Effect of Atorvastatin and Clopidogrel Co-Administration After Coronary Stenting in Korean Patients With Stable Angina

BACKGROUND AND OBJECTIVES: It was reported that atorvastatin co-administered with clopidogrel for 8 months did not affect the anti-platelet potency of clopidogrel in Korean patients with acute coronary syndrome, but not in patients with stable angina. We investigated whether co-administration of statins with clopidogrel affected the anti-platelet efficacy of clopidogrel in Korean patients with stable angina. SUBJECTS AND METHODS: This was a randomized, open-label and two-period crossover design study conducted at two centers. Two hundreds thirty three patients with stable angina scheduled for coronary stenting were randomized into two groups. In Group A, 119 patients first received atorvastatin (10 mg) followed by fluvastatin (80 mg) for 12 weeks per treatment. In Group B, 114 patients received the same treatments in reverse order. RESULTS: Baseline adenosine diphosphate (ADP, 10 micromol/L)-induced platelet aggregation was 54.4+/-9.1% in Group A and 53.8+/-9.0% in Group B (p=0.44), and significant differences were noted after each treatment period (p<0.001). Inhibition of platelet aggregation was similar between Group A and Group B at 24 hours following clopidogrel loading (29.2+/-11.0% vs. 30.4+/-12.7%; p=0.42). The two treatment least square means of 12-week ADP (10 mol/L)-induced platelet aggregation [29.50+/-0.79 {standard error (SE)}% on the atorvastatin treatment group vs. 28.16+/-0.70 (SE)% in the fluvastatin treatment group] in a 2x2 cross-over study were not significantly different (p=0.204). CONCLUSION: Statin and clopidogrel co-administration for 12 weeks is not associated with attenuated anti-platelet activity of clopidogrel in Korean patients with stable angina after coronary stenting, in support of the findings of similar studies conducted in Caucasian populations.

Case of Late-onset Acute Lung Injury Developed as a Complication of Organophosphate Intoxication-induced Acute Pancreatitis

Organophosphate insecticides are used globally and are household items in rural areas of Korea. Their ingestion for a suicidal purpose is common in Korea. Respiratory failure is the most serious manifestation and the usual cause of death in acute organophosphate poisoning, and is usually common during acute cholinergic crisis. But, respiratory failure may appear suddenly in a patient who is recovering from a cholinergic crisis, even while receiving conventional therapy. Most of these respiratory failures are associated with intermediate syndrome or pneumonia. In several recent studies, acute pancreatitis as a complication of organophosphate poisoning has been shown to be not a rare condition and respiratory failure may also occur in acute pancreatitis. However, acute lung injury developing as a complication of organophosphate intoxication-induced pancreatitis has not been hitherto reported in Korea. We described a case of a 50-year-old woman who had acute organophosphate intoxication-induced acute pancreatitis. The patient developed acute lung injury on the eighth day hospital day, after cholinergic crisis, without intermediate syndrome and pneumonia. Exclusion of other causes indicated that the acute lung injury may have developed due to acute pancreatitis.

Pathological Findings of a Renal Biopsy Showing Chronic Hepatitis B in A Patient with Acute Hepatitis A / 대한내과학회지

Hepatitis A is usually a self-limited liver disease that is treated conservatively. Acute renal injury complicating acute hepatitis A in the absence of fulminant hepatic failure is rare. We experienced a 33-year-old man who was healthy, and did not know that he was a hepatitis B virus (HBV)carrier with non-fulminant hepatitis A. He developed an acute kidney injury that necessitated dialysis therapy and a renal biopsy. He recovered within about 1 month. Pathologically, the renal biopsy showed acute tubular necrosis. It also showed IgA nephropathy and mesangium proliferation with glomerular nephritis, which are seen in chronic viral hepatitis B. We describe the association of acute hepatitis A with acute kidney injury and report the pathological findings of a renal biopsy related to chronic hepatitis B in an acute hepatitis A patient discovered by chance.

Interstitial Lung Disease Associated with Combination Chemotherapy of Oxaliplatin, 5-Fluorouracil, and Leucovorin / 대한소화기학회지

Oxaliplatin with 5-fluorouracil plus leucovorin (FOLFOX) has become the standard treatment in patients with colorectal cancer. Among known toxicities induced by oxaliplatin, hematological, gastrointestinal and neurological toxicities are common. However, acute pulmonary toxicity associated with oxaliplatin is unusual. One case of interstitial lung disease associated with the FOLFOX protocol is reported here.

Interstitial Lung Disease Associated with Combination Chemotherapy of Oxaliplatin, 5-Fluorouracil, and Leucovorin / 대한소화기학회지

Oxaliplatin with 5-fluorouracil plus leucovorin (FOLFOX) has become the standard treatment in patients with colorectal cancer. Among known toxicities induced by oxaliplatin, hematological, gastrointestinal and neurological toxicities are common. However, acute pulmonary toxicity associated with oxaliplatin is unusual. One case of interstitial lung disease associated with the FOLFOX protocol is reported here.