Fetal Abdominal Obesity Detected At 24 to 28 Weeks of Gestation Persists Until Delivery Despite Management of Gestational Diabetes Mellitus

Background@#Fetal abdominal obesity (FAO) has been reported to be affected at gestational diabetes mellitus (GDM) diagnosis at 24 to 28 weeks of gestation in older and/or obese women. This study investigated whether the management of GDM improves FAO in GDM subjects near term. @*Methods@#Medical records of 7,099 singleton pregnant women delivering at CHA Gangnam Medical Center were reviewed retrospectively. GDM was diagnosed by 100-g oral glucose tolerance test after 50-g glucose challenge test based on Carpenter–Coustan criteria. GDM subjects were divided into four study groups according to maternal age and obesity. FAO was defined as ≥90th percentile of fetal abdominal overgrowth ratios (FAORs) of the ultrasonographically estimated gestational age (GA) of abdominal circumference per actual GA by the last menstruation period, biparietal diameter, or femur length, respectively. @*Results@#As compared with normal glucose tolerance (NGT) subjects near term, FAORs and odds ratio for FAO were significantly higher in old and/or obese women with GDM but not in young and nonobese women with GDM. For fetuses of GDM subjects with FAO at the time of GDM diagnosis, the odds ratio for exhibiting FAO near term and being large for GA at birth were 7.87 (95% confidence interval [CI], 4.38 to 14.15) and 10.96 (95% CI, 5.58 to 20.53) compared with fetuses of NGT subjects without FAO at GDM diagnosis. @*Conclusion@#Despite treatment, FAO detected at the time of GDM diagnosis persisted until delivery. Early diagnosis and treatment might be necessary to prevent near term FAO in high-risk older and/or obese women.

Fetal Abdominal Obesity Detected At 24 to 28 Weeks of Gestation Persists Until Delivery Despite Management of Gestational Diabetes Mellitus

Background@#Fetal abdominal obesity (FAO) has been reported to be affected at gestational diabetes mellitus (GDM) diagnosis at 24 to 28 weeks of gestation in older and/or obese women. This study investigated whether the management of GDM improves FAO in GDM subjects near term. @*Methods@#Medical records of 7,099 singleton pregnant women delivering at CHA Gangnam Medical Center were reviewed retrospectively. GDM was diagnosed by 100-g oral glucose tolerance test after 50-g glucose challenge test based on Carpenter–Coustan criteria. GDM subjects were divided into four study groups according to maternal age and obesity. FAO was defined as ≥90th percentile of fetal abdominal overgrowth ratios (FAORs) of the ultrasonographically estimated gestational age (GA) of abdominal circumference per actual GA by the last menstruation period, biparietal diameter, or femur length, respectively. @*Results@#As compared with normal glucose tolerance (NGT) subjects near term, FAORs and odds ratio for FAO were significantly higher in old and/or obese women with GDM but not in young and nonobese women with GDM. For fetuses of GDM subjects with FAO at the time of GDM diagnosis, the odds ratio for exhibiting FAO near term and being large for GA at birth were 7.87 (95% confidence interval [CI], 4.38 to 14.15) and 10.96 (95% CI, 5.58 to 20.53) compared with fetuses of NGT subjects without FAO at GDM diagnosis. @*Conclusion@#Despite treatment, FAO detected at the time of GDM diagnosis persisted until delivery. Early diagnosis and treatment might be necessary to prevent near term FAO in high-risk older and/or obese women.

Low Serum Testosterone Concentrations in Hospitalized Men with Poorly Controlled Type 2 Diabetes

Our aim was to examine whether serum testosterone concentrations are in fact low in hospitalized men with poorly controlled type 2 diabetes compared with healthy men. In this study, 79 men aged 40 years or older (41 healthy men and 38 men with type 2 diabetes) were included. Total testosterone and sex hormone-binding globulin levels were measured. The average duration of diagnosed diabetes was 10.8 years and the mean glycated hemoglobin value was 10.8%. Total testosterone concentrations were lower in men with type 2 diabetes than in healthy men, after adjusting for age and body mass index (3.83+/-0.32 ng/mL vs. 5.63+/-0.31 ng/mL, P<0.001). In conclusion, this study shows that serum testosterone concentrations are lower in hospitalized men with poorly controlled type 2 diabetes than in healthy men. Therefore, men with poorly controlled type 2 diabetes should undergo further assessment for hypogonadism.

