The Comparison of the Associations of Lipoprotein(a) and the Atherogenic Index of Plasma With Coronary Artery Calcification in Patients Without High LDL-C: A Comparative Analysis

Objective@#Lipoprotein(a) (Lp[a]) and the atherogenic index of plasma (AIP) have been reported as predictive markers of coronary artery calcium (CAC). However, previous studies demonstrated that the cardiovascular risk associations with Lp(a) are attenuated in patients with low-density lipoprotein cholesterol (LDL-C) levels ≤135 mg/dL. However, few articles have identified the risk factors of CAC in patients without high LDL-C. Therefore, we performed this study to investigate the association of Lp(a) and AIP with CAC in patients with LDL-C levels ≤135 mg/dL. @*Methods@#This study included 625 lipid-lowering agent naive patients with LDL-C levels ≤135 mg/dL who underwent coronary computed tomographic angiography. We performed multivariate logistic regression analysis to evaluate the risk factors for a coronary artery calcium score (CACS) >0, CACS ≥400, and CAC ≥90th percentile. @*Results@#The mean age of the patients was 55.0±7.9 years and their mean LDL-C level was 94.7 ±23.3 mg/dL. Multivariate regression analysis showed that age, male sex, diabetes, hypertension, Lp(a), and AIP were independent predictors of CAS>0. Age, male sex, and diabetes were independent predictors of CACS≥400. Diabetes, hypertension, and AIP were independent predictors of CAC ≥90th percentile (all p<0.05). Unlike Lp(a), higher AIP tertiles were associated with significantly higher CAC percentiles and greater proportions of patients with CACS ≥400 and CAC ≥90th percentile. @*Conclusion@#In patients without high LDL-C, AIP could be a more reliable predictor of CAC than Lp(a).

A Rare Cause of Spontaneous Echo Contrast in Echocardiography

No abstract available.

Heterotopic Ossification of the Xiphoid Process after Abdominal Surgery for Traumatic Hemoperitoneum

Heterotopic ossification of the xiphoid process is extremely rare, with only three cases previously reported. However, the surgical pathology for postoperative elongation of the xiphoid process after abdominal surgery has not yet been reported. We report a case of the postoperative elongation of the xiphoid process, 8 years after abdominal surgery for traumatic hemoperitoneum in a 53-year-old man. The patient underwent surgical excision of the elongated mass of the xiphoid process. Histopathology revealed multiple exostoses. Heterotopic ossification can occur after surgical trauma to soft or bone tissue. Surgical excision with primary closure is the treatment of choice for symptomatic heterotopic ossification.

Dual Growing Rod Treatment for Progressive Pediatric Spinal Deformity

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the outcomes of dual growing rod treatment over a follow-up period of at least 2 years in patients with progressive pediatric spinal deformity. SUMMARY OF LITERATURE REVIEW: The dual growing rod treatment is safe and effective in curve correction and maintenance in patients with progressive pediatric spinal deformity. MATERIALS AND METHODS: Between 2009 to 2017, 14 patients who underwent dual growing rod treatment were followed up for more than 2 years. We analyzed their demographic and radiologic data, including age at surgery, sex, diagnosis, instrumented levels, number of total operations, number of lengthening procedures, interval of lengthening, Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, T1-S1 length, and complications. RESULTS: The mean age of the patients was 11.0±2.9 years old. There were 10 male and 4 female patients, including 8 cases of neuromuscular scoliosis, 3 cases of idiopathic scoliosis, 2 cases of spondyloepiphyseal dysplasia, and 1 case of congenital scoliosis. The mean follow-up period was 42.4±14.0 months. The total number of operations was 6.6±2.6. The average number of lengthening procedures was 4.3±2.3 at an interval of 6.9±2.1 months. The Cobb angle improved from 60.4°±27.9° to 33.5°±19.7° after the initial treatment and 29.1°±16.4° after the last follow-up or final fusion. The T1-S1 length increased from 328.2±57.5 mm to 388.0±64.9 mm after the initial treatment and 424.9±64.4 mm after the last follow-up or final spinal fusion. The average growth rate was 11.5 mm/year. Six patients experienced 11 complications, of which 4 were Implant-related, and 7 were Infections. CONCLUSIONS: The dual growing rod technique is an effective and relatively safe treatment in patients with progressive pediatric spinal deformity.

Anomalous Middle Cardiac Vein Draining into the Left Atrium

No abstract available.

