Clinical Impact of Coronary Collateral Vessels in Patients with Acute Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: Development of collateral vessels (CV) of the coronary artery in ischemic heart disease (IHD) differs in each individual. We tried to determine the relationship between the presence of CV and clinical characteristics and CAG findings, and the clinical impact of CV on prognosis. SUBJECTS AND METHODS: Seventy-one patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI) within 24 hours after symptom onset were included. The relationships between the presence of CV and risk factors of IHD and the findings of CAG, and influences of CV on 3-year mortality and cardiac events were evaluated. RESULTS: CV was absent in 35 patients (group A) and was observed in 36 (group B). There was no significant difference between these two groups in clinical characteristics or CAG findings. Risk factors of IHD, other than diabetes and high density lipoprotein-cholesterol (HDL-C), were not different. All seven cases of diabetes were in group A (p=0.005) and HDL-C was higher in group B than group A (41.6+/-12.0 mg/dL versus 50.1+/-17.3 mg/dL, p=0.021). There was a trend of higher mortality (14.3% versus 2.8%, p=0.056), whereas the higher rate of composite cardiac events in group A during follow-up was statistically significant (45.7% versus 22.2%; hazard ratio, 5.13; 95% confidence interval, 1.05-25.04; p=0.043). CONCLUSION: CV was more frequently observed in the non-diabetic patients and in the patients with higher HDL-C level. The presence of CV in patients with AMI treated with PCI was a favorable prognostic factor.

A Case of Traumatic Acute Pericarditis Mimicking Acute Myocardial Infarction, Caused by Swallowing Fishhook

A patient, with severe chest pain and isolated ST segment elevation, was evaluated in order to differentiate ischemic heart disease, such as acute myocardial infarction. A fishhook was incidentally found during coronary angiography, chest CT and esophagoscopy. With this information, the patient was re-interviewed, and it was learned that the patient had swallowed the fishhook from cooked fish after fishing trip. The patient was diagnosed as traumatic acute pericarditis with acute mediastinitis, associated with esophageal and pericardial perforation. The patient was successfully treated by surgical treatment drainage and adequate antibiotic use. We report a case of traumatic acute pericarditis, which mimicked an acute myocardial infarction, with a review of the literature.

Echocardiographic Findings and Clinical Manifestations of Hypertrophic Cardiomyopathy: Including 3 Cases of Anomalous Insertion of Papillary Muscle

OBJECTIVES: Hypertrophic cardiomyopathy (HCM) has been of great interest to clinicians because of its diverse clinical, morphologic, pathophysiologic and molecular genetic manifestations. We investigated the frequencies and clinical manifestations according to the types in Maron's classification of HCM. METHODS: Patients with HCM who were seen at our institution from June 1999 to July 2001 were retrospectively reviewed. Echocardiographic patterns were classified by Maron's classification. RESULTS: Of 62 patients (M/F=39/23, 56+/-14.8 years), 6 patients (9.7%) were type I (relatively mild left ventricular hypertrophy confined to the anterior portion of ventricular septum), 10 patients (16.1%) were type II (hypertrophy of the anterior and posterior septum in the absence of free-wall thickening), 25 patients (40.3%) were type III (diffuse hypertrophy of substantial portion of both the ventricular septum and anterolateral free wall), 1 patients (1.6%) were type IV (hypertrophy in the posterior septum or anterolateral free wall) and 20 patients (32.3%) were type V (apical hypertrophy). Compared with western countries in which the type III was most common, type III was also most common in Korea, but type V was more common in Korea. Systolic anterior motion of mitral leaflet (SAM) were noted in 12 patients in which 10 patients had type III. 43 of 62 patients (69.4%) had chest pain (33.9%), dyspnea on exertion (30.6%), palpitation (1.6%) and syncope (3.2%). 19 of 62 patients (30.6%) had no subjective symptoms, and there was no significant statistical difference between types. Three of 62 patients had anomalous insertion of papillary muscle at mitral valve. SUMMARY: The most common type was type III, and SAM was found mostly in type III. Anomalous insertion of papillary muscle was noted in 3 out of 62 cases. There was no differences in subjective symptom between the types.

Clinical Characteristics of the Patients with Myocardial Rupture after Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: Myocardial ruptures, including: ventricular free wall rupture (VFWR) and ventricular septal rupture (VSR), after acute myocardial infarction (AMI), are fatal complications. Recently, ubiquitous use of echocardiographs, and other imaging techniques, allows us to diagnose these complications in the antemortem period. Thus, this study retrospectively evaluated the clinical characteristics of patients with myocardial ruptures following AMI. SUBJECTS AND METHODS: 620 patients that had had AMIs, between January 1999 and June 2001, were analysed for the purpose of this study. Myocardial ruptures were diagnosed from their clinical symptoms, echocardiographs, and pericardiocenteses or cardiac catheterizations. The clinical characteristics of the patients with myocardial ruptures (n=15) were compared to those patients with myocardial infarction, without rupture (n=397), from their Q waves. RESULTS: The patients with myocardial ruptures were older than those without (67+/-9.7 years vs 60+/-11.7 years, p<0.05), and ruptures were more frequent in women (66.7% vs 25.2%, p<0.001). The frequency of systemic hypertension, DM, and the distribution of infarction sites were similar in both groups. Also, clinical characteristics between patients with VFWR, and those with VSR, were similar. Of the patients with VFWR (n=8), 7 suddenly died, and 1 was alive directly following surgery. Of the patients with VSR (n=7), 4 died. CONCLUSION: Myocardial rupture is a fatal complication of AMI, which is more frequent in women, and the patients with ruptures, in our study, were older than those without.

