Background: Umeclidinium/vilanterol (UMEC/VI; ANORO ELLIPTA, GSK) is a commonly used dual bronchodilator. This study evaluated the safety and effectiveness of UMEC/VI in Korean patients with chronic obstructive pulmonary disease (COPD) over a 6-year period. Methods: This was an open-label, multicentre, observational, post-marketing surveillance study. A total of 3,375 patients were enrolled consecutively in 52 hospitals, by 53 physicians, between July 2014 and July 2020. Patients who were administered UMEC/VI (fixed-dose 62.5 μg/25 μg) at least once and were monitored for safety and effectiveness were included in the analysis. Incidence and severity of adverse events (AEs) reported after administrating at least one dose of UMEC/VI were monitored, including unexpected adverse events (UAEs) and adverse drug reactions (ADRs). Effectiveness of UMEC/VI after 24 weeks of administration was also assessed using physician’s evaluation (effective, ineffectiveo change, worsening, indeterminable) and lung function improvement. Results: Of 3,375 patients, 3,086 were included in the safety assessment group (mean age±standard deviation: 69.76±8.80 years; 85.9% male [n=2,652]; 73.1% aged ≥65 years [n=2,255]). The overall incidence of AEs was 28.8% (n=890), of which 2.2% (n=67) were ADRs. Serious AEs and UAEs were reported in 181 (5.9%) and 665 (21.6%) patients, respectively, and two patients (<0.1%) reported unexpected severe ADR. Of the 903/3,086 patients analysed for effectiveness, most (82.8%, n=748) showed overall disease improvement after UMEC/VI treatment. Conclusion This study confirmed UMEC/VI administered to Korean patients according to the prescribing information was well-tolerated and can be considered an effective option for COPD treatment.

The Marfan syndrome is classified as a heritable disorder of connective tissue with clinical and pathological alterations involving supporting elements. In its classic form, the Marfan syndrome is associated with abnormalities of the eye(ectopia lentis), aorta(aortic dilatation and aortic regurgitation) and skeleton(dolichostenomelia, arachnodactyly and pectus deformity). The authers have experienced a case of marfan syndrome recently. The patient was 30-years-old male complaining of anterior chest pain radiating to upper back. Physical examination showed tall status, increased length of the limbs as compared with the trunk and arachnodactyly. On auscultation, heart sound was normal without murmur. He wore glasses because of moderate myopia. Roentgenogram of the chest P-A revealed normal cardiac and aortic contours and lung fields. Left lateral view of chest X-ray revealed concave depression of sternum showing mild pectus excavatum, fusiform dilatation of aorta from aortic root to mid portion of thoracic aorta and resulting in obliteration of retrosternal clear space. Echocardiogram demonstrated moderate dilatation of aortic root A-P diameter(4.5cm) without aortic or mitral valvular abnormalities and normal size of left ventricular cavity(EDD:5.3cm). These data coupled with a distinct family history could permit the diagnosis of Marfan syndrome.
Aorta ; Aorta, Thoracic ; Arachnodactyly ; Chest Pain ; Connective Tissue ; Depression ; Diagnosis ; Dilatation ; Extremities ; Eyeglasses ; Funnel Chest ; Glass ; Heart Auscultation ; Humans ; Lung ; Male ; Marfan Syndrome* ; Myopia ; Physical Examination ; Sternum ; Thorax

Allopurinol is widely used for chronic tophaceous gout as a uric acid lowering agent. Hypersensitivity to allopurinol occurrs in about 10% of patients, which limits the usage of allopurinol. The successful oral and intravenous desensitization of allopurinol has been reported worldwide since 1976. We recently experienced a 51-year-old male patient with gouty arthritis and hyperuricemia, who had previously experienced skin rash after allopurinol treatment. When allopurinol was retried, erythematous and foliative skin rash developed on entire body. Because allopurinol was essential in controlling hyperuricemia, the oral desensitization of allopurinol was tried. We report successful rapid oral allopurinol desensitization in the patient with chronic tophaceous gout, who exhibited exfoliative dermatitis as allopurinol hypersensitivity.
Allopurinol* ; Arthritis, Gouty ; Dermatitis, Exfoliative* ; Exanthema ; Gout ; Humans ; Hypersensitivity ; Hyperuricemia ; Male ; Middle Aged ; Uric Acid

No abstract available.
Germ Cells* ; Neoplasms, Germ Cell and Embryonal* ; Prognosis*

Purpose: To evaluate the effect of a ptosis correction operation on eyebrow position of senile upper lid ptosis patients. Methods: A retrospective study of 140 eyes of 70 patients who had a ptosis correction operation between June 2011 and July 2018 was conducted. Marginal reflex distance 1 and brow height were measured preoperatively and at 1 month and 3 months postoperatively. Patients were divided into two groups, according to whether brow height asymmetry was symmetrized (≤1 mm) or not after the operation. Results: The average brow height decreased after the operation (19.3-18.3 mm, p = 0.00), as did the brow height symmetricity (2.7-2.3 mm, p = 0.01). The symmetric group were older and had a higher female ratio than the asymmetric group, as well as a smaller preoperative brow symmetricity. Conclusions Brow height and brow asymmetry were reduced by ptosis correction of senile upper lid ptosis patients. The symmetrization rate was higher in patients who were older, female, and who had smaller preoperative brow symmetricity.

