Background: It is well known that a large number of patients with diabetes also have dyslipidemia, which significantly increases the risk of cardiovascular disease (CVD). This study aimed to evaluate the efficacy and safety of combination drugs consisting of metformin and atorvastatin, widely used as therapeutic agents for diabetes and dyslipidemia. Methods: This randomized, double-blind, placebo-controlled, parallel-group and phase III multicenter study included adults with glycosylated hemoglobin (HbA1c) levels >7.0% and <10.0%, low-density lipoprotein cholesterol (LDL-C) >100 and <250 mg/dL. One hundred eighty-five eligible subjects were randomized to the combination group (metformin+atorvastatin), metformin group (metformin+atorvastatin placebo), and atorvastatin group (atorvastatin+metformin placebo). The primary efficacy endpoints were the percent changes in HbA1c and LDL-C levels from baseline at the end of the treatment. Results: After 16 weeks of treatment compared to baseline, HbA1c showed a significant difference of 0.94% compared to the atorvastatin group in the combination group (0.35% vs. −0.58%, respectively; P<0.0001), whereas the proportion of patients with increased HbA1c was also 62% and 15%, respectively, showing a significant difference (P<0.001). The combination group also showed a significant decrease in LDL-C levels compared to the metformin group (−55.20% vs. −7.69%, P<0.001) without previously unknown adverse drug events. Conclusion The addition of atorvastatin to metformin improved HbA1c and LDL-C levels to a significant extent compared to metformin or atorvastatin alone in diabetes and dyslipidemia patients. This study also suggested metformin’s preventive effect on the glucose-elevating potential of atorvastatin in patients with type 2 diabetes mellitus and dyslipidemia, insufficiently controlled with exercise and diet. Metformin and atorvastatin combination might be an effective treatment in reducing the CVD risk in patients with both diabetes and dyslipidemia because of its lowering effect on LDL-C and glucose.

BACKGROUND: This study was done to determine whether the Osteoporosis Self-assessment Tool (OST) can predict central bone mineral density in Korean men above 50 years, as defined by dual energy X-ray absorptionmetry (DXA). METHODS: We applied the OST index to Korean men aged over 50 in Health Promotion Center of Konkuk University Hospital from September 2005 to September 2008. The calculated OST risk index was based on weight and age, truncated to an integer. RESULTS: The study population was 276 men. The mean age, height and weight of the men were 59.7 +/- 6.69 years, 167.6 +/- 6.14 cm and 67.5 +/- 8.93 kg respectively. By DXA, 4.7% of the men had a T score of -2.5 or less, and 46.4% had a T score of -2 or less at the spine, total hip, or femoral neck. The OST index ranged from -4 to 7. Using a cutoff score of 0, we predicted osteoporosis with a sensitivity of 85% and a specificity of 62%. The receiver operating characteristic curve showed an area under the curve of 0.77. When the subjects were analyzed by age and smoking status, the predictive value of the OST was maintained. CONCLUSION: The OST is a simple and useful method to predict osteoporosis in Korean men.
Aged ; Bone Density ; Femur Neck ; Health Promotion ; Hip ; Humans ; Male ; Mass Screening ; Osteoporosis ; ROC Curve ; Self-Assessment ; Sensitivity and Specificity ; Smoke ; Smoking ; Spine

Splenic infarction caused by malaria is a rare complication and this is mostly caused by plasmodium falciparum. We report here on a 38 year-old female patient who developed symptomatic splenic infarction that was caused by vivax malaria. She presented with fever and left upper quadrant pain. Computed tomography showed multiple low density areas in the spleen, and the peripheral blood smear revealed plasmodium vivax infestation. We examined for other causes of splenic infarction, but all were negative. This is just the second report of symptomatic splenic infarction that was caused by vivax malaria only. Unlike the previous case, the levels of D-dimer and fibrinogen degradation factor were elevated. This may be related with the hypercoagulable state caused by malaria. Treatment was conservative and the further course was uneventful.
Female ; Fever ; Fibrin Fibrinogen Degradation Products ; Fibrinogen ; Humans ; Malaria ; Malaria, Vivax ; Plasmodium falciparum ; Plasmodium vivax ; Spleen ; Splenic Infarction

