A 78-year-old man was diagnosed with renal cell carcinoma, and left nephrectomy was performed. He started pazopanib. One month later, he visited our hospital because of general weakness and dyspnea. His oxygen saturation was low. A chest X-ray showed pulmonary edema and bilateral pleural effusion. An echocardiogram showed a larger left ventricle and lower ejection fraction than observed at the previous examination. The patient discontinued pazopanib and started diuretics and digoxin. His symptoms improved and a follow-up X-ray showed improvement in the pulmonary edema with bilateral pleural effusion.
Aged ; Carcinoma, Renal Cell* ; Digoxin ; Diuretics ; Dyspnea ; Follow-Up Studies ; Heart Failure* ; Heart Ventricles ; Heart* ; Humans ; Nephrectomy ; Oxygen ; Pleural Effusion ; Pulmonary Edema ; Thorax

BACKGROUNDCentral blood pressure (BP) is pathophysiologically more important than peripheral BP for the pathogenesis of cardiovascular disease. Arterial stiffness is also a good predictor of cardiovascular morbidity and mortality. The effects of benidipine, a unique dual L-/T-type calcium channel blocker, on central BP have not been reported. This study aimed to compare the effect of benidipine and losartan on the central BP and arterial stiffness in mild to moderate essential hypertensives.

METHODSThis 24 weeks, multi-center, open label, randomized, active drug comparative, parallel group study was designed as a non-inferiority study. The eligible patients (n = 200) were randomly assigned to receive benidipine (n = 101) or losartan (n = 99). Radial artery applanation tonometry and pulse wave analysis were used to measure the central BP, pulse wave velocity (PWV) and augmentation index (AIx). We also measured the metabolic and inflammatory markers.

RESULTSAfter 24 weeks, the central BP decreased significantly from baseline by (16.8 ± 14.0/10.5 ± 9.2) mmHg (1 mmHg = 0.133 kPa) (systolic/diastolic BP; P < 0.001) in benidipine group and (18.9 ± 14.7/12.1 ± 10.2) mmHg (P < 0.001) in losartan group respectively. Both benidipine and losartan groups significantly lowered peripheral BP (P < 0.001) and AIx (P < 0.05), but there were no significant differences between the two groups. The mean aortic, brachial and femoral PWV did not change in both groups after 24-week treatment. There were no significant changes of the blood metabolic and inflammatory biomarkers in each group.

CONCLUSIONBenidipine is as effective as losartan in lowering the central and peripheral BP, and improving arterial stiffness.

Adolescent ; Adult ; Aged ; Angiotensin II Type 1 Receptor Blockers ; therapeutic use ; Blood Pressure ; drug effects ; Calcium Channel Blockers ; therapeutic use ; Dihydropyridines ; adverse effects ; therapeutic use ; Essential Hypertension ; Female ; Humans ; Hypertension ; drug therapy ; physiopathology ; Losartan ; adverse effects ; therapeutic use ; Male ; Middle Aged ; Vascular Stiffness ; drug effects

BACKGROUND: Toxocariasis is a common cause of eosinophilia and eosinophilic lung disease in Korea. We analyzed the characteristics of eosinophilic lung disease in toxocariasis. METHOD: One hundred and forty one patients with eosinophilia caused by a toxocara larval infection were evaluated from September 1, 2001 through March 30, 2006. The plain chest x-ray, chest CT(computed tomography), and bronchoalveolar larvage(BAL) were examined. A diagnosis of toxocariasis was made by ELISA using that secretory-excretory antigen from the T. canis larvae. RESULTS: Toxocarial eosinophilic lung diseases was diagnosed in 32 out of 141 patients. Ground glass attenuation was the main feature on the CT scans in 23 out of 141 patients (71.9%). Thirteen patients (40.6%) had a random in zonal distribution on CT. Pleural effusion was observed in 9 patients (28.1%). Twenty eight patients (87.5%) complained of respiratory symptoms. Eleven patients (34.4%) had gastrointestinal symptoms and 12 patients (37.5%) had liver infiltration. CONCLUSIONS: The most common findings of the chest CT in patients with toxocariasis was a randomly distributed ground grass attenuation. A toxocara infection should be considered in a differential diagnosis of patients who exhibit pulmonary infiltration with eosinophilia in Korea.
Diagnosis ; Diagnosis, Differential ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia ; Eosinophils ; Fluconazole ; Glass ; Humans ; Korea ; Larva ; Liver ; Lung Diseases* ; Lung* ; Parasites ; Pleural Effusion ; Pneumonia ; Poaceae ; Thorax ; Tomography, X-Ray Computed ; Toxocara canis* ; Toxocara* ; Toxocariasis

