Long-term Outcomes of Clopidogrel Monotherapy versus Prolonged Dual Antiplatelet Therapy beyond 12 Months after Percutaneous Coronary Intervention in High-risk Patients

Background@#There are no data on comparison between clopidogrel monotherapy and prolonged dual antiplatelet therapy (DAPT) in patients at high-risk undergoing percutaneous coronary intervention (PCI). @*Methods@#Of 2,082 consecutive patients undergoing PCI using second-generation drugeluting stent (DES), we studied 637 patients at high-risk either angiographically or clinically who received clopidogrel longer than 24 months and were event-free at 12 months after index PCI. Patients were divided into 2 groups: the clopidogrel monotherapy group and the prolonged DAPT group. The primary outcome was a composite of all-cause death, non-fatal myocardial infarction (MI), definite or probable stent thrombosis, or stroke between 12 months and 36 months after the index PCI. @*Results@#In propensity score-matched population (246 pairs), the cumulative rate of primary outcome was 4.5% in the clopidogrel monotherapy group and 4.9% in the prolonged DAPT group (hazard ratio, 1.21; 95% confidence interval, 0.54–2.75; P = 0.643). There was no significant difference in all-cause death, MI, stent thrombosis, stroke between the clopidogrel monotherapy group and the prolonged DAPT group. @*Conclusion@#Compared with prolonged DAPT, clopidogrel monotherapy showed similar long-term outcomes in patients at high-risk after second-generation DES implantation.

Long-term Outcomes of Clopidogrel Monotherapy versus Prolonged Dual Antiplatelet Therapy beyond 12 Months after Percutaneous Coronary Intervention in High-risk Patients

Background@#There are no data on comparison between clopidogrel monotherapy and prolonged dual antiplatelet therapy (DAPT) in patients at high-risk undergoing percutaneous coronary intervention (PCI). @*Methods@#Of 2,082 consecutive patients undergoing PCI using second-generation drugeluting stent (DES), we studied 637 patients at high-risk either angiographically or clinically who received clopidogrel longer than 24 months and were event-free at 12 months after index PCI. Patients were divided into 2 groups: the clopidogrel monotherapy group and the prolonged DAPT group. The primary outcome was a composite of all-cause death, non-fatal myocardial infarction (MI), definite or probable stent thrombosis, or stroke between 12 months and 36 months after the index PCI. @*Results@#In propensity score-matched population (246 pairs), the cumulative rate of primary outcome was 4.5% in the clopidogrel monotherapy group and 4.9% in the prolonged DAPT group (hazard ratio, 1.21; 95% confidence interval, 0.54–2.75; P = 0.643). There was no significant difference in all-cause death, MI, stent thrombosis, stroke between the clopidogrel monotherapy group and the prolonged DAPT group. @*Conclusion@#Compared with prolonged DAPT, clopidogrel monotherapy showed similar long-term outcomes in patients at high-risk after second-generation DES implantation.

Hypertriglyceridemia-induced Severe Necrotizing Pancreatitis Following Low Dose Tamoxifen Administration / 대한췌담도학회지

A 51-year-old woman visited the emergency room with severe abdominal pain of acute onset. She had undergone a breast cancer operation one year previously and had been taking a half-dose (10 mg per day) of tamoxifen for 6 months. She was diagnosed with severe acute necrotizing pancreatitis. She had no other specific underlying disease or medical history. She did not drink alcohol and showed no gallstones on endoscopic ultrasound examination. Her blood triglyceride level had been normal before tamoxifen but had gradually increased to 2,534 mg/dL 6 months after beginning tamoxifen. Tamoxifen was regarded as a very likely causative factor for her necrotizing pancreatitis. After discontinuing the drug and receiving supportive care, she eventually recovered, and her blood triglyceride levels dropped to a normal range. Tamoxifen may be a useful drug for treating breast cancer, but doctors should pay attention to the patient's blood triglyceride level during the medication regimen.

Toll-like Receptor 2 is Dispensable for an Immediate-early Microglial Reaction to Two-photon Laser-induced Cortical Injury In vivo

Microglia, the resident macrophages in the central nervous system, can rapidly respond to pathological insults. Toll-like receptor 2 (TLR2) is a pattern recognition receptor that plays a fundamental role in pathogen recognition and activation of innate immunity. Although many previous studies have suggested that TLR2 contributes to microglial activation and subsequent pathogenesis following brain tissue injury, it is still unclear whether TLR2 has a role in microglia dynamics in the resting state or in immediate-early reaction to the injury in vivo. By using in vivo two-photon microscopy imaging and Cx3cr1(GFP/+) mouse line, we first monitored the motility of microglial processes (i.e. the rate of extension and retraction) in the somatosensory cortex of living TLR2-KO and WT mice; Microglial processes in TLR2-KO mice show the similar motility to that of WT mice. We further found that microglia rapidly extend their processes to the site of local tissue injury induced by a two-photon laser ablation and that such microglial response to the brain injury was similar between WT and TLR2-KO mice. These results indicate that there are no differences in the behavior of microglial processes between TLR2-KO mice and WT mice when microglia is in the resting state or encounters local injury. Thus, TLR2 might not be essential for immediate-early microglial response to brain tissue injury in vivo.

