Ruptured Aneurysm of Descending Thoracic Aorta due to Salmonella Arteritis: 1 case report / 대한흉부외과학회지

A very rare case of mycotic aneurysm in the descending thoracic aorta due to salmonellosis was treated in our hospital. The patient was a 62 year-old male who 48 days before the operation was admitted to the department of internal medicine complaining of fever, nausia, vomiting, and loose stool. He was treated for 35 days and discharged. Three days after discharge, however, the patient was readmitted to the hospital complaining of right upper quadrant abdominal pain. Fever developed on the third hospital day, and on the eighth hospital day, the patient complained of back pain and epigastric pain. A simple chest x-ray showed evidence of hemothorax in the left plueral space, and therefore, computed tomography of the chest was done. The patient was diagnosed as a ruptured mycotic aneurysm of the descending thoracic aorta, and was transferred to our Department of Thoracic and Cardiovascular Surgery. The aneurysm and infected tissues was widely debrided, and the site was then patched with a Dacron graft. Salmonella choleraesuis was identified in the blood and aneurysm cultures, and antibiotics were administered for 6 weeks according to the sensitivity of the organism. The patient experienced no complication thereafter and for the last three months since the operation, he has been leading a healthy and normal social life.

Ischemic Preconditioning in Isolated Rabbit Heart : Effect on Left Ventricular Function, Infarct Size, and Protein Kinase C*

BACKGROUND: It has been demonstrated that ischemic preconditioning(IP, repetitive brief period of ischemia and reperfusion) enhances recovery of post-ischemic contractile dysfunction and reduces incidences of reperfusion-arrhythmia and infarct size after a prolonged ischemia. A lot of mechanisms have been proposed, however, controversies still remain. Recent studies suggested that IP could activate protein kinase C(PKC). Therefore, we measured left ventricular function, myocardial creatinin and PKC activities, and infarct size to assess whether IPs cardioprotective effect is related to PKC activation using isolated rabbit hearts. METHODS AND RESULTS: Hearts isolated from New Zealand White rabbits(1.5-2.0kg body weight) were perfused with Tyrode solution by Langendorff technique. After stabilization of baseline hemodynamics, the hearts were subjected to 60-min ischemia followed by 120-min reperfusion with IP(IP group, n=15) or without IP(control group, n=14), IP was induced by 4 cycles of 5-min global ischemia and 5-min reperfusion. Left ventricular function including developed pressure(LVEDP), dp/dt, heart rate(HR), and coronary flow(CF) was measured to determine the recovery of LVEDP, RPP(rate-pressure product, HRXLVEDP) and CF to baseline measurement. Frequency of arrhythmia was counted on reperfusion. Myocardial CK-MB, myocardial cytosolic and membrance PKC were measured and the infarct size was determined by staining with tetrazolium salt and planimetry. Data were analyzed by one-way ANOVA, Tukey's post-hoc test and t-test. There was no significant differences in the recovery of LVEDP, dp/dt, RPP, and CF and frequency of arrhythmia during reperfusion between the control and the IP groups. In comparison with the control groups, however, CK-MB was significantly lowered in the IP group(P < 0.05). Cytosolic PKC was significantly decreased but membrance PKC was increased(p < 0.05). These findings indicate that PKC was translocated and activated by IP. Furthermore infarct size was smaller and limited to the antero-lateral or posterior wall and papillary muscle in the IP group(p < 0.05). CONCLUSION: These results indicate that IP dose not improve post-ischemic contractile dysfunction after a prolonged ischemia of 60 minutes but has an infarct-limiting effect. This cardioprotective effect of IP may be related to PKC activation.

The Association of the Lipoprotein(a) Levels with Age and Sex

BACKGROUND: Lipoprotein(a)[Lp(a)], an independent risk factor for athrosclerosis, consist of low density lipoprotein like particle and specific glycoprotein, apolipoprotein(a). The levels of Lp(a) are mainly determined by the genetic pleomorphism of apolipoprotein(a) and has been though not to be influenced by age, sex and other biochemical parameters. Recent reports have shown that the concentrations of Lp(a) are correlated with age in women. The purpose of this study was to invastigate the association of Lp(a) concentration with sex and age. METHODS: The concentrations of Lp(a) were measured in 3,707 women and 389 men, free of diseases and medications known to affect the lipid levels. Plasma Lp(a) concentration were measured by commercial radioimmunoassay kit and other lipid profiles by conventional method. RESULTS: In female, median Lp(a) concentration increased with age till the early sixth decade (P=.0000) and then decreased. If peri- and postmenopausal women were excluded in the fifth decades, the relation between age and Lp(a) disappeared. In male, Lp(a) concentration were not associated with age. Median Lp(a) concentrations were higher in females than in males in the fifth(p=.0039) and the sixth decades(p=.0007), The difference became negligible after the exclusion of peri- and postmenopausal woman in the fifth decade. CONCLUSION: The concentrations of Lp(a) were corrected with age only in female. Females had higher levels than males in the fifth and the sixth decades. The relations are thought to be nither due to aging process nor sex but due to postmenopausal increase of Lp(a).

