Torsade de pointes is a life-threatening, polymorphic ventricular tachycardia associated with prolongation of the QTc interval. Although torsade de pointes is found in many clinical settings, it is mostly drug induced. Similar problems have been described with nonsedating H1-selective antihistamines like terfenadine and astemizole. The increased risks of both H1-antihistamines were associated with exposure to supratherapeutic doses or concomitant exposure to the cytochrome P-450 inhibitors, ketoconazole, erythromycin and cimetidine. We report a 51-year-old woman with torsade de pointes and a long QTc interval caused by the combined use of terfenadine and itraconazole. After discontinuation of these drugs and treatments with electrical cardioversion and magnesium sulfate, torsade de pointes and prolonged QTc interval were no longer observed and she was discharged in good condition with a normal ECG. In conclusion, physicians should be aware that terfenadine and astemizole can cause torsade de pointes in rare cases.
Astemizole ; Cimetidine ; Cytochrome P-450 Enzyme System ; Electric Countershock ; Electrocardiography ; Erythromycin ; Female ; Histamine Antagonists ; Humans ; Itraconazole* ; Ketoconazole ; Magnesium Sulfate ; Middle Aged ; Tachycardia, Ventricular ; Terfenadine* ; Torsades de Pointes*

The heart was considered to be relatively resistant to ionizing irradiation in the range of doses used in radiation therapy before follow up and review of a large number of patients who had undergone mediastinal irradiation and survived for several years. Cardiac complications after mediastinal irradiation include coronary artery disease, valvular heart disease, and acute and chronic pericardial disease. Pericarditis and pericardial effusion have been regarded as the most common side effects of cardiac irradiation. However, modern techniques of irradiation, dose fractionation, and reduction of the heart volume irradiated in most malignancies have substantially reduced the frequency of cardiac complications including pericarditis. Therefore, effusive- constrictive or constrictive pericarditis is less often noted after the completion of radiation therapy. Delayed appearance of effusive-constrictive pericarditis after mediastinal irradiation has not been commonly recognized by physicians. We recently experienced a case of delayed pericarditis with effusion occurring 36 months after radiation therapy for young patient with Hodgkin's disease. Mediastinal irradiation for Hodgkin's disease increases the risk of subsequent death from heart disease. Risk increased with high mediastinal doses, minimal protective cardiac blocking, young age at irradiation, and increasing duration of follow-up. Consequently, the current practice of using a subcarinal block and multiple portals, with irradiation through both anterior and posterior fields, may be expected to lead to a decline in the incidence and severity of cardiac abnormality after irradiation.
Cardiac Volume ; Coronary Artery Disease ; Dose Fractionation ; Follow-Up Studies ; Heart ; Heart Diseases ; Heart Valve Diseases ; Hodgkin Disease* ; Humans ; Incidence ; Pericardial Effusion ; Pericarditis* ; Pericarditis, Constrictive

BACKGROUND/AIMS: To determine the treatment modalities and the prognosis of a patient with liver cirrhosis, quantitative estimation of liver function is important. We assessed the Child-Pugh score (CPS), the common method as a severity index for the cirrhosis, the Promthombin, gamma GT, and Apolipoprotein A1 (PGA) index and model for end-stage liver disease (MELD) score. The purpose of this study was to evaluate the correlation between these indices in the patients with cirrhosis only and hepatocellular carcinoma (PHC), according to underlying causes (HBV and alcohol). METHODS: We reviewed medical records of 339 cirrhotic patients with/without hepatocellular carcinoma and divided patient groups by disease and underlying cause: cirrhosis caused by alcohol; LC-Al, cirrhosis caused by HBV; LC-B, hepatocellular carcinoma with cirrhosis caused by alcohol; HCC-Al, hepatocellular carcinoma with cirrhosis caused by HBV; HCC-B. We assessed the CPS, PGA index and MELD score and calculated the correlation coefficient between these scores. RESULTS: Among the total of 339 patients, 201 patients were diagnosed on the liver cirrhosis only, and 138 patients on the hepatocellular carcinoma with cirrhosis. In each groups, mean score values were not significantly different in CPS, PGA index and MELD score. The correlation of CPS, PGA index and MELD score in all groups, except for the correlation of PGA index and MELD score in HCC-Al group, was significantly positive (p<0.05). Compared to correlation coefficients between three indices, the patients with cirrhosis only had higher tendencies than the patients with hepatocellular carcinoma. The patients by HBV had higher tendencies than by alcohol. CONCLUSIONS: The correlations between CPS, PGA index and MELD score showed significantly positive correlations in the patients with liver cirrhosis only and hepatocellular carcinoma with cirrhosis (except in HCC-Al group). The patients with cirrhosis only had higher correlation coefficients than the patients with PHC and the patients by HBV had higher than by alcohol.
Adult ; Aged ; Carcinoma, Hepatocellular/*complications ; Female ; Hepatitis B/*complications ; Humans ; Liver Cirrhosis/*complications ; Liver Cirrhosis, Alcoholic/complications ; Liver Neoplasms/*complications ; Male ; Middle Aged ; Prognosis ; *Severity of Illness Index

