Focal dystonia of musicians is one of the most disabling problems for professional musicians. It has focal task-specificity, presenting with involuntary flexion or extension of individual fingers when musicians play their instruments. It occurs mostly in pianists, and controversies still exist about the pathophysiology, whether it is caused by motor function disability or by a psychological condition. Although sensorimotor rehabilitation, change in instrument, skill or teacher, and immobilization with brace have been tried as treatment, there is still no definitive treatment. Because botox therapy has been effective in certain cases without irreversible side effects, this could be applied even in professional players. We report a case of focal dystonia of the hand in a professional pianist treated using electromyogram-guided botox injection and a review of the relevant medical literature.
Botulinum Toxins, Type A ; Braces ; Dystonic Disorders ; Fingers ; Hand ; Immobilization

Secondary dyslipidemia, characterized by elevated blood cholesterol and triglycerides, arises from various underlying conditions. The identification and appropriate handling of these causes is crucial for effective treatment. Major contributors include unhealthy diets, diseases impacting lipid metabolism, and medication side effects. Prioritizing the correction of secondary causes before initiating conventional lipid-lowering therapies is essential. Subsequent lipid profiles guide the selection of appropriate guideline-based lipid-lowering interventions.

Secondary dyslipidemia, characterized by elevated blood cholesterol and triglycerides, arises from various underlying conditions. The identification and appropriate handling of these causes is crucial for effective treatment. Major contributors include unhealthy diets, diseases impacting lipid metabolism, and medication side effects. Prioritizing the correction of secondary causes before initiating conventional lipid-lowering therapies is essential. Subsequent lipid profiles guide the selection of appropriate guideline-based lipid-lowering interventions.

Secondary dyslipidemia, characterized by elevated blood cholesterol and triglycerides, arises from various underlying conditions. The identification and appropriate handling of these causes is crucial for effective treatment. Major contributors include unhealthy diets, diseases impacting lipid metabolism, and medication side effects. Prioritizing the correction of secondary causes before initiating conventional lipid-lowering therapies is essential. Subsequent lipid profiles guide the selection of appropriate guideline-based lipid-lowering interventions.

Secondary dyslipidemia, characterized by elevated blood cholesterol and triglycerides, arises from various underlying conditions. The identification and appropriate handling of these causes is crucial for effective treatment. Major contributors include unhealthy diets, diseases impacting lipid metabolism, and medication side effects. Prioritizing the correction of secondary causes before initiating conventional lipid-lowering therapies is essential. Subsequent lipid profiles guide the selection of appropriate guideline-based lipid-lowering interventions.

Elevated blood cholesterol and triglyceride levels induced by secondary causes are frequently observed. The identification and appropriate handling of these causes are essential for secondary dyslipidemia treatment. Major secondary causes of hypercholesterolemia and hypertriglyceridemia include an unhealthy diet, diseases and metabolic conditions affecting lipid levels, and therapeutic side effects. It is imperative to correct secondary causes prior to initiating conventional lipid-lowering therapy. Guideline-based lipid therapy can then be administered based on the subsequent lipid levels.

Elevated blood cholesterol and triglyceride levels induced by secondary causes are frequently observed. The identification and appropriate handling of these causes are essential for secondary dyslipidemia treatment. Major secondary causes of hypercholesterolemia and hypertriglyceridemia include an unhealthy diet, diseases and metabolic conditions affecting lipid levels, and therapeutic side effects. It is imperative to correct secondary causes prior to initiating conventional lipid-lowering therapy. Guideline-based lipid therapy can then be administered based on the subsequent lipid levels.

