Transvenous Pacemaker Lead Removal in Pacemaker Lead Endocarditis with Large Vegetations: A Report of Two Cases

Pacemaker lead endocarditis is treated with total removal of the infected device and proper antibiotics. The outcomes of patients undergoing percutaneous lead extraction for large vegetations (>2 cm) have not yet been shown. In this case report, we present two patients with pacemaker lead endocarditis with large vegetations of maximum diameter 2.4 cm and 3.2 cm. The first patient had multiple vegetations attached to the tricuspid and mitral valves and developed septic emboli to the brain, lung, and liver. The second patient had a large, persistent vegetation on the tricuspid valve, even two weeks after complete removal of the leads. Both patients were successfully treated with transvenous pacemaker lead removal and antibiotics.

Successful Management of a Rare Case of Stent Fracture and Subsequent Migration of the Fractured Stent Segment Into the Ascending Aorta in In-Stent Restenotic Lesions of a Saphenous Vein Graft

Stent fracture is a complication following implantation of drug eluting stents and is recognized as one of the risk factors for in-stent restenosis. We present the first case of successfully managing a stent fracture and subsequent migration of the fractured stent into the ascending aorta that occurred during repeat revascularization for in-stent restenosis of an ostium of saphenous vein graft after implantation of a zotarolimus-eluting stent. Although the fractured stent segment had migrated into the ascending aorta with a pulled balloon catheter, it was successfully repositioned in the saphenous vein graft using an inflated balloon catheter. Then, the fractured stent segment was successfully connected to the residual segment of the zotarolimus-eluting stent by covering it with an additional sirolimuseluting stent.

Prevalence and Clinical Characteristics of Pulmonary Arterial Hypertension in Human Immunodeficiency Virus-Infected Patients / 대한내과학회지

BACKGROUND/AIMS: Human immunodeficiency virus-associated pulmonary arterial hypertension (HIV-PAH) is a complication of HIV infection. Due to improvements in HIV survival rates following the introduction of highly active antiretroviral therapy, HIV-PAH has become an important cause of HIV-related morbidity. Thus, the objective of this study was to explore the prevalence and characteristics of HIV-PAH. METHODS: Ninety-two patients were enrolled in the study from March to August 2010. We investigated clinical characteristics and performed echocardiography. HIV-PAH was defined as having a mean pulmonary arterial pressure (mPAP) > or = 25 mmHg based on Mahan's equation, without lung disease or heart disease. The HIV-PAH-possible group was defined as having a tricuspid regurgitation velocity (TRV) of 2.9-3.4 m/s and a pulmonary arterial systolic pressure (PASP) of 37-50 mmHg. RESULTS: Fifteen patients (16.3%) met the criteria of HIV-PAH based on mPAP. With respect to TRV, six patients met the criteria of the HIV-PAH-possible group. Based on the criteria of mPAP, the duration of HIV infection was not different with or without HIV-PAH. HIV RNA titers and CD4 T cell counts tended to be higher in HIV-PAH patients (8,607 +/- 11 vs. 1,067 +/- 64 copies/mL, p = 0.371; 471 +/- 148 vs. 499 +/- 252 cells/mm3, p = 0.680, respectively). Echocardiographic indices of the right ventricle were significantly deteriorated in the HIV-PAH group as compared with the non-HIV-PAH group (TASPE: 20.52 vs. 23.2, p = 0.001; Tei index: 0.42 vs. 0.39, p = 0.037). In a multivariate regression analysis, HIV activity factors (HIV duration, HIV RNA titer, and CD4 cell count) were not associated with echocardiographic indices of PAH (mPAP, PASP, and pulmonary vascular resistance). CONCLUSIONS: In this study, the prevalence of HIV-PAH was comparable to that of previous studies.

