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A Case of Left Atrial Free-Floating Thrombus.

Dong Keun KIM ; Jung Seok KIM ; Ha Ram YI ; In Zoo CHOI ; Hyo Seung AHN ; Wook Hyun CHO

Keimyung Medical Journal.2015;34(2):133-140.

A 74-year-old woman who had paroxysmal atrial fibrillation without mitral stenosis was hospitalized for syncope and right-sided weakness. Echocardiography revealed a large free-floating thrombus in the left atrium, sometimes prolapsing partially into the left ventricle in diastole. Because of her poor neurological status, she was managed with anticoagulation. On the 12th day, the thrombus had disappeared on the follow-up echocardiography, and aortoiliac embolization was later detected on computed tomography. Unfortunately, she developed various complications of stroke and limb infarction, and died after 4 months of hospital care. In addition to this case report, we reviewed a total 70 cases of left atrial free-floating thrombus. Atrial fibrillation and mitral pathology were two major causative factors. All the cases, except 1, were confirmed on echocardiography. The most common presentation that led to echocardiography was systemic embolization, followed by heart failure. Others were acute hemodynamic decompensation from mitral obstruction, chest pain, palpitation, and bacteremia. Cardiac thrombectomy was the preferred treatment modality with favorable outcomes.
Aged ; Atrial Fibrillation ; Bacteremia ; Chest Pain ; Diastole ; Echocardiography ; Extremities ; Female ; Follow-Up Studies ; Heart Atria ; Heart Failure ; Heart Ventricles ; Hemodynamics ; Humans ; Infarction ; Mitral Valve Stenosis ; Pathology ; Stroke ; Syncope ; Thrombectomy ; Thrombosis*

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Pulmonary Mucormycosis Treated Successfully with Posaconazole as Salvage Therapy.

Jiwon CHOI ; Yeun Seoung CHOI ; Myoung Kyu LEE ; Sang Ha KIM ; Suk Joong YONG ; Kye Chul SHIN ; Seok Jeong LEE ; Ye Ryung JUNG ; Won Yeon LEE

Keimyung Medical Journal.2015;34(2):127-132.

Mucormycosis (formerly known as zygomycosis) is a life-threatening opportunistic mycosis that infects a broad range of hosts with qualitative or quantitative defects in innate immunity. The overall mortality rate of pulmonary mucormycosis is above 70%. The prognosis and outcome of pulmonary mucormycosis have not improved significantly over the last decade, mainly because of difficulty in early diagnosis and the limited activity of current antifungal agents against members of the order Mucorales. We report a case of pulmonary mucormycosis treated successfully with posaconazole as salvage therapy. We suggest that posaconazole may be considered as an alternative therapeutic approach in patients with invasive pulmonary mucormycosis who are unable to tolerate surgical treatment.
Antifungal Agents ; Early Diagnosis ; Humans ; Immunity, Innate ; Mortality ; Mucorales ; Mucormycosis* ; Prognosis ; Salvage Therapy*

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A Case of Chronic Myeloid Leukemia with Multiple Chloromas Treated Successfully with Dasatinib.

Won Young JANG ; Sei Myong CHOI ; Myeong Soon PARK ; Byung Chan AHN ; Mi Hwa HEO ; Jin Young KIM ; Ki Young KWON ; Young Rok DO

Keimyung Medical Journal.2015;34(2):120-126.

Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder of the primitive hematopoietic stem cells. CML is characterized by the overproduction of myeloid cells, which results in marked splenomegaly and leukocytosis. CML presented by multiple chloromas is extremely rare. Multiple chloromas in the skin and brain are quite rare as the initial presentation of CML. These rare manifestation should alert clinicians to include CML in the differential diagnosis of patients presenting with multiple non-pruritic skin nodules or neurologic symptoms. Dasatinib has promising therapeutic potential for managing intracranial leukemic disease. Here, we report the case of a patient who visited the hospital with multiple chloroma which is unusual presentation of CML, and treated with dasatinib successfully.
Brain ; Diagnosis, Differential ; Hematopoietic Stem Cells ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Leukocytosis ; Myeloid Cells ; Myeloproliferative Disorders ; Neurologic Manifestations ; Sarcoma, Myeloid* ; Skin ; Splenomegaly ; Dasatinib

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Implantable Bio-sensor Research for Administration of Chronic Disease.

Dae Wook KIM ; Jong Ha LEE ; Hee Joon PARK ; Yoon Nyun KIM

Keimyung Medical Journal.2015;34(2):114-119.

