Myopathy due to Chronic Clevudine Therapy: A Case Report

A 40-year-old man with chronic hepatitis B complained of progressive weakness of the proximal muscles and edema of both legs. He had been receiving long-term clevudine (nucleoside analogue reverse transcriptase inhibitor, NRTI) therapy for his hepatitis. The serum creatine kinase level was increased on the laboratory tests. His electromyography showed a generalized myopathic process. The muscle biopsy showed numerous ragged-red fibers, degenerating myofibers with variable sized cytoplasmic bodies, the prominence of type 1 fibers with type 2 fiber atrophy and an endomysial mononuclear cell infiltration. The electron microscopic examination revealed necrotic myofibers, including extremely dysmorphic mitochondria with extensive loss, blunting and focal clumping of the cristae and concentric cristae. Although clevudine is known to be a less cytotoxic agent among the various NRTIs, careful clinical attention should be paid to the patients who are receiving long-term clevudine therapy for the occurrence of myopathy.

Dissociated Automatic-Voluntary Lower Cranial Nerve Palsies and Anarthria After Left Corona Radiata Infarction: Foix-Chavany-Marie Sydrome

Foix-Chavany-Marie Syndrome (FCMS) is characterized by anarthria and bilateral facio-pharyngo-glosso-masticatory paralysis with an automatic-voluntary dissociation, which usually develops in bilateral opercular lesions. We present a case of FCMS caused by unilateral subcortical lesion. A 54-year-old man was admitted due to acute right hemiparesis with anarthria. He had voluntary facial paresis but automatic-involuntary facial movements were preserved. MRI showed an acute left corona radiata infarction and PET revealed decreased glucose metabolism in left basal ganglia and fronto-parietal lobe.

Usefulness of Plasma B-type Natriuretic Peptide Assay as a Screening Tool for Infants with Suspected Congenital Heart Disease

PURPOSE: B-type natriuretic peptide (BNP) is a cardiac neurohormone secreted predominantly from the ventricle in response to increased left and right ventricular pressure loads as well as volume loads. The aim of our study is to investigate the usefulness of plasma BNP assay as a screening tool for infants with suspected congenital heart disease (CHD). METHODS: Ninety-five infants less than 3 months of age with suspected CHD were enrolled and divided into a healthy control group (n=40) and a CHD group (n=50) according to physical examination, chest X-ray, electrocardiography and echocardiography. The CHD group was divided into the treatment group (n=15), requiring urgent treatment and the observation group (n=35), not requiring any treatment. Plasma BNP concentrations were measured using a commercial kit, Triage BNP(R) test kit. RESULTS: The mean BNP concentration of the CHD group was higher than that of the control group (639+/-1, 147 pg/mL versus 26+/-25 pg/mL, P<0.001). The mean BNP concentration of the treatment group was significantly higher than that of the observation group (1, 732+/-1, 629 pg/mL versus 171+/-229 pg/mL, P<0.001). The area under the Receiver Operating Characteristic curve for the detection of CHD was high: 0.821 (95% CI, 0.737-0.905, P<0.001). The best cut-off value of BNP concentration for the screening of CHD requiring urgent treatment was determined to be 282 pg/mL (sensitivity: 100%, negative predictive value: 100%). CONCLUSION: In infants, the plasma BNP measurement is useful and objective in screening the CHD infant without any specific professional skills. Especially in the outpatient department, it is very helpful to determine CHD infant requiring urgent treatment and thus an efficient consultation can be made to the pediatric cardiologist.

Analysis and Evaluation of the Reliability of Medical Information on Food Allergies on the Internet / 소아과

PURPOSE: The information in the internet is increasing and the number of people using the Internet to obtain medical information is increasing rapidly too. But, compared to the amount of information, the quality of information is extremely variable. To assess the accuracy of medical information on the Internet, the quality of information about food allergies available on the internet examined. METHODS: Online searches using the phrase "food allergy" were conducted on five major Internet search engines. The first 50 web pages generated by each engine were examined. Making an exception of the web pages which were inaccessible, irrelevant, and duplicated, sixty out of two hundred and fifty web pages were evaluated. Information scores were developed from 1(no statement) to 4 (sufficient) and designed to assess how well the web pages mentioned the summary, symptom, diagnosis, treatment, and education of the patients, and emergent management. RESULTS: When classified by ownership, there were six(10%) oriental clinics, twelve(20%) hospitals, twenty one(35%) profit-making institutions, fourteen(23%) non-profit institutions and seven others (12%). The mean information score(IS) was 10.7. Summary got the highest IS(2.25) and the education for patients and supporters got the lowest IS(1.33). Medical institutions such as hospital and clinic got 12.33 and non-medical institutions got 10.25. But there were no statistically significant differences between these two institutions(P=0.107). CONCLUSION: Overall, the quality of information on food allergy through the Internet was poor. The main reasons are unlimited listings of related information on the Internet and an absence of a reviewing process of the information. Therefore, people should not entirely rely on the Internet for medical information and medical-related institutions such as hospitals, schools, clinics and relevant academic associations should develop an Internet system to improve the quality of information.

Reliability of Diastolic Flow Velocity of the Left Pulmonary Artery for the Diagnosis of Patent Ductus Arteriosus in Preterm Infants

PURPOSE: Diagnosis of a hemodynamically significant patent ductus arteriosus (PDA) that should be treated is difficult to determine by clinical and echocardiographic examination. The purpose of this study is to clarify the usefulness of diastolic flow velocity (DFV) of the left pulmonary artery (LPA) determined by echocardiography in the assessment of significant PDA in preterm infants. METHODS: Clinical and echocardiographic findings, including DFV in LPA, of PDA were evaluated at 24 hours, 48-72 hours of age and after indomethacin treatment in thirty-nine infants ranging from 25 to 34 gestational weeks of age. DFVs of the study group (N=13) with significant PDA were compared with those of healthy control group (N=26) without significant PDA. RESULTS: DFVs in healthy preterm infants were high in the first few days and were significantly decreased after spontaneous ductal closure. DFVs in preterm infants with significant PDA who underwent indomethacin treatment were significantly higher than that of healthy control infants. After indomethacin treatment, DFVs in this study group remained high with continuing significant PDA and markedly decreased with disappearance of significant PDA. Until ductus arteriosus closed, DFVs showed a significant correlation with the magnitudes of ductal shunt. A cutoff value for DFV of 30 cm/sec showed a sensitivity of 77% and a specificity of 92% as a predictor of significnat PDA in preterm infants. CONCLUSION: Measurement of DFV in LPA by echocardiography is a useful method for assessing the significnat PDA which may require treatment in preterm infants.