We report a case of acute pancreatitis secondary to pancreatic neuroendocrine tumor. A 46-year old man presented with upper abdominal pain. The serum amylase and lipase were elevated. Abdominal computed tomography (CT) and magnetic resonance cholangiopancreatography revealed a 1.7 cm sized mass at the pancreas body with a dilatation of the upstream pancreatic duct and mild infiltrations of peripancreatic fat. An endoscopic ultrasound-guided fine needle biopsy was performed for the pancreatic mass, but only necrotic tissue was observed on the pathologic examination. A chest and neck CT scan revealed anterior mediastinal, paratracheal, and cervical lymph node enlargement, which were indicative of metastasis. An ultrasound-guided core needle biopsy was performed for the enlarged neck lymph node, and pathologic examination revealed a metastatic poorly differentiated carcinoma. Immunohistochemical analysis showed positive staining for synaptophysin, chromogranin A, and CD 56, indicative of a neuroendocrine carcinoma.
Abdominal Pain ; Amylases ; Biopsy, Fine-Needle ; Biopsy, Large-Core Needle ; Carcinoma, Neuroendocrine ; Cholangiopancreatography, Magnetic Resonance ; Chromogranin A ; Dilatation ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Lipase ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Pancreas ; Pancreatic Ducts ; Pancreatitis ; Synaptophysin ; Thorax ; Tomography, X-Ray Computed

Drug-eluting stents (DESs) are the treatment of choice for obstructive coronary artery disease when percutaneous intervention is feasible. However, late stent thrombosis seems to occur more frequently with DESs and is closely associated with the discontinuation of dual antiplatelet therapy. We report a case of very late stent thrombosis after discontinuation of dual antiplatelet therapy. The patient suffered from acute myocardial infarction (MI) and underwent bare metal stent (BMS) implantation in the left anterior descending artery (LAD) five years prior to presentation. Three years after BMS implantation, he presented again with acute MI and had a DES implanted in the right coronary artery (RCA). He ran out of his medication, but failed to refill his prescription. Sixteen days after discontinuing medication, he experienced an episode of chest pain and was taken to the cardiac catheterization laboratory, where he was found to have thrombosis in the DES, but no thrombosis in the BMS. It is possible that DESs are more vulnerable to late thrombosis than are BMSs, supporting the use of prolonged dual antiplatelet therapy in patients treated with DESs. The patient was successfully treated with balloon angioplasty and thrombus aspiration without complications.
Angioplasty, Balloon ; Arteries ; Blood Platelets ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Coronary Artery Disease ; Coronary Vessels ; Drug-Eluting Stents ; Humans ; Myocardial Infarction ; Prescriptions ; Stents ; Thrombosis

No abstract available.
Coronary Angiography ; Diagnosis, Differential ; Electrocardiography ; Heart Neoplasms/*secondary/therapy ; Humans ; Lung Neoplasms/*pathology/therapy ; Male ; Myocardial Infarction/*diagnosis ; Neoplasm Invasiveness ; *Neoplasm Recurrence, Local ; Predictive Value of Tests ; Tomography, X-Ray Computed

BACKGROUND/AIMS: It is known that mortality increases with age for patients who suffer with acute myocardial infarction (AMI). Yet there isn't much data on the clinical characteristics and long-term prognosis of young patients with AMI. METHODS: We analyzed two groups of patients with AMI who underwent coronary angiogram : 108 patients younger than 40 years as group I and 64 patients over 70 years old as group II. We compared the baseline clinical characteristics, the echocardiographic and coronary angiographic findings, and the major adverse cardiac event (MACE). RESULTS: Male gender (94.4% vs. 56.1%, respectively, p<0.001), smoking (78.7% vs. 46.9%, respectively, p<0.001) and hyperlipidemia (45.4% vs. 14.1%, respectively, p<0.001) were more frequent in group I, whereas hypertension (23.1% vs. 40.6%, respectively, p=0.015) and diabetes (11.6% vs. 34.4%, respectively, p<0.001) were more common in group II. The left ventricular ejection fraction (55.1+/-12.2% vs. 50.5+/-14.1%, respectively, p=0.042) was higher in group I. The serum levels of high sensitivity C-reactive protein (1.7+/-2.6 vs. 3.4+/-4.4 mg/L, respectively, p=0.015) and homocysteine (11.5+/-7.0 vs. 15.3+/-9.7 microgram/L, respectively, p=0.029) were higher in group II. One vessel disease (78.7% vs. 59.4%, respectively, p=0.007) and good Thrombolysis In Myocardial Infarction (TIMI) flow (TIMI II-III, 58.3% vs. 41.2%, respectively, p=0.040) were more common in group 1. There were no differences between the two groups for the development of MACE during the 28+/-21 months of clinical follow-up, but cardiac death was lower in group I than in group II (2.1% vs. 15.4%, respectively, p=0.002). CONCLUSIONS: Male gender, smoking and hyperlipidemia were the major risk factors of Korean young AMI patients. In addition, single vessel disease and good TIMI flow were more frequent and cardiac death was less frequent in the younger AMI patients.
C-Reactive Protein ; Death ; Follow-Up Studies ; Glycosaminoglycans ; Homocysteine ; Humans ; Hyperlipidemias ; Hypertension ; Male ; Myocardial Infarction ; Prognosis ; Risk Factors ; Smoke ; Smoking ; Stroke Volume

