Predictive factors for long-term survival after a platelet glycoprotein IIb/IIIa receptor blocker (Abciximab; ReoPro(R)) in patients undergoing high-risk percutaneous coronary intervention in acute myocardial infarction / 대한내과학회지

BACKGROUND: High-risk percutaneous coronary interventions (PCI) are associated with high complication rate, low procedural success rate and high restenosis rate. we analyzed the predictive factors of major adverse cardiac events (MACE) after administration a platelet glycoprotein IIb/IIIa receptor blocker (Abciximab; Reo-Pro(R)) in Korean patients with acute myocardial infarction (AMI) underwent high-risk PCI. METHODS: One hundred twenty-seven AMI patients with 158 lesion sites were administered ReoPro(R) who underwent high-risk PCI out of 3,532 patients at Chonnam National University Hospital between March 1999 and December 2001. The patients were divided into two groups: 94 patients without major adverse cardiac event (MACE) (Group I, 60.0 +/- 10.2 years, 73 male), and 33 patients with MACE (Group II, 59.8 +/- 9.7 years, 26 male) during clinical follow-up of 25.2 +/- 10.4 months duration. RESULTS: The primary success rate was 91.3% (116/127). Clinical follow-up was performed in 97.6% of patients. The MACE were developed in 33 cases (26.0%) composed of 8 deaths (6.3%) and 5 AMI (3.9%). There was no major bleeding after PCI. Prevalence of diabetes, target lesion artery, ACC/AHA types and inflammatory marker were not different between the two groups. The predictive factors of MACE by multiple logistic regression analysis were incidence of multi-vessel disease and Thrombolysis In Myocardial Infarction (TIMI) flow grade 0-1 after PCI in group II than in group I (p=0.036, 0.033, respectively). CONCLUSION: Multi-vessel lesion and low TIMI flow after high-risk PCI were associated with MACE in AMI patients treated on ReoPro(R) during long-term clinical follow-up.

A case of Sulfone syndrome hypersensitivity associated with dapsone / 천식및알레르기

Sulfone hypersensitivity syndrome, which is characterized by fever, skin rash, hemolytic anemia, atypical lymphocytosis, and acute hepatic injury, is a potentially fatal variant of dapsone hypersensitivity. A 62-year-old woman with a history of arthralgia developed sulfone syndrome while receiving dapsone 100 mg/day for 20 days. Fever, malaise, prominent rashes, hepatitis, eosinophilia and hemolytic anemia developed and she which required hospitalization. The patient's symptoms reversed following discontinuation of dapsone and administration of steroid (0.5 mg/kg). A case of sulfone syndrome and a brief review of the literature were presented.

Prediction of head-up tilt test result in patients with syncope of unknown origin / 대한내과학회지

BACKGROUND: Vasovagal syncope has been believed to account for the majority of syncope of unknown origin (SUO). Head-up tilt test (HUT) has been well recognized as a useful test in the evaluation of SUO. The purpose of this study was to determine the predictors of HUT to develop a less time-consuming test protocol and get an information on the pathophysiology of vasovagal syncope. METHODS: Eighty five patients (mean age, 43+/-18 years: 47 men, 38 women) underwent a 80 degree HUT without or with isoproterenol infusion (2 migcrogram/min and 5 migcrogram/min, each for 6 minutes) for unexplained syncope or pre-syncope. Positive HUT was defined as symptomatic hypotension (systolic blood pressure or = 10 seconds) or asystole > or = 3 seconds. The patients were divided into two groups according to the result of the HUT: Group I included 47 patients (M:F=25:22) with positive result, Group II, 38 patients (M:F=22:16) with negative result. RESULTS: Group I patients had more episodes of syncope than Group II (3.1+/-2.5/year vs. 2.0+/-2.1/year, p<0.05). There were no significant differences between the 2 groups in the heart rate (HR), systolic and diastolic blood pressure (BP) at the baseline supine position. BP after tilt was not significantly different between 2 groups except for systolic BP at 6 minutes after tilt, which was significantly lower in Group I than Group II (109.5+/-17.5 mm Hg vs. 118.1+/-18.2 mm Hg, p<0.05).However, HR after tilt was significantly faster in Group I than Group II (81.1+/-15.1/min vs. 74.2+/-14.9/min, p<0.05 at 2 minutes after tilt; 83.7+/-14.4/min vs. 74.6+/-14.7/min, p<0.01 at 4 minutes after tilt). The increase in HR was greater in Group I than Group II (19.9+/-12.6/min vs. 12.8+/-10.6/min, p<0.001). In the prediction of positive HUT with HR rise above 14/min during the early 6 minute of baseline head-up tilting, the specificity, sensitivity, and positive predictive value were 63.2%, 70.2%, and 70.2%, respectively. CONCLUSION: In patients with SUO, positive HUT can be predicted with the early HR response during head-up tilt. This result shows that vasovagal syncope is triggered by exaggerated HR response to the decreased venous return and allow us to develop a less time-consuming HUT protocol.

