BACKGROUND: A recently discovered adipokine, retinol-binding protein-4 (RBP-4), is reportedly associated with insulin resistance and metabolic syndrome. This study was performed to analyze the relationship between serum RBP-4 levels and coronary artery disease (CAD) in Korean adults. METHODS: In 235 subjects (mean age 58 years) in whom coronary artery angiograms were performed due to complaints of chest pain, serum RBP-4 levels were measured by enzyme-linked immunosorbent assay. Coronary artery angiograms were performed in all subjects and the severity of CAD was assessed by the number of stenotic vessels. The presence of metabolic syndrome was defined by AHA/NHLBI criteria with body mass index substituted for waist circumference. RESULTS: Coronary angiogram showed that 101 subjects (43%) had normal coronary vessel, 82 subjects (34.9%) had 1-vessel disease, 31 subjects (13.2%) had 2-vessel disease and 21 subjects (8.9%) had 3-vessel disease. Subjects with coronary artery stenosis showed a higher mean age (60.5 +/- 10.0 years), fasting glucose (123.3 mg +/- 45.0 mg/dL) and lower mean value for high-density lipoprotein cholesterol (HDL-C) level (49.0 +/- 13.2 mg/dL), although serum RBP-4 levels were not significantly different between those with and without CAD. Mean age and fasting glucose level increased significantly as the number of stenotic vessels increased, although serum RBP4 level showed no significant differences among the different groups. Among the metabolic parameters, only serum triglyceride levels showed a significant correlation with serum RBP-4 levels. CONCLUSION: There was no difference in mean serum RBP-4 levels between subjects with or without coronary artery disease in Korean adults. Further studies are warranted to draw a clear conclusion on the effect of RBP-4 on atherosclerosis.
Adipokines ; Adult ; Atherosclerosis ; Body Mass Index ; Chest Pain ; Cholesterol ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels ; Enzyme-Linked Immunosorbent Assay ; Fasting ; Glucose ; Glycosaminoglycans ; Humans ; Insulin Resistance ; Lipoproteins ; Waist Circumference

BACKGROUND: Klotho knock-out mouse is being thought as a good animal model for human aging and these mice show typically severe atherosclerosis of large arteries. Recent studies report on the association of KLOTHO gene mutation with cardiovascular diseases in humans. We observed the frequencies of G395A in promoter and C1818T in exon 4 of KLOTHO gene and investigated their relationships with the presence of coronary artery disease (CAD) in those patients underwent coronary angiograms METHODS: Total 168 subjects (mean age 58 years, 26-87 years) who underwent coronary angiograms due to chest pain were enrolled and blood pressure, body mass index, fasting blood glucose and lipid profiles were measured in all subjects. Genotypings were performed with real-time polymerase chain reaction from sampled blood. RESULTS: The allele frequencies of G395A were 0.872 for G allele and 0.128 for A allele and those of C1818T were 0.830 for C allele and 0.170 for T allele. Both were in compliance with Hardy-Weinberg equilibrium (p=0.99, p=0.82). When the subjects were classified into four groups according to the number of stenotic vessels, there were no differences among the mean values of the cardiovascular risk factors, except high-density lipoprotein cholesterol, that showed a significant difference between that of normal and the diseased vessel groups. There were no differences in the prevalence of CAD according to the genotypes of G395A polymorphism, but for C1818T polymorphism, subjects with T allele showed lower prevalence of CAD than those with CC genotype. When the subjects were divided into two groups according to age, in the group under 60 years of age, T allele carriers of C1818T polymorphism showed lower prevalence of CAD than non-carriers. In the group older than 60 years, A allele carriers of G395A polymorphism showed lower prevalence of CAD than non-carriers. CONCLUSIONS: The frequencies of KLOTHO G395A and C1818T polymorphisms in Koreans were observed similarly to those reported in other Asian races and the phenotypic expression on CAD was different according to age groups. These results infer the possibility of KLOTHO gene as the candidate gene of atherosclerosis in humans, which needs further research.
Aging ; Alleles ; Animals ; Arteries ; Asian Continental Ancestry Group ; Atherosclerosis ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Chest Pain ; Cholesterol ; Compliance ; Continental Population Groups ; Coronary Artery Disease* ; Coronary Vessels* ; Exons ; Fasting ; Gene Frequency ; Genotype ; Humans ; Lipoproteins ; Mice ; Models, Animal ; Prevalence ; Real-Time Polymerase Chain Reaction ; Risk Factors

