Torsades de pointes, a polymorphic ventricular tachycardia associated with prolonged QT interval, is a well-known life-threatening arrhythmia, which has been found to be induced by various causes such as drugs, electrolyte imbalances, and severe bradycardia. Cisapride is a gastrointestinal prokinetic drug, which is widely used to treat gastroesophageal reflux disease or other functional gastrointestinal disorders. Cisapride can cause torsades de pointes and cases of torsedes de pointes induced by cisapride have been reported in other countries. Cases of torsades de pointes associated with antihistamine drugs have been reported in Korea, however, cisapride-induced torsades de pointes case has not been reported. We report a case of 31 year-old female patient who experienced repeated loss of consciousness due to cisapride-induced torsades de pointes.
Adult ; Arrhythmias, Cardiac ; Bradycardia ; Cisapride* ; Female ; Gastroesophageal Reflux ; Gastrointestinal Diseases ; Humans ; Korea ; Tachycardia, Ventricular ; Torsades de Pointes* ; Unconsciousness

BACKGROUND AND OBJECTIVES: Even short-term treatment with angiotensin converting enzyme inhibitor in essential hypertension has been known to improve left ventricular (LV) diastolic function, LV hypertrophy (LVH), and aortic stiffness. The purpose of this study was to examine the effects of angiotensin II receptor antagonist (Losartan) on LV diastolic function, LVH, and aortic stiffness in essential hypertension. MATERIALS AND METHODS: Twenty-three hypertensive patients who were aged over 50 years, previously untreated, and without cardiac, renal, neurologic disease, or diabetes, were studied. Before and 12 weeks after monotherapy with Losartan 50 mg q.d., (1) supine arterial blood pressure by sphygmomanometry, (2) interventricular septum and LV posterior wall thickness, and LV end-diastolic dimension by M-mode echocardiography, (3) mitral peak E and A wave velocity by doppler echocardiography, (4) pulse wave velocity (PWV) in the descending aorta from aortic arch to the bifurcation by doppler echocardiography, were done. RESULTS: Twelve weeks after treatment, systolic blood pressure was lowered from 168.2+/-3.5 mmHg to 142.9+/-2.9 mmHg (p<0.05), diastolic blood pressure from 98.52.4 mmHg to 87.51.3 mmHg (p<0.05). Peak E/A ratio was increased from 0.75+/-0.04 to 0.82+/-0.04 (p<0.05). LV mass was decreased from 267.5+/-15.8 g to 235.6+/-12.6 g (p<0.05), and LV mass index from 166.8+/-8.0 g/m2 to 146.9+/-6.0 g/m2 (p<0.05). However, there were no significant change in PWV (from 7.18+/-0.10 m/sec to 7.23+/-0.30 m/sec, p>0.05), compliance (from 1.31+/-0.04 to 1.34+/-0.12, p>0.05), and compliance index (from 0.16+/-0.01 to 0.15+/-0.01, p>0.05). CONCLUSION: Short-term treatment with Losartan decreases blood pressure, improves LV diastolic function and LVH, but not aortic stiffness.
Angiotensin II* ; Angiotensins* ; Aorta, Thoracic ; Arterial Pressure ; Blood Pressure ; Compliance ; Echocardiography ; Echocardiography, Doppler ; Humans ; Hypertension ; Hypertrophy ; Losartan* ; Peptidyl-Dipeptidase A ; Pulse Wave Analysis ; Receptors, Angiotensin ; Vascular Stiffness* ; Ventricular Function, Left*

BACKGROUND: Currently available data suggests that uric acid (UA) functions as an antioxidant after acute ischemic stroke (AIS). Nevertheless, the prognostic value of serum UA in AIS is controversial. The aim of this study was to determine the relationship between UA and functional outcomes after AIS. METHODS: UA levels were analyzed within 48 hours of stroke onset in patients between 2007 and 2012. Mean serum UA levels were compared between patients with good and poor functional outcomes (modified Rankin Scale [mRS] score, 0-2 versus 3-6, respectively) at 3 months poststroke, and with and without early neurological improvement (ENI, > or = 4-versus <4-point differences on the National Institutes of Health Stroke Scale [NIHSS] score after 7 days). RESULTS: Serum UA levels differed according to the sex, age, stroke subtype, and presence of diabetes mellitus, smoking, and atrial fibrillation. Multivariate logistic regression analysis revealed an association between good functional outcome at 3 months and male gender, young age, history of dyslipidemia, good functional status before stroke (mRS score, 0-2), and low stroke severity (i.e., NIHSS score) on admission. However, higher serum UA levels were no longer associated with a good functional outcomes (odds ratio, 1.387; 95% confidence interval, 0.857-2.244; p=0.521). The mean serum UA levels did not differ significantly between patients with and without ENI. CONCLUSIONS: There was no association between serum UA levels and functional outcomes at 3 months in AIS.
Atrial Fibrillation ; Cerebral Infarction ; Cerebrovascular Disorders ; Diabetes Mellitus ; Dyslipidemias ; Humans ; Logistic Models ; Male ; Myocardial Infarction ; National Institutes of Health (U.S.) ; Smoke ; Smoking ; Stroke* ; Uric Acid*

