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Lymphomatous involvement of the heart is extremely rare at initial diagnosis and presentation of malignant lymphoma. Worldwide, only a few cases have been diagnosed and treated during life and only four cases were diagnosed before death in Korea. We report a case of non-Hodgkin's lymphoma with two right atrial masses detected by chest computed tomography and transesophageal echocardiography. The patient was an 80 year- old man and the presenting symptoms included generalized weakness, weight loss, constipation and low abdominal pain. For diagnosis, the mass of the perinephric area was biopsied under ultrasonographic guidance, and pathologically it was determined to be malignant lymphoma, diffuse large B cell type. The patient was treated with continuous low dose cyclophosphamide and prednisolone vice standard chemotherapy because of advanced age and renal dysfunction. After 2 months of treatment the masses in the atrium and the intraabdominal masses disappeared.

Emerging application areas of mass storage flash memories require low cost, high density flash memories with enhanced device performance. This paper describes a 64 Mb NAND flash memory having improved read and program performances. A 40 MB/s read throughput is achieved by improving the page sensing time and employing the full-chip burst read capability. A 2-/spl mu/s random access time is obtained by using a precharged capacitive decoupling sensing scheme with a staggered row decoder scheme. The full-chip burst read capability is realized by introducing a new array architecture. A narrow incremental step pulse programming scheme achieves a 5 MB/s program throughput corresponding to 180 ns/Byte effective program speed. The chip has been fabricated using a 0.4-/spl mu/m single-metal CMOS process resulting in a die size of 120 mm/sup 2/ and an effective cell size of 1.1 /spl mu/m/sup 2/.

The aim of this study was to investigate the relationship between somatostatinergic tone (SST) and the size of growth hormone (GH)-producing pituitary tumors. GH levels of 29 patients with newly diagnosed acromegaly were measured using a 75-gram oral glucose tolerance test (OGTT), an insulin tolerance test (ITT), and an octreotide suppression test (OST). Differences between GH levels during the ITT and the OGTT (ΔGHIO), and between the OGTT and the OST at the same time point (ΔGHOS) were compared according to the size of the tumor and the response pattern to the OST. ΔGHIO of macroadenomas (n=22) was non-significantly higher than those of microadenomas while ΔGHOS of macroadenomas were significantly higher than those of microadenomas. According to further analyses of macroadenomas based on the response pattern to the OST, GH levels during the ITT were significantly higher in non-responders. ΔGHOS showed near-significant differences between responders and non-responders. In conclusion, as the size of the pituitary tumor increases, the effect of glucose on SST appears to be attenuated. Macroadenomas that are non-responders to the OST possess a portion of GH secretion exceeding the range of regulation by SST.

Background Although an association between low-level environmental heavy metal exposure and the incidence of metabolic syndrome (MS) has been hypothesized, little research on this topic has been conducted on a population-wide level. Methods We analyzed MS status and whole blood lead, mercury, cadmium, manganese, and creatinine-adjusted urine arsenic concentrations in 1,405 subjects, ≥ 20 years of age, who were registered for the Korea National Health and Nutrition Examination Survey, 2008. Results Various demographic and biochemical parameters were associated with MS and blood heavy metal status. After adjusting for these variables, lead was the only heavy metal that was significantly associated with MS. Lead concentrations in subjects with MS were significantly higher than those in subjects without MS (p = 0.015). The prevalence of MS and a moderate/high risk for cardiovascular disease, as determined by Framingham risk score, also increased significantly according to the logarithmic transformation of the lead quartile (p p = 0.006). Conclusions These findings suggest that a higher prevalence of MS is associated with higher blood lead levels in the Korean population.

Sarcoidosis is a chronic multisystemic inflammatory disease of unknown etiology, which is characterized by noncaseating granulomatous inflammation of the involved organs. It is known that neurosarcoidosis involving the nervous system occurs in about 5% of patients with sarcoidosis. However, neurosarcoidosis without systemic involvement is extremely rare. We present a case of suspicious neurosarcoidosis affecting the pituitary gland, which was manifested as chronic uncontrolled headache, panhypopituitarism, central diabetes insipidus, and hypercalcemia. Though the biopsy at the pituitary lesion was not performed due to the high risk of surgical complication, treatment was needed urgently and we started steroid therapy. After steroid therapy, we observed the immediate symptom relief with improved hypercalcemia. According to the follow-up examination, no recurrent symptom was seen, and resolution of the pituitary lesion with improving panhypopituitarism was noted.

