Acute myocardial infarction with a giant left main aneurysm in atypical Kawasaki disease / 영남의대학술지

Kawasaki disease (KD) is an acute vasculitis of small and medium sized arteries. Even many years after onset, aneurysms and stenosis in coronary arteries may lead to an acute myocardial infarction, which is described as atypical or missed KD in childhood. KD is an underlying disease of young adults with acute myocardial infarction. We report on a rare case involving a total occlusion in the proximal left anterior descending coronary artery combined with a giant left main aneurysm in a young adult patient with acute myocardial infarction ascribed to antecedent KD that is undefined but almost certain.

Acute myocardial infarction with a giant left main aneurysm in atypical Kawasaki disease / 영남의대학술지

Kawasaki disease (KD) is an acute vasculitis of small and medium sized arteries. Even many years after onset, aneurysms and stenosis in coronary arteries may lead to an acute myocardial infarction, which is described as atypical or missed KD in childhood. KD is an underlying disease of young adults with acute myocardial infarction. We report on a rare case involving a total occlusion in the proximal left anterior descending coronary artery combined with a giant left main aneurysm in a young adult patient with acute myocardial infarction ascribed to antecedent KD that is undefined but almost certain.

Clinical and Echocardiographic Factors Affecting Tricuspid Regurgitation Severity in the Patients with Lone Atrial Fibrillation

BACKGROUND: Atrial fibrillation (AF) can be a risk factor for development of significant tricuspid regurgitation (TR). We investigated which clinical and echocardiographic parameters were related to severity of functional TR in patients with lone AF. METHODS: A total of 89 patients with lone AF were enrolled (75 +/- 11 years; 48% male): 13 patients with severe TR, 36 patients with moderate TR, and 40 consecutive patients with less than mild TR. Clinical parameters and echocardiographic measurements including right ventricular (RV) remodeling and function were evaluated. RESULTS: Patients with more severe TR were older and had more frequently persistent AF (each p < 0.001). TR severity was related to right atrial area and tricuspid annular systolic diameter (all p < 0.001). The patients with moderate or severe TR had larger left atrial (LA) volume and increased systolic pulmonary artery pressure (SPAP) than the patients with mild TR (p = 0.04 for LA volume; p < 0.001 for SPAP). RV remodeling represented by enlarged RV area and increased tenting height was more prominent in severe TR than mild or moderate TR (all p < 0.001). Multivariate analysis showed type of AF, LA volume, tricuspid annular diameter and tenting height remained as a significant determinants of severe TR. In addition, tenting height was independently associated with the presence of severe TR (p = 0.04). CONCLUSION: In patients with lone AF, TR was related to type of AF, LA volume, tricuspid annular diameter and RV remodeling. Especially, tricuspid valvular tethering seemed to be independently associated with development of severe functional TR.

Complete Atrioventricular Block Associated with Hyponatremia / 대한내과학회지

We report the case of a 77-year-old woman who developed complete atrioventricular (AV) block during an episode of thiazide-induced hyponatremia. She was taking hydrochlorothiazide to treat essential hypertension; she had no definite organic disease of the heart or lungs. Generally, the serum sodium concentration does not have a marked effect on cardiac conduction. However, we experienced a case of complete AV block associated with hyponatremia. This was treated successfully by correcting the electrolyte imbalance. Complete AV block associated with hyponatremia is very rare. To our knowledge, this is the first reported case in Korea.

A Case of Retrograde Dissection at the Right Sinus of Valsalva Resulted from Dissection of Right Coronary Artery during Ergonovine Test

Retrograde dissection extending into the sinus of Valsalva is a rare complication during percutaneous coronary intervention. That may occur due to trauma to the ostium from catheter manipulation and may sometimes require surgical repair. A 50-year old male patient was admitted because of chest pain. During catheterization of the right coronary artery (RCA) after ergonovine test, we encountered coronary artery dissection with retrograde dissection of right sinus of Valsalva leading to RCA occlusion. Then we placed coronary artery stent (4.0x24 mm Driver stent) at right coronary artery ostium and his coronary blood flow of RCA was recovered and no further extension of dissection was observed. Here, we present a case of acute myocardial infarction which resulted from the acute dissection of the sinus of Valsalva with obstruction of the right coronary ostia by intimal flap during angiography.

Gender Differences in Susceptibility to Smoking among Patients with Lung Cancer

BACKGROUND/AIMS: To determine whether female smokers are more or less susceptible to the detrimental pulmonary-function effects of smoking when compared to male smokers among patients with lung cancer. METHODS: Pack-years and pulmonary function indices were compared between 1,594 men and women with lung cancer ifferences in individual susceptibility to smoking were estimated using a susceptibility index formula. RESULTS: Of the patients, 959 (92.8%) men and 74 (7.2%) women were current smokers. Common histological types of lung cancer were squamous cell carcinoma, adenocarcinoma, and small cell carcinoma, among others. Women had a lower number of pack-years, forced expiratory volume in 1 second (FEV1, liters), forced vital capacity (FVC, liters), and total lung capacity (TLC, liters) compared to those of men (25.0 +/- 19.2 vs. 42.9 +/- 21.7 for pack-years; 1.4 +/- 0.5 vs. 2.0 +/- 0.6 for FEV1; 3.0 +/- 0.7 vs. 2.0 +/- 0.6 for FVC; 4.5 +/- 0.8 vs. 5.7 +/- 1.0 for TLC; all p < 0.001). The susceptibility index for women was significantly higher compared to that of men (1.1 +/- 4.1 vs. 0.7 +/- 1.1; p = 0.001). A significant inverse association was shown between the susceptibility index and TLC and FVC (r = -0.200 for TLC, -0.273 for FVC; all p < 0.001). CONCLUSIONS: The results suggest that the detrimental effects of smoking on pulmonary function are greater in women, as compared to those in men, among patients with lung cancer.

A Case of Blastic Plasmacytoid Dendritic Cell Neoplasm Initially Mimicking Cutaneous Lupus Erythematosus / Journal of the Korean Cancer Association, 대한암학회지

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare disease. The prognosis is poor in most cases with rapid progression despite administering chemotherapy. A 67-year-old man complained of skin rashes on his back and this spread to the trunk, face, arms and thighs, and he was initially diagnosed with cutaneous lupus erythematosus according to the skin biopsy. The skin rashes then became aggravated on a trial of low dose methylprednisolone for 3 months. Repeated skin biopsy revealed a diffuse infiltration of lymphoid cells with medium sized nuclei, positive for CD4 and CD56, negative for Epstein-Barr virus (EBV), indicating a diagnosis of BPDCN. Further workups confirmed stage IVA BPDCN involving the skin, multiple lymph nodes, the peripheral blood and the bone marrow. He was treated with six cycles of combination chemotherapy consisting of ifosphamide, methotrexate, etoposide, prednisolone and L-asparaginase, and he achieved a partial response. Herein we report on a rare case of BPDCN that was initially misinterpreted as cutaneous lupus erythematosus.