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

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

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

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

A percutaneous coronary intervention (PCI) is known to be one of effective methods in the treatment of coronary artery disease. However, restenosis remains a major limitation to a PCI. Although neointimal cell proliferation is suspected to be the major cause of coronary stent restenosis, few histological characterizations of recurrent instent restenosis exist. We report a case of a 61-year-old man suffering from unstable angina due to secondary coronary in-stent restenosis in the proximal left anterior descending artery (LAD). An atherectomized tissue, obtained by a directional coronary atherectomy, showed myxoid tissue, characterized by a few stellate smooth muscle cells in the abundant extracellular matrix, which was blue-colored proteoglycan on modified Movat staining.
Angina, Unstable ; Arteries ; Atherectomy, Coronary ; Cell Proliferation ; Coronary Artery Disease ; Extracellular Matrix ; Humans ; Middle Aged ; Myocytes, Smooth Muscle ; Percutaneous Coronary Intervention ; Proteoglycans* ; Stents

Coarctation of aorta is a rare vascular disorder which is one of causes of secondary hypertension. Since the early 1990s stenting in the coarctation of aorta has been introduced as an alternative treatment method, there were a few cases which were treated by stent implantation for the coarctation of the aorta in Korea. But the case which was treated using stent in congestive heart failure with pulmonary edema has never been reported. We report on successful management of a 64-year-old female patient, who presented with acute heart failure and pulmonary edema due to severe aortic coarctation. After endotracheal intubation, aortogram was performed, which revealed a severe narrowing in the distal thoracic aorta with a peak systolic pressure gradient of 100 mmHg across the lesion. Stent implantation was performed with 24x100 mm self-expandable Nitinol-S stent after predilation with 10x40 mm balloon. After stenting, patient's symptom and sign of congestive heart failure were remarkably improved and endotracheal intubation tube was able to be removed. And no significant adverse cardiac events observed during a nine-month clinical follow-up.
Angioplasty ; Aorta ; Aorta, Thoracic ; Aortic Coarctation* ; Blood Pressure ; Female ; Follow-Up Studies ; Heart Failure ; Humans ; Hypertension ; Intubation, Intratracheal ; Korea ; Middle Aged ; Pulmonary Edema* ; Stents*

Severe, occlusive spiral dissection during diagnostic coronary angiogram is very rare. A 41-year old female patient was admitted because of chest pain at night. Her left coronary angiogram revealed no significant stenosis with diffuse luminal narrowing. Immediately after right coronary artery (RCA) injection, sudden occlusion of middle RCA was noted, which was not improved despite multiple injections of intracoronary nitrate. The patient complained of severe chest pain and ST segment elevation was observed on electrocardiogram monitoring. After wiring into true lumen of RCA, distal flow was improved and intravascular ultrasound revealed spiral dissection flap extending from proximal to middle RCA. Final coronary angioram showed patent RCA with spiral dissection and good distal flow into the distal RCA. The patient had no clinical events during 2-month clinical follow-up.
Adult ; Catheters ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography* ; Coronary Disease ; Coronary Vessels ; Electrocardiography ; Female ; Follow-Up Studies ; Humans ; Phenobarbital ; Ultrasonography

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

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

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