Corticosteroid Therapy for Refractory Uremic Pleurisy / 이화의대지

Uremic pleuritis is a fibrinous pleuritis of unknown pathogenesis in patients with chronic kidney disease. Although it responds to regular dialysis or repeated thoracentesis, cases that are refractory to those therapies have been reported. We report a case of uremic pleuritis which showed marked improvement following corticosteroid therapy. The effusion was exudate, and negative in cytology and microbiology. Pleural biopsy revealed chronic inflammation with fibrosis. The pleural effusion did not respond to chest tube drainage and continuance of hemodialysis. With a diagnosis of refractory uremic pleuritis, we started methylprednisolone. The pleural effusion responded to the treatment and resolved without complication.

A Case of Simultaneous Primary Gastric and Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma after Therapeutic Endoscopy / 대한내과학회지

Primary gastrointestinal lymphoma is the most common type of extranodal non-Hodgkin's lymphoma. Most cases are defined histologically as mucosa-associated lymphoid tissue (MALT) lymphoma, while low-grade MALT lymphoma affecting the stomach and duodenum simultaneously is rare. In this case report, we describe the case of a 55-year-old female who presented to the gastroenterology clinic at our hospital for management of gastric adenoma and duodenal polyp by endoscopic mucosal resection and polypectomy. The pathology report noted MALT lymphoma with submucosal tubulovillous adenoma and hyperplastic polyps in the stomach and duodenum. She underwent eradication of Helicobacter pylori using proton pump inhibitor-based triple therapy.

Glycemic Index Lowering Effects of Breads Supplemented with Resistant Starch, Whole Rye Grain and Fructooligosaccharide / 대한지역사회영양학회지

Low glycemic index (GI) foods have been reported to be very important in the control of blood glucose levels in diseases such as diabetes mellitus and obesity, which are becoming more prevalent in Korea. Bread consumption at breakfast and as a snack is also on the rise. To provide low GI alternatives, breads supplemented with dietary fibersfructooligosaccharide (FOS), ground whole rye, and 2 types of resistance starch (RS2 and RS4)-were developed. The GIs for these breads were evaluated with 13 healthy college students (M6, F7) and sensory tests were done. Four kinds of breads were made through the modification of a basic recipe for white bread (the control, B) as follows: for Bf, the entire amount of sugar was replaced with FOS. For Ryef, 50% of the white wheat flower was replaced with roughly ground wholerye (20 mesh: 12-20 mesh = 1 : 3) in addition to replacing sugar with FOS. For RS2f and RS4f, 20% of the white wheat flower was replaced with RS2 or RS4, in addition to replacing sugar with FOS. The overall preference score of Bf was similar to that of B, while those of Ryef, RS2f and RS4f were lower than that of B, but showed the acceptable degree of the overall preference. The glycemic indices of Ryef and RS2f were 46.1 and 45.9 respectively, which were significantly lower than the GI of B, 67.8. The GIs of Bf and RS4f were, however, 66.7 and 80.5 respectively, showing no significant difference compared to B. The glycemic loads for a 30 g serving were 9.5, 5.9, 6.2, 11.0 and 9.0 for B, Bf, Ryef, RS2f and RS4f, respectively. In conclusion, addition of RS2 or roughly ground whole rye to the dough formula significantly lowered the GI. Since the preferences shown for those two breads were acceptable, they may be recommended as a substitute for white bread for persons who need blood glucose management. More studies on the bread making process are required to improve preference and acceptance. Although GI lowering effects for F and RS4 were not found in this study, further studies are needed to verify their effects.

Protection of Cardiomyocytes from Acute Ischemic Injury by Protein Kinase Cepsilon Expression

BACKGROUND AND OBJECTIVES: Ischemic injury is the most common and important cause of myocardial damage. Over past decades, a number of studies have identified a protective mechanism known as ischemic preconditioning, which can block or delay cell death from ischemic injury. Protein kinase C (PKC), especially theepsilonisoform has been proposed as a key factor in the signaling pathway of ischemic preconditioning. However, whether PKCepsilon expression in cardiomyocytes can offer such protection from acute ischemia has not been explored. MATERIALS AND METHODS: To demonstrate a direct effect of PKCepsilon expression, a lentiviral vector system was established. Using the lentiviral vector, PKCepsilon was introduced to neonatal rat ventricular myocytes (NRVM) cultured under ischemic conditions, and also to adult rat myocardium subject to left coronary artery ligation. RESULTS: Compared to control, PKCepsilon expression in cultured NRVM under ischemia resulted in preserved cell density and morphology, and a reduction in cell death (77.6+/-12.8% vs 58.1+/-7.2%, p<0.05). In adult rats, the infarcted area after coronary artery ligation was markedly reduced in myocardium injected with PKCepsilon vector compared to control (11.4+/-5.3% vs 20.5+/-11.3%, p<0.01). CONCLUSION: These results provide direct evidence that PKCepsilon is a central player in protection against cell death from acute ischemia.