Paraganglioma Presenting as Dilated Cardiomyopathy with Cardiogenic Shock and Sepsis / 대한내과학회지

Rarely, a paraganglioma can lead to disastrous cardiac complications such as heart failure, cardiomyopathy, or myocardial infarction and inflammatory complications such as sepsis. We describe a 41-year-old man who developed severe dilated cardiomyopathy with cardiogenic shock and sepsis who had a paraganglioma in the retroperitoneum. Echocardiography showed extensive global hypokinesia with severe left ventricular systolic dysfunction. In addition, leukocytosis with elevated inflammatory markers and positive blood cultures indicated sepsis. Abdominal enhanced computed tomography and magnetic resonance imaging showed a large heterogeneous mass with cystic changes in the retroperitoneum. Serum and urine samples indicated elevated levels of catecholamine and its metabolites, and a 131I-meta-iodobenzylguanidine (MIBG) scan indicated uptake of MIBG. After intensive medical treatment and surgical removal of the paraganglioma, the dilated cardiomyopathy and sepsis resolved. The diagnosis of paraganglioma should be considered in patients presenting with acute heart failure or sepsis of nonspecific origin.

Polymicrobial Purulent Pericarditis Probably caused by a Broncho-Lymph Node-Pericardial Fistula in a Patient with Tuberculous Lymphadenitis

Purulent pericarditis is a rare condition with a high mortality rate. We report a case of purulent pericarditis subsequently caused by Candida parapsilosis, Peptostreptococcus asaccharolyticus, Streptococcus anginosus, Staphylococcus aureus, Prevotella oralis, and Mycobacterium tuberculosis in a previously healthy 17-year-old boy with mediastinal tuberculous lymphadenitis. The probable route of infection was a bronchomediastinal lymph node-pericardial fistula. The patient improved with antibiotic, antifungal, and antituberculous medication in addition to pericardiectomy.

A Case of Pachydermoperiostosis Combined with Undifferentiated Arthritis

Pachydermoperiostosis (PDP) is a primary hypertrophic osteoarthropathy characterized by digital clubbing, pachydermia, and periostosis, which is inherited as an autosomal dominant or recessive trait. We report on a patient suffering from bilateral knee arthritis for 6 years who was newly diagnosed as PDP. PDP was confirmed by bilateral digital clubbing, hyperhidrosis, and cutis verticis gyrata, findings of pachydermatosis on the forehead and scalp, X-ray findings of proliferative periostitis. This case indicates that PDP is one of several possible rare diseases that should be considered in patients with undifferentiated arthritis.

Exercise Induced Left Bundle Branch Block Accompanied by Chest Pain

Exercise-induced left bundle branch block is a rare condition that has been reported along with and without demonstrable cardiac abnormalities. We describe the case of a 73-year-old female with chest pain on execration. Coronary angiography revealed normal findings. She underwent a treadmill stress test. During the exercise left bundle branch block with concomitant chest pain was demonstrated. Chest pain was relieved with cessation of exercise.

Embolization of Inferior Epigastric Artery for Treatment of Rectus Sheath Hematoma Caused by Insulin Injection During Anticoagulation and Antiplatelet Therapy

Rectus sheath hematoma, caused by rupture of epigastric vessel or muscle tear, is most frequently encountered in association with anticoagulation therapy, trauma, operation, and hematologic disorder. It rarely occurs spontaneously. Rectus sheath hematoma related to subcutaneous injection of insulin is very rare. We report a case of percutaneous catheterbased coil embolization for treatment of rectus sheath hematoma caused by subcutaneous injection of insulin on abdomen during anticoagulation and antiplatelet therapy in an 83-year-old thin woman with diabetes.

Usefulness of the Doppler Flow of the Ophthalmic Artery in the Evaluation of Carotid and Coronary Atherosclerosis

BACKGROUND AND OBJECTIVES: There is little information about the relationship between the Doppler flow of the ophthalmic artery (OA) and carotid and coronary atherosclerosis. The aim of the investigation was to assess the clinical usefulness of the Doppler flow of the OA to estimate the severity of carotid and coronary atherosclerosis. SUBJECTS AND METHODS: The study was a retrospective analysis of the findings in 140 patients (mean age: 60 years, male: 64%) who underwent coronary angiography (CA) for the evaluation of typical angina between July 2010 and October 2011 in our single center. The severity of coronary artery stenosis was based on the Gensini score (GS). Significant coronary artery disease (CAD) was defined as the obstruction of over 75% of the major coronary arteries confirmed with CA. The pulsed Doppler flow of the OA and carotid ultrasound were performed before CA. RESULTS: The mean systolic velocity/mean diastolic velocity (MSV/MDV), pulsatile index and resistance index in the Doppler flow of the OA were identified as significant and independent correlations with carotid intima-media thickness, and MSV/MDV was identified to have a significant and independent correlation with the GS. MSV/MDV >2.1 was the independent predictor for significant CAD {odds ratio (OR) 3.8, 95% confidence interval (CI) 1.5-9.7, p=0.005} and carotid plaque (OR 2.8, 95% CI 1.1-7.0, p=0.028), after adjustment for CAD-associated factors. CONCLUSION: The Doppler flow of the OA might be a useful predictor of the severity of carotid and coronary atherosclerosis.

