Metabolic Syndrome Causes Cardiovascular Disease under Stable Statin Medication

OBJECTIVE: Statins are known to prevent only 30–50% of cardiovascular disease(CVD) by reducing low-density lipoprotein cholesterol (LDL-C). There is a controversy about whether metabolic syndrome(MS) can increase the risk of CVD. The aim of this study is to investigate whether MS can increase the risk of CVD, even after LDL-C is ideally controlled by taking statins. METHODS: As a retrospective observational study, we investigated CVD events of 909 patients (61.3±10.2 years old) by reviewing medical records for at least 1 year before and after taking statins respectively, from June 2005 to February 2008, and analyzed the risk factors of CVD. RESULTS: During the study period (881.4±232.8 days), 46 cases of CVD events occurred in patients with a very high risk of CVD and in patients with a high risk of CVD. In patients with a very high risk of CVD, 56.8% (21 cases over 37) of CVD events occurred in patients who achieved LDL-C goal (< 70 mg/dL). A total of 9 events developed among high risk patients who reached LDL-C goal (< 100 mg/dL). The patients with MS revealed significantly higher rates of CVD events [p=0.015; hazard ratio (HR) 3.033; 95% confidence interval (CI) 1.184–7.768]. Significantly higher rates of CVD events were also found in subgroup analysis of the patient with a past history of CVD events [p=0.017; HR 3.431; 95% CI 1.183–9.956]. Similar pattern was demonstrated in patients with diabetes [p=0.049; HR 2.738; 95% CI 0.963–7.782]. Cox regression analysis identified metabolic syndrome [p=0.025; HR 5.237; 95% CI 1.235–22.204], a past history of CVD events [p=0.000; HR 5.349; 95% CI 2.321–12.327], basal LDL-C level [p=0.024; HR 1.013; 95% CI 1.002–1.025] and total cholesterol level after statin therapy [p=0.024; HR 0.978; 95% CI 0.959–0.997] as independent predictors of CVD among LDL-C goal achieved patients. CONCLUSION: Metabolic syndrome is the independent risk factor of CVD events in high risk patients with or without a past history of CVD events or diabetes. In these patients, statins could not prevent CVD events effectively.

Preoperative Coronary Stenosis Is a Determinant of Early Vascular Outcome after Carotid Endarterectomy

BACKGROUND AND PURPOSE: The benefit of carotid endarterectomy (CEA) is directly influenced by the risk of perioperative adverse outcomes. However, patient-level risks and predictors including coronary stenosis are rarely evaluated, especially in Asian patients. The aim of this study was to determine the relationship between the vascular risk factors underlying CEA, including coronary stenosis, and postoperative outcome. METHODS: One hundred and fifty-three consecutive CEAs from our hospital records were included in this analysis. All patients underwent coronary computed tomography angiography before CEA. Data were analyzed to determine the vascular outcomes in patients with mild-to-moderate vs. severe coronary stenosis and high vs. standard operative risk, based on the criteria for high operative risk defined in the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial. The vascular outcome was defined as the occurrence of postoperative (< or =30 days) stroke, myocardial infarction (MI), or death. RESULTS: An adverse vascular outcome occurred in 8 of the 153 CEAs, with 6 strokes, 2 MIs, and 3 deaths. The vascular outcome differed significantly between the groups with mild-to-moderate and severe coronary stenosis (p=0.024), but not between the high- and standard-operative-risk groups (stratified according to operative risk as defined in the SAPPHIRE trial). Multivariable analysis adjusting for potent predictors revealed that severe coronary stenosis (odds ratio, 6.87; 95% confidence interval, 1.20-39.22) was a significant predictor of the early vascular outcome. CONCLUSIONS: Severe coronary stenosis was identified herein as an independent predictor of an adverse early vascular outcome.

Brachioaxillary Artery Thromboembolism and Multiple Cerebral Infarction Manifested as Left Hand Clumsiness and Paresthesia

No abstract available.

Codelivery of IL-7 Augments Multigenic HCV DNA Vaccine-induced Antibody as well as Broad T Cell Responses in Cynomolgus Monkeys

BACKGROUND: A crucial limitation of DNA vaccines is its weak immunogenicity, especially in terms of eliciting antibody responses in non-human primates or humans; therefore, it is essential to enhance immune responses to vaccination for the development of successful DNA vaccines for humans. METHODS: Here, we approached this issue by evaluating interleukin-7 (IL-7) as a genetic adjuvant in cynomolgus monkeys immunized with multigenic HCV DNA vaccine. RESULTS: Codelivery of human IL-7 (hIL-7)-encoding DNA appeared to increase DNA vaccine-induced antibody responses specific for HCV E2 protein, which plays a critical role in protecting from HCV infection. HCV-specific T cell responses were also significantly enhanced by codelivery of hIL-7 DNA. Interestingly, the augmentation of T cell responses by codelivery of hIL-7 DNA was shown to be due to the enhancement of both the breadth and magnitude of immune responses against dominant and subdominant epitopes. CONCLUSION: Taken together, these findings suggest that the hIL-7-expressing plasmid serves as a promising vaccine adjuvant capable of eliciting enhanced vaccine-induced antibody and broad T cell responses.

