BACKGROUND: Visceral obesity is the most powerful contributor to the development of metabolic syndrome (MetS) and cardiovascular diseases. In light of visceral obesity, however, there is a paucity of data on the appropriate cutoff point of waist circumference (WC) in subjects with type 2 diabetes. The aim of this study was to investigate the optimal cutoff value for WC that signals insulin resistance (IR) and visceral obesity in Koreans with type 2 diabetes. METHODS: We evaluated 4,252 patients with type 2 diabetes (male 2,220, female 2,032, mean age 57.24 years) who visited our clinic between January 2003 and June 2009. WC was measured at the midpoint between the lower rib and the iliac crest, and insulin sensitivity was assessed by the rate constant of plasma glucose disappearance (Kitt %/min) using an insulin tolerance test. Visceral fat thickness was measured using ultrasonography. Statistical analysis was performed using receiver operating characteristic curve. RESULTS: The optimal cutoff points for WC for identifying the presence of IR and visceral obesity, as well as two or more metabolic components, were 87 cm for men and 81 cm for women. Moreover, these cutoff points had the highest predictive powers for the presence of visceral obesity. The MetS defined by new criteria correlated with the increased carotid intima-media thickness in female subjects. CONCLUSION: Our results suggest that the optimal cutoff values for WC in Koreans with type 2 diabetes should be reestablished based on IR and visceral obesity.
Blood Glucose ; Cardiovascular Diseases ; Carotid Intima-Media Thickness ; Diabetes Mellitus, Type 2 ; Female ; Humans ; Insulin ; Insulin Resistance* ; Intra-Abdominal Fat ; Male ; Obesity, Abdominal* ; Ribs ; ROC Curve ; Ultrasonography ; Waist Circumference*

There have been a few reports of hemophagocytic lymphohistiocytosis (HLH) with chromosomal abnormalities. Clonal chromosomal abnormalities in HLH patients are usually found in association with hematologic malignancies and rarely with epstein-barr virus (EBV) infection. Here, we report a fatal case of HLH with clonal karyotype abnormalities. A 75-yr-old man was admitted with persistent anorexia and high fever. Laboratory data revealed pancytopenia, hypofibrinogenemia, hyperferritinemia, prolonged prothrombin time and activated partial thromboplastin time, and marked elevated level of serum transaminases. In real time-PCR using whole blood, EBV DNA was not detected but cytomegalovirus (CMV) DNA was detected. The bone marrow aspiration smear showed hyperplasia of mature histiocytes with prominent hemophagocytosis. In chromosomal analysis of bone marrow aspirates, complex chromosomal abnormalities were found. In spite of steroid pulse therapy and antibiotic treatment, he died of disseminated intravascular coagulopathy.
Anorexia ; Bone Marrow ; Chromosome Aberrations ; Cytomegalovirus ; DNA ; Fever ; Hematologic Neoplasms ; Herpesvirus 4, Human ; Histiocytes ; Humans ; Hyperplasia ; Karyotype ; Lymphohistiocytosis, Hemophagocytic ; Pancytopenia ; Partial Thromboplastin Time ; Prothrombin Time ; Transaminases

Listeria monocytogenes is the causative agent in a spectrum of human disease ranging from gastroenteritis to invasive infections such as meningitis, encephalitis, and septicemia. Elderly patients or persons who have lower cell-mediated immunity with predisposing conditions such as transplants, lymphomas, and AIDS, are especially susceptible. The tropism of L.monocytogenes for the central nervous system leads to severe disease, often with high mortality. We report a case of L. monocytogenes meningitis in a 58-year old woman with end stage renal disease. The patient was discharged without neurological sequelae after antibiotic treatment.
Aged ; Central Nervous System ; Encephalitis ; Female ; Gastroenteritis ; Humans ; Immunity, Cellular ; Kidney Failure, Chronic* ; Listeria monocytogenes* ; Listeria* ; Lymphoma ; Meningitis ; Meningitis, Listeria* ; Middle Aged ; Mortality ; Sepsis ; Tropism

