An adult asymptomatic pulmonary artery sling / 영남의대학술지

A pulmonary artery sling is a very rare congenital abnormality in which the left pulmonary artery rises from the posterior surface of the right pulmonary artery and then passes between the trachea and the esophagus, causing tracheal compression. It is associated with tracheo-bronchial abnormalities (50%) and cardiovascular abnormalities (30%). It may produce respiratory symptoms through the airway compression of the abnormal left pulmonary artery and congenital abnormalities associated with it. Because most (90%) pulmonary artery sling patients present symptoms during infancy, their condition is often diagnosed in the first year of life. However, a pulmonary artery sling is occasionally found in adults. It is usually asymptomatic and found incidentally. This is a very rare case of an asymptomatic pulmonary artery sling in an adult. A 38-year-old man presented symptoms of mild exertional dyspnea. His spiral computed tomography showed a pulmonary artery sling. He was discharged without specific treatment because his symptoms improved without specific treatment and might not have been associated with a pulmonary artery sling. We report an adult case of an asymptomatic pulmonary artery sling diagnosed via spiral computed tomography, accompanied by a literature review.

A Case of Fatal Mechanical Mitral Valve Leaflet Fracture Embolization: A Case Report / 대한구급학회지

The fracture embolization of a mechanical valve is a very rare but potentially fatal event that can cause acute severe valve regurgitation and subsequent decompensated heart failure. Generally, the mechanical valve is durable and semi-permanent. If this is not the case, bacterial endocarditis can occur. However, leaflet fracture embolizations related to mechanical failure may occur in the specific mechanical valve brands associated with the subjects own structural fragilities. In this case, we dealt with a case of fatal Edward-Duromedics mechanical mitral valve leaflet fracture embolization that had been implanted 20 years ago. The patient presented with severe acute heart failure and shock. Severe transvalvular mitral regurgitation and only one valve leaflet was observed in echocardiography. Although the emergency mitral valve replacement was performed under the diagnosis with valve leaflet fracture embolization, the patient was not resuscitated from systolic pump failure and died.

A Case of Sparganosis That Presented as a Recurrent Pericardial Effusion

Sparganosis is caused by a larval tapeworm of the genus Spirometra, which commonly invades subcutaneous tissue, but less frequently invades muscle, intestines, spinal cord, and the peritoneopleural cavity. The authors managed a female patient who presented with a recurrent pericardiopleural effusion and peripheral eosinophilia. The anti-sparganum-specific IgG serum level was significantly higher than normal control levels. In this patient, sparganosis was caused by the ingestion of raw frogs in an effort to control her thyroid disease. The recurrent pericardiopleural effusion and peripheral eosinophilia were controlled by 3 consecutive doses of praziquantel (75 mg/kg/day). The patient is doing well 4 years after presentation. Sparganosis should be considered a rare, but possible cause of recurrent pericardial effusion and peripheral eosinophilia. Immunoserologic testing using enzyme linked immunosorbent assays can be helpful in diagnosing human sparganosis, especially in cases without a subcutaneous lump or mass. Praziquantel is an alternative treatment for sparganosis in surgically-unresectable cases.

A Case of a Single Coronary Artery Mimicking Anterior Wall Myocardial Infarction

A single coronary artery is a rare coronary anomaly. A 66-year-old man arrived at our emergency department with progressive dyspnea of 4 days duration. ST segment elevation, a Q wave in precordial leads, and elevated myocardial enzymes suggested recent myocardial necrosis. Coronary angiography revealed a single coronary artery that originated from the left coronary sinus and showed normal morphology of the left coronary system without a significant stenotic lesion;a distal left circumflex artery traveled to the right ventricle and right atrium as a functional right coronary artery. We report a case of a single coronary artery from a left coronary sinus with a brief review of the literature.

The Early Treatment Gap of Dyslipidemia for Patients With Acute Myocardial Infarction

