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.

Intravascular Ultrasound Analysis of Nonstented Adjacent Segments in Diffuse In-stent Restenosis Treated with Radiation Therapy with a Rhenium-188-Filled Balloon

BACKGROUND AND OBJECTIVES: Intracoronary stenting now constitute the majority of coronary interventions, and subsequently in-stent restenosis has become a significant clinical problem. Recently, several studies on intracoronary radiation therapy, in patients with in-stent restenosis, have demonstrated a reduction in binary angiographic restenosis and target lesion revascularization compared with control groups. The effects of beta-radiation therapy on non-stented adjacent segments in in-stent restenosis have not been sufficiently evaluated. beta-radiation therapy for in-stent restenosis was performed with a 188Re-MAG3 filled balloon. SUBJECTS AND METHODS: We evaluated, and compared, the effects of beta-radiation therapy on non-stented adjacent segments, in in-stent restenosis, by intravascular ultrasound (IVUS) analysis, between 50 patients who received radiation therapy and 9 controls. The changes (delta: follow-up-post-intervention) of the external elastic membrane (EEM), the lumen and other IVUS variables, were compared between the segments having received radiation therapy and those in the controls. RESULTS: Significant differences were found between the 2 groups, and were as follows: the delta EEM and delta lumen areas were 0.3mm2 and -1.0mm2, (p=0.005) and 0.2mm2 and -1.3mm2, (p<0.001) in those radiated and the controls, respectively. CONCLUSION: In conclusion, compared with the changes on the vessel shrinkage of the control group, there was significant vessel enlargement in the non-stented adjacent segments having received radiation therapy.

Prevalence and Clinical Impact of a Subclinical Intrapulmonary Right to Left Shunt Diagnosed by Contrast Echocardiography in Patients with End Stage Hepatic Disease

BACKGROUND AND OBJECTIVES: The clinical impact of an intrapulmonary right to left shunt, without hypoxia (subclinical IPS), has not been sufficiently evaluated. We investigated the prevalence and clinical impact of a subclinical IPS in patients with end stage hepatic disease. SUBJECTS AND METHODS: Contrast echocardiography, with hand-agitated saline, was performed in 72 consecutive candidates for a liver transplantation between April 2001 and November 2001. A positive contrast echocardiography indicated an intrapulmonary right to left shunt, and was defined as the delayed appearance of microbubbles in the left side of the heart (3 to 6 beats after the initial appearance in the contrast in the right side of the heart). We compared the clinical events of the patients both with and without a shunt, i.e. death, spontaneous bacterial peritonitis, sepsis, hepatic encephalopathy or variceal bleeding. RESULTS: A subclinical IPS was detected in 19 of the 72 candidates for a liver transplantation (26.3%). All these candidates were Child class C liver cirrhosis. There were no differences in the baseline characteristics between the patients and those without a shunt in the Child class C (n=57). The mean PaO2 value of the patients with at least a 3+ left ventricular opacification (3 to 4+, n=6) was significantly lower than those with a 1+ to 2+ left ventricular opacification (n=13) (76+/-10 mmHg vs. 103+/-13 mmHg, p< 0.05). The mortality was not significantly difference between the patients with (5%, 1/19) or without (21%, 8/38, p=0.24) a shunt. Also, there were no significant differences in the clinical events during the mean follow-up period of 7+/-3 months (68.4% vs. 83.5% p=0.12). CONCLUSION: Subclinical IPS's are not uncommon in patients with end stage hepatic disease. The extent of shunting correlates with the level of arterial oxygenation. However, a subclinical IPS is not associated with the mortality or clinical events of the patient selected.

Sequential changes of magnetocardiogram in rat models of experimental myocardial infarction / 대한내과학회지

BACKGROUND: Magnetocardiogram (MCG), which records the changes of magnetic fields generated by the heart's electrical activity, theoritically can provide unique data for clinical application. To date, MCG has been investigated only at a single time point after myocardial infarction (MI) with severe left ventricular dysfunction in rats. The purpose of the present study was to investigate sequential changes of MCG after MI and to evaluate effects of infarct size on MCG. METHODS: Acute MI were induced by the permanent ligation of left coronary artery in 22 rats. Magnetic fields were recorded just above a rat with Nb Superconducting Quantum Interference Device (SQUID) gradiometer inside a magnetically shielded room. MCG was measured before and immediately after surgery and it was subsequently recorded at the time points of 1, 4 and 6 hours postoperatively. MCG was also measured at 1, 3, 7 and 21 days after surgery. RESULTS: Elevation of ST segment and appearance of pathological Q wave on the MCG were evident immediately after the ligation of coronary artery and persisted to 6 hours after MI. On MCG, ST segment was depressed and T wave was inverted from 1 day after MI. In rats with small- and moderate-sized MI (infarct size or = 30%). CONCLUSION: Evolutional changes of MCG were well-recognized up to 21 days after MI. Furthermore, the infarct size can be expressed by the extent of Q wave and ST segment depression on MCG. Taken together, these data indicate that MCG is a helpful modality for the diagnosis, evaluation of infarct size and follow up after MI.

