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Cardiovascular beriberi: rare cause of reversible pulmonary hypertension

  • Song, Joon Hyuk;Cheon, Sang Soo;Bae, Myung Hwan;Lee, Jang Hoon;Yang, Dong Heon;Park, Hun Sik;Cho, Yongkeun;Chae, Shung Chull
    • Journal of Yeungnam Medical Science
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    • v.31 no.1
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    • pp.38-42
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    • 2014
  • Cardiovascular beriberi is caused by thiamine deficiency and usually presents as high cardiac output failure associated with predominantly right-sided heart failure and rapid recovery after treatment with thiamine. Because of its rarity in developed countries, the diagnosis can often be delayed and missed. We recently experienced a case of cardiovascular beriberi with pulmonary hypertension which successfully treated with thiamine infusion. A 50-year-old man with chronic heavy alcoholics was refered to our department for dyspnea with mental change. Echocardiography showed marked right ventricular (RV) dilatation and flattening of the interventricular septum with a D-shaped deformation of the left ventricle. Moderate tricuspid valve regurgitation was found and estimated RV systolic pressure was 52 mm Hg. Because of his confused mentality and history of chronic alcohol intake, neurological disorder due to thiamine deficiency was suspected and intravenous thiamine was administered and he continuously received a daily dose of 100 mg of thiamine. Follow up echocardiography showed marked reduction of RV dilatation and improvement of a D-shaped deformation of the left ventricle. He finally diagnosed as cardiovascular beriberi on the basis of dramatic response to intravenous thiamine. Thiamine deficiency can cause reversible pulmonary hypertension, and can still be encountered in the clinical setting. Thus high index of suspicion is critically needed for diagnosis.

A Study 'On the Diagnosis and Treatment of Jaundice According to the Morbid Pulse' in the Chapter 15 of Synopsis of Golden Chamber (금궤요약(金匱要略). 황달병맥증병치제십오(黃疸病脈證幷治第十五)에 대(對)한 연구(硏究))

  • Kim, Myeong-Soo;Ahn, Jun-Mo;Cho, Gyeong-Jong;Jeong, Heon-Young
    • Journal of Korean Medical classics
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    • v.19 no.2 s.33
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    • pp.115-137
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    • 2006
  • The Diagnosis and Treatment of Jaundice According to the Morbid Pulse in the Chapter 15 of Synopsis of Golden Chamber sets forth the classification, symptom, method of treatment, formula, prognosis of jaundice. The contents of this chapter can be induced by(from) yellowing and jaundice These two disease patterns assume various aspects of disease cause, pathomechanism, symptom, prognosis, and treatment. Jaundice was at first classified into liquor jaundice,dietary irregularly jaundice, black jaundicem abd sextual taxation jaundice, later classified into liquor jaundice, dietary irregularly jaundice, black jaundice, sextual tatation jaundice, and yellow sweat. the disease cause and pathomechanism of jaundice are said to be said to be due to the damp-heat, which is attacked with the evil of wind and dampness to affect the spleen-stomach and the liver. and to the inveterate drinking, damage by food, sextual taxation jaundice, sextual taxation, and vacuity taxation. This chapter mainly refers to jaundice as damp-heat, so that it lays down fundamental principles of clear heat and disinhibit dampness. In the prognosis of jaundice, ingibited urination shows symptoms of jaundice, and neither urination nor damp-heat develops symptoms of jaundice. and jaundice with thirst is difficult to cure, and that the symptoms of the abdominal fullness is also difficult to cure, while jaundice without thirst is ease to cure. Of the 18 days of suffering from jaundice, the symptoms of jaundice get better before and after 10 days. I think, however, that getting worse of its symptoms makes more meaningful clinically.

