The role of atypical bacteria and the effect of antibiotic treatments in acute bronchitis are still not clear. This study was conducted at 22 hospitals (17 primary care clinics and 5 university hospitals) in Korea. Outpatients (aged > or = 18 yr) who had an acute illness with a new cough and sputum (< or = 30 days) were enrolled in 2013. Multiplex real-time polymerase chain reaction (RT-PCR) was used to detect five atypical bacteria. A total of 435 patients were diagnosed as having acute bronchitis (vs. probable pneumonia, n = 75), and 1.8% (n = 8) were positive for atypical pathogens (Bordetella pertussis, n = 3; B. parapertussis, n = 0; Mycoplasma pneumoniae, n = 1; Chlamydophila pneumoniae, n = 3; Legionella pneumophila, n = 1). Among clinical symptoms and signs, only post-tussive vomiting was more frequent in patients with atypical pathogens than those without (P = 0.024). In all, 72.2% of the enrolled patients received antibiotic treatment at their first visits, and beta-lactams (29.4%) and quinolones (20.5%) were the most commonly prescribed agents. In conclusion, our study demonstrates that the incidence of atypical pathogens is low in patients with acute bronchitis, and the rate of antibiotic prescriptions is high.
Anti-Bacterial Agents/therapeutic use ; Bordetella parapertussis/genetics/*isolation & purification ; Bordetella pertussis/genetics/*isolation & purification ; Bronchitis/drug therapy/*microbiology ; Chlamydophila pneumoniae/genetics/*isolation & purification ; Community-Acquired Infections/microbiology ; Female ; Humans ; Hypertension/complications ; Legionella pneumophila/genetics/*isolation & purification ; Male ; Middle Aged ; Mycoplasma pneumoniae/genetics/*isolation & purification ; Real-Time Polymerase Chain Reaction ; Republic of Korea ; Sputum/microbiology

Deciding on the appropriate antiplatelet therapy is a challenge when treating patients with idiopathic thrombocytopenic purpura (ITP) and who are undergoing percutaneous coronary intervention (PCI). We describe here a case of PCI in a patient with chronic, refractory ITP. A 61-year-old woman presented with exertional chest pain and a low platelet count (4 x 109/L) at admission. Coronary angiography revealed 99% stenosis of the mid left anterior descending artery and 95% stenosis of the mid left circumflex artery. Antiplatelet agents couldn't be administered because of the risk of bleeding. After transfusion of platelets and administering intravenous immunoglobulin, we deployed baremetal stents in both lesions without administering any antiplatelet agents. Although focal in-stent restenosis developed 5 months later, there was no episode of stent thrombosis despite not using antiplatelet agents. The present case suggests that the rate of stent thrombosis may be lower was previously thought and antiplatelet therapy may be considered on a case by case for patient suffering with thrombocytopenia.
Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Female ; Hemorrhage ; Humans ; Immunoglobulins ; Middle Aged ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors* ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic* ; Stents* ; Thrombocytopenia ; Thrombosis

