Tumor Necrosis Factor-alpha as a Predictor for the Development of Nonalcoholic Fatty Liver Disease: A 4-Year Follow-Up Study

BACKGROUND: Tumor necrosis factor (TNF)-alpha is associated with insulin resistance and systemic inflammatory responses. The aim of this study was to investigate the relationship between TNF-alpha and the development of nonalcoholic fatty liver disease (NAFLD) in a longitudinal study. METHODS: Three hundred and sixty-three apparently healthy subjects (mean age, 40.5+/-6.1 years; male, 57.6%) without NAFLD were enrolled in 2003. Anthropometric and laboratory measurements were performed. The participants were grouped into tertiles according to their serum TNF-alpha levels from samples taken in 2003. At a 4-year follow-up, we compared the odds ratios (ORs) of the development of NAFLD according to the tertiles of TNF-alpha levels measured in 2003. RESULTS: At the 4-year follow-up, the cumulative incidence of NAFLD was 29.2% (106/363). The group that developed NAFLD had higher levels of TNF-alpha than those in the group without NAFLD (3.65+/-1.79 pg/mL vs. 3.15+/-1.78 pg/mL; P=0.016). When the 2003 serum TNF-alpha levels were categorized into tertiles: incidence of NAFLD observed in 2007 was significantly higher with increasing tertiles (22.6%, 35.8%, and 41.5%, respectively; P<0.05). The risk of developing NAFLD was significantly greater in the highest tertile of TNF-alpha than in the lowest tertile after adjusting for age, smoking, and BMI (OR, 2.20; 95% confidence interval, 1.12 to 4.01; P<0.05). CONCLUSION: Higher serum TNF-alpha levels in subjects without NAFLD were associated with the development of NAFLD. The results of study might suggest a pathologic role of inflammation in NAFLD.

Role of B-type natriuretic peptide in the recurrence of atrial fibrillation after electrical cardioversion / 대한내과학회지

BACKGROUND/AIMS: No studies have conclusively determined whether the B-type natriuretic peptide (BNP) level measured before electrical cardioversion for atrial fibrillation (AF) is associated with the maintenance of sinus rhythm after the procedure. Therefore, we investigated whether the plasma BNP can predict AF recurrence in the short-term. METHODS: We prospectively recruited 20 consecutive patients with persistent AF, without symptomatic congestive heart failure. The plasma BNP was measured before and after electrical cardioversion. RESULTS: In all patients, AF was converted to normal sinus rhythm (NSR) after the procedure. NSR was maintained in 70.0% of the patients at 1 week and in 52.6% of the patients at 4 weeks. Of the patients with NSR at 1 week, five patients had relapsed by 4 weeks (4-week relapse group, 4WRG). The log BNP levels after cardioversion decreased significantly in all patients, except for the failed group at 1 week and the 4WRG. Multivariate analysis revealed that the maintenance of sinus rhythm was associated with body mass index at 1 week, and left atrial diameter (LAD) and left ventricular mass index (LVMI) at 4 weeks. 4WRG had a significantly higher baseline BNP. The baseline BNP was associated with the LVMI (R2=0.241, p=0.028) and tissue Doppler imaging (TDI) E' (R2=0.432, p=0.002). CONCLUSION: A higher plasma BNP at baseline in AF patients may help to predict the failure to maintain sinus rhythm 4 weeks after electrical cardioversion, but not the early recurrence at 1 week.

Rhabdomyolysis Associated With Statin Medication, Exercise and Sauna

Rhabdomyolysis is a syndrome involving the breakdown of skeletal muscle, and this causes myoglobin and other intracellular proteins and electrolytes to leak into the circulatory system. We report here on a case of rhabdomyolysis associated with statin, exercise and sauna exposure. A 63-year-old woman presented to our hospital, and she had been taking simvastatin for over 6 years due to dyslipidemia. She complained of developing myalgia and weakness of the lower extremities over the previous 5 days. She had used a sauna more than 4 hours daily for 20 years, and she had started unaccustomed exercise in the sauna 1 week prior to admission. Her serum creatine kinase concentration was 45,990 IU/L. Conservative treatment was started with the discontinuation of her statin medication, exercise and use of the sauna. Her symptoms and serum creatine kinase level decreased 1 week after admission and she was discharged with minimal residual muscle weakness.

Thromboembolism during pregnancy or postpartum / 대한내과학회지

BACKGROUND/AIMS: Venous thromboembolism (VTE) during pregnancy or postpartum is a major cause of maternal complications and death; however, the risk is uncertain. In this study, we sought to estimate the incidence of VTE during pregnancy and to identify risk factors for pregnancy-related VTE. METHODS: We retrospectively evaluated the incidence, risk factors, treatment, and prognosis for VTE based on 40,989 deliveries at Cheil General Hospital, Kwandong University College of Medicine, over a five-year period from February 2003 to January 2008. The risk factors were analyzed by chi-square-analysis and forward stepwise logistic regression, and are presented as crude and adjusted odds ratios (ORs) with a 95% confidence interval (CI). RESULTS: The incidence of VTE was 0.042% (17 patients, mean age 32.4+/-2.5 years), with deep venous thrombosis (DVT) in 0.01% of the patients (4 patients, mean age 31.5+/-2.9 years), and pulmonary embolism (PE) in 0.032% of the patients (13 patients, mean age 32.6+/-2.5 years). The postnatal incidence of VTE was higher than the antenatal incidence (2 vs. 15). The main manifestations at the time of diagnosis, in order of frequency, were: dyspnea in 8 patients (62%), chest pain in 4 patients (31%), cough in 2 patients (15%), and syncope in 1 patient (8%). The risk factors for VTE were Cesarean section (OR=7.4; 95% CI: 2.1-25.7, p=0.002) and preeclampsia (OR=12.0; 95% CI: 4.2-34.2, p<0.000). All cases showed clinical improvement spontaneously, or with anticoagulation and surgical thrombectomy, and caused no fetal or maternal mortality. CONCLUSIONS: The incidence of VTE during pregnancy was 0.042%; the independent risk factors were Cesarean section and preeclampsia.

A Case of Condyloma Acuminatum Presenting as a Rectal Polyp / 대한소화기내시경학회지

Condyloma acuminatum, commonly known as anogenital warts, is caused by human papillomavirus (HPV). The most common location of condyloma acuminatum in women is the vulva. Other locations are the vagina, anus and perianal area, perineum and cervix. Condyloma acuminatum most commonly occur due to receptive anal intercourse, and can enlarge to form exophytic masses on the perianal skin, but rarely involve the rectum. We experienced an occurrence of a 12 mm polypoid lesion in the rectum of a heterosexual woman detected during a colonoscopy. The polypoid lesion was excised and was diagnosed as condyloma acuminatum. The lesion was positive for HPV type 11 based on the use of an HPV DNA chip test.