A 55-year-old female presented with extensive yellowish eruptive plaques over both elbows and the buttocks that she had first noticed 2 years earlier. Yellowish orange discoloration of her palmar creases was noted. Her serum cholesterol and triglyceride were markedly elevated. Lipoprotein electrophoresis showed a broad beta band. On apolipoprotein E genotyping, the arginine at position 158 had been replaced by cysteine in both alleles (E2/E2). Under a diagnosis of type III hyperlipoproteinemia, combined atorvastatin and fenofibrate therapy for 2 months normalized the serum cholesterol and triglyceride levels.
Alleles ; Apolipoproteins ; Arginine ; Buttocks ; Cholesterol ; Citrus sinensis ; Cysteine ; Elbow ; Electrophoresis ; Female ; Fenofibrate ; Heptanoic Acids ; Humans ; Hyperlipoproteinemia Type III ; Hyperlipoproteinemias ; Lipoproteins ; Middle Aged ; Pyrroles ; Xanthomatosis ; Atorvastatin Calcium

We investigated the cutoff values of surrogate of insulin resistance for diagnosing metabolic syndrome in Korean adults. The data from 976 non-diabetic individuals (484 men and 492 women) aged 30-79 yr were analyzed. We determined the odds ratios for the prevalence of metabolic syndrome according to the quartiles of fasting insulin, homeostasis model for insulin resistance (HOMA-IR), and quantitative insulin sensitivity check index (QUICKI) as independent variables, while adjusting for age, sex, and body mass index. The cutoff values of fasting insulin, HOMA-IR, and QUICKI were estimated by the areas under the receiver-operating characteristic (ROC) curves. The cutoff points for defining insulin resistance are a fasting insulin level of 12.94 micro U/mL, HOMA-IR=3.04 as the 75th percentile value, and QUICKI=0.32 as the 25th percentile value. Compared with the lowest quartile, the adjusted odds ratios for the prevalence of metabolic syndrome in the highest quartiles of fasting insulin, HOMA-IR, and QUICKI were 1.95 (1.26-3.01), 2.27 (1.45-3.56), and 2.27 (1.45-3.56), respectively. The respective cutoff values for fasting serum insulin, HOMA-IR, and QUIC-KI by ROC analysis were 10.57 micro U/mL (sensitivity 58.5%, specificity 66.8%), 2.34 (sensitivity 62.8%, specificity 65.7%), and 0.33 (sensitivity 61.2%, specificity 66.8%). Fasting insulin, HOMA-IR, and QUICKI can be used as surrogate measures of insulin resistance in Korean non-diabetic adults.
Triglycerides/blood ; Predictive Value of Tests ; Multivariate Analysis ; Middle Aged ; Metabolic Syndrome X/*blood/diagnosis/physiopathology ; Male ; Korea ; *Insulin Resistance ; Insulin/*blood ; Humans ; Female ; Fasting/blood ; Diabetes Mellitus/blood/physiopathology ; Cholesterol, HDL/blood ; Cholesterol/blood ; Blood Pressure/physiology ; Blood Glucose/analysis ; Aged ; Adult

The aims of this study were to compare the prevalence of the metabolic syndrome according to the WHO and NCEP ATP III criteria in Korean adults, and to compare the prevalence of the metabolic syndrome with the results in previous Korean studies. The study comprised 1, 230 subjects (627 men, 603 women) aged 30-79 years (mean 52.4+/-10.3 years) who underwent medical check-up from April to June, 2001 in the Korea Association of Health (KAH). The prevalence of the metabolic syndrome according to the modified WHO criteria was 21.8% of men and 19.4% of women. However, the prevalence was increased 1.6 times (34.2%) in men and 2.0 times (38.7%) in women using the modified NCEP criteria. The prevalence of the metabolic syndrome has varied widely according to differences in the criteria. Thus, further studies are necessary to define the appropriate criteria of the metabolic syndrome for Korean adults.
Adult ; Aged ; Asian Continental Ancestry Group/*statistics & numerical data ; *Cholesterol ; Comparative Study ; Female ; *Health Education ; Humans ; Korea/epidemiology ; Male ; Metabolic Syndrome X/*diagnosis/*epidemiology ; Middle Aged ; Practice Guidelines ; Prevalence ; *World Health Organization