BACKGROUND: Adiponectin, an adipocyte-secreted protein, is known to have anti-atherogenic, anti-inflammatory and anti-diabetic properties. Adiponectin levels are decreased in obesity, type 2 diabetes, and coronary artery disease. Several studies have been performed aiming to investigate the association of genetic variations in the adiponectin with obesity, insulin resistance, and type 2 diabetes but few studies were performed in association with coronary artery disease. Therefore we examined the association between two single nucleotide polymorphisms (SNPs) (+45T>G and +276G>T) of the adiponectin gene and coronary artery diseases (CAD). METHODS: One hundred fifty six subjects were enrolled in which coronary angiograms were performed due to chest pain in Kangbuk Samsung Hospital from April to August, 2003 (97 males, 59 females, mean age 57.40+/-11.15 yrs). Body mass index, fasting blood glucose, lipid profiles were measured in every subject. Single nucleotide polymorphisms (SNPs) in the adiponectin gene were determined by Taqman polymerase chain reaction (PCR) method. The presence of CAD was defined as a >50% reduction of coronary artery diameter. RESULTS: Among 156 subjects, the allele frequencies were 0.683 for G allele and 0.317 for T allele in SNP +276G>T and 0.705 for T allele and 0.295 for G allele in SNP +45T>G. Both genotypes were in compliance with Hardy-Weinberg equlibrium. Mean serum fasting glucose level was significantly higher and mean high-density lipoprotein cholesterol (HDL-C) level was lower in CAD groups (p=0.015, p=0.004). No association with the presence of CAD was observed for adiponectin gene SNP276 and SNP45 (p=0.954, p=0.843). Also, no significant association was observed between the severity of CAD and either SNPs (p=0.571, p=0.955). CONCLUSIONS: Our study showed that SNP +276G>T and +45T>G in adiponectin gene were not associated with the presence of CAD. Further studies will be necessary to confirm the role of SNP 276G>T and 45T>G in the development of CAD.
Adiponectin* ; Alleles ; Blood Glucose ; Body Mass Index ; Chest Pain ; Cholesterol ; Compliance ; Coronary Artery Disease* ; Coronary Vessels* ; Fasting ; Female ; Gene Frequency ; Genetic Variation ; Genotype ; Glucose ; Humans ; Insulin Resistance ; Lipoproteins ; Male ; Obesity ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide*

BACKGROUND: Osteoprotegerin (OPG) is a glycoprotein that acts as a decoy receptor to receptor-activated RANKL (receptor-activated NF-kappa B ligand) and inhibits the differentiation of osteoclasts. OPG knock-out mice showed severe osteoporosis and aortic calcification and high serum OPG levels have been shown to predict future cardiovascular mortality in old Caucasian females. We measured serum OPG levels in coronary artery disease patients, compared serum OPG levels among different groups according to the number of stenotic vessels and observed the correlation with aortic calcification and cardiovascular risk factors. METHODS: One hundred subjects were enrolled in which coronary angiograms were performed due to chest pain in Kangbuk Samsung Hospital from April to August, 2003 (59 males, 41 females, mean age 56.9 +/- 11.9 yrs). Blood pressure, body mass index, fasting blood glucose, total cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol levels were measured in every subject. Cardiac echocardiograms were checked in 82 subjects and left ventricular mass indices (LV mass index) were calculated. Serum OPG levels were measured with enzyme-linked immunosorbent assay (ELISA) method. The presence of calcifications in aortic knob was checked in simple chest X-ray. RESULTS: Subjects were divided in 4 groups according to the number of stenotic vessels (significant stenosis>or=50%); 45 subjects in normal group, 30 in 1-vessel disease group, 15 in 2-vessel disease group and 10 in 3-vessel disease group. Mean value for age was significantly different among groups (p<0.01). Mean serum HDL-cholesterol level of normal group was higher than that of 1-vessel disease or 2-vessel disease group (p<0.05). Serum OPG levels increased significantly as the number of stenotic vessels increased and in post-hoc analysis, mean serum OPG levels were higher in 3-vessel disease group than normal or 1-vessel disease groups (p<0.05). Age, LV mass index and number of stenotic vessels showed significantly positive correlation with serum OPG levels, although only number of stenotic vessels showed persistently significant correlation after adjustment for age. There were no differences of serum OPG levels according to the presence of fasting hyperglycemia or aortic calcifications. CONCLUSION: Serum OPG levels increased as the number of stenotic coronary arteries increased and showed positive relationships with age, LV mass index. OPG seems to be elevated as a compensatory mechanism to the progression of atherosclerosis in humans.
Animals ; Atherosclerosis ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Chest Pain ; Cholesterol ; Coronary Artery Disease* ; Coronary Vessels* ; Enzyme-Linked Immunosorbent Assay ; Fasting ; Female ; Glycoproteins ; Humans ; Hyperglycemia ; Lipoproteins ; Male ; Mice ; Mice, Knockout ; Mortality ; NF-kappa B ; Osteoclasts ; Osteoporosis ; Osteoprotegerin* ; Risk Factors* ; Thorax ; Triglycerides

