Search PubMed⌕ Search

Biomedical subjects

J H Juang

Publications and source records attributed to J H Juang.

12 recordsLinked to original sources
PubMed1992

[Cushing's syndrome with pregnancy. Report of three cases].

Cushing's syndrome with pregnancy is rare, and only about 60 cases have been reported. In the recent 4 years, 3 cases were diagnosed in Chang Gang Memorial Hospital. They presented with serious maternal complications early in the second month of pregnancy, including hypertension, proteinuria and lower leg edema. Unfortunately it was not diagnosed until the 20th week of pregnancy. They had the same hormone profile as other Cushing's syndrome patients who were not pregnant. Under the supportive treatment they had outcomes of two premature deliveries and one still birth. Just after delivery all patients received left adrenalectomy and pathology showed adenoma. All of them had good recovery courses. According to the literature, early treatment (surgical operation, medical treatment, or irradiation) could decrease maternal morbidity and fetal loss rate.

Adult↗
PubMed1992

[Pituitary apoplexy: a study of eighteen cases].

Pituitary Apoplexy is a rare but sometimes life threatening condition which requires prompt recognition and timely medical intervention to avoid catastrophic consequences. From January 1979 to June 1989 and total of one hundred and ninety eight pituitary tumor patients were operated on our hospital. Eighteen cases (9.1%) were diagnosed "pituitary apoplexy" according to histopathological findings. The group consisted of twelve men and six women ranging in age from twenty two to sixty one years with a mean of forty. There were three cases of prolactin-secreting adenomas (16.7%), four growth-hormone secreting adenomas (22.2%), and eleven nonfunctional adenomas (61.1%) with an incidence of 6.1%, 8.3%, and 11.4% respectively (P > 0.05). Clinical manifestation occurred acutely in 66.7% and nonacutely in 33.3%. The patients presented with headaches (100%), visual impairment (83.3%), visual field defects (66%), disturbed consciousness (22%), fever and meningismus (11%). Radiological examinations able to demonstrate abnormalities included plain skull films (84%), computed tomography (84.6%), and angiography (93.8%). Various investigations of endocrine function pre and post operatively showed a deficient gonad axis (53%, 62.5%), adrenal axis (26.7%, 56.2%), and thyroid axis (20%, 43.8%). Sixteen cases received a transsphenoid operation and three cases underwent a transfrontal craniotomy. No case of mortality was reported. Postoperative radiotherapy was given to nine cases and nine cases were followed up on a regular basis. Therefore, our retrospective study suggests that pituitary apoplexy is not uncommon and has an acute clinical presentation. No particular tumor type was prone to occur. Various radiological examinations could define perisellar abnormalities. With a decreasing order of hormone deficiency, gonad, adrenal and thyroid axis were observed during the course of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

C-peptide response to glucagon in patients with non-insulin-dependent diabetes mellitus.

To understand pancreatic beta cell function in patients with non-insulin-dependent diabetes, we analyzed C-peptide response to glucagon in 101 nonketotic patients with onset of diabetes at over 25 years of age and duration of diabetes of more than one year. The fasting serum C-peptide values (FCP), maximal incremental (delta CP) and 6-minute (6'CP) serum C-peptide values after 1 mg of intravenous glucagon administration were not related to age at diagnosis (r = 0.12, 0.06 and 0.10, respectively), duration of diabetes (r = 0.15, 0.05 and 0.10, respectively), fasting plasma glucose concentrations (r = 0.01, 0.18 and 0.12, respectively) or glycohemoglobin (HbA1c, r = 0.13, 0.22 and 0.16, respectively). In contrast, they showed a clear positive correlation with body mass index (BMI, r = 0.36, 0.52 and 0.41, p < 0.001). In order to evaluate the beta cell function in patients with different responses to treatment modalities, a subgroup of 45 patients was divided into three groups: diet successes (DS, n = 14), oral hypoglycemic agent (OHA) successes (OS, n = 19) and OHA failure (OF, n = 12). Among the three groups, patients in the OF group had the longest duration of diabetes (9.4 +/- 1.9 years) and the lowest BMI (19.3 +/- 1.0 kg/m2). Serum C-peptide responses to glucagon were different in the three study groups. Patients in the DS group had the highest response and patients in the OF group had the lowest response. However, the differences in mean FCP, delta CP and 6'CP among the three groups were not statistically significant, and there was a wide overlap of individual C-peptide values.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Agranulocytosis associated with anti-thyroid drug in patients with Graves' thyrotoxicosis--report of 11 cases.