While the performance of flash memory exceeds hard disk drives in almost every category, the cost of flash memory must come down in order to gain wider acceptance in mass storage applications. This paper describes a 3.3 V-only 32 Mb NAND flash memory that achieves not only high performance but also low cost with a 94.9 mm/sup 2/ die size, improved yields, and a simple process with 0.5 /spl mu/m CMOS technology. Die size is reduced by eliminating high voltage operation on the bitlines through a self boosted program inhibit voltage generation scheme. Incremental-step-pulse programming results in a 2.3 MB/s program data rate as well as improved process variation tolerance. Interleaved data paths and a boosted wordline results in a 25 ns burst cycle time and a 24 MB/s read data rate. Maximum operating current is less than 8 mA.

Glucose toxicity contributes to progressive β-cell failure and the development of overt diabetes. Oxidative stress is an important aspect of glucose toxicity in pancreatic β-cells. We investigated whether the flavonoid apigenin protects pancreatic β-cells from 2-deoxy-D-ribose (dRib)-induced oxidative cell damage. HIT-T15 pancreatic β-cells were cultured with or without apigenin in the presence of dRib. Time- and dose-dependent cell viability was monitored using a cell counting kit (CCK-8), while the induction of apoptosis was analyzed using a cell death enzyme-linked immunosorbent assay (ELISA) kit. Mitochondrial membrane potential (ΔΨ(m)) was determined using the JC-1 kit. Intracellular oxidative stress was measured by fluorometric analysis of DCFH oxidation using 2',7'-dichlorofluorescin diacetate (DCFH-DA) as the probe. In addition, the DNA binding activity of the oxidative stress-related transcriptional factors nuclear factor-κB (NF-κB) and activator protein 1 (AP-1) were analyzed. dRib reduced cell survival and ΔΨ(m), while it markedly increased intracellular levels of reactive oxygen species (ROS), apoptosis, and the activity of the oxidative stress-related transcription factors NF-κB and AP-1. However, pretreatment of cells with apigenin attenuated all the dRib-induced effects. The anti-oxidants, N-acetyl-L-cysteine (NAC) and alpha lipoic acid (ALA), also prevented both dRib-induced oxidative damage and activation of NF-κB and AP-1. Taken together, these results suggest that apigenin attenuates dRib-induced cell damage in pancreatic β-cells via oxidative stress-related signaling.

Acanthosis nigricans (AN) is a cutaneous marker for many underlying states such as endocrine abnormality, obesity, certain drugs, and malignancy. Generalized AN is a rare condition and is commonly seen in adults with an underlying malignancy. The type B insulin resistance syndrome, a rare autoimmune disorder, is caused by the autoantibodies to the insulin receptor. Patients typically present with hyperglycemia but also may present with hypoglycemia. We report a rare case of a 36-year-old man with generalized AN and type B insulin resistance syndrome with hypoglycemia.

Background There have been no systematic observations regarding changes in early phase insulin secretion among Korean prediabetes and early stage type 2 diabetes mellitus (T2DM) patients. Methods We conducted 75-g oral glucose tolerance tests (OGTT) in 873 subjects with suspected abnormal glucose tolerance. All subjects were diagnosed as having normal glucose tolerance (NGT), prediabetes (preDM), or T2DM according to the OGTT results and the insulin secretory and insulin resistance indices of each subject were calculated. Additionally, we analyzed the changes in early phase insulin secretion according to changes in fasting (Glc(0)), post-prandial (Glc(120)) glucose and HbA1c (A1c) levels. Results As compared to subjects with NGT, the insulin secretory indices of the preDM and T2DM subjects progressively declined, and the insulin resistance indices were progressively aggravated. Early phase insulin secretion decreased rapidly according to the increments of Glc(0), Glc(120) and A1c, and these changes were most prominent in the NGT stage. Compared to the control group, the early phase insulin secretion levels of the preDM or T2DM subjects were less than 50% when Glc(0) was over 100 mg/dL, Glc(120) was over 145 mg/dL, and A1c was over 5.8%. Conclusion This study suggests that progressive beta cell dysfunction in Koreans may be initiated and rapidly aggravated during the period generally designated as 'normal.'

