Addisons disease is relatively rare than secondary adrenal insufficiency and result from progressive adrenocortical destruction. The common causes are idiopathic autoimmune atrophy and tuberculosis of adrenal glands. It is generally regarded as incurable in the sense that substitution therapy is required for the rest of the patients life. We report a case of tuberculous primary adrenal insufficiency which was confirmed by biopsy. This case was treated with antituberculous medication and showen to have improved adrenocortical function after six months.
Addison Disease* ; Adrenal Glands ; Adrenal Insufficiency ; Atrophy ; Biopsy ; Humans ; Tuberculosis

We reviewed 49 cases of moderate or severe pericardial effusion on which we performed pericardiocentesis and percutaneous pericardial biopsy from Jan. 1987 to Sep. 1989. Of these, 11 cases were performed percutaneous pericardial biopsy in order to diagnose confirmative. We studied clinical manifestation including physical examination, ECG, and radiology, etiology and complication of pericardiocentesis and percutaneous pericardial biopsy. The results are as belows : 1) The physical examination of pericardial effusion were neck vein engorgement(73.5%), priction rub(25.5%), and pulsus paradoxus(4%). The ECG findings were low voltage(77.6%) and electrical alternans(16.5%), and most common x-ray finding was cardiomegaly (81.6%). 2) Underlying diseases were as follows : neoplastic disease(40.8%), tuberculosis(18.4%) systemic lupus erythematosus(10.2%), hemopericardium(8.2%), chronic renal failure(6.1%), congestive heart failure(4.1%), idiopathic pericarditis(4.1%), GVHD(2.0%), pyopericardium(2.0%), rheumatic carditis(2.0%), and postpericardiotomy syndrome(2.0%), in order. 3) Special etiologic diagnosis of neoplasm were lung cancer(50%), adenocarcinoma of unknown origin(20%), Malignant lymphoma(15%), stomach cancer(5%), hepatoma(5%), and malignant thymoma(5%), in order. From the percutaneous pericardial biopsy, the authors confirmed 36% by finding two cases of malignancy and two cases of tuberculosis. On the other hand, only one case was confirmed in cytology. These result in a rather low rate of diagnostic confirm. There were 8 cases of complication : hypotension(8.2%), premature ventricular contraction(6.1%) and ventricular tachycardia (2.0%) without death cases. In percutaneous pericardial biopsy, only two cases of hypotension were found with no death case. The result obtained from the above 11 cases of percutanous pericardial biopsy is not enough to make conclusive statement concerning rate of diagnostic confirmation and complication. We expect better results by examining more cases in the future.
Adenocarcinoma ; Biopsy* ; Cardiomegaly ; Diagnosis ; Electrocardiography ; Estrogens, Conjugated (USP) ; Hand ; Heart ; Humans ; Hypotension ; Lung ; Neck ; Pericardial Effusion ; Pericardiocentesis* ; Physical Examination ; Stomach ; Tachycardia, Ventricular ; Tuberculosis ; Veins