The centipede is an elongated and multi-segmented arthropod with a venom apparatus that consists of modified legs on either side of the body just behind the head. Generally, centipede envenomation causes local tissue swelling, redness, pruritus, swollen and painful lymph nodes, headache, nausea, vomiting and anxiety. Adverse systemic reactions such as acute renal failure, rhabdomyolysis and acute myocardial infarction have been associated with centipede bite. We experienced a case of a 57-year-old man who complained of severe chest pain after a centipede (20 cm in length) bite. The electrocardiogram recorded at the emergency medical center showed ST-T changes in the precordial leads. The levels of cardiac enzyme were not elevated [creatine kinase (CK) 101 U/L (35~172), CK-MB 5.1 U/L (2.3~9.5), troponin I 0.06 ng/mL (0~0.05), troponin T 0.02 ng/mL (0~0.1)]. He had a history of percutaneous coronary intervention in the left circumflex artery under the diagnosis of acute myocardial infarction 4 years ago. The emergency coronary angiogram revealed severe diffuse coronary artery spasm in the left coronary artery, which was improved after intracoronary nitroglycerin injection, and patent previously placed stent in the left circumflex artery was noted. He improved after medical treatment and was discharged on the eleventh day without any remained subjective symptoms.
Acute Kidney Injury ; Anxiety ; Arteries ; Arthropods ; Chest Pain ; Coronary Disease ; Coronary Vessels* ; Diagnosis ; Electrocardiography ; Emergencies ; Head ; Headache ; Humans ; Leg ; Lymph Nodes ; Middle Aged ; Myocardial Infarction ; Nausea ; Nitroglycerin ; Percutaneous Coronary Intervention ; Phosphotransferases ; Pruritus ; Rhabdomyolysis ; Spasm* ; Stents ; Troponin I ; Troponin T ; Venoms ; Vomiting

Maternal septic shock and disseminated intravascular coagulation (DIC) following amniocentesis is a relatively rare condition, and its incidence is only 0.03~0.19%. Acute myocardial infarction (AMI) associated with DIC is also rare. We report here on a 40-year-old female patient who had septic shock and DIC that was complicated by AMI following amniocentesis. The possible mechanism of AMI in this patient may have been coronary artery thrombosis associated with DIC.
Shock, Septic/*etiology ; Pregnancy ; Myocardial Infarction/*etiology ; Humans ; Female ; Disseminated Intravascular Coagulation/*complications/*etiology ; Amniocentesis/*adverse effects ; Adult

BACKGROUND AND OBJECTIVES: Carotid intima-media thickness (IMT) has been associated with an increased risk of ischemic stroke. To better understand this association, we evaluated the relationships of vascular risk factors, including carotid IMT and carotid plaque, and large territory cerebral infarction and small vessel stroke. SUBJECTS AND METHODS: A total of 502 patients with acute ischemic stroke were divided into two groups according to neurologic examinations and imaging studies; 1) a large territory infarction group (group I: n=126, 64.4+/-11 years, 78 males) and 2) a small vessel stroke group (group II: n=376, 62.5+/-11 years, 242 males). We evaluated associations between (a) territory and non-territory strokes and (b) age, sex, potential vascular risk factors, carotid image and cardiac function (by echocardiography). RESULTS: We did not find significant between group differences of age, sex, diabetes, previous history of ischemic stroke, plaque (presence, site and size of carotid plaque), and velocity of carotid blood flow and left ventricle ejection fraction. However, group I had a higher incidence of hypertension (p=0.006), smoking (p=0.003), and dyslipidemia (p=0.001). Group I had thicker carotid IMT than group II (right carotid: 0.81+/-0.21 mm vs. 0.76+/-0.19 mm, p=0.035; left carotid: 0.88+/-0.23 mm vs. 0.80+/-0.20 mm, p=0.014) and a higher e/e' level (12.08 vs. 9.66, p<0.001). Dyslipidemia, thicker carotid IMT and elevated E/E' ratios were significant independent predictors for large territory infarction in patients with ischemic stroke. CONCLUSION: Carotid IMT is significantly increased in patients with large territory infarction compared with those with small vessel stroke.
Carotid Arteries ; Carotid Intima-Media Thickness ; Cerebral Infarction ; Dyslipidemias ; Glycosaminoglycans ; Heart Ventricles ; Humans ; Hypertension ; Incidence ; Infarction ; Neurologic Examination ; Risk Factors ; Smoke ; Smoking ; Stroke

