Diabetes mellitus is a major risk factor for the development of heart failure. Furthermore, the prognosis of heart failure is worse in patients with diabetes mellitus than in those without it. Therefore, early diagnosis and proper management of heart failure in patients with diabetes mellitus are important. This review discusses the current criteria for diagnosis and screening tools for heart failure and the currently recommended pharmacological therapies for heart failure. We also highlight the effects of anti-diabetic medications on heart failure.

Reexpansion pulmonary edema is a rare but potentially lethal complication. We report a case of suspected reexpansion pulmonary edema that led to cardiac arrest. Case: A 16-year-old male patient underwent wedge resection due to right pneumothorax. The patient showed pink frothy sputum three hours following surgery, and a chest x-ray showed right unilateral pulmonary edema. Thirteen hours following surgery, the patient continuously showed pink frothy sputum and presented with severe hypoxemia, tachypnea, and tachycardia. After transferring to the intensive care unit (ICU), he developed ventricular tachycardia. Cardiopulmonary resuscitation was performed for 32 min. Chest X-ray showed diffuse bilateral pulmonary edema. Extracorporeal membrane oxygenation was performed. During the 65 days of ICU care, the patient became mentally alert. However, follow-up echocardiography revealed severe heart failure. Conclusions: Rexpansion pulmonary edema can rapidly progress to diffuse bilateral pulmonary edema. Therefore, careful observation is required for the patients who show signs of pulmonary edema after reexpansion.

BACKGROUND: Cardiovascular risk remains increased despite optimal low density lipoprotein cholesterol (LDL-C) level induced by intensive statin therapy. Therefore, recent guidelines recommend non-high density lipoprotein cholesterol (non-HDL-C) as a secondary target for preventing cardiovascular events. The aim of this study was to assess the efficacy and tolerability of omega-3 fatty acids (OM3-FAs) in combination with atorvastatin compared to atorvastatin alone in patients with mixed dyslipidemia. METHODS: This randomized, double-blind, placebo-controlled, parallel-group, and phase III multicenter study included adults with fasting triglyceride (TG) levels ≥200 and <500 mg/dL and LDL-C levels <110 mg/dL. Eligible subjects were randomized to ATOMEGA (OM3-FAs 4,000 mg plus atorvastatin calcium 20 mg) or atorvastatin 20 mg plus placebo groups. The primary efficacy endpoints were the percent changes in TG and non-HDL-C levels from baseline at the end of treatment. RESULTS: After 8 weeks of treatment, the percent changes from baseline in TG (−29.8% vs. 3.6%, P<0.001) and non-HDL-C (−10.1% vs. 4.9%, P<0.001) levels were significantly greater in the ATOMEGA group (n=97) than in the atorvastatin group (n=103). Moreover, the proportion of total subjects reaching TG target of <200 mg/dL in the ATOMEGA group was significantly higher than that in the atorvastatin group (62.9% vs. 22.3%, P<0.001). The incidence of adverse events did not differ between the two groups. CONCLUSION The addition of OM3-FAs to atorvastatin improved TG and non-HDL-C levels to a significant extent compared to atorvastatin alone in subjects with residual hypertriglyceridemia.

BACKGROUND AND OBJECTIVES: The effectiveness of turbinate surgery has been well demonstrated in allergic rhinitis refractory to medication. On the contrary, the efficacy of surgery in allergic rhinitis that responds to medication has not been assessed. The aim of this study was to determine the surgical outcomes in patients with allergic rhinitis responsive to medication. SUBJECTS AND METHOD: Patients with allergic rhinitis responsive to medication and those who had undergone coblation turbinate reduction were enrolled in this study. The visual analog scale was used to assess the allergic symptoms before treatment, during medication treatment as well as postoperatively at 6 and 12 months. In addition, the degree of patient satisfaction regarding the surgery was investigated postoperatively at 12 months. RESULTS: Twenty-four patients (mean age=33.6±14.9 years; men-to-women ratio=1:1) were included in this study. During the pretreatment period, all allergic symptoms significantly improved after treatment with both medication and surgery. At 6 months postoperatively, the degree of patients' allergic symptoms was lower than in those treated with medication. However, when compared at 12 months postoperatively, all the symptoms, excluding nasal obstruction, were not significantly different from those who received medication. Surveyed postoperatively at 12 months 54.2% of patients advocated for surgical treatment. CONCLUSION: Although surgery yielded better outcome than did medication during the early postoperative period, there was little difference in the outcome at 12 months postoperatively. Therefore, we need to be careful when choosing surgical intervention for patients with allergic rhinitis responsive to medication.
Humans ; Methods ; Nasal Obstruction ; Patient Satisfaction ; Postoperative Period ; Pulsed Radiofrequency Treatment ; Rhinitis, Allergic* ; Treatment Outcome ; Turbinates* ; Visual Analog Scale