We report a case of spontaneous bacterial peritonitis from Ochrobactrum anthropi. O. anthropi is recognized as an emerging pathogen in immunocompromised patients. In contrast to most previously described cases, the patient reported here had no indwelling catheter. To our knowledge, no case of O. anthropi spontaneous bacterial peritonitis has been reported in the medical literature until now.
Treatment Outcome ; Rare Diseases/diagnosis/drug therapy/microbiology ; Peritonitis/*diagnosis/drug therapy/*microbiology ; Ochrobactrum anthropi/drug effects/*isolation & purification ; Middle Aged ; Male ; Humans ; Gram-Negative Bacterial Infections/*diagnosis/drug therapy/*microbiology ; Anti-Bacterial Agents/administration & dosage

Pneumonia and meningitis are the most frequent manifestations of pneumococcal infections. Pneumococcal spinal epidural abscesses have been rarely reported. Spinal epidural abscess by Streptococcus pneumoniae has been diagnosed among the patients with diabetes mellitus, alcoholism, corticosteroid therapy, intravenous drug use, chronic renal failure, AIDS, and history of spinal surgery. Recently, we experienced a case of pneumococcal spinal epidural abscess after spinal trauma. A 36-year-old male patient was admitted with back pain, fever, and paraplegia which occurred 5 days after the trauma. Spine MRI revealed spinal epidural abscess at the level from T2 to T9. He was treated with antimicrobial agents and surgical exploration for spinal epidural abscess. Pus culture grew S. pneumoniae which was susceptible to penicillin. Despite early surgical treatment, neurologic sequelae remained. Considering the high mortality and morbidity of pneumococcal spinal epidural abscess, early diagnosis and aggressive treatment including surgical intervention and antibiotics therapy should be implemented immediately.
Adult ; Alcoholism ; Anti-Bacterial Agents ; Anti-Infective Agents ; Back Pain ; Diabetes Mellitus ; Early Diagnosis ; Epidural Abscess* ; Fever ; Humans ; Kidney Failure, Chronic ; Magnetic Resonance Imaging ; Male ; Meningitis ; Mortality ; Paraplegia ; Penicillins ; Pneumococcal Infections ; Pneumonia* ; Spine ; Streptococcus pneumoniae ; Suppuration

Pneumonia and meningitis are the most frequent manifestations of pneumococcal infections. Pneumococcal spinal epidural abscesses have been rarely reported. Spinal epidural abscess by Streptococcus pneumoniae has been diagnosed among the patients with diabetes mellitus, alcoholism, corticosteroid therapy, intravenous drug use, chronic renal failure, AIDS, and history of spinal surgery. Recently, we experienced a case of pneumococcal spinal epidural abscess after spinal trauma. A 36-year-old male patient was admitted with back pain, fever, and paraplegia which occurred 5 days after the trauma. Spine MRI revealed spinal epidural abscess at the level from T2 to T9. He was treated with antimicrobial agents and surgical exploration for spinal epidural abscess. Pus culture grew S. pneumoniae which was susceptible to penicillin. Despite early surgical treatment, neurologic sequelae remained. Considering the high mortality and morbidity of pneumococcal spinal epidural abscess, early diagnosis and aggressive treatment including surgical intervention and antibiotics therapy should be implemented immediately.
Adult ; Alcoholism ; Anti-Bacterial Agents ; Anti-Infective Agents ; Back Pain ; Diabetes Mellitus ; Early Diagnosis ; Epidural Abscess* ; Fever ; Humans ; Kidney Failure, Chronic ; Magnetic Resonance Imaging ; Male ; Meningitis ; Mortality ; Paraplegia ; Penicillins ; Pneumococcal Infections ; Pneumonia* ; Spine ; Streptococcus pneumoniae ; Suppuration