BACKGROUND AND OBJECTIVES: A treatment gap for dyslipidemia can occur during the early phase of acute myocardial infarction (AMI) because the baseline low density lipoprotein-cholesterol (LDL-C) level during this period rapidly decreases physiologically. SUBJECTS AND METHODS: We retrospectively reviewed the medical records of the patients who were admitted with AMI from December 2004 to July 2007 and their baseline LDL-C levels were less than 100 mg/dL. We analyzed the baseline lipid profiles and its serial changes in these patients. The initial LDL-C value, which can be expected to increase to over 100 mg/dL of LDL-C after discharge, was estimated statistically. RESULTS: Among the 298 AMI patients, 94 (31.5%) patients showed a LDL-C level below 100 mg/dL. The LDL-C level increases between baseline and within 2 weeks, 2-6 weeks and 6 weeks after discharge were 11.8+/-22.5, 24.4+/-23.8 and 26.6+/-16.6 mg/dL, respectively. We made a receiver operating characteristics (ROC) curve of the LDL-C level at baseline and within 2 weeks after discharge for predicting the increment of the LDL-C level. Using the cutoff value 74 mg/dL for the initial LDL-C level, the sensitivity and specificity were 83% and 50%, respectively. With using an 81 mg/dL cutoff value at 2 weeks, the sensitivity and specificity were 83% and 62%, respectively. CONCLUSION: A significant portion of AMI patients with an LDL-C level less than 100 mg/dL and who were not prescribed statin in the early phase of infarction showed an elevated LDL-C level over 100 mg/dL at 2 weeks after the infarction. The early administration of statin should be considered for treating an LDL-C=74 mg/dL during the initial period of AMI or an LDL-C=81 mg/dL at 2 weeks after AMI because their LDL-C level will increase to over 100 mg/dL during the subsequent follow-up period.

A case of acute interstitial nephropathy and toxic hepatitis after short-term herbal medication / 대한내과학회지

There are many kinds of herbal medication available in Korea, and some of them have been reported to be related with renal failure. However, the simultaneous occurrence of toxic hepatitis and acute renal failure associated with herbal medicine has rarely been reported. A 26-year-old male was admitted with a sudden onset of jaundice and generalized weakness after taking two doses of herbal medication. A physical examination revealed no abnormalities other than scleral icterus. The patient's blood chemistry demonstrated a blood urea nitrogen level of 91 mg/dL, a creatinine level of 13 mg/dL, an AST of 212 IU/L, an ALT of 1,528 IU/L and a bilirubin level of 8.5 mg/dL. Renal biopsy showed interstitial edema and an infiltration of neutrophils and lymphocytes with preserved glomeruli and vascular structure; these findings were consistent with administering medical supportive care without renal replacement therapy. He was discharged on the 8th hospital day. This case provides the possibility of development of hepatitis and renal failure due to herbal medication. We propose that a meticulous history taking for determining the herbal medications a patient has taken should be done for those cases of simultaneous toxic hepatitis and renal failure that are without any obvious cause in Korea.

A Case of Acute Renal Failure after Application of Mercury to the Skin / 대한신장학회잡지

Mercury is one of the heavy metals that cause intoxications. Mercury can cause muscular tremor, psychic irritability, renal toxicity and so on. Mercury intoxications usually occur chrough chronic respiratory ingestion. We describe a case in that a woman had applicated inorganic mercury to her whole body and developed mercury intoxications which can be characterized by the whole body skin rash, fever, acute renal failure and the hepatotoxicity appeared. We managed the patient with diuretics, antibiotics and continuous veno-venous hemodiafiltration. On the 6th hospital day, serum creatinine was normalized. Since then, the skin rash and hepatotoxicity were gradually alleviated.

A case of stomach metastasis from breast cancer / 대한내과학회지

Metastatic cancer from breast cancer is not uncommon and it often involves multiple organs. Gastric metastasis from breast cancer is much rarer than lung, bone and lymph node metastasis. Most of the symptoms are nonspecific, so it is not easy to differentiate primary gastric cancer from gastric metastasis from the breast. In particular, gastric and breast cancers are the two most common cancers among Korean women, so efforts should be made to distinguish primary gastric cancer from gastric metastasis because treatment and prognosis are very different between two. A few cases have been reported in Korea concerning gastric metastasis from breast cancer. We report here a case of gastric metastasis from infiltrating duct carcinoma of the breast.

A Case of Paraquat Intoxication Caused by Intramuscular Injection / 대한신장학회잡지

Paraquat intoxication is a fatal problem. Most of paraquat intoxications happen through oral administration. But there is no clinical data for parenteral paraquat intoxication, so we will describe its fatal progression and clinical course. A 52-year-old male injected paraquat solution on his thigh. Initial serum level of paraquat was 42.7 microgram/mL and urgent hemoperfusion was performed and his serum level of paraquat was reduced by 5.2 microgram/mL. But the patient expired due to respiratory failure and hypoxemia. Different from oral paraquat poisoning, serum level of the drug increases rapidly in intramuscular intoxication. So the paraquat in blood rapidly accumulates in tissue, especially lung parenchyme. We removed his paraquat in blood rapidly, but could not get rid of tissue concentration, so we lost him even with lowered serum paraquat level. Through this case, it is thought that the paraquat intoxication via intramuscular injection can make up a extremely poor prognosis even with very a little amount of paraquat.