Prevalence and Clinical Characteristics of Pulmonary Arterial Hypertension in Human Immunodeficiency Virus-Infected Patients / 대한내과학회지

BACKGROUND/AIMS: Human immunodeficiency virus-associated pulmonary arterial hypertension (HIV-PAH) is a complication of HIV infection. Due to improvements in HIV survival rates following the introduction of highly active antiretroviral therapy, HIV-PAH has become an important cause of HIV-related morbidity. Thus, the objective of this study was to explore the prevalence and characteristics of HIV-PAH. METHODS: Ninety-two patients were enrolled in the study from March to August 2010. We investigated clinical characteristics and performed echocardiography. HIV-PAH was defined as having a mean pulmonary arterial pressure (mPAP) > or = 25 mmHg based on Mahan's equation, without lung disease or heart disease. The HIV-PAH-possible group was defined as having a tricuspid regurgitation velocity (TRV) of 2.9-3.4 m/s and a pulmonary arterial systolic pressure (PASP) of 37-50 mmHg. RESULTS: Fifteen patients (16.3%) met the criteria of HIV-PAH based on mPAP. With respect to TRV, six patients met the criteria of the HIV-PAH-possible group. Based on the criteria of mPAP, the duration of HIV infection was not different with or without HIV-PAH. HIV RNA titers and CD4 T cell counts tended to be higher in HIV-PAH patients (8,607 +/- 11 vs. 1,067 +/- 64 copies/mL, p = 0.371; 471 +/- 148 vs. 499 +/- 252 cells/mm3, p = 0.680, respectively). Echocardiographic indices of the right ventricle were significantly deteriorated in the HIV-PAH group as compared with the non-HIV-PAH group (TASPE: 20.52 vs. 23.2, p = 0.001; Tei index: 0.42 vs. 0.39, p = 0.037). In a multivariate regression analysis, HIV activity factors (HIV duration, HIV RNA titer, and CD4 cell count) were not associated with echocardiographic indices of PAH (mPAP, PASP, and pulmonary vascular resistance). CONCLUSIONS: In this study, the prevalence of HIV-PAH was comparable to that of previous studies.

Late Stent Thrombosis After Drug-Eluting Stent Implantation: A Rare Case of Accelerated Neo-Atherosclerosis and Early Manifestation of Neointimal Rupture

An 80-year old woman suffered from sudden onset of chest pain and dyspnea, and visited the emergency room. She received stent implantation with a biolimus A9-eluting stent (Nobori(R) 3.0x24 mm) at a the mid-portion of the left anterior descending artery 5 months prior to admission. The emergency 5-month follow-up angiogram was performed under the impression of late stent thrombosis. The follow-up angiogram showed subtotal occlusion at the mid-portion of the left anterior descending artery, which was the same segment of previous stent implantation 5 months ago. Immediately after thrombus aspiration with the thrombus aspiration catheter, the optical coherence tomography showed layered appearance of neointimal hyperplasia and neointimal rupture within the previously stented segment. Thus, neointimal rupture within accelerated growth of neointimal tissue was observed within a relatively shorter period (i.e., about 5 months) after stent implantation.

A Case of Ankylosing Spondylitis with Follicular Lymphoma

Several autoimmune and chronic inflammatory conditions have been consistently linked with an increased risk of hematologic malignancies. Although ankylosing spondylitis (AS) is a chronic inflammatory disease, previous studies have demonstrated that it is not associated with an increase in risk of malignant lymphomas. Cases of AS accompanied by hematologic malignancies such as multiple myeloma, chronic myelogenous leukemia, and Hodgkin's disease have been reported. In Korea, AS with non-Hodgkin's lymphoma or follicular lymphoma has not been reported. We experienced a 38-year-old male who had been diagnosed with follicular lymphoma with bone metastasis, who achieved complete remission after having been treated with chemotherapy, developed new inflammatory back pain. An MRI of his hip showed an active inflammation of the left sacroiliac joint and a positive HLA-B27. The patient was diagnosed with AS and was treated with naproxen, which improved the pain in his back and buttock.

A Case of Primary NK/T Cell Lymphoma of the Testis

Primary testicular lymphoma account for 1~5% of all testicular neoplasms. The majority of these tumors are diffuse large B-cell non-Hodgkin lymphoma. Primary NK/T cell lymphoma of the testis is a rare entity. Regardless of treatment, the majority of these patients have exhibited a highly aggressive clinical course and they have died within 1 year because of early dissemination. We report here on a case of the aggressive 'nasal type' natural killer (NK)/T cell lymphoma that initially presented as a testicular tumor. A 63-year-old man presented with painless left testicular swelling, and so a left orchiectomy was performed. A biopsy specimen of the testis revealed an extranodal NK/T cell lymphoma of the nasal type. In-situ hybridization for Epstein-Barr virus proved positive. The patient received systemic chemotherapy with 3 courses of a combination regimen.