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Background/Aims@#We aimed to assess the role of vitamin D supplementation in the response to pegylated interferon-α (PEG-IFN-α) plus ribavirin (RBV) treatment in patients with chronic hepatitis C (CHC). @*Methods@#Our study was a multi-center, randomized controlled trial in 11 hospitals. CHC patients were randomly assigned (1:1) to two groups namely, PEGIFN-α plus RBV (control group) or PEG-IFN-α plus RBV + vitamin D (800 IU daily) (vitamin D group). The primary end-point was the rate of sustained virologic response (SVR). @*Results@#One hundred forty eight CHC patients were randomly assigned to two groups. Seventy-one patients received the PEG-IFN-α plus RBV and 77 patients received the PEG-IFN-α plus RBV + vitamin D. A total of 105 patients completed the study (control group, 47 vs. vitamin D group, 58). Baseline characteristics were mostly similar in both the groups. There was a modest but non-significant increase in SVR in the vitamin D group compared to the control group with the intention to treat analysis (64.0% vs. 49.3 %, p = 0.071) as well as in the per protocol analysis (control group vs. vitamin D group: 74.5% vs. 84.5%, p = 0.202). Fifty-two patients (73.2%) in the control group and 63 patients (81.8%) in the vitamin D group experienced at least one adverse event. The drop-out rate due to adverseeffects was not different between both groups (control group vs. vitamin D group: 19.7% vs. 10.4%, p = 0.111). @*Conclusions@#Vitamin D supplement did not increase SVR in treatment naïve patients with CHC irrespective of genotype.
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Dysphagia aortica is a rare condition defined by difficulty in swallowing and is caused by extrinsic compression of the esophagus due to an ectatic, tortuous, or aneurysmatic atherosclerotic thoracic aorta. It is easy to miss the diagnosis if the clinician does not consider the possibility of dysphagia caused by a thoracic aortic aneurysm. We present the case of an 82-year-old man who developed dysphagia aortica associated with a large thoracic aortic aneurysm. Extrinsic compression of the esophagus caused by an enlarged thoracic aorta was seen on upper gastrointestinal endoscopy, barium esophagogram, and chest computed tomography. With dietary modifications, his symptoms of dysphagia gradually improved.
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Idoso de 80 Anos ou mais , Humanos , Aorta Torácica , Aneurisma da Aorta Torácica , Bário , Deglutição , Transtornos de Deglutição , Diagnóstico , Endoscopia Gastrointestinal , Esôfago , Comportamento Alimentar , TóraxRESUMO
<p><b>Background</b>Until now, various types of combined therapy with nucleotide analogs and pegylated interferon (Peg-INF) in patients with hepatitis B patients have been tried. However, studies regarding the benefits of de novo combination, late-add on, and sequential treatment are very limited. The objective of the current study was to identify the efficacy of sequential treatment of Peg-INF after short-term antiviral treatment.</p><p><b>Methods</b>Between June 2010 and June 2015, hepatitis B e antigen (HBeAg)-positive patients (n = 162) received Peg-IFN for 48 weeks (mono-treatment group, n = 81) and entecavir (ETV) for 12 weeks with a 48-week course of Peg-IFN starting at week 5 of ETV therapy (sequential treatment group, n = 81). The primary endpoint was HBeAg seroconversion at the end of follow-up period after the 24-week treatment. The primary endpoint was analyzed using Chi-square test, Fisher's exact test, and regression analysis.</p><p><b>Results</b>HBeAg seroconversion rate (18.2% vs. 18.2%, t = 0.03, P = 1.000) and seroclearance rate (19.7% vs. 19.7%, t = 0.03, P = 1.000) were same in both mono-treatment and sequential treatment groups. The rate of alanine aminotransferase (ALT) normalization (45.5% vs. 54.5%, t = 1.12, P = 0.296) and serum hepatitis B virus (HBV)-DNA <2000 U/L (28.8% vs. 28.8%, t = 0.10, P = 1.000) was not different in sequential and mono-treatment groups at 24 weeks of Peg-INF. Viral response rate (HBeAg seroconversion and serum HBV-DNA <2000 U/L) was not different in the two groups (12.1% vs. 16.7%, t = 1.83, P = 0.457). Baseline HBV-DNA level (7 logU/ml vs. 7.5 logU/ml, t = 1.70, P = 0.019) and hepatitis B surface antigen titer (3.6 logU/ml vs. 4.0 logU/ml, t = 2.19, P = 0.020) were lower and predictors of responder in mono-treatment and sequential treatment groups, respectively.</p><p><b>Conclusions</b>The current study shows no differences in HBeAg seroconversion rate, ALT normalization, and HBV-DNA levels between mono-therapy and sequential therapy regimens.</p><p><b>Trial Registration</b>ClinicalTrials.gov, NCT01220596; https://clinicaltrials.gov/ct2/show/NCT01220596?term=NCT01220596&rank=1.</p>
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No abstract available.