BACKGROUND: Rosiglitazone, an insulin sensitizer of thiazolidinedione class, is known as a highly selective and potent agonist for the peroxisome proliferator-activated receptor-gamma. This study was performed to evaluate the antidiabetic activity and insulin sensitizing effect of rosiglitazone combination therapy in insulin-resistant type 2 diabetic patients who were poorly controlled with oral agents such as metformin and/or sulfonylurea. The factors affecting response of rosiglitazone were also evaluated on the basis of the degree of glycemic control. METHODS: One hundred twenty insulin-resistant (glucose disposal rate, Kitt < 2.5%/min) type 2 diabetic patients (M:F=42:78, mean age 58.6+/-9.2 years, body mass index 24.2+/-2.8 kg/m2) were enrolled and randomly divided into two groups. For 12 weeks, the treated group daily received 4 mg of rosiglitazone and the control group had diet and exercise therapy in addition to previous medications. The responders were defined as more than 20% decrease of fasting plasma glucose level or more than 1% decrease of HbA1c. As for the indices of insulin resistance and insulin secretory function, Kitt (Kitt=0.693/t1/2 X 100) by insulin tolerance test, HOMA(IR) and HOMA(beta-cell) function by 'HOMA index (Homeostasis model assessment)' were evaluated. RESULTS: In rosiglitazone treated group (60 patients, M:F=19:45), 12 weeks of rosiglitazone treatment decreased fasting plasma glucose (28.2%), postprandial 2-hour glucose (23.2%), and HbA1c (12.2%). Rosiglitazone also significantly decreased HOMA(IR) (41.2%), and increased Kitt (53.3%) and HOMA(beta-cell) function (46.9%). Forty-five patients (75%) satisfied responder. Females and those who had higher body mass index and waist-hip ratio showed better response. The basal fasting plasma glucose, HbA1c, and systolic blood pressure were also higher in responders. The responders showed significantly higher fasting serum insulin level and HOMA(IR), and also higher tendency of fasting serum C-peptide level and HOMA(beta-cell) function than nonresponders. CONCLUSION: From these results, rosiglitazone treatment can improve not only hyperglycemia and insulin resistance but also insulin secretory function in uncontrolled insulin-resistant type 2 diabetes. The factors that affect response of rosiglitazone are female, obesity (especially central obesity), high insulin secretory function, and severe insulin resistance. As a conclusion, the therapeutic efficacy or response of rosiglitazone is likely to depend on the degree of preserved pancreatic beta-cell function and the severity of insulin resistance.
Blood Glucose ; Blood Pressure ; Body Mass Index ; C-Peptide ; Diabetes Mellitus, Type 2 ; Diet ; Exercise Therapy ; Fasting ; Female ; Glucose ; Humans ; Hyperglycemia ; Insulin ; Insulin Resistance ; Metformin ; Obesity ; Peroxisomes ; Waist-Hip Ratio

BACKGROUND: There are a few limitations in application of staged diabetes management (SDM) program to Korean type 2 diabetic patients because of their unique characteristics, such as non-obese but centrally obese anthropometry and variable relationships between insulin secretion and insulin resistance compared to western diabetic patients. Therefore, we proposed new therapeutic model which considers ethnic characteristics and assesses patient by insulin secretion and insulin resistance. METHODS: We have previously assessed patient's insulin secretion by serum fasting C-peptide level and insulin resistance by insulin tolerance test (ITT) and proposed new therapeutic model: by cut-off value of 2.5%/min in insulin resistance and 1.1 ng/dL, 1.7 ng/dL in insulin secretion. RESULTS: Total 183 patients were enrolled in this program and 59% of total subjects had to change the treatment modality according to this new therapeutic model. Mean fasting glucose level dropped from 177.0+/-38.6 mg/dL (9.83+/-2.14 mmol/L) to 148.2+/-31.2 mg/dL (8.23+/-1.73 mmol/L) (p<0.001), mean postprandial 2 hour glucose level dropped from 255.6+/-60.1 mg/dL (14.19+/-3.34 mmol/L) to 221.1+/-58.4 mg/dL (12.27+/-3.24 mmol/L) (p<0.001), mean HbA1c level dropped from 8.37+/-1.42% to 7.72+/-1.39% (p<0.001) even though baseline group already received conventional treatment. 51.4% of the post-treatment group achieved a HbA1c valued of less than 7.5% compared to 28.4% of the pre-treatment group. CONCLUSION: The new standardized therapeutic model strongly suggests its valuable clinical application in Korean type 2 diabetic patients.
Anthropometry ; C-Peptide ; Diabetes Mellitus ; Fasting ; Glucose ; Humans ; Insulin ; Insulin Resistance