OBJECTIVE: The purpose of this study was to estimate the prevalence of metabolic syndrome, as defined by the ATP III report, in some Korean adults and use the Asian-Pacific proposed waist circumference to investigate waist circumference in some Korean adults using ROC curves. METHODS: Study subjects were seventy-five thousands and ninety one persons (47, 979 men and 27, 111 women) who were selected among the patients who visited hospital for health evaluation from January 2000 to December 2001. All subjects were measured by height, weight, waist and hip circumferences, blood pressure and blood chemistry (lipid profile). RESULTS: The mean age was 41.6+/-8.5 years in men, 41.1+/-10.4 years in women (p< 0.05). Body mass index was in the normal range in 35.3% of men, and 55.9% of women. In both men and women, blood pressure, blood sugar, total cholesterol and triglyceride were positively correlated with BMI. waist circumference, and Broca's index (p< 0.01). However HDL. choloesterol was correlated negatively (p< 0.01). Using ROC curve, the calculated waist circumferences were 84 cm in men (sensitivity 61.4% and specificity 64.1%) and 74 cm in women (sensitivity 65.0% and specificity 73.2%). The age adjusted prevalences of the metabolic syndrome as defined by NCEP ATP III were different for men (6.4%) and women (14.6%). The prevalence increased from 1.2% among participants aged 20 through 29years to 15.0% among participants aged over 60years in men (p< 0.05) and from 1.6% to 27.4% respectively, in women. The age adjusted prevalences, as defined by using the waist circumference that was recommended by WHO's regional office for the western Pacific, were 10.6% in men and 18.5% in women. The age adjusted prevalences, as defined by using the waist circumference that was calculated by the ROC curves, were 17.1% in men and 22.4% in women. And All prevalences were increased following increased BMI and Broca's index. CONCLUSIONS: The prevalence of metabolic syndrome in some Korean adults was lower than that in western adults. Nevertheless because waist circumference was differed among race and region, application of the same criteria was not proper. Morcover, a higher awareness was required in women, because the prevalence of metabolic syndrome was rapidly increased with increment of age.
Adenosine Triphosphate ; Adult* ; Blood Glucose ; Blood Pressure ; Body Mass Index ; Chemistry ; Cholesterol ; Continental Population Groups ; Female ; Hip ; Humans ; Male ; Obesity ; Prevalence* ; Reference Values ; ROC Curve ; Sensitivity and Specificity ; Triglycerides ; Waist Circumference*

BACKGROUND/AIMS: Recent studies suggest possibility of continuous and prolonged liver ischemia exceeding one hour. We compared mortality rates, liver function, serum Interleukin-6(IL-6) concentration and liver cell necrosis after continuous and intermittent hepatic ischemia in rats. METHODS: Sixty rats were divided into 6 groups to compare 7 day mortality rate. Continuous and intermittent left hepatic inflow occlusion was performed for a total period of 45, 60 and 90 minutes. In a separate study, following 90 minutes continuous or intermittent ischemia, systemic blood was sampled at 0 minute, 6 hours and 24 hours after final clamp release for measurement of SGOT, SGPT and IL-6. Pathologic examination was performed 24 hours or 7 days after reperfusion accordingly. RESULTS: There were no differences in the mortality rates within seven days. There were no differences in the level of SGOT, SGPT and IL-6 between each experimental group. In a pathologic examination, similar liver cell necrosis was found in each group until 24 hours of reperfusion. However, at 7 days after reperfusion, significantly higher grade of hepatic necrosis was noted in the group having continuous ischemia compared with intermittent ischemia of 90 minutes(p<0.05). CONCLUSION: Continuous ischemia is associated with significant risk in the aspect of pathologic study, although it did not affect short term mortality rates.
Alanine Transaminase ; Animals ; Aspartate Aminotransferases ; Interleukin-6 ; Ischemia ; Liver ; Mortality ; Necrosis ; Rats* ; Reperfusion ; Reperfusion Injury*

Thyrotoxicosis factitia, a syndrome that results from a surreptitious ingestion of excess thyroid hormone, has generally been diagnosed in young or middle-aged women who have psychopathological disturbances. An 18-year-old female was admitted to the hospital 24 hours after taking an overdose of more than 50 tablets of synthyroid (levothyroxine, 5mg). She had taken 6 to 9 tablets of synthyroid daily for 6 months for the purpose of weight reduction even though she was not overweight. Because of her stuporous mental state and an acute respiratory failure, she was intubated and treated in the intensive care unit. After careful history taking and after her plasma thyroid hormone levels were determined, we diagnosed a thyroid storm that was caused by a thyrotoxicosis factitia. The laboratory results were, T3 430.0 ng/dL, free T4 70.0 ng/dL, TSH 0.05 IU/mL. Her symptoms improved after treatment by steroids and propranolol. She was discharged 8days after admission. Cases of thyrotoxicosis factitia have been reported very infrequently and, there has been no reports of a thyroid storm due to thyrotoxicosis factitia in Korea. We now report a case of a thyroid storm that resulted from thyrotoxicosis factitia that was caused by the ingestion of a massive dose of thyroid hormone that was takan daily for 6 months. We also present a brief review of the relevant literature.
Adolescent ; Eating ; Female ; Humans ; Intensive Care Units ; Korea ; Overweight ; Plasma ; Propranolol ; Respiratory Insufficiency ; Steroids ; Stupor ; Tablets ; Thyroid Crisis* ; Thyroid Gland* ; Thyrotoxicosis* ; Weight Loss