Retrospective analysis of 11 Chinese patients with Graves' thyrotoxicosis developing agranulocytosis during anti-thyroid treatment was done. Seven of them received methimazole and 4 received carbimazole. None of the 11 patients had taken propylthiouracil. The major chief complaints were high fever (100%), chillness (91%), and sore throat (73%). The duration of drug treatment prior to the detection of agranulocytosis ranged from 13 to 63 days (mean +/- 1SE: 33.1 +/- 16.1). At the time of agranulocytosis detected, the peripheral leukocyte counts were 0.5 to 2.1 X 1000/mm3 (mean +/- 1SE: 1.05 +/- 0.47 X 1000/mm3), absolute neutrophil counts 0 to 450/mm3 (mean +/- 1SE: 54.27 +/- 132.12/mm3), and hemoglobin 8.2 to 15.9 g/dl (mean +/- 1SE: 11.85 +/- 2.24 gm/dl). Three of the 11 patients had positive bacterial blood cultures. The recovery time of absolute neutrophil counts above 500/mm3 ranged from 3 to 25 days (mean +/- 1SE: 10.5 +/- 6.6) after discontinuation of antithyroid drugs. Mortality was found in 2 of them (18%).

Adolescent↗
PubMed1990

Insulin autoimmune syndrome as a cause of hypoglycemia--report of four cases.

Insulin autoimmune syndrome is a syndrome consisting of fasting hypoglycemia, hyperinsulinemia and detectable insulin-binding antibodies in patients who have never been exposed to exogenous insulin. Four cases who developed symptoms of hypoglycemic attack with self-limited duration and spontaneous remission were collected in our hospital from 1984 to 1988. The elevated serum total and free insulin and C-peptide levels, as well as the titer of insulin autoantibodies, decreased gradually; but insulin autoantibodies were still present in the serum for more than six months after the initial episodes of hypoglycemia. Three of four patients had Graves' disease and developed the syndrome after methimazole treatment. The fourth one had a history of hemorrhagic cystitis and denied history of specific drug exposure. The cause or stimulus for insulin autoantibody formation is still unknown, but drugs containing a sulfhydryl group like methimazole may play a role in the development of the syndrome. Extremely high insulin antibodies in patients with fasting hypoglycemia along with elevated serum levels of insulin and C-peptide suggest a diagnosis of insulin autoimmune syndrome and usually exclude the possibility of insulinoma or factitious hypoglycemia.

Adult↗
PubMed1990

Effect of dietary therapy on pancreatic beta cell function in noninsulin-dependent diabetes mellitus.

UNLABELLED: Twenty-four noninsulin-dependent diabetics, who were newly diagnosed or had discontinued therapy for at least 10 months, were studied for the effect of dietary therapy on pancreatic beta cell function. The mean fasting plasma glucose (176 +/- 14 vs 212 +/- 16 mg/dl, p less than 0.01) and glycosylated hemoglobin (HbA1c, 8.6 +/- 0.5 vs 9.4 +/- 0.6%, p less than 0.001) decreased significantly after 1 month of dietary control, although there was no significant change in mean body weight (57.4 +/- 2.0 vs 57.7 +/- 2.0 kg, p greater than 0.5). The mean incremental serum C-peptide (delta CP) response to oral glucose stimulation (OGTT) increased (4.6 +/- 0.6 vs 3.5 +/- 0.7 ng/ml, p less than 0.01), but that to intravenous glucagon (GT) did not (2.5 +/- 0.2 vs 2.7 +/- 0.2 ng/ml, p greater than 0.1). In 12 patients whose glycemic control improved after dietary treatment, there was a good correlation between the decrement in fasting plasma glucose and the increment in delta CP response to OGTT (r = 0.66, p less than 0.05). IN CONCLUSION: after 1 month of dietary therapy in noninsulin-dependent diabetics, (1) the serum C-peptide response to OGTT, but not to GT, improved; (2) the beta cell secretion increased only in those patients with improved glycemic control; (3) there was a good correlation between glycemic control and beta cell function.

Adult↗
PubMed1990

Outcome following radioactive iodine therapy in Graves' disease.

One hundred and fifty three patients with Graves' hyperthyroidism treated with I-131 from March 1984 to September 1988 were analyzed. The dose of I-131 was given according to the formula: 100 microCi/gm x estimated thyroid size (gm) x 100/24 hr I-131 uptake (%) The mean dose was 5.41 mCi and the maximum dose was 7 mCi. After one year of follow up, 45 patients (29.4%) were euthyroid, 35 patients (22.9%) became hypothyroid, and 73 patients (47.7%) were persistently hyperthyroid. Discriminant analysis of pretreatment variables suggested that those patients who were still hyperthyroid at the end of the first year had significantly larger goiter size, and higher serum T4 and T3 levels. Men had greater incidence of relapse. Besides, those who had received antithyroid drug before I-131 therapy had a significantly higher incidence of failure. As compared with previous studies, our report had a significantly higher incidence (22.9%) of hypothyroidism one year after I-131 therapy, which may be due to recognition of subclinical hypothyroidism through TSH assay.

Adult↗
PubMed1990

Bone changes in hyperthyroidism--a preliminary study.

