The Korean Society for the Study of Obesity (KSSO) has defined the waist circumference cutoff value of central obesity as 90 cm for men and 85 cm for women. The purpose of this investigation was to determine the corresponding waist circumference values. A total of 3,508 persons in the Korean Rural Genomic Cohort Study were enrolled in this survey. Receiver operating characteristic (ROC) curve analysis was used to find appropriate waist circumference cutoff values in relation to insulin resistance determined by homeostasis model assessment for insulin resistance (HOMA-IR), body mass index (BMI), and components of metabolic syndrome. The optimal waist circumference cutoff values were 87 cm for men and 83 cm for women by ROC analysis to HOMA-IR and 86 cm for men and 83 cm for women by ROC analysis to value with more than two components of metaobolic syndrome. By using a BMI > or =25 kg/m2, 86 cm for men and 82 cm for women were optimal waist circumference cutoff values. In this study, we suggest that the most reasonable waist circumference cutoff values are 86-87 cm for men and 82-83 cm for women.
Cohort Studies ; Diagnosis, Computer-Assisted/*methods ; Female ; *Health Status Indicators ; Humans ; Korea/epidemiology ; Male ; Metabolic Syndrome X/*diagnosis/*epidemiology ; Middle Aged ; Physical Examination/methods/statistics & numerical data ; Prevalence ; Reproducibility of Results ; Risk Assessment/methods ; Risk Factors ; Rural Population/*statistics & numerical data ; Sensitivity and Specificity ; *Waist Circumference

PURPOSE: The short insulin tolerance test is a simple and reliable method of estimating insulin sensitivity. This study was designed to compare the insulin sensitizing effects of thiazolidinediones (TZDs) on the degree of insulin resistance, determined by a short insulin tolerance test (Kitt) in type 2 diabetic patients. PATIENTS AND METHODS: Eighty-three subjects (mean age = 57.87 +/- 10.78) with type 2 diabetes mellitus were enrolled and received daily one dose of rosiglitazone (4mg) or pioglitazone (15mg). The mean follow-up duration was 25.39 +/- 9.66 months. We assessed insulin sensitivity using HOMA-IR and the short insulin tolerance test before and after TZDs treatment. RESULTS: When we compared patients' characteristics before and after TZDs treatment, the mean fasting glucose level was significantly decreased (183.27 +/- 55.04 to 137.35 +/- 36.42mg/dL, p < 0.001) and the mean HbA1C level was significantly decreased (9.24 +/- 1.96 to 8.11 +/- 1.39%, p < 0.001). Also, Kitt values were significantly increased (2.03 +/- 1.14 to 2.67 +/- 0.97%/min, p = 0.003), whereas HOMA-IR was significantly decreased (2.98 +/- 0.68 to 1.04 +/- 0.24, p < 0.05). When classifying insulin resistance by Kitt values, insulin resistant subjects' values were increased (< 2.5%/min; 1.51 +/- 0.53%/min to 2.63 +/- 0.88, p < 0.001), whereas the values decreased in insulin sensitive subjects (> or = 2.5%/min; 3.50 +/- 0.75%/min to 2.75 +/- 1.12%/min, p = 0.002). CONCLUSION: The glucose lowering effects of TZDs by improving insulin resistance could be determined by using Kitt. However, Kitt may be a beneficial tool to determine TZDs' effects only when patients' Kitt values are less than 2.5%/min.
Aged ; Blood Glucose/metabolism ; Diabetes Mellitus, Type 2/blood/*diagnosis/*drug therapy ; Drug Tolerance ; Female ; Humans ; Hypoglycemic Agents/therapeutic use ; Insulin/diagnostic use ; *Insulin Resistance ; Male ; Middle Aged ; Thiazolidinediones/*therapeutic use

BACKGROUND: Postmenopausal status is associated with a 60% increased risk for metabolic syndrome. It is thought to be associated with decreased estrogens and increased abdominal obesity in postmenopausal women with metabolic syndrome. The purpose of this study was to investigate the association between metabolic syndrome components and menopausal status. METHODS: A total of 1,926 women were studied and divided into three groups according to their menstrual stage (premenopausal, perimenopausal or postmenopausal). The presence of metabolic syndrome was assessed using the National Cholesterol Education Program's (NCEP) Adult Treatment Panel III criteria. RESULTS: The prevalence of metabolic syndrome was 7.1% in premenopause, 9.8% in perimenopause, and 24.2% in postmenopause. The strong correlation was noted between the metabolic syndrome score and waist circumference in postmenopause (r = 0.56, P < 0.01) and perimenopause (r = 0.60, P < 0.01). Along the menopausal transition, the risk of metabolic syndrome increased with high triglyceride after the age-adjusted (odds ratio (OR) 1.517 [95% confidence interval (CI) 1.014~2.269] in perimenopausal women and OR 1.573 [95% CI 1.025~2.414] in postmenopausal women). In addition, the prevalence of metabolic syndromeincreased in accordance with elevated alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase (GGT) levels. CONCLUSION: Triglyceride and waist circumference were important metabolic syndrome components, though ALT and GGT may also be related for predicting metabolic syndrome during the transition to menopause.
Adult ; Alanine Transaminase ; Cholesterol ; Estrogens ; Female ; gamma-Glutamyltransferase ; Humans ; Menopause ; Obesity, Abdominal ; Perimenopause ; Postmenopause ; Premenopause ; Prevalence ; Waist Circumference