Allergic bronchopulmonary aspergillosis with coexistent aspergilloma / 천식및알레르기

A 61-year-old woman with a history of asthma and pulmonary tuberculosis was presented with purulent bloody sputum. She was treated as having lung abscess initially, but her signs and symptoms did not improve with traditional therapy. Finally, in the clinical course and laboratory data during hospitalization, she was diagnosed as ABPA with coexistent aspergilloma. Thereafter she was treated with itraconazole for aspergilloma, and corticosteroid for ABPA. The symptoms of hemoptysis and dyspnea were improved. A case of ABPA with coexistent aspergilloma and a brief review of the literature were presented.

Imported tertian malaria resistant to primaquine

In Plasmodium vivax and Plasmodium ovale malaria, some of the liver stage parasites remain dormant. The activation of these dormant forms (called hypnozoite) can give rise to relapse weeks, months or years after the initial infection. To prevent relapses, a course of primaquine may be given as terminal prophylaxis to patients. Different strains of Plasmodium vivax vary in their sensitivity to primaquine and, recently, cases of relapse of Plasmodium vivax after this standard primaquine therapy were reported from various countries. We reported a case of primaquine resistant malaria which initially was thought to be relapsed caused by loss of terminal prophylaxis.

A Case of Thyrotoxic Periodic Paralysis Presenting as Ventricular Tachycardia / 대한내분비학회지

sociated with hyperthyroidism occurs in 2.0% of Graves disease and is characterized by myasthenia or bilateral flaccid paralysis of lower extremity, in some cases, it may be accompanied with cardiac arrhythmias which are mostly due to hypokalemia. The most common type of cardiac arrhythmias associated with hyperthyroidism is sinus tachycardia, 1015% of patients have atrial fibrillation. Rarely, ventricular tachycardia or ventricular fibrillation develop and lead to cardiac arrest in severe case. A 26-year-old man was admitted to the hospital because of weakness of lower extremity. The initial EKG showed ventricular tachycardia. The laboratory results were, TSH 0.08 microunit/mL, free T4 4.11 ng/mL, T3 2.88 ng/mL, serum K 1.9 mEq/L. He was diagnosed as ventricular tachycardia associated with hypokalemic thyrotoxic periodic paralysis. His symptoms improved during the treatment with propylthiouracil and potassium replacement. We report a case of thyrotoxic periodic paralysis presenting as ventricular tachycardia with brief review of literatures.

MR Findings of Degenerating Parenchymal Neurocysticercosis

PURPOSE: To evaluate MR imaging findings of degenerating parenchymal neurocysticercosis and to determine the characteristics which distinguish it from other brain diseases. METHODS: MR imagings of 19 patients (56 lesions)of degenerating parenchymal neurocysticercosis were retrospectively evaluated, focusing on the size and locationof lesions, signal intensity patterns of cyst fluid and wall, the extent of the surrounding edema and features of contrast enhancement. RESULTS: Degenerating parenchymal neurocysticercosis was located in gray or subcortical white matter in 89.3% of 56 lesions(50/56); most of these (98.2%) were smaller than 2cm in diameter. Cyst fluidsignal was hyperintense relative to CSF on T1 and proton density weighted images (92.9%). A hypointense signal rimof the cyst wall was noted in the lesions on proton density (92.9%) and T2 weighted (98.2%) images. Surrounding edema was mostly mild. Peripheral rim enhancement was noted in all lesions, and this was frequently irregular and lobulated (67.9%) with a focal defect in the enhancing rim (41.1%). CONCLUSION: Findings which could be helpfulin distinguishing degenerating parencymal neurocysticerosis from other brain diseases are as follows : small, superficial lesions ; hyperintense signal of the cyst fluid on T1 and proton density weighted images ; hypointense signal of the cyst wall on proton density and T2 weighted images ; relatively mild extent of surrounding edema,and peripheral rim enhancement which is frequently irregular and lobulated with a focal defect in the enhancingrim.