BACKGROUND: Previous studies showed 'treatment gap' phenomenon in the treatment of hyperlipidemia, meaning failure to adhere to the recommendation in the treatment guideline. In Korea, systematic research on this issue has never been done. This investigation was to estimate the hypercholesterolemia treatment gap in coronary artery disease (CAD) patients in tertiary care centers according to NCEP ATP-III guideline. METHODS: Ten Korean educational hospital participated in the survey, reviewing medical record of 1,048 patients. Patients were enrolled when they were documented as having coronary artery disease by coronary angiography or stress tests or medical history of myocardial infarction, percutaneous coronary intervention or bypass surgery. Thirty or more medical records per each of 3 or more cardiologists were reviewed in each hospital. Sampling was done sequentially based on outpatient or inpatient list. Pharmacological treatment for hyperlipidemia included the first and last records of prescription. Baseline and the most recent lipid profiles were collected. RESULTS: Findings from the survey was summarized as '10 to 50% rule': 10%: mean LDL-cholesterol reduction without lipid-lowering drug, 20%: LDL-cholesterol level at the treatment goal before any treatment, 30%: mean LDL-cholesterol reduction with lipid-lowering drug treatment, 40%: proportion of CAD patients without lipid-lowering drug, 50%: treatment goal achievement after treatment. CONCLUSIONS: Significant treatment gap exists in Korean cardiology practice in tertiary care centers. Systematic approach to reduce this gap is warranted.
Cardiology ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Exercise Test ; Guideline Adherence ; Humans ; Hypercholesterolemia* ; Hyperlipidemias ; Inpatients ; Korea ; Medical Records ; Myocardial Infarction ; Outpatients ; Percutaneous Coronary Intervention ; Prescriptions ; Tertiary Care Centers

BACKGROUND AND OBJECTIVES: We sought to characterize the lesion characteristics of mitral valve prolapse (MVP), which is being increasingly recognized as a cause of mitral regurgitation (MR) in Koreans SUBJECTS AND METHODS: 497 Patients with MVP that was diagnosed by echocardiography in 13 university-affiliated hospitals from Jan to Dec 2003 were prospectively enrolled in our study. RESULTS: A total of 497 patients (270 males, 54%) were enrolled and their mean age was 52+/-17 years. Grade 4 MR was present in 272 patients (54.7%); grade 3, 2 and 1 MR as present in 30.2%, 10.7% and 4.2%, respectively. MVP of the anterior and posterior mitral leaflet was present in 170 patients (34.2%) and 223 patients (44.9%), respectively; MVP developed in both leaflets in 104 patients (20.9%). In 37 patients (7.4%), MVP developed in all 6 segments of the mitral leaflet and these patients were younger (37+/-14 versus 54+/-16 years, respectively, p<0.05) and had a lower prevalence of chordae rupture and severe MR compared to the other patients. Among the 266 mitral segments showing prolapse in the 132 patients (26.6%) who underwent transesophageal echocardiography, the posterior medial scallop was the most frequently diseased one (26%), and this was followed by the posterior middle scallop (18%), the medial (17%), lateral (14%) and middle (13%) part of the anterior leaflet, and the posterior lateral scallop (12%). Younger patients with a mean age <45 years showed a lower prevalence of single segment prolapse, hypertension, severe MR and chordae rupture compared to the older patients (p<0.001, each). CONCLUSION: The medial part of both mitral leaflets was the predilection site for the development of MVP in Koreans and the lesion characteristics were different according to the patients' age.
Echocardiography* ; Echocardiography, Transesophageal ; Humans ; Hypertension ; Korea* ; Male ; Mitral Valve Insufficiency ; Mitral Valve Prolapse* ; Mitral Valve* ; Pectinidae ; Prevalence ; Prolapse ; Prospective Studies* ; Rupture