During the progression of Type 2 diabetes, glucose toxicity is likely to contribute importantly to progressive beta cell failure. Oxidative stress is an important aspect of glucose toxicity in pancreatic beta cells, and reducing sugars, such as 2-deoxy-D-ribose (dRib), produce reactive oxygen species. Furthermore, many of the biological properties of flavonoids are likely to be related to their antioxidant and free-radical scavenging abilities. Accordingly, in the present study, we investigated whether kaempferol (a flavonol) protects beta cells from dRib-induced oxidative damage. HIT-T15 cells were cultured with various concentrations of dRib for 24h. Cell survivals, amounts of reactive oxygen species (ROS) generated, apoptosis, and lipid peroxidation were measured. dRib was found to dose-dependently reduce cell survival and to markedly increase intracellular ROS levels, apoptosis, and lipid peroxidation. However, kaempferol (10 microM) suppressed dRib (20 mM) induced intracellular ROS, apoptosis, and lipid peroxidation. So, we demonstrate that kaempferol reduces dRib-mediated beta cell damage interfering with ROS metabolism and protective effects against lipid peroxidation. Our findings indicate that kaempferol protects HIT-T15 cells from dRib-induced associated oxidative damage.

Reducing sugar, 2-deoxy-D-ribose (dRib), produces reactive oxygen species through autoxidation and protein glycosylation and causes osteoblast dysfunction. Kaempferol, a natural flavonoid, was investigated to determine whether it could influence dRib-induced cellular dysfunction and oxidative cell damage in the MC3T3-E1 mouse osteoblastic cell line. Osteoblastic cells were treated with 30 mM dRib in the presence or absence of kaempferol (10(-9)-10(-5) M) and markers of osteoblast function and lipid peroxidation were subsequently examined. Kaempferol (10(-9)-10(-5) M) significantly inhibited the dRib-induced decrease in growth of MC3T3-E1 osteoblastic cells. In addition, treatment with kaempferol resulted in a significant elevation of alkaline phosphatase (ALP) activity, collagen content, and mineralization in the cells. Treatment with kaempferol increased osteoprotegerin (OPG) secretion and decreased malondialdehyde (MDA) contents of MC3T3-E1 osteoblastic cells in the presence of 30 mM dRib. Taken together, these results suggest that kaempferol inhibits dRib-induced osteoblastic cell damage and may be useful for the treatment of diabetes-related bone disease.

Introduction In recent studies, apolipoprotein E (apo E) genetic polymorphism in association with dyslipidemia have been proposed as the one of the risk factors for the development of diabetic nephropathy. We found that type 2 diabetic patients with microalbuminuria (MA) had higher plasma triglyceride levels than those with normoalbuminuria (NA) in our previous study. Therefore, we aimed for investigating the association among apo E genetic polymorphism, dyslipidemia and the development of diabetic nephropathy in type 2 diabetic patients. Method We included 58 subjects with normoalbuminuria and 36 subjects with microalbuminuria in analysis. They were all Korean and type 2 diabetic patients who had normal renal function, history of diabetes longer than 10 years and the data of urine albumin excretion rate at 10th year diabetes duration. Mean HbA1c, plasma total cholesterol and triglyceride levels for 10 years and several clinical characteristics were examined. Apo E genotypes were confirmed by real time PCR. Results The frequency of e3/e4 genotype (20.7% versus 5.6%, p = 0.045) and E4 carrier (22.8% versus 5.9%, p = 0.035) was significantly higher in NA group than in MA group. On logistic regression analysis, crude odds ratio of E2 carrier and E4 carrier were 0.833 (95% CI: 0.245–2.833) and 0.205 (95% CI: 0.043–0.986), respectively. However, after adjusted by HbA1c, hypertension, total cholesterol and triglyceride, odds ratio of E2 carrier and E4 carrier were 0.664 (95% CI: 0.134–3.289) and 0.365 (95% CI: 0.061–2.187) and the association became weak. There were no correlation between apo E carrier and lipid profile. HbA1c (7.6 ± 1.3% versus 7.0 ± 0.9%, p = 0.012) and mean creatinine (1.2 ± 0.7 mg/dL versus 1.0 ± 0.2 mg/dL, p = 0.004) levels were significantly higher in MA group than in NA group as expected. Conclusions These data suggest that E4 carrier might be associated with the protection for the development of diabetic nephropathy in type 2 diabetic patients without respect to dyslipidemia.

