Aloe-induced Toxic Hepatitis

Aloe has been widely used in phytomedicine. Phytomedicine describes aloe as a herb which has anti-inflammatory, anti-proliferative, anti-aging effects. In recent years several cases of aloe-induced hepatotoxicity were reported. But its pharmacokinetics and toxicity are poorly described in the literature. Here we report three cases with aloe-induced toxic hepatitis. A 57-yr-old woman, a 62-yr-old woman and a 55-yr-old woman were admitted to the hospital for acute hepatitis. They had taken aloe preparation for months. Their clinical manifestation, laboratory findings and histologic findings met diagnostic criteria (RUCAM scale) of toxic hepatitis. Upon discontinuation of the oral aloe preparations, liver enzymes returned to normal level. Aloe should be considered as a causative agent in hepatotoxicity.

A case of pituitary resistance to thyroid hormone with nonfunctioning pituitary microadenoma / 대한내과학회지

Resistance to thyroid hormone (RTH) is an autosomal dominant disorder that's characterized by inappropriate normal or elevated TSH levels despite of the elevated thyroid hormone levels. RTH is distinguished from the TSH secreting pituitary adenoma by performing the TRH stimulation test, TSH alpha subunit measurement and sellar MRI. A 23 year old woman visited our hospital complaining of fatigue, palpitation and heat intolerance and she had an anterior neck mass. She had elevated total T3, free T4 and TSH levels. The serum TSH levels were increased during the TRH stimulation test before and after T3 suppression. The serum TSH alpha subunit showed a normal response and the serum TSH alpha subunit/TSH molar ratio did not increase over 1.0 with TRH stimulation. Thyroid hormone receptor beta gene mutation was identified. Although a left pituitary microadenoma was revealed on sellar MRI, the patient was diagnosed as having pituitary RTH with a nonfunctioning pituitary microadenoma. We report here on a patient with pituitary RTH and a nonfunctioning pituitary microadenoma, and this is the first such case in Korea.

A case of transient mid-ventricular ballooning syndrome / 대한내과학회지

Transient left ventricular apical ballooning syndrome is also known as takotsubo cardiomyopathy, and this is characterized by transient wall-motion abnormalities involving the left ventricular apex without significant stenosis on the coronary angiogram. We report here on a new variant of transient left ventricular ballooning in which only the mid-ventricle was affected. The patient initially presented with dyspnea and she had wall-motion abnormalities involving the mid-ventricle with hypercontractility of the apical and basal segments in the absence of a significant coronary artery stenosis. Emotional or physical stress or other preceding triggering factors might play a key role in this cardiomyopathy, but the precise etiology remains unknown. So far, the cases of this syndrome have been reported only among the North America Caucasian population and the Japanese population.

Rates and Related Factors of Progression to Hypertension among Prehypertensive Local Residents Aged 45 or Over in Chuncheon City: Hallym Aging Study from a Community-Based Cross-Sectional Study

BACKGROUND AND OBJECTIVES: Prehypertension (preHT) is considered to a precursor of hypertension and it is a predictor of excessive cardiovascular risk. We investigated the rates and determinants of progression to hypertension (HT) among local residents aged 45 or over, and we compared the differences in demographic factors, anthropometric measurements, life styles and metabolic profiles between the progression individuals and non-progression individuals. SUBJECTS AND METHODS: Data from the Hallym Aging Study, which was conducted 3 years apart were used to form the sample of 489 adults. PreHT was defined by the Joint National Committee (JNC-7) criteria. We conducted interviews to determine the life style (alcohol, smoking and exercise) and the measured obesity indices. The metabolic profiles were fasting blood sugar (FBS), cholesterol, triglyceride and high density lipoprotein (HDL)-Cholesterol. The factors related to progression to HT were examined by using multiple logistic regression analysis. RESULTS: The progression rate to HT was 56.4% (56.9% in men, 55.9% in women). The presence of metabolic syndrome was significantly greater and the body mass index (BMI) and systolic blood pressure were significantly higher in the progression group compared with the non-progression group (p=0.0475, p=0.0099, p=0.0082, respectively). Important determinants of progression to HT are a BMI> or =25 kg/m(2) [odds ratio (OR): 2.26, 95% confidence interval (CI): 1.02-5.22] and a diastolic blood pressure of 85-89 mmHg (OR: 6.11, CI: 1.55-24.13). Changes of FBS (deltaFBS) and pulse pressure (deltaPP) according to a time interval of 3 years are the significant related factors (OR: 3.40, CI: 1.04-11.13 and OR: 9.40, CI: 2.19-40.12, respectively). CONCLUSION: PreHT frequently progresses to HT over a period of 3 years. A higher BMI and diastolic blood pressure at the index survey are significantly related to progression. deltaFBS and deltaPP are also important determinants. Therefore, early recognition of preHT and intensive life style modification are needed to prevent progression to HT.

