Right internal jugular vein catheterization is performed frequently as central venous catheterization by the landmark method. This procedure, however, might prove difficulty due to anatomic variations or thrombosis of internal jugular vein. We failed to catheterize right internal jugular vein by the landmark method in 70-year-old female patient. And then, we detected right internal jugular vein thrombosis by ultrasound scan. Left internal jugular vein catheterization was performed by the ultrasound guided technique. Central venous catheterization has possibility to fail despite several attempts by the landmark method. Then, ultrasound guided approach is a good choice to aid central venous catheterization when difficulties or complications have been encountered.
Aged ; Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Female ; Humans ; Jugular Veins ; Thrombosis

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is associated with metabolic syndrome including insulin resistance, hypertension, dyslipidemia, central obesity, type 2 diabetes, and cardiovascular disease. In NAFLD, insulin resistance plays an important role in the progression of liver damage. In this study, we evaluated insulin resistance, plasma adiponectin, hepatic steatosis, and their association in adults with normal liver transaminase concentrations. METHODS: We analyzed 111 subjects, aged over 20 years old, who visited the Health Management Center at Chung-Ang University Hospital between May 2006 and August 2006. They had neither history nor clinical evidence of diabetes, cardiovascular or liver disease. They were divided into three groups by the degree of hepatic steatosis based on ultrasound findings. Anthropometric parameters were measured and blood samples were drawn after eight hours of fasting. RESULTS: Hepatic steatosis had a positive correlation with body mass index, waist circumference, blood pressure, triglycerides, HOMA-IR, and QUICKI. Moreover, it had a negative correlation with high-density lipoprotein cholesterol and adiponectin. Triglycerides, Adiponectin, and QUICKI were independent variables in predicting the degree of hepatic steatosis. CONCLUSION: This finding suggests that triglycerides and plasma adiponectin are independent predictors of hepatic steatosis in adults with normal liver transaminase concentrations.
Adiponectin ; Adult ; Aged ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases ; Cholesterol ; Dyslipidemias ; Fatty Liver ; Humans ; Hypertension ; Insulin Resistance ; Lipoproteins ; Liver ; Liver Diseases ; Obesity, Abdominal ; Plasma ; Triglycerides ; Waist Circumference

BACKGROUND: It is well known that non-alcoholic fatty liver disease is associated with type 2 diabetes mellitus, obesity, and dyslipidemia. Non-alcoholic fatty liver disease is frequently found in non-diabetic, normal weight adults, but the meaning of it is not fully investigated. We tested the hypothesis that there is association between non-alcoholic fatty liver disease with insulin resistance in non-diabetic, normal weight adults. METHODS: We examined 60 Korean adults above the age of 30 years, participating in medical check-up at the Chung-Ang University Hospital, from Sep 2003 to Jan 2004. Heapatitis B and C serologies were negative, and not the history of alcohol abuse. A standard interview, physical exam and biochemical study were conducted, and an experienced operator carried out ultrasound liver studies. We assessed the clinical characteristics of subjects and HOMA (Homeostasis Model Assessment), QUICKI (Quantitative Insulin Sensitivity Check Index) as an index of insulin resistance. RESULTS: We classified subjects into 2 groups: the controls (n=42), and those with non-alcoholic fatty liver disease (n=18). The frequency in the men was higher than that in the women (70 vs 30 %, p<0.05). Body mass index, waist circumference, hip circumference, waist/hip ratio, triglyceride, HDL-cholesterol, alanine transferase, and uric acid was significantly different between two groups (p<0.05). Insulin resistance (HOMA-IR) was significantly higher in subjects with non-alcoholic fatty liver disease (p<0.05). CONCLUSION: Non-alcoholic fatty liver disease is associated with insulin resistance in non- diabetic, normal weight adults.
Adult* ; Alanine ; Alcoholism ; Body Mass Index ; Diabetes Mellitus, Type 2 ; Dyslipidemias ; Fatty Liver* ; Female ; Hip ; Humans ; Insulin Resistance* ; Insulin* ; Liver ; Male ; Obesity ; Transferases ; Triglycerides ; Ultrasonography ; Uric Acid ; Waist Circumference