Free Floating Left Atrial Thrombus Disappearing during Echocardiography

No abstract available.

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Initially Visualized by Echocardiography and Multidetector Computed Tomography Coronary Angiography

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly associated with very high mortality during infancy. We report a 35-year-old female patient with ALCAPA initially visualized by echocardiography. She visited outpatient department presenting with intermittent chest discomfort for 3 weeks. Transthoracic echocardiography showed left coronary artery arising from main pulmonary artery and abundant septal color flow Doppler signals. Transesophageal echocardiography clearly revealed markedly dilated and tortuous right coronary artery showing windsock appearance. Multidetector computed tomography and coronary angiography enabled visualization of anomalous left coronary artery originating from left side of main pulmonary trunk. After treadmill exercise test which showed ST-segment depression presenting inducible myocardial ischemia, patient underwent direct re-implantation of the anomalous coronary artery into the aorta without any complication.

Reversible Pulmonary Hypertension in Adolescent with Left Atrial Myxoma

We report a patient of left atrial huge myxoma presenting with severe pulmonary hypertension in adolescents. A patient was a 14-year-old boy presented with sudden onset dyspnea. Transthoracic echocardiographic study revealed the presence of a nodular, 4.34 x 8.11 cm sized, mobile, hyperechoic mass in the left atrium and severe pulmonary hypertension with tricuspid insufficiency. After surgical therapy, tricuspid regurgitation and pulmonary hypertension was decreased and the patient was stabilized and had an uneventful clinical course.

A case of spontaneous intracerebral hemorrhage in neurofibromatosis type 1 associated with pheochromocytoma / 대한내과학회지

Spontaneous intracerebral hemorrhage is very rare in patients with neurofibromatosis type 1. A 30-year-old woman was referred to our hospital for evaluation of headaches, nausea, and vomiting. She was diagnosed with neurofibromatosis type 1 and a spontaneous intracerebral hemorrhage. She was treated with conservative management, including antihypertensive medications for 32 months. However, because of sustained hypertension, we performed screening tests for a pheochromocytoma. The 24 hr urine VMA and urine metanephrines were elevated. Abdominal CT showed a right adrenal mass, 7.5 x 5.8 cm in size.. After a successful resection of the tumor, the hypertension resolved without medication for > 1 year. This case illustrates that delayed diagnosis and treatment of pheochromocytoma can cause serious complications from hypertension, such as cerebrovascular hemorrhage. Thus, in patients with neurofibromatosis and hypertension, screening for pheochromocytoma is important for the early detection of an adrenal tumor.

Prognostic Significance of the Lown Grades and Late Potentials in Patients after Myocardial Infarction

BACKGROUND AND OBJECTIVES: The aims of this study were to assess the long term overall survival of patients after an acute myocardial infarction (AMI), and to determine the association of survival with the occurrence of ventricular arrhythmia, as recorded by Holter electrocardiography (ECG) and signal-averaged electrocardiography (SAECG). SUBJECTS AND METHODS: One hundred fifty two patients with an AMI were enrolled between January 2000 and August 2006. SAECG and Holter ECG were performed before hospital discharge (at range of 2-10 day). The grading system of Lown was used to evaluate the ventricular premature beats on Holter ECG. Three groups of patients were identified based on the seriousness of the ventricular arrhythmia, as identified by the Holter ECG: Lown grade 0, Lown grades 1, 2 and Lown grades 3, 4, 5. SAECG was performed with a high pass frequency of 25 Hz and 40 Hz. The presence of late potentials (LPs) recorded on SAECG was evaluated. The predictors for survival were assessed using Cox's proportional hazard model and Kaplan-Meier analysis. RESULTS: The mean duration of follow-up was 45.8+/-25.5 months. Twenty four patients (15.8%) died during follow-up. The multivariate predictors of all cause death included age [hazard ratio (HR)=1.25, 95% confidence interval (CI)=1.08-1.47, p=0.003] and Lown grades 3, 4 and 5 (HR=19.17, 95% CI=1.25-290.80, p=0.034). Survival analysis did not show a significant relationship between LPs and overall patient survival. The only predictors for overall mortality were age and the Lown grade. CONCLUSION: SAECG did not predict mortality for the patient with AMI. The ventricular arrhythmias recorded by conventional Holter before hospital discharge may be a useful noninvasive prognostic test after an AMI.

