A cardiovascular collapse, due to preoperatively administered intravenous vitamin K (phytonadione), was experienced in a 59-year-old woman who was scheduled to undergo a left upper lung lobectomy. The patient developed sudden facial flushing, an upper torso rash, dyspnea, palpitation, and severe hypotension about 2 min after the intravenous administration of approximately 2 mg of vitamin K. Immediate hydration and an injection of 20 mg ephedrine restored her blood pressure to the preoperative level within 5 min. The patient recovered without any sequelae, but the operation was postponed. The patient's symptoms seemed to be due to an anaphylactoid reaction or anaphylaxis following the intravenous administration of vitamin K. This case report suggests that physicians should carefully review the indications of vitamin K prior to administration, even at low doses.
Administration, Intravenous ; Anaphylaxis ; Blood Pressure ; Dyspnea ; Ephedrine ; Exanthema ; Female ; Flushing ; Humans ; Hypotension ; Lung ; Middle Aged ; Torso ; Vitamin K ; Vitamins*

The use of magnesium sulphate has recently increased in anesthesiology and pain medicine. The roles of magnesium sulphate are as an analgesic adjuvant, a vasodilator, a calcium channel blocker and reducing the anesthetic requirement. These effect are primarily based on the regulation of calcium influx into the cell and antagonism of the N-methyl-D-aspartate receptor. We discuss here the clinical effects of magnesium sulphate on anesthesiology and pain medicine.
Anesthesiology ; Calcium ; Calcium Channels ; Magnesium ; N-Methylaspartate

OBJECTIVE: We report a case with a long-standing history of the ankylosing spondylitis(AS) who showed multiple cerebellar infarctions with bulbar symptom owing to vertebral artery obstruction, due to anterior and vertical subluxation of atlanto-axial and atlanto-occipital joint. CLINICAL PRESENTARION: An 51-year-old male patient with swallowing difficulty, tongue deviation to the left side and severe nuchal pain and rigidity is presented. INTERVENTION: After removal of posterior portion of foramen magnum, posterior portion of left transverse foramen of axis was decompressed. CONCLUSIONS: Spontaneous anterior atlanto-axial subluxation occurs in patients with AS about 2% of presents with or without signs of spinal cord compression. Vertical subluxation occurs in 3-8% of patient with rheumatoid arthritis but it is an exceedingly rare complication of AS. Close observation and follow-up are needed in patients with AS and if subluxation occurs, good prognosis is anticipated using an early operative treatment.
Arthritis, Rheumatoid ; Atlanto-Occipital Joint* ; Axis, Cervical Vertebra ; Deglutition ; Follow-Up Studies ; Foramen Magnum ; Humans ; Infarction ; Male ; Middle Aged ; Prognosis ; Spinal Cord Compression ; Spondylitis, Ankylosing* ; Tongue ; Vertebral Artery*

The aims of this study were to verify the hypoxia-reoxygenation injury of primary cultured Kupffer cells and the effect of propofol against the hypoxia-reoxygenation injury through quantitating lactate dehydrogenase (LDH) release and superoxide dismutase (SOD) activity.The sequential treatments with hypoxia and reoxygenation induced significant increasement of LDH release (P.0.01) and decresement of SOD activity(P.0.05) in primary cultured Kupffer cell. The level of LDH release and SOD activity after sequential treatments with hypoxia and reoxygenation were restored to the control level by the propofol treatment in the concentration of 0.5 and 5 microgram/mL. Propofol in concentration of 50 microgram/mL induced significant increasement of LDH release (P.0.01) on both normal culture and hypoxia-reoxygenation culture of the Kupffer cell. As hypoxia and reoxygenation procedures and propofol treatment were concurrently added to the cultured Kupffer cell, propofol treatment in the concentration of 50 microgram/mL decreased significantly the SOD activity (P.0.01). In conclusion, propofol in this hypoxia-reoxygenation model could provide a valuable clue for the study of liver transplantation and of propofol.
Anoxia ; Kupffer Cells ; L-Lactate Dehydrogenase ; Liver Transplantation ; Propofol* ; Superoxide Dismutase* ; Superoxides*

