Predictive Factors for the Therapeutic Response to Concomitant Treatment with DPP-4 Inhibitors in Type 2 Diabetes with Short-Term Follow-Up / 고신대학교의과대학학술지

OBJECTIVES: To evaluate the efficacy and predictive factors of Dipeptidyl peptidase-4 (DPP-4) inhibitors in type 2 diabetes mellitus (T2DM) patients who were not well controlled with other oral antidiabetic drugs or insulin in real clinical practice. METHODS: From December 2012 to January 2014, retrospective longitudinal observation study was conducted for patients with T2DM who were not reached a glycemic target (glycated hemoglobin [HbA1c] > 6.5%) with other oral antidiabetic drugs or insulins. Type 1 diabetes or other types of diabetes were excluded. Responders were eligible with decreased HbA1c from baseline for more than 5% during follow up period. RESULTS: Of total 135 T2DM patients having an average 9.0 months follow-up period, 84 (62.2%) of patients were responder to DPP-4 inhibitors. After concomitant treatment with DPP-4 inhibitors, patients had a mean decrease in HbA1c of 0.69 ± 1.3%, fasting plasma glucose of 13 ± 52 mg/㎗, and postprandial plasma glucose of 29 ± 85 mg/㎗ from baseline (all P < 0.05). Independent predictive factor for an improvement of glycemic control with DPP-4 inhibitors was higher baseline HbA1c (odds ratio 2.07 with 95% confidence interval 1.15-3.72) compared with non-responders. CONCLUSIONS: A clinical meaningful improvement in glycemic control was seen when DPP-4 inhibitors were added to other anti-diabetic medications in patients with T2DM regardless of age, duration of T2DM, type of combination treatment regimen. Patients who had higher HbA1c were more easily respond to DPP-4 inhibitors treatment in short-term follow-up period.

Epstein-Barr Virus Associated Hemophagocytic Syndrome after Scrub Typhus Infection / 감염과화학요법

There have been a small number of cases of scrub typhus-associated hemophagocytic syndrome (HPS), most of which were treated successfully using adequate antibiotics. Here, we report a case of Epstein-Barr virus (EBV)-associated HPS after scrub typhus infection that was not improved using antirickettsial treatment. A 73-year-old male who had been diagnosed with scrub typhus according to an eschar and a positive serology was transferred to our institution because of a persistent fever despite 7-day doxycycline therapy. Physical and laboratory data showed hepatosplenomegaly, bicytopenia, hyperferritinemia, and hypofibrinogenemia. A bone marrow examination (BM) revealed hypercellular marrow with hemophagocytosis and histiocyte infiltration. EBV was detected in BM aspirates using polymerase chain reaction. After a diagnosis of HPS was made, the patient was treated successfully using high-dose steroids.

Primary Non-ampullary Duodenal Adenocarcinoma: A Single-center Experience for 15 Years / 대한소화기학회지

BACKGROUND/AIMS: Primary non-ampullary duodenal adenocarcinomas (PNADAs) comprise or =2 mg/dL (OR, 85.28; 95% CI, 3.77-1,938.79; p=0.005) and distant metastasis (OR, 26.74; 95% CI, 3.13-2,328.14; p=0.003) at the time of diagnosis were independent poor prognostic factors. CONCLUSIONS: The majority of patients were diagnosed at an advanced stage. Presence of distant metastasis was independent prognostic factor of PNADA together with elevated total bilirubin.

Unplanned Extubation in Patients with Mechanical Ventilation: Experience in the Medical Intensive Care Unit of a Single Tertiary Hospital / 결핵및호흡기질환

BACKGROUND: Potentially harmful unplanned extubation (UE) may occur in patients on mechanical ventilation (MV) in an intensive care unit (ICU) setting. This study aimed to evaluate the clinical characteristics of UE and its impact on clinical outcomes in patients with MV in a medical ICU (MICU). METHODS: We retrospectively evaluated MICU data prospectively collected between December 2011 and May 2014. RESULTS: A total of 468 patients were admitted to the MICU, of whom 450 were on MV. Of the patients on MV, 30 (6.7%) experienced UE; 13 (43.3%) required reintubation after UE, whereas 17 (56.7%) did not require reintubation. Patients who required reintubation had a significantly longer MV duration and ICU stay than did those not requiring reintubation (19.4+/-15.1 days vs. 5.9+/-5.9 days days and 18.1+/-14.2 days vs. 7.1+/-6.5 days, respectively; p<0.05). In addition, mortality rate was significantly higher among patients requiring reintubation than among those not requiring reintubation (54.5% vs. 5.9%; p=0.007). These two groups of patients exhibited no significant differences, within 2 hours after UE, in the fraction of inspired oxygen, blood pressure, heart rate, respiratory rate, and pH. CONCLUSION: Although reintubation may not always be required in patients with UE, it is associated with a poor outcome after UE.

