A Case of Immunoglobulin E Mediated Anaphylaxis to Levodropropizine

We experienced a case of immunoglobulin E (IgE) mediated anaphylaxis to levodropropizine. The patient was an 18-year old Korean woman. After taking the common cold medication including acetaminophen, domperidone, and levodropropizine, skin rash, angioedema and anaphylaxis were developed immediately. As she was tolerable to acetaminophen alone, we thought the culprit agent was maybe a levodropropizine tablet. To confirm the culprit, she underwent skin prick test and oral drug provocation test with the suspected one. Finally we detected levodropropizine specific IgE and confirmed the specificity by inhibition enzyme-linked immunosorbent assay (ELISA).

A Comparison of Active Surveillance Programs Including a Spontaneous Reporting Model for Phamacovigilance of Adverse Drug Events in a Hospital

BACKGROUND/AIMS: Spontaneous reporting systems have several weak points, such as low reporting rates and insufficient clinical information. Active surveillance programs, such as ward rounds and a clinical data repository (CDR), may supplement the weak points of such systems. We developed active surveillance programs and compared them with existing spontaneous reporting. METHODS: We collected adverse drug event (ADE) cases, which comprised 1,055 cases of spontaneous reporting, 309 reported by ward rounds, and 229 found using a CDR. The clinical features and causative drugs were evaluated. RESULTS: Active surveillance programs detected additional serious ADEs compared to those of spontaneous reporting programs. The ADEs identified by CDR (22.9%) were more likely to be classified as "serious" than those reported spontaneously (5.2%) or identified during ward rounds (10.3%). Causative drugs also differed. Opioids, antibiotics, and contrast media were the most common drugs causing ADEs in the spontaneous reporting system, whereas the active surveillance programs identified antibiotics as the most common causative drug. Clinical features also differed. ADEs with gastrointestinal manifestations were reported most frequently by spontaneous reporting programs. ADEs reported from active surveillance more reliably identified events associated with changes in laboratory values, such as hepatobiliary toxicity, hematologic manifestations, and nephrologic manifestations, compared with spontaneous reporting programs. CONCLUSIONS: Our findings suggest that active surveillance programs can supplement spontaneous reporting systems in hospitals. ADEs related to laboratory abnormalities were monitored more closely by active surveillance programs and may be useful for identification of serious ADEs.

A case of lupus podocytopathy manifesting with generalized edema and proteinuria / 대한내과학회지

A 20-year-old woman with systemic lupus erythematosus presented with generalized edema and nephrotic range proteinuria. A renal biopsy revealed diffuse foot process effacement without significant glomerular immune deposits, which was compatible with minimal-change nephrotic syndrome. The diagnosis of lupus podocytopathy was made and high-dose prednisolone was started. After prednisolone therapy, the generalized edema and proteinuria improved.

Jejunal Intussusception with Gastrointestinal Bleeding Caused by Metastatic Lung Cancer / 대한소화기학회지

Intestinal intussusception caused by metastatic tumor is uncommon. Symptomatic small bowel metastases from lung cancer have been rarely reported. Here we report a case of intussusception with gastrointestinal bleeding induced by jejunal metastasis of non-small cell lung cancer with a review of the literature. A 52-year-old man was admitted to our hospital because of melena. He had underwent right pneumonectomy and received systemic chemotherapy with radiotherapy for squamous cell lung cancer. Esophagogastroduodenoscopy and colonoscopy failed to reveal bleeding focus. Abdominal CT scan revealed jejunal intussusception and histologic examination of resected jejunum showed metastatic mass from lung cancer. In patients with small bowel obstruction and history of malignancies, possibility of small bowel metastatic tumor should be considered.

Both Hydronephrosis Complicated with Emphysematous Pyelitis / 대한신장학회지

Emphysematous pyelonephritis is rare, severe, acute bacterial infection of the kidney characterized by the presence of gas within the renal parenchyma, collecting system or perinephric tissue and requires prompt diagnosis and the emergent intensive treatment. Emphysematous pyelitis is a distinct entity from emphysematous pyelonephritis and describes the presence of gas localized to the renal collecting system. Medical treatment is sufficient therapy if there is no obstruction. We report a case of both hydronephrosis complicated with emphysematous pyelitis which was occurred in 59-year-old diabetic patient. The patient was recovered by medical treatment alone.

Impact of Maximal Sterile Barrier during the Insertion of Central Venous Catheters in Adults Intensive Care Units / 병원감염관리

BACKGROUND: Catheter-related bloodstream infections (CR-BSIs) are common, costly, and potentially lethal. The purpose of this study was to ascertain the effect of maximal sterile barrier on CR-BSIs in intensive care units. METHODS: We monitored CR-BSIs in intensive care units of Sunlin Hospital in Pohang, before (September 2005 to May 2006) and after (June to December 2006) implementation of maximal sterile barrier. CR-BSIs were identified by using the definition of Centers for Disease Control and Prevention. RESULTS: During the intervention period, the proportion of conducting maximal sterile barrier was 84%. In the pre-intervention period, 10 episodes of CR-BSIs were recorded out of a total of 1,749 catheter-days, compared to 1 episode of CR-BSI out of a total of 1,277 catheter-days in the post-intervention period. The rate of CR-BSIs was significantly reduced from 5.72 to 0.57 per 1,000 catheter-days (P=0.03). CONCLUSION: Implementation of maximal sterile barrier resulted in a significant reduction in CR-BSIs.