Where We Can Find Bypass Tract in Ebstein's Anomaly?; a Case of Successful Ablation of Bypass Tract in Ebstein's Anomaly

In patients with Ebstein's anomaly, the localization of accessory pathways may be impeded by abnormal local electrograms recorded along the atrialized right ventricle and by the presence of multiple accessory pathways. We report a case of 50-year-old man diagnosed with Ebstein's anomaly with Wolff-Parkinson-White syndrome who presented with recurrent palpitations. He was referred to our institution for radiofrequency catheter ablation of paroxysmal supraventricular tachycardia. Transthoracic echocardiography revealed the tricuspid valve displaced into the right ventricle, consistent with Ebstein's anomaly. The electrophysiology study showed a right posterolateral accessory pathway. The optimal ablation site was located not in the atrioventricular line of the atrialized ventricular portion, but in the original atrioventricular line.

Flecainide-Induced Torsade de Pointes Successfully Treated with Intensive Pharmacological Therapy

Flecainide acetate is a potent class IC anti-arrhythmic drug with a major sodium channel blocking effect. Flecainide toxicity can cause myocardial impairment and precipitate circulatory collapse. It may also result in life-threatening arrhythmia, although cases of flecainide-induced torsades de pointes are rare. Furthermore, the electrical and hemodynamic deteriorations observed during flecainide toxicity may not respond to conventional treatments. In the present study, we report the case of a 20-year-old Korean man with flecainide poisoning, who presented with hypotension. The patient was successfully treated with sodium bicarbonate, amiodarone, MgSO₄, and lidocaine, with no recourse to extracorporeal therapy. Although there is no standard therapy for flecainide toxicity, this report demonstrates that intensive pharmacological treatment is beneficial in cases of flecainide overdose.

Late-Onset Postpneumonectomy Empyema Presenting as Right-Sided Heart Failure: Extrinsic Right Atrial Compression

Although it is rare, the right atrium can be encroached on by abnormal mediastinal structures, including aortic aneurysms, carcinomas, hepatic cysts and diaphragmatic paralysis. Extrinsic compression of the right atrium causes significant hemodynamic compromise and can lead to fatal outcomes. We describe the case of a 66-year old man with a past history of pulmonary tuberculosis that had undergone right pneumonectomy 40 years previously. He then presented with signs and symptoms of right-sided heart failure. These new signs and symptoms were recognized to be secondary to extrinsic compression of the right atrium, which was due to late-onset postpneumonectomy empyema, and the signs and symptoms were successfully relieved by performing open drainage of the empyema.

Familial Occurrence of Atrioventricular Nodal Reentrant Tachycardia in a Mother and Her Son

Atrioventricular nodal reentrant tachycardia (AVNRT), caused by a reentry circuit involving fast and slow atrioventricular nodal pathways, is one of the most common types of paroxysmal supraventricular tachycardias. While familial Wolff-Parkinson-White syndrome has been well recognized, familial AVNRT has been rarely reported. We report a familial occurrence of AVNRT in a mother and her son, who were symptomatic and successfully treated with radiofrequency catheter ablation of slow pathway.

Development of a Coronary Aneurysm at a Sirolimus-Eluting Stent-Implanted Lesion in a Patient With Churg-Strauss Syndrome

A coronary aneurysm (CA) can occur in sirolimus-eluting stent (SES)-implanted coronary lesions. Although several possible mechanisms have been suggested, the precise pathogenesis of a CA in SES-implanted lesions is still unknown. We report a patient with Churg-Strauss syndrome who underwent successful percutaneous coronary intervention with SES and then experienced a CA in an SES-implanted coronary lesion. We describe the CA characteristics through the use of coronary angiography, coronary 64-multidetector computed tomography, and intravascular ultrasound and discuss the etiological factors for the CA in this patient.

Successful Pacemaker Revision Through Sustained Right Superior Vena Cava in a Patient With Situs Inversus Totalis

In patients with situs inversus totalis, the superior vena cava is normally positioned on the left side and drains into a left-sided right atrium (RA). If right-side superior vena cava (RSVC) is also present, it should be thought of as a combined congenital anomaly. Here, we report a case of successful pacemaker lead insertion through the RSVC in a patient with situs inversus totalis. The left-side superior vena cava (LSVC) had been already used as a route for the first pacemaker lead insertion 15 years earlier. During the pacemaker lead revision, we found that the LSVC was obliterated, and used the RSVC as a route for a new pacemaker lead insertion.