Background: We developed for the first time a smartphone application designed for diabetes self-management in Korea and registered a patent for the relevant algorithm. We also investigated the user satisfaction with the application and the change in diabetes related self-care activities after using the application. Methods: We conducted a questionnaire survey on volunteers with diabetes who were using the application. Ninety subjects responded to the questionnaire between June 2012 and March 2013. A modified version of the Summary of Diabetes Self-Care Ac tivities (SDSCA) was used in this study. Results: The survey results exhibited a mean subject age of 44.0 years old, and males accounted for 78.9% of the subjects. Fifty percent of the subjects had diabetes for less than 3 years. The majority of respondents experienced positive changes in their clini cal course after using the application (83.1%) and were satisfied with the structure and completeness of the application (86.7%). Additionally, the respondents’ answers indicated that the application was easy to use (96.7%) and recommendable to others (97.7%) and that they would continue using the application to manage their diabetes (96.7%). After using the Diabetes Notepad application, diabetes related self-care activities assessed by SDSCA displayed statistically significant improvements ( P

Abstract - Background: To evaluate the relationships between deterioration in insulin secretion and aggravated insulin resistance in patients with newly diagnosed prediabetes (preDM) and type 2 diabetes mellitus (T2DM) according to the presence of metabolic syndrome (MS). Methods: We performed oral glucose tolerance test (OGTT) on 322 drug naive subjects with a history of hyperglycemia of ≤ 3 months, and divided these patients into 3 groups, normal glucose tolerance (NGT), preDM (IFG and/or IGT) and T2DM. We also diagnosed these subjects with respect to MS according to ATP III criteria modified by Asia-Pacific guidelines and compared IGI and HOMA-IR in the 3 groups. Results: According to OGTT, 63 subjects were diagnosed with NGT, 81 with preDM, and 178 with T2DM. Using modified ATP III criteria, 218 (67.7%) subjects were diagnosed as MS. When compare groups stratified by the presence of MS, preDM and T2DM groups with MS showed significantly higher mean HOMA-IR and IGI than those without MS. When compare groups with respect to glucose tolerance, NGT, preDM, and T2DM subgroups in MS group showed significant higher HOMA-IR and lower IGI according to glucose tolerance. However, NGT, preDM, and T2DM subgroups in non-MS group showed a significant decrease in IGI but no significant difference in HOMA-IR as glucose tolerance worsened. Conclusion: Deterioration in IGI and aggravation of HOMA-IR are both important in the primary pathogenesis of diabetes in those with MS. However, IGI deterioration may be the only important factor in the primary pathogenesis of T2DM in the absence of MS. (J Kor Diabetes Assoc 30:198~206, 2006) ━━━━━━━━━━━━━━━━ ━━

