A 52-year-old man was referred to our hospital due to fever and myalgia that occurred 2 weeks earlier. He showed a complete atrioventricular block on his electrocardiogram, and his vital signs were unstable. On his transthoracic echocardiograph, the 1.5 cm vegetation in the aortic valve with severe aortic regurgitation suggested infective endocarditis. His transesophageal enchocardiograph showed abscess in his mitral-aortic intervalvular fibrosa and vegetation was suspected on his anterior mitral valve leaflet. The patient underwent an emergent operation for valve replacement with temporary epicardial pacing. Intraoperatively, the septal leaflet of his tricuspid valve was injured during the debridement of the abscess pocket that was extended to the membranous septum. The aortic, mitral, and tricuspid mechanical valves were replaced with annular reconstruction without complications. After 14 days of intravenous antibiotics, we successfully changed the epicardial pacemaker into a transvenous DDD-type permanent pacemaker by placing a left ventricular lead via the coronary sinus and an atrial lead in the right atrium appendage. The patient was discharged in a tolerable state and was examined uneventfully in our hospital's outpatient clinic for 8 months.
Abscess ; Ambulatory Care Facilities ; Anti-Bacterial Agents ; Aortic Valve ; Aortic Valve Insufficiency ; Atrioventricular Block* ; Coronary Sinus* ; Debridement ; Electrocardiography ; Endocarditis* ; Fever ; Heart Atria ; Heart Block ; Heart Valve Prosthesis ; Humans ; Middle Aged ; Mitral Valve ; Myalgia ; Pacemaker, Artificial ; Tricuspid Valve ; Vital Signs

no abstract available.

A 29-year-old man was admitted to hospital with fever, myalgia, and sore throat. Initial laboratory findings were compatible with acute hepatitis; he was positive for the serologic marker for acute hepatitis A. On the 3rd day of admission, in spite of normalization of body temperature and a reduction in serum liver enzyme levels, serum levels of creatinine phosphokinase had increased up to 16,949 U/L. The patient recovered with supportive therapy and was discharged on the 12th day. We report a case of acute hepatitis A complicated by rhabdomyolysis during hospitalization.
Acute Disease ; Adult ; Alanine Transaminase/blood ; Aspartate Aminotransferases/blood ; Creatine Kinase/blood ; Hepatitis A/complications/*diagnosis ; Hospitalization ; Humans ; Male ; Rhabdomyolysis/*diagnosis/etiology

PURPOSE: The effects on the side-branch (SB) ostium, following paclitaxel-coated balloon (PCB) treatment of de novo coronary lesions of main vessels have not been previously investigated. This study was aimed at evaluating the serial morphological changes of the SB ostium after PCB treatment of de novo coronary lesions of main vessels using optical coherence tomography (OCT). MATERIALS AND METHODS: This prospective, single-center observational study enrolled patients with de novo lesions, which were traversed by at least one SB (≥1.5 mm) and were treated with PCB. The SB ostium was evaluated with serial angiographic and OCT assessments pre- and post-procedure, and at 9-months follow-up. RESULTS: Sixteen main vessel lesions were successfully treated with PCB, and 26 SBs were included for analysis. Mean SB ostial lumen area increased at 9-months follow-up (0.92±0.68 mm2 pre-procedure, 1.03±0.77 mm2 post-procedure and 1.42±1.18 mm2 at 9-months). The SB ostial lumen area gain was 0.02±0.24 mm2 between pre- and post-procedure, 0.37±0.64 mm2 between post-procedure and 9-months, and 0.60±0.93 mm2 between pre-procedure and 9-months. The ostial lumen area increased by 3.9% [interquartile range (IQR) of -33.3 to 10.4%] between pre- and post-procedure, 52.1% (IQR of -0.7 to 77.3%) between post-procedure and 9-months and 76.1% (IQR of 18.2 to 86.6%) between pre-procedure and 9-months. CONCLUSION: PCB treatment of de novo coronary lesions of main vessels resulted in an increase in the SB ostial lumen area at 9-months.
Aged ; Angioplasty, Balloon, Coronary/*methods ; Coronary Angiography ; Coronary Stenosis/diagnosis/*therapy ; Coronary Vessels/*pathology ; *Drug-Eluting Stents/adverse effects ; Female ; Humans ; Male ; Middle Aged ; Paclitaxel/*administration & dosage ; Prospective Studies ; Tomography, Optical Coherence/*methods ; Treatment Outcome ; Tubulin Modulators/administration & dosage