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Analysis of Characteristics in Children and Adolescents with Poisoning at Emergency Department (응급실로 내원한 소아 청소년 중독 환자의 특성 분석)

  • Kim, Do Young;Kim, Ji Hye;Paik, Jin Hui;Han, Seung Baek;Jung, Hyun Min
    • Journal of The Korean Society of Clinical Toxicology
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    • v.15 no.2
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    • pp.140-147
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    • 2017
  • Purpose: This study was conducted to analyze the features of poisoning in individuals aged 0-18 years to understand the characteristics of potential victims and eventually prevent poisoning. Methods: We retrospectively analyzed poisoned children and adolescents (0-18 years) who visited the emergency department of one tertiary hospital from January 2003 through December 2013. We collected data including their age, sex, reason for poisoning, components and dose of poison, results of treatment, and psychiatric diagnosis. Results: During the study period, there were 436 cases of poisoning (male 47.2% (n=206); female 52.8% (n=230)). Subjects were classified into four groups (0-1 years, 2-5 years, 6-12 years, 13-18 years). The most common cause of poisoning in all age groups was accidental poisoning (72.9%), but intentional poisoning increased as age increased (p<0.001). Moreover, females were more often subject to intentional poisoning than males (p<0.001). The most common poisoning material was drugs (41.7%). Among intentional poisoning patients, 62.7% patients had consulted a psychiatrist, and their most common diagnosis was adjustment disorder (44.6%). Conclusion: The most common cause of poisoning in individuals aged 0-18 years was accidental poisoning, while intentional poisoning was most common among adolescents. Guardians should take care to prevent accidental poisoning, while psychiatric consultation and national moderation will be needed to prevent intentional poisoning.

Predictive value of C-reactive protein for the diagnosis of meningitis in febrile infants under 3 months of age in the emergency department

  • Lee, Tae Gyoung;Yu, Seung Taek;So, Cheol Hwan
    • Journal of Yeungnam Medical Science
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    • v.37 no.2
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    • pp.106-111
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    • 2020
  • Background: Fever is a common cause of pediatric consultation in the emergency department. However, identifying the source of infection in many febrile infants is challenging because of insufficient presentation of signs and symptoms. Meningitis is a critical cause of fever in infants, and its diagnosis is confirmed invasively by lumbar puncture. This study aimed to evaluate potential laboratory markers for meningitis in febrile infants. Methods: We retrospectively analyzed infants aged <3 months who visited the emergency department of our hospital between May 2012 and May 2017 because of fever of unknown etiology. Clinical information and laboratory data were evaluated. Receiver operating characteristic (ROC) curves were constructed. Results: In total, 145 febrile infants aged <3 months who underwent lumbar punctures were evaluated retrospectively. The mean C-reactive protein (CRP) level was significantly higher in the meningitis group than in the non-meningitis group, whereas the mean white blood cell count or absolute neutrophil count (ANC) did not significantly differ between groups. The area under the ROC curve (AUC) for CRP was 0.779 (95% confidence interval [CI], 0.701-0.858). The AUC for the leukocyte count was 0.455 (95% CI, 0.360-0.550) and that for ANC was 0.453 (95% CI, 0.359-0.547). The CRP cut-off value of 10 mg/L was optimal for identifying possible meningitis. Conclusion: CRP has an intrinsic predictive value for meningitis in febrile infants aged <3 months. Despite its invasiveness, a lumbar puncture may be recommended to diagnose meningitis in young, febrile infants with a CRP level >10 mg/L.

A Study for the Establishment of the Diagnostic Definition of Sanhupung (U32.7) using the Delphi Method (산후풍의 진단적 정의 확립을 위한 전문가 델파이 조사 연구)

  • Oh, Su-Kyoung;Noh, Eun-Ji;Choi, Su-Ji;Kim, Dong-Il
    • The Journal of Korean Obstetrics and Gynecology
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    • v.34 no.2
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    • pp.16-30
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    • 2021
  • Objectives: The aim of this study was to establish a clear diagnostic definition of Sanhupung using the Delphi method. Methods: This study used the Delphi technique. A panel consisting of 21 experts of Korean medicine, particularly in of gynecologic medicine, participated in the Delphi examination that included answering the 4th round survey. The Delphi examination was carried out through evaluating and correcting the questionnaire by e-mail. Results: Through the Delphi survey, we have reached on an agreement regarding the basic concepts, time, cause, essential symptoms, and accessory symptoms of Sanhupung. They are as follows: 1) Sanhupung is a culture bound syndrome reflecting Korea's cultural specificity. 2) Sanhupung can be diagnosed even after the miscarriage. 3) For the diagnosis of Sanhupung, the main cause of symptoms should not be classified as other disease. 4) Sanhupung can be diagnosed based on essential symptoms and accessory symptoms. 5) Essential symptoms include local symptoms such as joint pain at specific areas, partial sensory impairment and general symptoms including pain of all the joints, whole body sensory impairment, increased sweating, feeling of wind coming into the body, worsened symptoms with the cold, intolerance to cold, and pain of all the muscles. Conclusions: The basic concepts and diagnostic definition of Sanhupung were suggested based on the Delphi survey among experts in the field. Further research is necessary to improve reliability and validity of diagnostic definition of Sanhupung in clinical trials.