Effects of Low-dose Androgen in Combination with Subcutaneous Recombinant Human Erythropoietin (r-HuEPO) on Anemia and Nutritional Parameters in Hemodialysis Patients / 대한신장학회잡지

Recombinant human erythropoietin(r-HuEPO) is the mainstay of anemia therapy in patient with end stage renal disease(ESRD), but the use of r-HuEPO is primarily limited by its high cost. So, it encourages any strategies that potentially enhance the erythropoietic response. However, studies designed to assess whether androgens would enhance the response to r-HuEPO were inconclusive. While androgens may be less expensive and may improve several nutritional parameters, their potential adverse effects discourage usage. We carried out a prospective study to examine the effect of low-dose androgen in combination with subcutaneous r-HuEPO on anemia and nutritional paramenters in hemodialysis patients. Twenty-four hemodialysis patients with hematocrit <24% or hemoglobin <8.0g/dL were randomly assigned into two groups. Group A(n=12) received 2000U r-HuEPO subcutaneously twice a week for six months. Group B(n=12) received the same dose of r-HuEPO plus nandrolone decanoate 100mg intramuscularly biweekly. Anthropometry, albumin, cholesterol, prealbumin, and transferrin were measured as nutritional parameters. The groups showed no differences in baseline levels of the followings : Hemoglobin, hematocrit; transferrin saturation; serum ferritin; intact serum parathyroid hormon, Kt/V; vitamin B12, folate; nutritional parameters. At the completion of the study, both groups showed significant increase in hematocrit compared with baseline levels(group A 20.7+/-2.2% to 26.0+/-3.8%; group B : 21.5+/-3.5% to 30.1+/-2.8%). The mean hematocrit in group B was significantly higher than in group A after 4 month study period(p<0.05). Ten of 12 patients in group B achieved a target hematocrit of 30%, as compared with four of 12 patients in group A. Both groups didn't show significant changes in any nutritional parameters. No significant side effects of androgen were noted during this short-term study. We conclude that low-dose androgen in combination with subcutaneous r-HuEPO is effetive treatment on anemia in hemodialysis patients, but does not improve nutritional status.

A Case of Adult Intussusception of the Colon Caused by Leiomyoma / 대한소화기내시경학회지

Adult intussusception represents 1% of patients with bowel obstruction and 5% of all intussusception. It presents with a variety of acute, intermittent and chronic symptoms, thus making its preoperative diagnosis is difficult. Overall, colonic intussusception in adults is most often related to a primary carcinoma and benign smooth muscle tumors of the gastrointestinal tract are uncommon. We experienced a case of adult intussusception of the colon caused by leiomyoma. The 18-year old man was suffered from intermittent, colicky left lower quadrant pain and bloody diarrhea. Physical examination revealed a mass in the left lower abdomen. An abdominal CT scan revealed a "target mass" in the distal colon. The patient was treated with segmental resection of the descending colon and anastomosis. Pathology revealed a benign leiomyoma of the distal colon as the leading point of the colo-colic intussusception. His postoperative course was uneventful and did well.

A Case of Anomalous Termination of the Common Bile Duct and the Pancreatic Duct into the Duodenal Bulb, Associated with Common Bile Duct Stones / 대한소화기내시경학회지

Usually, the papilla of Vater is located in the midportion or the distal half of the descending duodenum. Isolated cases of common bile duct termination in other sites, including the fourth portion of the duodenum, the pyloric ring, the duodenal bulb and the stomach, have been reported. A case is here in reported involving abdominal pain in the right upper quadrant area, in which an ERCP demonstrated an anomalous termination of the common bile duct and pancreatic duct into the duodenal bulb separately. This anomaly was associated with a bile duct dilatation and single common bile duct (CBD) stone. Trial of CBD stone removal during an ERCP failed. The patient's condition improved after a cholecystectomy and choledochojejunostomy.