Patient with noninsulin dependent diabetes mellitus(NIDDM) have a major risk factor of the coronary herat disease which is important cause of death in NIDDM patients. In addition, they have relatively high levels of plasma cholesterol.

In order to assess the hypolipidemic effect and adverse effect of lovastatin, we studied in 30 NIDDM with mild to moderate elevations of serum cholesterol.

Lovastatin, HMG-CoA reductase inhibitor(20mg once daily in the evening) was given for 12 wks, during which blood glucose concentration remained controlled.

The following results were obtained:

1) Lovastatin reduced totol cholesterol by 26.4%, low-density lipoprotein(LDL) by 26.9%, and triglyceride(TG) by 26.7%.

2) During the study period, one patient complained nausea and vomiting, the other patient complained itching. No abnormalities in serum values were noted.

In conclusion, lovastatin was effective agent in NIDDM with hypercholeste rolemia without siginificant side effect.

Congenital hypothyroidism result in permanent changes of skeletal system and intellectual development.

We treated a 37-year old man with congenital hypothyroidism due to thyroid hypoplasia. He was presented with mental retardation, dwarfism, skeletal abnormalities including hip dislocation and megacolion. He has never been diagnosed or treated.

Thyroid function test revealed decreased serum T3 and T4. increased TSH and decreased I-131 uptake. Technetium-99m-pertechnate thyroid scan diclosed no functioning thyroid tissue, but normal serum thyroglobulin suggesting thyroid hypoplasia rather than athyrosis. X-ray filims of skull, hands, pelvis and knee revealed still present epiphysis, unerupted teeth, dislocated hip. A CT scan of abdomen revealed enlarged colon and tectum.

Neonatal screening program of congenital hypothyroidism will be needed in Korea.

To evaluate whether the urinary and serum c-peptide is the indicator of insulin therapy in NIDDM, and whether the insulin secretery capacity improves after control of blood glucose, We measured 24 hour urinary c-peptide excretion, fasting and postprandial 2hour's serum c-peptide concentrations before and after insulin therapy in 20 patients with NIDDM.

The results were as follows ;

1) The postprandial 2 hour's serum c-peptide level was significantly lower in patients with NIDDM than normal controls, bu t fasting serum c-peptide level and 24hour urinary c-peptide excretion showed no significant difference between normal control group and patients with NIDDM

2) There was no significant difference in duration of disease, body mass index, fasting serum c-peptide level and 24 hour urinary c-peptide excretion between insulin-requiring group and non-insulin-requiring group among patients with NIDDM. But post prandial 2 hour's serum c-peptide level was significantly lower in insulin requiring group than non-insulin-requiring group before treatment.

3) After therapy with insulin, post prandial 2 hour's serum c-peptide level increased significantly in insulin requiring group, but fasting serum c-peptide and 24 hour urinary c-peptide excretion were not changed significantly after therapy with insulin comparing with the level before therapy.

Author concluded that postprandial 2 hour's serum c-peptide level was a market of insulin therapy in patients with NIDDM and insulin secretory capacity improved after controlling of blood glucose.

It is well kown that an increased incidence of atherosclerosis in diabetic patients, and hyperlipemia might contribute to its development. Although diabetic populations are increasing in Korea, there are few reports showing abnonmalities of serum lipid metabolism in these patients. Various lipid values in serum were measured in 22 NIDDM and impaired with those of 20 normal control group to assess abnormalities of lipid metabolism. Follwoing results are obtained ; 1) Total lipid concentration was significantly higher in diabetics than in normal control(P<0.01). After control of hyperglycemia, total lipid concentration was significantly decreased(P<0.05). 2) Triglyceride concentration was significantly higher diabetics than in normal control(p<0.01). After control of hyperglycemia, its concentraion was significantly decreased(P<0.05). 3) Total cholesterol concentration was higher in diabetics than normal control, but there were no statistical significances. After control of hyperglycemia, there were on difference among each group.