Adrenal Cavernous Hemangioma / 대한비뇨기과학회지

Cavernous hemangiomas are rarely found in the adrenal gland. Most of the tumors are nonfunctioning, and the patients present with no clinical symptoms. Although rare, the presence of adrenal hemangiomas should be kept in mind in the differential diagnoses of adrenal tumors. We report a case of an adrenal cavernous hemangioma that was removed by laparoscopic adrenalectomy in a 71-year-old female patient. The chief complaint was right flank pain. The patient was pathologically diagnosed as a having a cavernous hemangioma of the adrenal glands.

Comparison of Laparoscopic Radical Nephrectomy with Open Radical Nephrectomy / 대한비뇨기과학회지

PURPOSE: Laparoscopic surgery has become the standard surgical method within the urological community. This study was undertaken to evaluate the safety and efficacy of a standard laparoscopic radical nephrectomy (LRN) compared to an open radical nephrectomy (ORN) at a single medical center. MATERIALS AND METHODS: Between January 2003 and March 2006, laparoscopic radical nephrectomies for renal cell cancer were performed in 30 patients and the results of the laparoscopic radical nephrectomy were compared with those of the open counterpart. Surgical results, such as the operation time, estimated blood loss (EBL), transfusion rate, narcotic analgesic requirement, hospital stay, complications and pathologic results, were retrospectively reviewed and analyzed using the Student's t-test. RESULTS: There were no significant differences in the demographic data between the two groups. The pathological reports showed a clear cell type in 59 cases and a chromophobe type in 1 case. For the LRN and ORN groups, the mean operation times were 208 (120-320) vs. 206 min. (115-300) (p>0.05), EBL of 135 (100-200) vs. 318ml (100-2,000) (p=0.02), transfusion rates of 6.6 vs. 30%, narcotic analgesic requirements of 160 vs. 255mg diclofenac sodium, hospital stays of 6.7 vs. 10.5 days (p=0.04) and intraoperative complications in 0/30 (0%) vs. 2/30 cases (7%), respectively. The pathological surgical margins were all negative. The surgical and pathological parameters of the LRN group showed no significant differences to those of the ORN group, with the exception of the EBL and hospital stay. CONCLUSIONS: Laparoscopic radical nephrectomy resulted in less blood loss, a shorter hospital stay and earlier rapid recovery than an open radical nephrectomy. In our opinion, laparoscopic surgery could be a standard surgical treatment in renal cell cancer.

Unusual Metastasis in Renal Cell Carcinoma / 대한비뇨기과학회지

Approximately one-third of all patients with renal cell carcinoma have metastasis at the time of diagnosis. Metastatic lesions of renal cell carcinoma are most commonly seen in the lung, and they are frequently seen in the bone and liver. However, spleen and rectal metastases are extremely rare. A 63-year-old man had undergone left radical nephrectomy for renal cell carcinoma. About 22 months later, computed tomography revealed multiple enhanced masses in the spleen. Spleen metastasis was suspected and splenectomy was then performed. One year later, the patient visited with complaints of voiding difficulty. A huge pelvic mass was detected by performing prostate ultrasonography and MRI. The mass was 13cm in diameter and it was between the rectum and the prostate. Removal of the pelvic mass and lower anterior resection with end colostomy was done. Histologically, the resected specimens were diagnosed as metastases from the renal cell cancer. Herein, we report on a case of metachronous splenic and rectal metastasis from renal cell carcinoma.

