Prevalence of Congenital Coronary Artery Anomalies of Korean Men Detected by Coronary Computed Tomography

BACKGROUND AND OBJECTIVES: It has been demonstrated that the anomalous origin of coronary arteries (AOCA) are generally asymptomatic and rare diseases. However, some cases can cause severe life threatening events. To detect these anomalies, coronary angiographies and autopsies were used to detect coronary artery anomalies, but these procedures have limitations because of their invasiveness. The new device, Multidetector Computed Tomography (MDCT), now replaces the method of choice for detecting coronary anomalies. The prevalence of these anomalies in Korea has not been studied yet. This present analysis attempted to determine the prevalence of AOCA in Korean men by MDCT. SUBJECTS AND METHODS: 1582 Korean male police officers underwent coronary MDCT for their health screening voluntarily. After reconstruction of CT images, we could confirm coronary artery anomalies. RESULTS: The prevalence of AOCA in Korean men was 1.14% (18 out of 1582 cases). The most common abnormality (11 cases, 0.70%) was the origin of the coronary artery. Anomalies of the coronary artery end point were observed in 5 cases (0.32%). The anomalous location of coronary ostium on the aortic root was observed in 1 case (0.06%). An anomalous collateral vessel was observed in 1 case (0.06%). CONCLUSION: The prevalence of coronary artery anomalies in Korean men was 1.14%. Coronary CT is a safe and noninvasive modality for detecting coronary anomalies.

Causes and clinical characteristics of syncope in combat and auxiliary police in Korea / 대한내과학회지

BACKGROUND/AIMS: The most common type of syncope in young adults is neurocardiogenic in origin, which is not related to organic problems and has a benign nature. Therefore, there have been few reports regarding syncope in young Korean adults. Here, we examined the causes of syncope and its clinical characteristics in young combat and auxiliary police in Korea. METHODS: We performed a retrospective study of the medical records of 193 combat and auxiliary police in Korea admitted to the National Police Hospital for syncope or presyncope between January 2004 and December 2007. RESULTS: The subjects' mean age was 21+/-1.2 years, and there were 2.8+/-2.9 episodes of syncope (mean+/-SEM). The first syncope occurred after enlistment in the police in 102 patients (52.8%). Basic diagnostic studies showed two cases of elevated creatine phosphokinase and one case of anemia to be related to syncope. Syncope-related traumatic injuries occurred in 38 patients (19.7%), and syncope was more prevalent in the summer. Head-up tilt test was performed in 175 of the 193 patients, and 123 showed a positive response. Other evaluations, including brain magnetic resonance imaging, electroencephalography, and echocardiography, were not helpful for diagnosis. Syncope was neurocardiogenic in origin in the majority of cases. Other causes of syncope were exhaustion (n=2), hyperventilation syndrome (n=2), Meniere's disease (n=1), anemia (n=1), and psychiatric problems (n=5). The causes of syncope could not be identified in 59 patients (30.5%). CONCLUSIONS: Neurocardiogenic syncope was the most common type in our study population. More than half of our patients experienced their first episode after enlisting with the police. Further studies in these groups are necessary.

A case of Tangier disease with two novel mutations in the ATP-binding cassette transporter A1 gene / 대한내과학회지

Tangier disease (TD) is a rare autosomal recessive disorder of lipoprotein metabolism characterized by extremely low levels of high-density lipoprotein cholesterol (HDL-C) and apolipoprotein (apo) A-I resulting in accumulation of cholesterol esters in various organs. TD is caused by mutations in the ATP-binding cassette transporter A1 (ABCA1) gene. Here, we present the first case report of a Korean patient with TD. A 45-year-old man had corneal opacity, intestinal mucosa abnormalities, and extremely low levels of HDL-C (1.8 mg/dL) and apo A-I (T (p.G1050X) nonsense mutation and c.3202C>T (p.R1068C) missense mutation. The c.3202C>T mutation was not found in 192 normal control alleles.