BACKGROUND: Adiponectin is an adipocytokine that is highly specific to adipose tissue. In contrast to other adipocytokine, the adiponectin levels are decreased in obesity and/or type 2 diabetes. There are few studies regarding the correlation between the adiponectin concentration and obesity in children. Thus, whether the serum adiponectin concentrations are associated with adiposity in children was investigated. METHODS: One hundred and sixty four subjects were selected from the participants in an ongoing study on the relationship between birth weight and insulin resistance in children. The current weights, heights, body fat percentages, waist circumferences, blood pressures, lipid profiles and insulin resistance, by the HOMA method, were measured in all the subjects. The serum adiponectin concentrations were determined by a validated sandwich ELISA, using a human adiponectin-specific antibody. RESULTS: The serum adiponectin concentration was negatively correlated with the body mass index, waist circumference, systolic blood pressure, insulin resistance by HOMA and serum triglycerides, and positively correlated with the serum HDL cholesterol level. The serum adiponectin concentrations in the boys were significantly lower than in the girls. In a multiple regression analysis, the serum adiponectin concentration was strongly associated with waist circumference and gender. CONCLUSION: It is concluded that there was an inverse relationship between the serum adiponectin concentration and abdominal adiposity in children. However, further studies on independent gender differences on adiponectin are needed.
Adiponectin* ; Adipose Tissue ; Adiposity ; Birth Weight ; Blood Pressure ; Body Height ; Body Mass Index ; Child* ; Cholesterol, HDL ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Insulin Resistance ; Obesity* ; Triglycerides ; Waist Circumference ; Weights and Measures

BACKGROUND: High sensitivity C-reactive protein (hsCRP) is more sensitive than standard CRP assay for evaluation of risk of coronary heart diseases and other atherosclerotic events. But, there were no data of association of serum hsCRP with risk factors of cardiovascular diseases and nonalcoholic fatty liver in Korean type 2 diabetic and nondiabetic subjects. METHODS : A hundred type 2 diabetic subjects (51 men and 49 women) from Severance Hospital and 200 nondiabetic subjects participating medical checkup in Health Promotion Center (105 men and 95 women) were recruited and subjects with acute illnesses and chronic inflammatory diseases such as upper respiratory infection, rheumatoid arthritis, osteoarthritis, or viral hepatitis were excluded. A standardized interview was conducted by trained personnel; detailed information was collected on medical history, dietary habits and lifestyle characteristics, including smoking, alcohol and physical activity. Body mass index (BMI) was computed and biochemical study were undergone using fasting blood. All subjects were done abdominal ultrasonography for evaluation of fatty liver. Serum hsCRP concentration was measured by Nephelometer AnalyzerII (Behring Co.) and a lower detection limit of test was 0.18 mg/L. RESULTS : There was no difference in sex, BMI, presence of fatty liver, concentration of total cholesterol, triglyceride, high density lipoprotein-cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and uric acid between diabetic and nondiabetic subjects. Age, total colesterol/HDL-C ratio, fasting blood glucose and incidence of hypertension were higher in diabetic than nondiabetic subjects, but a rate of smoking was higher in nondiabetic than diabetic subjects. The mean concentration of serum hsCRP was remarkably increased in type 2 diabetic subjects than nondiabetic subjects (1.34 +/- 1.87 vs 0.71 +/- 0.80 mg/L, p<0.05). After adjustment of different variables between both groups, there was significantly difference of the concentration of serum hsCRP (p<0.05). In nondiabetic subjects, by univariate analysis, there was a positive correlation between hsCRP and age (r=0.26, p<0.05), BMI (r=0.34, p<0.05), systolic blood pressure (r=0.21, p<0.05), diastolic blood pressure (r=0.16, p<0.05), triglyceride (r=0.27, p<0.05), total cholesterol/HDL-C ratio (r=0.22, p<0.05), uric acid (r=0.15, p<0.05) and a negative correlation between serum hsCRP and HDL-C (r=-0.16, p<0.05). Interestingly, subjects with fatty liver had shown increased serum hsCRP concentration than subjects without fatty liver (0.99 +/- 0.96 vs 0.58 +/- 0.69 mg/L, p<0.05). But there were no correlation of serum hsCRP with the history of smoking, sex, physical activity, fasting plasma glucose and presence of hypertension. After multiple regression analysis, only BMI and age were associated with serum hsCRP. In diabetic subjects, there were significant correlation of serum hsCRP with HDL-C and fasting plasma glucose, but other risk factors of cardiovascular diseases and fatty liver were not. When we compared serum hsCRP according to numbers of risk factors of cardiovascular diseases in nondiabetic subjects, group without risk factors had 0.41 +/- 0.55 mg/L, group with one risk factor had 0.48 +/- 0.40 mg/L, group with two risk factors had 0.75 +/- 0.88 mg/L, group with three risk factors had 1.08 +/- 0.87 mg/L and group with four risk factors had 1.55 +/- 1.21 mg/L. There was significant difference of serum hsCRP according to numbers of risk factors of cardiovascular diseases (p<0.05). CONCLUSION : Serum hsCRP is correlated with risk factors of cardiovascular diseases and may be useful tool for prediction of accelerated, atherosclerotic process in nondiabetic subjects. Although there is association of serum hsCRP with few risk factors of cardiovascular diseases, serum hsCRP is elevated in diabetic subjects. Therefore it is necessary to evaluate usefulness of serum hsCRP using carefully selected diabetic subjects. In addition, our study had shown that subjects with nonalcoholic fatty liver have increased risk of cardiovascular events.
Arthritis, Rheumatoid ; Blood Glucose ; Blood Pressure ; Body Mass Index ; C-Reactive Protein* ; Cardiovascular Diseases* ; Cholesterol ; Cholesterol, LDL ; Coronary Disease ; Fasting ; Fatty Liver ; Food Habits ; Health Promotion ; Hepatitis ; Humans ; Hypertension ; Incidence ; Life Style ; Limit of Detection ; Male ; Motor Activity ; Osteoarthritis ; Risk Factors* ; Smoke ; Smoking ; Triglycerides ; Ultrasonography ; Uric Acid

