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Kim SM, Kwak CH, Lee B, Kim SB, Sir JJ, Cho WH, Choi SK. A case of severe coronary spasm associated with 5-fluorouracil chemotherapy. Korean J Intern Med 2012; 27:342-5. [PMID: 23019400 PMCID: PMC3443728 DOI: 10.3904/kjim.2012.27.3.342] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Revised: 06/16/2008] [Accepted: 07/30/2008] [Indexed: 11/27/2022] Open
Abstract
Cardiotoxicity associated with 5-fluorouracil (FU) is an uncommon, but potentially lethal, condition. The case of an 83-year-old man with colon cancer who developed chest pain during 5-FU infusion is presented. The electrocardiogram (ECG) showed pronounced ST elevation in the lateral leads, and the chest pain was resolved after infusion of nitroglycerin. A coronary angiogram (CAG) revealed that the patient had significant atherosclerosis in the proximal left circumflex artery. Coronary artery spasm with fixed stenosis was considered, and a drug-eluting stent was implanted. After 8 hours, the patient complained of recurring chest pain, paralleled by ST elevation on the ECG. The chest pain subsided after administration of intravenous nitroglycerin followed by sublingual nifedipine. Repeated CAG showed patency of the previous stent. This case supports the vasospastic hypothesis of 5-FU cardiac toxicity, indicating that a calcium channel blocker may be effective in the prevention or treatment of 5-FU cardiotoxicity.
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Affiliation(s)
- Sang-Min Kim
- Department of Internal Medicine, Cardiovascular Center, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Cheol-Hoon Kwak
- Department of Internal Medicine, Cardiovascular Center, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Bora Lee
- Department of Internal Medicine, Cardiovascular Center, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Seong Beom Kim
- Department of Internal Medicine, Cardiovascular Center, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Jung-Ju Sir
- Department of Internal Medicine, Cardiovascular Center, National Medical Center, Seoul, Korea
| | - Wook-Hyun Cho
- Department of Internal Medicine, Cardiovascular Center, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Suk-Koo Choi
- Department of Internal Medicine, Cardiovascular Center, Inje University Seoul Paik Hospital, Seoul, Korea
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Jung HJ, Sir JJ, Lee HK, Kang YK, Song BG, Choi SK. Very late thrombosis of sirolimus-eluting stent despite dual antiplatelet therapy for 4 years in a patient with lung cancer. Minerva Cardioangiol 2011; 59:113-116. [PMID: 21285937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Jung HJ, Sir JJ. Recurrent myocardial infarction due to one subacute and two very late thrombotic events of drug-eluting stent associated with clopidogrel resistance. J Invasive Cardiol 2011; 23:E15-E18. [PMID: 21297211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Although drug-eluting stent (DES) thrombosis is a recognized complication of coronary intervention, recurrent late stent thrombosis is rarely reported. Clopidogrel resistance or low-responsiveness may be associated with recurrent late stent thrombosis after DES implantation. We present a diabetic patient with hypertension, obesity and heavy smoking history, who suffered 3 recurrent attacks of acute anterior ST-segment elevation myocardial infarction over 6 years due to recurrent thromboses of DES despite prolonged and regular triple antiplatelet therapy. Laboratory evaluation of hypercoagulability yielded negative results, but low responsiveness for clopidogrel was revealed by the VerifyNow P2Y12 assay.
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Affiliation(s)
- Hye-Jin Jung
- Cardiovascular Center, Department of Internal Medicine, National Medical Center, 18-79 Euljiro 6-ga, Jung-gu, Seoul, 100-799, South Korea
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Min SK, Sir JJ, Nah JC, Kim YIL. Successful resection of a giant left ventricular pseudoaneurysm developed later after mitral valve replacement. J Korean Med Sci 2010; 25:1080-2. [PMID: 20592903 PMCID: PMC2890888 DOI: 10.3346/jkms.2010.25.7.1080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 07/09/2009] [Indexed: 11/20/2022] Open
Abstract
We present a case of successful surgical resection of a giant left ventricular (LV) pseudoaneurysm that developed 5 yr after mitral valve replacement (MVR). A 59-yr-old female was admitted with exertional chest pain radiating to left arm and back. 64-slice multidetector computed tomography (MDCT) revealed significant stenosis on the ostium of the first diagonal branch of the left anterior descending coronary artery and also a huge pseudoaneurysm compressing the right atrium and the inferior vena cava. She underwent resection of the pseudoaneurysm, and the pseudoaneurysm tunnel was repaired from the inside of LV cavity by removing the previously inserted prosthetic valve, followed by redo MVR together with coronary arterial bypass grafting (CABG) for a single-vessel disease. At the 6-month follow-up, the patient continued to do well without any complications.