The Clinical Characteristics of the Newly Diagnosed Early Onset (< 40 Years Old) Diabetes in Outpatients' Clinic / 당뇨병

BACKGROUND: The prevalence of type 2 diabetes in young adults and adolescents has increased in the last decade according to the increasing obese population. The aim of this study was to examine the clinical characteristics of patients diagnosed with diabetes mellitus before the age of 40 years as compared with patients diagnosed at older ages. METHODS: This was a cross-sectional, retrospective study using data from 350 diabetic patients who were diagnosed with diabetes in an outpatient setting between January 2005 and December 2007. Patients were diagnosed according to the criteria set forth by the American Diabetes Association. We examined the clinical characteristics and laboratory data of the patients through review of medical records and compared the early-onset diabetic patients ( or = 40 years old). RESULTS: The frequency of early-onset diabetes and usual-onset diabetes were 31.1% (n=109) and 68.9% (n=241), respectively. The early-onset diabetic patients more often had a positive family history of diabetes; higher HbA1c, fasting glucose, and postprandial glucose levels; experienced typical symptoms more frequently; had microalbuminuria more frequently; and required insulin therapy as initial treatment more frequently as compared to usual-onset diabetic patients, and these differences were significant. Conversely, hypertension was significantly more common in the usual-onset diabetic patients. CONCLUSION: It could be concluded that we should control early onset diabetes more strictly to prevent its complication because early onset diabetic patients represented more severe hyperglycemia and had more prevalent microalbuminuria.

Effects of Diabetes Education on Diabetic Management in Non-Insulin-Dependent Diabetics Mellitus Patients

The purpose of this study was to examine the effect of diabetes education on diabetic management by determining the changes of the knowledge and practice for diet therapy and blood glucose level pre-training and post-training. Statistical data analyses were completed using the SPSS 11.0 program. The results can be summarized as follows : The average age of the subjects was 52.8 years old, the period of suffering from diabetes was 7.9 years and 31% of the patients had a history of diabetes in their family members. In life style for self-management, they showed lower levels in drinking post-training, and significantly higher exercise levels post-training (P<0.05). Regarding the level of knowledge for diet, they showed significantly higher levels post-training in eight items such as importance of diet therapy for diabetes (p<0.005), principle of diet therapy (p<0.005), nutrient composition of foods (p<0.005), carbohydrate composition of foods (p<0.005), calorie prescribed to themselves (p<0.001), exchange units prescribed to themselves (p<0.005), exchange food items and exchanges units of cereal & grains (p<0.005) and exchange food items and exchanges units of fruit & juices (p<0.005). Regarding the practices of diet, they showed significantly higher levels of practice in keeping permitted meal size (p<0.005), using food exchange list (p<0.005), keeping exact meal times (p<0.001) and restricting most foods to eat (P<0.01) post-training. When measuring their bodies, average weight was lower post-training. Obesity was significantly lower post-training (p<0.01), and blood pressure both in systolic and diastolic was lower. Postcardinal-2hour blood glucose level decreased significantly from 268.4+/-98.9 pre-training to 180.9+/-48.4 post-training (p<0.001).

A Case of Transient Granulocytopenia during Treatment of a Patient with Graves' Disease and Type 1 Diabetes Mellitus - Differential Diagnosis from Agranulocytosis by a Single Injection of G-CSF / 대한내분비학회지

Granulocytopenia, which can be seen in patients with Graves' disease during treatment with antithyroid agents, could be a self resolving transient episode or can imply the beginning of life threatening agranulocytosis requiring a change in treatment modality. Transient granulocytopenia could be a manifestation of hyperthyroidism itself, or a mild side effect of antithyroid drugs. Aganulocytosis is a rare, but major complications of the termination drug, propylthiouracil (PTU), requiring prompt termination of the medication, and intensive care. Therefore, differentiation of agranulocytosis and transient granulocytopenia, is important, but is not practically easy. We introduce a case of transient granulocytopenia, which was detected in a patient with Graves'Disease, accompanied by underlying type 1 diabetes mellitus, during treatment with PTU. Diagnosis of transient granulocytopenia was made by a normal granulocyte count following a single injection of G-SCF, and the patient was treated with conservative therapy. This case confirms a diagnostic tool for differentiating transient granulocytopenia and PTU-induced agranulocytosis.