The Association of the Lipoprotein(a) Levels with Age and Sex

BACKGROUND: Lipoprotein(a)[Lp(a)], an independent risk factor for athrosclerosis, consist of low density lipoprotein like particle and specific glycoprotein, apolipoprotein(a). The levels of Lp(a) are mainly determined by the genetic pleomorphism of apolipoprotein(a) and has been though not to be influenced by age, sex and other biochemical parameters. Recent reports have shown that the concentrations of Lp(a) are correlated with age in women. The purpose of this study was to invastigate the association of Lp(a) concentration with sex and age. METHODS: The concentrations of Lp(a) were measured in 3,707 women and 389 men, free of diseases and medications known to affect the lipid levels. Plasma Lp(a) concentration were measured by commercial radioimmunoassay kit and other lipid profiles by conventional method. RESULTS: In female, median Lp(a) concentration increased with age till the early sixth decade (P=.0000) and then decreased. If peri- and postmenopausal women were excluded in the fifth decades, the relation between age and Lp(a) disappeared. In male, Lp(a) concentration were not associated with age. Median Lp(a) concentrations were higher in females than in males in the fifth(p=.0039) and the sixth decades(p=.0007), The difference became negligible after the exclusion of peri- and postmenopausal woman in the fifth decade. CONCLUSION: The concentrations of Lp(a) were corrected with age only in female. Females had higher levels than males in the fifth and the sixth decades. The relations are thought to be nither due to aging process nor sex but due to postmenopausal increase of Lp(a).

Heart Rate Adjustment of ST Segment Depression as a Myocardial Ischemia Index of Coronary Artery Disease

BACKGROUND: Exercise testing is an importnat diagnostic and prognostic procedure in the assessment of patients with ischemic heart disease. But standard ST-segment depression criteria was not high enough to estimate coronary srtery disease. Recently, the heart rate adjustment of ST segment depression, ST segment/heart rate slope and index, have been proposed as a more accurate criteria for diagnosing significant coronary artery disease. The objective of this study was to compare the discriminating power of proposed ST segment/heart rate slope and index with that of a standard method of assessing exercise-induced ST segment depression for estimating coronary artery disease. METHODS: Sixty nine patients with ischemic heart disease were studied with exercise treadmill testing and coronary angiography. Computer-measured ST-segment amplitudes were obtained and analysis of the heart rate-adjusted ST segment depression(ST/HR slope and big up tri, Delta ST/HR index) was done. The sensitivity, specificity, and extent of coronary artery disease on each criteria were compared. RESULTS: 1) The sensitivity of big up tri, Delta ST/HR index partition of 1.6uV/beats/min was slightly higher(83%) and the specificity of ST/HR slope partition of 2.4uV/beats/min was higher(87%) than the standard exercise electrocardiographic criteria. 2) Early onset of ischemic ST-segment depression, profound ST-segment depression(> or =2mm), and downsloping ST-segment were associated with more extensive coronary artery disease. 3) On ST/HR slope, no CAD was 1.7+/-0.26uV/beats/min, one vessel disease was 2.6+/-0.34 uV/beats/min, two vessel disease was 2.7+/-1.36uV/beats/min, one vessel disease was 2.8+/-0.35uV/beats/min, and on big up tri, Delta ST/HR index, no CAD was 1.8+/-0.38uV/beats/min, one vessel disease was 2.8+/-1.36uV/beats/min, two vessel disease 3.4+/-1.44uV/beats/min, and three vessel disease was 3.7+/-2.95uV/beats/min. The increment of ST/HR slope and big up tri, Delta ST/HR index were associated with the coronary artery disease and its severity, but the correlations were not high enough. CONCLUSION: The heart rate adjustment of ST segment depression was not high enough for improved detection of coronary artery disease, compared with standard ST-segment depression criteria. But these indexes can be improved the clinical usefulness of the treadmill exercise test for coronary aretry disease.