BACKGROUND: The manifestation of Membranoproliperative glomerulonephritis (MPGN) is variable from asymptomatic hematuria, nephrotic syndrome to advanced chronic kidney disease. The etiology, pathogenesis, and treatment of MPGN are unclear. The incidence of idiopathic MPGN is also rare in Korea, and the clinical course was rarely studied. So we investigated clinical course of idiopathic MPGN type 1. METHODS: From March 1990 to November 2004, renal biopsy was done in about 1500 patients in Dong-A universty hospital. Among them, 16 patients were diagnosed as idiopathic MPGN. Fourteen patients were observed over 6 months. We analyzed clinical data of these patients retrospectively. RESULTS: Male to female ratio of total 16 patients is 2.2:1. Mean age of patients was 37.6 years (14-76 years) at the time of diagnosis. Thirteen cases (81%) had nephrotic range proteinuria, 8 cases (50%) had hypertention, 12 cases (75%) had edema, and 4 cases (25%) had decreased renal fuction (serum creatinine>1.2 mg/dL) at the time of diagnosis. Average observation time was 55.7+/-37.4 (6-122)months. Six cases ended up with progressive renal failure. Three cases achieved complete remission. Renal survival time for 50% of cases was 92 months. In our study, edema and decreased renal fucntion at the time of diagnosis were related with later development of progressive renal failure (p<0.05). Of the total 14 cases, 4 cases ware treated conservatively, 6 cases were treated with anti-platelet agents, and 4 cases were treated with anti-platelet agents and prednisone. In conservative treatment group, 1 case ended up with progressive renal failure and 1 case achieved complete remission. In anti-platelet agents treatment goup, 4 cases ended up progressive renal failure. In combined anti-platelet agents and prednisone treatment group, 1 case ended up progressive renal failure and 2 cases achieved complete remission. However, the effect of each treatment is inconclusive because the number of the patients are too small. CONCLUSIONS: We suspect that deceased renal function and edema at the time of diagnosis may be risk factor predicting progressive renal failure in patients with idiopathic MPGN type 1.
Biopsy ; Diagnosis ; Edema ; Female ; Glomerulonephritis ; Glomerulonephritis, Membranoproliferative* ; Hematuria ; Humans ; Incidence ; Korea ; Male ; Nephrotic Syndrome ; Prednisone ; Proteinuria ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Retrospective Studies ; Risk Factors

Visceral artery aneurysms are rare, but potentially fatal, as they carry the risk of rupture and hemorrhage. Splenic artery aneurysms are the most common visceral artery aneurysm, with an occurrence rate of about 60%. Their risk of rupture has been estimated as between 2 and 10%, and the mortality rate due to a ruptured splenic artery aneurysm is significantly high, with reports of up to 25%. In most instances, an elective operation is recommended for low risk patients with a splenic artery aneurysm greater than 2 cm in diameter. Our patient had a 5x4x3 cm sized symptomatic splenic artery aneurysm and underwent an elective operation. However, during the operation, we unexpectedly found severely inflamed aneurysm embedded into the pancreatic tissue. The patient underwent proximal artery ligation and a distal pancreatectomy, including the affected artery, and a splenectomy. A histological examination of the pancreas revealed chronic granulomatous inflammation, with caseous necrosis, and the aneurysmal wall was dilated, with loss of elastic laminae. This report describes a rare case of a splenic artery aneurysm, with chronic pancreatitis due to a tuberculous infection as the predisposing factor.
Aneurysm* ; Arteries ; Causality ; Hemorrhage ; Humans ; Inflammation ; Ligation ; Mortality ; Necrosis ; Pancreas ; Pancreatectomy ; Pancreatitis ; Pancreatitis, Chronic* ; Rupture ; Splenectomy ; Splenic Artery*