A Case of a Huge Biliary Bezoar Treated with ESWL / 대한췌담도학회지

A bezoar is a mass formed by the accumulation of digested food. A biliary bezoar, namely a bezoar formed in the bile duct, is rare, which occurs mostly in patients who formerly underwent cholecystectomy. It appears that incompetent sphincter produces occasional reverse flow of foreign bodies including undigested food from the alimentary canal into the bile tract. Surgical treatment is used for huge biliary bezoar which is too huge to be removed by nonsurgical treatment. Extracorporeal shock wave lithotripsy (ESWL) is mostly used to fragment renal or urinary calculi, but may be sparingly used against biliary calculi. This is to report the rare case of a patient with biliary bezoar who formerly underwent open cholecystectomy and choledocoduodenostomy. The patient's huge biliary bezoar was removed by ESWL and the successive execution of endoscopic retrograde cholangio pancreatography (ERCP). ESWL is expected to be a comparatively safe and convenient solution to huge biliary bezoars.

The safety and efficacy of recombinant fibroblast growth factor 2 in human asthmatics: A pilot study

PURPOSE: Fibroblast growth factor 2 (FGF2) has been shown to inhibit airway inflammation, mucus production, and airway hyperresponsiveness in mouse model of asthma. The aim of this study was to evaluate the safety and efficacy of inhaled recombinant FGF2 in asthmatic patients. METHODS: Eight asthmatics were eligible for the study. All patients were admitted to a hospital, and recombinant FGF2 was administered using a nebulizer at a concentration of 4.5 ng/mL three times a day for one week. Pulmonary function test, methacholine bronchial provocation test, induced sputum analysis, asthma control test (ACT), and asthma quality of life questionnaire (AQLQ) were performed at the beginning of wash-out period, before and after the treatment, and at the end of study. And all these parameters were compared before and after FGF2 treatment. RESULTS: There were no serious adverse events associated with recombinant FGF2 during five-week study period. Daytime and nocturnal symptoms improved after the treatment (P=0.028 and P=0.012, respectively). AQLQ and ACT also improved after the treatment (P=0.017 and P=0.011, respectively). However, lung function, airway hyperresponsiveness, and airway inflammation showed no significant difference before and after the treatment. CONCLUSION: Inhaled recombinant FGF2 was safely used to eight asthmatics without any serious adverse events, and improved daytime and nocturnal symptoms, and quality of life in adult asthmatics. FGF2 may be a potential drug in the treatment of asthma.

ERRATUM: Author's Name Correction. The safety and efficacy of recombinant fibroblast growth factor 2 in human asthmatics: A pilot study

The fourth author's name was misprinted.

Early Gastric Cancer with Cellulitis-like Skin Metastasis / 대한소화기학회지

Skin metastasis from internal carcinoma rarely occurs and it has an incidence of 0.7% to 9%. Although the prognosis of the skin metastases varies considerably depending on the type of the primary malignancy, presence of metastatic skin cancer usually implies a widespread systemic disease and a high mortality. A 50-year-old Korean male patient visited Dankook University Hospital for evaluation of skin rash on his whole abdomen of about 1 month's duration. He had undergone laparoscopy-assisted distal gastrectomy due to early gastric cancer about 3 months ago. He did not complain of any noticeable symptoms like febrile sense or pruritus. Skin biopsy was performed on the periumbilical area at previous port site and around the scar. Microscopic examination revealed multiple malignant cells in lymphatic spaces, consistent with metastatic carcinoma. He was therefore diagnosed with isolated skin metastasis from early gastic cancer. Because of patient's poor liver function, systemic chemotherapy could not be performed and only best supportive care was provided. Herein, we report a rare case of cellulitis-like skin metastasis from early gastric cancer with a brief review of the literature.

