We describe a 54-year-old woman with isolated pulmonary arterial hypertension accompanied by hyperthyroidism due to Graves' disease. Her pulmonary artery hypertension resolved spontaneously after restoration of euthyroidism. This case suggests that hyperthyroidism should be considered a reversible cause of pulmonary arterial hypertension.
Female ; Graves Disease ; Humans ; Hypertension ; Hypertension, Pulmonary ; Hyperthyroidism ; Middle Aged ; Pulmonary Artery

We recently encountered an interesting case of acute inferior ST segment elevation myocardial infarction (STEMI). This patient had a rare anatomic variation, single coronary artery. The right coronary artery originate from the left circumflex proper artery, not from aorta, was totally obstructed with thrombi. Though it took more time to figure out the patient's coronary anatomy and the culprit lesion, we successfully performed primary percutaneous coronary intervention within the guideline-recommended time period. We performed left coronary angiography at the beginning. This strategy could be helpful in determining the culprit lesion and preventing unnecessary procedural delay in acute inferior STEMI.
Anatomic Variation ; Aorta ; Arteries ; Coronary Angiography ; Coronary Vessel Anomalies ; Coronary Vessels* ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention

We report a case of a cardiac lipoma arising from the free wall of right atrium, which was diagnosed as the presumed source of angina by compressing the right coronary artery in a 54-year-old woman. Surgical excision of the tumor was performed well. She continues to do well for six months without angina.
Coronary Vessels ; Female ; Heart Atria ; Humans ; Lipoma ; Middle Aged

Multivascular preventive and therapeutic approaches are necessary in patients with coronary artery disease because atherosclerosis has a common systemic pathogenesis. We present a rare case of sudden cardiac arrest with acute myocardial infarction induced by the total occlusion of left subclavian artery (LSCA) in a patient with a history of previous coronary artery bypass surgery using the left internal mammary artery. We initially performed blind-puncture of left brachial artery, attempting percutaneous coronary intervention because pulses were absent in both upper and lower extremities. However, the cause of sudden cardiac arrest was atherosclerotic total occlusion of LSCA. The patient was stabilized after successful revascularization of LSCA by percutaneous transluminal angioplasty with stent insertion.
Angioplasty ; Atherosclerosis ; Brachial Artery ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vessels ; Death, Sudden, Cardiac ; Humans ; Lower Extremity ; Mammary Arteries ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Stents ; Subclavian Artery

In hepatocellular carcinoma distant metastasis after curative surgical resection without intrahepatic metastasis is very rare. A 55-year old man presented with a huge pelvic bone mass. Eight years ago he underwent posterior hepatic segmentectomy following diagnosis of hepatocelluar carcinoma. He has received regular check-ups with abdominal ultrasonography and serum alpha-fetoprotein. On admission an MRI on the pelvic area showed an 18x10 cm sized lobulated mass invading the pelvic bone and acetabulum. Microscopic examination revealed that the tumor was a well differentiated hepatocellular carcinoma. There was no evidence of intrahepatic recurrence. He was treated with transarterial chemoembolization, external radiotherapy (total 3750 cGy), and systemic chemotherapy using 5-fluorouracil.
Acetabulum ; alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Diagnosis ; Drug Therapy ; Fluorouracil ; Humans ; Magnetic Resonance Imaging ; Mastectomy, Segmental ; Middle Aged ; Neoplasm Metastasis* ; Pelvic Bones* ; Radiotherapy ; Recurrence* ; Ultrasonography

A 44-year-old man, who had a history of myocardial infarction (MI) due to thrombotic occlusion of right coronary artery (RCA) aneurysm, visited emergency department presenting with ST-segment elevation myocardial infarction (STEMI). The patient had been on oral anticoagulant therapy (warfarin) from the first thrombotic event, but the medication had been recently changed to aspirin 4 months before the second event. Emergent coronary angiography revealed thrombotic total occlusion of RCA with heavy thrombotic burden from middle RCA to the ostium of the posterior descending branch. Combination pharmacotherapy was performed with anticoagulants (heparin), fibrinolytics (urokinase), and Glycoprotein IIb/IIIa antagonists (abciximab), in addition to mechanical thrombosuction. However, on hospital day 2, the patient complained recurrent chest pain and again underwent coronary angiography, which revealed distal embolization of large thrombus to the posterior lateral branch. Coronary flow was recovered after repeated mechanical thrombosuction was performed. This case has shown the importance of aggressive combination drug therapy, accompanied by mechanical thrombosuction in patient with myocardial infarction due to thrombotic occlusion of coronary artery aneurysm and the importance of unceasing life-long anticoagulant therapy in those particular patients.
Adult ; Aneurysm* ; Anticoagulants ; Aspirin ; Chest Pain ; Coronary Aneurysm ; Coronary Angiography ; Coronary Occlusion* ; Coronary Vessels* ; Drug Therapy ; Drug Therapy, Combination ; Emergency Service, Hospital ; Glycoproteins ; Humans ; Myocardial Infarction* ; Thrombectomy ; Thrombosis ; Warfarin*