Glucose toxicity to pancreatic β-cells is defined as irreversible β-cell damage, including apoptosis, caused by chronic exposure to high glucose levels in type 2 diabetes. Oxidative stress is an important mechanism for glucose toxicity to pancreatic β-cells. Reducing sugars produce reactive oxygen species through autoxidation and protein glycosylation. 2-Deoxy- d -ribose (dRib) is a reducing sugar with high reactivity. We investigated whether cAMP-stimulating agents could protect β-cells from dRib-induced oxidative damage. HIT-T15 cells were cultured with various concentrations of dRib for 24 h. We measured cell survival, intracellular cAMP and H 2 O 2 levels, and apoptosis. dRib decreased cell survival in a dose- and time-dependent manner and markedly increased intracellular H 2 O 2 levels and apoptosis. N -Acetyl- l -cysteine decreased dRib-induced rises in intracellular H 2 O 2 and apoptosis to control levels. Forskolin, IBMX, and dbcAMP markedly elevated intracellular cAMP levels and significantly attenuated dRib-induced cytotoxicity and apoptosis, but had no influence on the dRib-induced rise in intracellular H 2 O 2 levels. These results demonstrate that dRib produced oxidative stress and apoptosis in pancreatic β-cells and that elevated intracellular cAMP levels reduced dRib-induced damage, independent of reactive oxygen species metabolism.

Rapidly increasing solid-state mass-storage application areas are requiring low cost, high density flash memories with higher read and program throughputs. This paper describes a 3.3 V-only 64 Mb NAND flash memory fabricated using a 0.4 /spl mu/m single-metal CMOS technology. The read throughput of 40 MB/s is achieved by improving the random access time and by introducing a full-chip burst read. A typical program throughput of 5 MB/s corresponding to 180 ns/byte is achieved by using a narrow incremental step pulse programming (NISPP) technique. A staggered row decoder scheme relaxes layout limitations and improves the random access time.

BACKGROUND: The association between sarcopenia and cardiovascular disease (CVD) in elderly people has not been adequately assessed. The aim of this study was to investigate whether CVD is more prevalent in subjects with sarcopenia independent of other well-established cardiovascular risk factors in older Korean adults. METHOD: This study utilized the representative Korean population data from the Korea National Health and Nutrition Examination Survey (KNHANES) which was conducted in 2009. Subjects older than 65 years of age with appendicular skeletal muscle mass (ASM) determined by dual energy X-ray absorptiometry were selected. The prevalence of sarcopenia in the older Korean adults was investigated, and it was determined whether sarcopenia is associated with CVD independent of other well-known risk factors. RESULTS: 1,578 subjects aged 65 years and older with the data for ASM were selected, and the overall prevalence of sarcopenia was 30.3% in men and 29.3% in women. Most of the risk factors for CVD such as age, waist circumference, body mass index, fasting plasma glucose and total cholesterol showed significant negative correlations with the ratio between appendicular skeletal muscle mass and body weight. Multiple logistic regression analysis demonstrated that sarcopenia was associated with CVD independent of other well-documented risk factors, renal function and medications (OR, 1.768; 95% CI, 1.075-2.909, P = 0.025). CONCLUSIONS: Sarcopenia was associated with the presence of CVD independent of other cardiovascular risk factors after adjusting renal function and medications.

Background Intima-media thickness (IMT) of the carotid arteries is known to have a positive correlation with the risk of cardiovascular disease. This study was designed to identify risk factors affecting the progression of carotid IMT in patients with type 2 diabetes mellitus (T2DM). Methods Patients with newly diagnosed T2DM with carotid IMT measurements were enrolled, and their clinical data and carotid IMT results at baseline and 2 years later were compared. Results Of the 171 patients, 67.2% of males and 50.8% of females had abnormal baseline IMT of the left common carotid artery. At baseline, systolic blood pressure, body mass index and smoking in male participants, and fasting plasma glucose and glycated hemoglobin levels in females were significantly higher in patients with abnormal IMT than in those with normal IMT. Low density lipoprotein cholesterol (LDL-C) levels in males and high density lipoprotein cholesterol (HDL-C) levels in females at the 2-year follow-up were significantly different between the nonprogression and the progression groups. Reduction of the United Kingdom Prospective Diabetes Study (UKPDS) 10-year coronary heart disease (CHD) risk score after 2 years was generally higher in the nonprogression group than the progression group. Conclusion LDL-C levels in males and HDL-C levels in females at the 2-year follow-up were significantly different between participants with and without progression of carotid IMT. Furthermore, a reduction in the UKPDS 10-year CHD risk score appeared to delay the advancement of atherosclerosis. Therefore, the importance of establishing the therapeutic goal of lipid profiles should be emphasized to prevent the progression of carotid IMT in newly diagnosed T2DM patients.