Predictive Factors of Subepithelial Tumor and Gastrointestinal Stromal Tumor in the Patients with Upper Gastrointestinal Subepithelial Lesions / 대한소화기학회지

BACKGROUND/AIMS: Differentiating subepithelial tumor (SET) from non-neoplastic gastrointestinal subepithelial lesion (SEL) and gastrointestinal stromal tumor (GIST) from leiomyoma are very important for proper management. This study was conducted to analyze factors that could predict the presence of SET and GIST in patients with upper gastrointestinal (UGI) SELs. METHODS: A total of 527 patients were diagnosed with UGI SELs endosonographically at Gyeongsang National University Hospital from January 2008 to June 2013. Among these patients, histologic diagnosis was made in 84 patients. Data were collected by retrospectively reviewing the medical records. Variables that could differentiate neoplastic from non-neoplastic SELs and GIST from leiomyoma were analyzed. RESULTS: Among 84 patients with SELs, 64 (76.2%) had SETs including GIST (42.9%) and leiomyoma (19.0%). The patients' mean age (p=0.047), peak age distribution (p=0.047), proportions of patient > or =50 years (p=0.015), and number of proper muscle-originated lesions (p=0.001) were higher in neoplastic than non-neoplastic group. There were no significant differences in gender (p=0.195), size (p=0.266) and echogenicity (p=0.051) of the lesions. Older age (57.7 vs. 47.0 years, p=0.049), age > or =50 years (p=0.016), location in gastric body (p or =50 years, size > or =30 mm, and proper muscle-origin of lesion were independent predictors of SET; however, there were no predictive factors that could differentiate GIST from leiomyoma. CONCLUSIONS: In patients with SEL, the possibility of having SET should be considered for patients > or =50 years with UGI SELs > or =30 mm that arise from the proper muscle. Thorough monitoring and aggressive management is warranted for those with gastric muscular SET since factors predictive of GIST are lacking.

Effect of Bone Cement Augmentation of Pedicular Screwing for Osteoporotic Lumbar Spine / 대한척추외과학회지

STUDY DESIGN: Eighteen patients undergoing bone cement augmentation of pedicular screwing for osteoporotic lumbar spine were reviewed retropectively. OBJECTIVES: To assess the effectiveness of bone cement augmentation of pedicular screwing for osteoporotic lumbar spine. SUMMARY OF LITERATURE REVIEW: For the technical limit obtaining the dynamic stability in the bone-screw interface for osteoporotic lumbar spine, the additional device to enhance pedicular screw fixation strength needs. MATERIALS AND METHODS: We reviewed 18 cases undergoing pedicular screwing and fusion for the osteoporotic (Jikei grade I, II, III/III) lumbar spine from Feb. 2000 to Mar. 2001 with an average follow-up of 1.5 years. Mean age was 69.5 years with 6 male and 12 female. Inclusion criteria was 9 degenerative spinal stenosis, 5 spinal stenosis associated with compression fracture, 2 Kummel's disease, 1 spondylolisthesis and 1 internal disc disruption. We performed bone cement injection around the screws showing significantly low insertion torque, screw pullout or cut-up during surgery. We asssessed the radiographic results of sagittal angle correction (SAC) of the fused segment and disc height restoration (DHR) on the preoperative, postoperative and last follow up lumbar lateral views. Clinical results were evaluated according to the Kumano's criteria. RESULTS: Mean sagittal angle at preoperative, postoperative and last follow-up was 11.6-21.6-19.6 degrees with mean SAC gain 10 degrees (p0.05). Mean disc height of each period was 33.3-49.8-43.5% with mean DHR gain 16.5% (p0.05). The clinical result was analyzed as 14 good, 3 fair and 1 poor. Fusion success was achieved in all. There were 2 perioperative complications of 1 superficial surgical site infection and 1 incomplete L4 root injury, and 6 complications during follow up of 3 compression fractures above fused segment, 1 screw pullout, 1 screw cut-up, and 1 bone cement extrava-sation into canal. CONCLUSIONS: The bone cement augmentation of pedicular screwing for osteoporotic lumbar spine can be an alternative to enhance screw fixation strength.