BACKGROUND/AIMS: The major compounds of Cochinchina momordica seed extract (SK-MS10) include momordica saponins. We report that the gastroprotective effect of SK-MS10 in an ethanol-induced gastric damage rat model is mediated by suppressing proinflammatory cytokines and downregulating cytosolic phospholipase A2 (cPLA2), 5-lipoxygenase (5-LOX), and the activation of calcitonin gene-related peptide. In this study, we evaluated the gastroprotective effects of SK-MS10 in the nonsteroidal anti-inflammatory drug (NSAID)-induced gastric damage rat model. METHODS: The pretreatment effect of SK-MS10 was evaluated in the NSAID-induced gastric damage rat model using aspirin, indomethacin, and diclofenac in 7-week-old rats. Gastric damage was evaluated based on the gross ulcer index by gastroenterologists, and the damage area (%) was measured using the MetaMorph 7.0 video image analysis system. Myeloperoxidase (MPO) was measured by enzyme-linked immunosorbent assay, and Western blotting was used to analyze the levels of cyclooxygenase (COX)-1, COX-2, cPLA2, and 5-LOX. RESULTS: All NSAIDs induced gastric damage based on the gross ulcer index and damage area (p<0.05). Gastric damage was significantly attenuated by SK-MS10 pretreatment compared with NSAID treatment alone (p<0.05). The SK-MS10 pretreatment group exhibited lower MPO levels than the diclofenac group. The expression of cPLA2 and 5-LOX was decreased by SK-MS10 pretreatment in each of the three NSAID treatment groups. CONCLUSIONS: SK-MS10 exhibited a gastroprotective effect against NSAID-induced acute gastric damage in rats. However, its protective mechanism may be different across the three types of NSAID-induced gastric damage models in rats.
Animals ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Arachidonate 5-Lipoxygenase/drug effects ; Calcitonin Gene-Related Peptide/drug effects ; Cyclooxygenase 1/drug effects ; Cyclooxygenase 2/drug effects ; Disease Models, Animal ; Gastric Mucosa/chemistry/drug effects ; Group IV Phospholipases A2/drug effects ; Male ; Momordica/*chemistry ; Peroxidase/drug effects ; Plant Extracts/*pharmacology ; Rats ; Rats, Sprague-Dawley ; Seeds/*chemistry ; Stomach Ulcer/chemically induced/*prevention & control ; Treatment Outcome

Plasmacytoma is a monoclonal neoplastic proliferation of plasma cells derived from bone marrow. Plasmacytoma of the skull base is very rare. Recently, the authors experienced a case of a 50-year-old woman with a tumor like lesion originating from the right sphenoid bone. The patient presented with a 3-month history of right facial pain and paresthesia. She had been diagnosed and treated with multiple myeloma for more than 5 years, although she was in complete remission until recently. Imaging studies including contrast CT scan and MRI, showed a huge, enhanced and irregular shaped lesion in the sphenoid bone along with skull base destruction and intracranial invasion. The patient underwent transnasal endoscopic biopsy under local anesthesia. The pathology was consistent with a plasma cell tumor and it was confirmed as a solitary plasmacytoma of the bone of the skull base. We report this rare case along with a literature review.
Anesthesia, Local ; Biopsy ; Bone Marrow ; Cheek* ; Facial Pain ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Multiple Myeloma* ; Paresthesia* ; Pathology ; Plasma Cells ; Plasmacytoma* ; Skull Base* ; Sphenoid Bone ; Tomography, X-Ray Computed

A mucocele of the sphenoid sinus is relatively rare, and it has nonspecific clinical features. Hence, it is hard to diagnose it with the history of the illness alone. However, if the sphenoid mucocele is not detected and treated in early stage, its sequalae could be very serious or permanent, such as intracranial complication or blindness. Recently, the authors experienced a case of a sphenoid mucocele with unilateral visual disturbance for a period of one year. The patient underwent endoscopic sinus surgery-marsupialization successfully, but remnant visual disturbance as a sequalae did not fully recover. Thus high index of suspicion, prompt diagnosis using imaging studies, and urgent surgical intervention are crucial for promising of complete recovery from the disease.
Blindness ; Diagnosis ; Humans ; Mucocele* ; Optic Nerve Diseases* ; Sphenoid Sinus*