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Affiliation(s)
- Sun Kyung Min
- Cardiovascular Center, Department of Cardiovascular and Thoracic Surgery, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Jung-Ju Sir
- Department of Cardiology, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Jong-Chun Nah
- Department of Cardiology, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Yong-In L. Kim
- Cardiovascular Center, Department of Cardiovascular and Thoracic Surgery, Inje University Seoul Paik Hospital, Seoul, Korea
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Sir JJ, Cho YS, Chung WY, Koo BK, Chae IH, Choi DJ, Kim HS, Oh BH, Park YB. Additive Value of B-Type Natriuretic Peptide on Rest Tl-Dipyridamole Stress Tc-Sestamibi Gated Myocardial SPECT in Patients with Normal Left Ventricular Systolic Function. Cardiol Res Pract 2010; 2010:642045. [PMID: 20396662 PMCID: PMC2853079 DOI: 10.4061/2010/642045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 02/01/2010] [Accepted: 02/08/2010] [Indexed: 11/20/2022] Open
Abstract
We evaluated whether BNP has additive value to SPECT in patients with normal left ventricular (LV) systolic function. Data from 224 consecutive patients who underwent rest (201)Tl-dipyridamole stress (99m)Tc-sestamibi gated SPECT and coronary angiography due to chest pain were analyzed. Patients with true positive SPECT showed significant higher BNP level than those with false positive defect (38.5 (19.0-79.8) versus 19.0 (9.3-35.8), P = .01). Patients with true negative SPECT also showed significantly lower BNP level than those with false negative SPECT (39.0 (23.0-77.0) versus 22.0 (15.0-43.0), P = .002). In multivariate analyses, elevated BNP level (using a cut-off value of 23.0 pg/mL) was the strongest and independent predictor of CAD in overall patients (OR 2.75, 95% CI: 1.50-5.023, P = .001) and patients with positive SPECT (OR 3.34, 95% CI: 1.51-7.37, P = .003). The area under the receiver-operating characteristic curve for CAD in overall patients and patients with positive SPECT was 0.673 (95% CI: 0.603-0.743, P < .001) and 0.694 (95% CI: 0.602-0.786, P < .001), respectively. This study suggests that BNP level has additive diagnostic value to SPECT findings in predicting CAD in patients with normal LV systolic function.
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Affiliation(s)
- Jung-Ju Sir
- Department of Internal Medicine, Inje University College of Medicine, Busan 614-735, South Korea
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Park YI, Sir JJ, Park SW, Kim HT, Lee B, Kwak YK, Cho WH, Choi SK. Acute idiopathic hemorrhagic pericarditis with cardiac tamponade as the initial presentation of acquired immune deficiency syndrome. Yonsei Med J 2010; 51:273-5. [PMID: 20191022 PMCID: PMC2824875 DOI: 10.3349/ymj.2010.51.2.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 06/20/2008] [Accepted: 06/20/2008] [Indexed: 11/27/2022] Open
Abstract
This paper presents a case of cardiac tamponade with idiopathic hemorrhagic pericarditis as the initial symptom of human immunodeficiency virus (HIV) infection. A 29-year-old male came to the emergency room with a sudden onset of dizziness. Upon arrival, he was hypotensive although not tachycardic, and his jugular venous pressure was not elevated. His chest X-rays revealed a mild cardiomegaly. Transthoracic echocardiography revealed a large amount of pericardial effusion with a diastolic collapse of the right ventricle, a dilated inferior vena cava with little change in respiration, and exaggerated respiratory variation of mitral inflow velocities, representing echocardiographic evidence of cardiac tamponade. After pericardiocentesis, his blood pressure improved to 110/70 mmHg without inotropics support. Serial 12-lead electrocardiograms during hospitalization revealed upwardly concave diffuse ST-segment elevation followed by a T-wave inversion suggestive of acute pericarditis. Pericardial fluid cytology and cultures for bacteria, mycobacteria, adenovirus, and fungus were all negative. HIV enzyme-linked immunosorbent assay (ELISA) was positive and confirmed by Western blot. The CD4 cell count was 168/mm(3). Finally, the diagnosis of cardiac tamponade due to HIV-associated hemorrhagic pericarditis was made. It was concluded that HIV infection should be considered in the diagnosis of unexplained pericardial effusion or cardiac tamponade in Korea.