Two Cases with Adrenal Myelolipoma Treated by Surgical Resection / 대한내분비학회지

An increasing number of incidental adrenal masses are found during the evaluation for unrelated problems, which is the result of the development of sensitive noninvasive methods for the imaging of abdominal lesions, such as ultrasonography, computed tomographic scanning, and MRI. When there is no evidence of adrenocortical or medullary dysfunction for such adrenal masses, they are commonly referred to as "incidentalomas". Among these incidentalomas, adrenal myelolipoma is a rare, benign, endocrinologically inactive tumor, the histological structure of which consists of mature adipose tissue cells and normal hemopoietic tissues resembling bone marrow. Even though most eventually prove to be nonhyperfunctioning adrenocortical adenomas, we must not exclude a more serious pathology. Because of the rarity of adrenal myelolipoma, its natural history, proper prognostic considerations and treatment recommendations still need to be investigated. We experienced 46 year-old man with abdominal discomfort, and a 26 year-old man with no specific symptoms, have large incidentalomas (>5 cm) in adrenal sites, detected by abdominal sonography for routine health work-up. The ACTH, cortisol, renin, aldosterenone, metanephrine, VMA and tumor marker levels were normal, which was suggestive of nonfunctional adrenal tumors. Surgical treatments were performed for rule out malignant adrenal tumors due to the tumor size (>5 cm) and hemorrhage within the tumors. The surgical pathology was that of adrenal myelolipomas. An adrenal myelolipoma is a rare, benign, nonfunctional adrenal tumor, but only three cases have been reported in Korea. We report two cases of adrenal myelolipoma found incidentally by surgical treatment for a large tumor size (>5 cm).

Usefulness of Resistive Index and Pulsatility Index in Patient with Diabetic Nephropathy as Early Markers / 대한신장학회잡지

BACKGROUND: Diabetic nephropathy has long been known as most common culprit of ESRD. In NIDDM, histopathologically intrarenal hemodynamic changes are nonspecific, frequently with global glomerulosclerosis, interstitial fibrosis, tubular atrophy and severe arterosclerosis. Duplex renal Doppler sonography is useful in the noninvasive assessment of intrarenal hemodynamic change and Doppler indices reflect increased renal vascular resistance. So we compared the values of R.I. and P.I., in NIDDM patients, with several clinical parameters to identify that R.I. and P.I. values can reflect increased renal vascular resistance and predict diabetic nephropathy as early markers. METHODS: Renal Doppler US scan was performed on 40 patients with NIDDM to obtain Doppler signals from arcuate artery or interlobar artery and thereby calculate the R.I. and P.I. From every each individual, clinical and laboratory data including age, sex, morbidity period, BMI, mean blood pressure, total cholesterol, serum creatinine, BUN, HbA1c, 24 hr urine protein and creatinine clearance were analyzed. We analyzed the correlation between values of R.I. and P.I. with clinical parameters by using univariate and multiple linear regression analysis. The patients were classified as three groups on the basis of the amount of 24 hour urine protein and value of serum creatinine : Group 1(n=15) was defined as patients with 24 hr urine protein less than 150mg/day and serum creatinine less than 1.5mg/ dL, group 2(n=12) as between 150mg/day and 500mg/ day and serum creatinine less than 1.5mg/dL and group 3(n=13) as more than 500mg/day or serum creatinine above 1.5mg/dL. RESULTS: 1) R.I. values showed correlation with age, morbidity period, mean blood pressure, HbA1c, serum creatinine, BUN, creatinine clearance and 24 hour urine total protein. P.I. values showed correlation with age, morbidity period, mean blood pressure, serum creatinine, BUN, creatinine clearance and 24 hour urine total protein. 2) R.I. and P.I. values were significantly affected by creatinine clearance and age in multiple regression analysis. 3) There were statistically positive correlation between 24 hour urine protein and R.I. and P.I.. But when we divided into three groups based on their amount of 24 hour urine protein. R.I. didn't show statistical correlation but P.I. showed significant correlation in the group of patients with proteinuria over 500mg/day(p<0.05). CONCLUSION: Renal doppler indices reflect increased renal vascular resistance in NIDDM patients and correlate with clinical parameters of diabetic nephropathy. We suggest that the R.I. and P.I. are useful marker for indicating diabetic vascular complication in NIDDM patients. However, further comparative studies should be carried out to elucidate the usefulness of R.I. and P.I. as early markers or advantaging parameters in predicting diabetic nephropathy.

