Efficacy of Cardiac Resynchronization Therapy Using Automated Dynamic Optimization and Left Ventricular-only Pacing

BACKGROUND: Although device-based optimization has been developed to overcome the limitations of conventional optimization methods in cardiac resynchronization therapy (CRT), few real-world data supports the results of clinical trials that showed the efficacy of automatic optimization algorithms. We investigated whether CRT using the adaptive CRT algorithm is comparable to non-adaptive biventricular (BiV) pacing optimized with electrocardiogram or echocardiography-based methods. METHODS: Consecutive 155 CRT patients were categorized into 3 groups according to the optimization methods: non-adaptive BiV (n = 129), adaptive BiV (n = 11), and adaptive left ventricular (LV) pacing (n = 15) groups. Additionally, a subgroup of patients (n = 59) with normal PR interval and left bundle branch block (LBBB) was selected from the non-adaptive BiV group. The primary outcomes included cardiac death, heart transplantation, LV assist device implantation, and heart failure admission. Secondary outcomes were electromechanical reverse remodeling and responder rates at 6 months after CRT. RESULTS: During a median 27.5-month follow-up, there was no significant difference in primary outcomes among the 3 groups. However, there was a trend toward better outcomes in the adaptive LV group compared to the other groups. In a more rigorous comparisons among the patients with normal PR interval and LBBB, similar patterns were still observed. CONCLUSION: In our first Asian-Pacific real-world data, automated dynamic CRT optimization showed comparable efficacy to conventional methods regarding clinical outcomes and electromechanical remodeling.

A Case of Pulmonary Amyloidosis Mimicking Lymphangitic Lung Carcinomatosis / 대한내과학회지

Amyloidosis is defined by tissue deposits of amyloid, which cause both functional and structural damage to organs. Three histopathological types of pulmonary amyloidosis have been described: tracheobronchial, nodular parenchymal, and diffuse parenchymal or alveolar septal types. Diffuse alveolar septal involvement of the lung is a rare form of primary pulmonary amyloidosis, with radiological features similar to those of pulmonary edema, pulmonary fibrosis, and lymphangitic carcinomatosis. Therefore, it is always challenging to diagnose alveolar septal involvement of pulmonary amyloidosis. Here, we report a case of alveolar septal involvement of pulmonary amyloidosis mimicking lymphangitic carcinomatosis, which was diagnosed from a transbronchial lung biopsy.

Immune Reconstitution Inflammatory Syndrome Presenting as Cutaneous Miliary Tuberculosis in an HIV-Infected Patient / 대한내과학회지

Tuberculosis is one of the most common opportunistic diseases in human immunodeficiency virus (HIV)-infected patients in Korea, and extra-pulmonary infections are frequent in these patients. Cutaneous miliary tuberculosis is a rare form of tuberculosis that presents as a papulopustular eruption and hematogenous dissemination of Mycobacterium tuberculosis to multiple organs. This has been reported in patients with progressive HIV infection. We report the first case of cutaneous miliary tuberculosis that developed as a manifestation of immune reconstitution inflammatory syndrome (IRIS) after initiating antiretroviral therapy (ART).

Percutaneous Suture-Based Closure Device for Management of Inadvertent Subclavian Artery Catheterization / 대한내과학회지

Central venous catheterization is performed to secure pathways for large amounts of saline, drug infusion, parenteral nutrition support, and hemodialysis. Accidental subclavian artery cannulation is a possible complication of central venous catheterization. Here, we report two cases of 8 Fr. chemoports inadvertently inserted in subclavian arteries during internal jugular venous catheterizations. The chemoports were removed successfully, and puncture sites were repaired using suture-based closure devices (Perclose). One patient experienced minor neurological complications after the procedure. With effective management, the patient was treated with no sequelae. To our knowledge, this is the first report of stroke after procedures using suture-based devices.

A Case of Idiopathic Hypereosinophilic Syndrome Presenting With Acute Respiratory Distress Syndrome

Although idiopathic hypereosinophilic syndrome(IHES) commonly involves the lung, it is rarely associated with acute respiratory distress syndrome (ARDS). Here we describe a case of IHES presented in conjunction with ARDS. A 37-year-old male visited the emergency department at Samsung Medical Center, Seoul, Korea, with a chief complaint of dyspnea. Blood tests showed profound peripheral eosinophilia and thrombocytopenia. Patchy areas of consolidation with ground-glass opacity were noticed in both lower lung zones on chest radiography. Rapid progression of dyspnea and hypoxia despite supplement of oxygen necessitated the use of mechanical ventilation. Eosinophilic airway inflammation was subsequently confirmed by bronchoalveolar lavage, leading to a diagnosis of IHES. High-dose corticosteroids were administered, resulting in a dramatic clinical response.