One of the histopathologic hallmarks of early diabetic retinopathy is the loss of pericytes. Evidences suggest that the pericyte loss in vivo is mediated by apoptosis. However, the underlying cause of pericyte apoptosis is not fully understood. This study investigated the influence of methylglyoxal (MGO), a reactive -dicarbonyl compound of glucose metabolism, on apoptotic cell death in bovine retinal pericytes. Analysis of internucleosomal DNA fragmentation by ELISA showed that MGO (200 to 800 micrometer) induced apoptosis in a concentration-dependent manner. Intracellular reactive oxygen species were generated earlier and the antioxidant, N-acetyl cysteine, inhibited the MGO-induced apoptosis. NF-kB activation and increased caspase- 3 activity were detected. Apoptosis was also inhibited by the caspase-3 inhibitor, Z-DEVD-fmk, or the NF- kB inhibitor, pyrrolidine dithiocarbamate. These data suggest that elevated MGO levels observed in diabetes may cause apoptosis in bovine retinal pericytes through an oxidative stress mechanism and suggests that the nuclear activation of NF-kB are involved in the apoptotic process.
Acetylcysteine/pharmacology ; Animals ; *Apoptosis ; Caspases/metabolism ; Cattle ; Cell Death ; Cell Survival ; DNA Fragmentation ; Dose-Response Relationship, Drug ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Glucose/metabolism ; NF-kappa B/metabolism ; Nucleosomes/metabolism ; Oxidative Stress ; Pericytes/*drug effects ; Pyruvaldehyde/*pharmacology ; *Reactive Oxygen Species ; Retina/cytology/*drug effects

BACKGROUND: The risk of developing diabetes is high in the offspring of patients with type 2 diabetes. There have been no studies to assess the offspring's awareness of the risk of developing diabetes. The aim of this study was to investigate how the male offspring of type 2 diabetic patients assess their likelihood of developing diabetes. METHODS: One hundred and one non-diabetic men with one or both parents having type 2 diabetes, aged 19-28 years, were recruited. RESULTS: Thirty-nine subjects (38.6%) were concerned about diabetes and 85 (84.2%) considered diabetes a serious problem. However, only 10 (9.9%) thought they might develop diabetes and 9 (8.9%) had previously attended diabetes education programs with their parents. The educational level amongst the diabetic parents was the only independent predictor of perception of the increased risk. Age, body mass index, waist-to-hip ratio, educational level and the perception of diabetes as a serious problem were not associated with perception of the increased risk. CONCLUSION: Most offspring of diabetic parents lacked knowledge about the increased risk amongst family members. We suggest that physicians and diabetic educators should provide knowledge about the increased risk of developing diabetes in offspring and the benefit of lifestyle modification to delay or prevent the development of the disease.
Adult ; Body Mass Index ; Diabetes Mellitus, Non-Insulin-Dependent/epidemiology/*genetics ; Educational Status ; Family ; Human ; *Knowledge, Attitudes, Practice ; Korea ; Logistic Models ; Male ; Military Personnel ; Questionnaires ; Risk Factors

Chronic cough is defined as a cough that lasts for more than three weeks. In most patients, chronic cough is caused by four conditions: postnasal drip, asthma, chronic bronchitis, gastroesophageal reflux. Psychogenic chronic cough is not a frequent disorder. Furthermore, chronic vocal tic disorder is a very rare cause of chronic dry cough. A 22- year-old male suffered from chronic dry cough for last two years. His character showed obsessive- compulsive disorder. He has been shrugging both shoulders inadvertently since his childhood. Consequently, he was diagnosed as having chronic motor tic disorder. But after contracting respiratory tract infection, his motor tic disappeared and chronic dry cough was developed concomitantly. He had no history of smoking, chronic rhinitis, sinusitis, asthma, and gastroesophageal reflux. Physical examinations were normal. Chest X-ray, paranasal sinus view, metacholine bronchial provocation test, and esophago-gastroscopy were normal. Chronic cough was never relieved despite empirical treatment. Psychiatric consultation suggested chronic vocal tic disorder. The frequency of cough was diminished two days after administeration of valium and haloperidol and thereafter his complaint disappeared in one month. Here we report a very rare case of chronic motor tic disorder which was transformed into chronic vocal tic disorder presenting as a chronic cough. As far as we know, this is the first case of its kind in Korea.
Asthma ; Bronchial Provocation Tests ; Bronchitis, Chronic ; Cough ; Diazepam ; Gastroesophageal Reflux ; Haloperidol ; Humans ; Korea ; Male ; Physical Examination ; Prader-Willi Syndrome ; Respiratory Tract Infections ; Rhinitis ; Shoulder ; Sinusitis ; Smoke ; Smoking ; Thorax ; Tic Disorders ; Tics

Tuberculosis infection of skeletal muscle is rare even in countries in which tuberculosis is a relatively common disease. Because tuberculosis of muscle is almost always secondary to underlying tuberculosis of the bone or adjacent joint, hematogenous tuberculosis of skeletal muscle is extremely rare. Therefore, We report a case of hematogenous tuberculosis of skeletal muscle with the review of literatures. A 79-year-old man presented with a history of left shoulder pain, edema, fever and chill. MRI showed inflammatory changes of infraspinatus and deltoid muscle. The histopathology of skeletal muscle showed granulomas surrounded by epithelioid cells and Langhans' giant cells. Mycobacterium tuberculosis was grown from the specimens of sputum, pleural fluid and muscle tissue. The patient improved on anti-tuberculosis treatment.
Aged ; Deltoid Muscle ; Edema ; Epithelioid Cells ; Fever ; Giant Cells ; Granuloma ; Humans ; Joints ; Magnetic Resonance Imaging ; Muscle, Skeletal* ; Mycobacterium tuberculosis ; Shoulder Pain ; Sputum ; Tuberculosis*

