An experimental asthma exacerbation following discontinuation of inhaled corticosteroids treatment in patients with controlled asthma / 천식및알레르기

BACKGROUND: It has been recognized that cessation of treatment with inhaled corticosteroids evokes a recurrence of symptoms in most asthmatics within a month. OBJECTIVE: To examine whether a useful model of asthma for studies on effects of new antiasthmatic drugs can be induced by discontinuation of inhaled corticosteroids treatment. METHOD: Twenty five patients with controlled asthma on inhaled corticosteroids were enrolled in this study. Spirometric measurements were performed before and 2 weeks after cessation of treatment with inhaled budesonide. Peak expiratory flow rates(PEFR), asthma symptom scores, and short-acting inhaled beta2 agonist requirements were checked during 2-week period before and during 2-week period after the cessation of inhaled budesonide. RESULTS: Discontinuation of treatment with inhaled budesonide resulted in significant falls in FEV1, and morning and evening PEFRs, and significant increase in diurnal variability of PEFR (40% of patients showed diurnal variability of > or = 20%). Their symptom scores and the days required for salbutamol use were also significantly increased. However, the mean fall in FEV1 was 6.9% and the maximum fall 29%, and a significant fall (> or =15%) occurred in only 29% of patients. CONCLUSION: These findings demonstrate that asthma exacerbation can be safely induced by discontinuation of treatment with inhaled corticosteroids in controlled asthmatics, suggesting that this experimental model of mild asthma exacerbation can be used for studying the effects of new antiasthmatic drugs.

Clinical Characteristics of Lower Gastrointestinal Bleeding / 대한소화기내시경학회지

BACKGROUND AND AIMS: The frequency of different etiologies of lower gastrointestinal bleeding varies by a number of factors including patient age, the severity of bleeding evaluated, the diagnostic method, and the institution. There were few reports on the clinical analysis of lower gastrointestinal bleeding in Korea. Therefore, this study was conducted to evaluate the frequency of various etiologies, diagnostic methods, and the management of patients with lower gastrointestinal bleeding. METHODS: 474 patients with lower gastrointestinal bleeding who were admitted to Samsung Medical Center from September 1994 to April 1998 were reviewed. The inclusion criteria were as follows: 1) age at least 15 years, and 2) patients whose bleeding was attributed to a lesion distal to the ligament of Treitz. The age and sex distribution, etiology, diagnostic methods, treatment, and transfusion were checked. RESULTS: 474 patients (261 males and 213 females) met the inclusion criteria. The average age of the patients was 51 years old. The etiologies of bleeding were as follows: colorectal cancer, 43%; anorectal disease, 32%; inflammatory bowel disease, 6.6%; ischemic colitis, 5%; miscellaneous, 6%; and unknown, 7.4%. Colonoscopy was the most commonly employed diagnostic modality and was used in 245 (52%) patients of the study group. Other tests included sigmoidoscopy in 136 (29%), barium enema in 90 (19%), small bowel radiography in 24, radionuclide bleeding scans in 8, and mesenteric angiography in 7. Patients who improved with conservative and medical treatment were 29%, and 71% required surgery. Patients who required a transfusion were 37%. 139 patients (68.8%) with diagnosed malignant neoplasm received a transfusion. CONCLUSIONS: The incidence of lower gastrointestinal bleeding was high in old age. Colorectal cancer was the most common cause and required surgery. Colonoscopy was a valuable diagnostic tool for the evaluation of lower gastrointestinal bleeding.

Unolateral Aldosterone-producing Adenoma with a Contralateral Black Adenoma / 대한내분비학회지

Primary aldosteronism due to unilateral adenoma is a rare cause of surgically curable hypertension. Bilateral adrenal mass has occasionally been reported in this syndrome, and bilateral aldosterone-producing adenoma (APA), or bilateral adrenal nodular hyperplasia have been demonstrated in some cases. However, another possibility is the coexistence of a unilateral APA with a contralateral benign or metastatic nonfunctioning mass, because adrenal tumors are frequently found at autopsy or incidentally detected during abdominal morphological evaluation in patients without adrenal dysfunction. A 39 year-old woman presented with hyperaldosteronism, suppressed renin levels, and bilateral adrenal mass on adrenal CT scanning. Selective adrenal venous sampling was unsuccessful in demonstrating concentration gradient of aldosterone. Postoperative measurement of hormone content in the tumor extract revealed unilateral aldosteron-producing adenoma with contralateral nonfunctioning black adenoma, Determination of hormone content in the tumor extract could be useful for the discrimination of functioning and nonfunctioning endocrine tumors, particularly in case of multiple tumors.

A Case of Infective Endocarditis Complicated with Mycotic Aneurysm of Superior Mesenteric Artery / 감염

Mycotic aneurysm of mesenteric artery is an uncommon complication of infective endocarditis. Early diagnosis is important and surgical intervention is often needed for effective treatment of mycotic aneurysm of mesenteric artery because of the high incidence of aneurysmal rupture. We experienced a case of infective endocarditis complicated with mycotic aneurysm of the superior mesenteric artery in a 54-year old man, who was admitted because of pain on the right lower quadrant of abdomen. Echocardiography showed mitral regurgit-ation and vegetations on the mitral valve and viridans streptococcus was identified from blood cultures. He was successfully treated with ceftriaxone and gentamicin for the initial 2 weeks, then ceftriaxone alone for two weeks more without surgical intervention. To our knowledge, this is the first case of infective endocarditis complicated with superior mesenteric artery aneurysm in Korea.

A Case of Endocarditis Caused by Pasteurella multocida Complicated with Cerebral Infarction / 감염

In recent years, an increasing number of infections with Pasteurella multocida in human have been reported, causing a wide range of systemic illness. Infective endocarditis with P. multocida, however, is still quite rare. Recently we experienced a case of P. multocida endocarditis in a 26-year old man who was admitted because of fever and headache. He denied any recent contact with animals. P. multocida was identified from blood cultures and echocardiography showed mitral regurgitation and vegetation on mitral valve area. He became stuporous on the fourth hospital day and the brain MRI showed acute cerebral infarction. He was treated with penicillin intravenously for six weeks, which successfully controlled clinical features of infections. To our knowledge, this is the first case of P. multocida endocarditis complicated with cerebral infarction in Korea.