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Humanos , Masculino , Pessoa de Meia-Idade , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/complicações , Cateterismo Periférico/efeitos adversos , Angiografia Cerebral/efeitos adversos , Eletrocardiografia , Evolução Fatal , Artéria Femoral , Parada Cardíaca/diagnóstico , Infarto do Miocárdio/diagnóstico , Punções , Seio Aórtico/diagnóstico por imagem , Trombose/diagnósticoRESUMO
Coronary artery fistula draining into lung parenchymal vasculature has not been reported. Herein, we describe a case of an 81-year-old woman who presented with a localized pulmonary edema on right upper lobe associated with coronary fistula emptied into vasculature in right upper lobe. She underwent transcatheter closure of the fistula with an Amplatzer Vascular Plug 4, which resulted in complete occlusion and improved localized pulmonary edema.
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Idoso de 80 Anos ou mais , Feminino , Humanos , Vasos Coronários , Fístula , Pulmão , Edema PulmonarRESUMO
BACKGROUND AND OBJECTIVES: Cardiovascular symptoms are integral and often the most predominant clinical presentation in patients with thyrotoxicosis. In patients with known or suspected coronary artery disease, myocardial ischemia and angina-like chest pain may be presented due to increase in cardiac output and cardiac contractility as a result of thyrotoxicosis. In addition, coronary spasm may result in angina-like chest pain in thyrotoxicosis patients without any fixed coronary artery stenosis. However, there are few reports about clinical characteristics of thyrotoxicosis associated with coronary artery spasm. MATERIALS AND METHODS: Coronary angiography, thyroid function test, and follow-up clinical data of patients were analyzed retrospectively. RESULTS: Twelve patients with coronary artery spasm were included over 4.5 years (male:female, 5:7). The mean age of patients was 53.3 years (range, 27 to 68), and female patients were younger than male patients (mean, 56.2 vs. 51.2 years). Only 4 patients (33%) presented typical thyrotoxic symptoms. The causes of thyrotoxicosis were Grave's disease (75%) and painless thyroiditis (25%). On coronary angiography, severe coronary spasm was observed by provocation in 6 patients, and total occlusion of right coronary artery and left circumflex artery with chest pain developed in 2 of 6 patients. After antithyroid treatment, all patients became free of chest pain. CONCLUSION: Severe coronary artery spasm can be associated with thyrotoxicosis. Thyroid function test might be a differential diagnostic test in patients with coronary artery spasm. It should be considered that thyrotoxicosis can be presented by coronary artery spasm without typical symptom of thyrotoxicosis.