BACKGROUND: Recently, B-natriuretic peptide (BNP) level and left atrial volume index (LAVi) were known to correlate with indices of LV diastolic function. As a screening method, we tried to evaluate the efficacy to BNP, ANP, and LAVi to predict the advanced diastolic dysfunction that means myocardial relaxation abnormality and elevated LV filling pressure. METHODS: In 100 patients who referred for echocardiography, Doppler recording of the mitral inflow and tissue Doppler imaging of the mitral annulus were obtained and classified into 4 diastolic function grades (normal, impaired relaxation, pseudonormal, and restrictive). Advanced diastolic dysfunction was defined as pseudonormal and restrictive physiology. LAVi was measured by modified Simpson's method in apical 4-chamber view at end-systole. Plasma levels of BNP and ANP were measured on the same day as echocardiogram was done. RESULTS: BNP and ANP levels were increased as diastolic function grade was worsening (BNP : 60+/-92, 108+/-204, 778+/-1,023 and 1,426+/-1,421 pg/ml, p<0.001; ANP: 22+/-30, 23+/-26, 94+/-92, 96+/-61 pg/ml, p<0.001). LAVi was also increased as diastolic dysfunction was advanced: 24+/-7 ml/m2, 27+/-9 ml/m2, 37+/-12 ml/m2, 45+/-12 ml/m2, p<0.001. The areas under the curve of receiver-operator characteristic curve for BNP, ANP and LAVi to detect the advanced diastolic dysfunction were 0.91, 0.88 and 0.84, respectively. BNP of 137 pg/ml, ANP of 34 pg/ml, and LAVi of 30 ml/m2 were the best values of sensitivity and specificity, respectively. CONCLUSION: These data suggest that BNP, ANP and LAVi provide meaningful sensitivity and specificity for the detection of advanced diastolic dysfunction, respectively. Among these, BNP is better than ANP or LAVi for the screening method to predict the advanced diastolic dysfunction.
Atrial Natriuretic Factor ; Diastole ; Echocardiography, Doppler ; Heart Atria ; Humans ; Mass Screening* ; Natriuretic Peptide, Brain ; Natriuretic Peptides* ; Physiology ; Plasma ; Relaxation ; Sensitivity and Specificity

PURPOSE: Postoperative hypocalcemia is one of the most common complications in patients who undergo a bilateral thyroid resection and can prolong hospital stay. However, there is no reliable predictor of clinical hypocalcemia after a thyroidectomy. The aim of this study was to identify the clinical predictors of hypocalcemia after a thyroidectomy and to determine if the perioperative measurements of iPTH would be helpful in identifying patients at risk of post-thyroidectomy hypocalcemia. METHODS: 213 consecutive patients undergoing thyroidectomy between Nov 2004 and Feb 2005 were examined. The iPTH, serum calcium and ionized calcium levels were measured at 6 hours, 1 day and 2 weeks after surgery, respectively. All the patients were divided into the lower PTH group (<10 pg/ml) and normal PTH group according to the level of iPTH measured at 6 hours after surgery. RESULTS: The lower PTH group comprised 33% of all patients: 39% after the total thyroidectomy and 11% after a less than total thyroidectomy. The incidence of IV calcium replacement was 36% in the lower PTH group compared with 13% in the normal PTH group. Hypocalcemia and a lowered PTH level occurred more frequently in patients who underwent surgery for a malignant tumor than for a benign tumor. CONCLUSION: There was a correlation between the level of ionized calcium and the incidence of calcium replacement and with the 6 hr-later iPTH level. Therefore, a iPTH leve Calcium ; Humans ; Hypocalcemia* ; Incidence ; Length of Stay ; Parathyroid Hormone* ; Thyroid Gland ; Thyroidectomy

Pituitary tumor can be accompanied with various pituitary hormone abnormalities. Pituitary tumors can be divided into functioning or nonfunctioning tumors. A functioning pituitary tumor, via the oversecretion of pituitary hormones, causes diverse clinical features. A nonfunctioning pituitary tumor can be accompanied with pituitary dysfunction and this may be due to compression or destruction of normal pituitary tissue, suppression of the pituitary portal system or direct damage to the hypothalamus. Corticotropin-releasing hormone (CRH) deficiency, which is caused by defects in the synthesis or release of CRH, is a cause of secondary adrenocortical insufficiency. The clinical presentations are hypoglycemia, weight loss, anemia, weakness, nausea, vomiting and hyponatremia. Acquired CRH deficiency has also been suggested to occur based on a lack of adrenocorticotropic hormone (ACTH) response to insulin-induced hypoglycemia, but there is a normal ACTH response to exogenous CRH. We experienced a case of a woman with pituitary macroadenoma accompanied with CRH deficiency. We report here on this case with the review of the literature.
Adrenocorticotropic Hormone ; Anemia ; Corticotropin-Releasing Hormone ; Female ; Humans ; Hypoglycemia ; Hyponatremia ; Hypothalamus ; Nausea ; Pituitary Hormones ; Pituitary Neoplasms ; Portal System ; Vomiting ; Weight Loss