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Affiliation(s)
- Young Il Park
- Cardiovascular Center, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jung-Ju Sir
- Cardiovascular Center, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sung-Won Park
- Cardiovascular Center, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hyun-Tae Kim
- Cardiovascular Center, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Bora Lee
- Cardiovascular Center, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Ye-Kyung Kwak
- Cardiovascular Center, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Wook-Hyun Cho
- Cardiovascular Center, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Suk-Koo Choi
- Cardiovascular Center, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Park IK, Sir JJ, Jung HJ, Jo SY, Cho WH, Choi SK. Atypical takotsubo cardiomyopathy associated with nasal packing for paranasal sinus surgery. ACTA ACUST UNITED AC 2009; 11:186-8. [PMID: 20042420 DOI: 10.1093/ejechocard/jep174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Takotsubo cardiomyopathy (TC) is characterized by reversible left ventricular (LV) apical ballooning and no significant coronary artery stenosis. New variants of TC with localized wall motion abnormality or inversed pattern with hyperdynamic apex have been reported. We present the case of a 24-year-old female with atypical presentation of TC occurring in the setting of paranasal sinus surgery under local anaesthesia with post-surgical nasal packing. She did not demonstrate ST-segment elevation on electrocardiogram, but transient moderate LV systolic dysfunction and localized wall motion abnormality affecting basal to mid-ventricular anterior and anteroseptal wall. She rapidly and completely recovered without sequelae.
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Affiliation(s)
- Il-Kwon Park
- Department of Internal Medicine, Cardiovascular Center, Inje University Seoul Paik Hospital, Inje University College of Medicine, 85 Jeo-Dong 2-ga, Jung-Gu, Seoul, Republic of Korea
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Kim JY, Cho HJ, Sir JJ, Kim BK, Hur J, Youn SW, Yang HM, Jun SI, Park KW, Hwang SJ, Kwon YW, Lee HY, Kang HJ, Oh BH, Park YB, Kim HS. Sulfasalazine induces haem oxygenase-1 via ROS-dependent Nrf2 signalling, leading to control of neointimal hyperplasia. Cardiovasc Res 2009; 82:550-60. [PMID: 19234301 DOI: 10.1093/cvr/cvp072] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Inflammation, and the subsequent proliferative activity of vascular smooth muscle cells (VSMCs), is one of the major pathophysiological mechanisms associated with neointimal hyperplasia following vascular injury. Although sulfasalazine (SSZ) has been used as an anti-inflammatory and immune-modulatory agent in various inflammatory diseases, its primary targets and therapeutic effects on vascular disease have not yet been determined. We investigated whether SSZ could suppress VSMC growth and prevent neointimal hyperplasia. METHODS AND RESULTS SSZ was found to have pro-apoptotic and anti-proliferative activity in cultured VSMCs. Unexpectedly, these effects were not mediated by nuclear factor kappa B (NF-kappaB) inhibition, which has been suggested to be the anti-inflammatory mechanism associated with the effects of SSZ. Instead, cell-cycle arrest of the VSMCs was observed, which was mediated by induction of haem oxygenase-1 (HO-1) followed by an increased expression of p21(waf1/Cip1). The underlying mechanism for SSZ-induced HO-1 expression was by reactive oxygen species (ROS)-dependent nuclear translocation and activation of nuclear factor erythroid-2-related factor 2 (Nrf2). In a rat carotid artery balloon injury model, administration of SSZ significantly suppressed neointimal growth. In a series of reverse experiments, inhibition of HO-1 by shRNA, ROS by N-acetylcysteine (NAC) or Nrf2 by dominant-negative Nrf2 abrogated the beneficial effects of SSZ. CONCLUSION Our data demonstrate that SSZ inhibits VSMC proliferation in vitro and in vivo through a novel signalling pathway and may be a promising therapeutic option for the treatment of proliferative vascular disease.
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Affiliation(s)
- Ju-Young Kim
- National Research Laboratory on Cardiovascular Stem Cell, Seoul National University, College of Medicine, Seoul, Korea
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Abstract
Cor triatriatum is a rare congenital cardiac malformation characterized by a fibromuscular membrane that divides the left atrium into two distinct chambers. In almost all cases, it is diagnosed in childhood, whereas adult cases are extremely rare. Herein, we describe an unusual case of cor triatriatum in a 55-year-old woman who presented with embolic cerebral infarction. The patient experienced sudden-onset, transient left-sided homonymous hemianopsia and echocardiography and multidetector computed tomography detected a membrane-like structure across the left atrium, confirming the diagnosis of a cor triatriatum. The laboratory examination for hypercoagulopathy was negative. She was conservatively treated with anticoagulation and her neurological manifestation gradually improved.