Foreign bodies in the digestive system in the diarrheic Hanwoo calves: A retrospective study

  • Dong-Gun, Park;Byung-Hoon, Ko;Won-Jae, Lee
    • Korean Journal of Veterinary Service
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    • v.45 no.4
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    • pp.293-304
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    • 2022
  • Among several diseases of calves, diarrhea is the most prevalent disease and has been a major cause of economic loss to the cattle industry. The main etiologic agents of diarrhea in calves are bacteria, viruses, and protozoa, but non-infectious factors including foreign bodies obstruction in the digestive system also focused as the cause of calf diarrhea in the recent days. Because there is still limited information for foreign body-related diarrhea in calves, especially in Hanwoo, the present retrospective study reviewed the medical records for diarrheic calves with foreign body in the digestive system (n=32). The morbidity was determined as 3.03% and more than half of them presented the acidosis, hyponatremia, and azotemia. The mortality in laparotomy-operated calves to remove foreign bodies or in non-operated ones was 28% or 85.7%, respectively, implied the importance of aggressive decision for laparotomy when the foreign bodies were determined in the digestive system in diarrheic calves. During laparotomy, trichobezoars (hair balls) and hays were the main foreign bodies and prevalently placed in the abomasum. In the trials to predict prognosis by several clinical factors, the time for laparotomy over 2 days after first diagnosis, acidosis, and foreign body in the abomasum were highly associated with mortality. Therefore, we believe that prompt surgical procedure (laparotomy) is necessary upon obstruction in the digestive system by foreign bodies is tentatively diagnosed in the diarrheic calf. In addition, when differential diagnosis list is made, foreign body-related diarrhea is necessary to be included in case of diarrheic calf.

Identifying Small Bowel Gastrointestinal Stromal Tumor as the Culprit Lesion in Obscure Gastrointestinal Bleeding: Emphasis on Angiographic Findings (원인불명의 위장관 출혈을 보인 소장 위장관 기질종양 식별: 혈관조영술 소견의 강조)

  • Hyung In Choi;Min Jeong Choi;Bong Man Kim;Hwan Namgung;Seung Kyu Choi
    • Journal of the Korean Society of Radiology
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    • v.83 no.2
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    • pp.400-405
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    • 2022
  • Gastrointestinal stromal tumors (GISTs) are not uncommon and often cause gastrointestinal bleeding. GISTs occurring in the small intestine are occasionally difficult to identify by endoscopy and CT. In this case, the patient underwent CT three times before surgery, and the lesion was found to be located in a different area of the abdominal cavity on each CT scan. Moreover, the lesion was missed in the first two CT images because it was difficult to distinguish it from the nearby collapsed small intestine. The lesion was eventually detected through angiography; however, the correct diagnosis and treatment were delayed for 3 years because it was mistaken for a vascular malformation, which is the most common cause of obscure GI bleeding in elderly patients. This report emphasizes the need for interventional radiologists to be updated and vigilant of the angiographic features of GISTs to make an accurate diagnosis and establish a management strategy.