Relationship Between Serum Uric Acid Level and Metabolic Syndrome According to Gender

BACKGROUND AND OBJECTIVES: Hyperuricemia is known to be a risk factor for atherosclerosis, as is gender. The variables related to metabolic syndrome (MS), as well as other cardiovascular risk factors such as serum uric acid (SUA), differ according to gender. The aim of this study was to evaluate the relationship between SUA and the variables of MS according to gender. SUBJECTS AND METHODS: We randomly recruited 675 subjects (373 men and 302 women), who underwent health screening. The subjects were divided into four groups according to SUA quartiles. We compared each quartile of the SUA with the incidence of MS. The variables included body mass index (BMI), hypertension, fasting blood glucose (FBS), high-density lipoprotein (HDL) cholesterol, triglyceride (TG), and the MS score. RESULTS: The incidence of MS in men was significantly increased compared to women, and the incidence of MS was increased according to the SUA values in women. The MS scores tended to increase according to the SUA values in both genders. The incidence of high BMI, high blood pressure, and high TG were correlated with the SUA values in both genders. However, HDL-cholesterol was correlated with MS scores in women, and fasting glucose was not correlated with MS in either gender. CONCLUSION: The variables of the MS might be independently associated with SUA values in both genders. In addition, the incidence of MS in women might be significantly increased according to the SUA values. However, large scale follow-up studies will be required to confirm these possibilities.

Coordinated change of a ratio of methylated H3-Iysine 4 or acetylated H3 to acetylated H4 and DNA methylation is associated with tissue-specific gene expression in cloned pig

Various cell types in higher multicellular organisms are genetically homogenous, but are functionally and morphologically heterogeneous due to the differential expression of genes during development, which appears to be controlled by epigenetic mechanisms. However, the exact molecular mechanisms that govern the tissue-specific gene expression are poorly understood. Here, we show that dynamic changes in histone modifications and DNA methylation in the upstream coding region of a gene containing the transcription initiation site determine the tissue-specific gene expression pattern. The tissue-specific expression of the transgene correlated with DNA demethylation at specific CpG sites as well as significant changes in histone modifications from a low ratio of methylated H3- lysine 4 or acetylated H3-lysine 9, 14 to acetylated H4 to higher ratios. Based on the programmed status of transgene silenced in cloned mammalian ear-derived fibroblasts, the transgene could be reprogrammed by change of histone modification and DNA methylation by inhibiting both histone deacetylase and DNA methylation, resulting in high expression of the transgene. These findings indicate that dynamic change of histone modification and DNA methylation is potentially important in the establishment and maintenance of tissue-specific gene expression.

Spinal Epidural Cavernous Hemangioma Simulating a Disc Protrusion: A Case Report

The authors present a case of solitary pure epidural cavernous angioma. A 47-year-old man was admitted our department due to acute back pain and left lower extremity radicular pain. Lumbar spine magnetic resonance(MR) image revealed a mass, 1x0.8x0.8cm in size, located in L4/5 intervertebral disc space. We performed surgical excision and it was confirmed cavernous angioma, histologically. Postoperatively, patient has no neurological deficit and no specific complication. Follow-up MR imaging six months later showed no residual mass. The solitary pure spinal epidural cavernous angiomas are exceedingly rare. It is suggested that spinal epidural cavernous angioma should be included in the differential diagnosis of epidural mass and simple herniated disc.

The Outcome of Anterior Microforaminotomy for Single Level Cervical Radicular Disease

OBJECTIVE: Anterior cervical microforaminotomy has become one of surgical options to treat cervical rad iculopathy. The goal of this study is to evaluate the effectiveness of anterior cervical microforaminotomy for single-level cervical radicular disease. METHODS: We performed a prospective review of radiological data and clinical records only in patients whom the patients met the inclusion criteria for this study. Among 53 patients who underwent anterior cervical microforaminotomy between June 2000 and May 2002, 36 patients were evaluated in this study. RESULTS: Male to female rate was 2: 1 and mean age was 46.1(28-63) years. Compressive pathological lesions included disc herniation in 24 cases(66.7%), spondylosis 10 cases(27.8%), and a combined of the two in 2 cases(5.5%). Twenty eight patients(77.8%) experienced excellent results, six patients(16.7%) experienced good results, and two patients(5.5%) experienced fair results. No patient demonstrated a poor or unchanged outcome. All patients showed adequate decompression in their postoperative computed tomography or magnetic resonance images. There were no complications. Mean hospital stay was 3.9(3-12) days. CONCLUSION: Patients treated with the anterior cervical microforaminotomy procedure for single-level cervical radicular disease have good outcomes. It appears to be a good alternative procedure for cervical radicular disease. But this procedure have complications such as vertebral artery injury. And long term follow up should be analyzed for instability or recurrence of disc herniation.