Churg-Strauss syndrome (CSS) is a disorder characterized by systemic small-to-medium vessel vasculitis, extravascular granulomas and hypereosinophilia. Gastrointestinal manifestations can occur in 37~62% of CSS patients but intestinal perforation is very rarely demonstrated. We report a case of 34-year-old man with CSS, who presented with intestinal perforation three months after diagnosed as CSS. Emergency laparotomy was performed and jejunal ulcers with perforation were found. Partial jejunectomy was performed. Pathologic findings of the resected specimen were interpretated as mucosal ulcerations which are considered to be caused by ischemia secondary to the vasculitis and eosinophilic infiltration. Since the operation, the patient has been asymptomatic.
Adult ; Churg-Strauss Syndrome* ; Emergencies ; Eosinophils ; Granuloma ; Humans ; Intestinal Perforation* ; Ischemia ; Laparotomy ; Ulcer ; Vasculitis

BACKGROUND: Baker's asthma is a common occupational respiratory disease and its prevalence rate varies from 15% to 30% of the workers in foreign countries. It has been reported mainly in bakers and millers due to sensitization to wheat, rye, storage mites, and several enzymes etc. But, the main allergen of baker's asthma is wheat. As there is an increase of consumption of food made of wheat due to westernized life style, it is expected that the prevalence of baker's asthma is increasing or already increased. But, there has been no study to investigate the prevalence of baker's asthma in this country. OBJECTIVE: The purpose of this study was to investigate the prevalence of baker's asthma due to wheat sensitization in baking factory workers. METHOD: A total of 147 bakers (age 32.6+/-8.2 years, male 63%) were enrolled in this study. They responded to a modified ISSAC questionnaire and underwent methacholine bronchial challenge test, and skin prick test with common inhalant allergens and work-related allergens including commercial wheat antigen, bread flour, and cake flour antigen prepared in our laboratory. And specific bronchial challenge test with wheat extract was performed to volunteers. RESULTS: The atopic prevalence based on skin prick test was 43% (63/147), and wheat sensitization rate (including commercial wheat, bread flour and cake flour antigen) was 15% (22/147). The risk factors for wheat sensitization were atopy, long duration occupied in baking process, and current or past work history in mixing and/or measuring part where wheat flour exposure was relatively high (p<0.05). Wheat sensitization was highly associated with bronchial hyperresponsiveness, work related symptoms such as asthma, rhinitis, conjunctivitis, and dermatitis (p<0.05) respectively. The prevalence of current asthma based on questionnaire and methacholine bronchial challenge test was 8% (11/147 bakers). Of these, 8 bakers were sensitized to wheat antigen, and all of them except one baker complained of work-related symptoms. These seven bakers were highly suspected of baker's asthma due to wheat sensitization. Two of these seven bakers showed early asthmatic response on specific broncho-provocation test. CONCLUSION: Wheat sensitization rate was 15%, The prevalence of baker's asthma due to wheat sensitization was 5% in baking factory workers and it's risk factors were atopy, long duration occupied in baking process, and current or past work history in mixing and/or measuring part of baking process.
Acaridae ; Allergens ; Asthma* ; Bread ; Bronchial Provocation Tests ; Conjunctivitis ; Dermatitis ; Flour ; Humans ; Life Style ; Male ; Methacholine Chloride ; Prevalence* ; Rhinitis ; Risk Factors ; Secale ; Skin ; Triticum* ; Volunteers ; Surveys and Questionnaires

BACKGROUND: Patients with bronchial asthma are thought to be at higher risk for pulmonary complications during the perioperative period, and these complications may lead to serious morbidity. But the world-wide guideline for the adequate perioperative management of asthmatics has not yet been established. OBJECTIVE: The purpose of this study was to determine the effect of perioperative amino- phylline coadministration in asthmatics pretreated with systemic glucocorticoid before and after surgery. METHODS: Forty-one patients with bronchial asthma admitted for surgical procedures under general anesthesia were included. They were divided into two groups: group I (21 patients, perioperative management with steroid alone) and group II (17 patients, perioperative mana- gement with steroid and aminophylline). Selection of the patients was made from an allocation list based on the patient's admission number to the program. Spirometry was performed before, 24 hr and 48 hr after operation. EKG, pulse oxymetry and/or arterial blood gas analysis, and serum electrolytes were checked before and 24 hr after operation. Chest x-ray was obtained before and 48 hr after operation. RESULTS: FEV1 was decreased after operation, but there was no significant difference between the two groups. Oxygen saturation in pulse oxymetry and/or arterial oxygen were not signifi- cantly decreased during the perioperative period. In group I, two patients had intraoperative bron- chospasm and one patient had postoperative asthmatic attack. In group II, two patients had intraoperative bronchospasm, one patient had multifocal ventricular arrhythmia. Pneumothorax, pneumonia, and other complications were not noted. CONCLUSION: These results suggest that most persons with asthma can safely undergo generalanesthesia with perioperative steroid administration. Presuming adequate preoperative assessment and preparation, additional aminophylline preparations before surgery may not be preferable.
Aminophylline* ; Anesthesia, General ; Arrhythmias, Cardiac ; Asthma ; Blood Gas Analysis ; Bronchial Spasm ; Electrocardiography ; Electrolytes ; Humans ; Oxygen ; Perioperative Period ; Pneumonia ; Pneumothorax ; Spirometry ; Thorax