Background: Sodium-dependent glucose cotransporter 2 (SGLT2) mediates glucose reabsorption in the renal proximal tubules, and SGLT2 inhibitors are used as therapeutic agents for treating type 2 diabetes mellitus. This study aimed to elucidate the effects and mechanisms of SGLT2 inhibition on hepatic glucose metabolism in both serum deprivation and serum supplementation states. Methods: Huh7 cells were treated with the SGLT2 inhibitors empagliflozin and dapagliflozin to examine the effect of SGLT2 on hepatic glucose uptake. To examine the modulation of glucose metabolism by SGLT2 inhibition under serum deprivation and serum supplementation conditions, HepG2 cells were transfected with SGLT2 small interfering RNA (siRNA), cultured in serum-free Dulbecco’s modified Eagle’s medium for 16 hours, and then cultured in media supplemented with or without 10% fetal bovine serum for 8 hours. Results: SGLT2 inhibitors dose-dependently decreased hepatic glucose uptake. Serum deprivation increased the expression levels of the gluconeogenesis genes peroxisome proliferator-activated receptor gamma co-activator 1 alpha (PGC-1α), glucose 6-phosphatase (G6pase), and phosphoenolpyruvate carboxykinase (PEPCK), and their expression levels during serum deprivation were further increased in cells transfected with SGLT2 siRNA. SGLT2 inhibition by siRNA during serum deprivation induces nuclear localization of the transcription factor forkhead box class O 1 (FOXO1), decreases nuclear phosphorylated-AKT (p-AKT), and p-FOXO1 protein expression, and increases phosphorylated-adenosine monophosphate-activated protein kinase (p-AMPK) protein expression. However, treatment with the AMPK inhibitor, compound C, reversed the reduction in the protein expression levels of nuclear p- AKT and p-FOXO1 and decreased the protein expression levels of p-AMPK and PEPCK in cells transfected with SGLT2 siRNA during serum deprivation. Conclusion These data show that SGLT2 mediates glucose uptake in hepatocytes and that SGLT2 inhibition during serum deprivation increases gluconeogenesis via the AMPK/AKT/FOXO1 signaling pathway.

BACKGROUND: We investigated the association of coronary artery calcium score (CACS) with body composition and insulin resistance in apparently healthy Korean adults. METHODS: Nine hundred forty-five participants (mean age, 48.9 years; 628 men) in a medical check-up program were selected for analysis. Body composition was assessed by bioelectrical impedance analysis (BIA). Insulin resistance was evaluated using the homeostasis model assessment of insulin resistance (HOMA-IR). The CACS was assessed by multidetector computed tomography. RESULTS: One hundred forty-six subjects (15.4%) showed coronary artery calcification and 148 subjects (15.7%) had metabolic syndrome. CACS showed a significant positive correlation with age, fasting glucose level, waist circumference (WC), blood pressure, hemoglobin A1c, HOMA-IR, and waist-hip ratio (WHR) assessed by BIA. CACS had a negative correlation with high density lipoprotein cholesterol (HDL-C). Subjects with high CACS showed significantly higher mean WHRs and lower mean values for lean body mass compared with subjects without coronary artery calcification. In logistic regression analyses with coronary artery calcification as the dependent variable, the highest quartile of WHR showed a 3.125-fold increased odds ratio for coronary artery calcification compared with the lowest quartile after adjustment for confounding variables. When receiver operating characteristics analyses were performed with coronary artery calcification as the result variable, WHR showed the largest area under the curve (AUC) value among other variables except for age and WC in women (AUC=0.696 for WHR, 0.790 for age, and 0.719 for WC in women). CONCLUSION: In our study population of apparently healthy Korean adults, WHR was the most significant predictor for coronary artery calcification among other confounding factors, suggesting that it may have implication as a marker for early atherosclerosis.
Adult ; Atherosclerosis ; Blood Pressure ; Body Composition ; Calcium ; Cholesterol ; Cholesterol, HDL ; Confounding Factors (Epidemiology) ; Coronary Vessels ; Electric Impedance ; Fasting ; Female ; Glucose ; Hemoglobins ; Homeostasis ; Humans ; Insulin Resistance ; Lipoproteins ; Logistic Models ; Obesity, Abdominal ; Odds Ratio ; ROC Curve ; Waist Circumference ; Waist-Hip Ratio

