A Case of an Accessory Cystic Duct Draining into the Right Intrahepatic Duct / 대한췌담도학회지

Anatomic variations in the biliary tree may not be detected until adulthood and they can cause unexplained jaundice and biliary pain. Recognition of these anatomic variations is important to avoid an incorrect diagnosis and significant ductal injury during biliary surgery. Although there are numerous anatomic bile duct variations, an accessory cystic duct draining into the right hepatic duct is rare. We report a case of an accessory cystic duct draining into the right hepatic duct with cholelithiasis, in which the abnormality was identified by endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography and confirmed by laparoscopic cholecystectomy.

Pseudomembranous Colitis: A Complicated Case with Transient Increase of Carcinoembryonic Antigen / 이화의대지

Pseudomembranous colitis (PMC) is a frequent cause of morbidity and mortality among hospitalized patients. Although diarrhea is the most common manifestation, PMC may be associated with intraperitoneal fluid accumulation in the severe cases. And a few cases showing both ascites and pleural effusion have been reported in patients with PMC. We report a case of PMC who showed elevated serum and ascites levels of carcinoembryonic antigen (CEA) with a normal CEA level in pleural effusion and who successfully recovered after oral administration of metronidazole. After treatment, the serum CEA level returned to the reference range.

A Case of Near Total Occlusion of the Renal Artery after Endovascular Abdominal Aortic Aneurysm Repair

Endovascular abdominal aortic aneurysm repair is a safe, durable, and effective procedure. However, complications could occur with stent graft devices. When the renal ostia become obstructed by this device, renovascular hypertension may result. In general, renal artery occlusion secondary to stent graft impingement remains uncommon. We herein describe a patient with renal atrophy, new-onset hypertension, and elevated serum renin and aldosterone levels following endovascular aneurysm repair. Blood pressure and the levels of renin and aldosterone were normalized by renal artery stenting.

Postimplantation Syndrome After Endovascular Aortic Aneurysm Repair in an Elderly Patient

Endovascular procedures have been proposed as minimally invasive alternative treatments, allowing safe and effective aortic aneurysm repair. Despite the potential benefits, endovascular stent grafting may elicit an unexpected systemic inflammatory response, called postimplantation syndrome (PIS). The main features of PIS include fever, elevated C-reactive protein levels, leukocytosis and/or coagulation disturbances, perigraft air on abdominal computed tomography, and no evidence of infection. The main management of PIS is supportive care. Antibiotics have no clinical benefit. We report a case of PIS after endovascular aortic aneurysm repair in an elderly patient.

Obesity Increases Blood Pressure Variability during the Night

BACKGROUND: Previous studies have reported that obesity increases heart rate variability. Body mass index (BMI) has been reported to affect blood pressure variability (BPV) over 24 hours. However, the diurnal variation in the effect of BMI on BPV has not been evaluated. This study aimed to clarify the diurnal variation in the effect of BMI on BPV. METHODS: A total of 2,044 patients were consecutively enrolled in this study, and the data were analyzed retrospectively. All patients underwent 24-hour ambulatory blood pressure monitoring. We divided patients into two groups according to BMI (non-obese group: n = 1,145, BMI or = 25). We compared BPV during daytime and nighttime between the non-obese and obese groups. We also evaluated the impact of BMI on BPV by multivariate regression analysis. RESULTS: On univariate regression analysis, there was no significant difference in BPV during daytime (systolic BP [SBP] variability: 20.7 vs. 21.7, p = 0.511; diastolic BP [DBP] variability: 16.8 vs. 17.5, p = 0.539). However, both SBP variability (13.8 vs. 17.6, p = 0.009) and DBP variability (11.7 vs. 14.3, p = 0.042) during nighttime were affected significantly by BMI. After adjusting other compounding variables (age > 60 years, current smoking habit, hypertension, diabetes mellitus, and use of calcium channel blockers and renin-angiotensin-aldosterone system blockers), multivariate analysis showed that BMI was an independent factor associated with increase in BPV during the night (SBP variability: p = 0.039; DBP variability: p = 0.034). CONCLUSIONS: Obesity increased BPV during nighttime.

The Inflammation Markers According to the Presence of Coronary Artery Disease in Patients with Peripheral Artery Disease

OBJECTIVE: Prevalence of coronary artery disease (CAD) has been reported to be high in patients with atherosclerotic peripheral artery disease (PAD) in lower extremities. Various inflammatory markers have been known to be associated with CAD. The aim of study was to explore the role of inflammatory makers for CAD in patients with PAD. METHODS: A total of 346 PAD patients (71.51+/-9.41 years, 337 males) who underwent percutaneous transluminal angioplasty from June 2006 to April 2012 were included in this study. Patients were divided into the Group I (PAD with CAD: n=151, 149 males) and the Group II (PAD without CAD: n=195, 188 males). RESULTS: Among 346 patients, 149 patients had CAD (43.6%). The prevalence of diabetes mellitus (DM) (p=0.023) and smoking (p=0.010) were significantly higher in the group I when compared withthe group II. The level of high sensitivity C-reactive protein (hs-CRP) increased (p or =3.0 mg/dL) (OR=2.595, 95% CI: 1.548-4.350, p<0.001), and age (OR=0.645; 95% CI, 0.454-0.915; p=0.014) were independent predictors for the development of CAD in PAD patients. CONCLUSION: 43.6% of patients with PAD also had CAD, and the predictors of CAD were smoking, DM, and high level of hs-CRP.