Prosthetic vascular graft infection (PVGI) is a relatively uncommon complication of peripheral vascular surgery and although rare, is the most severe complication in reconstructive vascular surgery. The early diagnosis of this complication can reduce the mortality. We report a case of aorto-femoral bypass graft infection, which was diagnosed by Tc-99m HMPAO WBC scan, complicated with infective endocarditis. A 60-year-old man had been operated with aortofemoral bypass graft because of aortojejunal fistula due to abdominal aortic aneurysm. Nine months later, he was admitted with fever of two months' duration. On echocardiolography, aortic regurgitation and vegetation were observed, and then he was diagosed with infective endocarditis. He was treated with antibiotics for 6 weeks. Recurrent bacteremia of unknown origin persisted despite antibiotic therapy. Multiple microorganisms were separately isolated from the blood cultures. He complained of intermittent right groin pain. Imaging study (CT, MRI, US) showed no definite evidence of graft infection. However, Tc-99m HMPAO WBC scan demonstrated uptake in the aortofemoral bypass graft site. The patient underwent emergent aortofemoral graft removal with axillobifemoral bypass and right femoropopliteal bypass.
Anti-Bacterial Agents ; Aortic Aneurysm, Abdominal ; Aortic Valve Insufficiency ; Bacteremia ; Early Diagnosis ; Endocarditis* ; Fever ; Fistula ; Groin ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Mortality ; Technetium Tc 99m Exametazime ; Transplants*

Prosthetic vascular graft infection (PVGI) is a relatively uncommon complication of peripheral vascular surgery and although rare, is the most severe complication in reconstructive vascular surgery. The early diagnosis of this complication can reduce the mortality. We report a case of aorto-femoral bypass graft infection, which was diagnosed by Tc-99m HMPAO WBC scan, complicated with infective endocarditis. A 60-year-old man had been operated with aortofemoral bypass graft because of aortojejunal fistula due to abdominal aortic aneurysm. Nine months later, he was admitted with fever of two months' duration. On echocardiolography, aortic regurgitation and vegetation were observed, and then he was diagosed with infective endocarditis. He was treated with antibiotics for 6 weeks. Recurrent bacteremia of unknown origin persisted despite antibiotic therapy. Multiple microorganisms were separately isolated from the blood cultures. He complained of intermittent right groin pain. Imaging study (CT, MRI, US) showed no definite evidence of graft infection. However, Tc-99m HMPAO WBC scan demonstrated uptake in the aortofemoral bypass graft site. The patient underwent emergent aortofemoral graft removal with axillobifemoral bypass and right femoropopliteal bypass.
Anti-Bacterial Agents ; Aortic Aneurysm, Abdominal ; Aortic Valve Insufficiency ; Bacteremia ; Early Diagnosis ; Endocarditis* ; Fever ; Fistula ; Groin ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Mortality ; Technetium Tc 99m Exametazime ; Transplants*

PURPOSE: This study was performed to evaluate the treatment results, prognostic factors and complication rates in patients with locally advanced cancer of uterine cervix after radiotherapy with high-dose rate (HDR) brachytherapy. MATERIALS AND METHODS: One hundred and twenty patients with a locally advanced (stages IIB~IVA according to FIGO classification) carcinoma of the uterine cervix were treated with radiotherapy at the Department of Radiation Oncology, Samsung Medical Center between September 1994 and December 2001. The median age of the patients was 61 years (range 29 to 81). Sixty-one, 56 and 3 patients had FIGO stage IIB, III, and IV diseases, respectively. All patients were given external beam radiotherapy over the whole pelvis (median 50.4 Gy) and HDR intracavitary brachytherapy, with a median of 4 Gy per fraction, to point A. Twenty-one patients received chemotherapy, of which 13 and 21 received neoadjuvant chemotherapy and concurrent chemotherapy, respectively, during the first and fourth weeks of external beam radiotherapy. The chemotherapy was not randomly assigned and the median follow-up time was 28.5 months (range: 6~100 months). RESULTS: The three- and 5-year overall survival (OS) and disease-free survival (DFS) rates were 64.4 and 57.0%, and 63.7 and 60.2%, respectively. The 5-year OS and DFS rates of the patients at stages IIB, III and IV were 602, 57.9 and 33.3%, and 57.4, 65.4 and 33.3%, respectively. Univariate analysis indicated that the FIGO stage, overall treatment time (OTT) and treatment response were significant variables for the OS (p=0.035, p=0.0649 and p=0.0009) and of the DFS (p=0.0009, p=0.0359 and p=0.0363). Multivariate analysis showed that the treatment response was the only significant variable for the OS (p=0.0018) and OTT for the DFS (p=0.0360). The overall incidence of late complications in the rectum and bladder were 11.7 and 6.7%, respectively. In addition, insufficiency fractures were observed in 7 patients (5.8%). CONCLUSION: The results of this study suggest that radical radiotherapy with HDR brachytherapy was appropriate for the treatment of locally advanced uterine cervix cancer. Also, the response after treatment and OTT are significant prognostic factors.
Brachytherapy ; Cervix Uteri* ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Fractures, Stress ; Humans ; Incidence ; Multivariate Analysis ; Pelvis ; Radiation Oncology ; Radiotherapy* ; Rectum ; Urinary Bladder