PURPOSE: To provide the insight into the role of LXR alpha on the progression of diabetic nephropathy, we measured the production of extracellular matrix in the cultured mesangial cells treated with the LXR agonist. METHODS: With the mesangial cells extracted from C57BL6 mice, we cultured them in the presence of 25 mM glucose with or without TO901317, an agonist of LXRalpha We transfected siRNAs of SREBP1 and LXR alpha into the mesangial cell to suppress the activity of the two genes. RESULTS: TO901317 increased expressions of LXR alpha, SREBP-1, TGF beta-1, and collagen IV and triglyceride amount in mesangial cells cultured in 25mM glucose. These effects of TO901317 were attenuated by inhibiting transcription of LXR alpha or SREBP-1 with transfection of siRNAs. In mesangial cells transfected with siRNA of SREBP-1, changes by TO901317 were attenuated regardless of increased expression of LXR alpha. That suggested the activation of SREBP-1, an downstream gene of LXR alpha, would be more important to induce changes in mesangial cells by TO901317. CONCLUSION: The TO901317, an agonist of LXR alpha, increases extracellular matrix, collagen IV, and TGF beta-1 production in cultured mesangial cells. The SREBP-1 as well as dyslipidemia in mesangial cells enhanced by LXR agonist would be the important mechanism to induce those changes.
Animals ; Collagen ; Diabetic Nephropathies ; Dyslipidemias ; Extracellular Matrix ; Glucose ; Hypertriglyceridemia ; Liver ; Mesangial Cells ; Mice ; Orphan Nuclear Receptors ; RNA, Small Interfering ; Sterol Regulatory Element Binding Protein 1 ; Transfection

Background: A chronic disease management program including patient education, recall and remind service, and reduction of out-of-pocket payment was implemented in Korea through a chronic care model. This study aimed to assess the effect of a community-based intervention program for improving medication adherence of patients with diabetes mellitus in rural areas of Korea. Methods: We applied a non-equivalent control group design using Korean National Health Insurance Big Data. Hongcheon County has been continuously adopting this program since 2012 as an intervention region. Hoengseong County did not adopt such program. It was used as a control region. Subjects were a cohort of patients with diabetes mellitus aged more than 65 years but less than 85 years among residents for 11 years from 2010 to 2020. After 1:1 matching, there were 368 subjects in the intervention region and 368 in the control region. Indirect indicators were analyzed using the difference-in-difference regression according to Andersen’s medical use model. Results: The increasing percent point of diabetic patients who continuously received insurance benefits for more than 240 days from 2010 to 2014 and from 2010 to 2020 were 2.6%p and 2.7%p in the intervention region and 3.0%p and 3.9%p in the control region, respectively. The number of dispensations per prescription of diabetic patient in the intervention region increased by approximately 4.61% by month compared to that in the control region. Conclusion The intervention program encouraged older people with diabetes mellitus to receive continuous care for overcoming the rule of halves in the community. More research is needed to determine whether further improvement in the continuity of comprehensive care can prevent the progression of cardiovascular diseases.

Dermatomyositis (DM) is an idiopathic inflammatory myopathy, characterized by inflammation of the proximal skeletal muscles and typical skin manifestations, which results in symmetric muscle weakness. A 43-year-old man was presented with skin rash and left leg weakness, and he had a history of poliomyelitis. Initially, he was diagnosed as having post-polio syndrome (PPS) due to unilateral muscle weakness and a result of an the electromyography (EMG), which had shown patterns of PPS. After 4 months with conservative therapy for PPS, weakness of bilateral upper arms had developed and skin rashes on his entire body had aggravated and progressed. He was diagnosed as having dermatomyositis, based on elevated muscle enzyme levels, typical skin rashes, and typical EMG findings, which indicated muscle disease. When a patient with previous poliomyelitis has a newly developed muscle weakness or pain, we should consider various possible causes other than PPS.
Adult ; Arm ; Dermatomyositis* ; Diagnosis, Differential* ; Electromyography ; Exanthema ; Humans ; Inflammation ; Leg ; Muscle Weakness* ; Muscle, Skeletal ; Myositis ; Poliomyelitis* ; Postpoliomyelitis Syndrome* ; Skin Manifestations

