The Effect of Pravastatin on Insulin Resistance in Hyperglycemic Patients / 임상당뇨병

BACKGROUND: The effect of pravastatin on insulin resistance (IR) is controversial and poorly studied in prediabetes. METHODS: This study was performed in hyperglycemic patients at Saint Carollo Hospital from January 1, 2013 to December 31, 2015. Among them, we selected 40 patients (24 prediabetes and 16 new onset diabetes [NOD]) who had been treated with pravastatin 20 mg daily for 2 or 4 months and in whom fasting insulin and fasting glucose had been measured before and after administration of pravastatin. IR was defined as a fasting insulin level ≥ 12.94 µU/mL, homeostasis model for IR (HOMA-IR) ≥ 3.04 or quantitative insulin sensitivity check index (QUICKI) ≤ 0.32. RESULTS: Pravastatin treatment decreased total cholesterol and low-density lipoprotein cholesterol levels by 25.2% and 32.3% respectively (P = 0.000 for all), but did not affect fasting insulin level, HOMA-IR, or QUICKI in total, prediabetes, and NOD groups. Prevalence of IR was significantly different between prediabetes and NOD groups both before and after pravastatin treatment (0% versus 37.5%, P = 0.001), but pravastatin treatment did not affect the prevalence of IR in the prediabetes or NOD group. Fasting glucose level was not significantly different before and after pravastatin treatment in prediabetes (106.8 ± 6.4 mg/dL versus 103.8 ± 8.4 mg/dL, P = 0.223) but was significantly different in the NOD group (171.5 ± 70.1 mg/dL versus 124.4 ± 26.7 mg/dL, P = 0.017). CONCLUSION: Pravastatin treatment did not affect IR or fasting glucose level in hyperglycemic patients. Therefore, we suggest pravastatin can be prescribed to hypercholesterolemic patients with hyperglycemia.

A Case of Acute Hyperglycemia Induced by Jerusalem Artichoke in a Patient with Type 2 Diabetes Mellitus / 임상당뇨병

Jerusalem artichoke (JA) mainly consists of inulin. In many experimental studies, inulin has been shown to be beneficial for decreasing glucose level. Therefore, JA is lately attracting wide attention as an anti-diabetic food. Therefore, many patients ingest JA in extract form. However, there are no published clinical studies in patients with diabetes to demonstrate benefit from the use of inulin-type fructans. We experienced a diabetes inpatient with acute hyperglycemia associated with JA. We could not control the patient's blood glucose in spite of addition and increment of insulin. We found that she had taken extracts of JA and recommended cessation. After discontinuing JA extracts, her blood glucose was well controlled in spite of discontinuation of insulin. Thus, in this patient, JA had actually increased blood glucose. We suggest that JA may be dangerous for use in diabetic patients.

Spinal, Cerebral and Cerebellar Embolism after Injection of N-Butyl-2-Cyanoacrylate in Esophageal Variceal Bleeding

We report a case of spinal, cerebral and cerebellar embolism that occurred following injection sclerotherapy with n-butyl-2-cyanoacrylate for variceal bleeding. The patient had been diagnosed with alcoholic liver cirrhosis and esophageal variceal bleeding. We performed injection sclerotherapy with n-butyl-2-cyanoacrylate. The patient complained of both leg motor weakness and left arm motor weakness after injection and was diagnosed with spinal, cerebral and cerebellar embolism following the n-butyl-2-cyanoacrylate injection. At the follow-up examination, the patient's neurologic symptoms had improved, but left leg motor weakness remained. To our knowledge, this is the first report of a case of multiple embolizations including the spine, cerebrum and cerebellum after n-butyl-2-cyanoacrylate injection for treatment of esophageal variceal bleeding.

Aorta-right Atrial Tunnel Accompanying Infective Endocarditis / 대한내과학회지

Aorta-right atrial tunnel is a vascular anomaly that originates from the aortic sinus and terminates in either the superior vena cava or the right atrium. The patency of the tunnel can result in volume overload in both ventricles, bacterial endocarditis, aneurysm formation, and spontaneous rupture. Transesophageal echocardiography was performed in a 42-year-old male patient diagnosed with infectious endocarditis, and vegetation of the mitral and aortic valves, right atrial enlargement, and an extracardiac blood vessel connecting the aorta to the right atrium were discovered. Therefore, we were able to diagnose an aorta-right atrial tunnel leading to infectious endocarditis and proceeded with surgical treatment. Together with a review of the literature, we present a case report of a patient with aorta-right atrial tunnel accompanied by infectious endocarditis.

Comparison of Safety after Percutaneous Coronary Intervention Between Octogenarians and Counterparts with Coronary Artery Disease

BACKGROUND: Elderly patients usually have comorbid and poor general conditions. They are more likely to have complex coronary lesions with cardiac dysfunction. Percutaneous coronary intervention (PCI) in octogenarians remains controversial. In this study, we determined the safety after PCI for octogenarians and their younger counterparts with coronary artery disease. METHODS: We reviewed 1,057 patients (110 octogenarians vs. 947 younger counterparts) who underwent PCI for coronary artery disease at Saint Carollo Hospital. We analyzed the baseline characteristics, angiographic findings, in hospital mortality, and post procedural complications between the two groups. RESULTS: The mean ages of octogenarians and younger counterparts were 83.1+/-4.5 years and 62.6+/-10.3 years, respectively. The octogenarian group had a significantly (p<0.001) higher ratio of female patients compared to their younger counterpart group (57.3% vs. 27.5%). However, the octogenarian group had a significantly (p=0.035) lower ratio of patients with history of diabetes mellitus compare to their younger counterpart group (22.7% vs. 32.6%). Incidence of acute myocardial infarction in octogenarians was significantly (p<0.001) higher than that in the younger counterparts (43.7% vs. 18.0%). There was no significant difference in admission duration, major complication, or in-hospital mortality between two groups. CONCLUSION: Our results revealed that hospital mortality and incidence of major complications in octogenarians who underwent invasive PCI were not higher than those in their younger counterparts, suggesting that PCI could be safely used in patients aged 80 years or older. However, long-term follow-up data are needed.