A case of successfully treated scrub typhus with azithromycin in pregnant woman / 대한내과학회지

Scrub typhus is a acute febrile illness by Orientia tsutsugamushi that is endemic in Asian-Pacific areas. But it is difficult to found this disease in pregnant woman. As yet, many clinicians have difficulty in making choice of appropriate and safe drugs to pregnant women with scrub typhus, because the drugs such as tetracycline (doxycycline) and chloramphenicol which have been used are proven harmful to fetus and neonates. We experienced a case of successfully treated scrub typhus with azithromycin in pregnant woman, and report it with references.

A Case of the Ruptured Splenic Artery Aneurysm Treated with Transcatheter Embolization / 대한소화기학회지

Splenic artery aneurysms are the most common visceral artery aneurysms, which are usually found incidentally. The most common complication of splenic artery aneurysms is spontaneous rupture into the peritoneal cavity, which leads to acute peritonitis and shock. Less commonly, it may rupture directly into the stomach, small bowel or pancreatic duct and may present with acute gastrointestinal hemorrhage. We report a rare case of the ruptured splenic artery aneurysm, presenting as acute massive hematochezia which was treated with transcatheter embolization.

A Case of Acute Ethanol Intoxication Complicated with Sciatic Neuropathy Treated with Hemodialysis / 대한신장학회잡지

A 20-year-old man presented with semicoma due to severe ethanol intoxication. Initially, his blood ethanol level was markedly elevated to 73 mmol/L. The patient's level of consciousness did not change for 6 hours with conservative treatment. In an attempt to expedite his recovery, hemodialysis was started using a femoral vein catheter. After an initial session of hemodialysis, his blood ethanol level was decreased to 19 mmol/L, and his mental status showed improvement. Subsequent hemodialysis further reduced his blood ethanol concentration to 3 mmol/L and improved his consciousness level. The patient was treated conservatively for additional complications caused by ethanol toxicity including liver failure, rhabdomyolysis and peripheral polyneuropathy. Most commonly, peripheral polyneuropathy is related with chronic ethanol intoxication and it is extremely rare in acute ethanol intoxication. We report a case of peripheral polyneuropathy related with acute ethanol intoxication and suggest that hemodialysis should be considered in patients with severe ethanol intoxication for life preservation and prevention of complications.

Clinical Characteristics of Hypothermia with Osborn Wave on ECG Based on the Analysis of 5 Patients

BACKGROUND AND OBJECTIVES: The Osborn wave is the name designated to the wave formation produced when there is a large, prominent deviation of the J point from the baseline. The wave has been reported in many countries, but only 2 cases have been reported in Korea. Thus, the purpose of our study was to evaluate the clinical characteristics and therapy of hypothermia employing the Osborn wave with Koreans. SUBJECTS AND METHODS: Between February 2001 and April 2001, five patients visiting our department with hypothermia were enrolled in this study. We analyzed these patients for their distribution, symptoms and signs, associated disorders, risk factors, electrocardiogram and laboratory findings. RESULTS: All 5 patients were male with an average age was 44.8+/-12.7 years. Three patients had a semi-comatose mentality and 2 cases had a comatose mentality. Their associated disorders were diabetes (2 cases), psychotic problems (1 case) and nutritional deficiency (1 case). Risk factors were alcohol abuse (3 cases) and drug in toxication (1 case). Laboratory abnormalities were acidosis (4 cases), increased serum glucose levels (all 5 cases) and increased serum potassium levels (3 cases). After active core rewarming by a line heat exchanger, 3 of the 5 patients completely recovered from hypothermia, 1 case immediately expired following admission and 1 case survived for 10 days, but later expired due to acute respiratory distress syndrome. The Osborn wave was persistent in 1 case and disappeared in 3 cases. CONCLUSION: We experienced 5 cases of hypothermia with an Osborn wave. The mortality of patients displaying an Osborn wave is expected to decrease if this anomaly is immediately found and treated by an appropriate method.

Comparison of Efficacy and Safety of Simvastatin, 10 mg and 20 mg in the Treatment of Hypercholesterolemia Patients Over 60-Year Old

BACKGROUND: Elevated serum cholesterol level is a major risk factor for cardiovascular morbidity and mortality. Simvastatin is effective for treating hypercholesterolemia. The aim of the study was to evaluate efficacy and safety of 6-month therapy with simvastatin with relatively low dose, 10 mg and 20 mg/day over 60-year-old patients. METHODS: Seventy-senven patients with hyperlipidemia(triglycerides 130 mg/dL) were randomized to receive either simvastatin 10 mg/day(n=32) or 20 mg/day(n=45). Efficacy was determined by measuring changes from baseline in lipid parameters including LDL cholesterol, total cholesterol, triglycerides and high-density lipoprotein(HDL) cholesterol. RESULTS: Of the senventy-seven patients randomized to treatment, eighteen patients were men and fiftynine patients were women. sixty-five percent of patients had hypertension, eighteen percent coronary artery disease and fourteen percent type 2 diabetes mellitus. Mean baseline lipid concentrations were 254 (total cholesterol), 291(triglycerides), 50(HDL) and 166 mg/dL(LDL). Both 10 mg and 20 mg of simvastatin produced statistically significant improvements in all measured serum lipid parameters(p<0.001). Compared with 10 mg of simvastatin, 20 mg of simvastatin produced significantly greater(p<0.001) reductions from baseline LDL cholesterol(32.9 mg/dL vs 24.2 mg/d). There was no significant difference in both doses at improving total cholesterol and HDL cholesterol level and TG cholesterol level. Percentage of patients at goal LDL as recommended by NCEP guideline(ATP III) were 100% and 89% for patients in low risk but 25% and 38.5% for patients in coronary heart disease and its risk equivalents, taking 10 mg and 20 mg/day respectively. Both doses were well tolerated. Only 3 patients(6.6%) in the 20 mg group and one patient(3. 1%) in the 10 mg group experienced mild adverse events. Most patients contacted by telephone wanted to take 10 mg of simvastatin. CONCLUSION: In patients with hypercholesterolemia over 60 year old in Korea, both doses(10 mg, 20 mg) of simvastatin were effective in improving serum lipid parameters and well-tolerated. We recommend, considering patients preference, that 10 mg of simvastatin be intial dosage and in patients with coronary heart disease, higher doses than 20 mg should be prescribed to allow most patients to reach their NCEP target levels.