No abstract available.
Cholecystitis ; Emphysematous Cholecystitis* ; Pneumoperitoneum*

Antiphospholipid antibody syndrome (APS) is characterized by raised levels of antiphospholipid antibodies (aPL), in association with thrombosis, recurrent fetal loss, and thrombocytopenia. Development of APS is related with idiopathic origin, autoimmune disease, malignancy and, on rare occasions, infection. However, in secondary APS combined with bacterial infections, aPL is usually shown with low titer and rarely associated with thrombotic events. A 52-year-old male was admitted due to pneumonia and multiple hepatosplenic abscesses. He had been treated with proper antibiotics, but he presented ascites and sudden variceal bleeding because of portal vein thrombosis. The bleeding was controlled by endoscopic variceal ligation. Acute portal vein thrombosis was successfully managed by low molecular weight heparin and hepatosplenic abscesses were completely resolved by antibiotics. This case suggests that systemic bacterial infection in immunocompetent patients possibly develops into secondary APS.
Abscess ; Anti-Bacterial Agents ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Ascites ; Bacterial Infections* ; Esophageal and Gastric Varices* ; Gastrointestinal Hemorrhage* ; Heparin, Low-Molecular-Weight ; Humans ; Ligation ; Male ; Middle Aged ; Pneumonia ; Portal Vein ; Thrombocytopenia ; Venous Thrombosis

Amiodarone has been widely used for supraventricular and ventricular arrhythmias and many patients benefit from its effectiveness in treating potentially life-threatening arrhythmias. However, this drug can cause multi-organ toxicity, including amiodarone-induced pulmonary toxicity (APT). Not only does amiodarone have a long half-life but also is lipophilic and therefore can easily accumulate in tissues. Hence, it is difficult to monitor therapeutic levels and side effects, making it difficult to predict toxicities. In this case, we describe multi-organ complications secondary to amiodarone use, especially APT combined with pneumonia with atypical pathogens and pulmonary hemorrhage. The patient reached a high cumulative dose of amiodarone despite a low maintenance dose of amiodarone. This case highlights an unusual presentation of APT with multi-organ toxicity and we review articles regarding the association between the cumulative dose of amiodarone and amiodarone-induced toxicities.
Amiodarone* ; Arrhythmias, Cardiac ; Biopsy, Needle* ; Drug Toxicity* ; Half-Life ; Hemorrhage ; Humans ; Pneumonia ; Respiratory Insufficiency

No abstract available.
Colon ; Lipoma

Arterial remodeling is commonly observed in human atherosclerosis. It is a heterogeneous response ranging from positive remodeling to negative remodeling. Negative remodeling is a condition in which the vessel area decreases in size, often as a result of a structural change in the coronary vessel wall. But its contribution to myocardial ischemia in a de novo lesion has not been clearly shown. A 51-year-old female with exertional angina was admitted to our hospital. Coronary angiography was performed, revealing a severe stenosis at the middle part of the right coronary artery (RCA). Although we predilated ballooning at the middle RCA, the degree of stenosis did not improve. Thus intravascular ultrasound (IVUS) was performed. The lesion was not nearly showed plaque burden and severe negative remodeling. Though the cross-sectional narrowing percentage was significant, we decided to medical treatment for fearing coronary perforation by stenting. This case report intends to emphasize that severe coronary stenosis should be performed IVUS before the stenting. We describe a rare case with severe negative remodeling at the middle part of the RCA without atheroma plaque.
Atherosclerosis ; Constriction, Pathologic ; Coronary Angiography ; Coronary Stenosis ; Coronary Vessels ; Female ; Glycosaminoglycans ; Humans ; Myocardial Ischemia ; Plaque, Atherosclerotic ; Stents