Author studied with seventeen patients of acute viral hepatitis and seventeen normal volunteer by abdominal ultrasonography who were before and after fat meal after twelve hrs fasting. The results were as follows: 1) The gallbladder wall was significantly thicker than that of control group(2.38±0,54mm) in acute hepatitis group (4.0±1.98mm) (P<0.005) but in convalescent stage of acute viral hepatitis, the thickness of GB wall were decreased significantly to 2.62±0.05mm(P<0.025). There was no significant difference of the inner diameter of the GB between acute viral hepatitis group and convalescent stage of acute viral hepatitis group. 2) There was no significant difference of the inner diameter of the GB between acute viral hepatitis group (5.7±3.42cm²) than that those of normal control group (7.96±2.66cm²) (P<0.05). There was no significant difference of the inner cross sectional area of the GB between convalescent stage of acute viral hepatitis group and normal control group nor acute viral hepatitis group (P>0.1). 4) There was no correlation between the thickness of GB wall and the cross sectional area of the GB. 5) There was no significant difference of predicted outer cross sectional area of the GB among the 3 group(P>0.1). 6) The contraction of GB revealed 1.5hr after fat meal except 1 case. 7) There was no significant differences of contracted area of GB after fat meal among the 3 group (P>0.1) 8) There was no significantly increased the thickness of GB wall after fat meal in normal control group (3.49±0.8mm) (P>0.005), There was significantly increased in acute viral hepatitis group (5.49±1.77mm) (P>0.25) and convalescent stage of acute viral hepatitis (4.0±0.84mm) (P<0.005) in that of 12 hr fasting.

The expectorant effect of Ambroxol was observed in 13 cases of respiratory diseases (5 cases with bronchial asthma, 2 cases with acute bronchitis, 2 cases with lung ca, 2 cases with pneumonia, 1 case with chronic bronchitis and 1 cases with pulmonary tuberculosis) between Nov. '83 and Mar. '84. The folliwing results were obtained; 1) Clinical improvement of % of cases after treatment with Ambroxol was 78% of cough, 62% of frequency of sputum expectoration, 59% of amount of sputum vloume, 80% of expectoration and 75% of color of sputum. 2) Clinical improvement of pulmonary function test was as follows;(1) Improvement of less than 10% of FVC was 9 cases(69.2%) improvement between 10% and 20% of FVC was 3 cases(23.1%), and improvement of more than 20% of FVC was 1 case(7.7%). (2) Improvement of less than 10% of FEV₁/FVC was 11 cases(84.6%), improvement between 10% and 20% of FEV₁/FVC was 2 cases(15.4%)3) No remarkable side effects was observed.

The ketaocidosis is one of the acute complication in patients with diabeds mellitus and its mortality rate is much decreased after low dose insulin infusion therapy. Clinically, diabetic ketoacidosis showed metabolic abnormalities such as metabolic acidosis, fluid-electrolyte imbalance and hypophosphatemia. Many studies are now available about its mechanism or treatment for the better prognosis. This study included 20 cases of diabetic ketoacidosis who had been admitted to the Department of Internal Medichine at Ewha Womans University Hospital, from March 1982 to May 1984. We observed the correlation between serum phosphate and other metabolic abnormalities. The results obtained were as follows; 1) Diabetic ketoacidosis was more common in female than male. The ratio of male to female was 1:1.85. The age incidence was the highest in 6th decade(35%). The first diagnosis was 3 cases(15%). 2) The commonest precipitating cause was infection(8 cases, 40%). 3) The requiring fluid amount was 6.0+3.01 to correct fluid-electrolyte imbalance. The mean value of serum osmolarity was 309.0+23.7 mOsm/L, serum sodium 130±17.9-mEq/L serum potassium 3.0+1.3mg/dl, urea nitrogen 30.4+20.0mg/dl, bicarnate 10.85+8.5mEq/dl and blood ketone from ++ to +++. 4) The mean value of blood glucose was 575.6+242.8mg/dl. The rate of decrease of glucose was 82.7+47.2mg/dl/hr after insulin therapy. The time of decreased blood sugar level below 250mg/dl was 5.72+2.5hr and the priming dose of insulin was 11.4+6.8u. The infusion rate of insulin was 4.9+1.56u/hr and total amount of insulin was 56.6+28.7u for correction of electrolyte imbalance. 5) The comparison of group A(↓serum phosphate 2.5mg/dl, 5 cases) with group B(↑serum phosphate 2.5mg/dl, 10 cases) : The mean value of serum phosphate was 1.5+0.4mg/dl in group A and 3.8+09mg/dl in group B. The mean value of glucose was significantly higher in group A(796.6+312mg/dl) than in group B(508+164.7mg/dl)(P<0.005) and the mean value of the serum pH was significantly lower in group A(7.058+0.124) than in group B(7.339+0.163)(P<0.01). However there was no significant correlation between two groups in serum osmolarity, sodium, potassium, insulin amount and correction time. 6) The common complications of ketoacidosis were infection(3 cases, 15%) and myocardial infarction(2 cases, 10%). The mortality rate was 5%(1 case) and its cause of death was sepsis with disseminated intravascular coagulation.

