Effect of Post-Activation Potentiation according to Sequence of Velocity Using Isokinetic Device on Short-Term Performance of Lower Extremity: Taekwondo Athletes and Healthy Adults

Purpose@#The purpose of this study was to figure out how PAP (Post-Activation Potentiation) phenomenon affects short-term performance efficiently. @*Methods@#This study was conducted with 18 Taekwondo athletes and 16 healthy adults. By using isokinetic dynamometer, two different intervention, TDP (Top-down program) and BUP (Bottom-up program), were performed to measure isokinetic parameter; (peak torque:PT, total work: TW, average power: AP, and average torque: AT) of knee extensor for intragroup, intergroup comparison and two-way ANOVA. @*Results@#The Taekwondo athletes group showed statistically significant differences in all isokinetic parameters PT, TW, AP, and AT after TDP (p 0.05). PT and TW at TDP were statistically significant (p < 0.05) when the rate of change in TDP and BUP was compared and analyzed considering the difference in physical ability between the Taekwondo athlete group and the healthy adult group. However, AP and AT were not statistically significant. Finally, when examining the interaction between the two groups and two exercise sequence according to isokinetic parameters, only TW (p < 0.05) showed a statistically significant interaction, while PT (P = 0.099), AP (P = 0.103), and AT (P = 0.096) did not. This study suggests that short-term performance can be improved through the PAP phenomenon when TDP is applied to the Taekwondo group. @*Conclusion@#According to our result, for Taekwondo athletes, if the goal is to improve short-term performance just before the main game, we suggest a training program through TDP.

HDL Subclass Analysis in Predicting Metabolic Syndrome in Koreans With High HDL Cholesterol Levels

BACKGROUND: High-density lipoprotein cholesterol (HDL-C) is a complex mixture of subclasses with heterogeneous atheroprotective activities. We analyzed HDL-C subclass in relation to cardiovascular risk and metabolic syndrome (MetS) in a population with high HDL-C levels.METHODS: A total of 300 Korean individuals with high HDL-C levels (≥2.331 mmol/L) were enrolled following a comprehensive general medical examination including body composition analysis. HDL3-C levels were measured using the HDL3-EX SEIKEN kit (Randox Ltd., Crumlin, UK) and non-HDL3-C levels were calculated by subtracting HDL3-C levels from total HDL-C levels.RESULTS: HDL3-C levels and HDL3-C proportion had a weak positive correlation with low-density lipoprotein cholesterol (LDL-C) and triglycerides (r=0.21, r=0.25; r=0.26, r=0.34, respectively, all P<0.001); in contrast, non-HDL3-C levels had a weak negative correlation with these parameters (r=−0.17 and r=−0.25, respectively, both P<0.005). HDL3-C levels and HDL3-C proportion were significantly higher in the MetS group (N=8) than in the non-MetS group (0.71 vs 0.63 mmol/L, P=0.001; 29.7 vs 25.8%, P=0.001, respectively); these were the only predictors of MetS among the lipid variables (areas under the curves [AUC]=0.84 and 0.83, respectively, both P=0.001).CONCLUSIONS: In populations with high HDL-C levels, HDL-C subclass may provide a greater amount of information on cardiovascular risk and MetS than HDL-C levels alone.

Prognostic Role of High-sensitivity Cardiac Troponin I and Soluble Suppression of Tumorigenicity-2 in Surgical Intensive Care Unit Patients Undergoing Non-cardiac Surgery

BACKGROUND: The prognostic utility of cardiac biomarkers, high-sensitivity cardiac troponin I (hs-cTnI) and soluble suppression of tumorigenicity-2 (sST2), in non-cardiac surgery is not well-defined. We evaluated hs-cTnI and sST2 as predictors of 30-day major adverse cardiac events (MACE) in patients admitted to the surgical intensive care unit (SICU) following major non-cardiac surgery. METHODS: hs-cTnI and sST2 concentrations were measured in 175 SICU patients immediately following surgery and for three days postoperatively. The results were analyzed in relation to 30-day MACE and were compared with the revised Goldman cardiac risk index (RCRI) score. RESULTS: Overall, 30-day MACE was observed in 16 (9.1%) patients. hs-cTnI and sST2 concentrations differed significantly between the two groups with and without 30-day MACE (P < 0.05). The maximum concentration of sST2 was an independent predictor of 30-day MACE (odds ratio=1.016, P=0.008). The optimal cut-off values of hs-cTnI and sST2 for predicting 30-day MACE were 53.0 ng/L and 182.5 ng/mL, respectively. A combination of hs-cTnI and sST2 predicted 30-day MACE better than the RCRI score. Moreover, 30-day MACE was observed more frequently with increasing numbers of above-optimal cut-off hs-cTnI and sST2 values (P < 0.0001). Reclassification analyses indicated that the addition of biomarkers to RCRI scores improved the prediction of 30-day MACE. CONCLUSIONS: This study demonstrates the utility of hs-cTnI and sST2 in predicting 30-day MACE following non-cardiac surgery. Cardiac biomarkers would provide enhanced risk stratification in addition to clinical RCRI scores for patients undergoing major non-cardiac surgery.

