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BACKGROUND/AIMS: Nailfold capillaroscopy (NFC) has been used to examine morphological and functional microcirculation changes in connective tissue diseases. It has been demonstrated that NFC patterns reflect abnormal microvascular dynamics, which may play a role in fibromyalgia (FM) syndrome. The aim of this study was to determine NFC patterns in FM, and their association with clinical features of FM. METHODS: A total of 67 patients with FM, and 30 age- and sex-matched healthy controls, were included. Nailfold capillary patterns were quantitatively analyzed using computerized NFC. The parameters of interest were as follows: number of capillaries within the central 3 mm, deletion score, apical limb width, capillary width, and capillary dimension. Capillary dimension was determined by calculating the number of capillaries using the Adobe Photoshop version 7.0. RESULTS: FM patients had a lower number of capillaries and higher deletion scores on NFC compared to healthy controls (17.3 +/- 1.7 vs. 21.8 +/- 2.9, p < 0.05; 2.2 +/- 0.9 vs. 0.7 +/- 0.6, p < 0.05, respectively). Both apical limb width (microm) and capillary width (microm) were significantly decreased in FM patients (1.1 +/- 0.2 vs. 3.7 +/- 0.6; 5.4 +/- 0.5 vs. 7.5 +/- 1.4, respectively), indicating that FM patients have abnormally decreased digital capillary diameter and density. Interestingly, there was no difference in capillary dimension between the two groups, suggesting that the length or tortuosity of capillaries in FM patients is increased to compensate for diminished microcirculation. CONCLUSIONS: FM patients had altered capillary density and diameter in the digits. Diminished microcirculation on NFC may alter capillary density and increase tortuosity.
Adult ; Capillaries/*pathology/physiopathology ; Case-Control Studies ; Female ; Fibromyalgia/*diagnosis/pathology/physiopathology ; Humans ; Image Interpretation, Computer-Assisted ; Male ; Microcirculation ; *Microscopic Angioscopy ; Nails/*blood supply ; Predictive Value of Tests ; Regional Blood Flow

9.Allopurinol hypersensitivity syndrome in patients with hematological malignancies: characteristics and clinical outcomes.

Hong Ki MIN ; Boin LEE ; Seung Ki KWOK ; Ji Hyeon JU ; Wan Uk KIM ; Young Min PARK ; Sung Hwan PARK

The Korean Journal of Internal Medicine 2015;30(4):521-530

BACKGROUND/AIMS: Allopurinol is a urate-lowering agent that is commonly used to prevent chemotherapy-related hyperuricemia. Allopurinol hypersensitivity syndrome (AHS) is a disorder involving multiple organs, which may be accompanied by cutaneous adverse reactions. We identified the characteristics and clinical outcomes of chemotherapy-associated AHS in patients with hematological malignancies. METHODS: This retrospective single-center study included 26 AHS patients (11 with and 15 without hematological malignancies) admitted to Seoul St. Mary's Hospital. AHS was defined using the criteria of Singer and Wallace. Comparisons were made using the Mann-Whitney U test and Fisher exact test as appropriate. RESULTS: In patients with a hematological malignancy and AHS, statistically significant differences were observed in terms of younger age at onset; shorter duration of exposure; higher starting and maintenance doses of allopurinol; lower incidence of eosinophilia, leukocytosis, and underlying renal insufficiency; and more frequent occurrence of fever compared to AHS patients without a hematological malignancy. Two AHS patients with a hematological malignancy were examined for human leukocyte antigen (HLA)-B typing, but neither patient harbored the HLA-B*5801 allele. All of the patients ceased allopurinol treatment, with most patients making a full recovery. Two patients in the study died; however, these deaths were unrelated to AHS. One patient developed serious sequelae of AHS that required hemodialysis. CONCLUSIONS: Physicians who prescribe allopurinol for the prevention of chemotherapy-related hyperuricemia should be aware of the unique risk of AHS, even in patients with hematological malignancies who do not have known risk factors for AHS. Novel urate-lowering agents should be considered alternative treatments.
Adolescent ; Adult ; Age Factors ; Aged ; Allopurinol/*adverse effects ; Antineoplastic Agents/*adverse effects ; Comorbidity ; Dose-Response Relationship, Drug ; Drug Hypersensitivity Syndrome/diagnosis/drug therapy/*etiology ; Female ; Glucocorticoids/therapeutic use ; Gout Suppressants/*adverse effects ; Hematologic Neoplasms/*drug therapy ; Humans ; Hyperuricemia/chemically induced/diagnosis/*prevention & control ; Male ; Medical Records ; Middle Aged ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Young Adult

10.Drug utilization review of mupirocin ointment in a Korean university-affiliated hospital.