It has been suggested that there is an association between environmental, low-level arsenic exposure and the risk of diabetes mellitus (DM), but little research has been conducted. Here, the glucose tolerance status and urinary creatinine adjusted total arsenic concentrations were analyzed in 3,602 subjects ≥ 20 yr of age who were registered for the Korea National Health and Nutrition Examination Survey, 2008-2009. Various demographic parameters were associated with urinary arsenic concentrations. After adjusting for these variables, urinary arsenic concentrations in subjects with DM were significantly higher than those in subjects with normal glucose tolerance and those with impaired fasting glucose (P < 0.001). Compared with the lowest quartile ( < 70.7 µg/g creatinine), the odds ratios and 95% confidence intervals for DM were 1.11 (0.73-1.68), 1.42 (0.94-2.13), and 1.56 (1.03-2.36) for urinary arsenic concentrations of 70.7 to < 117.7, 117.7 to < 193.4, and ≥ 193.4 µg/g creatinine, respectively, following multivariate adjustment. Furthermore, the urinary total arsenic concentration was inversely associated with the insulin secretion index, HOMA2 %B (β = -0.033, P = 0.032). These findings suggest that arsenic exposure, possibly involving beta cell dysfunction, is associated with an increased risk of DM in the Korean population.

Parathyroid carcinoma is very rare in patients with primary hyperparathyroidism, only accounts for 1% to 2% of all cases. It is characterized by higher incidence of renal dysfunction, metabolic bone disease and gastrointestinal symptoms. Although the clinical manifestations of hyperparathyroidism are more severe in patients with parathyroid carcinoma when compared to those with those with parathyroid adenoma, it is difficult to differentiate carcinoma from adenoma without pathologic confirmation. To our knowledge, there have only been a few cases of hyperparathyroidism due to parathyroid carcinomas reported to date. Here, we report a case of 63-year-old woman developing osteoporosis, hypercalcemia and hypophosphatemia due to a parathyroid tumor and was diagnosed with parathyroid carcinoma postoperatively. [Korean Journal of Bone Metabolism, 19(1): 59-65, 2012]

The aim of the study was to assess the association between usual dietary nutrient intake and obesity in Korean type 2 diabetic patients. We examined 2,832 type 2 diabetic patients from the Korean National Diabetes Program cohort who completed dietary assessment and clinical evaluation in this cross-sectional study. In men, higher dietary fiber intake was associated with a lower odds of being obese (P(trend) = 0.003) and in women, higher protein intake was associated with a lower odds of being obese (P(trend) = 0.03) after adjustment for age, diabetes duration, HbA1c, alcohol drinking, income, education level, and calorie intake. In men, higher fiber intake was associated with lower odds of obesity after further adjustment for diastolic blood pressure, physical activity, and possible confounding nutritional intake and medication. The multivariable adjusted odds ratio for the highest quintile of fiber intake was 0.37 (P(trend)0.001). In women, protein intake was not associated with obesity after further adjustment. In conclusion, higher intake of dietary fiber is associated with lower odds of being obese in type 2 diabetic men, suggesting a role for dietary fiber in the management and prevention of obesity in type 2 diabetes (ClinicalTrials.gov: NCT 01212198).

Received: 10 June 2010, Accepted: 6 January 2011 Corresponding author: In-Kyung Jeong Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Korea Tel: +82-2-440-6126, Fax: +82-2-440-6295, E-mail: jik1016@khu.ac.kr A Case of Primary Adrenal Insufficiency in a Patient with Acquired Immunodeficiency Syndrome Jae Ho Choi, Suk Chon, Yu Chul Hwang, Jun Seong Son, Seung Joon Oh, Kyu Jeung Ahn, Ho Yeon Chung, Jeong Taek Woo, Sung Woon Kim, Jin Woo Kim, Young Seol Kim, In-Kyung Jeong Department of Endocrinology and Metabolism, Infection, College of Medicine, Kyung Hee University, Seoul, Korea