Comparisons of the Short-Term Angiographic Outcomes of Cypher and Taxus Stents Implanted in the Same Patient

BACKGROUND AND OBJECTIVES: Drug-eluting stents (DES) have been shown to substantially reduce both angiographic and clinical restenosis. Cypher(R) (sirolimus-eluting stent, Cordis, Johnson and Johnson, Florida, USA) and Taxus(R) (paclitaxel-eluting stent, Boston Scientific, Boston, USA) are the two most widely used DESs, and they both have distinct pharmacological properties and release kinetics. It has been not studied whether these two DESs show different angiographic outcomes when they are simultaneously implanted in the same patient. SUBJECTS AND METHODS: We retrospectively analyzed the angiographic findings of the short-term follow-up in 34 patients (average age: 63 year old, 9 women) in whom both Cypher and Taxus stents were implanted at the same time for the treatment of obstructive coronary lesion. RESULTS: There was no significant difference in the basal angiographic characteristics of the lesions that had two stents deployed in terms of the AHA/ACC classification, reference diameter, the percent diameter stenosis and minimal luminal diameter. The post-procedure results were similar between the two stents. At 6 months follow-up, the Cypher stent displayed significantly less in-stent lumen loss compared with the Taxus stent (0.16+/-0.04 mm vs 0.27+/-0.04 mm; respectively, p=0.040) and a smaller percent diameter stenosis (15.9+/-1.3% vs 19.9+/-2.2%, respectively, p=0.049). CONCLUSION: The Cypher stent showed significantly less luminal loss during short term follow-up compared with the Taxus stent when implanted in the same patient. This result suggests that in a given individual patient, the Cypher stent induces less neointimal proliferation than does the Taxus stent.

The Elevation of Serum Cardiac Troponin I in Patients with Supraventricular Tachycardia without Evidence of Coronary Artery Disease

BACKGROUND AND OBJECTIVES: Cardiac troponin I (cTnI) is a sensitive and specific marker of myocardial injury. Although myocardial infarction due to coronary artery occlusion is the most common cause of cTnI elevation, its rise has been reported in non-coronary artery diseases such as paroxysmal tachycardia. This study was conducted to determine the incidence of cTnI elevation in supraventricular tachycardia and to identify the factors associated with the rise in cTnI. SUBJECTS AND METHODS: We studied sixty-nine patients (35 males and 34 females, average age: 59+/-14 years) who were admitted for supraventricular tachycardia without evidence of coronary artery disease between January 2001 and December 2004. Coronary artery disease was excluded on the basis of clinical examinations, non-invasive techniques or coronary angiography. The subjects comprised 31 patients with paroxysmal supraventricular tachycardia, 36 patients with atrial fibrillation and 2 patients with atrial flutter. RESULTS: Serum cTnI elevation was observed in 22 of the 69 patients (31.9%) with supraventricular tachycardia. Multiple regression analysis revealed interventricular septal thickness (p<0.0001), the diastolic left ventricular internal dimension (p=0.0416) and hypertension (p=0.0460) as the significant factors related to cTnI elevation. However, the type or duration of tachycardia, the heart rate during tachycardia and patient's age were not related to cTnI elevation. CONCLUSION: This study showed that cTnI elevation may occur not infrequently in the patients with supraventricular tachycardia even in the absence of coronary artery disease. Myocardial hypertrophy and hypertension were the important factors related to cTnI elevation in this setting.

A Case of Cytomegalovirus Pneumonia and Retinitis in a Patients with Systemic Lupus Erythematosus / 대한류마티스학회지

Cytomegalovirus (CMV) is the member of the herpesviridae of virus, which are large DNA viruses that share the biologic properties of latency and reactivation. In patients with advanced acquired immune deficiency syndrome (AIDS) and those immunocompomised due to bone marrow transplantation or solid organ transplantation, CMV infection is the major cause of morbidity and mortality. CMV pneumonia is the most severe complication of these CMV disease. There have been reported a few cases of CMV interstitial pneumonitis occurring in a patient with SLE after intensive immunosuppressive therapy with prednisolone and cyclophosphamide, and there has been reported a case in Korea. Then we report a case of CMV pneumonia and retinitis occurring in a patient with SLE who was being treated with high dose steroid for 1 month, and was treated with ganciclovir and immunoglobulin.