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Feminino , Humanos , Masculino , Artérias , Débito Cardíaco , Dor no Peito , Angiografia Coronária , Doença da Artéria Coronariana , Estenose Coronária , Vasoespasmo Coronário , Vasos Coronários , Testes Diagnósticos de Rotina , Seguimentos , Isquemia Miocárdica , Espasmo , Tórax , Testes de Função Tireóidea , Glândula Tireoide , Tireoidite , TireotoxicoseRESUMO
The etiology and pathophysiology of takotsubo cardiomyopathy have not yet been fully clarified. We report a case of takotsubo cardiomyopathy associated with severe hypocalcemia secondary to hypoparathyroidism. A 69-year-old woman presented with acute pulmonary edema caused by severe left ventricular dysfunction with apical ballooning compatible with takotsubo cardiomyopathy. Laboratory tests revealed severe hypocalcemia secondary to idiopathic hypoparathyroidism. Coronary angiography showed normal coronary artery function. Her symptoms and signs of heart failure improved dramatically with the correction of hypocalcemia through calcium and calcitriol replacement.
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Idoso , Feminino , Humanos , Calcitriol , Cálcio , Angiografia Coronária , Vasos Coronários , Insuficiência Cardíaca , Hipocalcemia , Hipoparatireoidismo , Edema Pulmonar , Cardiomiopatia de Takotsubo , Disfunção Ventricular EsquerdaRESUMO
Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi that is characterized by focal or disseminated vasculitis and perivasculitis. Scrub typhus can have fatal complications, such as acute respiratory distress syndrome, septic shock, and acute kidney injury. However, there are few reports of fatal myocarditis caused by scrub typhus. We present a case of acute fatal myocarditis combined with acute kidney injury complicating scrub typhus.
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Injúria Renal Aguda , Miocardite , Orientia tsutsugamushi , Síndrome do Desconforto Respiratório , Tifo por Ácaros , Choque Séptico , VasculiteRESUMO
BACKGROUND/AIMS: When combined with pegylated interferon alpha-2b (Peg-IFN alpha-2b) for the treatment of genotype 1 chronic hepatitis C (CHC) in Korea, the current guideline for the initial ribavirin (RBV) dose is based on body weight. However, since the mean body weight is lower for Korean patients than for patients in Western countries, current guidelines might result in Korean patients being overdosed with RBV. METHODS: We retrospectively reviewed the medical records of patients with genotype 1 CHC who were treated with Peg-IFN alpha-2b and RBV combination therapy. We divided the patients into groups A (> or =15 mg/kg/day, n=23) and B (<15 mg/kg/day, n=26), given that the standard dose is 15 mg/kg/day. The clinical course in terms of the virologic response, adverse events, and dose modification rate was compared between the two groups after therapy completion. RESULTS: The early response rates (92.0% vs. 83.3%, P=0.634) and sustained virologic response rates (82.6% vs. 73.1%, P=0.506) did not differ significantly between the two groups. During the treatment period, the RBV dose reduction rate was significantly higher in group A than in group B (60.9% vs. 23.1%, P=0.01). CONCLUSIONS: RBV dose reduction is performed frequently when patients are treated according to the current Korean guidelines. Given that lowering the RBV dose did not appear to decrease the virologic response during therapy, reducing RBV doses below the current Korean guideline may be effective for treatment, especially in low-weight patients.
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Feminino , Humanos , Masculino , Antivirais/farmacologia , Índice de Massa Corporal , Peso Corporal , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Genótipo , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/farmacologia , Polietilenoglicóis/farmacologia , RNA Viral/análise , Proteínas Recombinantes/farmacologia , Estudos Retrospectivos , Ribavirina/farmacologia , Fatores Sexuais , Resultado do TratamentoRESUMO
Klinefelter's syndrome (KFS) is a gonosomal aberration disease that occurs in males, and is characterized by 47, XXY karyotype, hypogonadism and a lack of secondary sexual characteristics. A potential link between this hormonally deficient syndrome and autoimmune disease, particularly systemic lupus erythematosus (SLE), has been reported. On the other hand, KFS is rarely reported to be accompanied by rheumatoid arthritis (RA), and there are no Korean cases reported. We report the first Korean case of a KFS patient with sero-positive RA and discuss the role of the pathogenesis of RA with KFS.