Recurrent urinary tract infection due to vesicoureteral reflux is one of the important medical complications in renal transplant recipients. Injection of macroplastique is recommended to reduce the vesicoureteral reflux, but it can result in poor responses. Ureteroureterostomy is an invasive method, but it is advisable in patients with higher grades of vesicoureteral reflux that do not respond to medical or macroplastique injection. We here report on two cases of successful treatment of vesicoureteral reflux by ureteroureterostomy. These patients experienced repeated episodes of acute pyelonephritis in spite of long-term antibiotic treatment and repeated macroplastique injection. No more urinary tract infection was observed after ureteroureterostomy. We recommend ureteroureterostomy in renal transplant recipients who suffer with repeated acute pyelonephritis due to vesicoureteral refulx.
Dimethylpolysiloxanes ; Humans ; Kidney Transplantation ; Pyelonephritis ; Transplants ; Urinary Tract Infections ; Vesico-Ureteral Reflux

PURPOSE: This study compared the angiographic outcomes of paclitaxel-coated balloon (PCB) versus plain old balloon angioplasty (POBA) treatment for de novo coronary artery lesions. At present, there is no available data comparing the efficacy of PCB versus POBA for the treatment of de novo coronary lesions. MATERIALS AND METHODS: This multicenter retrospective observational study enrolled patients with de novo coronary lesions with a reference vessel diameter between 2.5 mm and 3.0 mm and lesion length < or =24 mm who were successfully treated with PCB or POBA. Angiographic measurements and quantitative coronary analysis were performed before and after the procedure, and at 9 months follow-up. RESULTS: A total of 72 patients (49 receiving PCB and 23 receiving POBA) were enrolled in this study. Late luminal loss was -0.12+/-0.30 mm in the PCB group and 0.25+/-0.50 mm in the POBA group (p<0.001). There was a higher percentage of binary restenosis (diameter stenosis > or =50%) in POBA, compared to PCB (30.4%, n=7 vs. 4.1%, n=2, p<0.001). Target vessel revascularization was higher in the POBA group (13.0%, n=3 vs. 0%, p=0.033). CONCLUSION: PCB treatment of de novo coronary lesions showed better 9-month angiographic outcomes than POBA treatment alone.
Aged ; Angioplasty, Balloon, Coronary/*instrumentation/methods ; Coronary Angiography ; Coronary Artery Disease/therapy ; Coronary Stenosis/*therapy ; Coronary Vessels/pathology ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Paclitaxel/*administration & dosage/therapeutic use ; Retrospective Studies

PURPOSE: When performing coronary angiography (CAG), diagnostic catheter intubation to the ostium can cause damping of the pressure tracing. The aim of this study was to determine the predictors of atherosclerotic ostial stenosis in patients showing pressure damping during CAG. MATERIALS AND METHODS: In total, 2926 patients who underwent diagnostic CAG were screened in this study. Pressure damping was defined as an abrupt decline of the coronary blood pressure with a blunted pulse pressure after engagement of the diagnostic catheter. According to CAG and intravascular ultrasound (IVUS), we divided damped ostia into two groups: atherosclerotic ostial lesion group (true lesion group) and non-atherosclerotic ostium group (false lesion group). Clinical and angiographic characteristics were compared between the two groups. RESULTS: The overall incidence of pressure damping was 2.3% (68 patients and 76 ostia). Among the pressure damped ostia, 40.8% (31 of 76 ostia) were true atherosclerotic ostial lesions (true lesion group). The true lesion group had more frequent left main ostial damping and more percutaneous coronary interventions (PCIs) performed on non-ostial lesions, compared to the false lesion group. On multivariate logistic regression analysis, left main ostial damping [hazard ratio (HR) 4.11, 95% confidence interval (CI) 1.24-13.67, p=0.021] and PCI on non-ostial lesion (HR 5.34, 95% CI 1.34-21.27, p=0.018) emerged as independent predictors for true atherosclerotic ostial lesions in patients with pressure damping. CONCLUSION: Left main ostial damping and the presence of a non-ostial atherosclerotic lesion may suggest a significant true atherosclerotic lesion in the coronary ostium.
Aged ; *Coronary Angiography ; Coronary Artery Disease/etiology/*radiography ; Coronary Occlusion/diagnosis/*therapy ; Coronary Stenosis/etiology/*radiography ; Coronary Vessel Anomalies/radiography ; Coronary Vessels/*pathology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Percutaneous Coronary Intervention/adverse effects/methods ; Predictive Value of Tests ; Proportional Hazards Models ; Radiography, Interventional