Diagnostic Approach to a Patient with a Pleural Effusion Including Ultrasound-guided Paracentesis Performed by a Medical Resident / 결핵및호흡기질환

BACKGROUND: A patient with a pleural effusion that is difficult to safely drain by a "blind" thoracentesis procedure is generally referred to a radiologist for ultrasound-guided thoracentesis. But such a referral increases the cost and the patient's inconvenience, and it causes delay in the diagnostic procedures. If ultrasound-guided thoracentesis is performed as a bedside procedure by a medical resident, then this will reduce the previously mentioned problems. So these patients with pleural effusions were treated by medical residents at our medical center, and the procedures included bedside ultrasound-guided thoracenteses. METHODS: We studied 89 cases of pleural effusions from March 2003 to June 2005. A "blind" thoracentesis was performed if the amount of pleural effusion was moderate or large. Bedside ultrasound-guided thoracentesis was performed for small or loculated effusions or for the cases that failed with performing a "blind" thoracentesis. RESULTS: "Blind" thoracenteses were performed in 79 cases that had a moderate or large amount of uncomplicated pleural effusions and the success rate was 93.7% (74/79 cases). Ultrasound-guided thoracentesis by the medical residents was performed in 15 cases and the success rate was 66.7% (10/15 cases). The 5 failedcases included all 3 cases with loculated effusions and 2 cases with a small amount of pleural effusion. All the failed cases were referred to one radiologist and they were then successfully treated. If we exclude the 3 cases with loculated pleural effusions, the success rate of ultrasound-guided thoracentesis by the medical residents increased up to 83% (10/12 cases). Two cases of complications (1 pneumothorax, 1 hydrohemothorax) occurred during ultrasound-guided thoracentesis. CONCLUSION: Ultrasound-guided thoracentesis performed as a bedside procedure by a medical resident may be relatively effective and safe. If a patient has a loculated effusion, then it would be better to first refer the patient to a radiologist.

Rhabdomyolysis due to hyponatremia in a patient taking benzodiazepines / 대한내과학회지

Hyponatremia is rarely reported to cause rhabdomyolysis and there has been only one case report on rhabdomyolysis due to hyponatremia, possibly complicated by benzodiazepines. We experienced a case of rhabdomyolysis due to hyponatremia during the use of benzodiazepines in a patient with an acute psychosis. A 60-year-old man was admitted to the emergency room due to altered mentality. He had been taking benzodiazepines for 1 month because of insomnia, uneasiness, and depression. His initial blood chemistry revealed severe hypotonic hyponatremia in the absence of polydipsia, edema, and features of dehydration. While correcting the hyponatremia, rhabdomyolysis developed with no evidence of trauma, seizures, or tremor. In patients with acute psychosis, the development of rhabdomyolysis due to hyponatremia or its correction should not be underestimated and should be assessed thoroughly. Clinicians also need to be aware of the potential risk of benzodiazepines for the development of rhabdomyolysis.

Hepatocellular Carcinoma with Right Atrial Invasion Detected by PET/CT / 핵의학분자영상

The role of positron emission tomography (PET) with F-18 fluorodeoxyglucose (F-18 FDG) in the diagnosis of hepatocellulcar carcinoma (HCC) has been limited because of a variable FDG uptake in HCC. However, the usefulness of PET/CT for detecting extrahepatic metastasis and monitoring of the treatment response in HCC has been reported. A 55-year-old man with a hepatitis B surface antigen-positive, was admitted to our hospital due to dyspnea, general weakness and body weight loss for one month. Chest X-ray showed multiple reticulo-nodular densities on both lower lung fields, which implies metastatic lesions. F-18 FDG PET/CT revealed consecutively intense hypermetabolic mass in right hepatic lobe, inferior vena cava and right atrium. We report a case of HCC with IVC and right atrium invasion identified by F-18 FDG PET/CT.

