Background: There are many patients in society using antihypertensive medication, which has been initiated just after a single office measurement but actually they are normotensive and in contrast, there are many patients not using any antihypertensive medication because of a normal blood pressure (BP) at the doctor's office but they are actually hypertensive. Materials and Methods: We randomly took 438 consecutive patients. Clinical BP was measured by the same physician, and a 10-day twice daily home blood pressure measurement (HBPM) and 24-hour ambulatory blood pressure measurement (ABPM) were obtained. Results: Among 438 patients, 170 (38%) normotension (NT), 190 (43%) white coat hypertension (WCHT), 10 (2%) masked hypertension (MHT), and 68 (15%) sustained hypertension (HT) cases were detected. Although the prevalences of sustained HT and MHT increased by decade, the prevalence of WCHT was much higher in all decades until the eighth decade. Even in the second decade, its prevalence was 33% and higher than 45% in the third, fourth, and fifth decades of life. No statistically significant difference was found for number of WCHT, MHT, and sustained HT cases between ABPM and HBPMs. Conclusion: HBPM should be the preferred method of diagnosis of WCHT, MHT, and sustained HT against conventional BPM at the doctor's office and even ABPM due to its simplicity and equal effectiveness with ABPM. It should be applied to every patient above the age of 40 years once a year due to high prevalences of sustained and masked HT cases. Additionally, due to the very high prevalences of WCHT even in the very early decades, WCHT should be thought of as a normal response of the body against various stresses and its management should be limited to annual follow-up with HBPMs.
A 79-year-old man underwent stent implantation from the proximal site to the left main trunk with one bare metal stent after rotation atherectomy. He received 200 mg/day ticlopidine and 200 mg/day aspirin from 2 days pre-stenting. Subacute thrombosis occurred 5 days after coronary stenting. We performed a test of platelet aggregation one month after the commencement of dual antiplatelet therapy and the test showed no response to ticlopidine in this case. An increased dose of ticlopidine was not effective for suppressing platelet aggregation. We report a case of subacute stent thrombosis which is related to ticlopidine resistance.
A 45 -year-old woman presented chest pain and a well-defined oval shaped mass on a chest radiograph. A malignant pulmonary tumor was suspected and a right pneumonectomy was performed. The tumor measured about 13 × 12 cm, was pale-yellow in color and soft in texture. Histologically, it had round to oval and spindle-shaped cells with minimal cytoplasm, hyperchromatic nuclei, inconspicuous mitoses and only slight fibrous stroma. Immunohistochemically, the tumor cells were positive for vimentin, CD 99, BCL-2 protein and EMA. The reverse transcriptase-polymerase chain reaction (RT-PCR), using RNA extracted from fresh-frozen tissue, demonstrated SYT/SSX-2 fusion transcripts, confirming the diagnosis of synovial sarcoma.
Two patients with rheumatoid arthritis (RA) that developed serious infectious complications following anti-TNFα therapy (infliximab) are reported. Patient 1 developed tuberculosis with high fever, refractory diarrhea and mediastinal lymphadenopathy. Trans-bronchial needle biopsy was useful to confirm the diagnosis. Patient 2 showed sudden onset of dyspnea with diffuse bilateral lung infiltration caused by pneumocystis jiroveci pneumonia and the diagnosis was confirmed by broncho-alveolar lavage. Physicians should be alerted to infectious complications with atypical presentation and rapid progression in infliximab-treated patients. Invasive diagnostic procedures including fiber-optic bronchoscopy may be necessary early in the course for such cases.
Leflunomide is a disease-modifying antirheumatic drug (DMARD) that has been available in Japan since August 2003. Leflunomide-induced interstitial pneumonitis has not been reported as an adverse effect in other countries. We report a suspected case of leflunomide-induced interstitial pneumonitis. A 77-year-old woman with rheumatoid arthritis and a history of methotrexate-induced pneumonitis developed sudden-onset dyspnea on exertion about 2 months after the administration of leflunomide. She maintained a high concentration of an active metabolite of leflunomide for more than 3 weeks after withdrawal of the drug. She did not respond to treatment and died. Leflunomide must be administered with caution to patients with a history of interstitial pneumonitis or drug-induced pneumonitis. If leflunomide-induced pneumonitis is suspected, the plasma concentration must be immediately checked, along with elimination and withdrawal of the medication.