OBJECTIVES: The goal of this study is to compare the degree of patient discomfort between endoscopic sinus surgery (ESS) and septoplasty under local anesthesia. MATERIAL AND METHODS: A total 95 patients that underwent ESS and septoplasty under local anesthesia between July 2009 and January 2010 were enrolled in this study. The patients estimated the parameters of their own discomfort (pain, position, noise, anxiety, and memory). The score of each of the parameters ranged from 0 to 4. We compared the scores of the parameters between the ESS and septoplasty groups. RESULTS: Of the 95 patients, 61 (64%) received ESS, 32 (34%) received septoplasty, and 2 (2%) received both. The scores of all the parameters were not greater than moderate in both groups. There were no significantly statistical differences between the two groups. However, the ESS group had lower scores than the septoplasty group in the parameters of pain, position, noise, and memory. No remarkable complications occurred. CONCLUSION: The patients in this study had modest discomfort and no noticeable complications during the surgeries under local anesthesia. Although no statistical difference existed between the two groups, the ESS group experienced relatively lower discomfort levels during the surgery under local anesthesia compared to the septoplasty group.
Anesthesia, Local* ; Anxiety ; Humans ; Memory ; Nasal Septum ; Nasal Surgical Procedures ; Noise ; Paranasal Sinuses

OBJECTIVES: Since few studies on surgical training and learning curves have been performed, majority of inexperienced surgeons are anxious about performing operations. We aimed to access the results and learning curve of septoplasty with radiofrequency volume reduction (RFVR) of the inferior turbinate. METHODS: We included 270 patients who underwent septoplasty with RFVR of the inferior turbinate by 6 inexperienced surgeons between January 2009 and July 2011. We analyzed success score, cases of revision, cases of complication, operation time, and acoustic rhinometry. RESULTS: Success score was relatively high and every surgeon had few cases of revision and complication. No significant difference was found in success score, revision, complication case, or acoustic rhinometry values between early cases and later cases. Operation time decreased according to increase in experience. However, there was no significant difference in the operation time after more than 30 cases. CONCLUSION: We can conclude that 30 cases are needed to develop mature surgical skills for septoplasty with RFVR of the inferior turbinate and that training surgeons do not need to be anxious about performing this operation in the unskilled state.
Acoustics ; Humans ; Learning Curve* ; Learning* ; Nasal Septum ; Rhinometry, Acoustic ; Surgical Procedures, Operative ; Turbinates*

BACKGROUND/AIMS: Cochinchina momordica seed extract (SK-MS10) has a gastric protective effect. We aimed to assess the effect of SK-MS10 on gastric acid secretion with morphologic changes in the aged rat. METHODS: Acid secretions were evaluated in the male F344 rats of four different ages (6-, 31-, 74-week, and 2-year). The 31-week-old rats were divided to three groups and continuously administered chow containing vehicle, SK-MS10 and lansoprazole, respectively. At the age of 74 weeks and 2 years, basal and stimulated acid was measured and the expression of mRNA and protein of H(+)-K(+)-ATPase were determined. The area of connective tissue of lamina propria was measured. RESULTS: Basal and stimulated gastric acid significantly decreased and connective tissue of lamina propria increased with age. The expression of mRNA and protein of H(+)-K(+)-ATPase significantly decreased with age. However, 74-week-old rats in the SK-MS10 group had higher stimulated gastric acid secretion than those in the vehicle and lansoprazole groups. In 2-year-old rats of SK-MS10 group, there was no increase of connective tissue. CONCLUSIONS: As SK-MS10 kept the capacity of acid secretion as well as connective tissue area to comparable to young rats, it might valuable to perform further research regarding mechanism of SK-MS10 as an antiaging agent in the stomach.
2-Pyridinylmethylsulfinylbenzimidazoles ; Aged ; Aging ; Animals ; Connective Tissue ; Gastric Acid ; Humans ; Male ; Momordica ; Mucous Membrane ; Preschool Child ; Rats ; Rats, Inbred F344 ; RNA, Messenger ; Seeds ; Stomach