Radiologic Approach for Pulmonary Vasculitis (폐혈관염의 영상의학적 접근)

  • Chohee Kim;Yoon Kyung Kim;Joungho Han
    • Journal of the Korean Society of Radiology
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    • v.82 no.4
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    • pp.791-807
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    • 2021
  • Vasculitis is a systemic disease, characterized by inflammation of the vascular wall. Although rare, it is sometimes life-threatening due to diffuse pulmonary hemorrhage or acute glomerulonephritis. Besides primary vasculitis, whose cause is unknown, numerous conditions such as autoimmune diseases, drugs, infections, and tumors can cause secondary vasculitis. Vasculitis displays various non-specific symptoms, signs, and laboratory findings; hence, diagnosis of the disease requires integration of various results including clinical features, imaging findings, autoantibody tests, and pathological findings. In this review, we have discussed the clinical, radiologic, and pathological features of vasculitis. Further, we elaborated the imaging findings and differential diagnosis of typical vasculitis that frequently involves the lung and introduced a new international classification of vasculitis, the Diagnostic and Classification Criteria in Vasculitis.

The suggestion of common cause of disease, characteristics of human body, and medical treatment (질병 발생의 원인과 특성에 대한 제언)

  • Cho, Byung-Jun;Kwon, Ki-Rok
    • Journal of Pharmacopuncture
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    • v.14 no.2
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    • pp.81-91
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    • 2011
  • Objectives & Methods: This suggestion was attempted to be elevated the recognition of common characteristics in disease. So, we performed to analyze the correlation of common cause of disease, characteristics of human body, and medical treatment. And the results are as follows. Results: 1. The cause of disease is consist of genetic factor, aging, habit, food of not good in health, weather, environment, deficit of the physical activity, stress and so on. 2. Generally, human has common and individual weakness. Individual weakness is appeared similar to the occurrence of volcano and lapse. 3. The correlation of disease and medical treatments is possible to explain using the quotation of the law of motion made by Isaac Newton, the great physicist. 4. When the process of the medical treatment was not progressed, the prognosis is determined by the correlation of the homeostasis(H') in human body and the homeostasis(H) of disease. 5. The prognosis of disease is determined by the relationship between the energy of disease(F) and medical treatment(F'). 6. The exact diagnosis is possible to predict the treatment sequence, and the facts that homeostasis in human body and disease, relationship between the energy of disease(F) and medical treatment(F'), action and reaction are important to determine the prognosis. 7. The careful observation of improving response and worsening action of disease becomes available for exact prognosis. Conclusion: The above described contents may be useful in clinical studies, and the concrete clinical reports about this will be made afterward.

Association Between Socioeconomic Status and All-Cause Mortality After Breast Cancer Surgery: Nationwide Retrospective Cohort Study (사회경제적 위치와 유방암 수술 후 총 사망위험과의 관련성)

  • Park, Mi-Jin;Chung, Woo-Jin;Lee, Sun-Mi;Park, Jong-Hyock;Chang, Hoo-Sun
    • Journal of Preventive Medicine and Public Health
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    • v.43 no.4
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    • pp.330-340
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    • 2010
  • Objectives: This study aims to evaluate and explain the socioeconomic inequalities of all-cause mortality after breast cancer surgery in South Korea. Methods: This population based study included all 8868 females who underwent radical mastectomy for breast cancer between January 2002 and June 2003. Follow-up for mortality continued from January 2002 to June 2006. The patients were divided into 4 socioeconomic classes according to their socioeconomic status as defined by the National Health Insurance contribution rate. The relationship between socioeconomic status and all-cause mortality after breast cancer surgery was assessed using the Cox proportional hazards model with adjusting for age, the Charlson’s index score, emergency hospitalization, the type of hospital and the hospital ownership. Results: Those in the lowest socioeconomic status group had a significantly higher hazard ratio of 2.09 (95% CI =1.50 - 2.91) compared with those in the highest socioeconomic group after controlling for all the identifiable confounding variables. For allcause mortality after radical mastectomy, all the other income groups showed significantly higher 3-year mortality rates than did the highest income group. Conclusions: The socioeconomic status of breast cancer patients should be considered as an independent prognostic factor that affects all-cause mortality after radical mastectomy, and this is possibly due to a delayed diagnosis, limited access or minimal treatment leading to higher mortality. This study may provide tangible support to intensify surveillance and treatment for breast cancer among low socioeconomic class women.