Prolonged monitoring is more likely to result in an accurate diagnosis of atrial fibrillation patients than intermittent or short-term monitoring. In this study, we present an implantable ECG sensor to monitor atrial fibrillation patients in real time. The developed implantable sensor is composed of a micro controller unit, analog to digital converter, signal transmitter, antenna, and two electrodes. The sensor detects ECG signals from the two electrodes and transmits these signals to the external receiver that is carried by the patient. The sensor continuously transmits signals, so its battery consumption rate is extremely high. To overcome this problem, we consider using a wireless power transmission module in the sensor module. This module helps the sensor charge power wirelessly without holding the battery in the body. The size of the integrated sensor is approximately 0.12 x 1.18 x 0.19 inch. This sensor size is appropriate enough for cardiologists to insert the sensor into patients without the need for a major surgery. The data sampling rate was 300 samples/sec, and the frequency was 430 Hz for signal and power transmission.
Atrial Fibrillation ; Chronic Disease* ; Diagnosis ; Electrocardiography ; Electrodes ; Humans

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Study on Current Changes of Atropine Regimen in Organophosphate Pesticides Poisoning.

Min Soo KIM ; Sang Chan JIN ; Sung Jin KIM ; Woo Ik CHOI

Keimyung Medical Journal.2015;34(2):108-113.

Appropriate early atropinization is important for the recovery and prognosis of the organophosphate pesticides poisoning patient. However, recommended guidelines of atropine regimen in the treatment of organophosphate pesticides poisoning is not present in Korea. The authors analyzed the domestic literatures and books to investigate a trend of the regimen of atropine for organophosphate pesticides poisoning. We found 11 papers and 6 books about organophosphate pesticides poisoning that published in Korea. Then calculates elapsed time for atropinization by the each regimen of atropine. References recommendations varied markedly - atropinization of an average patient, requiring the mean dose of 23.4 mg, would have taken 15 to 432 minutes; atropinization of a very ill patient, requiring maximum dose of 75 mg, would have taken 20 to 1,385 min, Recently, it suggested atropine regimen that doubling the dose for organophosphate pesticides poisoning in Korea. So it needs to study for ensure a higher validity and application of organophosphate pesticides poisoning patients.
Atropine* ; Humans ; Korea ; Pesticides* ; Poisoning* ; Prognosis

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Resistin Inhibits Insulin Secretion Through Inhibition of Insulin Granule Docking Via Downregulation of Rab3A in Pancreatic Beta-cells.

Jae Hyung PARK

Keimyung Medical Journal.2015;34(2):98-107.

Resistin is a recently described novel adipokine that has been suggested to play an important role in the development of insulin resistance and type 2 diabetes by inhibiting insulin receptor signaling in myocytes and adipocytes. In the present study, we evaluated the direct effect of resistin on insulin secretion in pancreatic beta-cells. After treatment with recombinant resistin for 30 min, changes in glucose uptake, intracellular ATP and calcium levels, and insulin secretion were measured in glucose-stimulated INS-1 cells. The number of insulin granules morphologically docked to the plasma membrane was measured using a total internal reflection fluorescence microscope. Resistin significantly inhibited glucose-stimulated insulin secretion in INS-1 cells. Although resistin had no effects on intracellular glucose uptake, ATP and calcium levels, it caused a significant decrease in the number of docked insulin granules. In addition, the expression of rab3A was decreased after treatment with resistin. These results suggest that resistin can inhibit insulin secretion through inhibition of insulin granule docking via downregulation of rab3A in pancreatic beta-cells. The present finding may also be an important mechanism of resistin for the development of type 2 diabetes.
Adenosine Triphosphate ; Adipocytes ; Adipokines ; Calcium ; Cell Membrane ; Down-Regulation* ; Fluorescence ; Glucose ; Insulin Resistance ; Insulin* ; Muscle Cells ; Obesity ; Receptor, Insulin ; Resistin*

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Underlying Hemato-oncologic, Gastrointestinal-nutritional Diseases, or Prematurity May Be Risk Factors for Hypovitaminosi D in Children.

Byung Wook JO ; Nani JUNG ; Ye Jee SHIM ; Jin Hyeok CHOI ; Heung Sik KIM

Keimyung Medical Journal.2015;34(2):89-97.