Multiple myeloma is a malignant disease of plasma cells, whereas ankylosing spondylitis is a chronic inflammatory disease of axial joints. The relationship between the two diseases is uncertain, but chronic inflammation could trigger multiple myeloma. The authors report the cases of two ankylosing spondylitis patients with a disease duration of more than 20 years, that subsequently developed IgA kappa and IgG lambda chain myeloma, respectively, and discuss the possible pathogenetic relationship between these diseases.
Humans ; Immunoglobulin A ; Immunoglobulin G ; Inflammation ; Joints ; Monoclonal Gammopathy of Undetermined Significance ; Multiple Myeloma ; Plasma Cells ; Spondylitis, Ankylosing

OBJECTIVES: Proper risk assessment is important for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, no validated risk prediction tools are currently in use in Korea. This study sought to develop a 10-year risk prediction model for incident ASCVD. METHODS: Using the National Sample Cohort of Korea, 325,934 subjects aged 20-80 years without previous ASCVD were enrolled. ASCVD was defined as a composite of cardiovascular death, myocardial infarction, and stroke. The Korean atherosclerotic cardiovas cular disease risk prediction (K-CVD) model was developed separately for men and women using the development dataset and validated in the validation dataset. Furthermore, the model performance was compared with the Framingham risk score (FRS) and pooled cohort equation (PCE). RESULTS: Over 10 years of follow-up, 4,367 ASCVD events occurred in the overall population. The predictors of ASCVD included in the model were age, smoking status, diabetes, systolic blood pressure, lipid profiles, urine protein, and lipid-lowering and blood pressure-lowering treatment. The K-CVD model had good discrimination and strong calibration in the validation dataset (time-dependent area under the curve=0.846; 95% confidence interval, 0.828 to 0.864; calibration χ2=4.73, goodness-of-fit p=0.32). Compared with our model, both FRS and PCE showed worse calibration, overestimating ASCVD risk in the Korean population. CONCLUSIONS Through a nationwide cohort, we developed a model for 10-year ASCVD risk prediction in a contemporary Korean population. The K-CVD model showed excellent discrimination and calibration in Koreans. This population-based risk prediction tool would help to appropriately identify high-risk individuals and provide preventive interventions in the Korean population.

An intramural duodenal hematoma has been mostly reported as a consequence of trauma. It can also result from a hematological disorder, anticoagulant drug use and a post-therapeutic endoscopic procedure. Common symptoms of patients with an intramural duodenal hematoma are vomiting and abdominal pain. An intramural duodenal hematoma is rarely accompanied with pancreatitis and cholangitis due to intestinal obstruction. A diagnosis is made by esophagogastroduodenoscopy and the use of an abdominal CT scan. An intramural duodenal hematoma is mainly treated with conservative therapy but it may sometimes be treated with a surgical procedure. We report one case of an intramural duodenal hematoma after performing a therapeutic endoscopic procedure in a chronic renal failure patient undergoing maintenance hemodialysis.
Abdominal Pain ; Cholangitis ; Duodenal Ulcer ; Duodenoscopy ; Duodenum ; Endoscopy, Digestive System ; Epinephrine ; Hematoma ; Hemorrhage ; Humans ; Intestinal Obstruction ; Kidney Failure, Chronic ; Pancreatitis ; Renal Dialysis ; Vomiting