Cardiopulmonary bypass (CPB) is widely used for cardiac surgery by virtue of its proven safety over the course of its use during the past half century. Even though perfusion is safer, incidents still occur. During the repair of a ventricular-septal defect in an 11-month-old infant, we experienced a critical incident related to the potential hazardous effect of volatile anesthetics on the polycarbonate connector of extra-corporeal circuit. The damage to the polycarbonate connector had occurred after spillage of isoflurane during the filling of the vaporizer, causing it to crack and leak. The incident was managed by replacement of the cracked connector during a temporary circulatory arrest. The patient was hypothermic and the time off bypass was less than 1.5 min. There were no neurologic sequelae, the patient made an uneventful recovery. In conclusion, the spillage of volatile anesthetics can cause cracks in the polycarbonate connector of the extra-corporeal circuit, leading to potentially interruption of CPB.
Anesthetics ; Cardiopulmonary Bypass ; Humans ; Infant ; Isoflurane ; Nebulizers and Vaporizers ; Perfusion ; Polycarboxylate Cement ; Thoracic Surgery ; Virtues

BACKGROUND: As single donor platelets (SDP) has been increasingly used, the quality of SDP, especially apheresis-induced platelet activation, has become a major issue. This study evaluated the activation of SDP platelets prepared with three different cell separators that are currently being used at the Korean Red Cross. METHODS: CD62p, CD63 and CD42 were measured in 35 units of SDP prepared with Amicus (Baxter, Deerfield, IL, USA), MCS+ (Haemonetics, Braintree, MA, USA), or Trima (Gambro BCT, Lakewood, USA) using flow cytometry. RESULTS: Expression of CD62p gradually increased with storage time, but no difference in expression was noted between cell separators. Expression of CD63 also increased with storage time and platelets prepared with the Amicus displayed significantly higher CD63 expression 72 and 120 hours after collection compared to those prepared with MCS+ and Trima. Expression of CD42b tended to decrease with storage time, but this was only significant for Amicus 120 hours after collection. No difference in CD42b expression was noted between cell separators. CONCLUSIONS: Platelet activation increased with storage time, and platelet activation was more pronounced in the platelets prepared with the Amicus. However, because in vitro results of platelet activation does not necessarily reflect in vivo platelet function and survival, additional studies are needed to clarify clinical effectiveness of activated platelets.
Blood Platelets* ; Flow Cytometry ; Humans ; Platelet Activation* ; Plateletpheresis* ; Red Cross ; Tissue Donors

Amyloidosis of the prostate is a rare disease. With more patients undergoing biopsy of the prostate to exclude malignancy, the likelihood of identifying primary or secondary amyloidosis of the prostate has increased. We report a case of amyloidosis of the prostate in a 70-year-old man. The diagnosis was made from prostatic biopsy. Later, he was diagnosed with prostatic adenocarcinoma after transurethral resection of the prostate due to persistent lower urinary tract symptoms.
Adenocarcinoma ; Aged ; Amyloidosis* ; Biopsy ; Diagnosis ; Humans ; Lower Urinary Tract Symptoms ; Prostate* ; Rare Diseases

Amyloidosis of the prostate is a rare disease. With more patients undergoing biopsy of the prostate to exclude malignancy, the likelihood of identifying primary or secondary amyloidosis of the prostate has increased. We report a case of amyloidosis of the prostate in a 70-year-old man. The diagnosis was made from prostatic biopsy. Later, he was diagnosed with prostatic adenocarcinoma after transurethral resection of the prostate due to persistent lower urinary tract symptoms.
Adenocarcinoma ; Aged ; Amyloidosis* ; Biopsy ; Diagnosis ; Humans ; Lower Urinary Tract Symptoms ; Prostate* ; Rare Diseases