Acute cor pulmonale due to pulmonary tumor thrombotic microangiopathy in two patients with breast cancer

No abstract available.

Three-dimensional echocardiography in adult congenital heart disease

Congenital heart disease (CHD) is now more common in adults than in children due to improvements in fetal echo, neonatal and pediatric care, and surgical techniques leading to dramatically increased survivability into adulthood. Adult patients with CHD, regardless of prior cardiac surgery, experience further cardiac problems or therapeutic challenges; therefore, a non-invasive, easily accessible echocardiographic examination is an essential follow-up tool. Among echocardiographic modalities, three-dimensional (3D) echocardiography provides better delineation of spatial relationships in complex cardiac geometries and more accurate volumetric information without geometric assumptions. For atrial septal defects, an en face view of the tissue defect allows better decisions on device closure. For tricuspid valve malformations, an en face view provides diagnostic information that is difficult to obtain from routine 2D tomography. In repaired tetralogy of fallot with pulmonary regurgitation, preoperative 3D echocardiography- based right ventricular volume may be used to determine the timing of a pulmonary valve replacement in conjunction with cardiovascular magnetic imaging. For optimal adult CHD care, 3D echocardiography is an important complement to routine 2D echocardiography.

Kawasaki Disease with Fever and Cervical Lymphadenopathy as the Sole Initial Presentation

BACKGROUND AND OBJECTIVES: Some patients with Kawasaki disease (KD) present with fever and cervical lymphadenopathy alone. The purpose of this study was to characterize the clinical features of these unusual KD patients and determine whether this is a severe form of KD associated with increased risks of intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs). SUBJECTS AND METHODS: A total of 146 children with KD were reviewed retrospectively, and classified into two groups according to initial clinical features. Those presenting with only fever and cervical lymphadenopathy (LKD) were classified as LKD patients. Other-KD patients included all except the LKD patients. RESULTS: Among 146 KD patients, 13 (8.9%) were classified as LKD patients. The LKD patients were significantly older and admitted earlier. The duration between fever onset and KD diagnosis was significantly longer in the LKD patients (5.9 days vs. 4.9 days, p=0.023). The frequency of IVIG resistance was not different between the two groups., In the LKD patients, the incidence of CALs was significantly higher in the acute phase, and without significant difference in the convalescent phase. The percentage of neutrophils and C-reactive protein, albumin, and total bilirubin levels were significantly higher in LKD patients. CONCLUSION: Even though LKD patients were older, admitted earlier, and had higher inflammatory marker levels, they did not have a greater risk of CALs or IVIG resistance. However, echocardiography may be helpful in the acute stage if patients have only fever and cervical lymphadenopathy and are unresponsive to empirical antibiotics.

Non-invasive Myocardial Strain Imaging to Evaluate Graft Failure in Cardiac Xenotransplantation / 대한이식학회지

