Infectivity and Pathogenicity of Hepatitis A Virus during an Outbreak in a Communal Living Setting / 대한내과학회지

BACKGROUND/AIMS: Acute viral hepatitis A infection in adults is an emerging public health problem in Korea. The infectivity and pathogenicity of hepatitis A virus (HAV) among people living in close contact have not been studied previously. This study investigated the secondary attack rate and pathogenicity rate of HAV during an outbreak among auxiliary police in a communal living setting in Korea. METHODS: A total of 70 people in close contact with a hepatitis A patient (index case) were enrolled in the study, which included a thorough oral history, physical examination, and laboratory testing. The subjects were part of an auxiliary police unit living in a communal setting (HAV contact group). Serum antibody titers were measured in the contact group at two points during the study. Subjects in another auxiliary police unit without exposure to hepatitis A were examined as a control group (HAV non-contact group). The secondary attack rate and pathogenicity rate were calculated from the data. RESULTS: In the HAV non-contact group, none of the subjects had anti-HAV antibodies. In the HAV contact group, three subjects had both IgM and IgG anti-HAV antibodies, and two had only IgG anti-HAV antibodies. Two of three HAV-infected subjects were treated for hepatitis A. CONCLUSIONS: The secondary attack rate of HAV was 4.3~7.1% and the pathogenicity rate was 40~66.7% in the group of young adults.

Causes and clinical characteristics of syncope in combat and auxiliary police in Korea / 대한내과학회지

BACKGROUND/AIMS: The most common type of syncope in young adults is neurocardiogenic in origin, which is not related to organic problems and has a benign nature. Therefore, there have been few reports regarding syncope in young Korean adults. Here, we examined the causes of syncope and its clinical characteristics in young combat and auxiliary police in Korea. METHODS: We performed a retrospective study of the medical records of 193 combat and auxiliary police in Korea admitted to the National Police Hospital for syncope or presyncope between January 2004 and December 2007. RESULTS: The subjects' mean age was 21+/-1.2 years, and there were 2.8+/-2.9 episodes of syncope (mean+/-SEM). The first syncope occurred after enlistment in the police in 102 patients (52.8%). Basic diagnostic studies showed two cases of elevated creatine phosphokinase and one case of anemia to be related to syncope. Syncope-related traumatic injuries occurred in 38 patients (19.7%), and syncope was more prevalent in the summer. Head-up tilt test was performed in 175 of the 193 patients, and 123 showed a positive response. Other evaluations, including brain magnetic resonance imaging, electroencephalography, and echocardiography, were not helpful for diagnosis. Syncope was neurocardiogenic in origin in the majority of cases. Other causes of syncope were exhaustion (n=2), hyperventilation syndrome (n=2), Meniere's disease (n=1), anemia (n=1), and psychiatric problems (n=5). The causes of syncope could not be identified in 59 patients (30.5%). CONCLUSIONS: Neurocardiogenic syncope was the most common type in our study population. More than half of our patients experienced their first episode after enlisting with the police. Further studies in these groups are necessary.

AIDS Diagnosed in the Course of Managing Duodenal Fistula Caused by Tuberculosis: A Case Report / 감염과화학요법

Extrapulmonary tuberculosis, such as intestinal tuberculosis, has become more common with the increase in human immunodeficiency virus infection. However, the diagnosis and treatment of intestinal tuberculosis are often delayed because the symptoms are nonspecific and diverse. We experienced a case of AIDS with intestinal tuberculosis that manifested as a duodenal fistula. The presence of AIDS should be suspected in patients who have extrapulmonary tuberculosis with atypical presentations.

AIDS Diagnosed in the Course of Managing Duodenal Fistula Caused by Tuberculosis: A Case Report / 감염과화학요법

Extrapulmonary tuberculosis, such as intestinal tuberculosis, has become more common with the increase in human immunodeficiency virus infection. However, the diagnosis and treatment of intestinal tuberculosis are often delayed because the symptoms are nonspecific and diverse. We experienced a case of AIDS with intestinal tuberculosis that manifested as a duodenal fistula. The presence of AIDS should be suspected in patients who have extrapulmonary tuberculosis with atypical presentations.