Macrovascular dysfunction detected by comparison of serum FDP detected by simplified venous occlusion test in patients with NIDDM and CVA / 대한내과학회지

OBJECTIVES: In diabetic patients, the incidence of atherosclerotic disease are increased, which may be due to decreased fibrinolytic activity. The aim of study is to elucidate the relationship between angiopathies and vascular function evaluated by simplified venous occlusion test in patients with non-insulin dependent diabetes mellitus (NIDDM) and cerebrovascular accident (CVA). METHODS: The study was conducted on 63 patients who were hospitalized during the period from March 1, 1994 to May 30, 1997. The serum concentration of fibrinogen degradation products (FDP) was measured before and 5 min after venous occlusion in 31 NIDDM patients, 16 CVA patients and 16 age-matched control subjects. FDP was measured with the anti-fibrinogen- coated latex particle agglutinin assay system. RESULTS: 1) The basal serum FDP level was higher in diabetic patients with macroangiopathy (12.3+/-5.8 ug/ml) and patients with CVA (11.2+/-5.1 ug/ml) than in control subjects (5.7+/-1.8 ug/ml) (p<0.05). 2) The increment of serum FDP level after venous occlusion in diabetic patients with microangiopathy (6.6+/-2.2 to 10.3+/-4.1 ug/ml) and control subjects (5.7+/-1.8 to 11.4+/-4.3 ug/ml) was significantly higher than basal serum FDP level (p<0.05). But the increment of serum FDP level after venous occlusion in diabetic patients with macroangiopathy (12.3+/-5.8 to 15.2+/-5.1 ug/ml) and patients with CVA (11.2+/-5.1 to 13.7+/-4.8 ug/ml) wasn't significantly higher than basal serum FDP level. 3) The increment rate of serum FDP after venous occlusion in diabetic patients with macroangiopathy (24.4+/-29.3%) and patients with CVA (29.4+/-34.5%) was significantly lower than diabetic patients with microangiopathy (66.3+/-71.7%) and control subjects (84.1+/-69.3%) (p<0.05). CONCLUSION: The responsiveness of fibrinolytic activity to venous occlusion was significantly lower in diabetic patients with macroangiopathy, as in patients with CVA, compared with that in control subjects. We conclude that measurement of the increase in serum FDP concentration 5 min after venous occlusion may be useful to detect vascular dysfunction in patients with macrovascular disease caused by atherosclerosis.

Thrombotic thrombocytopenic purpura during pregnancy in monozygotic twin sisters / 대한혈액학회지

No abstract available.

A Study of Allergy Skin Tests with Korean Pollen Extracts

In Korea, there are two descrite pollen seasons: a tree pollen season and a weed pollen season. In order to investigate the incidence of sensitization to the major pollens and to evaluate is clinical significance in respriatory allergic disease, skin prick tests were performed using 7 species of Korean pollen extracts (K-P extracts) and specific IgE was measured by the Phadebas radioallergosorbent test (RAST) in patients with positive skin prick tests. Of the 317 patients with respiratory allergic diseases 73 patients (23.0%) were skin prick test positive to one or more K-P extracts and the positive reactions to individual pollens were as follows: 14.2% (45/317) positive to sagebrush 10.4% to ragweed, 5.0% to grass, 4.1% to oak, 3.8% to alder, 1.9% to poplar; and 0% to pine. The 30-39yr old group manifested the highest skin test positivity 36.7%. There was no difference in the skin reactivity according to the patient's sex and the kinds of allergic disease. Also there was no relationship between birth season and skin test positivity. The agreement between the results of the skin prick test with K-P and commercially prepared Bencard's pollen extracts (B-P extracts) was good. There were good correlations between the strongly positive skin prick test and a posivite RAST and also between a netative skin prick test and a negative RAST. From this study, it can be concluded that overall sensitization rate of respiratory allergy patients to K-P exstracts was 23.0%, and that weed pollens such as sagebrush and ragweed were major pollens.