BACKGROUND: The shortage of human hearts for allotransplantation makes xenotransplantation a possible option for controllable organ providers. To detect acute xenograft rejection, invasive biopsy seems inevitable; however, this occasionally results in poor incision wound healing or infection. To date, no method of noninvasive imaging for early detection of xenograft rejection has been established. We hypothesized that ultrasound speckle tracking would better detect xenograft failure than routine left ventricular ejection fractions (EF). METHODS: From August 2013 to July 2015, a total of six cardiac heterotopic xenotransplants (α 1, 3-galactosyltransferase gene-knockout porcine heart) into cynomolgus monkeys were monitored with echocardiography every 3 to 7 days. M-mode and two-dimensional (2D)-EF measurements and myocardial strain analyses were performed. Cardiac xenograft pathology was reviewed from the immediate postoperative biopsy, as well as the necropsy. RESULTS: Myocardial speckle tracking analysis was feasible in all six cases. The longest survival was 43 days. Only one pathology-proven immunologic rejection occurred. Cardiac xenograft failure appeared as two types: a dilated pattern with decreased EF or a myocardial-thickening pattern with preserved EF. Both antibody-mediated rejection (n=1) and sepsis-induced myocardial dysfunction (n=2) revealed decreased radial or circumferential strains, but normal-range EF. Xenograft functional decline was significant with respect to radial or circumferential strain (P=0.028), but not to conventional M-mode or 2D-EFs (P=0.600, P=0.340, respectively). CONCLUSIONS: Radial and circumferential strains were significantly decreased in both types of xenograft failure, regardless of EF. Further studies are warranted to correlate the strain analysis and immunopathological details.

Comparing Results of Five Glomerular Filtration Rate-Estimating Equations in the Korean General Population: MDRD Study, Revised Lund-Malmö, and Three CKD-EPI Equations

BACKGROUND: Estimated glomerular filtration rate (eGFR) is a widely used index of kidney function. Recently, new formulas such as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations or the Lund-Malmö equation were introduced for assessing eGFR. We compared them with the Modification of Diet in Renal Disease (MDRD) Study equation in the Korean adult population. METHODS: The study population comprised 1,482 individuals (median age 51 [42-59] yr, 48.9% males) who received annual physical check-ups during the year 2014. Serum creatinine (Cr) and cystatin C (CysC) were measured. We conducted a retrospective analysis using five GFR estimating equations (MDRD Study, revised Lund-Malmö, and Cr and/or CysC-based CKD-EPI equations). Reduced GFR was defined as eGFR <60 mL/min/1.73 m2. RESULTS: For the GFR category distribution, large discrepancies were observed depending on the equation used; category G1 (≥90 mL/min/1.73 m2) ranged from 7.4-81.8%. Compared with the MDRD Study equation, the other four equations overestimated GFR, and CysC-based equations showed a greater difference (-31.3 for CKD-EPI(CysC) and -20.5 for CKD-EPI(Cr-CysC)). CysC-based equations decreased the prevalence of reduced GFR by one third (9.4% in the MDRD Study and 2.4% in CKD-EPI(CysC)). CONCLUSIONS: Our data shows that there are remarkable differences in eGFR assessment in the Korean population depending on the equation used, especially in normal or mildly decreased categories. Further prospective studies are necessary in various clinical settings.

Soluble Suppression of Tumorigenicity 2 and Echocardiography in Sepsis

Soluble suppression of tumorigenicity 2 (sST2) has emerged as a biomarker of cardiac stretch or remodeling, and has demonstrated a role in acutely decompensated heart failure. However, its role in sepsis-induced cardiac dysfunction is still unknown. We explored whether sST2 serum concentration reflects either systolic or diastolic dysfunction as measured by Doppler echocardiography. In a total of 127 patients with sepsis, correlations between sST2 and blood pressure, left ventricular (LV) ejection fraction, LV diastolic filling (ratio of early transmitral flow velocity to early diastolic mitral annulus velocity), and resting pulmonary arterial pressure were evaluated. Correlations between sST2 and other sepsis biomarkers (high-sensitivity C-reactive protein [hs-CRP] and procalcitonin) were also examined. sST2 showed a moderate correlation with mean arterial pressure (r=-0.3499) but no correlation with LV ejection fraction, diastolic filling, or resting pulmonary hypertension. It showed moderate correlations with hs-CRP and procalcitonin (r=0.2608 and r=0.3829, respectively). sST2 might have a role as a biomarker of shock or inflammation, but it cannot reflect echocardiographic findings of LV ejection fraction or diastolic filling in sepsis.

Pathological Substratum for a Case of Fulminant Myocarditis Treated with Extracorporeal Membrane Oxygenation and Subsequent Heart Transplantation

Fulminant myocarditis has been defined as the clinical manifestation of cardiac inflammation with rapid-onset heart failure and cardiogenic shock. We report on the case of a 23-yr-old woman with pathology-proven fulminant lymphocytic myocarditis presenting shock with elevated cardiac troponin I and ST segments in V1-2, following sustained ventricular tachycardia and a complete atrioventricular block. About 55 min of intensive cardio-pulmonary resuscitation, with extracorporeal membrane oxygenation support, bridged the patient to orthotopic heart transplantation. The explanted heart revealed diffuse lymphocytic infiltration and myocyte necrosis in all four cardiac chamber walls. Aggressive mechanical circulatory support may be an essential bridge for recovery or even transplantation in patients with fulminant myocarditis with shock.