Laminar flow within large vessels or organs can cause artifact that may simulate thrombus during computed tomographic study. The degree of venous enhancement depends on the size of blood pool and cardiac output in relation to the time of scanning. When venous structures are scanned too fast after injection of contrast material, poor mixing of enhanced and unenhanced blood creates flow artifact that gives an appearance of deep venous thrombosis. As compared with dynamic computed tomography (CT), because of a shorter acquisition time of spiral CT, vascular and organ enhancement on spiral CT scan are more dependent on factor that affect delivery of contrast material into the blood stream. Differentiation from true thrombus can be made by use of delayed scan as well as increased density and finding of relatively poor margination of artifact. In addition, both angiography and echocardiography could complement CT to assure that false-positive results are minimized. We experienced a case of artifact mistaken for intracardiac mass on spiral CT, but it was not noted on echocardiography.
Angiography ; Artifacts* ; Cardiac Output ; Complement System Proteins ; Echocardiography ; Heart Neoplasms* ; Rivers ; Thrombosis ; Tomography, Spiral Computed ; Venous Thrombosis

Although the occurrence of fatal pulmonary embolism may be diminishing, it still accounts for a substantial proportion of postoperative deaths in the middle-aged and older persons, especially among those undergoing major orthopedic surgery, despite improvements in patient management. We experienced cardiac arrest during bipolar endoprosthesis. Cardiopulmonary resuscitation was started and the transesophageal echocardiogram showed right heart failure. We suspected acute pulmonary thromboembolism and decided to perform thromboembolectomy with cardiopulmonary bypass. A massive old blood clot and a 1.0 x 1.5 cm thrombus were removed from both pulmonary arteries. However, despite massive fluid therapy and the use of inotropic agent, the patient failed to recover successfully with postoperative management in the intensive care unit.
Cardiopulmonary Bypass* ; Cardiopulmonary Resuscitation ; Fluid Therapy ; Heart Arrest ; Heart Failure ; Hip* ; Humans ; Intensive Care Units ; Orthopedics ; Pulmonary Artery ; Pulmonary Embolism* ; Thrombosis

Chronic hypophosphatemia caused by decreased intestinal absorption or increased renal clearance, may lead to rickets or osteomalacia independently of other predisposing abnormalities. The conditions commonly associated with increased renal clearance of phosphate are X-linked hypophosphatemic rickets, tumor associated rickets/osteomalacia, RTA and Fanconi syndrome. Recently we experienced 3 men with adult-onset, histologically proven osteomalacia associated with increased renal clearance of phosphate. None of them had a family history of bone disease, tumors or other tubular defects. All of these had remarkable biochemical and clinical improvement with medical treatment such as 1, 25-dihydroxyvitamin D and phosphate supplementation. Although we did not find tumors yet, we could not rule out the possibility of tumor-associated osteomalcia since it often takes several years to make a diagnosis because of small size, benign nature and unusual location of tumors. Thus, careful long-term follow up for tumor occurrence will be maintained in these patients with sporadic nonfamilial hypophosphatemic osteomalacia.
Bone Diseases ; Diagnosis ; Familial Hypophosphatemic Rickets ; Fanconi Syndrome ; Follow-Up Studies ; Humans ; Hypophosphatemia ; Intestinal Absorption ; Male ; Osteomalacia ; Rickets

BACKGROUND/AIMS: Hepatocytes on the hepatic lobule mipate from portal zone to centrilobular mea as the DNA synthesis within it. And also, the xenobiotic reactions reveal characteristic differences associated with zone specific metabolism in the liver acinus. In this study, the zonal distribution of ethylnitrosourea (ENU)-induced hepatic precancerous lesion was stereologically investigated. METHODS: Nine B6C3F1 mices were given I.p. injection of ENU (60 ug/pn body weight) when the pups were 15 days old prior to sacrifices at 8 weeks of life. All the 150 consecutive sections, 3 p m in thickness, were stained with hematoxylin and eosin and identified the basophilic precancerous lesions with 80-165 p m diameter in equatorial plane by the Zeiss microprojector. And then the distances from the center of selected foci to terminal hepatic vein or portal vein branches were estimated under the microscopic fields. As a control group, the same estimations were performed from the random points by the appointments of random digit table. RESULTS: Mean distance between ENU-induced 52 hepatocellular foci and the nearest terminal hepytic vein was 181.15+112.39 p m (Mean+ SD), but that of randomly selected 104 points was 291.73+157.98pm (Mean+5D) (Students t-test, p<0.0005). Substantially, 52.7% of ENU-induced 52 hepatocellular foci were within 300 p m from the terminal hepatic vein, but randomly selected 104 points were only 50.9% (Shapiro Wilk W test, w=0.819857, p=0.048038). Mean distance from ENU-induced 52 foci to portal vein was 398.85+149.98pm (Mean+SD), but that from the randomly selected 104 points was 315.87+145.79 pm (Mean+SD)(Students t-test, p<0.0005). CONCLUSION: Stereologically, ENU-induced mice liver cell foci distribute non-randomly to Zone III, centrilobular zone of mouse hepatic acini where promote invasion toward terminal hepatic veins.
Animals ; Appointments and Schedules ; Basophils ; Cholestasis ; DNA ; Eosine Yellowish-(YS) ; Ethylnitrosourea ; Fluconazole ; Hematoxylin ; Hepatic Veins ; Hepatocytes ; Liver ; Metabolism ; Mice* ; Portal Vein ; Veins

Episodic angioedema with eosinophilia was described by Gleich, et al. as a distinct entity characterized by recurrent angioedema, urticaria, leukocytoeis with remarkable eosinophilia, fever and periadically increased body weight. Since then, several cases of this disorder have been reported in the United States, Europe and Japan. We present a Korean patient whose clinical, histopathologic, and laboratory findings are consistent with the syndrome of episodic angioedema with eosinophilia. This case supports the previous study that revealed some differences between Asian and Caucasian patients.
Angioedema* ; Asian Continental Ancestry Group ; Body Weight ; Eosinophilia* ; Europe ; Fever ; Humans ; Japan ; United States ; Urticaria