Sarcoidosis is a multisystemic granulomatous disease with an of unknown etiology, involving bilateral hilar lymphadenopathy, pulmonary, skin and eye lesions. However, involvement of the endocrine system in sarcoidosis is quite rare, and the coexistence of both diseases is extremely unusual. We describe a 60-year-old woman presenting with sarcoidosis and Graves' disease. She was admitted for evaluation of dry cough, dyspnea, palpitation and general weakness. Both thyroid glands were enlarged diffusely. The thyroid function tests showed suppressed serum thyrotropin and an increased thyroid hormone level. The levels of the TSH receptor antibody, anti-thyroglobulin antibody and anti-microsomal antibody were higher than normal. The radionuclide scan(131I) showed increased iodine uptake. The chest X-ray revealed pulmonary hilar enlargement and high resolution CT showed both hilar lymph nodes enlargement and tiny parenchymal nodules. The transbronchial lung biopsy showed a noncaseating granuloma without necrosis. We report this case of pulmonary sarcoidosis plus Graves' disease with a review of the relevant literatures.
Biopsy ; Cough ; Dyspnea ; Endocrine System ; Female ; Granuloma ; Graves Disease* ; Humans ; Hyperthyroidism ; Iodine ; Lung ; Lymph Nodes ; Lymphatic Diseases ; Middle Aged ; Necrosis ; Receptors, Thyrotropin ; Sarcoidosis ; Sarcoidosis, Pulmonary* ; Skin ; Thorax ; Thyroid Function Tests ; Thyroid Gland ; Thyrotropin

BACKGROUND: Although the most common pathogen of liver abscess was Escherichia coli in the past, there has been an increasing number of reports on liver abscess caused by Klebsiella pneumoniae, especially in Asia and its more frequent occurrence in diabetes mellitus. Our study was to clarify the different clinical characteristics and prognostic factors of K. pneumoniae and non-K. pneumoniae liver abscess in patients with or without diabetes. MATERIALS AND METHODS: We reviewed medical records of pyogenic liver abscess diagnosed by defined criteria at 7 different tertiary care hospitals in Seoul and Gyeonggi Province from January 2000 to December 2003 retrospectively. RESULTS: Of the 248 cases, 86 cases (34.7%) of patients were diabetic. Cryptogenic cause (73.4%) was the most frequent portal of entry in liver abscess and 58 cases (23.4%) were the secondary following biliary disease. There were no differences in portal of entry between DM group and non- DM group. The most common organism was K. pneumoniae (70.2%) followed by E. coli (11.5%) and alpha-hemolytic streptococcus (5.2%). There were no significant differences in causative organism of liver abscess between DM group and non-DM group as K. pneumoniae was dominant pathogen [76.6% in DM group vs 66.2% in non-DM group (P=0.11)]. The metastatic complication occurred in 15 cases (8.6%) and found more frequently in DM group (P=0.042). All of the metastatic abscesses were found in liver abscess caused by K. pneumoniae (P=0.007). Ten patients died and the overall mortality rate was 4.1%. The factors associated with mortality were level of serum creatinine, past history of intra-abdominal surgery and underlying biliary malignancy. CONCLUSION: The most commom pathogen of the pyogenic liver abscess is K. pneumoniae and the metastatic complications are usually found in liver abscess caused by K. pneumoniae, especially more frequently in patients with diabetes than in patients without diabetes.
Abscess ; Asia ; Creatinine ; Diabetes Mellitus* ; Escherichia coli ; Gyeonggi-do ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess ; Liver Abscess, Pyogenic* ; Medical Records ; Mortality ; Pneumonia* ; Prognosis* ; Retrospective Studies ; Seoul ; Streptococcus ; Tertiary Healthcare