BACKGROUND: After the resurgence of endemic malaria case in 1993, the number of malaria cases is increasing in succeeding years and most of patients were soldiers who served in the northern parts of Kyeonggi-do and Kangwon-do. Because group donations of blood from soldiers are frequent in these area, it is possible that donated blood from these area cause malaria. So we examined blood donation history of malaria patients to know their donation behavior. METHODS: The subject was 1,671 malaria patients who were diagnosed in 1997 and referred to blood transfusion research institute and their past donation history, time and frequency of donation were examined. The database consisted of malaria patients and blood donors who are known to be related with transfusion-transmitted malaria has been retrieved at each red cross blood center for every blood donors. The results were analyzed from January to December, 1998. RESULTS: About 60% (1,017) of 1,691 malaria patients in 1997 had donated their blood before diagnosis. The number of one time donation was 268; two time 289; more than three time was 460. Two hundred thirty six donors were checked by malaria registry file. In 236 donors, 92 cases were diagnosed with malaria, 96 cases were suspected to have malaria, 48 cases were namesakes. Conclusion: Because some malaria patients donate their blood after their diagnosis, it would be necessary to operate 'the computerized retrieving programme'to detect their donation after the diagnosis. Also, an education for malaria patients for their risk of transmitting malaria and strict history taking from donors for malaria will be required.
Academies and Institutes ; Blood Donors* ; Blood Transfusion ; Diagnosis ; Education ; Gangwon-do ; Gyeonggi-do ; Humans ; Malaria* ; Military Personnel ; Red Cross ; Tissue Donors

BACKGROUND: Seroincidence of hepatitis B virus (HBV) among Korean blood donors has not been reported. This study was conducted to calculate the seroincidence of HBV among blood donors and to estimate the risk of post-transfusion hepatitis B by donated blood in window period of infection. METHODS: HBV seroincidence was calculated among repeat-donors who had donated from Nov. 1994 through Dec. 1996. To calculate the person-years, the database of the Korean National Red Cross was used in which results for HBsAg enzyme immunoassay were filed up. The observed incidence was adjusted by interdonation interval of incident cases, who were defined as donors showing seroconversion. The risk of post-transfusion hepatitis B by donated bloods in window period of infection was estimated. RESULTS: HBV seroincidence was estimated to be 180.85/100,000 person-years. This was adjusted as 602.83/100,000 person-years by considering interdonation intervals. The risk of post-transfusion hepatitis B was estimated to be 974 units per one million of whole blood units due to be in window period of infection. CONCLUSION: The estimated seroincidence of HBV among Korean blood donors and thereby the risk of HBV transmission by donated bloods in window period of infection was about 50 to 60 times higher than those of Japan and United States of America.
Americas ; Blood Donors* ; Hepatitis B Surface Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Immunoenzyme Techniques ; Incidence ; Japan ; Red Cross ; Tissue Donors ; United States

BACKGROUND: Seroincidence of hepatitis B virus (HBV) among Korean blood donors has not been reported. This study was conducted to calculate the seroincidence of HBV among blood donors and to estimate the risk of post-transfusion hepatitis B by donated blood in window period of infection. METHODS: HBV seroincidence was calculated among repeat-donors who had donated from Nov. 1994 through Dec. 1996. To calculate the person-years, the database of the Korean National Red Cross was used in which results for HBsAg enzyme immunoassay were filed up. The observed incidence was adjusted by interdonation interval of incident cases, who were defined as donors showing seroconversion. The risk of post-transfusion hepatitis B by donated bloods in window period of infection was estimated. RESULTS: HBV seroincidence was estimated to be 180.85/100,000 person-years. This was adjusted as 602.83/100,000 person-years by considering interdonation intervals. The risk of post-transfusion hepatitis B was estimated to be 974 units per one million of whole blood units due to be in window period of infection. CONCLUSION: The estimated seroincidence of HBV among Korean blood donors and thereby the risk of HBV transmission by donated bloods in window period of infection was about 50 to 60 times higher than those of Japan and United States of America.(Korean J Blood Transfusion 10(1): 1-4, 1999)
Blood Donors* ; Blood Transfusion ; Hepatitis B Surface Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; Humans ; Immunoenzyme Techniques ; Incidence ; Japan ; Red Cross ; Tissue Donors ; United States

No abstract available.
Collagen* ; Female ; Humans