Sung Hee YOUN ; Seung Soon LEE ; Sukyeon KIM ; Jeong A LEE ; Bum Joon KIM ; Jounghee KIM ; Hye Kyung HAN ; Jae Seok KIM

The Korean Journal of Internal Medicine 2015;30(4):515-520

BACKGROUND/AIMS: Intranasal mupirocin and chlorhexidine bathing are candidate strategies to prevent healthcare-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA). In Korea, intranasal mupirocin is not available, and mupirocin ointment, an over-the-counter drug, has been used indiscriminately. Furthermore, because it is covered by health insurance, mupirocin is easy to prescribe within hospitals. METHODS: We performed a mupirocin drug utilization review (DUR) within Hallym University Sacred Heart Hospital. Annual use of mupirocin was investigated between 2003 and 2013, and monthly consumption of mupirocin was assessed during the final 2-year period. The DUR focused on August 2012, the period of highest use of mupirocin. Also, we investigated trends in mupirocin resistance in MRSA between 2011 and 2013. RESULTS: Annual consumption of mupirocin increased from 3,529 tubes in 2003 to 6,475 tubes in 2013. During August 2012, 817 tubes were prescribed to 598 patients; of these, 84.9% were prescribed to outpatients, and 77.6% at the dermatology department. The most common indication was prevention of skin infections (84.9%), and the ointment was combined with systemic antibiotics in 62.9% of cases. The average duration of systemic antibiotic administration was about 7.8 days. The rate of low-level mupirocin resistance in MRSA increased from 8.0% to 22.0%, and that of high-level mupirocin resistance increased from about 4.0% to about 7.5%. CONCLUSIONS: Inappropriate use of mupirocin is prevalent. Considering the increase in resistance and the future application of intranasal mupirocin, prophylactic use of mupirocin in dermatology departments should be reconsidered.
Administration, Cutaneous ; Anti-Bacterial Agents/*administration & dosage/adverse effects ; Drug Prescriptions ; Drug Resistance, Multiple, Bacterial ; Drug Utilization Review ; *Hospitals, University ; Humans ; Inappropriate Prescribing/*trends ; Methicillin-Resistant Staphylococcus aureus/*drug effects ; Microbial Sensitivity Tests ; Mupirocin/*administration & dosage/adverse effects ; Ointments ; Practice Patterns, Physicians'/*trends ; Predictive Value of Tests ; Republic of Korea ; Retrospective Studies ; Staphylococcal Skin Infections/diagnosis/*drug therapy/microbiology ; Time Factors

1.Importance of careful Tc-MIBI interpretation in patients with thyroid cancer and primary hyperparathyroidism.

2.Hepatic hydatid cyst.

3.Imatinib mesylate-induced interstitial lung disease in a patient with prior history of Mycobacterium tuberculosis infection.

4.Metastatic sarcomatoid carcinoma presenting as a pedunculated mass on the floor of the mouth.

5.Fatal ischemic stroke in a case of progressive moyamoya vasculopathy associated with uncontrolled thyrotoxicosis.

6.Type 2 myocardial infarction after ingestion of mad honey in a patient with normal coronary arteries.

7.Extramedullary relapse of multiple myeloma presenting as massive upper gastrointestinal bleeding: a rare complication.

8.Quantitative analysis of nailfold capillary morphology in patients with fibromyalgia.

9.Allopurinol hypersensitivity syndrome in patients with hematological malignancies: characteristics and clinical outcomes.

10.Drug utilization review of mupirocin ointment in a Korean university-affiliated hospital.

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