PURPOSE: For the research of Boron Neutron Capture Therapy (BNCT), fast neutrons generated from the MC-50 cyclotron with maximum energy of 34.4 MeV in Korea Cancer Center Hospital were moderated by 70 cm paraffin and then the dose characteristics were investigated. Using these results, we hope to establish the protocol about dose measurement of epi-thermal neutron, to make a basis of dose characteristic of epi-thermal neutron emitted from nuclear reactor, and to find feasibility about accelerator-based BNCT. METHOD AND MATERIALS: For measuring the absorbed dose and dose distribution of fast neutron beams, we used Unidos 10005 (PTW, Germany) electrometer and IC-17 (Far West, USA), IC-18, EIC-1 ion chambers manufactured by A-150 plastic and used IC-17M ion chamber manufactured by magnesium for gamma dose. There chambers were flushed with tissue equivalent gas and argon gas and then the flow rate was 5 cc per minute. Using Monte Carlo N-Particle (MCNP) code, transport program in mixed field with neutron, photon, electron, two dimensional dose and energy fluence distribution was calculated and there results were compared with measured results. RESULTS: The absorbed dose of fast neutron beams was 6.47x10-3 cGy per 1 MU at the 4 cm depth of the water phantom, which is assumed to be effective depth for BNCT. The magnitude of gamma contamination intermingled with fast neutron beams was 65.2+/-0.9% at the same depth. In the dose distribution according to the depth of water, the neutron dose decreased linearly and the gamma dose decreased exponentially as the depth was deepened. The factor expressed energy level, D20/D10, of the total dose was 0.718. CONCLUSION: Through the direct measurement using the two ion chambers, which is made different wall materials, and computer calculation of isodose distribution using MCNP simulation method, we have found the dose characteristics of low fluence fast neutron beams. If the power supply and the target material, which generate high voltage and current, will be developed and gamma contamination was reduced by lead or bismuth, we think, it may be possible to accelerator-based BNCT.
Argon ; Bismuth ; Boron Neutron Capture Therapy* ; Boron* ; Cyclotrons ; Electric Power Supplies ; Fast Neutrons* ; Hope ; Korea ; Magnesium ; Neutrons ; Nuclear Reactors ; Paraffin ; Plastics ; Water

BACKGROUND: We wanted to investigate the effect of infectious complications on the outcome of patients who received allogeneic hematopoietic stem cell transplantation (HSCT), and we determined the risk factors for predicting infectious complication and the mortality in allogeneic HSCT recipients. METHODS: We enrolled all the patients who underwent allogeneic HSCT at Samsung Medical Center from February 1996 to October 2003. RESULTS: A total of 139 patients were enrolled. A total of 450 infectious episodes were observed in 131 allogeneic recipients (90.8%). Infectious complications occurred in the allogeneic recipients [3.243.00 episodes/patient]. Microbiologically documented infection (MDI), clinically documented infection (CDI), and unknown fever (UF) accounted for 41.6%, 34.0% and 24.4%, respectively, of the total infections. Pneumonia (15.1%) was the most common infection. Among the 187 MDIs, bacterial infection, viral infection and fungal infection accounted for 50.3%, 39.6%, and 7.5%, respectively. Twelve of 24 deaths in the late post-transplantation period were related with infection. The statistically significant risk factors for infection related to mortality, by multivariate analysis, were the underlying disease risk, the duration of neutropenia, the failure of stem cell engraftment, acute GVHD, MDI, UF, the number of infectious episodes, bacteremia, fungemia, pneumonia, genitourinary tract infections, S. aureus, E. coli, Pseudomonas spp., Aspergillus spp., Non-albicans candida and CMV diseases. CONCLUSIONS: The incidence of fungal infections was still low in our institute, even though prophylaxis for fungal infections was not applied, except for gargling with nystatin. In addition, most of them were non-albican Candida and Aspergillus species. Therefore, routine fluconazole prophylaxis may not be needed in our institute.
Aspergillus ; Bacteremia ; Bacterial Infections ; Candida ; Fever ; Fluconazole ; Fungemia ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Incidence ; Mortality ; Multivariate Analysis ; Neutropenia ; Nystatin ; Pneumonia ; Pseudomonas ; Risk Factors ; Stem Cells