BACKGROUND: Although the most common pathogen of liver abscess was Escherichia coli in the past, there has been an increasing number of reports on liver abscess caused by Klebsiella pneumoniae, especially in Asia and its more frequent occurrence in diabetes mellitus. Our study was to clarify the different clinical characteristics and prognostic factors of K. pneumoniae and non-K. pneumoniae liver abscess in patients with or without diabetes. MATERIALS AND METHODS: We reviewed medical records of pyogenic liver abscess diagnosed by defined criteria at 7 different tertiary care hospitals in Seoul and Gyeonggi Province from January 2000 to December 2003 retrospectively. RESULTS: Of the 248 cases, 86 cases (34.7%) of patients were diabetic. Cryptogenic cause (73.4%) was the most frequent portal of entry in liver abscess and 58 cases (23.4%) were the secondary following biliary disease. There were no differences in portal of entry between DM group and non- DM group. The most common organism was K. pneumoniae (70.2%) followed by E. coli (11.5%) and alpha-hemolytic streptococcus (5.2%). There were no significant differences in causative organism of liver abscess between DM group and non-DM group as K. pneumoniae was dominant pathogen [76.6% in DM group vs 66.2% in non-DM group (P=0.11)]. The metastatic complication occurred in 15 cases (8.6%) and found more frequently in DM group (P=0.042). All of the metastatic abscesses were found in liver abscess caused by K. pneumoniae (P=0.007). Ten patients died and the overall mortality rate was 4.1%. The factors associated with mortality were level of serum creatinine, past history of intra-abdominal surgery and underlying biliary malignancy. CONCLUSION: The most commom pathogen of the pyogenic liver abscess is K. pneumoniae and the metastatic complications are usually found in liver abscess caused by K. pneumoniae, especially more frequently in patients with diabetes than in patients without diabetes.
Abscess ; Asia ; Creatinine ; Diabetes Mellitus* ; Escherichia coli ; Gyeonggi-do ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Liver Abscess ; Liver Abscess, Pyogenic* ; Medical Records ; Mortality ; Pneumonia* ; Prognosis* ; Retrospective Studies ; Seoul ; Streptococcus ; Tertiary Healthcare

BACKGROUND: A pulmonary embolism often presents with nonspecific symptoms and signs. However, a delayed diagnosis can result in catastrophic outcome. The majority of preventable deaths associated with a pulmonary embolism can be ascribed to a missed diagnosis rather than to the failure of existing treatments. Therefore, accurate and rapid diagnostic methods are essential for the management of a pulmonary embolism. The recent generation of multidetector-row spiral CT scanners appears to outperform other imaging modalities in detecting a central and peripheral pulmonary embolism. However, there are some variations in the interpretations of the findings between observers. This study examined the inter-observer differences of the diagnoses in patients with a pulmonary embolism. METHOD: 64 patients who were diagnosed with a pulmonary embolism either clinically or with spiral chest CT from 2002 to 2004, were included. Two thoracic radiologists interpreted the multidetector-row spiral CT in terms of the diagnosis of a pulmonary embolism and the location of the thrombus independently. Among 64 patients, 14 patients were excluded because there was no evidence of a pulmonary embolism or there was different interpretation of the pulmonary embolism between radiologists. A clinical diagnosis was based on "Rules for predicting the probability of embolism". RESULTS: The mean score of the patients according to the Wells method was 3.91 +/- 0.30 (0-9). The accordance of the radiologists was 95% in the main, 85% in the lobar, 91.2% in the segmental, and 96% in the sub-segmental pulmonary arteries. After excluding the negative interpretation from both radiologists, their agreement was 76.2%(kappa: 0.83) in the main, 57.6%(kappa: 0.63) in the lobar, 51.5%(kappa: 0.63) in the segmental, and 34.6%(kappa: 0.49) in the sub-segmental pulmonary arteries. CONCLUSION: Chest CT has been recently applied to patients suspected of having a pulmonary embolism. It was found that spiral CT is a rapid test for diagnosing a thrombus, and there was reliable accordance between the observers from the area of the large pulmonary arteries. However, there was a lack of agreement between the observers in diagnosing thrombi located distal to the sub-segmental arteries.
Arteries ; Delayed Diagnosis ; Diagnosis ; Humans ; Pulmonary Artery ; Pulmonary Embolism* ; Thorax* ; Thrombosis ; Tomography, Spiral Computed ; Tomography, X-Ray Computed