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Humanos , Masculino , Hidróxido de Alumínio , Artrite Reumatoide , Doenças Autoimunes , Carbonatos , Mãos , Hipogonadismo , Cariótipo , Síndrome de Klinefelter , Lúpus Eritematoso Sistêmico , Cromossomo XRESUMO
Prolongation of QTc interval associated with Takotsubo cardiomyopathy (TC) has previously been reported in published case series. We report an unusual case of a patient who presented with TC associated with long-QT syndrome and developed cardiac arrest secondary to torsade de pointes. Since QT prolongation and bradycardia persisted after the resolution of TC, the patient received permanent pacemaker. Since then additional event did not occur. QT prolongation and bradycardia could be persistent even after recovery of TC, and permanent pacemaker insertion may be a treatment option of long QT syndrome related with TC.
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Idoso , Feminino , Humanos , Bradicardia/diagnóstico , Estimulação Cardíaca Artificial , Angiografia Coronária , Diagnóstico Diferencial , Eletrocardiografia , Parada Cardíaca/diagnóstico , Síndrome do QT Longo/diagnóstico , Cardiomiopatia de Takotsubo/complicações , Torsades de Pointes/diagnósticoRESUMO
Spontaneous retroperitoneal hemorrhage is a distinct clinical entity that can present in the absence of specific underlying pathology or trauma and is typically associated with anticoagulation therapy. We report a case of a 74-year-old female patient with a cerebral infarction related to atrial fibrillation who developed a spontaneous lumbar arterial hemorrhage complicating heparin therapy. The diagnosis was suggested by a computed tomography scan and confirmed by angiography. She was treated successfully with transcatheter embolization.
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Idoso , Feminino , Humanos , Anticoagulantes/efeitos adversos , Embolização Terapêutica , Hemorragia/etiologia , Heparina/efeitos adversos , Vértebras Lombares/irrigação sanguínea , Espaço Retroperitoneal , Terapêutica , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: The importance of central blood pressure evaluation for cardiovascular risk stratification has been emphasized. The aim of this study is to evaluate whether brachial blood pressure obtained by the oscillometric method accurately reflects central blood pressure. METHODS: The subjects consisted of 84 consecutive patients with suspected coronary artery disease who underwent cardiac catheterization. Central blood pressure was invasively measured in the origin of the left subclavian artery by using the fluid-filled system, and at the same time, brachial blood pressure in the left upper arm was measured by the oscillometric method. RESULTS: No significant difference was found between central systolic pressure and brachial systolic pressure (144.49+/-18.84 mmHg vs. 142.44+/-14.96 mmHg, P=0.063). Bland-Altman analysis accounted for only a small bias of +2.25 mmHg, and the limits of agreement were 24.15 mmHg and -19.65 mmHg. Central diastolic pressure was significantly lower than brachial diastolic pressure (75.80+/-8.74 mmHg vs. 86.70+/-10.48 mmHg, P<0.001). Bland-Altman analysis showed a significant bias of -5.45 mmHg, and the limits of agreement were 2.83 mmHg and -13.73 mmHg. CONCLUSION: These results indicate that central systolic pressure can be directly estimated from brachial systolic pressure using the noninvasive oscillometric method and observed biases seem to remain within the practical range. However, use of the brachial diastolic pressure and pulse pressure measured by the noninvasive oscillometric method is doubtful in clinical practice because of their large biases.
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Humanos , Braço , Viés , Pressão Sanguínea , Cateterismo Cardíaco , Cateteres Cardíacos , Doença da Artéria Coronariana , Oscilometria , Artéria SubcláviaRESUMO
Atherosclerotic renal artery stenosis (RAS) usually involves the ostium and the proximal one-third of the renal artery main branch. Percutaneous renal artery angioplasty with stent placement is a well recognized treatment for atherosclerotic RAS. Occasionally, atherosclerotic RAS involves renal artery bifurcations. However, stent implantation in atherosclerotic RAS involving bifurcation is not only troublesome, but also challenging because of side branch occlusion and in-stent restenosis (ISR). In the present report, we describe the use of drug-eluting stents (DES) with provisional T-stenting technique for the treatment of renal artery bifurcation lesion. Follow-up angiogram showed no significant ISR 18 months after the procedure. In the treatment of renal bifurcation lesions, a two-stent strategy using DES could be a viable option in selected patients.