Rhabdomyolysis due to hyponatremia in a patient taking benzodiazepines / 대한내과학회지

Hyponatremia is rarely reported to cause rhabdomyolysis and there has been only one case report on rhabdomyolysis due to hyponatremia, possibly complicated by benzodiazepines. We experienced a case of rhabdomyolysis due to hyponatremia during the use of benzodiazepines in a patient with an acute psychosis. A 60-year-old man was admitted to the emergency room due to altered mentality. He had been taking benzodiazepines for 1 month because of insomnia, uneasiness, and depression. His initial blood chemistry revealed severe hypotonic hyponatremia in the absence of polydipsia, edema, and features of dehydration. While correcting the hyponatremia, rhabdomyolysis developed with no evidence of trauma, seizures, or tremor. In patients with acute psychosis, the development of rhabdomyolysis due to hyponatremia or its correction should not be underestimated and should be assessed thoroughly. Clinicians also need to be aware of the potential risk of benzodiazepines for the development of rhabdomyolysis.

Incidence and Seroprevalence of Hepatitis A Virus among Korean Auxiliary Police Officers / 감염과화학요법

BACKGROUND: In Korea, cases with hepatitis A have been reported to Korea Centers for Disease Control and Prevention through the sentinel surveillance system. However, it was difficult to study the exact nation-wide incidence of hepatitis A infection. We studied the incidence of clinically apparent hepatitis A infection and the seroprevalence of anti-HAV IgG among auxiliary police officers. MATERIALS AND METHODS: We analyzed clinically apparent and hospitalized hepatitis A patients from 2002 to 2006 in National Police Hospital via medical records. We also measured anti-HAV IgG antibody from 507 auxiliary police officers. RESULTS: The estimated annual incidence of clinically apparent hepatitis A infection among auxiliary police officers was 10.6-14.8 cases per 100,000 population from 2002 to 2006. The overall anti-HAV IgG seropositive rate among auxiliary police officers was 0.6% (3/507). CONCLUSION: Among auxiliary police officers, the estimated annual incidence of clinically apparent hepatitis A infection was above 10 cases per 100,000 population and the positive rate of anti-HAV IgG was very low. The results were comparable to those in the low endemicity countries. The routine HAV vaccination among auxiliary police officers might be suggested.

Incidence and Seroprevalence of Hepatitis A Virus among Korean Auxiliary Police Officers / 감염과화학요법

BACKGROUND: In Korea, cases with hepatitis A have been reported to Korea Centers for Disease Control and Prevention through the sentinel surveillance system. However, it was difficult to study the exact nation-wide incidence of hepatitis A infection. We studied the incidence of clinically apparent hepatitis A infection and the seroprevalence of anti-HAV IgG among auxiliary police officers. MATERIALS AND METHODS: We analyzed clinically apparent and hospitalized hepatitis A patients from 2002 to 2006 in National Police Hospital via medical records. We also measured anti-HAV IgG antibody from 507 auxiliary police officers. RESULTS: The estimated annual incidence of clinically apparent hepatitis A infection among auxiliary police officers was 10.6-14.8 cases per 100,000 population from 2002 to 2006. The overall anti-HAV IgG seropositive rate among auxiliary police officers was 0.6% (3/507). CONCLUSION: Among auxiliary police officers, the estimated annual incidence of clinically apparent hepatitis A infection was above 10 cases per 100,000 population and the positive rate of anti-HAV IgG was very low. The results were comparable to those in the low endemicity countries. The routine HAV vaccination among auxiliary police officers might be suggested.