BACKGROUND: It is well known that non-alcoholic fatty liver disease is associated with metabolic syndrome such as obesity, type II diabetes mellitus, dyslipidemia. Non-alcoholic fatty liver disease is frequently found in non-obese adults, but the meaning of it is unknown. So we studied the association of non-alcoholic fatty liver disease in non-obese adults and metabolic abnormalities. METHODS: We examined 779 Korean adults above 30 years old (274 men, 505 women) participating in medical check-up in Health Promotion Center. Hepatitis B and C serologies were negative, and average weekly alcohol intake was or=25 kg/m2, n=348) group (65.5 vs 32.3%, p<0.05). Compared with obese group, waist circumference, waist hip ratio, body fat, impaired fasting serum glucose, total cholesterol, HDL-cholesterol, total cholesterol to HDL-cholesterol ratio, fasting insulin, proinsulin, HOMA-IR and HOMA-beta were significantly different in non-obese, non-alcoholic fatty liver group. After multiple regression analysis, waist circumference was associated with non-alcoholic fatty liver disease in non-obese individuals. Odd ratios of insulin resistance in non-obese, non-alcoholic fatty liver group were 5.8 (CI: 3.1~10.9). CONCLUSION: The frequency of non-alcoholic fatty liver disease was very high in non-obese adults and well associated with central obesity and insulin resistance.
Adipose Tissue ; Adult* ; Blood Glucose ; Body Mass Index ; Cholesterol ; Diabetes Mellitus ; Dyslipidemias ; Fasting ; Fatty Liver* ; Female ; Health Promotion ; Hepatitis B ; Humans ; Insulin ; Insulin Resistance ; Liver ; Male ; Obesity ; Obesity, Abdominal ; Physical Examination ; Proinsulin ; Ultrasonography ; Waist Circumference ; Waist-Hip Ratio