OBJECTIVE: The aim of this study is to compare cholesterol lowering effects of low dose 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) in Korean patients. METHODS: A total of 909 consecutive patients were enrolled prospectively according to the criteria of National Cholesterol Education Program guidelines. Lipid profiles were obtained before and 2 months after statin therapy. RESULTS: Atorvastatin 10 mg (n=260), lovastatin 20 mg (n=145), pitavastatin 2 mg (n=80), pravastatin 20 mg (n=28), rosuvastatin 5 mg (n=145), and simvastatin 20 mg (n=208) reduced low density lipoprotein (LDL) cholesterol by -41.8+/-11.0%, -33.8+/-12.8%, -39.3+/-10.8%, -31.5+/-8.9%, -48.8+/-12.3%, and -42.8+/-13.5%, respectively. LDL cholesterol less than 130 mg/dL was achieved in 90.3%, 76.9%, 88.5%, 85.2%, 97.2%, and 94.2%, respectively. The reduction of LDL cholesterol by 30% or more was obtained in 84.4%, 60.7%, 81.6%, 63.0%, 93.0%, and 83.5%, respectively. LDL cholesterol less than 70 mg/dL or the reduction by 50% or more was observed in a small portion of patients and was variable according to the different types of statins. CONCLUSION: A low dose statin was enough to manage dyslipidemia in most Korean patients with low to moderate risks and was even effective in a subpopulation of high risk patients.
Cholesterol* ; Cholesterol, LDL ; Coenzyme A ; Dyslipidemias ; Education ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Hypercholesterolemia ; Lipoproteins ; Lovastatin ; Oxidoreductases ; Pravastatin ; Prospective Studies ; Simvastatin ; Atorvastatin Calcium ; Rosuvastatin Calcium

PURPOSE: Plasma adiponectin concentrations are inversely related with metabolic syndrome (MetS), and MetS is associated with increased risk for heart failure (HF). However, the relationship between adiponectin and MetS in HF remains undetermined. Therefore, we tested whether MetS was associated with the degree of plasma adiponectin concentrations in HF patients. MATERIALS AND METHODS: One hundred twenty eight ambulatory HF patients with left ventricular ejection fraction of <50% (80 males, 61.8+/-11.9 years old) were enrolled for this cross-sectional study. Echocardiographic measurements were performed, and plasma concentrations of adiponectin, lipoproteins, apolipoproteins (apoB, apoA1) and high sensitive C-reactive protein (hsCRP) were measured. RESULTS: Adiponectin concentrations in HF patients with MetS (n=43) were significantly lower than those without MetS (n=85) (9.7+/-7.0 vs. 15.8+/-10.9 microg/mL, p=0.001). Higher concentrations of apoB (p=0.017), apoB/A1 ratio (p<0.001), blood urea nitrogen (p=0.034), creatinine (p=0.003), and fasting insulin (p=0.004) were observed in HF patients with MetS compared with those without MetS. In HF patients with MetS, adiponectin concentrations were negatively correlated with hsCRP (r=-0.388, p=0.015) and positively correlated with the ratio of early mitral inflow velocity to early diastolic mitral annular velocity, E/E' (r=0.399, p=0.015). There was a significant trend towards decreased adiponectin concentrations with an increasing number of components of MetS (p for trend=0.012). CONCLUSION: Our study demonstrated that adiponectin concentrations decreased in HF patients with MetS, and that relationship between adiponectin, inflammation and abnormal diastolic function, possibly leading to the progression of HF.
Adiponectin/*blood ; Aged ; Diabetes Mellitus, Type 2/epidemiology/metabolism ; Female ; Heart Failure/*epidemiology/*metabolism/ultrasonography ; Humans ; Male ; Metabolic Syndrome X/*epidemiology/*metabolism ; Middle Aged ; Risk Factors ; Ventricular Function, Left/physiology

Scedosporium apiospermum, the anamorph of Pseudallescheria boydii, is a ubiquitous saprophytic fungus. S. apiospermum can cause life-threatening infections usually in immunocompromised patients or after near-drowning incidents. Here, we report the first case of disseminated infection caused by S. apiospermum after near-drowning in Korea. A 44-year-old healthy man developed aspiration pneumonia, followed by multiple brain abscesses, and endopthalmitis, after a near-drowning incident in a septic tank. S. apiospermum infection was diagnosed on the 33rd day after the incident had occurred. The patient died from the progressive renal failure 255 days after incident, although he had been treated with voriconazole.
Adult ; Brain Abscess ; Fungi ; Humans ; Immunocompromised Host ; Korea ; Near Drowning ; Pneumonia, Aspiration ; Pseudallescheria ; Pyrimidines ; Renal Insufficiency ; Scedosporium ; Triazoles