Ischemic Burden Assessment Using Single Photon Emission Computed Tomography in Single Vessel Chronic Total Occlusion of Coronary Artery

Background and Objectives@#Studies evaluating the nature of ischemic burden of chronic total occlusion (CTO) vessels are still lacking. @*Methods@#A total of 165 patients with single vessel CTO >2.5 mm in an epicardial coronary artery who underwent single photon emission computed tomography (SPECT) were enrolled in the study. Ischemic burden was calculated with the use of semi-quantitative SPECT analysis, and was defined as the summed difference score (SDS) divided by the maximal limit of the score (=SDS/68). @*Results@#The mean age of the participants was 59.5 years and the CTO of the left anterior descending coronary artery (LAD), left circumplex coronary artery (LCX), and right coronary artery (RCA) accounted for 93 (56.4%), 18 (10.9%), and 54 (32.7%) patients, respectively. The median ischemic burden of the total population was 8.8%, and it was highest in the LAD CTO (10.3%) compared with the LCX (5.9%) and RCA CTO (5.9%, p10%) was observed in 66 patients (40.0%), and in 47 patients (50.5%) of the LAD CTO. Ischemic burden was different according to the CTO location only in LAD CTO. The statistically significant predictors for high-ischemic burden were hypertension, baseline ejection fraction >45%, LAD CTO, proximal CTO location, and de novo CTO. Japanese-CTO score and Rentrop scale collateral grade were not associated with high-ischemic burden. @*Conclusions@#Only 40% of patients with single vessel CTO had ischemic burden >10%. For CTO vessels, measurement of ischemic burden using SPECT prior to revascularization may be helpful in identifying beneficial subjects.

A Case Report of Transfusion-Related Acute Lung Injury Induced in the Patient with HLA Antibody after Fresh Frozen Plasma Transfusion / 대한수혈학회지

Development of transfusion-related acute lung injury (TRALI), a non-cardiogenic pulmonary edema, after blood transfusion, is a rare but potentially leading cause of mortality from blood transfusion. We report on a case of TRALI in a 51-year male with acute calculous cholecystitis and liver cirrhosis. As preoperative treatment, he was given ten units of fresh frozen plasma (FFP) for 3 days before the operation. During the transfusion of the 10th unit of FFP, he experienced a sudden onset of hemoptysis, tachypnea, tachycardia, and cyanosis. Bilateral pulmonary infiltration not observed on the chest X-ray at the visit was newly developed. There was no evidence of volume overload but severe hypoxemia. Blood transfusion was stopped and he recovered fully after 8 days of oxygen therapy through a nasal cannula. Although HLA and HNA antibodies were not detected in the donor's blood, HLA antibodies (A2, B57, B58) were detected in the patient's blood. We reported this meaningful case of TRALI that occurred after transfusion of only fresh frozen plasma which did not contain human leukocyte antibody in a patient with HLA antibody.

A Case of Stress-Induced Cardiomyopathy after Propofol Anesthesia / 대한내과학회지

Propofol is an intravenous hypnotic agent that is generally used for sedation in the intensive care unit and for induction of anesthesia during minimally invasive surgery, endoscopy, and plastic surgery in local clinics. Low blood pressure and transient apnea might occur under propofol sedation, whereas stress-induced cardiomyopathy is a very rare complication. We herein describe a case involving a 25-year-old woman without cardiovascular risk factors who developed stress-induced cardiomyopathy after propofol injection for anesthesia and was treated with conservative treatment. This case reminds us that clinicians should consider the possible occurrence of stress-induced cardiomyopathy after anesthesia using propofol, even in patients without cardiovascular risk factors.

Clinical Correlation between Serum Cytokeratin-18 and Metabolic Parameters in Patients with Sonographic Non-alcoholic Fatty Liver Disease / 대한소화기학회지