SUMMARY We suspected the presence of pheochromocytoma and were able to confirm our diagnosis in a patient presenting with symp-toms of fatal cardiogenic shock due to catecholamine-induced car-diomyopathy. Furthermore, we evaluated the possibility of MEN 2A as the source of the thyroid nodules and diagnosed MTC using various tests and surgery. The patient had a younger sister who un-derwent follow-up observation for benign thyroid nodules, and as a result, the diagnosis of MTC was established during selective test-ing for MEN 2A. Genetic testing for the RET gene demonstrated that the diagnosis of MEN 2A was due to a mutation of C634R on exon 11. Using a selective test for familial genes, mutations of the same genes were confirmed, and a family of MEN 2A individuals was identified. ACKNOWLEDGEMENT The authors appreciate the efforts of Young Ji Yoon in the prepa-ration of the manuscript. REFERENCES 1. Mulligan LM, Kwok JB, Healey CS, Elsdon MJ, Eng C, Gardner E, LoveDR, Mole SE, Moore JK, Papi L, Ponder MA, Telenius H, Tunnacliffe A, Ponder BJ: Germ-line mutations of the RET proto-oncogene in multiple endocrine neoplasia type 2A. Nature 363:458-460, 1993

A hyalinizing trabecular tumor (HTT) is a rare benign thyroid tumor that can present as a solitary thyroid nodule, a prominent nodule in a multinodular goiter, or as an incidental finding within a thyroidectomy specimen. The clinical importance of this entity is that it is frequently misdiagnosed as papillary carcinoma or medullary carcinoma on fine-needle aspiration cytology or histopathologic examination. The cytology of HTT is characterized by hypercellularity, nuclear grooves, nuclear pseudoinclusions, and powdery chromatin of the tumor cells, which is frequently seen in papillary carcinomas. The histologic findings of the tumor show polygonal and spindle cells arranged in a trabecular growth pattern with the presence of a variable hyalinized stroma. Calcitonin and other neuroendocrine markers can be used to differentiate HTT from medullary carcinoma. MIB-1, galectin-3, or other cytokeratin markers help to exclude papillary carcinoma. We report a patient with a thyroid tumor misdiagnosed as a medullary carcinoma on fine-needle aspiration and finally diagnosed as HTT after total thyroidectomy and immunohistochemical examination. (J Korean Endocr Soc 23:327~331, 2008)

Paragangliomas are extra-adrenal pheochromocytomas that arise from specialized neural crest cells. They are distributed anywhere from the upper neck to the pelvic floor, a nd they are classified on the basis of their anatomic origin. Functioning paragangliomas can cause the same clinical manifestations as pheochromocytoma, such as hypertension, diabetes mellitus, hyperadrenergic spells and so on. We experienced a retroperitoneal paraganglioma that was found in 66 year-old male who suffered from intractable constipation, and his constipation was caused by paralytic ileus and uncontrolled hyperglycemia. After he was diagnosed, removal of the paraganglioma was done and his clinical symptoms and sustained hyperglycemia were successfully

Currently finger pricking is the common method of blood glucose measurement in patients with diabetes mellitus. However, diabetes patients have proven to be reluctant to check their glucose profiles regularly because of the discomfort associated with this technique. Recently, a non-invasive and continuous Reverse Iontophoresis based Glucose Monitoring Device (RIGMD) was developed in Korea. The study was conducted during the period November 2003-January 2004 on 19 in-patients. Glucose measurements were performed using RIGMD between 10 a.m. and 4 p.m. Concurrent plasma glucose levels were checked hourly and subsequently compared with RIGMD data. The mean error of RIGMD measurements was -3.45 +/- 52.99 mg/dL with a mean absolute relative error of 20+/-15.16%. Measurements obtained by RIGMD were correlated with plasma glucose levels (correlation coefficient; 0.784 (p