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Idoso , Humanos , Masculino , Angioplastia , Stents Farmacológicos , Artéria Renal/patologia , Obstrução da Artéria Renal/patologia , Resultado do TratamentoRESUMO
A single coronary artery (SCA) is a rare congenital anomaly of the coronary circulation, which is often associated with myocardial ischemia and other congenital cardiac anomalies. A 77-year-old woman visited our hospital complaining of typical chest pain. Coronary angiography revealed an isolated SCA. The right coronary artery did not originate from the aorta, but instead emerged from the distal left circumflex artery, with significant stenosis at the proximal portion of the left anterior descending artery. A stent was successfully implanted at the culprit lesion. There was no perfusion defect detected by a cardiac SPECT study.
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Idoso , Feminino , Humanos , Angina Pectoris , Aorta , Artérias , Dor no Peito , Constrição Patológica , Angiografia Coronária , Circulação Coronária , Anomalias dos Vasos Coronários , Vasos Coronários , Isquemia Miocárdica , Perfusão , Stents , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
Post-cardiac injury syndrome (PCIS) includes post-myocardial infarction syndrome and post-pericardiotomy syndrome. PCIS is usually observed 1~6 weeks after cardiac surgery or myocardial infarction, and rarely after pacemaker implantation, coronary perforation, pulmonary thromboembolism, or radio-frequency ablation. PCIS is characterized by a low-grade fever, pleuritic chest pain, myalgia, a pericardial friction rub, increased inflammatory markers, and pericardial and pleural effusions. Although the pathophysiology of PCIS is controversial, the presence of anti-heart antibodies has implicated an autoimmune response, which has been widely accepted. The treatment of PCIS includes nonsteroidal anti-inflammatory drugs and corticosteroids. Currently, intervention is being performed increasingly in complicated obstructive coronary artery disease, such as chronic total occlusion, long-segment obstructive lesion, and left main coronary artery disease. We report a very rare case of PCIS following coronary artery perforation during PCI.
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Corticosteroides , Anticorpos , Autoimunidade , Dor no Peito , Doença da Artéria Coronariana , Vasos Coronários , Febre , Fricção , Infarto , Infarto do Miocárdio , Derrame Pleural , Embolia Pulmonar , Cirurgia TorácicaRESUMO
A 63-year-old woman was diagnosed with ovarian cancer and peritoneal carcinomatosis. The day after paclitaxel was administered, an acute myocardial infarction occurred. Emergency coronary angiography revealed a filling defect in the left main coronary artery and total occlusion in the distal left anterior descending coronary artery, with no luminal irregularity or narrowing. Intravascular ultrasonography showed no significant plaque in the left main coronary artery. A thrombophilia work-up was negative, and the patient was treated with tirofiban, clopidogrel, and aspirin. The follow-up coronary angiogram showed that the occlusion of the distal obtuse marginal branch and distal left anterior descending artery had cleared. Paclitaxel has been associated with acute myocardial infarction. However, the pathogenesis of myocardial infarction associated with paclitaxel is not known. This case raises the possibility that paclitaxel can induce coronary artery thrombosis, resulting in myocardial infarction.