Short Term Outcomes of Laparoscopic Radical Cystectomy with an Extracorporeal Ileal Conduit: Comparative Analysis with the Open Method / 대한비뇨기과학회지

PURPOSE: We analyzed the perioperative and early oncological outcomes following radical cystectomy with using the laparoscopic method, and we compared these findings with those of the conventional open method. MATERIALS AND METHODS: Between January 2003 and December 2006, we performed laparoscopic radical cystectomy(LRC) with an extracorporeal ileal conduit for treating bladder cancer in 22 patients, and the results of the LRC were compared with those of open radical cystectomy(ORC) in 20 cases. The surgical results such as the operation time, the estimated blood loss(EBL), the transfusion rate, the hospital stay, the complications and the oncological results were reviewed retrospectively and then analyzed via the Mann-Whitney U test. RESULTS: There were no significant differences of demographic data between the two groups. The pathologic reports showed a transitional cell type in all cases. For the LRC and ORC groups, the mean operation time for cystectomy was 186.5 min(150-240) vs 192.4 min(150-240), respectively (p=0.276), the EBL was 228.18ml(150-380) vs 995.0ml(400-1,200), respectively(p<0.01), the transfusion rate was 15.7% vs 85.0%, respectively, the hospital stay was 11.2 days vs 12.4 days, respectively(p=0.67), the intraoperative complications was 3/22 cases(13.6%) vs 9/20 cases(45.0%), respectively. The pathologic surgical margins were all negative. The surgical and pathologic parameters of the LRC group showed no significant differences compared to those of the ORC group, except for the EBL and transfusion rate. CONCLUSIONS: LRC resulted in less blood loss, a lower transfusion rate and earlier, more rapid recovery than did ORC. In our opinion, lararoscopic surgery is a feasible treatment for bladder cancer.

A Case of Myocardial Stunning in Hyperthyroidism

Although myocardial stunning occurs in coronary artery disease, it has rarely been reported with hyperthyroidism. A 72-year-old woman presented with general weakness, shortness of breath and febrile sensation of 10 days duration. The serum thyroid hormone level was elevated. Serial EKGs showed significant ST elevation suggesting transmural ischemia, but coronary angiography was not significant. Echocardiography showed regional wall motion abnormality of apical hypokinesia, which was improved after medication for hyperthyroidism. We report this case as an example of myocardial stunning associated with hyperthyroidism.

A Case of Myocardial Stunning in Hyperthyroidism

Although myocardial stunning occurs in coronary artery disease, it has rarely been reported with hyperthyroidism. A 72-year-old woman presented with general weakness, shortness of breath and febrile sensation of 10 days duration. The serum thyroid hormone level was elevated. Serial EKGs showed significant ST elevation suggesting transmural ischemia, but coronary angiography was not significant. Echocardiography showed regional wall motion abnormality of apical hypokinesia, which was improved after medication for hyperthyroidism. We report this case as an example of myocardial stunning associated with hyperthyroidism.

Relationship of Adiponectin to Body fat Distribution, Insulin Sensitivity and Plasma Lipoproteins: in Healthy Premenopausal Women

BACKGROUND AND OBJECTIVES: The precise mechanism linking obesity and vascular disease is still unclear. Previous studies have demonstrated that the plasma levels of adiponectin, an adipose-derived hormone, decrease in obese subjects, and that hypoadiponectinemia are associated with ischemic heart disease. In this study, we investigated the determinant factors of plasma adiponectin concentration in healthy premenopausal women. SUBJECTS AND METHODS: We analyzed the plasma adiponectin concentrations in healthy, obese premenopausal women (n=37, BMI> or =25 Kg/m2) and in age-matched, healthy, non-obese premenopausal women (n=23, BMI<25 Kg/m2). The visceral and subcutaneous fat areas were measured by CT scan. RESULTS: Plasma levels of adiponectin in the obese subjects were lower than those in the non-obese subjects (3.24+/-1.08 vs. 4.90+/-2.06 microgram/ml, p<0.01). Significant, univariate, inverse correlations were observed between plasma adiponectin levels and visceral fat areas (r=-0.643, p<0.001), and between adiponectin levels and subcutaneous fat areas (r=-0.407, p<0.01). In univariate analysis, adiponectin was directly related to insulin sensitivity, hsCRP, triglyceride, HDL and LDL cholesterol. In multivariate analysis, visceral fat areas (beta=-0.483, p=0.001) and HDL cholesterol remained significantly related to plasma adiponectin concentrations (beta=0.283, p<0.05). CONCLUSION: These results suggest that HDL cholesterol and visceral fat mass were independently associated with plasma concentrations of adiponectin.