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Affiliation(s)
- Kyung-Jun Park
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University, Seoul, Republic of Korea
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Affiliation(s)
- Jung-Ju Sir
- Department of Internal Medicine, Cardiovascular Center, Inje University Seoul Paik Hospital, Inje University, Seoul, Republic of Korea.
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11
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Sir JJ, Chung WY, Hwang SJ, Kang HJ, Cho YS, Koo BK, Chae IH, Choi DJ, Kim HS, Sohn DW, Kim CH, Oh BH, Park YB, Choi YS. N-terminal pro-B-type natriuretic peptide as a predictor of repeat coronary revascularization. Int J Cardiol 2008; 126:322-32. [PMID: 17544525 DOI: 10.1016/j.ijcard.2007.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 03/29/2007] [Accepted: 04/01/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent studies suggest that natriuretic peptides are potential biomarkers for myocardial ischemia. However, little is known about the value of NT-proBNP as a predictor of repeat revascularization (RR) at follow-up angiography in patients with normal LV systolic function. METHODS We collected and analyzed the clinical and angiographic data from 445 consecutive patients (62.5+/-10.1 years; 73% males) who showed normal LV systolic function and no regional wall motion abnormalities on transthoracic echocardiogram performed at baseline and follow-up angiography. RESULTS Overall, NT-proBNP level on admission for follow-up angiography was significantly higher in patients with RR (n=55) than those without RR (n=390) [92.4 (47.5-178.5) pg/ml vs. 54.8 (30.6-93.1) pg/ml, P<0.001]. In asymptomatic patients, NT-proBNP did not show significant difference between patients with RR and those without RR (P=0.42). An elevated NT-proBNP level, especially in symptomatic patients (n=77) (>87.5 pg/ml as an optimal cut off value) was a strong independent predictor for RR at follow-up angiography (OR, 12.3; 95% CI, 3.25-46.2; P=0.001). NT-proBNP (>122.9 pg/ml) showed high specificity (85.9%) and negative predictive value (91.0%) for predicting RR in overall patients. However, NT-proBNP (>97.0 pg/ml) showed low sensitivity (49.1%) and positive predictive value (23.5%). The areas under the receiver operator characteristic (ROC) curve in predicting RR in overall patients and symptomatic patients were 0.648 (95% CI; 0.564-0.732, P<0.001) and 0.768 (95% CI; 0.653-0.884, P<0.001), respectively. CONCLUSION Our data show that NT-proBNP level at follow-up is a strong independent predictor for RR especially in symptomatic patients. Although routine measurement may be not useful for predict RR, NT-proBNP may help to identify patients with low risk of repeat revascularization.
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Affiliation(s)
- Jung-Ju Sir
- Department of Internal Medicine, Inje University College of Medicine, Cardiovascular Center, Seoul Paik Hospital, South Korea
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Lee B, Sir JJ, Park SW, Kim SB, Nah JC, Kang YK, Lee HK, Kim YI, Cho WH, Choi SK. Right-sided myxomas with extramedullary hematopoiesis and ossification in Carney complex. Int J Cardiol 2008; 130:e63-5. [PMID: 18230408 DOI: 10.1016/j.ijcard.2007.11.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Revised: 08/18/2007] [Accepted: 11/12/2007] [Indexed: 11/25/2022]
Abstract
The authors report the case of multiple right-sided myxomas in a 42-year-old man with Carney complex. He had previously been diagnosed as Cushing's syndrome and undergone resection of pituitary adenoma at the age of 21. After 10 years, bilateral adrenalectomy had been performed with recurrence of Cushing's syndrome. Recently, he complained of palpitation and intracardiac masses were detected. On physical examination, he had nevi on the lips and in the oral cavity. A tiny eyelid nodule was noted and histopathological analysis confirmed the diagnosis of skin myxoma. Thyroid ultrasonography revealed multiple hypoechoic nodules, which were confirmed pathologically as follicular adenomas. Scrotal ultrasonography also revealed small multiple testicular tumors. Echocardiography demonstrated intracardiac masses in right atrium and right ventricle. Right atriotomy revealed a right atrial mass attached to the annulus of the tricuspid valve and another mass arising from the interatrial septum. In right ventricle, a polypoid mass arose from the anterior leaflet of the tricuspid valve. Also, there were multiple tiny to small masses on the interatrial septum. The masses were completely excised and the tricuspid valve was repaired with annuloplasty. Histopathological analysis confirmed myxomas with foci of extramedullary hematopoiesis and ossification.