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Feminino , Humanos , Pessoa de Meia-Idade , Artérias , Aspirina , Carcinoma , Angiografia Coronária , Trombose Coronária , Vasos Coronários , Emergências , Seguimentos , Infarto do Miocárdio , Neoplasias Ovarianas , Paclitaxel , Fenobarbital , Trombofilia , Trombose , Ticlopidina , Tirosina , Ultrassonografia de IntervençãoRESUMO
BACKGROUND AND OBJECTIVES: Left ventricular hypertrophy (LVH) is a major cardiovascular complication and an important predictor of mortality in patients with end stage renal disease. Some studies have shown that the serum aldosterone levels are correlated with LVH in non-diabetic patients undergoing hemodialysis. The objective of this study was to elucidate the relationships between serum biomarkers, including aldosterone, and echocardiographic findings, such as LVH, in patients on peritoneal dialysis. SUBJECTS AND METHODS: Thirty patients on continuous ambulatory peritoneal dialysis (CAPD) for >12 months at Soonchunhyang University Cheonan Hospital were included. Transthoracic echocardiography was performed and the left ventricular mass index (LVMI) was calculated using the Devereux formula. Serum biomarkers {N-terminal pro B-type natriuretic peptide (NT-proBNP), troponin T, C-reactive protein, renin, and aldosterone} were measured. RESULTS: Sixteen of 30 patients had LVH on the basis of the LVMI. The mean serum aldosterone level was 62.53+/-60.73 pg/mL (range, 5.03-250.68 pg/mL). LVH, on the basis of the LVMI, was not correlated with the serum aldosterone level. The serum aldosterone levels were not associated with echocardiographic findings, even with co-existing diabetes mellitus. The LVMI had a negative correlation with the hemoglobin (r=-0.405, p=0.029) and hematocrit (r=-0.374, p=0.042), and a positive correlation with NT-proBNP (r=0.560, p=0.002). The other biomarkers (renin, aldosterone, troponin T, and C-reactive protein) were not correlated with the LVMI. The LVMI was correlated with the left atrium volume index (r=0.675, p<0.001). CONCLUSION: NT-proBNP is a good marker to predict LVH in patients undergoing CAPD. The serum aldosterone level is not correlated with LVMI, even with co-existing diabetes mellitus.
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Humanos , Aldosterona , Biomarcadores , Proteína C-Reativa , Diabetes Mellitus , Ecocardiografia , Átrios do Coração , Hematócrito , Hemoglobinas , Hipertrofia Ventricular Esquerda , Falência Renal Crônica , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Diálise Peritoneal , Diálise Peritoneal Ambulatorial Contínua , Diálise Renal , Renina , Troponina TRESUMO
Concurrent cerebral and coronary artery embolization is a theoretically possible, but extremely rare complication of an atrial myxoma. We present a paitent with a left atrial mass (a probable myxoma) who presented with concurrent cerebral and myocardial infarctions due to emboli of tumor origin. An 84-year-old woman presented with an acute cerebral infarction of the middle cerebral artery territory. Several hours after admission, she complained of chest pain consistent with a myocardial infarction. Transthoracic and transesophageal echocardiographic studies revealed the presence of a large, mobile, heteroechoic mass with a few daughter nodules in the left atrium, compatible with a myxoma. Coronary angiography disclosed subtotal occlusion of the ramus intermedius branch and visible tumor vascularization adjacent to the right coronary artery. With medical treatment, including anticoagulation, the patient was stabilized and had an uneventful clinical course for the ensuing 6 months since discharge.
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Idoso de 80 Anos ou mais , Feminino , Humanos , Infarto Cerebral , Dor no Peito , Angiografia Coronária , Vasos Coronários , Átrios do Coração , Artéria Cerebral Média , Infarto do Miocárdio , Mixoma , Núcleo FamiliarRESUMO
Hypereosinophilic syndrome is a clinical disorder characterized by peripheral eosinophilia and eosinophilic infiltration of multiple organ systems, including the cardiovascular system. The manifestations are variable, but cardiac involvement is the major source of morbidity and mortality, and several case reports have highlighted the various types of cardiac involvement. However, no reported case has simultaneously presented with pericardial effusion, myocarditis, and ascites. We report a case of a 28-year-old woman with hypereosinophilic syndrome involving both the heart and intra-abdominopelvic cavity.