BACKGROUND: We measured plasma vancomycin concentrations as a part of therapeutic drug monitoring (TDM) consultation and compared and analyzed the estimated plasma steady-state therapeutic drug levels of vancomycin obtained on the basis of measured concentrations and by population PK parameters using a PK simulation software in Korean patients to find the factors influencing the discrepancies that lie between these estimates. MATERIALS AND METHODS: We analyzed the PK parameters of the 188 patients for whom vancomycin TDM was done for 239 episodes between March, 2001 and September, 2002. The trough vancomycin plasma concentrations were measured from plasma samples that were drawn 30 minutes before a vancomycin dose. Based on the measured concentrations, we estimated the steady-state therapeutic levels (ECm) and PK parameters (apparent volumes of distribution, Vdm; clearance, Clm; and half life, T1/2m) using the single-point linear method utilized in CAPCIL (Simkin, Inc.) software program. We compared these with the steady-state levels and PK parameters estimated based on population PK database supplied by the software (ECp, Vdp, Clp, and T1/2p). We stratified and compared the values based on the patients' renal functions, body weights relative to ideal body weights, the magnitude of differences between ECm and ECp. Multiple logistic regression using SAS software package was done to analyze factors that significantly influence the discrepancies. RESULTS: One hundred and eleven were males, and 77 were females. The mean ECm were significantly lower than the mean ECp (11.9+/-9.9 microgram/ml vs. 19.2+/-19.5 microgram/ml). Clm and Vdm were higher than Clp and Vdp, respectively. The same patterns could be applied to the subclasses of patients based on renal functions and body weights. The factors that contribute to the differences in ECm and ECp were body weight, age, height, IBW, BUN, and Clcr, of which age, body weight, and BUN were found to be most significant by multiple regression analysis. CONCLUSIONS: Significant sizes of discrepancies between the estimated plasma steady-state therapeutic drug levels of vancomycin obtained on the basis of measured concentrations and by population PK parameters using a PK simulation software in Korean patients necessitate adjustment of dosage and confirmation of steady-state levels by follow-up TDM. We emphasize the need for obtaining vancomycin population PK database in Korean patients.
Body Weight ; Drug Monitoring* ; Female ; Follow-Up Studies ; Half-Life ; Humans ; Ideal Body Weight ; Logistic Models ; Male ; Pharmacokinetics ; Plasma ; Vancomycin*

BACKGROUND: We measured plasma vancomycin concentrations as a part of therapeutic drug monitoring (TDM) consultation and compared and analyzed the estimated plasma steady-state therapeutic drug levels of vancomycin obtained on the basis of measured concentrations and by population PK parameters using a PK simulation software in Korean patients to find the factors influencing the discrepancies that lie between these estimates. MATERIALS AND METHODS: We analyzed the PK parameters of the 188 patients for whom vancomycin TDM was done for 239 episodes between March, 2001 and September, 2002. The trough vancomycin plasma concentrations were measured from plasma samples that were drawn 30 minutes before a vancomycin dose. Based on the measured concentrations, we estimated the steady-state therapeutic levels (ECm) and PK parameters (apparent volumes of distribution, Vdm; clearance, Clm; and half life, T1/2m) using the single-point linear method utilized in CAPCIL (Simkin, Inc.) software program. We compared these with the steady-state levels and PK parameters estimated based on population PK database supplied by the software (ECp, Vdp, Clp, and T1/2p). We stratified and compared the values based on the patients' renal functions, body weights relative to ideal body weights, the magnitude of differences between ECm and ECp. Multiple logistic regression using SAS software package was done to analyze factors that significantly influence the discrepancies. RESULTS: One hundred and eleven were males, and 77 were females. The mean ECm were significantly lower than the mean ECp (11.9+/-9.9 microgram/ml vs. 19.2+/-19.5 microgram/ml). Clm and Vdm were higher than Clp and Vdp, respectively. The same patterns could be applied to the subclasses of patients based on renal functions and body weights. The factors that contribute to the differences in ECm and ECp were body weight, age, height, IBW, BUN, and Clcr, of which age, body weight, and BUN were found to be most significant by multiple regression analysis. CONCLUSIONS: Significant sizes of discrepancies between the estimated plasma steady-state therapeutic drug levels of vancomycin obtained on the basis of measured concentrations and by population PK parameters using a PK simulation software in Korean patients necessitate adjustment of dosage and confirmation of steady-state levels by follow-up TDM. We emphasize the need for obtaining vancomycin population PK database in Korean patients.
Body Weight ; Drug Monitoring* ; Female ; Follow-Up Studies ; Half-Life ; Humans ; Ideal Body Weight ; Logistic Models ; Male ; Pharmacokinetics ; Plasma ; Vancomycin*