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Nah JC, Lee B, Kwak CH, Kim SB, Kim SM, Park SW, Kang YK, Lee HK, Ku BI, Sir JJ, Cho WH, Choi SK. Spontaneous rupture of idiopathic thymic abscess with a markedly increased CA-125 level. Intern Med 2008; 47:953-6. [PMID: 18480581 DOI: 10.2169/internalmedicine.47.0699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a rare case of spontaneous rupture of idiopathic thymic abscess into the pleural cavity. A 64-year-old woman was admitted to hospital with pleuritic retrosternal chest pain. Chest roentgenograms disclosed a small amount of bilateral pleural effusion, the examination of which exposed a sterile serous exudate with a markedly increased CA-125 level. Chest computed tomography revealed a large anterior mediastinal cystic mass with bilateral pleural effusions. Following complete resection of the mass, the histological examination revealed cavitary lesion with necrotic thymic tissue and inflammatory infiltrate surrounded by fibrous wall. The immunohistochemical staining for CA-125 displayed strong positivity at the Hassall's corpuscles. Cyst fluid also revealed a highly elevated CA-125 level. Her serum CA-125 concentration two months after surgery had fallen to 28 IU/L. She is now doing well without recurrence of the cyst five months after surgery.
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Affiliation(s)
- Jong-Chun Nah
- Department of Internal Medicine, Inje University, College of Medicine, Seoul Paik Hospital, Seoul, Republic of Korea
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Kim HL, Park KW, Kwak JJ, Kim YS, Sir JJ, Lee SJ, Lee HY, Chang HJ, Kang HJ, Cho YS, Chung WY, Chae IH, Choi DJ, Kim HS, Oh BH, Park YB, Koo BK. Stent-related cardiac events after non-cardiac surgery: Drug-eluting stent vs. bare metal stent. Int J Cardiol 2008; 123:353-4. [PMID: 17346821 DOI: 10.1016/j.ijcard.2006.11.182] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Accepted: 11/18/2006] [Indexed: 12/15/2022]
Abstract
For evaluation of post-operative stent associated cardiac events after drug-eluting stent (DES) implantation we analyzed data of 138 patients who underwent non-cardiac surgery after DES implantation and compared the data with those of 101 patients who underwent non-cardiac surgery after bare metal stent (BMS) implantation. Three patients (2.2%) in DES group developed post-operative cardiac events and none in BMS group (p=0.2). One patient died due to suspected stent thrombosis and the other two had myocardial infarction due to angiographically proven stent thrombosis. The time interval between stent implantation and surgery in those with cardiac events was 6, 264, and 367 days, respectively. Our data shows that peri-operative stent-related thrombotic complications can occur long after DES implantation and careful peri-operative monitoring for cardiac events is needed in patients receiving non-cardiac surgery after DES implantation.
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Lee B, Park SW, Nah JC, Kim SW, Koo BI, Cho WH, Sir JJ, Choi SK. Clinical image: popliteal artery pseudoaneurysm following arthroscopic synovectomy. ACTA ACUST UNITED AC 2007; 56:3432. [PMID: 17907142 DOI: 10.1002/art.22958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bora Lee
- Seoul Paik Hospital, Inje University College of Medicine, Seoul, South Korea
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Kim SH, Kim TB, Yun YS, Shin JI, Oh IY, Sir JJ, Kim KM, Park HK, Kang HR, Chang YS, Kim YK, Cho SH, Song YW, Choi DC, Min KU, Kim YY. Hypereosinophilia presenting as eosinophilic vasculitis and multiple peripheral artery occlusions without organ involvement. J Korean Med Sci 2005; 20:677-9. [PMID: 16100465 PMCID: PMC2782169 DOI: 10.3346/jkms.2005.20.4.677] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report here a case with hypereosinophilia and peripheral artery occlusion. A 32-yr-old Korean woman presented to us with lower extremity swelling and pain. Angiography revealed that multiple lower extremity arteries were occlusive. The biopsy specimen showed perivascular and periadnexal dense eosinophilic infiltration in dermis and subcutaneous adipose tissue. Laboratory investigations revealed a persistent hypereosinophilia. She was prescribed prednisolone 60 mg daily. Her skin lesion and pain were improved and the eosinophil count was dramatically decreased. After discharge, eosinophil count gradually increased again. Cyanosis and pain of her fingers recurred. She had been treated with cyclophosphamide pulse therapy. Her eosinophilia was decreased, but the cyanosis and tingling sense were progressive. The extremity arterial stenoses were slightly progressed. Skin biopsy showed perivascular eosinophilic infiltration in the dermis and CD40 ligand (CD40L) positive eosinophilic infiltration. The serum TNF-alpah was markedly increased. These results suggest that CD40L (a member of TNF-alpah superfamily) could play a role in the inflammatory processes when eosinophil infiltration and activation are observed. We prescribed prednisolone, cyclophosphamide, clopidogrel, cilostazol, beraprost and nifedipine, and she was discharged.