The antidiarrheal effects of Lidamidine was observed in 30 cases of acute and chronic diarrhea between Mar. '85 and May '85. The following results were obtained. 1) Overall evaluation of therapy was rated by physician and patient at the end of the study revealed excellant control in 50%, good control in 30%, fair control in 15% and poor in 5% of the cases and in placebe 10 of 10 cases all revealed no effect. 2) Vital signs were stable and all laboratory findings including CBC, urinalysis, liver function test revealed no significant change during the treatment. 3) Mean daily dose were 32.3±29.4mg. 4) There was no side effect of Lidamidine Hydrochloride. 5) Mean duration of treatment were 4.5±1.5 days.

Lipoprotein cholesterol and triglyceride levels have been determined innormal and diabetes. The abnormalities of lipoprotein were investigated by SDS-polyacrylamide gel electrophoresis in the serum and the 3 major lipoprotein classes for diabetes. HDL cholesterol levels were lower in the diabetes compared to the normals. VLDL triglyceride levels also elevated in the diabetes. There were significant shifts in the distribution of lipoprotein cholesterol, with an increase in LDL cholesterol and decrease in HDL cholesterol. The results of this study suggest that diabetes may be associated with changes in both lipoprotein triglyceride and cholesterol levels. The electrohoretic patterns of VLDL and HDL in diabetes showed the abnormal pattern in comparison to normal.

The authors studied 50 controls(25 male and 25 female) and 79 diabetes mellitus patients(38 male and 41 female) who were admitted to Ewha Womans University Hospital from June, 1983 to May, 1984 to investigate the disorders of lipid metabolism, hemoglobin A_1c and their correlaton. The results were as follows: 1) Age incidence was highest in the 6th decades. 2) Mean fasting blood sugar was 191.9±82.29mg% and postprandial 2hour blood sugar was 278.81±118.19mg% in male diabetes mellitus patients, and 196.48±68.94mg% and 261.16±85.84mg% in female diabetes mellitus patients. After control diabetes mellitus blood sugar levels were decreased significantly. 3) Hemoglobin A_1clevels at fasting and postprandial 2 hour were significantly higher than those of controls. And Hemoglobin A_1c level were progressivly decreased after 3 months' controlling of diabetes mellitus. 4) Pre-β and β-lipoprotein, triglycerides and cholesterol were significantly higher than those of controls but α-lipoprotein was lower than that of controls. After 6 months of diabetic control, pre β-lipoprotein, triglycerides and cholesterol were decreased. 5) Between Hemoglobin A_1c and fasting blodo sugar had positive correlation, an cholesterol and hemoglobin A_1c also had positive correlation, but those were not statistically significant.

A case of hypokalemic familial periodic paralysis is presented and the litures are reviewed. A 15-year-old boy was admitted to Ewha Womans University Hospital with chief complaints of paralysis of both extremities and trunk on awaking in the morning. He had a history of quadriplegia, 8 months ago. Laboratory study revealed a hypokalemia(1.6mEq/L) and biopsy specimen taken from the gastrocnemius muscle showed mild vacuolization. After treatment with potassium chloride, paralysis was completely recovered.

No abstract available.

The maximum exercise testing using treadmill walking was performed in 36 patients of diabetes mellitus who were admitted to the Ewha Womans University Hospital from March, 1983 to August, 1983 and 30 normal control subjects to evaluate the efficacy of significance to detect latent coronary artery disease in diabetes mellitus as a chronic complication.

