ABSTRACT
Lung toxicity associated with cyclophosphamide use is a rare but serious side effect, that may result in a fatal course. However no such cases have been reported in Korea, so clinicians would not be alert to this adverse effect. We recently experienced a woman with Wegener's granulomatosis and idiopathic pulmonary fibrosis. This patient had been administered 12 grams of cyclophosphamide for 4 months. At that time of admission, She felt aggravating dyspnea on exertion for 2 weeks. Her chest x-ray and high resolution CT revealed aggravated reticular opacities and ground glass appearances. Dyspnea was improved and ground glass appearances on HRCT was disappeared after discontinuation of cyclophosphamide. We diagnosed this case as cyclophosphamide-induced pneumonitis and report it with a brief review of the literature.
Subject(s)
Female , Humans , Cyclophosphamide , Drug-Related Side Effects and Adverse Reactions , Dyspnea , Glass , Idiopathic Pulmonary Fibrosis , Korea , Lung , Pneumonia , Thorax , Granulomatosis with PolyangiitisABSTRACT
BACKGROUND: Irbersatan, an orally active antihypertensive agent, effectively reduce blood pressure by directly blocking angiotensin II receptors without any significant adverse effects. The purpose of this study is to evaluate the efficacy and safety of irbesartan in patients with mild to moderate hypertension. METHODS: This study enrolled 83 patients who had diastolic pressure above 95 mmHg and below 110 mmHg on two measurements. Sixty eight patients were administered 150mg of irbesartan, an angiotensin II receptor blocker, daily for four weeks as an initial dosage. If the sitting diastolic pressure was equal to or greater than 90 mmHg after a 4 week treatment period, the dosage was doubled until the end of 8 weeks. Baseline pressures, antihypertensive effect, side effects, laboratory findings were compared before and after treatment. RESULTS: Fourty two patients out of 53 patients having completed this study showed decreased blood pressure equal to or more than 5 mmHg of the sitting diastolic pressure (response rate=79%). Twenty one patients out of 53 patients showed normalized blood pressure below 90 mmHg of the sitting diastolic pressure (normalization rate=40%). The extent of decrease in diastolic and systolic blood pressure after eight week treatment was an average 11.7+/-10.1 mmHg and 16.3+/-18.9 mmHg, respectively (p<0.05). Nineteen ontoward side effects was observed in 17 patients out of 68 patients with medication (frequency of ontoward effects=25%). Only one case with headache was considered to be related to the medication. Abnormal laboratory findings were observed in eight patients, and only one case with elevation of bilirubin and ALT levels was considered to be related to the medication. CONCLUSION: In conclusion, irbesartan is a safe and effective antihypertensive drug in patients with mild to moderate hypertension with tolerable side effects.
Subject(s)
Humans , Bilirubin , Blood Pressure , Headache , Hypertension , Receptors, AngiotensinABSTRACT
Since amyloidosis is usually diagnosed later in the disease process, a high index of suspicion is therefore necessary for earlier diagnosis. Confirmative diagnosis rests on a biopsy of the involved organ. Gastrointestinal amyloidosis causes a variety of symptoms including intestinal obstruction, ulcers, malabsorption, hemorrhaging, protein loss, diarrhea, anorexia, nausea, vomiting, and dysphagia. We confirmed amyloid deposits in the stomach in three patients with epigastric pain through a biopsy of erosive gastritis documented on a gastrofiberscopy. One patient with primary amyloidosis which had invaded his kidney, stomach, and heart, expired, although aggressive treatment with a pacemaker insertion, peritoneal dialysis, and ventilator care was performed. Another patient with multiple myeloma died on the 38th day, after having started systemic chemotherapy. The other patient with secondary amyloidosis due to rheumatoid arthritis, is currently receiving colchicine at our out patient clinic.
Subject(s)
Humans , Amyloidosis , Anorexia , Arthritis, Rheumatoid , Biopsy , Colchicine , Deglutition Disorders , Diagnosis , Diarrhea , Drug Therapy , Gastritis , Heart , Intestinal Obstruction , Kidney , Multiple Myeloma , Nausea , Peritoneal Dialysis , Plaque, Amyloid , Stomach , Ulcer , Ventilators, Mechanical , VomitingABSTRACT
The sheaths of tendons are an uncommon site of tuberculous invclvement as compared to other parts of the body. But tuberculou, tenosynovitis occurs often enough to varrant particular attention and study. We report a case of tuberculous tenosynovitis occuring in a 49-year-old woman who had multiple yellowish palpable nodules and swellings distributed along the tencon of flexor digitorum superficialis on the left palm for 3 month. Histopathologic findings showed multip e tuberculoid granulomas in the mid-and deep-dermis. Eosinophilic homogenous trabeculated structure(remnants of tendon sheath resistant to necrosis) was present within the area of caseation. Acid-fast stain showed a crowd of acid-fast bacilli in the deep dermis. The cultures from the skin biopsy spec mens on Ogawa media(3% KH PO4) at 24C, 32C and 37C were all negative. She was treated with surgical excision of granulation tissue and involved tendon sheath followed by systemic administration of INH, RIF and ethambutol for 1 year. The lesions were markedly improved and showed no relaps, during last 5 months of follow up period.