Coronary Spastic Angina and Life Threatening Arrhythmia despite Nitroglycerine Infusion / 이화의대지

Variant angina pectoris is characterized by chest symptoms at rest and transient ST elevation on the electrocardiography due to coronary artery spasm. Although most patients with coronary spasm respond well to medical treatment with vasodilators such as calcium channel blockers and nitrates, some patients show intractable attack of coronary vasospasm despite standard medical therapy. We experienced 50-year-old woman with intractable chest pain due to coronary artery spasm, who suffered from ventricular fibrillation despite continuous intravenous nitrate therapy.

Polyp Clearance via Operative and Endoscopic Polypectomy in Patients With Peutz-Jeghers Syndrome After Multiple Small Bowel Resections

Peutz-Jeghers syndrome is an autosomal dominant inherited disease that manifests as a combination of mucocutaneous pigmentation and gastrointestinal hamartomatous polyps that usually cause intussusception and intestinal hemorrhage. We report the case of a 40-year-old male patient who was diagnosed 20 years ago and had previously undergone 3 intestinal resection surgeries. This time, with the use of combined operative and endoscopic polypectomy, more than 100 polyps were removed. This technique is useful for providing a "clean" small intestine that allows the patient a long interval between laparotomies and reduces the complications associated with multiple laparotomies and resections.

Incidence of and Risk Ractors for Zolpidem-Induced Delirium / 대한내과학회지

BACKGROUND/AIMS: Zolpidem is a safe and effective drug for the treatment of insomnia. However, there are some reports of adverse effects, such as delirium, after administration of zolpidem. The aim of this study was to evaluate the incidence of and risk factors for zolpidem-induced delirium. METHODS: This retrospective study enrolled 481 patients who were admitted to hospital and received zolpidem between January and May 2011. We analyzed the incidence and risk factors associated with zolpidem-induced delirium. RESULTS: Zolpidem-induced delirium occurred in 19 of 481 (4.0%) patients. Zolpidem-induced delirium was significantly associated with old age (> or = 65 years; odds ratio [OR] = 4.35, 95% confidence interval [CI] = 1.52-12.44, p = 0.006) and co-administration of benzodiazepine (OR = 4.30, 95% CI = 1.52-12.12, p = 0.006). When males > 65 years-old took both benzodiazepine and zolpidem simultaneously, the incidence of delirium was notably elevated (OR = 6.04, 95% CI = 1.80-20.20, p = 0.003). Other factors, including dosage, did not influence the occurrence of delirium. CONCLUSIONS: Old age and co-administration of benzodiazepine were independent risk factors for zolpidem-induced delirium. Therefore, a detailed medical history should be taken before prescribing zolpidem to an older person, and zolpidem should be used cautiously, with careful monitoring, in these patients.

Safety and Efficacy of Modern Insulin Analogues

BACKGROUND: A1chieve(R) was a noninterventional study evaluating the clinical safety and efficacy of biphasic insulin aspart 30, insulin detemir, and insulin aspart. METHODS: Korean type 2 diabetes patients who have not been treated with the study insulin or have started it within 4 weeks before enrollment were eligible for the study. The patient selection and the choice of regimen were at the discretion of the physician. The safety and efficacy information was collected from the subjects at baseline, week 12, and week 24. The number of serious adverse drug reactions (SADRs) was the primary endpoint. The changes of clinical diabetic markers at week 12 and/or at week 24 compared to baseline were the secondary endpoints. RESULTS: Out of 4,058 exposed patients, 3,003 completed the study. During the study period, three SADRs were reported in three patients (0.1%). No major hypoglycemic episodes were observed and the rate of minor hypoglycemic episodes marginally decreased during 24 weeks (from 2.77 to 2.42 events per patient-year). The overall quality of life score improved (from 66.7+/-15.9 to 72.5+/-13.5) while the mean body weight was slightly increased (0.6+/-3.0 kg). The 24-week reductions in glycated hemoglobin, fasting plasma glucose and postprandial plasma glucose were 1.6%+/-2.2%, 2.5+/-4.7 mmol/L, and 4.0+/-6.4 mmol/L, respectively. CONCLUSION: The studied regimens showed improvements in glycemic control with low incidence of SADRs, including no incidence of major hypoglycemic episodes in Korean patients with type 2 diabetes.

A Case of Secondary Gout Associated with Essential Thrombocythemia

Gouty arthritis is a metabolic disorder characterized by hyperuricemia, deposition of monosodium urate crystal in the joints, and recurrent episodes of acute inflammatory arthritis. Depending on the actual causes of hyperuricemia, gout is classified as primary or secondary gout. In myeloproliferative neoplasms, a turnover of nucleic acids is greatly augmented and therefore the blood concentration of uric acid may be markedly increased. But an acute attack of gout is extremely rare in patients with myeloproliferative neoplasms. Essential thrombocythemia, one of the myeloproliferative neoplasms, is characterized by megakaryocytic hyperplasia in bone marrow and marked thrombocytosis. We report a case of secondary gout in a 66-year-old man with essential thrombocythemia.

Treatment of Hypercholesterolemia in Elderly Patients; From the Viewpoint of Statins

No abstract available.

Electron microscopic observation of Chlamydia pneumoniae / 대한임상병리학회지

BACKGROUND: Chlamydia pneumoniae causes pneumonia and upper respiratory tract infection and has been recently reported to be associated with coronary atherosclerosis. The difference between C. pneumoniae and other Chlamydia spp. has been demonstrated by serologic study, DNA analysis and ultrastructural observation. However, studies concerning the developmental cycle of C. pneumoniae are relatively short. This study was conducted to investigate the morphological changes and developmental characteristics of C pneumoniae in the HeLa cell. METHODS: To observe the intracellular inclusion of C. pneumoniae, the cultured HeLa cell monolayer was stained with Jones' iodine and Giemsa. The ultrastructures were examined with an electron microscope at 6, 24, 48, 72 and 96 hr after inoculation of elementary bodies. RESULTS: The C. pneumoniae organisms which formed intracytoplasmic inclusion bodies in HeLa cells were negative on iodine stain. In Giemsa-stained preparation, the inclusion bodies of variable sizes with a bluish purple color were identified in the cytoplasm of infected HeLa cells. After 6 hrs of infection, the elementary bodies with electron-dense spicule shaped substance of C. pneumoniae were enclosed by the HeLa cell membrane and were taken the host cell by endocytosis. After 24 hrs of infection, the electron-dense material in the elementary bodies were disappearing and the elementary bodies were transforming into reticulate bodies. After 48 hrs of infection, the reticulate bodies of C. pneumoniae were seen dividing by binary fission. Small electron-dense round bodies(miniature bodies) appeared near completion of division. After 72 hrs of infection. about half of the reticulate bodies were transformed into elementary bodies. Newly formed elementary bodies had a pear-shaped structure and large periplasmic space. After 96 hrs of infection. mature elementary bodies with condensed electron-dense material and a rigid outer membrane were observed. Miniature bodies were located in the cytoplasm of the elementary bodies. CONCLUSIONS: These unique morphological changes in HeLa cell culture show the developmental characteristics of C. pneumoniae.