A Case of Ischemic Colitis in a Young Woman with Chronic Obstructive Type Constipation / 대한소화관운동학회지

Although ischemic colitis is often considered to be a condition occurred in elderly patients or in patients with vascular diseases, it also can occur in younger healthy persons. Some drugs, such as oral contraceptives, may play an important role in the development of ischemic colitis in young women. However, constipation also can play an important role in this condition. We recently experienced a case of reversible ischemic colitis of a young woman, who had been suffered from obstructive type of chronic constipation, after taking a laxative and enema. We report this case with literature review. Proper managements and educations in patients with chronic constipation should be emphasized.

Dose Dependent Changes of Lipid Profiles, IL-6 and CRP in Unstable Angina Patients after Simvastatin Therapy

BACKGROUND AND OBJECTIVES: The beneficial effects of statins in preventing cardiovascular events may depend, in part, on their anti-inflammatory action. We previously reported that low dose statin therapy has cholesterol lowering effects, but no effect on inflammation, and proposed that a sufficient dose of therapy might be needed to achieve anti-inflammatory action. The aims of this study were to confirm the suggestions made in our previous study. SUBJECTS AND METHODS: Fifteen unstable angina patients who were enrolled in our previous study were evaluated. The usual dose (20 mg) of simvastatin was administrated for 26 weeks, blood samples collected following the administration and tested for their lipid profiles and inflammatory markers (IL-6, CRP). The changes in the lipid profiles and inflammatory markers, from baseline levels, to the usual and low doses of statin therapy were evaluated. RESULTS: The changes in the IL-6 and hsCRP levels after the usual dose simvastatin therapy compared with the baseline levels were -72.8 and -59.6% (p< 0.05), respectively. The changes in the IL-6 and hsCRP levels after the usual dose simvastatin therapy compared with a 5 mg dose were -77.2 and -47.1% (p< 0.05), respectively. There was statistically significant correlation between the change in the levels of IL-6 and hsCRP during statin therapy. CONCLUSION: Our data confirmed the preliminary result of Chung et al, which suggested the usual dose of simvastatin is required to inhibit the inflammation of unstable plaque in patients with unstable angina associated with hypercholesterolemia.

Clinical Impact of Bronchial Reactivity and Its Relationship with Changes of Pulmonary Function After Asthmatic Attack Induced by Methacholine / 결핵

BACKGROUND: Bronchial reactivity is known to be a component of airway hyperresponsiveness, a cardinal feature of asthma, with bronchial sensitivity, and is increments in response to induced doses of bronchoconstric tors as manifested by the steepest slope of the dose-response curve. However, there is some controversy regarding methods of measuring bronchial reactivity and clinical impact of such measurements. The purpose of this study was to evaluate the clinical significance and assess the clinical use by analyzing the relationship of the bronchial sensitivity, the clinical severity and the changes in pulmonary function with bronchial reactivity. METHOD: A total of 116 subjects underwent a methacholine bronchial provocation test. They were divided into 3 groups : mild intermittent, mild persistent, moderate and cough asthma. Severe patients were excluded. Methacholine PC20 was determined from the log dose-response curve and PC40 was determined by one more dose inhalation after PC20. The steepest slope of log dose-response curve, connecting PC20 with PC40, was used to calculate the bronchial reactivity. Body plethysmography and a single breath for the DLCO were done in 43 subjects before and after methacholine test. RESULTS: The average bronchial reactivity was 38.0 in the mild intermittent group, 49.8 in the mild persistent group, 61.0 in the moderate group, and 41.1 in the cough asthma group. There was a weak negative correlation between PC20 and bronchial reactivity. A heightened bronchial reactivity tends to produce an increased clinical severity in patients with a similar bronchial sensitivity and basal spirometric pulmonary function. There were significant correlations between the bronchial reactivity and the initial pulmonary function before the methacholine test in the order of sGaw, Raw, FEV1/FVC, MMFR. There were no correlations between the bronchial sensitivity and the % change in the pulmonary function parameters after the methacholine test. However, there were significant correlations between the bronchial reactivity and the PEF, FEV1, DLCO. CONCLUSION: There was weak significant negative correlation between the bronchial reactivity and the bronchial sensitivity, and the bronchial reactivity closely reflected the severity of the asthma. Accordingly, measuring both the bronchial sensitivity and the bronchial reactivity can be of assistance in assessing of the ongoing disease severity and in monitoring the effect of therapy.