BACKGROUND: Bacterial and Helicobacter gene were commonly detected in diseased human bile, although the meaning of the presence of Helicobacter in biliary tract is still unclear. The aim of this study was to evaluate the changes of bile acid composition in bacterial and Helicobacter infected bile, and to determine whether Helicobacter pylori might grow in human bile or not. METHODS: Thirty bile samples were obtained by percutaneous transhepatic biliary drainage or gallbladder puncture during cholecystectomy. According to the polymerase chain reaction analysis using bacterial 16S rRNA and Helicobacter genus specific 16S rRNA primers, 3 groups were divided; Group I; no presence of any bacterial DNA, Group II; positive bacterial DNA only, Group III; positive bacterial and Helicobacter DNA. Bile acid analysis for deoxycholic acid (DCA), chenodeoxycholic acid (CDCA), lithocholic acid (LCA), and ursodeoxycholic acid (UDCA) was performed by high performance liquid chromatography. And then Helicobacter pylori was tried to culture in broth mixed with human bile at a final bile concentration of 50%. RESULTS: The concentrations of DCA in group II and III were very low and significantly reduced compared to group I (p<0.01, respectively). The concentrations of LCA or UDCA were not shown any relationships between groups. Helicobacter pylori has grown actively in the broth mixed with human bile containing both of less than 0.1 gm/L of DCA and CDCA, compared to no growth in media mixed with human bile containing more than 3.0 gm/L of DCA and/or CDCA. CONCLUSION: DCA seems to have the strongest antibacterial effect. Helicobacter pylori is likely to grow in human bile containg very low concentrations of CDCA and DCA.
Bile* ; Biliary Tract Diseases* ; Biliary Tract* ; Chenodeoxycholic Acid ; Cholecystectomy ; Chromatography, Liquid ; Deoxycholic Acid ; DNA ; DNA, Bacterial ; Drainage ; Gallbladder ; Helicobacter Infections* ; Helicobacter pylori ; Helicobacter* ; Humans ; Lithocholic Acid ; Polymerase Chain Reaction ; Punctures ; Ursodeoxycholic Acid

The carcinoid tumor of the ampulla of Vater is extremely rare. We report a case of 57-year old male with carcinoid tumor of ampulla of Vater. This patient had been presented with bronchial asthma for one year. Abdominal CT finding revealed diffuse dilatation of common bile duct and pancreatic duct, and also ampullary soft mass protruded into duodenal lumen. The correct diagnosis was made preoperatively by endoscopic retrograde cholangiography with biopsy. Pancreatico- duodenectomy with lymph nodes dissection was performed. Malignant carcinoid tumor originating from ampulla of Vater was diagnosed with pericholedochal lymphatic metastasis. Surgical removal led to complete resolution of asthmatic symptoms.
Ampulla of Vater* ; Asthma ; Biopsy ; Carcinoid Tumor* ; Cholangiography ; Common Bile Duct ; Diabetes Mellitus ; Diagnosis ; Dilatation ; Humans ; Insulin Resistance ; Lymph Nodes ; Lymphatic Metastasis ; Male ; Middle Aged ; Obesity ; Pancreatic Ducts ; Polymerase Chain Reaction ; PPAR gamma ; Tomography, X-Ray Computed

Agenesis of dorsal pancreas is a rare congenital anomaly that arises from the failure of the dorsal pancreatic bud of endodermal cells to form the body and tail of the pancreas. It may be associated with diabetes mellitus, pancreatic exocrine dysfunction, or abdominal pain. Complete or partial agenesis of dorsal pancreas has been reported in a small number of pediatric and adult patients. A case is herein described involving a complete agenesis of dorsal pancreas and diabetes mellitus. A 38-year-old man with a 7-months history of non-insulin dependent diabetes mellitus was admitted due to weight loss and abdominal pain. Abdominal ultrasonography and computed tomography showed a normal biliary tree and enlarged head of the pancreas without visualization of the pancreatic body and tail. Endoscopic retrograde cholangiopancreatography (ERCP) revealved the short duct of Wirsung in the uncinate process and a head without opacification of any ducts in the pancreatic body or tail. The patient underwent explo-laparotomy for evaluation of the suspected pancreatic cancer. The patient was diagnosed as having complete agenesis of the dorsal pancreas by ERCP, CT, and surgery.
Abdominal Pain ; Adult ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Diabetes Mellitus ; Endoderm ; Head ; Humans ; Pancreas* ; Pancreatic Ducts ; Pancreatic Neoplasms ; Ultrasonography ; Weight Loss