Clinical outcomes according to coronary calcium scores in asymptomatic individuals undergoing coronary CT angiography / 대한내과학회지

BACKGROUND/AIMS: In general, multidetector computed tomography (MDCT) is not recommended as a screening tool for asymptomatic individuals. However, the programs for general health evaluation at several hospitals in Korea include MDCT to detect cardiac disease. The objectives of this study were to evaluate the clinical outcomes of asymptomatic individuals according to the coronary artery calcium score (CACS) obtained from screening MDCT and to assess the eligibility of risk stratification in the NCEP-ATP III guidelines for predicting a significant stenosis on MDCT. METHODS: We reviewed the medical records of 845 asymptomatic subjects (age 53+/-9 years, 67% men) who underwent MDCT as part of a general health evaluation at Asan Medical Center, Seoul, Korea, from January to December 2008. RESULTS: Atherosclerotic plaques were identified in 332 (39.3%) subjects. Sixty (7.1%) individuals had significant stenosis (> or = 50% diameter stenosis). The prevalence of significant stenosis was higher in the group that had more than a 10% risk of coronary heart disease (CHD) at 10 years (p or = 110 was associated with a significantly higher rate of coronary revascularization in asymptomatic patients with significant stenosis on MDCT.

A Case of Idiopathic Thrombocytopenic Purpura in a Patient with Behcet's Disease / 대한류마티스학회지

In Behcet's disease, thrombocytopenia has rarely been reported in association with the hemolytic uremic syndrome, thrombotic thrombocytopenic purpura or in association with cyclosporine or chlorambucil in the treatment of ocular inflammatory disease and meningoencephalitis. In this paper we report a case of thrombocytopenia in a 33-year-old female with Behcet's disease who has taken no medications for three years. After history taking, physical examination, routine laboratory and bone marrow examination, we diagnosed her case as idiopathic thrombocytopenic purpura (ITP). She recovered with high dose steroid treatment. To our knowledge, this is the first report having ITP in a patient with Behcet's disease.

Liver Abscess Caused by Gemella morbillorum / 대한소화기학회지

Gemella morbillorum, an anaerobic-to-aerotolerant Gram-positive coccus, is a normal flora of the oral cavity, respiratory tract, urogenital organ and gastrointestinal tract, and infections caused by this organism are unusual. It has been associated mainly with endocarditis and bacteremia, and rarely with arthritis, spondylodiscitis, meningitis, brain abscess and septic shock. Liver abscess caused by G. morbillorum is very rare, and only a few cases were reported. We experienced a case of liver abscess by G. morbillorum in a 56-year-old woman presented with fever. We report this case with a review of literatures.

Choledocho-duodenal Fistula Caused by Tuberculosis / 대한소화기내시경학회지

Choledocho-duodenal fistula is a rare condition. It is usually developed as a complication of the gallstone disease, and rarely developed by penetrating peptic ulcer, trauma and neoplasm. Tuberculosis as a etiology of choledocho-duodenal fistula is very rare, and only a few cases were reported. We experienced a case of choledocho-duodenal fistula due to tuberculous lymphadenitis in a 26 year-old man presented with epigastric pain. After 6 months of anti-tuberculous medication, He was free of symptom and the fistula was closed spontaneously. We report the case with a review of literatures.

A Case of Subphrenic Abscess with Ileal Fistula Caused by Metastatic Adenocarcinoma of Unknown Origin / 대한소화기학회지

Usual sources of subphrenic abscess with intestinal fistula are previous abdominal operation, inflammatory bowel disease and malignancy. Reported cases of intestinal fistula caused by adenocarcinoma were complicated by direct invasion. In this report, a 70-year-old male had a subphrenic abscess with intestinal fistula and the cause was a metastatic adenocarcinoma of unknown origin. As far as we know, this has not been reported previously in the literatures. The abscess went on chronic course for six months because intermittent administration of antibiotics modified its clinical presentation. The fistulous tract between the abscess and ileum was demonstrated by tubogram via the drainage catheter in abscess. The patient underwent surgical treatment because the cause of fistula was obscure. Invasion of the ileum by metastatic adenocarcinoma was diagnosed by the histologic examination of surgical specimen. Therefore, when a fistula develops without any apparent cause, there is a possibility of malignancy, and surgical approach must be considered. An early surgical approach will prevent the delay in treatment and reduce the mortality.

A Case of Biliary Obstruction Secondary to Shrapnel / 대한소화기내시경학회지

Obstructive jaundice primarily results from choledocholithiasis, neoplasm, inflammation and infection such as primary sclerosing cholangitis, postsurgical stricture, AIDS cholangiopathy, extrinsic compression of the biliary trees. However, obstructive jaundice secondary to foreign bodies is rare. Especially, shrapnel induced biliary obstruction is very rare and has never been reported in Korea. We report a patient who had biliary obstruction due to metal shrapnel. He had shrapnel injury 52 year ago during the Korean War. For a long time, he had had no symptoms. He was admitted to our hospital for epigastric pain and jaundice. Abdominal CT scan showed a metallic foreign body in the common bile duct. The patient underwent ERCP, and the shrapnel and several stones were successfully extracted with a basket.