Background: We prospectively evaluated the applicability and effect of noninvasive ventilation (NIV) in acute respiratory failure and tried to find out the parameters that could predict successful application of NIV. Methods: Twenty-six out of 106 patients with either acute ventilatory failure (VF: PaCO2> 43 mm Hg with pH <7.35) or oxygenation failure (OF: PaO2/FIO2 < 300 mm Hg with pH> or = 7.35) requiring mechanical ventilation were managed by NIV (CPAP + pressure support, or BiPAP) with face mask. Eleven out of 19 cases with VF (57.9%) (M: F=7: 4, 55.4 +/-14.6 yrs) and 15 out of 87 cases with OF (17.2%) (M: F= 12: 3, 50.6+/-15.6 yrs) were suitable for NIV. Respiratory rates, arterial blood gases and success rate of NIV were analyzed in each group. Results: 81.8% (9/11) of VF and 40% (6/15) of OF were successfully managed on NIV and were weaned from mechanical ventilator without resorting to endotracheal intubation. Complications were noted in 2 cases (nasal skin necrosis 1, gaseous gastric distension 1). In NIV for ventilatory failure, the respiration rate was significantly decreased at 12 hour of NIV (34+/-9 /min pre-NIV, 26+/-6 /min at 12 hour of NIV, p=0.045), while PaCO2 (87.3+/-20.6 mm Hg pre-NIV, 81.2+/-9.1 mm Hg at 24 hour of NIV) and pH (7.26 +/-0.04, 7.32 +/-0.02, respectively, p< 0.05) were both significantly decreased at 24 hour of NIV. In NIV for oxygenation failure, PaO2 were not different between the successful and the failed cases at pre-NIV and till 12 hours after NTV. The PaO2/FIO2 ratio, however, significantly improved at 0.5 hour of NIV in successful cases and were maintained at around 200 mm Hg (n=6: at baseline, 0.5h, 6h, 12h: 120.0+/-19.6, 218.9+/-98.3, 191.3+/-55.2, 232.8+/-17.6 mm Hg, respectively, p=0.0211), but it did not rise in the failed cases (n=9: 127.9+/-63.0, 116.8+/-24.4, 100.6 +/-34.6, 129.8+/-50.3 mm Hg, respectively, p=0.5319). Conclusion: From the above results we conclude that NIV is effective for hypercapnic respiratory failure and its success was heralded by reduction of respiration rate before the reduction in PaCO2 level. In hypoxic respiratory failure, NIV is much less effective, and the immediate improvement of PaO2/FIO2 ratio at 0.5h after application is thought to be a predictor of successful NIV.
Gases ; Health Resorts ; Humans ; Hydrogen-Ion Concentration ; Intubation, Intratracheal ; Masks ; Necrosis ; Noninvasive Ventilation ; Oxygen ; Prospective Studies ; Respiration, Artificial* ; Respiratory Insufficiency* ; Respiratory Rate ; Skin ; Ventilators, Mechanical

We experienced an extremely rare case of lipoid pneumonia combined with empyema. A 53-year-old patient was admitted because of chilling sensation and blood tinged sputum. Simple X-ray and computered tomography(CT) showed a huge homogeneous opacification in the left lower lung field. This patient was diagnosed as endogenous type lipoid pneumonia by a computed tomography guided needle biopsy; decortication and left lower lobectomy are performed. We diagnosed it as endogenous type lipoid pneumonia because it revealed a foreign body reaction and lipid laden macrophage on the pathologic examination.
Biopsy, Needle ; Empyema ; Foreign-Body Reaction ; Humans ; Lung ; Macrophages ; Middle Aged ; Pneumonia* ; Sensation ; Sputum ; Tolnaftate

The diffuse form of supravalvar aortic stenosis represents a surgical challenge when the ascending aorta, aortic arch, proximal descending thoracic aorta and arch arteries are involved. It can be treated by a variety of surgical approaches. We report a case of severe diffuse supravalvar aortic stenosis combined with an aortic valve anomaly and occlusion of the right coronary artery ostium in a 14-year-old boy with Williams syndrome. We enlarged the aortic root (Nick's procedure), ascending aorta, aortic arch, proximal descending thoracic aorta, and innominate artery with patches and replaced aortic valve with 19 mm St. Jude valve. Deep hypothermic circulatory arrest and retrograde cerebral perfusion were used during repair of the arch and arch artery.
Adolescent ; Aorta ; Aorta, Thoracic ; Aortic Stenosis, Supravalvular* ; Aortic Valve* ; Arteries ; Brachiocephalic Trunk ; Circulatory Arrest, Deep Hypothermia Induced ; Coronary Vessels ; Humans ; Male ; Perfusion ; Williams Syndrome