A comparative study of the clinical features and hematobiochemical indices between the lung-uptake group and the non-lung-uptake group of malarial patients undergoing liver scanning / 대한내과학회지

BACKGROUND: Lung uptake during liver scanning has been considered as a passing phenomenon related to several diseases, and especially infectious diseases and malignancy. Some reports have shown diffuse lung uptake during liver scanning of malarial patients. Therefore, we tried to determine the relationship between the abnormalities of the clinical features, including the hematobiochemical indices and the lung uptake during liver scanning, by analyzing the information of the malarial patients. METHODS: We performed 99mTechnethium(Tc)-sulfur colloid liver scanning on 20 of the 45 malarial patients who were admitted from 1999 to 2004. We divided them into two groups, the Lung-Uptake (LU) group and the Non-Lung-Uptake (NLU) group. We analyzed the hematobiochemical indices and clinical features, including the respiratory symptoms, between the two groups. RESULTS: 10 of the 20 malarial patients showed lung uptake on the liver scan. The mean platelet counts were 74,000/L and 165,000/L, respectively, in the LU group and the NLU group (p=0.012). Also, the mean total cholesterol levels were 80.3 mg/dL and 105.7 mg/dL, respectively, in the LU group and the NLU group (p=0.033). The scores ofthe bone marrow (BM) uptake in the LU group were higher than those in the NLU group (p=0.008). Yet the other values such as Hb, ALT, albumin and total bilirubin were not statistically significant, nor were the peak body temperatureand other features. CONCLUSIONS: Half of the patients had lung uptake on the liver scanning, and this may be considered as a characteristic of vivax malaria. The BM uptake during liver scanning in the LU group was more increased, and this is supposed to be a consequence of hyperstimulated reticuloendothelial system, which was accompanied by thrombocytopenia and a lower level of total cholesterol in malarial patients.

Clinical Characteristics of Tuberculosis in Combat and Auxiliary Police in Korea / 감염과화학요법

BACKGROUND: The purpose of this study was to document the incidence and clinical characteristics of patients with tuberculosis (TB) in combat and auxiliary police, living in a group, in Korea where the incidence rate of active TB in a general population is higher than in Western countries. MATERIALS AND METHODS: We retrospectively reviewed the medical records of all tuberculosis patients diagnosed at National Police Hospital from January 2002 through December 2004. RESULTS: In 2002-2004, a total of 156 cases of tuberculosis were identified with the mean (Standard deviation) age of 20.6 (+/-1.0) years. Of these, 134 (85.9%) patients were registered as new cases, 11 (7.1%) as relapse, 2 (1.3%) as failure, 5 (3.1%) as treatment-after-default cases whereas 4 (2.6 %) patients were not included in any categories. Average annual new TB rate and smear-positive TB rate were 86.5/105 and 17.4/105 person-years, respectively. In 12 of 31 smear-positive cases, time from onset of symptoms to diagnosis was more than 30 days. Two multidrug-resistance TB cases were identified and two suspected outbreak episodes of TB had occurred during 3 years. CONCLUSION: There was no statistically significant difference in the incidence rate of new cases of TB between the general population aged 20 to 29 years and combat and auxiliary police in Korea.

Clinical Characteristics of Tuberculosis in Combat and Auxiliary Police in Korea / 감염과화학요법

BACKGROUND: The purpose of this study was to document the incidence and clinical characteristics of patients with tuberculosis (TB) in combat and auxiliary police, living in a group, in Korea where the incidence rate of active TB in a general population is higher than in Western countries. MATERIALS AND METHODS: We retrospectively reviewed the medical records of all tuberculosis patients diagnosed at National Police Hospital from January 2002 through December 2004. RESULTS: In 2002-2004, a total of 156 cases of tuberculosis were identified with the mean (Standard deviation) age of 20.6 (+/-1.0) years. Of these, 134 (85.9%) patients were registered as new cases, 11 (7.1%) as relapse, 2 (1.3%) as failure, 5 (3.1%) as treatment-after-default cases whereas 4 (2.6 %) patients were not included in any categories. Average annual new TB rate and smear-positive TB rate were 86.5/105 and 17.4/105 person-years, respectively. In 12 of 31 smear-positive cases, time from onset of symptoms to diagnosis was more than 30 days. Two multidrug-resistance TB cases were identified and two suspected outbreak episodes of TB had occurred during 3 years. CONCLUSION: There was no statistically significant difference in the incidence rate of new cases of TB between the general population aged 20 to 29 years and combat and auxiliary police in Korea.