PURPOSE: An adequate vitamin D level is important for normal growth, cancer prevention, controlling hormones, and immune regulation. However, no study has investigated vitamin D status in patients with serious illnesses, such as malignancies, malabsorption diseases, or prematurity in Korean children. Thus, we analyzed the results of 25-hydroxyvitamin D3 (25-D) levels in children in a single tertiary medical center. METHODS: Children who had their vitamin D level evaluated at Keimyung University Dongsan Medical Center from January 2004 to December 2014 were included. We reviewed the medical records and laboratory test results. RESULTS: Ninety-three children (male:female = 48:45) who had their vitamin D levels measured were included. The most common reason for measuring vitamin D level was hypocalcemia with or without neurological signs. Among the subjects, 61 children had hypovitaminosis D (25-D < 30 ng/mL). A positive correlation was detected between 25-D and total calcium levels (p = 0.001). Negative correlations were found between 25-D and immunoreactive parathyroid hormone (iPTH) levels (p = 0.002) and between 25-D and alkaline phosphatase (ALP) levels (p = 0.021). Twenty-three subjects (37.7%) had a critical underlying condition, including a hemato-oncologic issue (18.0%), gastrointestinal or nutritional problem (11.5%), and prematurity or low birth weight (8.2%). CONCLUSION: The levels of total calcium, ALP, and iPTH were correlated with 25-D level. An underlying malignancy, malabsorption issues, or prematurity may be risk factors for hypovitaminosis D in children.
Alkaline Phosphatase ; Calcifediol ; Calcium ; Child* ; Humans ; Hypocalcemia ; Infant, Low Birth Weight ; Infant, Newborn ; Medical Records ; Parathyroid Hormone ; Risk Factors* ; Vitamin D

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Cervical Spinal Cord Infarction Presenting Brown-Séquard-plus Syndrome.

Sang Won PARK ; Seok Kyung KWON ; Jin Suk KIM ; Bijoy K. MENON ; Jeong Ho HONG ; Sung Il SOHN

Keimyung Medical Journal.2014;33(1):44-47.

Brown-Séquard-plus syndrome is characterized by hemiparesis, contralateral spinothalamic sensory deficits with additional abnormal findings of other organs. We report a case of an 81-year-old man who had right hemiparesis, left sensory deficit and Horner syndrome on right eye. Diffusion-weighted MRI of the cervical spine and lower medulla confirm the diagnosis of anterior unilateral cervical spinal cord infarction. It is very rare that the unilateral long spinal cord infarction at the C1-C4 associated with Brown-Séquard-plus syndrome.
Aged, 80 and over ; Diagnosis ; Horner Syndrome ; Humans ; Infarction* ; Magnetic Resonance Imaging ; Paresis ; Spinal Cord* ; Spine ; Vertebral Artery

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Colonic Endometriosis with Extensive Smooth Muscle Metaplasia Simulating Leiomyoma.

Ilseon HWANG

Keimyung Medical Journal.2014;33(1):39-43.

It is difficult to distinguish colonic endometriosis with smooth muscle metaplasia from a colonic neoplasm. Especially, in a small biopsy specimen, marked smooth muscle proliferation can be misdiagnosed as a spindle cell lesion such as leiomyoma or as a gastrointestinal stromal tumor. We present the case of a woman aged 48 years who had a colonic polyp, raising suspicion of a submucosal tumor. In a endoscopic polypectomy specimen, the lesion showed marked smooth muscle proliferation but in the resection specimen, a nodular mass, composed of endometrial glands, stroma, and a smooth muscle component, was identified. By immunohistochemical staining, smooth muscle cells were positive for estrogen receptor, progesterone receptor, smooth muscle actin, and smooth muscle myosin heavy chain. Endometriosis in the colon can be misinterpreted as a benign or malignant neoplasm. When examining small biopsy specimens, clinicians and pathologists should be aware of the potential of this condition to mimic other intestinal diseases.
Actins ; Biopsy ; Colon* ; Colonic Neoplasms ; Colonic Polyps ; Endometriosis* ; Estrogens ; Female ; Gastrointestinal Stromal Tumors ; Humans ; Intestinal Diseases ; Leiomyoma* ; Metaplasia* ; Muscle, Smooth* ; Myocytes, Smooth Muscle ; Myosin Heavy Chains ; Receptors, Progesterone

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Nevoid Melanoma in the Forearm.

Misun CHOE ; Hye Ra JUNG ; Gyu Suk LEE

Keimyung Medical Journal.2014;33(1):34-38.

Nevoid melanoma is a very rare histological subtype of vertical growth phase melanoma. Histologically, it mimics benign nevus and thus may lead to an erroneous diagnosis. We report a case of nevoid melanoma arising in a 53-year-old American woman. High index of suspicion and evaluation of cytologic atypia with ancillary tests may help in establishing the diagnosis.
Diagnosis ; Female ; Forearm* ; Humans ; Melanoma* ; Middle Aged ; Nevus ; Skin

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