Trisomy 22 is closely associated with inv(16) or t(16;16) and could be a marker of cryptic rearrangement of CBFB/MYH11 in acute myeloid leukemia (AML). Trisomy 22 not associated with CBFB/MYH11 rearrangement is a rare event. Here, we report a case diagnosed as refractory anemia with excess blasts-2 (RAEB-2) with sole trisomy 22 in the absence of CBFB/MYH11 rearrangement. The cytogenetic study of bone marrow cells disclosed trisomy 22 in 10% of metaphase cells analyzed. The other chromosomal abnormalities were not found. Fluorescence in situ hybridization (FISH) using CBFB/MYH11 probe to detect cryptic inv(16)(p13q22) showed negative result. We also excluded rearrangements of chromosome 5, 7, 8, 20, and ETV6 by FISH. Sole trisomy 22 not associated with inv(16) is a true entity.
Anemia, Refractory ; Bone Marrow Cells ; Chromosome Aberrations ; Chromosomes, Human, Pair 22 ; Chromosomes, Human, Pair 5 ; Cytogenetics ; Fluorescence ; In Situ Hybridization ; Leukemia, Myeloid, Acute ; Metaphase ; Myelodysplastic Syndromes ; Trisomy

Polyuria is occasionally observed during general anesthesia. Usually urine output during general anesthesia is decreased because of anesthetic agents. The authors came across with a case of polyruia during sevoflurane anesthesia which occurred after induction of anesthesia. Polyuria is a nonspecific symptom, but can cause many serious complications. Therefore, it is very important to investigate the cause thoroughly and treat patient appropriately.
Anesthesia ; Anesthesia, General ; Anesthetics ; Humans ; Methyl Ethers ; Polyuria ; Porphyrins

Patients with chronic renal failure (CRF) are known to be more susceptible to tuberculosis infection due to impairment of the host defense mechanism. Although extrapulmonary tuberculosis is more prevalent in those subjects and it may induce dismal outcome, its diagnosis has been challenging since there is no specific symptoms of the disease and the clinical course is usually atypical. Herein, We report a case of disseminated tuberculosis diagnosed by ultrasound-guided liver biopsy in a 31-year-old CRF patient presenting sustained fever despite broad-spectrum antimicrobial therapy and progressive cholestatic jaundice.
Biopsy ; Fever ; Humans ; Jaundice, Obstructive ; Kidney Failure, Chronic ; Liver ; Tuberculosis

Transcatheter arterial chemoembolization (TACE) has become an effective alternative treatment strategy for patients with inoperable hepatocellular carcinoma (HCC). Although TACE is relatively safe, acute respiratory distress syndrome associated with pulmonary lipiodol embolism is a rare and potentially fatal complication. We report a rare case of acute respiratory distress syndrome after TACE for inoperable HCC. A 75-year-old man, with huge HCC in right lobe, was treated by TACE for the first time. Seven hours after uneventful TACE procedure, he felt dyspneic and his oxygen saturation recorded by pulse oximetry (SpO2) fell to 80% despite of applying non-rebreathing mask. He underwent mechanical ventilation with a protective ventilatory strategy. We experienced a case of acute respiratory distress syndrome after TACE for HCC.
Carcinoma, Hepatocellular ; Embolism ; Ethiodized Oil ; Humans ; Masks ; Oximetry ; Oxygen ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult

With the aging population, more patients who have undergone previous coronary artery bypass grafting (CABG) are surviving long enough to require subsequent aortic valve replacement (AVR). Conventional redo AVR after prior CABG involves resternotomy, dissection and clamping of the patent bypass graft vessel. Favorable results have been reported for AVR following previous CABG; however, the problems of this procedure includes that injury to the patent bypass grafts can result in catastrophic complications. Increasing patient age and comorbidities may increase operative mortality, less invasive percutaneous aortic valve intervention has advanced. However, because there are no sufficient data comparing transcatheter aortic valve intervention with surgical AVR, currently, the surgical approach should still be consider as the standard of treatment for AVR following previous CABG. We report a patient in whom successful conventional AVR was underwent after previous CABG with patent left internal mammary artery.
Aging ; Aortic Valve Stenosis ; Aortic Valve* ; Comorbidity ; Constriction ; Coronary Artery Bypass* ; Coronary Vessels* ; Heart Valve Prosthesis Implantation ; Humans ; Mammary Arteries* ; Mortality ; Transplants