PURPOSE: This study was performed to find out the prognostic factors affecting local control in early glottic cancer treated with radiation therapy alone. MATERIALS AND METHODS: We analysed 37 patients of histologically confirmed early glottic cancer treated at Chonnam National University Hospital between July 1986 and December 1995, retrospectively. Age of patients ranged from 30 to 73 years (median; 59 years). Thirty-five (95%) patients were male. Histological type was all squamous cell carcinoma. According to the staging system of 1997 American Joint Committee on Cancer, 37 patients were restaged as follows: T1a; 27 (73%), T1b; 3 (8%), T2; 7 (19%). Radiation therapy was done using 6 MV X-ray of linear accelerator. The range of total radiation dose delivered to the glottic lesion was between 5,040 cGy and 7,020 cGy (median; 6,600 cGy). Median follow-up period was 80 months. Local control rates were calculated by Kaplan-Meier method. Generalized Wilcoxon test was used to evaluate the difference of control rates between comparable groups. Multivariate analysis using Cox proportional hazard model was done to find out prognostic factors affecting local control. RESULTS: 5 year survival rate of 37 patients was 89%. Local control rate of 37 patients was 74% in 5 years. We included age, T-stage, anterior commissure involvement, fraction size, total radiation dose, treatment time of radiotherapy as potential prognostic factors in univariate and multivariate analysis. As a result, treatment time had statistical significance in local control rate in both univariate ( p=0.026) and multivariate ( p=0.017) analysis. Complication was not recorded except one patient with hypothyroidism. CONCLUSION: This study revealed that overall treatment time of radiation was a significant factor affecting local control rate.
Carcinoma, Squamous Cell ; Follow-Up Studies ; Humans ; Hypothyroidism ; Jeollanam-do ; Joints ; Male ; Multivariate Analysis ; Particle Accelerators ; Proportional Hazards Models ; Radiotherapy ; Retrospective Studies ; Survival Rate

BACKGROUND AND OBJECTIVE: The cysteinyl leukotrienes are bioactive lipid mediators that contribute to the pathophysiologic condition of asthma and rhinosinusitis. We tested whether the leukotriene receptor antagonist ONO-1078 (Pranukast) had steroid sparing effect on mode- rate to severe asthmatics with chronic rhinosinusitis. METHODS: Eighteen asthmatic patients with chronic rhinosinusitis who required more than 800 mcg/day of budesonide inhalation for the adequate control of asthma symptoms were recruited for this study. For the first 4 weeks, patients were treated with high dose (800-1200 mcg/day) budesonide inhalation. For the next 4 weeks, the dose of budesonide inhalation was decreased by 400 mcg/day and oral ONO-1078 (900mg/day) was administered. FEV1 was evaluated every 2 weeks, and PC20 on methacholine challenge, serum eosinophil cationic protein and blood eosinophil count were measured every 4 weeks. Diary cards were completed with morning and evening PEFR and symptom scores for asthma and rhinosinusitis during the treatment periods. RESULTS: Despite the reduction of the dose of inhaled corticosteroid by 400mcg/day, FEV1 and PEFR did not decrease with the addition of oral ONO-1078. The symptom scores of asthma and rhino-sinusitis did not change, and the need for beta2-agonist did not increase. CONCLUSION: These results suggest that ONO-1078 might have steroid sparing effect in moderate to severe persistent asthmatics with chronic rhinosinusitis who required high dose nhaled budesonide to control asthma symptoms.
Asthma ; Budesonide ; Eosinophil Cationic Protein ; Eosinophils ; Humans ; Inhalation ; Leukotrienes ; Methacholine Chloride ; Peak Expiratory Flow Rate ; Receptors, Leukotriene