Soluble ST2 Has a Prognostic Role in Patients With Suspected Sepsis

BACKGROUND: Soluble suppression of tumorigenicity 2 (sST2) has emerged as a novel biomarker for heart failure, and serum sST2 concentrations could be increased in inflammatory diseases. We explored whether sST2 is related to cardiac dysfunction/failure and has a prognostic role in patients with suspected sepsis. METHODS: In a total of 397 patients with suspected sepsis, sST2 concentrations were measured by using the Presage ST2 Assay (Critical Diagnostics, USA). sST2 concentrations were analyzed according to procalcitonin (PCT) concentrations, cardiovascular subscores of the sepsis-related organ failure assessment (SOFA) score, and clinical outcomes. RESULTS: sST2 concentrations were increased significantly according to the five groups of PCT concentrations and cardiovascular subscores of the SOFA score (P<0.000001 and P=0.036, respectively). In-hospital mortality was significantly higher among patients with sST2 concentrations above 35 ng/mL (P=0.0213) and among patients with increased concentrations of both sST2 and PCT (P=0.0028). CONCLUSIONS: sST2 seems to be related to both cardiac dysfunction/failure and severity in sepsis. Measurement of sST2 and PCT in combination would be useful for risk stratification and prognosis prediction in patients with suspected sepsis.

Comparison of the Impact of the Anesthesia Induction Using Thiopental and Propofol on Cardiac Function for Non-Cardiac Surgery

BACKGROUND: Thiopental and propofol have been widely used for general anesthesia induction, but their impacts on cardiac function have not been well described. A recent study speculated that anesthesia induction using propofol 2 mg/kg transiently reduced left ventricular (LV) contraction by analyzing tissue Doppler-derived imaging (TDI) during induction phase. The purpose of this study was to analyze and to compare the impacts of propofol- and thiopental-induction on LV function. METHODS: Twenty-four female patients with normal LV function undergoing non-cardiac surgery were randomly administered intravenous bolus thiopental (5 mg/kg, Thiopental-group, n = 12) or propofol (2 mg/kg, Propofol-group, n = 12) for anesthesia-induction. TDI of septal mitral annular velocity during systole (S'), early diastole (e') and atrial contraction (a') were determined by transthoracic echocardiography before and 1, 3, and 5 minutes after thiopental/propofol administration (T0, T1, T2, and T3, respectively). RESULTS: The bispectral index and systolic blood pressure declined significantly during anesthesia induction in both groups, however, more depressed in Thiopental-group compared with those in Propofol-group at T2 and T3 (all, p < 0.05). Among TDI two parameters demonstrated a significant inter-group difference: the S' in propofol was lower than that in Thiopental-group at T3 (p = 0.002), and a' velocities were persistently lower in Propofol-group, compared with same time values in Thiopental-group (T1, T2, and T3: p = 0.025, 0.007, and 0.009, respectively). CONCLUSION: Anesthesia induction using propofol revealed a more persistent and profound decline of LV and atrial contraction than that using thiopental. Further studies are needed to understand the clinical implication.

Cases of Hemolytic Anemia with Periprosthetic Leaks Evaluated by Real-Time 3-Dimensional Transesophageal Echocardiography

Hemolytic anemia is recognized as a rare complication of mitral valve replacement or repair. We report on a 44-year-old man with shortness of breath and hemolytic anemia, 23 years after mitral valve replacement (Hall-Kaster), and a 63-year-old woman diagnosed of hemolytic anemia, 4 years after mitral and tricuspid annuloplasty (Tailor ring, An-core ring). Routine 2-dimensional transthoracic echocardiography revealed paravalvular leakage around the prosthesis. Subsequent real-time 3-dimensional (3D)transesophageal echocardiography helped the perceptional appreciation of the leakage and the measuring of the regurgitant orifice area using the anatomically correct plane. Surgical findings of each case fit those of 3D volumetric images.

