A Case of Mixed Malarial Infection with Plasmodium falciparum and Plasmodium vivax / 감염

We experienced a case of mixed infection with Plasmodium falciparum and P. vivax in a 48-year old Korean man. He returned to Korea from Papua New Guinea, where he worked for 20 days. Approximately one month after return to Korea, he developed high fever and myalgia. Malaria was suspected and he was admitted to our hospital. The peripheral blood smear demonstrated ring forms of P. falciparum. He was treated with quinine and doxycycline successfully. However, fever and myalgia reappeared five months later. This time, the peripheral blood smear showed gametocytes of P. vivax, while indirect immunofluorescence antibody test revealed high titers to both P. vivax and P. falciparum. He was treated with chloroquine and primaquine. Three months later, vivax malaria recurred again; he was treated with chloroquine and higher dose of primaquine. The patient was well after 6 months of follow-up. We hereby report a case of mixed malarial infections with a review of literatures.

A Case of Splenic Abscess with Multiple Fistulas Caused by Klebsiella pneumoniae / 감염

Splenic abscess is an uncommon but frequently fatal condition. Signs and symptoms are variable and do not always include left upper quadrant pain or tenderness. Unexplained thrombocytosis in a septic patient with persistent left pleural effusion is suggestive of splenic abscess. We report a case of splenic abscess with complicated multiple fistulas by Klebsiella pneumoniae which was successfully managed by antibiotic therapy, and percutaneous catheter drainage.

24 hour circadian pattern of blood pressure and its related target organ damage in hypertensive subjects / 대한내과학회지

OBJECTIVE: Pattern with essential hypertension generally shows the same circadian pattern as the normothensive person with a night-time reduction or "DIP" in blood pressure in sleep. The definition of "Dipper" and "Non-dipper" are assigned according to arbitrary criteria e.g. a night time average blood pressure which is at least 10% less than the average daytime blood pressure. Prospective evidence that the absence of an overnight dip is a strong adverse prognostic indicator for target organ damage .Thus we investigate circardian rhythm of blood pressure, related target organ damage, its frequency & drug in hypertensive subjects. Method : 24hr ambulatory blood pressure monitoring, history taking, physical examination, fundoscopy, ECG, chest X ray, dipstick urinanlysis, serum creatinine level are performed in essential hypertensive subjects. Exclusion criteria are duration of hypertension over 5 years, DM, renovascular hypertension & heart failure. RESULTS: Total 42 patients performed study.17 subjects classify dipper group,25 subjects classify non-dipper group. Between dipper & non-dipper group shows no significantly difference at stroke history, C/T ratio over 0.5 in chest X-ray, left ventrcular hypertrophy in ECG,ST-T change in ECG, proteinuria & serum creatinine level. Non-dipper group shows significantly difference to dipper group in frequency of hypertensive retinopathy and number of combined drug used subjects. CONCLUSION: Number of hypertensive retinopathy is significantly frequency in non-dipper group. Hypertensive retinopathy is atherosclerotic complication, thus we predict other target organ damage, therefore non-dipper type circardian rhythm of blood pressure is adverse prognostic factor for target organ damage of hypertensive subjects.

24 Hours Heart Rate Variability in Elderly Hypertensive Patients

BACKGROUND: Heart Rate Variability help us to diagnose the impairment of autonomic nervous system in patients with diabetes, hypertension, ischemic heart disease, chronic renal disease, and arrhythmia. Change of autonomic nervous system is related to circadian rhythm, stress, physical activity, and so on. Especially, impairment of vagal nervous system with age help us to expect sudden cardiac death, myocardial infarction, and arrhythmia. So we survey heart rate variability by using 24 hours holter monitoring to expect impairment of autonomic nervous system in elderly hypertensive patients. METHODS: In order to assess 24 hours heart rate variability, we use Del Mar Avionics 563 holter monitoring on 11 elderly hypertensive patients( > or =65 years), 12 younger hypertensive patients( <65 years), and 15 normal subjects. RESULTS: 1) Standard deviation of mean R-R interval, LF(low frequency), HF(high frequency), TPSD(total power spectral density) are more decreased in elderly hypertensive patients than in younger hypertensive patients in 24 hours health rate variability analysis(t-test p<0.05). 2) According to age, elderly control group had lower LF power spectral parameter than younger control group had, but other parameters were not decreased, and elderly hypertensive group had lower LF, HF, TPSD, SD of mean R-R interval than younger hypertensive group did(p<0.05). 3) In circardian rhythm, normal subjects had high HF power spectral parameter and low LF power spectral parameter at evening and night. On the other hand, elderly hypertensive group had constant low level of LF, HF power spectral parameter during the day and night. CONCLUSIONS: On heart rate variability analysis using by 24 hours Holter monitoring, heart rate variability was decreased, and impairment of autonomic nervous system was accelerated in elderly hypertensive patients.

Circadian Variation of Cardiac Autonomic Function in Hypertensives

BACKGROUND: We addressed the problem of the circadian changes in neural control of the circulation in ambulant hypertensive subjects. With spectral analysis of heart rate variability the tonic sympathetic and vagal activities and their changes are respectively assessed by the power of 0.050 - 0.015Hz(low frequency, LF) and 0.150 - 0.350Hz(respiratory linked, high frequency, HF) components of the spectrum of the beat by beat variability of RR interval. METHODS: Heart rate variability(HRV) and its circadian rhythm were evaluated in 15 patients with hypertension. By using 24-h Holter monitoring, HRV and its spectral components were measured. Finding were compared with 15 age-matched normal controls. RESULTS: The 24-hour plot of the SDs revealed that heart rate variability was significantly lower in the hypertensive patients, and the differences reached statistical significance during hours 2, 3, 9, 13, 16, 18, 19, and 23(p<0.05). Spectral analysis showed that power in the high-frequency range(0.150 to 0.350Hz) was lower among the hypertensive patients than among the normal controls during 22 of 24 hours but that the difference was statistically significant only during 2 hours(p<0.05). Power in the low frequency range(0.050 to 0.150Hz) was low at night, increased in the morning, and high during the day among controls ; this circadian rhythm was absent among hypertensive patients. CONCLUSIONS: Among hypertensive patients, HRV is decreased with a partial withdrawal of parasympathetic tone, and the circadian rhythm of sympathetic/parasympathetic tone is altered.