Correlation Between Levels of N-terminal Pro-B-Type Natriuretic Peptide and Degrees of Heart Failure

BACKGROUND: The N-terminal fragment of pro Brain Natriuretic Peptide (NT-pro BNP) is a neuro-hormone synthesized in the cardiac ventricles in response to increased wall tension. The purpose of this study was to assess the correlation between the NT-pro BNP levels and the New York Heart Association function class (NYHA Fc) of dyspnea and echocardiographic findings for the patients who visited our cardiology departments. METHODS: From October, 2002 to April, 2003, serum NT-pro BNP levels were measured in 348 patients who visited the Samsung Medical Center and the Jong Koo Lee Heart Clinic. RESULTS: The NT-pro BNP levels were increased with the progression of NYHA Fc of dyspnea (p< 0.001 by ANOVA), the increase in the systolic left ventricular internal dimension (p< 0.05), and the decrease in the ejection fraction (p< 0.01). For the NYHA Fc I patients, the NT-pro BNP levels were positively correlated with age (p< 0.001) and left atrial size (p< 0.001). For the patients with ischemic heart disease, the NT-pro BNP levels were also positively correlated with the NYHA Fc (p< 0.001 by ANOVA). The NT-pro BNP levels were increased with the increase in the systolic (p< 0.001) and diastolic pressure (p=0.017), the left ventricular internal dimension as well as the decrease in the ejection fraction (p< 0.001). The area under the receiver operating characteristic (ROC) curve for the NT-pro BNP levels was 0.994 (95% confidence interval, 0.979-0.999), and the most reliable cut-off level for the NT-pro BNP was 293.6 pg/mL. CONCLUSION: The NT-pro BNP levels were positively correlated with the NYHA Fc of dyspnea and the systolic dysfunction for the patients who visited our cardiology departments. A 300 pg/mL value for the NT-pro BNP cut-off point appears to be a sensitive level to differentiate dyspnea originating from an ailing heart or not for the patients who visited our cardiology departments.

A Prospective Study for Comparing the Effects of Macrolide and Second-generation Cephalosporin on the Treatment of Pneumonia among Combat Policemen / 결핵및호흡기질환

BACKGROUND: The study of pneumonia among young men living in a group is rare. prospective study was conducted to determine the etiology, and compare the effects of macrolide and second-generation cephalosporin on the treatment of pneumonia among combat policemen. PATIENTS AND METHODS: From January 2003 to April 2004, Fifty-two patients with pneumonia were treated with either azithromycin(n=25) or cefuroxime(n=27). In order to determine the cause of the pneumonia, culture studies and serologic tests for antibodies to Mycoplasma pneumoniae and Chlamydia pneumoniae were carried out. During the two weeks of medication, the Chest X-rays, blood tests and culture studies(if necessary) were followed weekly. A serologic study was followed at the end of the second week. RESULTS: The main pathogens for pneumonia among combat policemen were Mycoplasma pneumoniae(50.0%), Chlamydia pneumoniae(10.8%), and Streptococcus pneumoniae(3.8%). The treatment was successful in most cases(51/52 cases, 98.1%). The effects of azithromycin and cefuroxime were similar (96.0% vs 100%, p>5). In one patient who had taken azithromycin, the clinical and radiological findings did not improved until intravenous second generation ce?phalosporin had been infused. CONCLUSION: Atypical pathogens were the main causes of the pneumonia in the combat policemen, and the effects of macrolide and second generation cephalosporin for pneumonia were similar. However, further studies will be needed to determine if single therapy with macrolide is possible.

