Effects of intensive versus mild lipid lowering by statins in patients with ischemic congestive heart failure: Korean Pitavastatin Heart Failure (SAPHIRE) study

BACKGROUND/AIMS: This study was designed to evaluate the dose-effect relationship of statins in patients with ischemic congestive heart failure (CHF), since the role of statins in CHF remains unclear. METHODS: The South koreAn Pitavastatin Heart FaIluRE (SAPHIRE) study was designed to randomize patients with ischemic CHF into daily treatments of 10 mg pravastatin or 4 mg pitavastatin. RESULTS: The low density lipoprotein cholesterol level decreased by 30% in the pitavastatin group compared with 12% in the pravastatin (p < 0.05) group. Left ventricular systolic dimensions decreased significantly by 9% in the pitavastatin group and by 5% in the pravastatin group. Left ventricular ejection fraction (EF) improved significantly from 37% to 42% in the pitavastatin group and from 35% to 39% in the pravastatin group. Although the extent of the EF change was greater in the pitavastatin group (16% vs. 11%) than that in the pravastatin group, no significant difference was observed between the groups (p = 0.386). Exercise capacity, evaluated by the 6-min walking test, improved significantly in the pravastatin group (p < 0.001), but no change was observed in the pitavastatin group (p = 0.371). CONCLUSIONS: Very low dose/low potency pravastatin and high dose/high potency pitavastatin had a beneficial effect on cardiac reverse remodeling and improved systolic function in patients with ischemic CHF. However, only pravastatin significantly improved exercise capacity. These findings suggest that lowering cholesterol too much may not be beneficial for patients with CHF.

Sclerotherapy of Multiple Intraoral Venous Malformations with Use of Ethanolamine Oleate: A Case Report

Immature Platelet Fraction: Establishment of a Reference Interval and Diagnostic Measure for Thrombocytopenia / 대한진단검사의학회지

BACKGROUND: Immature platelet fraction (IPF, %) is a measure of reticulated platelets (RPs), which represents the state of thrombopoiesis. The IPF is obtained from an automated hematology analyzer as one of the platelet parameters. This study was performed to establish reference intervals of IPF and its cut-off values for the differential diagnosis of thrombocytopenia. METHODS: Blood samples from 2,039 healthy individuals (1,161 males, 878 females) were obtained to establish reference intervals. The patient group included patients with idiopathic thrombocytopenic purpura (ITP) (N=150) and aplastic anemia (AA) (N=51) with platelet counts of less than 100x10(9)/L. We evaluated the reliability of the IPF measurements, the reference intervals, and cut-off value for the diagnosis of ITP. RESULTS: The reference intervals of IPF were 0.5-3.2% in males and 0.4-3.0% in females (95% confidence interval). The median IPF% of ITP and AA were 7.7% (range, 1.0-33.8%) and 3.5% (range, 0.6-12.9%), respectively. Statistical analysis revealed a significant difference between the IPF% of ITP and AA (P<0.0001). The cut-off value of IPF for differentiating ITP from AA was 7.3% with a sensitivity and specificity of 54.0% and 92.2%, respectively. CONCLUSIONS: A rapid and inexpensive automated measurement of IPF can be integrated as a standard parameter to evaluate the thrombopoietic state of the bone marrow. This study determined the reference intervals of IPF from a large population of healthy individuals, including children. Further studies are needed to establish the clinical utility of IPF.

The role of hypoalbuminemia as a marker of the severity of disease in patients with tsutsugamushi disease / 대한내과학회지

BACKGROUND: Although hypoalbuminemia is common in patients with tsutsugamushi disease, acute rickettsial infectious disease, its impact on the severity of disease is not reported. Therefore, we studied the role of hypoalbumiemia as a marker of the severity of disease in patients with tsutsugamushi disease. METHODS: We retrospectively reviewed clinical data of 95 patients with tsutsugamushi disease who were admitted between January 1994 and December 1999 at Uijongbu St. Mary's hospital. We compared clinical and laboratory findings, complications, and mortality between hypoalbuminemic group (serum albumin or = 3.0 g/dL). RESULTS: Of the total 95 patients, 50 patients (52.6%) had hypoalbuminemia. In hypoalbuminemic group, the incidence of hypotension was higher (20.0% vs 2.2%, p=0.006) and the duration of admission was longer (12.0+/-4.5 vs 8.8+/-2.7 days, p<0.001), compared to control. The degree of thrombocytopenia in hypoalbuminemic group was severer than that in control (84,000+/-46,000 vs 138,000+/-75,000/mm3, p<0.001). Hypoalbuminemic group showed higher incidence of interstitial pneumonia (64.0 vs 13.3%, p<0.001), hypoxia (40.0 vs 6.6%, p<0.001), metabolic acidosis (12.0 vs 0%, p=0.018), and acute renal failure (18.0 vs 4,4%, p=0.038), compared to control. Four patients who had hypoalbuminemia died due to septic shock and multiorgan failure. CONCLUSION: This study shows that hypoalbuminemia could be used as a marker of the severity of disease in patients with tsutsugamushi disease.