Hepatoid Adenocarcinoma of the Stomach: A Case Report

Hepatoid adenocarcinoma of the stomach is a gastric carcinoma with both adenocarcinomatous and hepatocellular carcinomatous differentiation. It usually produces large amount of serum alpha-fetoprotein. It often occurs in aged person, commonly located in the gastric antrum. Because of early lymph node and liver metastasis, prognosis is poor. A case of hepatoid adenocarcinoma of the stomach in a 49-year-old man is reported. The patient's serum alpha-fetoprotein level was high(3380ng/ml). Liver function test was normal, otherwise. A mass was observed in right lobe of the liver on US and CT. It was hypervascular with increased uptake of lipiodol on hepatic arteriography. A large ulcerative tumor involving the gastric antrum and body was also found at barium study of the stomach. Subtotal gastrectomy and right Iobectomy of the liver resulted in rapid decrease in serum alpha-fetoprotein. Histopathologically the diagnosis was hepatoid adenocarcinoma of the stomach with liver metastasis.

Hepatoid Adenocarcinoma of the Stomach: A Case Report

Hepatoid adenocarcinoma of the stomach is a gastric carcinoma with both adenocarcinomatous and hepatocellular carcinomatous differentiation. It usually produces large amount of serum alpha-fetoprotein. It often occurs in aged person, commonly located in the gastric antrum. Because of early lymph node and liver metastasis, prognosis is poor. A case of hepatoid adenocarcinoma of the stomach in a 49-year-old man is reported. The patient's serum alpha-fetoprotein level was high(3380ng/ml). Liver function test was normal, otherwise. A mass was observed in right lobe of the liver on US and CT. It was hypervascular with increased uptake of lipiodol on hepatic arteriography. A large ulcerative tumor involving the gastric antrum and body was also found at barium study of the stomach. Subtotal gastrectomy and right Iobectomy of the liver resulted in rapid decrease in serum alpha-fetoprotein. Histopathologically the diagnosis was hepatoid adenocarcinoma of the stomach with liver metastasis.

Benign Clustered Microcalcifications on Mammography: Comparison with Malignant Calcifications

PURPOSE: To evaluate morphologic characteristics of the clustered microcalcifications in benign lesions and to compare with that of malignant lesions. MATERIALS AND METHODS: We retrospectively reviewed 33 patients with clustered microcalcifications( five calcifications in number per square centimeter)on mammography. We analyzed mammographic findings with regard to shape, size, number/cm2, irregularity of size and shape, presence of central lucency, and accompanied mass density. RESULTS: Of 12 benign lesions, the most frequent shape was dot or round form (4/12, 33.3%) followed by ring form (3/12, 25%). The size was smaller than 0.5mm in 5 patients (41.7%), 0.5-1 mm in one and more than 1 mm in 6 patients(50%). The number of calcifications per square centimeter were five to ten in 41.7%, more than ten in 58.3%. Of all 21 malignant lesions, the most frequent shape was branching form (8/21, 38.1%). The sizes of calcification were less than 0.5ram in 76.1%(16/21). Central lucency within the calcification was seen only in benign lesions (3/14, 21%). Irregularity ih size and shape of calcifictions was noted in both benign and malignant lesions. Accompanied parenchymal mass density was more commonly associated with malignant lesions(80. 9%) than benign lesions(58.3%). CONCLUSION: Our results suggest that benign clutered microcalcifications on mammography could be differentiated from malignant calcifications with the criteria of larger size, central lucency and infrequent accompanied mass.

Benign Clustered Microcalcifications on Mammography: Comparison with Malignant Calcifications

PURPOSE: To evaluate morphologic characteristics of the clustered microcalcifications in benign lesions and to compare with that of malignant lesions. MATERIALS AND METHODS: We retrospectively reviewed 33 patients with clustered microcalcifications( five calcifications in number per square centimeter)on mammography. We analyzed mammographic findings with regard to shape, size, number/cm2, irregularity of size and shape, presence of central lucency, and accompanied mass density. RESULTS: Of 12 benign lesions, the most frequent shape was dot or round form (4/12, 33.3%) followed by ring form (3/12, 25%). The size was smaller than 0.5mm in 5 patients (41.7%), 0.5-1 mm in one and more than 1 mm in 6 patients(50%). The number of calcifications per square centimeter were five to ten in 41.7%, more than ten in 58.3%. Of all 21 malignant lesions, the most frequent shape was branching form (8/21, 38.1%). The sizes of calcification were less than 0.5ram in 76.1%(16/21). Central lucency within the calcification was seen only in benign lesions (3/14, 21%). Irregularity ih size and shape of calcifictions was noted in both benign and malignant lesions. Accompanied parenchymal mass density was more commonly associated with malignant lesions(80. 9%) than benign lesions(58.3%). CONCLUSION: Our results suggest that benign clutered microcalcifications on mammography could be differentiated from malignant calcifications with the criteria of larger size, central lucency and infrequent accompanied mass.