Comparison of the hemostatic effect between argon plasma and heat probe for peptic ulcer bleeding / 대한내과학회지

BACKGROUND/AIMS: Endoscopic heat probe coagulation (HP) and argon plasma coagulation (APC) are considered to be safe and effective for the treatment of peptic ulcer bleeding. The aim of this study was to evaluate the efficacy and safety of APC and HP for treating bleeding peptic ulcer. METHODS: Between May 2004 and November 2006 we conducted a prospective randomized trial on 99 patients with peptic ulcer bleeding and for whom a visible vessel or active bleeding was identified. The patients were randomized into two groups: the APC group that was comprised of 56 patients who received argon plasma coagulation and HP group that was comprised of 43 patients who received heat probe coagulation. RESULTS: There were no significant differences between the study groups in terms of age, risk factors, the initial hemoglobin values, the number of patients who showed signs of hemodynamic impairment, the location of ulcer and the bleeding activity. The initial hemostatic rate was 89.3% in the APC group and 93% in the heat probe group (p=0.521). After successful initial endoscopic treatment, rebleeding was observed in 4 cases of the APC group (7.1%) and in 4 cases of heat probe coagulation group (9.3%). CONCLUSIONS: Argon plasma coagulation and heat probe coagulation are equally effective for controlling bleeding from peptic ulcer.

The Efficacy of Cimetropium Bromide as a Premedication before Esophagogastroduodenoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: Cimetropium bromide has been used widely as a premedication for endoscopy; however, there are no subjective data pertaining to the effects of cimetropum bromide as a premedication. Thus, the current study was undertaken to compare the effects of cimetropum bromide with placebo as a premedication for esophagogastroduodenoscopy (EGD). METHODS: Two hundred ninety-nine consecutive outpatients who had undergone EGD were enrolled in this study. Thirty minutes before EGD, the patients were randomly given an intramuscular injection of cimetropium bromide (5 mg) or saline using a placebo-controlled, double-blind, randomized technique. Immediately after EGD, all the patients and endoscopists were requested to fill out the questionnaire form. RESULTS: One-hundred patients were injected with cimetropium bromide and 150 patients were injected with placebo. There was no statistically significant difference in the degree of residual gastric secretions, the peristaltic activity detected by endoscopists, and the comfort experienced by the patients in each study group. CONCLUSIONS: The intramuscular injection of cimetropium bromide (5 mg) as a premedication for EGD was not significantly superior to placebo, at least with respect to subjective parameters, in spite of its broad use.