Thyrotoxicosis may cause osteopenia and lead to increased risk of fractures. From July 1988 to March 1989, 88 hyperthyroid patients and 65 age, sex matched normal controls were enrolled for lumbar spine bone mineral density (BMD) study. Significantly lower BMD values can be found in premenopausal hyperthyroid women (1.233 gm/cm2 vs 1.317 gm/cm2, p less than p less than 0.05). In the group of thyrotoxicosis, no linear correlation can be found between BMD and the degree of hyperthyroidism (N = 84, r = 0.01 and N = 74, r = 0.054 as comparing BMD to T4 and T3, respectively). After treatment with antithyroid drugs (ATD) for 3 months, BMD did not change significantly (1.258 gm/cm2 vs 1.242 gm/cm2, p = 0.02) in the hyperthyroid patients. Therefore, premenopausal hyperthyroid women have lower BMD than premenopausal euthyroid women. The treatment of hyperthyroidism after 3 months' course did not increase lumbar spine BMD.

Adult↗
PubMed1989

C-peptide response to glucagon in young diabetics.

Pancreatic beta cell function was measured in 15 nondiabetic controls, 10 insulin-dependent diabetics (IDD) and 19 non-insulin-dependent diabetics (NIDD), aged 18 to 45 years, by means of the peripheral serum C-peptide response to 1 mg of glucagon. The fasting serum C-peptide (FCP) in IDD was lower than in the controls and NIDD (p less than 0.01), but there was no significant difference between the controls and NIDD (p greater than 0.05). The maximal in crement of serum C-peptide (delta CP) after glucagon stimulation in the controls was higher than in IDD and NIDD (p less than 0.01), and there was a gap between IDD (less than or equal to 0.69 ng/ml) and NIDD (1.20 ng/ml). During the glucagon test, serum C-peptide concentrations were highest in the first 15 minutes unlike plasma glucose which reached its highest value between 20 and 40 minutes. NIDD, either obese or nonobese, had a lower mean delta CP value than did controls. In the controls, IDD and NIDD, the FCP was correlated well with delta CP (r = 0.61, 0.93 and 0.59) but not with fasting plasma glucose (r = 0.19, -0.08 and 0.23). During the glucagon test, the mean maximal increments of plasma glucose were between 52.5 and 62.5 mg/dl. Nausea was the main complaint in 19 (43%) of the subjects but it was mild and transient. In conclusion, measuring serum C-peptide response after glucagon stimulation is a simple and safe test which may be a discriminative method to establish insulin dependency in young diabetic patients.

Adolescent↗
PubMed1989

HLA-A,B,C and DR antigens in Chinese with non-insulin-dependent diabetes: comparison with goitrous diabetics.

To examine the relationship between HLA antigens and Type 2 non-insulin-dependent diabetes (NIDDM), 72 patients were studied and compared with 282 controls. Twenty of 72 patients had an associated non-toxic goiter. The clinical features of the goitrous diabetic patients were similar to those without goiter except that those with goiter were predominantly female (95%). Of the 46 antigens assayed, only A10 was increased in the 72 diabetics when compared with the controls (12.5 vs 5.7%, RR = 2.37, chi 2 = 4.07, p less than 0.05), but statistically this was not significant after p value correction. In the patients with goiter, antigens A2, A9, A10, B27, BW46, CW1, DR1, DR5, DR8, DRW9 showed 2 folds or greater differences in frequencies when compared to the non-goitrous diabetics. However, only A2 had a significant decrease in the former as compared with the latter (30.0 vs 59.6%, chi 2 = 5.07, p less than 0.05), but this was also statistically insignificant. The present study showed no significant HLA associations in Chinese NIDDM patients with or without non-toxic goiter, and the distribution of each antigen was not related to the presence or absence of goiter.

Adult↗
PubMed1988

Effect of time on measurement of hepatic glucose production.

Basal hepatic glucose production (HGP) was determined in obese and nonobese normal subjects and patients with noninsulin-dependent diabetes mellitus (NIDDM) using [3-3H]glucose and the nonsteady state equations of Steele. When HGP was estimated at hourly intervals from 0800-1300 h, it became evident that calculated values for HGP fell for the first 2-4 h until a plateau was reached, and this decline was quite precipitous during the first 2 h in patients with NIDDM. Furthermore, when the same patient with NIDDM was studied on two occasions, similar values for HGP were not uniformly obtained unless measurements were made at least 4 h after [3-3H] glucose administration. Since it has been the convention to use the nonsteady state equations of Steele to calculate HGP in patients with NIDDM 2 h after [3-3H] glucose administration, it is almost certain that published values for HGP in patients with NIDDM are falsely high. Based upon the data presented, we suggest that HGP using [3-3H]glucose and the nonsteady state Steele equations be measured for at least a 4-h period in patients with NIDDM in order to increase the validity of the calculated value.

Diabetes Mellitus, Type 2↗