Prevalence and Related Factors of Vitamin D Deficiency in Critically Ill Patients / 대한구급학회지

BACKGROUND: To identify the prevalence and related factors for vitamin D deficiency in the patients who admitted to the medical intensive care unit (ICU) of a Korean tertiary care hospital. METHODS: We retrospectively analyzed the data from ICU patients requiring mechanical ventilation (MV) for a period of > 48 h to identify the prevalence and associated factors for vitamin D deficiency. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D [25(OH)D] level < 20 ng/mL. RESULTS: Among 570 patients admitted to the ICU, 221 were enrolled in the study, 194 in the vitamin D deficient group and 27 in the non-deficient group. Prevalence of vitamin D deficiency in critically ill patients was 87.8%. The patient age was lower in the vitamin D deficient group compared with the non-deficient group (64.4 ± 15.4 vs. 71.0 ± 9.6 years, p = 0.049). A higher acute physiology and chronic health evaluation II (APACHE II) score (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.10-1.37) and chronic illness (OR 3.12, 95% CI 1.08-9.01) were associated with vitamin D deficiency after adjusting for age and body mass index. Clinical outcomes of duration of MV, ICU stay, and 28- and 90-day mortality rates were not significantly different between the vitamin D deficient and nondeficient groups. CONCLUSIONS: Vitamin D deficiency was common in critically ill patients, particularly among younger patients. Higher APACHE II score and chronic illness were associated with vitamin D deficiency.

Prevalence and Related Factors of Vitamin D Deficiency in Critically Ill Patients / 대한중환자의학회지

BACKGROUND: To identify the prevalence and related factors for vitamin D deficiency in the patients who admitted to the medical intensive care unit (ICU) of a Korean tertiary care hospital. METHODS: We retrospectively analyzed the data from ICU patients requiring mechanical ventilation (MV) for a period of > 48 h to identify the prevalence and associated factors for vitamin D deficiency. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D [25(OH)D] level < 20 ng/mL. RESULTS: Among 570 patients admitted to the ICU, 221 were enrolled in the study, 194 in the vitamin D deficient group and 27 in the non-deficient group. Prevalence of vitamin D deficiency in critically ill patients was 87.8%. The patient age was lower in the vitamin D deficient group compared with the non-deficient group (64.4 ± 15.4 vs. 71.0 ± 9.6 years, p = 0.049). A higher acute physiology and chronic health evaluation II (APACHE II) score (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.10-1.37) and chronic illness (OR 3.12, 95% CI 1.08-9.01) were associated with vitamin D deficiency after adjusting for age and body mass index. Clinical outcomes of duration of MV, ICU stay, and 28- and 90-day mortality rates were not significantly different between the vitamin D deficient and nondeficient groups. CONCLUSIONS: Vitamin D deficiency was common in critically ill patients, particularly among younger patients. Higher APACHE II score and chronic illness were associated with vitamin D deficiency.

A Case of Recurrent Liver Abscess Due to Choledochoduodenal Fistula / 영남의대학술지

Cholelithiasis, duodenal ulcer, duodenal perforation and tumor invasion may lead to choledochoduodenal fistula (CDF). CDF often has no specific symptoms and may be incidentally detected in an upper gastrointestinal radiographic study or endoscopy; but in some cases, it may be accompanied by recurrent cholangitis and liver abscess. In this paper, a case of recurrent liver abscess caused by CDF is reported. A 62-year-old female was admitted to the authors' hospital because of right upper quadrant pain and fever. The abdominal computed tomography showed a liver abscess in the right lobe. A duodenal fistulous orifice was detected with endoscopy, and a contrast was injected through the duodenal orifice using a catheter under fluoroscopy. The injection of the contrast revealed a fistulous track between the duodenal bulb and the common hepatic duct. In fistulas complicated by recurrent liver abscess, surgery or medical management may be needed. The CDF in this case study was treated via endoscopic clipping.

A Case of Hypomyopathic Dermatomyositis / 영남의대학술지

Dermatomyositis is a rare and idiopathic inflammatory myopathy with a characteristic cutaneous manifestation. A 62-year-old female complained of polyarthralgia that lasted for many years. She was diagnosed with hypomyopathic dermatomyositis by the typical skin rash associated with dermatomyositis but without muscle involvement such as muscle weakness, elevated level of creatinine phosphokinase and aldolase. Her symptoms improved with treatment of hydroxychloroquine and prednisolone. We experienced a case of hypomyopathic dermatomyositis on 62-year-old female patient and report with review of literatures.

Recanalization of Chronic Total Occlusion of Coronary Arteries by Prolonged Intracoronary Urokinase Infusion

BACKGROUND: PTCA is often unsuccessful in a patient with chronic total occlusion of coronary arteries with success rates varying from 60 to 70%. Success rates are related to the duration of total occlusion, longer occlusions being associated with lower success rates. Chronic total occlusion may be associated with thrombi superimposed on the stenotic lesion. We used an intra-coronary bolus of urokinase followed by a prolonged urokinase infusion in an attempt to lyse the lesion and allow for passage of the PTCA wire during subsequent angioplasty. The purpose of prolonged durokinase infusion was to reduce the clot sufficiently to recanalize the coronary artery and make it more amenable to PTCA. METHODS: Study patients: We were included six patients who developed total occlusion for more than 3 weeks and good collateral channels of Grade 2 or more and previous attempts at angioplaty had failed. Procedures: All patients underwent dual catheter system and incremental dose protocol of intracoronary urokinase infusion. RESULTS: The mean duration of occlusion was calculated to be 65.3+/-2.7 weeks and urokinase dose ranged from 130,000 to 200,000U/hr and treatment lasted 21.7+/-1.4 hours in our study. The prolonged urokinase infusion resulted in reperfusion of the occluded dvessel in 5 of the 6 patients(83%), with or without the complementary balloon inflation. One patient failed to recanalize the occluded vessel because cardiac tamponade was developed during the prolonged urokinase infusion. CONCLUSION: We concluded that the prolonged urokinase infusion in occluded coronary artery appeared to increase the likelihood of successful PTCA in patients with chronic total occlusion of coronary arteries.Also, in carefully selected patients, prolonged urokinase infusion in occluded coronary artery was relatively safe and well tolerated.