Current feeding practices and maternal nutritional knowledge on complementary feeding in Korea / 소아과

PURPOSE: To evaluate current feeding practices and maternal nutritional knowledge on complementary feeding. METHODS: Mothers of babies aged 9-15 months who visited pediatric clinics of 14 general hospitals between September and December 2008 were asked to fill questionnaires. Data from 1,078 questionnaires were analyzed. RESULTS: Complementary food was introduced at 4-7 months in 89% of babies. Home-made rice gruel was the first complementary food in 93% cases. Spoons were used for initial feeding in 97% cases. At 6-7 months, <50% of babies were fed meat (beef, 43%). Less than 12-month-old babies were fed salty foods such as salted laver (35%) or bean-paste soup (51%) and cow's milk (11%). The following were the maternal sources of information on complementary feeding: books/magazines (58%), friends (30%), internet web sites (29%), relatives (14%), and hospitals (4%). Compared to the 1993 survey, the incidence of complementary food introduction before 4 months (0.4% vs. 21%) and initial use of commercial food (7% vs. 39%) had decreased. Moreover, spoons were increasingly used for initial feeding (97% vs. 57%). The average maternal nutritional knowledge score was 7.5/10. Less percentage of mothers agreed with the following suggestions: bottle formula weaning before 15-18 months (68%), no commercial baby drinks as complementary food (67%), considering formula (or cow's milk) better than soy milk (65%), and feeding minced meat from 6-7 months (57%). CONCLUSION: Complementary feeding practices have considerably improved since the last decade. Pediatricians should advise timely introduction of appropriate complementary foods and monitor diverse information sources on complementary feeding.

Inherited metabolic diseases in the urine organic acid analysis of complex febrile seizure patients / 소아과

PURPOSE: Seizure associated with fever may indicate the presence of underlying inherited metabolic diseases. The present study was performed to investigate the presence of underlying metabolic diseases in patients with complex febrile seizures, using analyses of urine organic acids. METHODS: We retrospectively analyzed and compared the results of urine organic acid analysis with routine laboratory findings in 278 patients referred for complex febrile seizure. RESULTS: Of 278 patients, 132 had no abnormal laboratory findings, and 146 patients had at least one of the following abnormal laboratory findings: acidosis (n=58), hyperammonemia (n=55), hypoglycemia (n=21), ketosis (n=12). Twenty-six (19.7%) of the 132 patients with no abnormal findings and 104 (71.2%) of the 146 patients with statistically significant abnormalities showed abnormalities on the organic acid analysis (P<0.05). Mitochondrial respiratory chain disorders (n=23) were the most common diseases found in the normal routine laboratory group, followed by PDH deficiency (n=2 ) and ketolytic defect (n=1). In the abnormal routine laboratory group, mitochondrial respiratory chain disorder (n=29) was the most common disease, followed by ketolytic defects (n=27), PDH deficiency (n=9), glutaric aciduria type II (n=9), 3-methylglutaconic aciduria type III (n=6), biotinidase deficiency (n=5), propionic acidemia (n=4), methylmalonic acidemia (n=2), 3-hydroxyisobutyric aciduria (n=2), orotic aciduria (n=2), fatty acid oxidation disorders (n=2), 2-methylbranched chain acyl CoA dehydrogenase deficiency (n=2), 3-methylglutaconic aciduria type I (n=1), maple syrup urine disease (n=1), isovaleric acidemia (n=1), HMG-CoA lyase deficiency (n=1), L-2-hydroxyglutaric aciduria (n=1), and pyruvate carboxylase deficiency (n=1). CONCLUSION: These findings suggest that urine organic acid analysis should be performed in all patients with complex febrile seizure and other risk factors for early detection of inherited metabolic diseases.

A Congenital Cystic Adenomatoid Malformation with Intact Pulmonary Vascularities

Congenital cystic adenomatoid malformation (CCAM) is a rare pulmonary disease. It is thought to represent the abnormal proliferation of immature alveoli and other mesenchymal components secondary to abrupt halting of terminal alveolus formation after 16 weeks of gestation. Radiographic parameters such as size, number, and content are variable. On grayscale ultrasound, anechoic, thin-walled cysts are usually noted in pleural or cardiodiaphragmatic locations. To our knowledge, there has been no report of a CCAM showing normal pulmonary vascularities. We report a case of CCAM with normal pulmonary vascularities found within the hypodense lesions on dynamic chest CT.