Prevalence and clinical characteristics of gastroesophageal reflux disease and reflux esophagitis in chuncheon city-Health care examination study / 대한내과학회지

BACKGROUND/AIMS: The aims of this study were to estimate the frequency of symptoms of gastroesophageal reflux disease and reflux esophagitis, to evaluate the difference in characteristics among groups subdivided by symptoms, and to compare clinical features between a reflux esophagitis group and a non reflux esophagitis group in Chuncheon City. METHODS: A total of 1,011 persons who underwent endoscopy for health check up were enrolled between July 1, 2005, and June 30, 2006. All persons were given a validated, self reported questionnaire, which inquired about the presence, frequency, and severity of typical symptoms (heartburn and acid regurgitation) and atypical symptoms. The questionnaire also inquired about smoking, alcohol intake, and Helicobacter pyroli eradication. The subjects were subdivided into typical symptomatic, atypical symptomatic, no discomfort, and asymptomatic groups. RESULTS: The prevalence of heartburn and acid regurgitation occurring at least weekly was 7.5%. Reflux esophagitis, hiatal hernia, smoking, and alcohol intake were more common in males (p<0.05). Ninety eight cases (9.7%) were endoscopically diagnosed as reflux esophagitis, and sixty nine cases (6.8%) were endoscopically suspected esophageal metaplasia (ESEM). Subjects in the symptomatic group more frequently manifested reflux esophagitis than subjects in the asymptomatic group (p<0.05). CONCLUSIONS: The presence of reflux induced symptoms is related to reflux esophagitis, but the intensity and frequency of symptoms are poor predictors of the presence or severity of endoscopic mucosal breaks.

A Case of Severe Acute Respiratory Distress Syndrome Treated with Extracorporeal Life Support / 결핵및호흡기질환

The incidence of acute respiratory distress syndrome (ARDS) has been estimated worldwide to range from 1.7 to 75 cases per 100,000. There are many treatments for ARDS, but only the low tidal volume strategy is based on strong clinical evidence from randomized clinical trials. The efficacy of extracorporeal life support (ECLS) in adults remains controversial. Ongoing clinical trials and research have shown a benefit for its use to salvage severe ARDS patients that are in failure with conventional treatment. We encountered a 41-year-old woman who developed ARDS induced by pneumococcal pneumonia. Despite conventional mechanical ventilation in the emergency room, severe hypoxia remained. We treated the patient immediately with ECLS. The patient has almost fully recovered, and was discharged from a 177-day stay at our hospital.

A Case of Severe Acute Respiratory Distress Syndrome Treated with Extracorporeal Life Support / 결핵및호흡기질환

The incidence of acute respiratory distress syndrome (ARDS) has been estimated worldwide to range from 1.7 to 75 cases per 100,000. There are many treatments for ARDS, but only the low tidal volume strategy is based on strong clinical evidence from randomized clinical trials. The efficacy of extracorporeal life support (ECLS) in adults remains controversial. Ongoing clinical trials and research have shown a benefit for its use to salvage severe ARDS patients that are in failure with conventional treatment. We encountered a 41-year-old woman who developed ARDS induced by pneumococcal pneumonia. Despite conventional mechanical ventilation in the emergency room, severe hypoxia remained. We treated the patient immediately with ECLS. The patient has almost fully recovered, and was discharged from a 177-day stay at our hospital.

Clinical Characteristics and Prognosis of Acinetobacter Nosocomial Pneumonia between MDR and non-MDR / 결핵및호흡기질환

BACKGROUND: Acinetobacter baumannii has emerged as an important nosocomial pathogen worldwide. The incidence of these infections has recently begun to increase. The mortality rate associated with these infections is high (bacteremia; 52% , pneumonia: 23%~73%) and multidrug resistance has been reported. For the effective control of multidrug- resistant Acinetobacter baumannii(MDR-AB), the impact of these organisms in clinical practice should be determined. This study compared the clinical characteristics, mortality and morbidity of Acinetobacter nosocomial pneumonia between MDR strain and non-MDR strain. METHODS: From Jan. 1, 2002 to Nov. 1. 2004, 47 adult patients with Acinetobacter nosocomial pneumonia in Chuncheon Sacred Heart Hospital were recruited and analyzed retrospectively. MDR-AB was defined as showing in vitro resistance to all commercially available antibiotics against A. baumannii. RESULTS: There were 47 patients with Acinetobacter nosocomial pneumonia. MDR-AB and non MDR-AB was the cause of the pneumonia in 17 and 30 patients, respectively. Mean age of the former was 69+/-11 years old and the latter was 70+/-13 years old. The mean APCHE II score, ICU days and mortality were not different between the two groups(16.1+/-5.4 vs. 14.9+/-4.8, P=0.43, 25.1+/-13.6 vs. 39.1+/-31.0, P=0.2, 58.8% vs. 40%, P=0.21). CONCLUSION: There are no significant differences in mortality and morbidity between MDR and non-MDR Acinetobacter baumannii. The mortality of the two groups is surprisingly high, therefore proper infection control practices are essential.

