Effect of Multiple Exposure to Perfluorinated Chemicals on Thyroid Function among Adults in the US: The National Health and Nutrition Examination Survey 2007-2008 and 2011-2012

Background and Objectives@#Perfluoroalkyl substances (PFASs) are known to disrupt the thyroid hormone system. However, no study has assessed the association between multiple exposure to PFASs and the thyroid hormone system. This study aimed to identify the singular effects of each PFAS and the effects of multiple exposure to PFASs on the thyroid hormone profile in a representative sample of the US population. @*Materials and Methods@#We used data from the US National Health and Nutrition Examination Survey (NHANES) 2007-2008 and 2011-2012. To assess the effect of simultaneous exposure to multiple PFASs on thyroid function, principal component (PC) analysis with varimax rotation was performed. Multivariate linear regression analysis was conducted to identify the effect of each PFAS and PC on thyroid function. @*Results@#In this study, perfluorooctanoate (PFOA) was associated with a decrease in total T4 and Free T4 levels. Perfluorooctane sulfonate (PFOS) was associated with a decrease in total T4 level and perfluorononanoate (PFNA) and perfluorodecanoate (PFDeA) were associated with decreases in TSH levels. In PC analysis, two PCs were identified. PC1 included PFOA, PFOS, perfluorohexane sulfonate (PFHxS), PFNA and 2-(N-methyl-perfluorooctane sulfonamido) acetic acid with high loading. PC2 included PFNA, PFDeA, and perfluoroundecanoate (PFUA). In the multivariate linear regression analysis, PC1 showed negative correlations with total T4 and Free T4 levels, whereas PC2 showed a negative correlation with TSH level. @*Conclusion@#We found that singular and multiple exposure to PFASs was associated with a disruption in thyroid hormone system.

Abdominal Wall Hematoma as a Rare Complication following Percutaneous Coronary Intervention

Abdominal wall hematoma is a rare but potentially serious vascular complication that may develop after coronary angiographic procedures. In particular, an oblique muscle hematoma caused by an injury of the circumflex iliac artery is very rare, yet can be managed by conservative treatment including hydration and transfusion. However, when active bleeding continues, angiographic embolization or surgery might be needed. In this study, we report an uncommon case of injury to the circumflex iliac artery by an inappropriate introduction of the hydrophilic guidewire during the performance of a percutaneous coronary intervention.

Two Cases of Treatment with Thrombolysis and an Extracorporeal Membrane Oxygenator in Patients with Pulmonary Embolism and Cardiac Arrest / 대한내과학회지

Massive pulmonary embolism (PE) is associated with poor prognosis and high mortality. Moreover, patients with massive PE who present with shock have mortality rates ranging from 30% to 50%. Thrombolysis should be administered to patients with massive PE unless there are absolute contraindications to its use. However, treatment failure still occurs, and there is no consensus for the management of massive PE with cardiopulmonary arrest with regard to thrombolysis. In this study, two cases of massive PE with cardiopulmonary arrest are described, both of which were successfully treated with thrombolysis and hemodynamic support, which was administered by extracorporeal membrane oxygenation (ECMO). This report suggests that ECMO may provide safe and adequate cardiopulmonary support in patients with massive PE with refractory thrombolysis and cardiopulmonary arrest.

Sick Sinus Syndrome Following Severe Hyponatremia Associated with Desmopressin Therapy / 대한내과학회지

Desmopressin diacetate arginine vasopressin (DDAVP) is a synthetic analogue of the arginine vasopressin that is widely used in the treatment of diabetes insipidus, nocturnal enuresis, and polyuria. Although it is generally well-tolerated, DDAVP can cause hyponatremia, especially in elderly patients. There are many reports of DDAVP-induced hyponatremia, but there has been only one case report in which sinus node dysfunction was caused by severe hyponatremia. Here we report a case of sick sinus syndrome that occurred during an episode of severe hyponatremia induced by chronic use of desmopressin in a 91-year-old man who had nocturnal enuresis.