Thrombolytic Treatment of Prosthetic Valve Thrombosis

BACKGROUND: Prosthetic valve thrombosis is an uncommon but serious complication. Thrombolytic therapy has recently been proposed as an alternative to surgical methods in treating this condition and is used increasingly. However, the indications for thrombolytic treatment in prosthetic valve thrombosis have not been well defined and differential diagnosis of thrombosis is still difficult. METHODS: Four symptomatic patients with prosthetic valve thrombosis underwent 9 thrombolytic sessions for 7 distinct episodes. Transthoracic or transesophageal echocardiography and cinefluoroscopy were performed and repeated after each thrombolytic session. Urokinase or rt-PA (recombinant tissue-type plasminogen activator) was used and repeated dose was given if necessary. Recurrent thrombosis was treated also either with urokinase or rt-PA. RESULTS: All patients were female and mean age was 38.5 years old. Two valves were in mitral position and the other two were in tricuspid position. The anticoagulation status was inadequate in three patients. The initial success after first dose was 43% (3/7), which increased to 54% (4/7) after repeated thrombolytic therapy. Thrombolytic therapy was failed in three episodes; two thromboses and one ingrowths of pannus. Operations were needed in these cases. No complication was seen. CONCLUSION: Thrombolytic treatment can be used as an alternative to surgical therapy with a low risk of complications. But guideline of thrombolytic therapy for the recurrent thrombosis and education for the patients about the adequate anticoagulation were needed.

A Case of Pure Red Cell Aplasia Associated with Sinus Histiocytosis with Multiple Lymphadenopathy / 대한혈액학회지

Pure red cell aplasia (PRCA) is characterized by severe anemia with reticulocytopenia and absence of erythroblast from the bone marrow. Sinus histiocytosis with massive lymphadenopathy (SHML : Rosai-Dorfman disease) is rare systemic disease characterized by painless cervical, axillary, inguinal and mediastinal lymphadenopathy and frequent extranodal invasion. Histologically, lymph node sinuses are expanded by numerous distinctive histiocytes which contains well preserved lymphocytes. We report a case of sinus histiocytosis with massive lymphadenopathy in inguinal lymph node biopsy with polyclonal gammopathy and pure red cell aplasia in bone marrow biopsy who was infected by Epstein-Barr virus.

Four case of silicone fluid induced acute pulmonary embolism / 대한내과학회지

Silicone(polydimethylsiloxane) is a liquid polymer, widely used for medical purpose, especially breast augmentation and other cosmetic procedures, with a minimal tissue reaction and a high degree of thermal stability. Illegal injections of slilicone in human beings, however have been associated with many adverse effects, including migration of the silicone, skin hypopigmentation, granulomatous hepatitis, mastitis, human adjuvant disease (progressive systemic sclerosis, SLE, mixed connective tissue disease, rheumatoid Arthritis, Hashimoto's thyroiditis, morphea, etc.). Pulmonary involvement has rarely been mentioned in the literature. We experienced the unusual four cases of respirtory difficulty after injection of liquid silicone in the breast, vigina, uterus, hip. They were all young adult female and previously healthy, one of them died of the injection, and the others survived with health. Two patients were admitted because of dypena, cough, chest discomfort and bilateral pulmonary infiltration after injection of silicone. Transbrochial lung biopsy and autopsy disclosed numerous oil like materials filling the alveolar septal capillaries and marcrophages. High resolution C.T. disclosed multiple alveolar lesion in the peripheral lesion of both lung. Transbronchial lung biopsy, autopsy, high resolution C.T. lung scan disclosed abnormalities compatible with silicone fluid induced pulmonary embolism, which is followed by acute respiratory distress syndrome, especially after injection of liquid silicone in the vagina, uterus. The other patients had mild dypnea, cough, pulmonary function test initially showed mild restrictive pattern in one patient. Lung scan disclosed abnormalities compatible with silicone induced pulmonary embolism, after injection in the hip, breast. It is strongly suggested that illegal injection of slilicone fluid carries pulmonary problem and can induce acute pulmonary embolism followed by acute respiratory distress syndrome, especially after silicone injection in vigina and uterus surrounded by numerous blood vessels.

A Case of Acute Myelogeneous Leukemia Associated with Acute Febrile Neutrophilic Dermatosis / 대한혈액학회지

No abstract available.

Stellate Ganglion Block for the Treatment of Adult Onset Still's Disease: A case report / 대한마취과학회지

A 31-year-old woman was referred to our pain clinic department under the diagnosis of an adult onset Still's disease. She had been suffering from high fever, skin rash, multiple arthralgia, morning stiffness and lymph node enlargement for 16 months. She had taken conventional medication with steroid and NSAIDs, but the symptoms were a remittent nature. And also, she complained of systemic side effects of corticosteroids. Stellate ganglion block with 0.25% bupivacaine was performed 67 times for the treatment of adult onset Still's disease and then, her symptoms were improved eventually. We could discontinue steroid and NSAIDs, laboratory data were satisfactory. As we experienced an adult onset still's disease improved with stellate ganglion block, we report this case with a review of the literature.

A Case of Systemic Lupus Erythematosus Associated With Myelofibrosis / 대한내과학회지

Myelofibrosis is characterized by excessive deposition of collagen, laminin and fibronectin within the bone marrow stroma. These change can be due to primary myeloproliferative disorders, a variety of malignant process, endocrine disturbances, or inflammatory disease. Clinical and laboratory finding are suggest in the immune process with myelofibrosis. It has been rarely reported that myelofibrosis coexisting with SLE. This is a case report of systemic lupus erythematosus coexisting with bone marrow fibrosis in a 44 years old female patient presenting with menorrhagia, syncope and palpitation. We report the case with relevant literature review. Treatment with corticosteroid in a patient with SLE and myelofibrosis remit to the clinical and hematologic abnormalities.