A case of food-dependent exercise-induced anaphylaxis developed only in winter / 대한내과학회지

Food-dependent exercise-induced anaphylaxis has been recognized a variant of exercise-induced anaphylaxis charaterised by symptoms occuring on exertion after certain meal. We experienced a patient who developed an anaphylaxis induced by wheat flour made food followed by exercise only in cold temperature. A 22-year-old male patient was presented urticaria, angioedema, dyspnea, and loss of consciousness induced by exercise after ingestion of wheat flour made food only in winter. Skin prick test was negative for wheat or bread but positive for mushroom. By contrast, RAST was positive for wheat and negative for mushroom. In order to confirm the diagnosis exercise challenge test was done. The attack developed after ingestion of wheat flour made food and 10 min of outdoor jogging in temperature about 10 degrees C, but not by indoor treadmill test in temperature about 20 degrees C or ingestion of mushroom. This is the first case of food-dependent exercise-induced anaphylaxis developed only in cold temperature in Korea.

The efficacy and safety of angioseal(R) compared to conventional manual compression after transfemoral percutaneous coronary intervention / 대한내과학회지

BACKGROUND: Although the number and the quality of percutaneous coronary intervention have been recently increased dramatically, the vascular complication at puncture site is still the major cause of patients' morbidity. We evaluated the safety and efficacy of newly-developed collagen-based arterial closure device, angioseal(R) after transfemoral percuatenous coronary intervention. METHODS: This study was designed as a prospective single center non-randomized comparative study. A total 200 patients undergoing transfemoral percutaneous coronary intervention were enrolled between April 2002 and May 2003. They were divided into two groups; angioseal(R) group (group A, n=100) and manual compression group (group B, n=100). The baseline clinical and angiographic characteristics were reviewed. The time to sit up, the time to ambulation, the duration of hospital stay, major and minor vascular puncture site complications were monitored. The patients were followed-up for 1 week after the procedure by telephone. RESULTS: The baseline clinical characteristics, clinical diagnosis, cardiovascular risk factors, types of procedure, doses and numbers of anticoagulants were similar between two groups. The blood pressure and activated clotting time were also similar. The time to sit up (group A: 4.3 0.3 hours, group B: 13.7 0.8 hours, p=0.004) and the time to ambulation (group A: 6.8 0.5 hours, group B: 18.8 2.1 hours, p=0.013) were shorter in group A. No major vascular complications were noted. The incidence of hematoma and bleeding were not significantly different between two groups. The incidence of ecchymosis, however, was significantly lower in group A (group A: 12%, group B: 3%, p=0.001) The duration of hospital stay was similar between two groups. During 7 days of follow-up period, the incidence of hematoma was significantly lower in group A (p=0.004). Although the incidence of ecchymosis was not significantly different between two groups. CONCLUSION: The angioseal(R) may be associated with earlier ambulation and less patients' morbidity with low incidence of local complication rate compared to manual compression after transfemoral percutaneous coronary intervention.

Correlation between levels of n-terminal pro-b-type natriuretic peptide and degrees of heart failure / 대한내과학회지

BACKGROUND: N-terminal fragment of pro Brain Natriuretic Peptide (NT-pro BNP) is a neuro-hormone synthesized from the cardiac ventricles in response to increased wall tension. The purpose of this study was to assess the correlation between NT-pro BNP levels and New York Heart Association function class (NYHA Fc) and echocardiographic findings in patients, who visited cardiology department. METHODS: From October, 2002 to April, 2003, serum NT-pro BNP levels were measured in 348 patients, who visited Samsung Medical Center and Jong Koo Lee Heart Clinic. RESULTS: NT-pro BNP levels were increased with the progression of NYHA Fc of dyspnea (p<0.001 by ANOVA) as well as with the increase in systolic left ventricular internal dimension (p<0.05) and the decrease in ejection fraction (p<0.01). In NYHA Fc I patients, NT-pro BNP levels were positively correlated with age (p<0.001) and left atrial size (p<0.001). In patients with ischemic heart disease, NT-pro BNP levels were also positively correlated with NYHA Fc (p<0.001 by ANOVA). NT-pro BNP levels were increased with the increase in systolic (p<0.001) and diastolic (p=0.017) left ventricular internal dimension as well as the decrease in ejection fraction (p<0.001). The area under the receiver operating characteristic (ROC) curve for NT-pro BNP levels was 0.994 (95% confidence interval, 0.979-0.999), and the most reliable cut-off level of NT-pro BNP was 293.6 pg/mL. CONCLUSION: NT-pro BNP levels were positively correlated with NYHA Fc of dyspnea and systolic dysfunction in patients, who visited cardiology department. A 300 pg/mL of NT-pro BNP level appears to be a sensitive level to differentiate dyspnea of heart origin or not in patients, who visited cardiology department.

afety and Feasibility in Trans-radial Coronary Interventions for Chronic Total Occlusion

BACKGROUND AND OBJECTIVES: Recent advances in trans-radial coronary intervention (TRI) have shown a reduction in patient's morbidity. However, the role of TRI for a chronic total occlusion (CTO) is not well established. The aim of this study was to assess the safety and feasibility of TRI for a CTO. SUBJECTS AND METHODS: Sixty-three successive CTO lesions of more than 2 months duration were prospectively included in this registry between April 2002 and November 2003. Guiding catheters with strong back-up, stiff guide wires and supportive infusion catheters were actively used. The angiographic and procedural characteristics were prospectively evaluated. RESULTS: There were 45 male and 18 female patients, with a mean age of 59.8+/-9.5 years. The most common clinical diagnosis was stable angina (95.2%). The mean duration of the occlusions was 10.3+/-1.6 months. Procedural success was achieved in 53 lesions (84.1%). No cases were crossed over to transfemoral procedure. The most common cause of procedural failure was guide wire passage failure (7 lesions). The mean duration of occlusions was significantly longer in the failure group (7.5+/-1.1 versus 24.8+/-6.5 months, p<0.001). Bridging collateral vessels, long occlusions, calcification at lesion sites, a side branch at the occlusion site and blunt entry morphology were also statistically significant predictors for procedural failure. Procedure-related complications were noted in 6 patients (9.8%), which included coronary perforations (3.3%), severe dissections (3.3%), arrhythmia (1.6%) and branch artery occlusion (1.6%). No patients suffered from local complications, such as hematoma or radial artery occlusion. CONCLUSION: TRI for a CTO seems to be safe and feasible, with acceptable success and complication rates.

Correlation between Vascular Compliance and Increase of Blood Pressure on Exercising in Normotensive Group

BACKGROUND AND OBJECTIVES: Vascular compliance is known to be decreased in hypertension, even at an early stage. The blood pressure response to exercise reflects the future risk of developing hypertension. A study was performed on the relationship between the vascular compliance and blood pressure response to exercise, to evaluate whether the vascular compliance is decreased in normotensive persons with a relatively higher future risk of developing hypertension. SUBJECTS AND METHODS: The subjects of the study were adults with normal blood pressure (SBP<120 mmHg, DBP<80 mmHg), who had undergone health screening and both echocardiography and treadmill test. Those patients with a history of diabetes mellitus or clinical cardiovascular diseases were excluded form the subjects. An index of overall vascular compliance (SVI/PP) was calculated using echocardiography. The relationship between the peak systolic blood pressure during exercise and vascular compliance was also investigated. RESULTS: The subjects were 77 patients, 54 male and 23 female, with a mean age of 47.6+/-7.7 years. The measured vascular compliance and average of peak systolic pressure on exercising were 1.08+/-0.24 L/m2/mmHg and 154+/-21 mmHg, respectively. The peak systolic pressure was correlated with the vascular compliance (r=-0.24, p<0.05). The peak systolic pressure at stage 3 was also correlated with the vascular compliance (r=-0.24, p<0.05). This relationship persisted after adjustment for age, gender, basal systolic blood pressure and maximal oxygen consumption (p<0.05). CONCLUSION: The vascular compliance was lower in subjects with a larger increase in blood pressure during exercise whose basal blood pressure was even below 120/80 mmHg. This finding may suggest that a decreased vascular compliance precedes the changes of hypertension. A longitudinal follow-up study is warranted.

Effect of Cardiac Rehabilitation on Physiologic and Inflammatory Markers in Patients with Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: here are several reports of cardiac rehabilitation (CR) having beneficial effects on the reduction of cardiovascular mortality and in the prevention of recurrent coronary events in patient with myocardial infarction (MI). An 8-week CR program was investigated to see if it affected the prognostic factors, such as inflammatory markers, after acute MI. SUBJECTS AND METHODS: 33 male and 5 female patients, with a mean age of 55+/-10 yrs, were consecutively assigned to the CR (n=19) and the control (n=19) groups three weeks after acute MI. The 8-week CR program consisted of life style modification and aerobic exercise training. At the baseline, and after 8 weeks, the symptom limited exercise test and peripheral blood sampling were performed to measure the physiologic capacity, the serum levels of high sensitive C-reactive protein (hs-CRP) and the plasma levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha. The interval changes of each parameter were compared between the two groups. RESULTS: The interval increments of the maximal oxygen uptake (14.3% vs. 10.6%, CR vs. control group, p=0.014), anaerobic threshold (18.8% vs. 7.0%, CR vs. control group, p=0.044) and exercise duration (9.4% vs. 3.1%, CR vs. control group, p=0.009) were larger in the CR than in the control group. The magnitudes of the interval changes in hs-CRP, IL-6 and TNF-alpha, as inflammatory markers, did not differ between the two groups (p>0.05). CONCLUSION: This 8-week CR program demonstrated an improved exercise capacity for MI patients, but a larger clinical trial, with modified exercise intensity and duration, will be necessary to detect any possible effect on the inflammatory markers.

Pharmacokinetic Profiles of Isoniazid and Rifampicin in Korean Tuberculosis Patients / 결핵

BACKGROUND: Isoniazid(INH) and rifampicin(RFP) are the most effective anti-tuberculosis drugs which make the short-course chemotherapy possible. Although prescribed dosages of INH and RFP in Korea are different from those recommended by American Thoracic Society, there has been few study about pharmacokinetic profiles of INH and RFP in Korean patients who receive INH, RFP, ethambutol(EMB) and pyrazinamide(PZA) simultaneously. METHODS: Among the patients with active tuberculosis from Dec. 1997 to July 1998, we selected 17 patients. After an overnight fast, patients were given INH 300mg, RFP 450mg, EMB800mg and PZA 1500mg daily. Blood samples for the measurement of plasma INH(n=15) and RFP(n=17) level were drawn each at 0, 0.5, 1, 1.5, 2, 4, 6, 8 and 12hrs, and urine was also collected. INH and RFP level in the plasma and the urine were measured by high-performance liquid chromatography(HPLC). Pharmacokinetic parameters such as peak serum concentration(Cmax), time to reach to peak serum concentration(Tmax), half-life, elimination rate constant(Ke), total body clearance(CLtot), nonreanl clearance(CLnr), and renal clearance(CLr) were calculated. RESULTS: 1) Pharmacokinetic parameters of INH were as follows: Cmax; 7.63 +/- 3.20 micro gram /ml, Tmax; 0.73 +/- 0.22hr, half-life;2.12 +/- 0.84hrs, Ke;0.83 +/- 0.15hrs-1, CLtot;17.54 +/- 8.89L/hr, CLnr; 14.74 +/- 8.35L/hr, CLr; 2.79 +/- 1.31L/hr 2) Pharmacokinetic parameters of RFP were as follows : Cmax; 8.93 +/- 3.98 micro gram/ml, Tmax;1.76 +/- 1.13hrs, half-life;2.27 +/- 0.54hrs, Ke;0.32 +/- 0.08hrs-1, CLtot;14.63 +/- 6.60L/hr, CLr;1.04 +/- 1.55L/hr, CLnr;13.59 +/- 6.21L/hr. 3) While the correlation between body weight and Cmax of INH was not statistically significant (gamma=-0.514, p value >0.05), Cmax of RFP was significantly affected by body weight of the patients(gamma=-0.662, p value <0.01). CONCLUSION: In Korean patients with tuberculosis, 300mg of INH will be sufficient to reach the ideal peak blood level even in the patients over 50kg of body weight. However, 450mg of RFP will not be the adequate dose in the patients who weigh over 50~60kg.

Long-term Follow-up in Patients with Neurocardiogenic Syncope with or without Therapy

BACKGROUND AND OBJECTIVES: Neurocardiogenic syncope is the major type of syncope and beta-blocker is initial drug of choice. However, the data generated from the studies so far could not represent the beneficial effects of beta-blocker, and the recurrence rate in the long term was not established. This study examined the long-term follow-up on patients with neurocardiogenic syncope with or without therapy and campared among the therapeutic strategies in preventing the relapse of syncope. MATERIALS AND METHOD: Among the 197 patients with neurocardiogenic syncope or presyncope, who underwent head-up tilt test (HUT) from Oct. 1994 to Sep. 1996, we investigated 125 patients (59 males and 66 females). They were either interviewed on the phone or answered the questionnaire. The mean age was 3916 years old and the mean duration of follow-up was 195.9 months. RESULTS: Out of the 125 patients, 85 patients (68%) turned out to be HUT-positive and 40 patients (32%), negative. In the course of the follow-up on the HUT-positive patients, the symptoms recurred in 2 (10%) of the 20 patients who continued medication, 4 (25%) of the 16 patients who had no medication, and 11 (22.4%) of the 49 patients who discontinued medication on the way. Out of the 20 HUT-positive patients who continued medication, the symptom recurred in 1 (7.1%) of the 14 patients who received head-up tilt guided therapy, and 1 (16.1%) of the 6 patients in empirical therapy group. CONCLUSION: The outcome of the group who had gone through the long-term treatment of neurocardiogenic syncope, was found to be more favorable than the one of no therapy group, and this implies that the tilt-guided therapy may be more effective than the empirical therapy in order to prevent neurocardiogenic syncope. However, there would be more radomized, placebo-controlled and larger scale research to be desired at this point.

Talc Pleurodesis via Video-Assisted Thoracoscopic Surgery(VATS) in Malignant Pleural Effusions / 결핵

BACKGROUND: Chemical pleurodesis is a widely used method for the control of symptomatic and recurrent malignant pleural effusions. Tab has been accepted to k the most effective sclerosing agent for chemical pleurodesis. This study was undertaken to evaluate the usefulness of talc pleurodesis via video-assisted thoracoscopic surgery(VATS) in treatment of malignant pleural effusion& METHODS: A retrospective analysis of the medical records and radiographic findings was performed. The success of the procedure was defined as daily pleural fluid drainage below l00microliter within 1 week after pleurodesis and complete expansion of tie lung on simple chest radiograph. Recurrence was defined as reaccumulation of pleural fluid on follow-up chest radiographs, arid complete response as no fluid accumulation on follow-up chest radiographs. RESULTS: Between October 1994 and August 1996, talc pleurodesis via VATS was performed in 35 patient& Duration of follow-up ranged from 5 days to 828 days(median 79days). The initial success rate of procedure was 8S.6%(31 of 35 cases). Complete responses were observed in 92.8% at3O days, 75.7% at 90 days and 64.9% at 180 days. Postoperative complications were fever(54.3%), subcutaneous emphysema(11.4%), reexpansion pulmonary edema(2.9o%) and respiratory failure(5.7%). But procedure related mortality or respiratory failure was not found. CONCLUISON: Talc p1eurodesis via VATS is a safe and effective method F or the control of symptomatic malignant pleural effusions.