The comparision of the quality of life between the well controlled hypertension group and the uncontrolled hypertension group

BACKGROUND: Hypertension is an important as well as common disease in primary practice, so family physicians should concern about it. It is well known that if hypertension were well controlled, it could lower cardiovascular complications. However, there are few studies on the impact of hypertension affecting the quality of life. Therefore, we carried out this study to compare the quality of life in the hypertensive patients by whether it is well controlled or not. METHODS: The authors surveyed the quality of life using the questionnaire named as CMC Health Survey Version 1.0 for the hypertensive patients. The subjects had no complications and no other diseases, and aged 40 or more, and visited doctors at the Department of Family Medicine, Kyung Hee University Hospital or the Department of Internal Medicine, Sungmin Hospital from May 1 to Aug 31, 1998. We categorized the subjects into the two groups of the well controlled group(SBP or = 140 mmHg or DBP> or = 90 mmHg) and compared the quality of life and lifestyle. RESULTS: The total number of subjects was 119, that of well controlled group was 69, and that of the uncontrolled group was 50. Mean systolic and diastolic blood pressure was 133.1+/-7.5 mmHg and 85.3+/-5.2 mmHg in the well controlled group, 159.2+/-7.4 mmHg and 100.2+/-5.5 mmHg in the uncontrolled group. The comparison of the distribution of age, sex, education, occupation, and monthly income between the two groups showed no difference. The comparision of the lifestyle between two groups by Alameda 7 questionnaire showed no difference ,too. As for the comparison of quality of life between two groups, the well controlled group had significantly higher scores in the domain of physical function, social function, general health, vitality(above P<0.01), emotional function, role limitation, and health perception(above P<0.05) than uncontrolled group. However, the scores of the domain of change in health, satisfaction, bodily pain were not significantly different between two groups. After covariated by obesity, the comparion of quality of life between two groups showed similar results. CONCLUSION: We confirmed that the well controlled group had better quality of life than the uncontrolled group. So family physicians should consider the quality of life when they consult the patients with hypertension.

Complications of Endoscopic Sphincterotomy: CT Grading and Its Clinical Significance

PURPOSE: To evaluate the CT grading of complications developing after endoscopic sphincterotomy (EST), and their clinical course. MATERIALS AND METHODS: We retrospectively evaluated CT in 19 patients in whom pancreatitis or duodenal perforation developed after EST in 594 patients. The CT grading of pancreatitis was classified as mild, moderate or severe, according to the extent of peripancreatic infiltration; duodenal perforation was classified as mild, moderate or severe grade, according to the extent of fluid collection. We attempted to correlate CT grade with the average duration of hospitalization after EST, treatment method and mortality. RESULTS: Post-EST complications detected on CT were pancreatitis (ten patients, 1.7%) and duodenal perforation (nine patients, 1.5%). In those with pancreatitis, hospitalization after EST lasted an average of nine days in mild cases (n=2), 21 days in moderate (n=1) and 41 days in severe (n=7). Nine of ten patients with pancreatitis were treated conservatively, while the other, whose grade was severe, underwent percutaneous drainage. Eight of these ten recovered; the two who died were severe grade patients, one having been treated conservatively and the other by percutaneous drainage. In patients with duodenal perforation, hospitalization after EST lasted an average of 13 days in mild cases (n=2), 16 days in moderate (n=2) and 37 days in severe (n=5). Four of nine patients with duodenal perforation were treated conservatively, while the other five (severe, four; moderate, one) underwent percutaneous drainage. One patient, graded as severe, expired, but the remaining eight rocovered. Percutaneous drainage was performed mostly in severe grade cases, and among patients thus graded, only three (3/594; 0.5%) died. CONCLUSION: CT is considered useful for predicting the clinical course and prognosis of complications occurring after EST.