PURPOSE: This study was conducted to compare clinical features between Mycoplasma pneumonia and viral pneumonia. METHODS: We retrospectively analyzed the medical records of 428 patients requiring hospitalization among children younger than 18 years of age in 5 hospitals in Seoul and Gyeonggi-do. There were 131 patients with M. pneumonia and virus coinfection, 167 patients with M. pneumonia without virus coinfection, and 130 patients with viral pneumonia. All subjects had radiographic evidence of pneumonia with specimens available for both M. pneumonia and viral testing. Virus was identified using the polymerase chain reaction assay in a nasopharyngeal or oropharyngeal swab. M. pneumoniae pneumonia was diagnosed serologically. RESULTS: Human rhinovirus was detected in 60.3% (79 of 131) of children with M. pneumonia accompanied by virus coinfection. Respiratory syncytial virus (RSV) was detected in 38.2% (50 of 130) of children with viral pneumonia. The mean age was significantly lower in the viral pneumonia group than in the M. pneumonia group with and without virus coinfection. The sex distribution did not differ significantly among the 3 study groups. The procalcitonin level was higher in viral pneumonia and erythrocyte sedimentation rate level was higher in the M. pneumonia group although no significant difference was found in C-reactive protein level between the M. pneumonia and viral pneumonia groups. CONCLUSION: Clinical features and inflammatory markers between M. pneumonia and viral pneumonia may be useful for the treatment of community-acquired pneumonia.
Blood Sedimentation ; C-Reactive Protein ; Child* ; Coinfection ; Cross-Sectional Studies* ; Gyeonggi-do ; Hospitalization ; Humans ; Medical Records ; Mycoplasma* ; Pneumonia ; Pneumonia, Mycoplasma* ; Pneumonia, Viral ; Polymerase Chain Reaction ; Respiratory Syncytial Viruses ; Retrospective Studies ; Rhinovirus ; Seoul ; Sex Distribution

PURPOSE: The aim of this study was to compare the clinical usefulness of serum procalcitonin (PCT) levels in Mycoplasma pneumoniae pneumonia (M. pneumonia) and viral pneumonia in children. METHODS: We retrospectively analyzed the medical records of 348 patients admitted between June 2015 and December of 2015. There were 162 patients with M. pneumonia without virus coinfection (group 1) and 186 patients with viral pneumonia (group 2). All subjects had radiographic evidence of pneumonia with available specimens for both M. pneumonia and viral testing, and levels of serum PCT, white blood cell counts (WBC), neutrophil portion, and C-reactive protein (CRP). Fifty-eight children who performed follow-up sampling at the time of no fever for more than 48 hours were subdivided into group 3 (M. pneumonia with follow-up sampling, n=41) and group 4 (viral pneumonia with follow-up sampling, n=17). RESULTS: No difference was noted in the levels of serum PCT (P=0.168), CRP (P=0.296), WBC (P=0.732), and neutrophil proportion (P=0.069) between groups 1 and 2, after adjusting for age. Serial changes in serum PCT levels between the first and second samples were significant in group 3 (P=0.046). Serial changes in serum CRP levels between the first and second samples were significant in group 4 (P=0.008). CONCLUSION: Serum PCT and CRP levels may change differently after infection according to the etiology of pneumonia.
C-Reactive Protein ; Child* ; Coinfection ; Cross-Sectional Studies* ; Fever ; Follow-Up Studies ; Humans ; Leukocyte Count ; Medical Records ; Mycoplasma pneumoniae ; Mycoplasma* ; Neutrophils ; Pneumonia ; Pneumonia, Mycoplasma* ; Pneumonia, Viral* ; Retrospective Studies

BACKGROUND AND OBJECTIVES: It is known that angiotensin converting enzyme inhibitors and angiotensin II type 1 receptor blockers (ACEIs and ARBs, respectively) are effective in preventing atrial fibrillation (AF) in high-risk patients. However, it is not known whether ACEIs and ARBs are effective in preventing the recurrence of AF after catheter ablation. SUBJECTS AND METHODS: One hundred fifty-two patients (mean age, 57+/-10 years; M : F=94 : 58) who underwent catheter ablation due to drug-refractory paroxysmal (mean age, 57+/-10 years; M : F=58 : 43) or persistent AF (mean age, 56+/-10 years; M : F=36 : 15) were enrolled. We compared the recurrence rates between the groups with and without ACEIs or ARBs use in paroxysmal and persistent AF. The mean duration of follow-up was 18+/-14 months. RESULTS: The overall recurrence rate after ablation therapy was 26% (n=39). The recurrence rate was significantly decreased in the patients with persistent AF with the use of ACEIs or ARBs (12.1% vs. 61.1%, p<0.01), but this difference was not observed in the patients with paroxysmal AF (24.2% vs. 22.9%, p=0.87). In patients with persistent AF with and without recurrence, the size of the left atrium (44.2+/-8.4 mm vs. 44.3+/-5.8 mm, respectively, p=0.45) and the ejection fraction (62+/-6.5% vs. 61.5+/-6.2%, respectively, p=0.28) were not significantly different. In multivariate analysis, the use of ACEIs or ARBs was independently associated with recurrence after adjusting for the size of the left atrium and the ejection fraction {odds ratio (OR)=0.078, 95% confidence interval (CI)=0.02-0.35, p<0.01}. CONCLUSION:ACEIs and ARBs were shown to be effective in preventing AF recurrence after catheter ablation in patients with persistent AF.
Angiotensin II Type 1 Receptor Blockers ; Angiotensin-Converting Enzyme Inhibitors ; Angiotensins ; Atrial Fibrillation ; Catheter Ablation ; Follow-Up Studies ; Heart Atria ; Humans ; Multivariate Analysis ; Peptidyl-Dipeptidase A ; Recurrence