BACKGROUND: This study was desined to determine the efficacy and clincial usefulness of alfentanil and a combined use of alfentanil and esmolol for blunting hemodynamic responses after tracheal intubation in hypertensive patients who needed a rapid sequence induction. METHODS: Group 1 received alfentanil 15microgram/kg and group 2 received alfentanil 15microgram/kg and esmolol 1 mg/kg intravenously. Thiopental sodium 5 mg/kg and succinylcholine 1 mg/kg were used for the induction of anesthesia. Changes in blood pressure and herat rate were measured during intubation and induction of anesthesia with enflurane-N2O-O2 and vecuronium. Rate pressure products (RPP) was calculated and the frequencies of hypertension, hypotension, tachycardia, bradycardia were measured. RESULTS: In group 1, systolic blood pressure increased significantly at 1, 2 minute and decreased significantly at 4, 5, 10, 15 minute compared to base, and diastolic blood pressure increased significantly at 1 minute and decreased significantly at 4, 5, 10 minute. Heart rate increased significantly at 1, 2 minute. In group 2, systolic blood pressure decrease significantly at 3, 4, 5 minute after tracheal intubation compared to base, and diastolic blood pressure increased at 1 minute and decreased at 4, 5, 10, 15 minute. HR did not change significantly (P < 0.05). CONCLUSION: In treated hypertensive patients, the use of a combination of alfentanil 15/kg and esmolol 1 mg/kg is a useful method to attenuate hemodynamic responses after endotracheal intubation and especially for rapid sequence induction.
Alfentanil* ; Anesthesia ; Blood Pressure ; Bradycardia ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Hypotension ; Intubation ; Intubation, Intratracheal* ; Succinylcholine ; Tachycardia ; Thiopental ; Vecuronium Bromide

Prader-Willi syndrome (PWS) is a complex, multisystem disorder comprising congenital hypotonia, feeding difficulties, hypogonadism and hypogenitalism, short stature, small hands and feet, mental and psychomotor retardation, distinctive facial appearance, onset of obesity in early childhood and a tendency to develop glucose intolerance in adolescence. Yet the syndrome remains difficult to diagnose due to the subtle nature of many of the manifestations. We report an 19-year old man with PWS, confirmed by fluorescence in situ hybridization (FISH) with DNA probes specific for the PWS region on chromosome 15.
Adolescent ; Chromosomes, Human, Pair 15 ; Cryptorchidism* ; DNA Probes ; Fluorescence ; Foot ; Glucose Intolerance ; Hand ; Humans ; Hypogonadism ; In Situ Hybridization ; Male ; Muscle Hypotonia ; Obesity ; Prader-Willi Syndrome* ; Young Adult

Purpose: Repairing damaged DNA has been shown to be involved in an increased susceptibility to cancer development and prevention. Therefore, the genetic polymorphisms of the hOGG1 gene associated with the gene repair mechanism were investigated. In this study, the possible association of genetic polymorphisms in hOGG1 with bladder tumor risk was examined. MATERIALS AND METHODS: The hospital based, case-control investigation was carried out in 168 primary bladder tumor patients and 672 controls. The DNA extracted from the blood and tissue samples was analyzed by SSCP, PCR-based restriction fragment length polymorphism (RFLP) and direct DNA sequencing in order to characterize the genetic polymorphism of hOGG1. RESULTS: Two polymorphic sites in hOGG1 were found. A polymorphism at codon 326 (1a type) in exon 7 was associated with an amino acid exchange. Another polymorphic site at codon 324 (1b type) in exon 6 was silent. The association between the polymorphism at codon 326 and the risk of the bladder tumor was examined by age-sex adjusted analysis. The distribution of the hOGG1 codon 326 genotypes in the controls (Ser/Ser, 18.9%; Ser/Cys, 54.0%; Cys/Cys, 27.1%) was significantly different from that in the bladder tumor patients (26.2%, 51.8% and 22.0%, respectively) (p=0.034, adjusted OR=0.652, 95% CI=0.44-0.97). In particular, bladder tumor risk in Korean males under 40 years old was approximately 6 times higher than in males over 40 years old (p=0.015, adjusted OR=0.165, 95% CI=0.04-0.75). Furthermore, frequent mutations of codon 326 in the hOGG1 gene in tumor tissues (23.6%) might occur during tumorigenesis. CONCLUSIONS: The data suggests that polymorphism at codon 326 of hOGG1 gene might affect tumorigenesis of a bladder tumor.
Adult ; Carcinogenesis ; Case-Control Studies ; Codon ; DNA ; Exons ; Genotype ; Humans* ; Male ; Polymorphism, Genetic ; Polymorphism, Restriction Fragment Length ; Polymorphism, Single-Stranded Conformational ; Sequence Analysis, DNA ; Urinary Bladder Neoplasms* ; Urinary Bladder*