A Case of Liddle's Syndrome in a Seventy One-year Old Woman / 대한신장학회잡지

Liddle's syndrome is a rare inherited disease with characteristic clinical manifestations of hypertension and hypokalemic metabolic alkalosis. Markedly suppressed serum aldosterone and renin levels are important laboratory findings to differentiate this disorder from primary hyperaldosteronism. When Liddle et al. reported the disorder in 1963, they proposed aggressive Na+ absorption and increased excretion of K+ as the pathogenesis of the syndrome. Since then, specific mutation in the epithelial Na+ channel located in the collecting duct of the kidney has been elucidated as a disease mechanism. Liddle's syndrome is inherited by an autosomal dominant trait and generally the onset of the syndrome is before the age of 20 with increased risk of premature death due to stroke or heart failure. Recently, however, a few cases of late onset and genetically proven nonfamilial cases with de novo mutation of beta or gamma Na+ channel have been reported. We report a case of seventy-one year old woman who had hypertension with hypokalemic metabolic alkalosis and was diagnosed as Liddle's syndrome. Further evaluation revealed low serum renin and aldosterone levels. Primary aldosteronism, Cushing's syndrome, glucocorticoid remediable aldosteronism and deficiency of 11beta-OHase and 17alpha-OHase were ruled out based on her laboratory data and history. Her hypertension and hypokalemia responded to amiloride treatment but not to spironolactone.

A Case of Alport's Syndrome in an Adult / 대한신장학회잡지

Alport's syndrome is a hereditary disorder whose incidence is 1 in 10,000 in general population, and, majority are developed in childhood, so it is rare to develop in adults. This syndrome consists of hematuria, sensorineural hearing loss, and lenticonus, in classic form. However, there are many atypical forms which have not all clinical manifestations. Although most asymptomatic hematuria in adults results from IgA nephropathy(Berger's disease) or thin basement disease(benign hematuria), Alport's syndrome should be considered as a cause of hematuria. The authors experienced a case of Alport's syndrome in a 21-year-old man who showed only hematuria and proteinuria, and who was diagnosed by history, family history, audiogram, and kidney needle biopsy. So, we report this case with a review of literature.

The Evaluation of Gallbladder Function by Tc-99m-DISIDA Scintigraphy in Diabetic Patients / 대한내과학회지

OBJECTIVES: Diabetic autonomic neuropathy is a common complication of long standing diabetes mellitus and is well known to induce the motor dysfunction of cardiovascular system, genitourinary system and diges tive system. Although many studies have done to eval uate the diabetic autonomic neuropathy, gallbladder motor function and biliary dynamic study to evaluate the change of gallbladder function in diabetic patients is relatively rare. This study was performed to measure the gall bladder ejection fraction using Tc- 99m-DISIDA with fatty meal in order to evaluate the gallbladder motor func tion in diabetic patients and to examine the usefulness of it in analyzing diabetic autonomic neuropathy. METHODS: 51 diabetic patients(males 31, females 18, mean age 57yr(39-77yr)) and 18 control subjects(males 14, females 4, mean aged 47yr(31-70yr)) without gall stone and impaired liver function were enrolled in our study. Also the diabetic patients were categorized by age, disease duration, body weight and diabetic complications such as retinopathy, peripheral neuropathy and cardiovas cular autonomic neuropathy accompanying with or not. RESULTS: 1) Median value and interquartile range of gallbladder ejection fraction(%) were 66%(48-79%) in diabetic pa tients group and 75%(64-80%) in control subjects. There was no statistically significant difference between the two groups, but the mean value of diabetic patients was slightly lower than that of control subjects. 2) There was no significant difference between the two groups in mean value of gallbladder ejection fraction in every age group(P>0.05). 3) Median value of gallbladder ejection fraction in diabetic groups with less than 10 years of duration (both under 5 years and 5 to 10 years groups) was similar to that of control subjects. However in patients whose diabetic conditions last more than 10 years, the median range of gallbladder ejection fraction was significantly lower than that of control subjects(p0.05). Also seven diabetic patients whose gallbladder ejection fraction was reduced under 35% have had at least two diabetic complications. CONCLUSION: We observed that gallbladder ejection fraction of diabetic patients was reduced compared with that of control subjects. This is due to the reduced gallbladder muscle contractility resulting from diabetic autonomic dysfunction. These results suggest that the assessment of gallbladder ejection fraction using 99m- Tc-DISIDA would be useful to diagnose diabetic auto nomic neropathy.