Thyrotropin(TSH)-secreting pituitary adenoma is a rare disorder causing hyperthyroidism, which is one of the syndrome of inappropriate secretion of TSH. It is characterized by high serum T4, T3 as well as elevated serum TSH. Generally serum free alpha-subunit concentration is also increased and alpha- subunit/TSH molar ratio is more than 1. This alpha- subunit/TSH molar ratio is a clue of diagnosis as well as a useful marker of therapeutic response. We experienced a case of 29-years old man with hyperthyroidism due to TSH-secreting pituitary adenoma. He was underwent 1.5cm sized pituitary tumor removal via transsphenoidal approach in our neurosurgery department. In immunohistochemical stain monotonous tumor cells showed strong positive reaction to antihuman TSH antibody and equivocal reaction to ACTH antibody. After operation, goiter size was progressively decreased and also serum T4, T3 and TSH were decreased in nearly normal range. However, he showed elevated serum T4, T3 and TSH after 1 month due to residual tumor. So he received radiation therapy thereafter. In this case the alpha-subunit and alpha-subunit/TSH molar ratio were not increased. So we report a case of TSH-secreting pituitary macroadenoma which had low alpha-subunit/TSH molar ratio with a literature review.
Adrenocorticotropic Hormone ; Adult ; Diagnosis ; Goiter ; Humans ; Hyperthyroidism ; Molar* ; Neoplasm, Residual ; Neurosurgery ; Pituitary Neoplasms* ; Reference Values ; Thyrotropin*

To evaluate the clinical utility of Tc-99m MIBI scan in the detection of residual thyroid tissue or metastatic lesion in postoperative thyroid cancer patients, we compared Tc-99m MIBI scan with I-131 diagnostic and therapeutic scan in 30 postoperative well-differentiated thyroid cancer patients. Thyroglobulin levels of both on and off thyroid hormone medication and antithyroglobulin antibody were tested [Tg(on), Tg(off)l Positive rates for I-131 diagnostic and Tc-99m MIBI scan were 81% and 68% respectively. Concordance between I-131 diagnostic and Tc-99m MIBI scan was observed in 15 cases; 12 positive and 3 negative respectively Among the 6 cases with negative I-131 diagnostic scan and positive Tc-99m MIBI scan, 4 were positive in the therapeutic I-131 scan. We concluded that Tc-99m MIBI scan maybe a useful complementary modality to the currently established method of I131 scan and serum thyroglobulin level in the detection of recurrent or metastatic thyroid cancer, especially in the case of negative I-131 diagnostic scan.
Follow-Up Studies* ; Humans ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms*

To evaluate the utility of I-131, T1-201 scintigraphy, and serum thyroglobulin(Tg) in the follow-up of differentiated thyroid cancer, we compared retrospectively the data from 33 patients who underwent total or subtotal thyroidectomy. I-131 scintigraphy was performed after optimal endogenous TSH stimulation (TSH>50microgram/ml). Total 41 cases of I-l3l and T1-201 scintigraphy pairs were examined. Concomitant serum thyroglobulin levels were measured for 41 pairs of scan. Tg-off levels(that measured after discontinuation of the thyroid hormone) higher than 40ng/ml were considered positive, and Tg-on levels(that measured during the thyroid hormone replacement) higher than 5ng/ml were considered positive. The concordance rates between I-131 therapeutic scintigraphy and T1-201 scintigraphy was 48% in the 38 case of total scan pairs(59% in the 17 cases of postoperative preablation group, and 38% in the 21 cases of postoperative postablation group), Of 17 studies before the I-131 ablation therapy (preablation group), 7 showed positive I-131 therapeutic scintigraphy despite of negative T1-201 scintigraphy. Among patients with negative I-131 therapeutic scintigraphy, no patients had abnormal T1-201 uptake. However, of 21 studies which were done after radioiodine therapy(postablation group) 6 had abnormal uptake on T1-201 scintigraphy which were not seen on I-131 therapeutic scintigraphy, and Tg-off levels also elevated in this 4 of 6 cases. As a result, I-131 therapeutic scintigraphy showed highest positive rate at postoperative preablation follow-up study in differentiated thyroid cancer patients. T1-201 scintigraphy may be useful in postablation studies, and the use of the combined modalities(T1-201 and Tg levels) provides a higher diagnostic yield.
Follow-Up Studies* ; Humans ; Radionuclide Imaging* ; Retrospective Studies ; Thyroglobulin* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy