Clinical features of active tuberculosis that developed during anti-tumor necrosis factor therapy in patients with inflammatory bowel disease

BACKGROUND/AIMS: Anti-tumor necrosis factor (TNF) therapy for active ulcerative colitis (UC) and Crohn's disease (CD) is associated with increased risks of tuberculosis (TB) infection. We analyzed the incidence and clinical features of Korean patients with inflammatory bowel disease (IBD) who developed active TB during anti-TNF therapy. METHODS: Ten cases of active TB developed in patients treated with infliximab (n=592) or adalimumab (n=229) for UC (n=160) or CD (n=661) were reviewed. We analyzed demographics, interval between start of anti-TNF therapy and active TB development, tests for latent TB infection (LTBI), concomitant medications, and the details of diagnosis and treatments for TB. RESULTS: The incidence of active TB was 1.2% (10/821): 1.5% (9/592) and 0.4% (1/229) in patients receiving infliximab and adalimumab, respectively. The median time to the development of active TB after initiation of anti-TNF therapy was three months (range: 2-36). Three patients had past histories of treatment for TB. Positive findings in a TB skin test (TST) and/or interferon gamma releasing assay (IGRA) were observed in three patients, and two of them received anti-TB prophylaxis. Two patients were negative by both TST and IGRA. The most common site of active TB was the lungs, and the active TB was cured in all patients. CONCLUSIONS: Active TB can develop during anti-TNF therapy in IBD patients without LTBI, and even in those with histories of TB treatment or LTBI prophylaxis. Physicians should be aware of the potential for TB development during anti-TNF therapy, especially in countries with a high prevalence of TB.

Clostridium difficile Colitis after Topical Ophthalmic Use of Levofloxacin / 이화의대지

Clostridium difficile colitis (CDC) has been associated with virtually all available antibiotics. It is well known that administration of drugs by the ocular route can result in systemic absorption with the possibility of systemic effect. We report a case of a 74-year-old woman who was treated with 0.5% levofloxacin eyedrops for ten weeks running for the post operative management of two separate bilateral cataract surgeries. Toxin assay for C. difficile was positive and the endoscopic findings were compatible with CDC. The plasma concentrations reached after intraocular administration of levofloxacin seem so trivial, but the administration of topical agents could make accumulated effect and be a potential cause of systemic toxicity.

Clostridium difficile Colitis after Topical Ophthalmic Use of Levofloxacin / 이화의대지

Clostridium difficile colitis (CDC) has been associated with virtually all available antibiotics. It is well known that administration of drugs by the ocular route can result in systemic absorption with the possibility of systemic effect. We report a case of a 74-year-old woman who was treated with 0.5% levofloxacin eyedrops for ten weeks running for the post operative management of two separate bilateral cataract surgeries. Toxin assay for C. difficile was positive and the endoscopic findings were compatible with CDC. The plasma concentrations reached after intraocular administration of levofloxacin seem so trivial, but the administration of topical agents could make accumulated effect and be a potential cause of systemic toxicity.

Acute Pancreatitis Caused by Dyslipidemia / 이화의대지

Hyperlipidemia can be a cause of acute pancreatitis. For example, dyslipidemia classified Fredrickson/WHO classification type I, V can induce acute pancreatitis spontaneously. Secondary hyperlipidemia (DM, alcohol, estrogen, etc.) also can induce acute pancreatitis. High serum amylase level and triglyceride level are hall markers of diagnosis. But lactescent serum interferes with accurate laboratory analysis of amylase. Serum amylase was normal or low in 50% of cases. Clinical course and treatment are similar with other causes of acute pancreatitis. Lipoprotein electrophoresis helps classify dyslipidemia by Fredrickson/WHO classification. In some cases, to prevent hyperlipidemic pancreatitis, serum triglyceride should be lower than 500 mg/dl. We report two cases of acute pancreatitis caused by dyslipidemia.

Mallory-Weiss Syndrome Occurring in a Hanging Patient: Case Report

Reflex gasping when hanging leads to passive and vigorous vomiting, the mechanical force of which causes gastric mucosa laceration. Mallory-Weiss syndrome is a tear in the gastro-esophageal junction or its adjacent mucosa, and this can occur due to nausea or vomiting that is caused by various etiologic factors. Gastric fundus is the most common site of gastric mucosa lacerations. We report a case of a 41-year-old man, who tried to hang himself and, as a result, caused multiple gastric mucosa lacerations that were treated by an endoscopic hemostatic procedure in the emergency room.

The effect of preparation procedure on implant-abutment joint stability / 대한치과보철학회지

STATEMENT OF PROBLEM: Little is known about the effect of abutment preparation procedure on de-torque values in different implant platform and the relationship of final de-torque values with different implant platform size. PURPOSE: This study evaluated the effect of abutment preparation procedure on de-torque values in different implant platform and the relationship of final de-torque values with different implant platform size. MATERIAL AND METHOD: Six ITI implants (2 narrow-neck implants, 2 regular-neck implants, 2 wide-neck implants) and six Bra.nemark implants (2 narrow platforms, 2 regular platforms, 2 wide platforms) were embedded in each acrylic resin block with epoxy resin. Eighteen synOcta(R) abutments (6 narrow-neck implant-abutments, 6 regular-neck implant-abutments, 6 wide-neck implant-abutments) and eighteen esthetic abutments (6 narrow platform-abutments, 6 regular platform-abutments, 6 wide platform-abutments) were tightened to each implant with digital torque gauge. Initial de-torque values were measured using digital torque gauge. After preparation of abutments, Final de-torque values were measured with digital torque gauge. RESULTS AND CONCLUSION: 1. Screws loosening or abutments motion were not detected in all experimental group, but some scratches of implant-abutment joints were detected in all group. 2. Reduction ratios of final de-torque values were greater than initial de-torque values in all measured group, except in narrow-neck implant-abutment group (p<0.05). 3. Reduction ratios of final de-torque values in wide-neck implant-abutment group were greater than regular-neck implant-abutment group (p<0.01). 4. The greatest standard deviation value was detected in wide platform group in both implant systems.

A Case of Lemierre's Syndrome with Cranial Nerve Palsies

Lemierre's syndrome is a rare acute medical condition characterized by anaerobic oropharyngeal infections leading to septic thrombophlebitis of the internal jugular vein. The illness is often complicated by septic pulmonary emboli and distant metastatic infections. Treatment consists of long-term intravenous antibiotic therapy and surgical drainage of purulent collections. Although Lemierre's syndrome is rare, it is potentially fatal and remains an important entity for clinicians to recognize and treat appropriately. We report a 19-year-old female of Lemierre`s syndrome complicated with bacterial meningitis and multiple cranial neuropathies. (J Korean Neurol Assoc 19(5):529~532, 2001)

Effect of iontophoresis anesthesia of the tympanic membrane on middle ear pressure / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES:The presence of encapsulated nerve corpuscles that is involved in regulating middle ear pressure has been noticed in previous studies. Based on those findings, how the sensory receptors in the tympanic membrane and tubal function are related was tested in the present study. MATERIALS AND METHODS: Tubal function was tested by 9 step test using Grason-Stadler institute(GSI) Middle ear analyzer II Eustachian tube function(ETF) test mode. Tubal function was recorded as compliance of the tympanic membrane on an otoadmittance meter. To anesthetize the sensory receptors in the tympanic membrane, iontophoresis was applied to the twenty right ears of the twenty subjects. RESULTS: Peak pressure difference in the middle ear was reduced after the tympanic membrane (TM) anesthesia, which indicates that the tubal function has decreased due to pressure change in the sensory receptors in the tympanic membrane. CONCLUSION: The findings of the present study suggest that there may be a neural connection between the sensory receptors in the tympanic membrane and the tubal muscle, as the eustachian tube function changed following the TM anesthesia.