BACKGROUND/AIMS: The serum cytokeratin-18 (CK-18) has been suggested to be a surrogate marker of non-alcoholic fatty liver disease (NAFLD). The aim of this study was to investigate the correlation between CK-18 and metabolic parameter in NAFLD patients. Correlation between CK-18 and macronutrient composition was also assessed. METHODS: A total of 212 subjects were recruited. Blood chemistry including fasting glucose, cholesterol level, AST, ALT, and CK-18 were compared. Data on calorie intake and carbohydrate consumption were acquired by five-day-diet diary using 24 hour recall method. RESULTS: Plasma CK-18 were markedly increased in patient with NAFLD compared with control group (420.4+/-282.3 vs. 313.6+/-179, p<0.001). Plasma CK-18 were positively correlated with systolic blood pressure (r=0.130), ALT (r=0.503) and negatively correlated with HDL cholesterol (r=-0.246). NAFLD patients with metabolic syndrome had higher CK-18 level than those without metabolic syndrome (484.0 vs. 372.1 U/L, p=0.021). When NAFLD patients were subdivided into two groups with CK-18 cut-off value of 400 U/L, patients with CK-18 level over 400 U/L showed higher body mass index (28.0+/-4.5 vs. 25.5+/-4.3), subcutaneous abdominal fat (283.5+/-172.2 vs. 195.7+/-147.8), AST (52.7+/-26.3 vs. 40.7+/-23.5) and ALT (102.0+/-52.6 vs. 61.2+/-32.2). Calorie intake (r=0.301) and carbohydrate intake (r=0.305) also showed positive correlation with CK-18. CONCLUSIONS: Plasma CK-18 showed positive correlation with metabolic parameters as well as calorie and carbohydrate intake when its cut-off value of greater than 400 U/L was used.

A Clinical Study of Gallbladder Polyps

PURPOSE: Gallbladder cancer had poor prognosis because it is usually detected at a late stage. Some GB polyps are diagnosed as cancerous on the postoperative pathology. Because of the significance of the early detection of the cancer, the relationship between GB polyp and cancer is important. METHODS: From January 1994 to May, 2004, 94 cases of GB polypoid lesions were identified and diagnosed after cholecystectomy was performed at the Korea University Medical Center Anam hospital. The pateints' age, gender, the symptoms and signs, the diagnostic tools, the operative methods and the histopathologic findings were investigated. RESULTS: For the 94 patients, the mean age was 50.3+/-13.1 years and there were 42 males (44.7%). 92 patients were evaluated by abdominal ultrasonography, and it had a sensitivity of 72.8%. On the histopathologic results, there were 76 cases of benign polyps and 18 cases of malignant polyps. The diameter of the malignant polyps was 17.3+/-8.5 mm and the diameter of the benign polyps was 6.4+/-3.0 mm, so the malignant polyps were larger than the benign polyps. The mean age of the malignant polyp group was 62.6+/-14.2 years and the mean age of the benign polyp group was 47.1+/-11.1. The patients of the malignant polyp group were older than the patients of the benign polyp group. 19 GB polyps were greater than 10 mm in diameter and among them, there were 15 cases of malignant polyps (78.94%). CONCLUSION: The size of the polyps and the patient's age could be risk factors for malignant polyps, and the malignant potential was high for the polyps that exceeded 10 mm and for a patient age that exceeded 60 years. Surgical treatment is recommended for these patients.

MMF-related Colitis Carrying GVHD-like Pathologic Feature in Renal Transplant Recipient / 대한이식학회지

BACKGROUND: Graft-Versus-Host Disease (GVHD) is known to be associated with bone marrow transplantion. It is very rare in solid organ transplantation, especially in renal transplantation. There were only a few reported cases of GVHD in pancreas, liver transplant recipients or transfusion associated GVHD in immunocompromised patients. CASE: A 36 years-old man received renal transplantation from his mother on May 20th, 1996. Cyclosporine A, azathioprine & prednisolone were used as immunosuppressants. There was no episode of acute rejection after transplantation. After transplantation, he suffered from cytomegalovirus (CMV) cystitis, bile duct stones. He had never been transfused blood products since transplantation. Thereafter, his post-transplantation course was quite favorable until December 20th, 2003, when troublesome diarrhea and weight loss developed. At that time, he was taking 1.25 g/day of MMF (25 mg/kg/day). Hospital course: The MMF dose was reduced to 500mg bid (312 mg/m2/dose or 20 mg/kg/day) under the suspicion of CMV colitis. The results of serologic test and culture for CMV were all negative. The colonoscopic biopsy revealed pathologic features such as crypt drop-out, crypt abscess, crypt atrophy, single cell apoptosis and goblet cell depletion just like in GVHD. He had no necrotic skin lesion and his liver function test was in normal range. However, his complete blood count showed pancytopenic features. The MMF was discontinued immediately after the pathologic results were reported. His diarrhea and other clinical sym-ptoms were disappeared, and the pancytopenic features recovered gradually after discontinuation of MMF. He also gained 2.6 kg weight and discharged with good graft function.