Cholangiocarcinoma is a form of adenocarcinoma arising from the intrahepatic or extrahepatic biliary epithelium. Apparent predisposing factors include some chronic hepatobiliary parasitic infsttations, congenital anomalies with ectatic ducts, sclerosing cholangitis and chronic ulcerative colitis and occupational exposure to possible biliary tract carcinogens. Patients with cholangiocarcinoma usually present with biliary obstruction, painless jaundice, pruritus, weight loss and acholic stools. Because the obstructing process is gradua1, the cholangiocarcinoma is often far advanced by the time it presents clinically. The diagnosis is most frequently made by cholangiography following ultrasound demonstration of dilated intrahepatic bile ducts. We report a case of common bile duct cancer spreading to gallbladder and common hepatic duct along the biliary mucosal epitherium and submucosal tissue in 68-year-old female patient along with a review of literature.
Adenocarcinoma ; Aged ; Bile Ducts, Intrahepatic ; Biliary Tract ; Carcinogens ; Causality ; Cholangiocarcinoma ; Cholangiography ; Cholangitis, Sclerosing ; Colitis, Ulcerative ; Common Bile Duct* ; Diagnosis ; Epithelium ; Female ; Gallbladder* ; Hepatic Duct, Common* ; Humans ; Jaundice ; Occupational Exposure ; Pruritus ; Ultrasonography ; Weight Loss

Gallbladder carcinoma is an uncommon neoplasm, and hemobilia caused by this disease is rare. We present a case of hemobilia in a patient with gallbladder carcinoma, which was recognized at forward duodenoscopy. A 42-year-old man visited our hospital due to intermmittent right upper quadrant pain. Duodenoscopy revealed blood clots with bile juice around the ampulla of Vater and the second portion of the duodenum. Endoscopic ultrasonography for the gallbladder showed a dumbell-shaped mass with a homogenous internal echogenicity on the body of the gallbladder. MR cholangiography showed a lobulated mass with low-signal intensity in the T1-weighted and T2-weighted images. Subsequently, laparoscopic cholecystectomy with regional lymph node dissection was performed, and adenocarcinoma was confirmed.
Adenocarcinoma ; Adult ; Ampulla of Vater ; Bile ; Cholangiography ; Cholecystectomy, Laparoscopic ; Duodenoscopy ; Duodenum ; Endosonography ; Gallbladder* ; Hemobilia* ; Humans ; Lymph Node Excision

Tamoxifen citrate is a non-steroidal agent that has demonstrated estrogen agonist and antagonist properties and has found successful application for all stages, as adjuvant therapy, in the treatment of primary breast cancer. The drug was originally introduced for the treatment of high risk postmenopausal women or for postmenopausal patients with advanced disease. Since then, it was reported that long term treatment schedules could provide maximal benefit in preventing recurrences. Recent analyses of clinical trials have demonstrated an increase of disease-free survival in breast cancer among patients with positive estrogen receptor tumor. Tamoxifen is now recommended for chemoprevention of breast cancer in healthy high risk women. An agonist estrogenic effect upon the endometrium, the so called "paradoxical" effect, is suggested when proliferative changes, such as endometrial hyperplasia, adenocarcinoma, polyps. We report a case of endometrial cancer which developed in premenopausal patients with breast cancer under tamoxifen therapy.
Adenocarcinoma* ; Appointments and Schedules ; Breast Neoplasms ; Chemoprevention ; Disease-Free Survival ; Endometrial Hyperplasia ; Endometrial Neoplasms ; Endometrium ; Estrogens ; Female ; Humans ; Polyps ; Recurrence ; Tamoxifen*

