Clinical Characteristics of Nosocomial Infective Endocarditis in a Tertiary Referral Hospital

BACKGROUND AND OBJECTIVES: Despite case reports of nosocomial infective endocarditis (NIE), the clinical characteristics of the hospital acquired infective endocarditis have not been investigated in Korea. SUBJECTS AND METHODS: The clinical records of patients with infective endocarditis, treated at Asan Medical Center between January 1989 and December 2003, were retrospectively analyzed. RESULTS: Of the 309 case of native-valve endocarditis, 17 (5.5%) cases were found to be NIE. The mean age of these 17 patients was 51+/-17 years, which included 9 women and 8 men. Staphylococcus aureus was the most frequent causative organism of NIE in 11 cases (65%), of which nine (82%) had methicillin-resistant strains. The prevalence of right-sided vegetation in NIE was higher than that of community acquired infective endocarditis (CIE)(29 vs. 10%, p<0.05); however, left-sided vegetation was observed in more than 70% of patients with NIE (12/17). Surgeries, with or without wound infection (59%) and insertion of a central venous catheter (29%), were the two most common possible sources of NIE. In hospital mortality was significantly higher in patients with NIE than in those with CIE (47 vs. 11%, p<0.001). CONCLUSION: Patients with NIE, which comprises a minor portion of those with infective endocarditis, show unique clinical characteristics in terms of causative organisms, risk factors, sites of vegetation and in-hospital mortality.

A case of stent-graft insertion for treatment of localized aortic dissection developed during medical treatment of aortic intramural hematoma / 대한내과학회지

Aortic intramural hematoma, a variant form of classic aortic dissection, has been accepted as an increasingly recognized and potentially fatal entity of acute aortic syndrome. Although favorable clinical course and resorption of hematoma has been reported with medical treatment, it can progress to development of typical aortic dissection in a localized aortic segment. The standard treatment option for this lesion has not been established. We report a case of a 50 year-old male who developed localized aortic dissection during medical treatment for distal aortic intramural hematoma and was successfully treated with a stent-graft.

A Case of Juxtaglomerular Cell Tumor / 대한신장학회잡지

The juxtaglomerular cell tumor is a rare benign tumor which causes surgically correctable hypertension. We report a case of hypertension caused by juxtaglomerular cell tumor in a 17-year old man. He presented with hypokalemia, metabolic alkalosis and hyperreninemic hyperaldosteronism. Renal angiography showed no evidence of renal artery stenosis. Though no mass was suspected in renal angiography, CT scan showed a well demarcated mass, 3 cm in diameter, in the upper portion of left kidney, which was resected and diagnosed to be a juxtaglomerular cell tumor. After resection of the tumor, blood pressure was normalized with resolution of hypokalemia, metabolic alkalosis and hyperreninemic hyperaldosteronism.

Chronobiological Patterns of Acute Aortic Syndrome : Comparison with Those of Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: Chronobiological rhythms have been shown to influence the occurrence of a variety of cardiovascular disorders, including acute myocardial infarction (AMI). The present study investigated whether the onset of acute aortic syndrome (AAS) has unique chronobiological rhythms in Korean populations. SUBJECTS AND METHODS: The clinical data of 371 consecutive AAS patients, admitted between 1993 and 2003, were retrospectively analyzed; 310 AMI patients, who underwent primary percutaneous angioplasty in the hyperacute phase between 1998 and 2001, were also selected. RESULTS: In the AAS group, the final diagnoses were aortic dissection (AD) and aortic intramural hematoma (AIH) in 212 and 159 patients, respectively Similar to AMI, AAS showed a significantly higher occurrence from 6 AM to noon compared with other time periods (p=0.0013). AAS showed a second peak occurrence from 6 PM to midnight, which was not observed in the AMI group. A subgroup analysis revealed that younger patients (age < 60 years) and those with a past medical history of hypertension had the highest occurrence from 6 PM to midnight, which was quite different compared to the AAS patients. No significant variation was found for the day of the week in either group. Although no significant seasonal variation was observed in the frequency of AMI, the frequency of AAS was significantly higher during winter (p<0.001). The circadian and seasonal variations in the frequency of AIH were similar to those of AD. CONCLUSION: AAS shows unique circadian and seasonal variations in Korean populations. Our findings may have implications for the prevention of AAS by tailoring treatment strategies to ensure maximal benefits during the vulnerable periods.

Acute pericarditis caused by penetrated polymethylmethacrylate of the right ventricle after percutaneous vertebroplasty / 대한내과학회지

Percutaneous vertebroplasty (PVP) has been known as minimally invasive procedure to treat aggressive vertebral hemangioma, painful osteolytic vertebral tumors, and osteoporotic compression fractures. Some cases were reported to be associated with infrequent but serious complications of this procedure, such as severe arterial hypotension, pulmonary embolism, cerebral embolism, paraplegia, and bronchospasm. We report a case of acute pericarditis after PVP, which was treated successfully with open heart surgery.

A Case of Idiopathic Chylothorax and Chyluria / 결핵및호흡기질환

We report a rare case of idiopathic chylothorax and chyluria. A 31 year-old woman was referred to our hospital with a right-sided pleural effusion. Cream-colored pleural fluid and urine were confirmed as chylothorax and chyluria, respectively, by a lipoprotein electrophoresis. Even though she had previously underwent surgery for pelvic fibrosarcoma and experienced its recurrence, there has been no change of mass size and no evidence of thoracic duct or urinary tract obstruction as of the moment. Hence, idiopathic chylothorax and chyluira was diagnosed. Because she responded poorly to conservative treatment, thoracic duct ligation and pleurodesis were performend ; wherease chyluria was resolved spontaneously.

Early and late clinical outcomes after primary stenting of the unprotected left main coronary artery stenosis in the setting of acute myocardial infarction / 대한내과학회지

BACKGROUND: Acute left main coronary artery occlusion is a dramatic condition with very high mortality. The study was aimed to evaluate the effect of primary stenting in patients with left main coronary artery disease in the setting of acute myocardial infarction. METHODS: Between June 1997 and April 2002, primary stenting for left main coronary artery disease was performed in eighteen patients with acute myocardial infarction. We evaluated clinical outcomes and prognostic determinants in this clinical setting. RESULTS: Mean ages of patients were 59 +/- 12 years. Fourteen patients had cardiogenic shock on admission. Angiographic success (TIMI flow >or= 2 and diameter stenosis or= 2) was identified as a good prognostic determinant of in-hospital survival. During mean follow-up of 39 +/- 22 months, there was no late death and 1 patient received bypass surgery. Probability of freedom from death at 3-year was 56 +/- 12%. CONCLUSION: Primary stenting is a valuable therapeutic strategy for left main coronary disease in the setting of acute myocardial infarction, and it might save the life especially in patients with good pre-intervention TIMI flow (grade >or= 2). Long-term clinical outcome of patients surviving to hospital discharge is favorable.