Among 36 patients of diabetes mellitus, ten(27.8%) were treadmill exercise test positive, of whom two had ST depression in resting electrocardiogram but eight didn't have any changes in resting electrocardiogram.

Since treadmill exercise test can be a useful sensitive diagnostic tool for early detection of latent coronary artery disease in the patients of diabetes mellitus as a chronic complication.

The authors experienced a 29 year old female patient with hypoplastic anemia during her illness of typhoid fever. Because that is very rare and unreported, we are reporting this patient. She was promptly recovered from hypoplastic anemia with antibiotics for typhoid fever.

A clinical observation was done on 144 cases of coronary heart disease admitted to Ewha Womans University Hospital from January, 1973 to December, 1997. The following results have been obtained. 1. The 144 cases were composed with 46.4% of atherosclerotic heart disease, 29.2% of myocardial infarction, 18.8% of coronary insuffiency and 5.6% of angina pectoris. 2. The ration of male to female was 1:1.14. The most patients were in the age group between the 6th and 7th decades(60.4%). 3. The major symptoms of coronary heart disease were precordial pain(54.2%) and dyspnea(45.1%). The pain was radiated in 24.3% 4. The most common preceding disease was hypertension(39.3%) followed by diabetes mellitus(11.5%). 5. There were leukocytosis in 66.6%, increased SGOT in 39.3%, increased LDH in 71.5% and increased cholesterol in 49.5% 6. The common associatd electrocardiographic abnormalities were left ventricular hypertrophy(28%), sinus tachycardia(16.9%), premature ventricular beat(11.6%). first degree AV block (8.4%) and premature atrial beats(6.1%). 7. The ratio of anterior to posterior wall infarction was 4:1. 8. The common findings of chest PA were cardiomegaly(38.5%), Atherosclerotic changes of aorta(15.2%) and pulmonary congestion(2.4%). 9. The mortality rate was 6.2%(10 cases). Among them, myocardial infarcition was 5 cases. atherosclerotic hart disease was 4 cases and coronary insufficiency was 1 case.

The authors analyzed 34 patients admitted to Ewha Womans University Hospital from January, 1, 1979 to June, 30, 1979 by animpression of cholelithiasis clinically. Ultrasonic and radiologic cholecystography were performed in all patients. In 20 patients of 34 patients, exploration was done. The result were as follow: 1) The accuracy of gallstone detected by ultrasound was 90%, which confirmed by exploratory laparotomy (20 cases), but 88% in non-visualized gallbladder by oral cholecystography(20 cases). False positive was 6%(1 case) and false negative was 6%(1 case). 2) In 13 cases(38%) GB stone was visualized by oral cholecystography, while in 20 cases(59%) were nonvisualized gallbladder by oral cholecystography(20 cases). False positive was 6%(1 case) and false negative was 6%(1 case). 3) In 20 cases that gall bladder wasn't visualized by oral cholecystography, gall stone was detected in 17 cases(85%), normal GB in 2 cases(10%), no stone in 1 case(5%) by ultrasonography. 4) Among 20 cases which were confirmed by operation, 4 cases were concomitant with cholecystography, ultrasonography and operative findings. Among 16 cases nonvisualized by oral cholecystography, 15 cases were detected as gall stone by ultrasonography, which were gall stone in 14 cases, normal gall bladder in 1 case(i.e. false positive, 6%) and no stone in 1 case(i.e. false negative, 6%)

A clinical observation was made on 221 cases of upper gastrointestinal bleeding, who were admitted to Ewha Womans University hospital from January, 1973 to December 1977. Following results were obtained. 1) The ratio of the number of the upper gastrointestinal bleeding to the total number of patients admitted to the department of internal medicine during the same period was 3.97% as a whole and the yearly ratio has increased since 1975. 2) of 221 cases of upper gastrointestinal bleeding, peptic ulcer was presented in 46.6%, gastric cancer in 29.0%, esophageal varices in 11.3%, gastritis in 10.0% and unknown origin in 3.2%. 3) The ratio between male and female was 2.2:1 in the total group and peak age incidence was in the sixth decade. 4) Hematemesis only was noted in 20.4% and melena only in 50.2% while hematemesis and melena were seen in 29.4%. 5) Among 221 cases, 45.7% was belonged to massive bleeding group by Hamilton's criteria. 6) The frequency of bleeding was observed that first bleeding accounted for 73.8%, second bleeding for 18.6% and bleeding more than three times for 7.7%. 7) Eighty percents of patinets were improved with conservative treatment, whereas 19.9% of patients required surgical treatment, 82.5% of the operated cases were improved. 8) The mortality rate during the hospitalization was in 5.4% and the causes were mainly due to uncontrollable bleeding, hepatic failure and renal shutdown related to sustained shock in this order.