Imaging Features of Tuberculous Mastitis: Comparison with non-Tuberculous Mastitis

PURPOSE: The purpose of this report is to evaluate the characteristic findings of tuberculosis of the breast on mammogram, sonogram, and CT and to compare the results with the imaging features of non-tuberculous mastitis. MATERIALS AND METHODS: Using mammograms and sonograms, nine cases of tuberculosis of the breast were evaluated, and for four cases, CT was used. Aspects evaluated were contour, shape and size of the lesion, homogeneity ofinternal content, and extension of the lesion from/to the adjacent organs. Diagnosis was based on aspiration,surgery, and pathologic findings including acid-fast bacillus (AFB) staining. Mammograms and sonograms of 19 patients with non-tuberculous mastitis of the breast were reviewed. RESULTS: No cases of tuberculous mastitis presented clinical evidence of acute inflammation such as fever, swelling or skin redness. Nine cases of tuberculous mastitis were seen as a distinct mass on mammogram and sonogram. Four of nine cases (44.4%) showed arelatively smooth peripheral margin on mammogram and a cold abscess form on sonogram and CT. There were other fociof tuberculosis in the chest wall, anterior mediastinum, pleural cavity or lung. Five cases demonstrated as a nodular type on US. In the non-tuberculous mastitis group, an abscess with distinct margin or direct contiguity between a breast lesion and the adjacent organ was observed neither on mammogram nor on sonogram. CONCLUSION: Inan afebrile patient, relative homogeneous density with distinct margin in the breast on mammogram and a fistulous connection or direct continuity between breast abscess form with the adjacent organ on sonogram or CT is acharacteristic feature of the tuberculous mastitis. The cold abscess type is a frequent subtypes of this entity, and must also be included.

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.

Intussusception in Childhood: The Role of Plain Abdominal Radiographs

PURPOSE: The purposes of this study were to evaluate the plain radiologic findings of the childhood intussusception and to evaluate the role of plain abdominal films in predicting the success of air or barium reduction. SUBJECTS AND METHODS: We retrospectively reviewed 140 cases with the diagnosis of intussusception in children. The radiological signs that included soft tissue mass, dilatation of small bowel suggesting obstruction, crescent sign, and target sign were evaluated in terms of frequency. The relationship between radiological findings and outcome of reduction was analyzed. The site of soft tissue mass or crescent sign seen on plain radiographs was correlated with the position of the apex of the intussusceptum seen at the beginning of barium enema. The degree of dilated small bowel was evaluated by calculating the proportion of air-filled small bowel occupying peritoneal cavity and measuring the maximal diameter of dilated bowel lumen. The radiological finding for small bowel obstruction is determined by observation of the degree of small bowel dilatation and/or air-fulid levels. RESULTS: Ninety-two cases out of 140 showed one or more radiographic signs. Two most common signs were soft tissue mass and small bowel obstruction. The success rate of air or barium reduction was significantly lower in patients with most severe degree of dilatation of small bowel and/or more than 7 air-fulid levels on erect view. The suspected location of intussusception on plain radiographs correlated well with the true location of intussusception seen in the first few seconds of barium reduction. CONCLUSION: Plain abdominal radiography is useful in the diagnosis of intussusception and provides helpful informations for the reduction procedure as well as for the exclusion of the contraindications such as bowel perforation.