Osteogenesis imperfecta (OI) is a genetic disease that is caused by a synthetic anomaly of type I collagen. It is characterized by such features as low bone density, multiple fractures, bone deformities and chronic bone pain. According to the hereditary pattern and degree of phenotypical expression, it also has various extraskeletal manifestations such as blue sclera, hearing deformities and dentinogenesis imperfecta. Recently, an expanded seven subgroup classification of OI has been suggested by means of its clinical severity and mutational characteristics. However, most of the OI cases reported in Korea have been classified as type II or III that can be diagnosed easily and present with severe clinical manifestations. Only rare type I OI cases have been currently reported in Korea. Herein, we report a case of type I OI that was differentially diagnosed as a cause of a spinal compression fracture. (J Kor Endocr Soc 22:446~452, 2007)

Background : The expression of c-FLIP (cellular Fas-associated death domain-like interleukin-1 β-converting enzyme (FLICE)-inhibitory protein), which is a member of the family of inhibitors of apoptosis, has been associated with tumor development and progression. The aim of this study was to evaluate the expression of c-FLIP in gastric cancer and its correlation with tumor cell proliferation, apoptosis and the clinicopathologic features. Methods : Immunohistochemical staining with anti-c-FLIP antibody was performed in 98 tissue samples obtained from gastric cancer patients who underwent surgical treatment. The apoptotic cells were visualized by terminal deoxynucleotidyl transferase (TdT) mediated deoxyuridine triphosphate (dUTP) nick-end labeling (TUNEL), and the proliferative cells were visualized by staining with Ki-67 antibody. Results : The positive expression of c-FLIP in the gastric cancer tissues was demonstrated in 57.1% of the cases. The expression of c-FLIP was increased in the gastric cancer tissues compared with the matched normal gastric mucosa. The expression of c-FLIP was significantly associated with histologic differentiation (p=0.038). However, there was no association between the c-FLIP expression and the other clinicopathological parameters, including patient survival. The Ki-67 labeling index (KI) for the 98 tumors ranged from 7.6 to 85.0 with a mean KI of 50.4±15.7. The mean KI value of the c-FLIP positive tumors was 54.1±15.3 and this was significantly higher than that of the c-FLIP negative tumors (p=0.005). The apoptotic index (AI) for the 98 tumors ranged from 0.0 to 10.0 with a mean AI of 7.4±2.3. There was no significant difference between the c-FLIP expression and the AI (p=0.347). Conclusions : These results suggest that the c-FLIP expression may be associated with tumor cell proliferation of gastric cancer.

Vitamin D is a kind of hormone that can be synthesized in the skin or it is supplied in the diet it is involved in a central role in bone and calcium homeostasis in vivo. Metabolic bone diseases such as rickets in children and osteomalacia in adults can also be caused by deficiency or metabolic defects in the vitamin D hormone related system. However, there has been a lack of generalized epidemiologic studies about the vitamin D deficiency status in Koreans. We recently experienced a case of osteomalacia caused by severe vitamin D deficiency. These kinds of case have not been reported elsewhere in Korea for the last twenty years. (J Kor Endocrinol Soc 22:55~61, 2007)

Malignant insulinomas are very rare endocrine tumours with a variable clinical course. Here, a case of a malignant insulinoma, resected from the tail of the pancreas 10 years previously, which was found to have hepatic metastasis, is reported. A pancreatic mass, without evidence of metastasis, has been found using an abdominal CT scan and intra-operative ultrasonography 10 years previously. Recently, the patient has suffered from dizziness, sweating and an altered mentality. Hyperinsulinemia was diagnosed from the biochemical laboratory finding. An abdominal CT scan and intra-operative abdominal sonography showed multiple hepatic metastasis, without local recurrence in pancreas. Therefore, a partial hepatic segmentectomy was performed. Immunohistochemical staining of the postoperative specimen was strongly positive for insulin. The postoperative biochemical response was normalized, and the patient experienced no further hypoglycemic symptom (J Kor Soc Endocrinol 21:68~73, 2006).

Background: Self monitoring of blood glucose plays an important role in the management of diabetes. However, traditional finger prick testing causes pain and so compliance with self monitoring of blood glucose is usually poor. Using an alternative site for sampling may reduce the level of pain and be beneficial for improving the compliance of diabetic patients. We evaluated the accuracy and acceptability of blood glucose testing from the forearm by analyzing the performance of the CareSens ® (i-Sens, Inc. Korea) device for