A Review of Cardiac Myxoma: 33-year Experience in a Single Institution

BACKGROUND AND OBJECTIVES: Cardiac myxomas are uncommon. Early diagnosis and treatment are essential to reduce morbidity or mortality. Before 1970, preoperative diagnosis was difficult. With the development of echocardiography, a correct diagnosis is made before operation. We reviewed our clinical experience in diagnosis and management of 52 cases of myxomas seen over a 33-year period, 1966 to 1998. PATIENTS AND METHODS: There were 20 males (38%) and 32 females (62%);age range 7 - 80. All the patient's medical records were reviewed. In twenty-five patients in whom echocardiographic features could be reviewed, clinical fetures were compared according to two distinct echocardiographic features;Round and polypoid type. RESULTS: Eighty-four percents of the presenting symptoms were cardiac origin while systemic embolism (SE) accounted for 15%. Echocardiography was used most often for diagnosis. The myxomas were located in the left atrium in 50 (96%), right atrium in 2 (4%). One patient had multiple myxoma. The incidence of SE was significantly higher in polypoid type than in round type (58% vs 0%, p<0.05). Multivariate regression analysis revealed polypoid type was the only independent predictor of SE (p=0.0029). Follow-up duration was ranged from 1 to 266 months. There was no deaths associated with myxoma. One patient presented with a recurrence 3 years after resection, and reoperation was performed uneventfully. CONCLUSION: Due to the nonspecific presentation of myxoma, a high index of suspicion is needed. Surgical excision of myxoma can be considered curative with excellent long-term result. However, because of high possible occurrence of SE, a close attention should be given to those patients who have myxoma of polypoid type.

A Case of Hydroxyzine Induced Torsades de Pointes

Torsades de pointes is a polymorphic ventricular tachycardia associated with prolonged QT interval and increased U wave amplitude. It has been found to be induced by various drugs, electrolyte imbalances, and so on, but the mechanism of torsades de pointes has not been completely documented. Two hypotheses, early afterdepolarization and dispersion of repolarization have been known to be the possible mechanism. Terfenadine and astemizole are the antihistamines, known to be one of the etiologic agents of torsades de pointes, and factors associated with increased risk are significant liver disease, drug overdose, and concomitant administration of imidazole and macrolide antimicrobial drugs. There has been only one case reported that torsades de pointes had been induced by first-generation antihistamine, piprinhydrinate. We experienced a case of 43 year old male patient with torsades de pointes induced by first-generation antihistamine, hydroxyzine and treated successfully with drug cessation, MgSO

A Case of Bilateral Sacroiliitis in Systemic Lupus Erythematosus / 대한류마티스학회지

Sacroiliitis is a prototyical feature of the seronegative spondyloarthropathies. It has been reported rarely in patients with systemic lupus erythematosus. We report a case of bilateral sacroiliitis in a 26 year-old female who presented 5 out of 11 ARA criteria for systemic lupus erythematosus. She complained of right low back pain since 1 week after delivery. Plain roentgenogram, computed tomogram and magnetic resonance imaging revealed no evidence of subluxation or pyogenic infection that may be possibly related to delivery, but bilateral sacroiliitis especially more severe in the right side that showed concordantly increased uptake on bone scan. Also she had neither HLA DR-3 nor B-27 antigens and had no other clinical findings of limitation of motion of spine and chest expansion, which suggest that there is a less likelihood of coexistent ankylosing spondylitis. In this case, we suggested that sacroiliitis may be a infrequent manifestation of systemic lupus erythematosus.

P53 overexpression in gastric adenocarcinoma with Helicobacter pylori infection

Gastric carcinogenesis has been studied in various aspects. Helicobacter pylori (Hp) infection and mutation of the p53 tumor suppressor gene have recently been argued to be important factors of gastric carcinogenesis. There have been many studies to determine the precise mechanism of how Hp is related to gastric cancer, but it is so far still unknown. We studied the relationship of Hp infection and p53 overexpression and tried to discover some significance in clinicopathologic factors such as age, sex, stage, site, differentiation and gross morphology. Ninety-six patients who were diagnosed with gastric cancer at Severance Hospital, Yonsei University Medical College from November 1995 to March 1996, and 96 control patients of non-ulcer dyspepsia (NUD) were studied by endoscopic biopsy of normal gastric tissue and cancer tissue. They also underwent the CLO (Delta West, Melbourne, Western Australia) test for Hp positivity and p53 immunohistochemical stain for p53 positivity. These data were analyzed for comparison with the clinicopathologic characteristics of gastric cancers. In conclusion, the differentiated group cancer had a significantly high Hp positivity and p53 positivity. There is a possibility that Hp infection and p53 tumor suppressor gene mutation might be significantly related in the gastric carcinogenic process of well- and moderately-differentiated adenocarcinomas, but further study is necessary to determine more direct clues on the carcinogenic roles of these factors.