BACKGROUND AND OBJECTIVES: Left ventricular (LV) remodeling is a heterogeneous process, involving both infarcted and non-infarcted zones, which affects wall thickness and chamber size, shape and function. SUBJECTS AND METHODS: A total of 758 consecutive patients (62.8+/-12.0 years, 539 males) with acute myocardial infarction (AMI), who were examined by echocardiography at admission and after 6 months. An increase in LV end-diastolic volume index >10% was defined as a progressive LV dilation. They were divided into two groups according to the extent of progressive LV dilatation during 6 months. Group I with progressive LV dilatation (n=154, 61.4+/-11.0 years, 110 males) vs. group II without LV dilatation (n=604, 64.1+/-12.0 years, 429 males). RESULTS: The age and gender were no significant differences between two groups. The levels of glucose, creatinine, maximal creatine kinase (CK), CK-MB, troponin T and I were significantly increased in group I than in group II (p<0.05). Low ejection fraction (EF) and high wall motion score index (WMSI) were more common in group I than in group II (p<0.05). The presence of dyslipidemia {odds ratio (OR); 1.559, confidence interval (CI); 1.035-2.347, p=0.03}, low EF less than 45% (OR; 3.328, CI 2.099-5.276, p<0.01) and high WMSI above 1.5 (OR; 3.328, CI 2.099-5.276, p<0.01) were sig-nificant independent predictors of progressive LV dilatation by multivariate analysis. CONCLUSION: Dyslipidemia, decreased systolic function and high WMSI were independent predictors of LV remodeling process in patients with AMI.
Creatine Kinase ; Creatinine ; Dilatation ; Dyslipidemias ; Echocardiography ; Glucose ; Heart Failure ; Humans ; Myocardial Infarction ; Prognosis ; Stroke Volume ; Troponin T

Polycythemia vera is a chronic myeloproliferative disease characterized by clonal proliferation that arises at the level of the pluripotent stem cell and is also characterized by multiple episodes of bleeding or thrombotic complications. Rarely, polycythemia vera causes coronary arterial occlusion and can lead to ischemic heart disease. We experienced a case of acute ST elevation myocardial infarction in a 70-year-old man with polycythemia vera, who had been treated with hydoxyurea and phlebotomy since August 2005. He complained of severe chest pain of a one-hour duration and an ECG revealed an acute anterior ST elevation myocardial infarction. His leukocyte count was 18,700/mm3, red blood cell count 6,790,000/mm3, hemoglobin level 16.6 g/dL and platelet count 520,000/mm3. A diagnostic coronary angiography showed critical stenosis in the middle left anterior descending artery (LAD) and thrombotic total occlusion in the first diagonal branch (D1). Successful primary percutanenous coronary intervention was performed using a drug eluting stent in the LAD and balloon angioplasty for the D1 lesion.
Aged ; Angioplasty ; Angioplasty, Balloon ; Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Electrocardiography ; Erythrocyte Count ; Hemorrhage ; Humans ; Leukocyte Count ; Myocardial Infarction* ; Myocardial Ischemia ; Phlebotomy ; Platelet Count ; Pluripotent Stem Cells ; Polycythemia Vera* ; Polycythemia* ; Stents ; Thrombosis

Recently the incidence of coronary artery diseases in young patients has been increased in Korea, which may be related with the changes in dietary habits, stress and smoking. This report presents an 18-year-old male patient who suffered from acute non-ST elevation myocardial infarction. He had a history of 1.5 pack-years smoking, but no other risk factors. Depression of ST segments more than 3 mm in V1-6, I and aVL was documented on a twelve-lead electrocardiogram. Two-Dimensional echocardiography revealed hypokinetic anteroseptal wall motion, and myocardial SPECT demonstrated severe, reversible perfusion defects in the anteroseptal wall. A diagnostic coronary angiogram and an intravascular ultrasound revealed total occlusion in the proximal left anterior descending coronary artery due to heavy atheromatous plaque. The lesion was treated successfully by a coronary balloon and stent. He has no major adverse cardiovascular event on nine-month clinical follow-up after discharge.
Adolescent ; Coronary Artery Disease ; Coronary Vessels ; Depression ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Food Habits ; Humans ; Incidence ; Korea ; Male* ; Myocardial Infarction* ; Perfusion ; Risk Factors ; Smoke ; Smoking ; Stents ; Tomography, Emission-Computed, Single-Photon ; Ultrasonography