Cases of Hemolytic Anemia with Periprosthetic Leaks Evaluated by Real-Time 3-Dimensional Transesophageal Echocardiography

Hemolytic anemia is recognized as a rare complication of mitral valve replacement or repair. We report on a 44-year-old man with shortness of breath and hemolytic anemia, 23 years after mitral valve replacement (Hall-Kaster), and a 63-year-old woman diagnosed of hemolytic anemia, 4 years after mitral and tricuspid annuloplasty (Tailor ring, An-core ring). Routine 2-dimensional transthoracic echocardiography revealed paravalvular leakage around the prosthesis. Subsequent real-time 3-dimensional (3D)transesophageal echocardiography helped the perceptional appreciation of the leakage and the measuring of the regurgitant orifice area using the anatomically correct plane. Surgical findings of each case fit those of 3D volumetric images.

Pleural effusion caused by extravasation of irrigation fluid during arthroscopic shoulder surgery: A case report / 대한마취과학회지

Arthroscopic shoulder surgery has become a common and routine procedure because it provides several advantages for the diagnosis and therapy of shoulder injuries. However, shoulder arthroscopy is not a technique that's void of complications. We describe here a unique case of a patient who experienced pleural effusion caused by extravasation of irrigation fluid during arthroscopic shoulder surgery, and this surgery was done under general anesthesia.

Modelflow method versus continuous thermodilution technique for cardiac output measurement in liver transplant patients / 대한마취과학회지

BACKGROUND: In critically ill patients, cardiac output (CO) is used as a parameter for assessing hemodynamic status and efficacy of treatment. Continuous CO (CCO) could facilitate this assessment during general anesthesia. A new method of arterial pulse wave analysis has been introduced, which estimates beat to beat CO from arterial pressure via Modelflow. It remains uncertain how well this method performs in high output states. We analyzed the relationship between CCO and Modelflow computed from radial and femoral pressures (MFCO(RA), MFCO(FA)) during liver transplantation (LT). METHODS: Measurements were performed in 100 liver transplant patients. Groups A had 36 patients, and group C had 64 patients with both groups composed of Child-Turcotte A, B and C patients Eighty patients had CCO 10 L/min (group E) during anhepatic phase. RESULTS: CCO ranged from 5.0 to 15.4 L/min (MFCO(RA) 3.2 to 10.7 L/min, MFCO(FA) 4.3 to 11.8 L/min). Bland-Altman analyses showed the limit of agreement of MFCO(RA) (-1.5 to 5.2, bias = 1.9 L/min) and of MFCO(FA) (-2.6 to 4.4, bias = 0.9 L/min). CO measured by the two methods was significantly different in groups, except for MFCO(FA) in group C. In group D, bias was 1.5 L/min (SD 1.3 L/min) for MFCO(RA) and 0.9 L/min for MFCO(FA) (SD 1.4 L/min). In group E, biases of 3.5 L/min and 2.4 L/min were obtained for MFCO(RA) and MFCO(FA), respectively. CONCLUSIONS: These results suggest that the group-average value of MFCO is not an accurate parameter for estimating CO during LT, with the exception of MFCO(FA) in groups C and D.

Terminal QRS Complex Distortion on the Admission Electrocardiogram in Anterior Acute Myocardial Infarction and Association with Residual Flow and Infarct Size after Primary Angioplasty

BACKGROUND: Terminal QRS complex distortion on admission is a simple and reliable predictor of infarct size in patients with acute myocardial infarction (AMI). It is uncertain, however, whether this reflects reduced myocardial perfusion of the infarct area and a larger area of the myocardium at risk. This study was conducted to investigate whether terminal QRS distortion complex on admission is a reliable predictor of reduced residual flow and a larger area of the myocardium at risk compared to patients who are admitted without a terminal QRS distortion. METHODS: We evaluated the relationship between terminal QRS complex distortion and residual flow to the infarct zone and risk area in 46 anterior AMI patients undergoing primary angioplasty. 99mTc-sestamibi imaging was performed at baseline and 5-9 days after angioplasty. The study population was divided into those with (Group I, n=16) and without (Group II, n=30) terminal QRS complex distortion. RESULTS: Baseline characteristics were similar between the two groups. The area of the myocardium at risk was higher in Group I (59.9 +/- 15.3%) than in Group II (48.6 +/- 13.7%, p< 0.05; mean+SD) while the nadir measurement of the residual flow was lower in Group I (0.10 +/- 0.07) than in Group II (0.16 +/- 0.09, p< 0.05). Although the final infarct size was significantly higher in Group I (40.8 +/- 17.2%) than in Group II (27.1 +/- 18.1%, p< 0.05), the myocardial salvage index did not differ significantly between the two groups. CONCLUSION: Terminal QRS complex distortion seems to be associated with less residual flow to the infarct zone, a larger risk area and greater infarct size in patients with anterior AMI.