PUPOSE: The superficial spreading type of early gastric cancer has different clinicopathologic features from other types of early gastric cancer in terms of its invasiveness and lymph-node metastases. Therefore, we attempted to elucidate the pathological features, surgical procedures and patients prognoses. MATERIALS AND METHODS: Clinical information was reviewed for patients who had undergone a gastrectomy for gastric cancer during an 8-year period (1995~2002) at Dankook University Hospital and Ulsan University, with an average follow-up of 48 months. Three hundred (300) superficial spreading lesions were analyzed with respect to macroscopic type, lymph-node (LN) metastasis, recurrent pattern, survival rate and method of surgical operation. In addition, the clinicopathological features of the superficial spreading type were compared with those of 739 other patients with small-sized cancer. RESULTS: In both groups, the IIc-type macroscopic lesion, the elevated subtype to be more specific, occurred most frequently. There was no significant difference in the method of surgery between the groups. The submucosal invasion was 39.8% in small-sized cancer, and 61.7% in superficial spreading cancer (P=0.005). The incidence of LN metastasis was 11.3% in early gastric cancer, 7.8% in small-sized cancer and 20.0% in superficial spreading cancer (P=0.005). The incidence of lymphatic invasion was 4.6% in small-sized cancer and 13.0% in superficial spreading cancer (P=0.009). The incidence of recurrence was 1.4% in small-sized cancer and 3.6% in superficial spreading cancer. The overall 5-year survival rate was 84.8% in superficial spreading cancer and 93.0% in small-sized cancer (P=0.052). The 5-year disease- free survival rate was 94.7% in superficial spreading cancer and 87.5% in small-sized cancer (P=0.053). CONCLUSION: The superficial spreading type of early gastric cancer tends to be more invasive and to show a higher incidence of lymph-node metastasis than small-sized early gastric cancer. A wide resection with extensive lymph-node dissection seems to be an appropriate treatment for a superficial spreading type of early gastric cancer.
Follow-Up Studies ; Gastrectomy ; Humans ; Incidence ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Stomach Neoplasms* ; Survival Rate ; Ulsan

BACKGROUND AND OBJECTIVES: Nonsteroidal anti-inflammatory drug (NSAID)-activated gene (NAG-1), which is induced by NSAIDs, has proapoptotic and antitumorigenic effects in colorectal cancer cells. However, NAG-1 induction and its effect on the apoptosis in human oral cavity cancer cells (SCC 1483) have not been determined. MATERIALS AND METHOD: NAG-1 expression by various NSAIDs in SCC 1483 cells was investigated by Western blot analysis. The induction of apoptosis by NSAID and the relationship between NAG-1 expression and apoptosis were determined by Western blot assay and flow cytometry. Drosophila cells stably expressing NAG-1 were constructed and NAG-1 conditioned medium (NCM) were made. Apoptosis was examined with flow cytometry on SCC 1483 cells treated with NCM. RESULTS: Diclofenac was the most potent inducer of NAG-1. Diclofenac inhibited the proliferation of SCC 1483 cells and this inhibition was proved as apoptosis. Diclofenac induced the expression of NAG-1 and also induced apoptosis in time and dose dependent manner. In the concentrated NCM, the expression of NAG-1 was intense and apoptosis was induced by addition of 5 mu of NCM. CONCLUSION: Based on these data, we could assure that NSAIDs induced NAG-1 in oral cavity cancer cells and NAG-1 induced apoptosis. Therefore, we suggest that it is possible to use NSAIDs as a chemopreventive agent in oral cavity cancer. Further studies on the mechanism of NAG-1 and clinical use will be needed.
Anti-Inflammatory Agents, Non-Steroidal ; Apoptosis* ; Blotting, Western ; Colorectal Neoplasms ; Culture Media, Conditioned ; Diclofenac ; Drosophila ; Flow Cytometry ; Humans* ; Mouth Neoplasms ; Mouth*