenitis* ; Humans ; Liver ; Lupus Erythematosus, Systemic ; Lymph Nodes ; Lymphadenitis ; Lymphocytes ; Lymphohistiocytosis, Hemophagocytic* ; Methylprednisolone ; Pancytopenia

Kikuchi's disease usually occurs in young women and is characterized by localized lymphadenitis (mostly cervical) usually associated with fever. It is considered a self-limited disease and most patients recover spontaneously within a few weeks to 6 months without any serious sequelae. However, patients with Kikuchi's disease require a systemic survey and regular follow-up for several years because it may be associated with other diseases such as systemic lupus erythematosus. To our knowledge, there are very few reports of Kikuchi's disease accompanied by hemophagocytic lymphohistiocytosis. Biopsy of a right cervical lymph node in a 35-year-old female who presented with fever and masses in the right cervical region showed necrotizing lymphadenitis and a diagnosis of Kikuchi's disease was reached. She was started on methylprednisolone pulse therapy (500 mg for 3 days) but developed generalized rash and fever. Laboratory data showed pancytopenia, elevation of serum transaminase and ferritin levels. Bone marrow and liver biopsy showed proliferation of histiocytes and Kupffer's cells engulfing lymphocytes, platelets and red blood cells, respectively. We report a case of Kikuchi's disease accompanied by hemophagocytic lymphohistiocytosis.
Adult ; Biopsy ; Bone Marrow ; Diagnosis ; Erythrocytes ; Exanthema ; Female ; Ferritins ; Fever ; Follow-Up Studies ; Histiocytes ; Histiocytic Necrotizing Lymphadenitis* ; Humans ; Liver ; Lupus Erythematosus, Systemic ; Lymph Nodes ; Lymphadenitis ; Lymphocytes ; Lymphohistiocytosis, Hemophagocytic* ; Methylprednisolone ; Pancytopenia