Two Cases of Treatment with Intrathecal Rituximab for Primary Central Nervous System Lymphoma / 대한내과학회지

Primary central nervous system lymphoma (PCNSL) is an aggressive non-Hodgkin's lymphoma (NHL), usually composed of diffuse large B-cells. Although rituximab is known for its curative effect on B-cell NHL, data on the use of intrathecal rituximab for PCNSL are limited. In this report, we present two patients showing relapsed PCNSL with lymphomatous meningitis. Both patients were refractory to conventional methotrexate-based intrathecal chemotherapy. However, after intrathecal rituximab with or without conventional intrathecal chemotherapy, both patients showed stable disease on magnetic resonance brain imaging and cerebrospinal fluid analysis. There were no serious adverse events during each of 3 and 6 cycles with intrathecal rituximab immunotherapy.

A Case of Bronchial Artery Aneurysm in Cavitary Pulmonary Tuberculosis / 대한내과학회지

A bronchial artery (BA) aneurysm is a rare, life-threatening disease when it ruptures. Recently, we experienced a case of massive hemoptysis due to a BA aneurysm rupture in a pulmonary tuberculosis cavity, treated with BA embolization followed by surgical resection of the cavitary lesion. To our knowledge, this is the first case of a BA aneurysm associated with cavitary pulmonary tuberculosis.

A Case of Bronchial Artery Aneurysm in Cavitary Pulmonary Tuberculosis / 대한내과학회지

A bronchial artery (BA) aneurysm is a rare, life-threatening disease when it ruptures. Recently, we experienced a case of massive hemoptysis due to a BA aneurysm rupture in a pulmonary tuberculosis cavity, treated with BA embolization followed by surgical resection of the cavitary lesion. To our knowledge, this is the first case of a BA aneurysm associated with cavitary pulmonary tuberculosis.

A Case of Basaloid Squamous Cell Carcinoma of Rectosigmoid Colon / 대한소화기학회지

Basaloid squamous cell carcinoma is a rare and aggressive variant of squamous cell carcinoma, which mostly occurs in the upper aerodigestive tracts. Basaloid squamous cell carcinoma also typically arises in the anal canal, but is extremely rare in the lower gastrointestinal tract. A 70-year-old man presented with loose stool and intermittent hematochezia 2 months ago. Colonoscopy showed an ulceroinfiltrative mass on the rectosigmoid colon from 16 cm to 18 cm above the anal verge. Conventional colonoscope could not pass through the lesion but it was possible with pediatric colonoscope. Abdominal CT scan showed 1.6 cm sized wall thickening with circumferential luminal narrowing in the rectosigmoid colon and multiple ill-defined low density masses in both lobes of the liver. Therefore, colon cancer with liver metastasis was suspected. However, basaloid cells were noted on histologic examination, and they were weakly positive for synaptophysin on immunohistochemical study. After palliative lower anterior resection, histologic examination of the resected specimen revealed basaloid differentiation with keratin pearls, and tumor cells were positively stained with high molecular weighted cytokeratin (34BE12) and CK 5/6. Thus, the patient was finally diagnosed with basaloid squamous cell carcinoma of rectosigmoid colon with distant metastases.

Radiofrequency Thermocoagulation of Splanchnic Nerve in Patients with Upper Abdominal Pain / 대한마취과학회지

The splanchnic nerve block can be an alternative method for the pain control in the upper abdomen, when the celiac plexus block does not work. And the radiofrequency thermocoagulation has benefits over alcohol or phenol block because its effect is more localized and predictable. This report describe two patients with metastatic cancer pain in the abdominal cavity who successfully treated with the splanchnic nerve block by using radiofrequency thermocoagulation.

Tracheal Diverticulum Discovered during Endotracheal Intubation / 대한마취과학회지

A seven-year-old boy with a history of recurrent aspiration pneumonia was admitted to the Seoul National University Hospital for suspension examination. Anesthesia was induced through the T-cannula with oxygen and enflurane, and ventilation of the lungs was performed easily and resulted in good bilateral breathing sounds. After administration of thiopental, atropine, and vecuronium, endotracheal intubation was administered through the tracheostomy site with an endotracheal tube. Manual ventilation through the pediatric circuit system failed to raise the chest wall. Breathing sounds were absent. Manual assessment of the reservoir bag revealed extremely poor compliance. Immediately, we examined the trachea via ventilation-assisted bronchoscopy and a 2 cm-long diverticulum located in the posterior wall 1.5 cm below the tracheostomy site was discovered. we could therefore understand the reason for the ventilation impairment. The tip of the tube impinged through the diverticulum. After widening the pathway, endotracheal intubation was accomplished successfully into the tracheostomy site and ventilation of the lung was performed easily and resulted in good bilateral breathing sounds. After suspension examination and T-cannula insertion the patient recovered from anesthesia and was transfered to the recovery room.