A Case of Graves' Disease Accompanied with Acute Hepatitis A Virus Infection / 대한소화기학회지

Concurrent presentation of acute hepatitis A virus (HAV) infection and Graves' disease has not been reported in literature worldwide. Although there is no well-established mechanism that explains the induction of Graves' disease by HAV to date, our case suggests that HAV infection may be responsible for inducing Graves' disease. A healthy 27-year-old female presented fever, palpitation, and diarrhea, and she was subsequently diagnosed as acute HAV infection. Concurrently, she showed hyperthyroidism, and the diagnosis was made as Graves' disease. She had never had symptoms that suggested hyperthyroidism, and previous thyroid function test was normal. Acute HAV infection was recovered by conservative management, however, thyroid dysfunction was maintained even after normalization of liver enzymes. Methimazole was used to treat Graves' disease. We report a case of concurrent acute HAV infection and Graves' disease in a patient without preexisting thyroid disease. This suggests that HAV infection may be a trigger for an autoimmune thyroid disease in susceptible individuals.

Gender Related Differences of Clinical Symptoms and Triggering Factors in Patients With Acute Myocardial Infarction in China / 中国循环杂志

Objective: To explore the gender related differences of clinical symptoms and triggering factors in patients with acute myocardial infarction (AMI) in China. Methods: A population of 14 854 AMI patients with CAMI registration from 2013-01 to 2014-03 were studied, which included 10999 (74.0%) male and 3855 (26.0%) female. The gender related differences of clinical symptoms and triggering factors were analyzed in the population. Results: The chest pain and severe sweating were the most common symptoms of AMI patient, there were 66.4%of patients with persistent chest pain and 63.7%of patients with severe sweating. Male patients were more with chest pain (67.8%vs 62.4%) and severe sweating (65.8%vs 58.0%) than female, while female patients were more with radiating pain (36.0%vs 31.0%) and nausea/vomiting (35.6%vs 25.0%) than male, all P Conclusion: Chest pain and severe sweating were the most common clinical symptoms for AMI patients in China, about 1/5 of them had triggering factors and it was more in male patients.

Monitoring and Analysis of Paroxysmal Atrial Fibrillation and Its Related Triggering Factors by 12-leads HOLTER / 昆明医科大学学报

Objective To apply 12-leads HOLTER monitoring and analysis to observe paroxysmal atrial fibrillation (PAF) and its related atrial arrhythmias so as to explore the triggering factors of PAF. Methods 47 patients with PAF, including 20 male patients and 27 female patients, were given 12-HOLTER monitoring and analysis. Their average age was 64.89 ±12.70 years-old.PAF patients were subdivided into 2 subgroups: the triggered PAF subgroup and the untriggered PAF subgroup. Patients with atrial premature beats but without PAF were selected into the control group. The PAF and its related atrial arrhythmias were detected and analyzed by 12-HOLTER.Results (1) 9 events of PAF were found in 47 patients by 12-HOLTER monitoring and analysis, among them 72 events of PAF were triggered by atrial premature (AP) (91.1%, 72/79), 6 events of PAF occurred automatically and suddenly (7.6%, 6/79);and only 1 events of PAF was triggered by atrial flutter (1.3%,1/79) . (2) The coupling interval of AP in the triggered PAF subgroup was significantly shorter than that of the untriggered PAF subgroup and control group (490 ±90ms vs. 590 ±140 ms and 630 ±90ms, <0.05);The index of AP was smaller significantly in the PAF group than that of the untriggered PAF subgroup and controll group (0.52±0.12 vs. 0.62±0.09 and 0.71±0.06, <0.05);TheP' on Tof AP was significantly higher in the PAF group than that of the untriggered PAF subgroup and control group (84.72%vs. 26.73%and 2.78%, <0.017);The interval before the AP in PAF group was prolonged more significantly than that of controlled group (990±280 ms vs. 940±210 ms, <0.05) . (3) During 2 min~30 s before the PAF occurrence control as total times,the AP appeared more frequently (from 0.43 beats/min to 3.5~6.00 beats/min, <0.017) . (4) Most of the AP which triggered PAF was originated from the upper part of the left atrium (61/72,84.7%) .Conclusions Most events of PAF are triggered by AP, the AP which can trigger PAF may be of some of the features such as a shorter coupling interval,a smaller AP index,P' on Tand a longer interval before the AP,PAF more occurrence while the AP may take place more frequently.Most of the AP which triggered PAF are originated from the upper part of left atrium.

Clinical Features of Trigeminal Neuralgia / 대한통증학회지

BACKGROUND: The diagnosis of trigeminal neuralgia (TN) is based on only clinical criteria. The purpose of this study was to estimate the clinical manifestations of TN patients treated at our pain clinic. METHODS: A total of 341 patients with TN from Jan. 2004 to Dec. 2006 was evaluated the intensity, site, and onset of pain, facial sensation, duration of pain attack, pain free interval, triggering factors, and effects of the previous treatments with TN specific questionnaire and interview at the first visit of our pain clinic. RESULTS: About 80% of the patients were over 50 years of age and 256 (75%) patients were women. Average durations from first attack of their pain and from current pain attack were 7 years and 16 weeks, respectively. The two most frequently involved trigeminal nerve branches were maxillary (40%) and mandibular (39%) branches. Three quarters of the total patients experienced only paroxysmal pain that lasted less than one minute. About 90% of patients had pain free period at least one time. Most common triggering factors were chewing (88%), brushing teeth (82%), washing face (79%), and talking (70%). Only 16 patients (5%) had no previous treatment and the others had more than one treatment, such as medication (68%) and interventional procedures (35%). The most common reasons for early discontinuation of carbamazepine were dizziness, ataxia, and vomiting. CONCLUSIONS: TN has specific clinical features of pain, which should be considered at diagnosis.

Prevalence rate and triggering factors of syncope in medical students / 대한내과학회지

BACKGROUND: Syncope is a sudden and brief loss of consciousness associated with a loss of postural tone, from which recovery is spontaneous. The most frequently identified causes of syncope are neurocardiogenic, cardiac, cerebrovascular and side effects of drugs. However, in many cases, it is not easy to make a diagnosis of syncope. The prevalence rate of syncope also is variable according to the nature of the study. We investigated the prevalence rate, characteristics and triggering factors of syncope in young medical students. METHODS: We contacted 400 medical students of Kyungpook National University, Daegu, Korea, and a questionnaire on the prevalence, triggering factors, and recurrence rate of syncope was handed out. The data from 379 medical student (male 168, female 211, mean age 22.3 years) were included for further analysis. RESULTS: Fifty-eight students (15.3%) experienced syncope and female students reported higher prevalence rate than male students (20.4 versus 8.9%, p=0.002). Among 58 students with syncopal history, 22 students (male 2, female 20) experienced recurrent syncope. The students who experienced recurrent syncope were younger at first syncope than those without recurrent syncope (15.0 versus 17.3 years, p=0.039). The triggering factors of syncope were prolonged standing, warm environment, immediate standing, tiredness, emotional upset, menstruation, and so on. CONCLUSION: The prevalence rate of syncope was 15% in medical student with mean age of 22.3 years. As the syncope in female and early onset syncope showed higher rate of recurrence, more attention may prevent recurrent syncope in these cases.