Calciphylaxis is a rare but life-threatening complication in patients with end stage renal disease (ESRD). Clinical presentation consists of violaceous skin lesions that progress to nonhealing ulcers and gangrene. Secondary infection of skin lesions is common, often leading to sepsis and death. We report a case presenting in 15months after maintenance hemodialysis for diabetic ESRD with painful violaceous skin discoloration on distal fingers of both hands and toes of left foot. X-ray of both hands and left foot showed vascular calcification along the course of the arteries. Despite symptomatic treatement, skin lesions progressed to nonhealing ulcers and became necrotic, and amputation of the second and fifth fingers of right hand was required. The surgical biopsy specimen revealed circumferential calcium deposition in the intima and media of the arteries by von Kossa stain. Two months after the operation, the patient died of cachexia.
Amputation ; Arteries ; Biopsy ; Cachexia ; Calciphylaxis* ; Calcium ; Coinfection ; Diabetes Mellitus ; Fingers ; Foot ; Gangrene ; Hand ; Humans ; Kidney Failure, Chronic* ; Renal Dialysis ; Sepsis ; Skin ; Toes ; Ulcer ; Vascular Calcification

To estimate the prevalence of hepatitis B virus(HBV) and hepatitis C virus(HCV) infection and to determine associated risk factors, a population-based seroepidemiologic study was carried out. In 1993, a health examination survey of the population was carried out in rural area known to have a high incidence of liver cancer. The study population were those who volunteered to participate in a health survey over 10 years of age. Examinees were interviewed by specially trained staffs. Sera from 1,033 study subjects were tested for hepatitis B surface antigen (HBsAg) by reverse passive hemagglutinin (RPHA) estimation and for hepatitis C virus antibody (anti-HCV) by 2nd generation passive hemagglutinin (PHA) estimation, The age and sex standardized prevalence of HBsAg was 6.3% which was similar to national average, but that of anti-HCV was 5.1% which was 4 to 5 times higher than that of blood or other health examinees in Korea. In a multivariate analysis, transfusion history, surgical operative history, and acupuncture history were not associated with HBsAg positivity. In contrast, acupuncture history (adjusted odds ratio[OR]=2.2 : 95% Confidence interval[CI] 1.0-4.7) and surgical operative history(adjusted OR=2.0 : 95% CI 1.0-4.1) were associated with anti-HCV positivity. The present study suggest that there is an highly endemic area of HCV infection in Korea and probably this endemicity is associated with a parenteral source of HCV infection other than blood transfusion.
Acupuncture ; Blood Transfusion ; Health Surveys ; Hemagglutinins ; Hepacivirus ; Hepatitis B Surface Antigens ; Hepatitis B* ; Hepatitis C* ; Hepatitis* ; Incidence ; Korea* ; Liver Neoplasms ; Multivariate Analysis ; Prevalence ; Risk Factors ; Seroepidemiologic Studies*

BACKGROUND: The single nucleotide polymorphism (SNP) of interleukin-10 and the variable number of tandem repeat (VNTR) of CA dinucleotide of Interferon-gamma are reported to have an influence on the production of IL-10 and IFN-gamma respectively. The aims of this study are to investigate the gene polymorphisms of IL-10 and IFN-gamma in Korean renal transplant patients and to assess their impacts on the clinical courses of renal allografts. METHODS: The one hundred eighty-five patients who received renal allografts and were followed for more than 5 months from 1991 to May 2000 in Kangdong Sacred Heart Hospital, and ninety-eight normal healty controls were investigated. Three SNPs in promoter region of IL-10 gene were assayed by PCR-RFLP. The (CA) dinucleotide repeat polymorphism of IFN-gamma were assessed by evaluation of size of PCR products. RESULTS: Allele*2 and allele*3 were major alleles of IFN-gamma in our study and there was no significant difference of alleleic and genotypic distribution between recipient and control group. The -592*A and -592*C in the IL-10 promotor region were tightly linked to -819*T and -819*C, respectively. The frequency of -1082*G/*A genotype of recipent group was 7.0% and smaller than that of control group (17.3%, p=0.02). The *G/*G genotype (IL-10 high producer) was absent in all our study subjects, which was quite different from Western studies. IFN-gamma and IL-10 gene polymorphisms had no impact on the incidence and severity of acute rejection, and long term graft fucntion after transplantation. CONCLUSION: Unlike IFN-gamma the SNPs of IL-10 promoter were quite different from those in Western patients. The frequency of -1,082*G/*A genotype of IL-10 was smaller in recipient group. In conclusion, the polymorphisms of IL-10 and IFN-gamma had no impact on the clinical courses of renal allografts under the current therapeutic strategies.
Alleles ; Allografts ; Dinucleotide Repeats ; Genotype ; Heart ; Humans ; Incidence ; Interferon-gamma* ; Interleukin-10* ; Kidney Transplantation ; Korea* ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Promoter Regions, Genetic ; Tandem Repeat Sequences ; Transplants