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Affiliation(s)
- Sung-Hwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Sun Yun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Im Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Il-Young Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Ju Sir
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Mook Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hye-Kyung Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hye-Ryun Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon-Keun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yeong-Wook Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Chul Choi
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Kyung-Up Min
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - You-Young Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Park KW, Kim DH, You HJ, Sir JJ, Jeon SI, Youn SW, Yang HM, Skurk C, Park YB, Walsh K, Kim HS. Activated forkhead transcription factor inhibits neointimal hyperplasia after angioplasty through induction of p27. Arterioscler Thromb Vasc Biol 2005; 25:742-7. [PMID: 15662024 DOI: 10.1161/01.atv.0000156288.70849.26] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We examined the effects of FKHRL1 (forkhead transcription factor in rhabdomyosarcoma like-1) overexpression on vascular smooth muscle cell (VSMC) proliferation, apoptosis, and cell cycle, in vitro, and the role of FKHRL1 and p27 in the pathophysiology of neointimal growth after balloon angioplasty, in vivo. Furthermore, we tested whether FKHRL1 overexpression can inhibit neointimal hyperplasia in a rat carotid artery model. METHODS AND RESULTS Adenovirus expressing the constitutively active FKHRL1 (FKHRL1-TM; triple mutant) with 3 Akt phosphorylation sites mutated was transfected to subconfluent VSMCs. FKHRL1 overexpression in cultured VSMCs increased p27 expression, leading to G1 phase cell-cycle arrest and increased apoptosis. In vivo, the phosphorylation of FKHRL1 increased significantly 3 hours after balloon injury and decreased thereafter, with the subsequent downregulation of p27. Although the phosphorylation of FKHRL1 was greatest at 3 hours, the downregulation of p27 showed a temporal delay, only slightly starting to decrease after 3 hours and reaching a nadir at 72 hours after balloon injury. Gene transfer of FKHRL1-TM increased p27, decreased proliferation, and increased apoptosis of VSMCs, which resulted in a marked reduction in neointima formation (intima-to-media ratio: 0.31+/-0.13 versus 1.17+/-0.28, for FKHRL1-TM versus Adv-GFP; P<0.001). CONCLUSIONS Balloon angioplasty leads to the phosphorylation of FKHRL1 and decreased expression of p27, thereby promoting a proliferative phenotype in VSMCs in vitro and in vivo. This study reveals the importance of FKHRL1 in proliferation and viability of VSMCs and suggests that it may serve as a molecular target for interventions to reduce neointima formation after angioplasty.
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MESH Headings
- Angioplasty, Balloon/adverse effects
- Animals
- Aorta, Thoracic/injuries
- Aorta, Thoracic/pathology
- Aorta, Thoracic/physiology
- Apoptosis/physiology
- Cell Cycle Proteins/metabolism
- Cell Survival/physiology
- Cells, Cultured
- Cyclin-Dependent Kinase Inhibitor p27
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/metabolism
- Forkhead Box Protein O1
- Forkhead Box Protein O3
- Forkhead Transcription Factors
- Gene Expression
- Gene Transfer Techniques
- Humans
- Hyperplasia
- Male
- Muscle, Smooth, Vascular/injuries
- Muscle, Smooth, Vascular/pathology
- Muscle, Smooth, Vascular/physiology
- Nerve Tissue Proteins
- Phosphorylation
- Rats
- Rats, Sprague-Dawley
- Transcription Factors/genetics
- Transcription Factors/metabolism
- Tumor Suppressor Proteins/metabolism
- Tunica Intima/pathology
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Affiliation(s)
- Kyung-Woo Park
- Cardiovascular Laboratory, Clinical Research Institute, Seoul National University Hospital, Korea
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