Reversible Pulmonary Hypertension in Adolescent with Left Atrial Myxoma

We report a patient of left atrial huge myxoma presenting with severe pulmonary hypertension in adolescents. A patient was a 14-year-old boy presented with sudden onset dyspnea. Transthoracic echocardiographic study revealed the presence of a nodular, 4.34 x 8.11 cm sized, mobile, hyperechoic mass in the left atrium and severe pulmonary hypertension with tricuspid insufficiency. After surgical therapy, tricuspid regurgitation and pulmonary hypertension was decreased and the patient was stabilized and had an uneventful clinical course.

A Case of Essential Thrombocythemia Presenting as Esophageal Varix Bleeding and Multiple Thrombosis / 영남의대학술지

Essential thrombocythemia (ET), a subcategory of chronic myeloproliferative disorder, is characterized by absolute thrombocytosis due to excessive clonal proliferation of platelets, hyperaggregability of platelets, and increased incidence of thrombosis and hemorrhage. We consider a diagnosis of ET when an unexplained and persistent thrombocytosis is observed. It is difficult to consider ET first when we meet a patient with esophageal varix bleeding or unusual multiple thromboses like mesenteric vein, splenic vein, and portal vein. This article reports a patient who presented initially with esophageal varix bleeding and unusual multiple thromboses, thereafter, she was diagnosed with ET after testing positive for the Janus Tyrosine Kinase 2 (JAK2) V617F mutation. In conclusion, in patients with varix bleeding and unusual multiple thromboses, myeloproliferative disorders like essential thrombocythemia should be considered as a potential cause and testing for the JAK2 mutation is warranted.

E6 Oncoprotein Expression in Non-Small Cell Lung Cancer Patients / 결핵및호흡기질환

BACKGROUND: Lung cancer is the leading cause of cancer deaths in the world. Human papillomavirus (HPV) infection and E6 oncoprotein expression are known risk factors for the development of non-small cell lung cancer (NSCLC). This study was performed to evaluate the prevalence of HPV 16/18 E6 oncoprotein expression in patients with NSCLC. METHODS: Immunohistochemical stains of the HPV 16/18 E6 oncoprotein were performed in tumor tissues from 68 patients with NSCLC who underwent curative surgery from March 2006 to November 2008. RESULTS: The E6 oncoprotein was expressed in 29.4%of patients with NSCLC and a statistical analysis revealed that E6 oncoprotein expression was significantly higher in females (p=0.028), never smokers (p=0.045), and patients with adenocarcinoma (p=0.022) than that in other patients. CONCLUSION: The E6 oncoprotein was expressed in 29.4% of patients with NSCLC. Further studies detecting HPV infection and E6 oncoprotein expression in never smoking patients with NSCLC are needed.

A Case of Myoglobinuric Acute Kidney Injury due to Rhabdomyolysis Associated with Neuroleptic Malignant Syndrome / 대한신장학회지

Neuroleptic malignant syndrome (NMS) is a rare, adverse reaction associated with the use of neuroleptic medication, which is characterized by altered consciousness, muscle rigidity, autonomic instability, hyperthermia, and elevated serum creatine phosphokinase (CPK) levels. Myoglobinuric acute kidney injury (AKI) is considered as the most serious complication of NMS. We report here a 25-year-old female who developed NMS associated myoglobinuric AKI, and had previously received olanzapine, haloperidol, and quetiapine for the treatment of brief psychotic disorder. The peak level of blood urea nitrogen (BUN) was 53.5 mg/dL, serum creatinine (Cr) 2.2 mg/dL, serum myoglobin 36,745 ng/mL, and a serum CPK of >30,000 IU/L. She was treated supportively with combination therapy including withdrawal of neuroleptics, intravenous hydration, cooling, and oral dantrolene. She gradually improved with clearing of altered sensorium, decrease in rigidity and normalizing of the serum CPK level. Serum BUN and Cr also decreased to 8.0 mg/dL and 0.6 mg/dL, respectively. Early, aggressive volume repletion with alkalinized fluids, along with appropriate pharmacological therapy is needed to prevent myoglobinuric AKI in patients with NMS. Additionally, dipstick urinalysis including urine pH, specific gravity, and occult blood may be useful in monitoring changes in hydration status during periods of fluid therapy.