BACKGROUND AND OBJECTIVES: Passive smoking increases the risk of cardiovascular disease, but the factors responsible for this association remain largely unknown. We sought to determine whether passive smoke exposure is associated with systemic inflammation in a dose-dependent fashion, which is a known risk factor for cardiovascular events. SUBJECTS AND METHODS: We analyzed the data of self-reported non-smokers, > or =40 years of age, who were from the Third National Health and Nutrition Examination Survey (n=6,595). We quantified the passive nicotine exposure by dividing the non-smokers into quartiles, as based on the serum cotinine values. We used multiple linear and logistic regression models to determine the independent relationship between serum cotinine and the levels of C-reactive protein, fibrinogen and leukocytes, and the platelet expression. RESULTS: After adjustments were done for age, gender, body mass index and race, the participants in the highest serum cotinine quartile (quartile 4) had circulating platelet, fibrinogen and homocysteine levels that were 6,893/microliter higher (95% confidence interval [CI]: 1,886 to 11,900/microliter, p=0.007), 8.74 mg/dL (95% CI: 2.63 to 14.84 mg/dL, p=0.005) and 0.90 micromol/L (95% CI: 0.36 to 1.43 (micromol/L, p=0.001), respectively, than in those in the lowest quartile of serum cotinine (quartile 1). There was a dose-dependent increase in the circulating fibrinogen, homocysteine and platelet levels across the quartiles of cotinine. CONCLUSION: These findings indicate that even among nonsmokers, elevated serum cotinine is an independent risk factor for systemic inflammation. This suggests that passive smoke exposure promotes systemic inflammatory response in a dose-dependent fashion. These observations may explain why passive smoking is a risk factor for atherosclerosis and cardiovascular events.
Atherosclerosis ; Blood Platelets ; Body Mass Index ; C-Reactive Protein ; Cardiovascular Diseases ; Continental Population Groups ; Cotinine ; Epidemiology ; Fibrinogen ; Homocysteine ; Humans ; Inflammation* ; Leukocytes ; Logistic Models ; Nicotine ; Nutrition Surveys ; Observational Study* ; Risk Factors ; Smoke* ; Tobacco Smoke Pollution

An infant having parents of Jehovah s Witnesses was 4 months old and 5.6 kg in weight. Echocardiographic diagnosis was complete transposition of great arteries(TGA), ventricular septal defect(VSD), atrial septal defect(ASD), patent ductus arteriosus(PDA), and bilateral superior vena cava(SVC). The preoperative hemoglobin level was 14.9 g/dl. We performed an arterial switch operation(ASO) with VSD closure without transfusion and he was discharged uneventfully 16 days after the operation. At that time the hemoglobin level was 12.8 g/dl. We report that we could successfully correct the complex congenital heart disease without transfusion by the combined use of erythropoietin and aprotinin, intraoperative meti-culous hemostasis, and postbypass ultrafiltration.
Aprotinin ; Diagnosis ; Echocardiography ; Erythropoietin ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular* ; Hemostasis ; Humans ; Infant ; Jehovah's Witnesses* ; Parents ; Transposition of Great Vessels* ; Ultrafiltration