Central pontine myelinolysis (CPM)is a demyelinating disorder that affects pons and is characterized by disturbance of consciousness, quadriparesis, and mutism and has been considered to have poor prognosis. It commonly occurs in patients with rapidly corrected hyponatremia. However, hypoglycemia induced CPM has been rarely reported. Diagnosis is confirmed by MR imaging. Here we report a case of CPM after severe hypoglycemia without any electrolyte disturbance in a patients with diabetic nephropathy.
Consciousness ; Demyelinating Diseases ; Diabetic Nephropathies* ; Diagnosis ; Humans ; Hypoglycemia* ; Hyponatremia ; Magnetic Resonance Imaging ; Mutism ; Myelinolysis, Central Pontine* ; Pons ; Prognosis ; Quadriplegia

Patients with acromegaly have high incidence of benign or malignant neoplasia than general population. Around fifteen percent of the deaths reported in acromegaly are attributable to malignancy of cancer. On the whole, mortality in acromegaly has been shown to be correlated with the degree of growth hormone (GH) control. Especially, the levels of insulin like growth factor-1 (IGF-1) may be higher in neoplasm, but there is no clear evidence to prove that tumor development is triggered by IGF-1 in acromegaly. Henceforth, we report a case of acromegaly associated with lung and gastric cancer in a 58-year-old man, suggesting the possible carcinogenic role of IGF-1.
Acromegaly* ; Growth Hormone ; Humans ; Incidence ; Insulin ; Insulin-Like Growth Factor I ; Lung Neoplasms ; Lung* ; Middle Aged ; Mortality ; Stomach Neoplasms*

Fibromuscular dysplasia (FMD) is an uncommon hyperplastic disorder affecting medium-sized arteries. It can lead to renovascular hypertension, sometimes associated with dissection. But it rarely causes renal infarction. We here report a case of recurrent renal infarction due to FMD. A previously healthy 29- year-old man presented with acute onset of right flank pain. He had been treated for the same symptom 8 years ago. Abdominal CT scan showed renal infarction at upper pole of right kidney. Renal arteriography demonstrated string of bead, consistent with FMD. It showed also old renal infarction at lower pole of right kidney. To our knowledge, recurrent renal infarction due to FMD has not been previously reported.
Angiography ; Arteries ; Fibromuscular Dysplasia ; Flank Pain ; Hypertension, Renovascular ; Infarction* ; Kidney ; Tomography, X-Ray Computed

BACKGROUND: Eugenol is a major component of the essential oil isolated from Eugenia caryophyllata (Myrtaceae), and has been widely used as a traditional medicine. In this study, the effects of eugenol on the cytotoxicity, induction of apoptosis and putative pathways of its actions were investigated in human promyelocytic leukemia cells (HL-60). METHODS: After applying eugenol to cultured HL-60, the changes in the mitochondrial membrane potential of the cells were monitored after double staining with propidium iodide and rhodamine 123, with 2', 7'-dicholorofluorescin diacetate was used to measure of levels of reactive oxygen species (ROS) RESULTS: Eugenol was shown to be a potent inducer of apoptosis; transducing the apoptotic signal via ROS generation; thereby, inducing mitochondrial permeability transition (MPT) and cytochrome c release to the cytosol. The production of ROS, mitochondrial alteration and subsequent apoptotic cell death in eugenol-treated cells were blocked by the antioxidant, N-acetylcystein (NAC). CONCLUSION: Taken together, the present study has demonstrated that eugenol induces ROS-mediated mitochondrial permeability transition and resultant cytochrome c release.
Apoptosis* ; Cell Death ; Cytochromes c ; Cytosol ; Syzygium ; Eugenol* ; HL-60 Cells ; Humans* ; Leukemia* ; Medicine, Traditional ; Membrane Potential, Mitochondrial ; Oxygen* ; Permeability ; Propidium ; Reactive Oxygen Species ; Rhodamine 123

No abstract available.
Bone Marrow* ; Fibrosis* ; Humans ; Interferon-alpha* ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Mesylates* ; Imatinib Mesylate