Comparison of the Clinical Features of Apical Hypertrophic Cardiomyopathy Versus Asymmetric Septal Hypertrophy in Korea

BACKGROUND: We sought to test whether patients with apical hypertrophic cardiomyopathy (APH) have different clinical features compared to those with typical asymmetric septal hypertrophy (ASH). METHODS: Among 32, 534 patients who underwent routine echocardiography at Asan Medical Center from January 2000 to December 2001, 305 patients (0.9%), who were finally diagnosed with hypertrophic cardiomyopathy (HCMP), were evaluated. The type of HCMP was classified according to the echocardiographic findings. RESULTS: ASH was the most frequent type (n=160, 53%, group I), and APH was the second most frequent (n=91, 30%, group II). Mean age (60.8 +/- 10 vs. 48.2 +/- 14 years, p< 0.001) and prevalence of hypertension (32% vs. 19%, p=0.022) were significantly higher in group II than in group I. Family history of HCMP (4.4% vs. 0% p=0.043) and sudden cardiac death (8.8% vs. 1.1% p=0.014) was more prevalent in group I. During the follow-up period of 32.0 +/- 37.2 months, cardiac events occurred at a significantly higher rate in group I (25.5% vs. 8.8%, p=0.003). CONCLUSION: APH comprises a significant proportion of HCMP in Korea and patients with APH show different clinical features compared to those with ASH.

Clinical Characteristics of Constrictive Pericarditis Diagnosed by Echo-Doppler Technique in Korea

A retrospective analysis of clinical data of 71 patients with constrictive pericarditis (CP) diagnosed by echo-Doppler technique (mean age, 49 +/- 17) was done. In 27 patients (38%), the etiology was unknown, and the three most frequent identifiable causes were tuberculosis (23/71, 32%), cardiac surgery (8/71, 11%), and mediastinal irradiation (6/71, 9%). Pericardiectomy was performed in 35 patients (49%) with a surgical mortality of 6% (2/35), and 11 patients (15%, 11/ 71) showed complete resolution of constrictive physiology with medical treatment. Patients with transient CP were characterized by absence of pericardial calcification, shorter symptom duration, and higher incidence of fever, weight loss, and tuberculosis. The 5-yr survival rates of patients with transient CP and those undergoing pericardiectomy were 100% and 85 +/- 6%, respectively, which were significantly higher than that of patients without undergoing pericardiectomy (33 +/- 17%, p=0.0083). Mediastinal irradiation, higher functional class, low voltage in ECG, low serum albumin, and old age were the independent variables associated with a higher mortality. Tuberculosis is still the most important etio-logy of CP in Korea, and not infrequently, it may cause transient CP. Early diagnosis and decision-making using follow-up echocardiography are crucial to improve the prognosis of patients with CP.

Acute Venous Thrombosis of Splenomesenteric Portal Axis in Minimal Change Nephrotic Syndrome / 대한신장학회잡지

An association between nephrotic syndrome and thromboembolic phenomena has been known for many years. Most common sites of venous throm-bosis in nephrotic syndrome are al vein and deep vein of lower extremity. We report a case of minimal change nephrotic syndrome associated with unusual extensive venous thrombosis. A 29-year-old man was transferred to our hospital with severe abdominal pain and ascites. 2 months before admission, he was diagnosed as minimal change nephropathy at another hospital and treated with steroid therapy but he had persistent proteinuria on admission. The abdominal ultrasonography and CT scan revealed diffuse thrombosis of left renal vein, splenic vein, superior mesenteric vein and portal vein. Deep vein thrombosis of lower extremity was also found but not pulmonary embolism. There was no evidence of other primary hypercoagulable disease. He was treated with intravenous heparin immediately and three days later, abdominal pain disappeared. Prednisolone and cyclophosphamide were administered as well. After 1 month of therapy, proteinuria was resolved. Abdominal CT scan, taken after 2 months of therapy, revealed that diffuse thrombosis were almost resolved. From this case, diffuse abdominal thrombosis should be included as a diffrential diagnosis in a nephrotic patient with abdominal pain.