The authors were conducted the studies based on the analysis of the clinical and laboratory features of 145 cases of acute pancreatitis, admitted to the department of internal medicine, Ewha Womans University Hoispital, during the period from January, 1970 to December, 1976. The results obtained are as follows: 1) The incidence of acute pancreatitis was higher in woman than man and its peak level was 20 years and in next, 30 years both male and female. 2) The main symptoms were severe epigastric pain(97.9%) and in next, nausea and vomiting, radiating abdominal pain, fever, indigestion, diarrhea & constipation. The physical examination most frequently showed abdominal tenderness(92.4%) and in next, abdominal distension, muscle rigidity, jaundice & hepatomegaly. 3) The elevation of serum amylase above 300 somogyi unit was 71.7%, that of serum lipase was 45.6%, that of serum bilirubin was 42.4%. CAm/Ccr ratio was increased by more than 1.5~2 times of normal group in acute pancreatitis. 4) In radiologic studies, localized gas distension on small bowel in 93 cases of plain abdomen was 56.0%. Widened C-loop was 24.1% and spasticity of duodenal bulb was 13.8% in 29cases of upper G-1 series and non-visualization of gall bladder was 25.0% in 20 cases of oral GB series. 5) The possible etioloigic factors were overeating, undetermined, alcohol drinking & biliary tract disease in frequent orders. And associated diseases were biliary tract disorder, peptic ulcer & gastritis, pulmonary tuberculosis and paralytic ileus. 6) In 8 cases among 145 cases, surgical operation was performed, as a result of biopsy, hemorrhagic pancreatitis was 4 cases, pancreatic pseudocyst was 2 cases, fat necrosis was 1 case and pancreatic abscess was 1 case. 7) On the therapeutic results, recovery & improvement was 95.1%. No improvement & death were 4.9% each other and relapse was 2.8%.

A clinical study was performed on 322 cases of essential hypertension observed at Department of Internal Medicine, Ewha Womens University Hospital, during a period of 6 years, from 1971 to 1976. The results were as follows: 1) The annual incidence of hypertensive patients in all medical inpatients was 6.2%. The annual incidence was not very different, but the number of hypertensive patients seemed to increase annually. 2) The highest occurrence was observed in the 6th decade in man, and the 5th decade in woman. Male to female ratio was 1.3:1. 3) In systolic pressure, a mild hypertension level was most frequent with 38.8%, and in diastolic pressure, moderate hypertension with 38.2%. 4) The most frequent symptom was headache (55.6%), followed by dyspnea, dizziness and nausea-vomiting. Symptoms were more frequently seen in the age group under 59. 5) Retinopathy was noted in 51.9%, in which K-W grade II was the most frequent. In relation to blood pressure, the higher the blood pressure the more severe the retinal changes. 6) Proteinuria was noted in 50.0% and the higher the blood pressure the more severe the proteinuria. 7) Serum cholesterol levels were most frequent in 150-199mg%, and there is no correlation between the level of erum cholesterol and blood pressure. 8) The BUN level which was above 20mg% was found in 35.6%, and the higher the blood pressure the more severe the high level of BUN. 9) Abnormal ECG findings were noted in 71.0%, in which left ventricular hypertrophy was 40.0%. Left ventricular hypertrophy and ST, T wave changes were more frequently found in higher blood pressure. 10) The incidence of LVH was more frequent on ECG than cardiomegaly on roentgenogram. 11) Complications developed in 27.9%, and cerebrovascular accidents(22.0%) were most frequent. 12) Overall mortality during the last 6 years was 2.8%(9cases). Causes of death were cerebrovascular accidents(88.9%) and diabetes mellitus(11.1%).