Since introduce of antithyroid drugs (ATDs) in 1941, they have been widely used for treatment of Graves' disease and other hyperthyroid disorders. However, agranulocytosis, the most serious adverse effect of ATD treatment, has been occasionally reported. Agranulocytosis should be diagnosed and be treated promptly due to possible fatality.We have experienced a 17 year-old girl with PTU (propylthiouracil)-induced agranulocytosis. Initial graulocyte count was 400/mm2, and presenting symtoms were fever and sore throat. She has recovered from agranulocytosis without complications after use of G-CSF (granulocyte-colony stimulating factor). We reviewed and analyzed additional 7 cases of ATD-induced agranulocytosis in Yonsei University Hospital (From 1988 to 1998). We found that ATD-induced agranulocytosis, of which incidence is known to be ranged from 0.1 to 1 per cent, does not seem to have a distinct correlation with sex, age, dosage, and the kind of ATD. Event of agranulocytosis has a tendency to occur within 3 months, and in a few case it has been occasionally detected in asymptomatic patients, routine monitoring of the white blood cell count within 3 months after the start of ATD medication can be helpful in predicting and in detecting agranulocytosis. The treatment of ATD-induced agranulocytosis has been mainly composed of conservative care, but according to introduction and popular application of G-CSF, the use of G-CSF seems to be a promise of a reduction in morbidity and mortality.
Adolescent ; Agranulocytosis* ; Antithyroid Agents ; Female ; Fever ; Granulocyte Colony-Stimulating Factor ; Graves Disease* ; Humans ; Incidence ; Leukocyte Count ; Mortality ; Pharyngitis

PURPOSE: The incidence of adenocarcinoma of the uterine cervix is low. Traditionally, Low Dose R ate (LDR) brachytherapy has been used as a standard modality in the treatment for patients with carcinoma of the uterine cervix. The PURPOSE of this report is to evaluate the effects of the High dose rate (HL)R) brachytherapy in the patients with adenocarcinoma of the uterine cervix compared with the LDR. MATERIALS AND METHODS: From January 1971 to December 1992, 106 patients of adenocarcinoma of uterine cervix were treated with radiation therapy in the Department of Radiation Oncology, Yonsei University with curative intent. LDR brachytherapy was carried out on 35 patients and 7 1 patients w -re treated with HDR brachytherapy. In LDR Group, 8 patients were in stage I, 18 in stage II and 9 in st;ge III. External radiation therapy was delivered with 10 MV X-ray, daily 2 Gy fractionation, total dose 40-46 Gy (median 43 Gy), And LDR Radium intracavitary irradiation was performed with Henschke applicator, 22-59 Gy to point A (median 43 Gy). In HDR Group, there were 16 patients in stage I, 38 in stag <, II and 17 in stage III. The total dose of external radiation was 40-61 Gy(median 45 Gy), daily 1.8-2.0 3y. HDR Co-60 intracavitary irradiation was performed with RALS (Remote Afterloading System), 30-57 Gy (median 39 Gy) to point A, 3 times a week, 3 Gy per fraction. RESULTS: The 5-year overall survival rate in LDR Group was 72.9%, 6 1.9%, 45.0% in stage I, II, III, respectively and corresponding figures for HDR were 87.1%, 58.3%, 41.2%, respectively (p>0.05). There was no statistical difference in terms of the 5-year overall survival rate between HDR Group and LDR Group in a denocarcinoma of the uterine cervix. There was 1 1% of late complication rates in LDR Group and 27% in HDR Group. There were no prognostic factors compared HDR with LDR group. The incidence of the late complication rate in HDR Group stage II, III was higher than that in LDR Group ( 16.7% vs. 31.6% in stage II, 11. 1% vs. 35.3% in stage III, p>0.05). Although the incidence of radiation induced late complication rate was higher in HDR Group stage II and III patients than that in the LDR Group, statistical significance was not detected and within acceptable level. CONCLUSION: There was no difference in terms of 5-year survival rate and failure pattern in the patients with adenocarcinoma of the uterine cervix treated with HDR and LDR brachytherapy. Even late complication rates were higher in the HDR group it was an acceptable range. This retrospective study suggests that HDR brachytherapy seems to replace the LDR brachytherapy in the adenocarcinoma of the uterine cervix. However, further studies will be required to refine the dose rate effects.
Adenocarcinoma* ; Brachytherapy ; Cervix Uteri* ; Female ; Humans ; Incidence ; Radiation Oncology ; Radium ; Retrospective Studies ; Survival Rate