The Treatment of a Giant Mediastinal Bronchial Artery Aneurysm by Transarterial Coil Embolization: A Case Report

Cases of bronchial artery aneurysms (BAAs) are rare; to the best of our knowledge, only 50 cases have been reported in the literature to date. BAAs require optimal treatment due to the possibility of life-threatening hemorrhaging if the aneurysm was to rupture. BAAs are usually treated by surgical resection of the aneurysmal artery. However, when the patient is unstable due to massive or recurrent hemoptysis, a bronchial artery embolization is a useful alternative treatment method. We report a case of a giant mediastinal bronchial artery aneurysm that was treated by coil embolization.

Polymorphism Analysis of Helicobacter pylori Urease A Gene in Gastric Cancer Samples / 대한암학회지

PURPOSE: Several investigators reported the polymerase chain reaction (PCR) method was more sensitive than culture or other routine laboratory tests for the detection of H. pylori. In this study, we established the nested PCR method for the sensitive and specific determination of H. pylori from paraffin-embedded gastric cancer samples, and the polymorphisms of H. pylori urease A gene were analyzed using by restriction fragment length polymorphism (RFLP). MATERIALS AND METHODS: It was subjected to the nested PCR using two primer pairs from the urease A gene of H. pylori. The sensitivity of the nested PCR assay was investigated with serial dilutions of positive DNA of H. pylori. Polymorphisms of H. pylori were determined by digestion of thirty six PCR positive products with five different restriction endonuclease-MspI, AluI, DdeI, BstNI, and HinfI. RESULTS: Amplified H. pylori PCR products were detected to 106 dilutions (10-3 fg) by nested PCR technique. The polymorphic patterns of five types of H. pylori were found by MspI, DdeI and AluI. Sequence of type V was confirmed by direct sequencing and the sequences recognized by BstNI and HinfI were conserved regions. CONCLUSIONS: Nested PCR technique is a accurate, sensitive and reliable method for the laboratory diagnosis of H. pylori infection. Moreover nested PCR-RFLP analysis has a potential to differentiate H. pylori strains.

Toxicity of Ciprofloxacin in Vitreous Infusion Fluid on Rabbit Retina

To investigate the retinal toxicity of ciprofloxacin on retina, 23 New Zealand white rabbits received vitrectomy with intravitreal infusion that contain of 1 g/ml, 2 g/ml, 5 g/ml, 10 g/ml, and 25 g/ml of ciprofloxacin(20 eyes) or balanced salt solution(BSS) only(3 eyes). In transmission elctron microscope, no disintegration of all retinal layers and slightly irregular pattern of disc of outer segment of rod were observed in 1, 2 and 5 g/ml of ciprofloxacin groups at 14 days postinfusion. In concentration of 10 g/ml or greater, retina showed destroyed inner and outer segment of the photoreceptor cells, pyknotic nuclei in the outer nuclear layer, lucent vacoules and pigment granules in apical cytoplasm of the retinal pigment epithelium(RPE), loss of photoreceptor outer segment-RPE integration. This study suggest that infusion with 5 g/ml or less of ciprofloxacin may be safe when used in the treatment of bacterial endophthalmitis.

Secondary Intraocular Lens Implantation in Aphakia

The secondary implantation has gradually increased year by year. The authors conducted a study on eighty-two patients(92 eyes) recieving secondary intraocular lens implantation from Jan 1989 to Jan 1993. Sulcus fixation of posterior chamber IOL implantation was done in cases of intact or small posterior capsule rupture(56 cases). Anterior chamber intraocular lens(8 cases) and posterior chamber intraocular lens implantation by scleral fixation(28 cases) was done in eyes with large posterior capsule rupture or no zonular support. Final postoperative visual acuity of 0.5 or better was acquired in 77 eyes(83.7%) and didn't show statistically significant difference in three groups. The postoperative complications induced IOL decent ration(9.8%), uveitis(6.7%), cystoid macular edema(3.3%), vitreous hemorrhage(3.3%), and retinal detachment(3.3%). The causes of postoperative decreased visual acuity were cystoid macular edema(2.2%), fibrous membrane on IOL(2.2%), IOL decentration(1.1%) and IOL dislocation(1.1%), No statistically significant difference was noted in postoperative central corneal endothelial cell loss in three groups.