Pulmonary arterovenous malformation(PAVM) is an uncommon congenital anomaly. As pulmonary arteriovenous malformation is a direct communication between the Branches of pulmonary artery and vein which originated from the malformation of capillary development major disturbances in gas exchange can result. This malformation results in the several symptoms such as dyspnea hemopyssis cyanosis, and severe neurologic complaints. However, the most of patients are usually asymptomatic. Selective pulmonary angiography is well known the helpful diagnostic method. Recently, therapeutic embolization has been advocated as the treatment of choice for pulmonary arteriovenous malformations. We report a case of multiple pulmonary arteriovenous malformation, which was detected on the simple chest X-ray and snccessfully treated with coil embolization in a 19-year-old asymptomatic woman.
Angiography ; Arteriovenous Malformations* ; Capillaries ; Cyanosis ; Dyspnea ; Embolization, Therapeutic* ; Female ; Humans ; Pulmonary Artery ; Thorax ; Veins ; Young Adult

The demand for intravenous sedated upper gastrointestianl endoscopy is currently increasing steeply. Despite this trend, patient status complication due to this procedure is largerly neglected by most physicians. Recently, in three patients, mouthpiece fragment were left within the patients' body after intravenous sedated upper gastrointestinal endoscopy. They were transferred to our institution for the removal of the fragment. The patients complained of an uneasy sensation from within their body, around their necks and chests. After conducting therapeutic endoscopy, the fragment could be located around the distal part of their esophagus and within their stomach. The fragment were removed successfully by using snare in two patients, and by using forceps in another patient.
Eating* ; Endoscopy ; Endoscopy, Gastrointestinal* ; Esophagus ; Humans ; Neck ; Sensation ; SNARE Proteins ; Stomach ; Surgical Instruments ; Thorax

Benign intracranial hypertension (BIH) is very rare and its cause is unclear. Raised intracranial pressure in the absence of an intracranial mass or hydrocephalus (BIH or pseudotumor cerebri) has been described in association with many conditions including SLE. Several pathogenic pathways tie BIH with SLE as thrombotic obliteration of cerebral arteriolar and venous systems and immune complex deposition within the arachnoid villi that are responsible for cerebrospinal fluid (CSF) absorption. The diagnosis of BIH was confirmed by increased intracranial pressure in the absence of any abnormal radiological findings of the brain. We report a young woman with SLE and autoimmune thrombocytopenia complicated by BIH which resolved with corticosteroid therapy and osmotic diuretics.
Absorption ; Antigen-Antibody Complex ; Arachnoid ; Brain ; Cerebrospinal Fluid ; Diagnosis ; Diuretics, Osmotic ; Female ; Humans ; Hydrocephalus ; Intracranial Pressure ; Lupus Erythematosus, Systemic* ; Pseudotumor Cerebri* ; Purpura, Thrombocytopenic, Idiopathic

BACKGROUND/AIMS: In this study, we analysed the changes of matrix metalloproteinase-9 (MMP-9) expression in the gastric antral epithelium in respect to H. pylori eradication. METHODS: Twenty patients with H. pylori-positive chronic gastritis or peptic ulcer were studied. The expression of MMP-9 in the gastric antral biopsy specimens were compared before and after H. pylori eradication using immunohistochemical study. The positive rates and intensity of MMP-9 staining were evaluated at surface mucous cells and pyloric gland cells. RESULTS: The positive rate of MMP-9 staining in antral mucosal epithelial cells of H. pylori chronic gastritis is 63.8%. The positive rates of MMP-9 staining in the surface mucous cells and pyloric gland cells were 75.5% and 52.0% before H. pylori eradication, respectively. On the contrary, the rates were 85.5% and 82.0% after eradication. The MMP-9 overexpression in the pyloric gland cells were noticeably increased after H. pylori eradication. Strong positive staining of MMP-9 was increased significantly after H. pylori eradication in the pyloric gland cells. CONCLUSIONS: These results suggest that MMP-9 over-expression is associated with H. pylori infection as a host inflammatory response. The increased expression after H. pylori eradication indicates that MMP-9 may have a important role in remodeling or early tissue repairing process of gastric mucosa.
Adult ; Aged ; English Abstract ; Female ; Gastric Mucosa/*enzymology ; Gastritis/drug therapy/enzymology/microbiology ; Gelatinase B/*metabolism ; Helicobacter Infections/drug therapy/*enzymology/microbiology ; *Helicobacter pylori ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Peptic Ulcer/drug therapy/enzymology/microbiology ; Pyloric Antrum