Successful Pacemaker Revision Through Sustained Right Superior Vena Cava in a Patient With Situs Inversus Totalis

In patients with situs inversus totalis, the superior vena cava is normally positioned on the left side and drains into a left-sided right atrium (RA). If right-side superior vena cava (RSVC) is also present, it should be thought of as a combined congenital anomaly. Here, we report a case of successful pacemaker lead insertion through the RSVC in a patient with situs inversus totalis. The left-side superior vena cava (LSVC) had been already used as a route for the first pacemaker lead insertion 15 years earlier. During the pacemaker lead revision, we found that the LSVC was obliterated, and used the RSVC as a route for a new pacemaker lead insertion.

Changes of the Lipoprotein Profiles with Time after Discontinuation of Statin Therapy

BACKGROUND AND OBJECTIVES: Some patients stop statin therapy in spite of their doctors' advice. This study was designed to assess the pattern of lipoprotein profile changes and clinical characteristics of the patients who discontinued statin therapy. SUBJECTS AND METHODS: 69 patients (male 42.0%) were enrolled. The clinical characteristics and laboratory data on the lipoprotein levels were obtained from the medical records. RESULTS: The coexistence of diabetes mellitus (DM) was seen in 28% of the patients, hypertension was noted in 72% and coronary artery disease (CAD) was noted in 42%. The average lipoprotein levels during statin therapy were total cholesterol (TC)=163.8 mg/dL, triglycerides (TG)=174.3 mg/dL, high-density lipoprotein cholesterol (HDL-C)=34.8 mg/dL and low-density lipoprotein cholesterol (LDL-C)=94.2 mg/dL. LDL-C level increased by 44.9% at 2-3 months after ceasing statin therapy and by 54.6% at 4-6 months after ceasing statin therapy (p<0.01). The changes of the lipoprotein levels from baseline to 2-3 months and 4-6 months after discontinuation were +22.6% and +30.0% for the TC level, +20.8% and +24.0% for the TG level, and 0.06% and -0.65% for the HDL-C level respectively (p<0.01 for TC and TG, p=not significant (NS) for HDL-C). The achievement rate of target LDL-C level as suggested by the Adult Treatment Panel III (ATP III) of National Cholesterol Education Program (NCEP) was decreased 62.7% at 2-3 months and then it was decreased to 61.8% at 4-6 months after statin discontinuation. DM and CAD were more frequent in the patients who did not achieve the target LDL-C level even with life style modification. CONCLUSION: After statin discontinuation, TC and LDL-C were increased within 3 months. DM and CAD were highly prevalent in patients who didn't achieve their treatment goal.

Reversed Circadian Variation in Variant Angina

It is known that there is a marked variation in the frequency of variant angina attacks according to the circadian rhythm. The attack frequency is usually highest in the early morning and lowest in the afternoon. We describe here a middle-aged woman with variant angina whose chest pain occurred only during daytime. Because of her job, she sleeps from noon to 6 pm, and she experienced chest pain only during 2 to 3 pm. These findings suggest that the alterations to the sleep and wake cycle can affect the circadian variation of variant angina.

Interstitial Nephritis and IgA Nephropathy in a Patient with Acute Hepatitis A / 대한신장학회지

Hepatitis A is one of the most common infectious diseases. It is a self-limiting disease affecting the liver. Although extrahepatic manifestations are not common, a few cases associated with renal diseases have been reported. In those cases, patients presented with acute tubular necrosis, acute interstitial nephritis, IgA nephropathy, mesangioproliferative glomerulonephritis, etc. We here report a case of interstitial nephritis and IgA nephropathy associated with acute hepatitis A. A previously healthy 31-year old woman was admitted with an acute hepatitis A, which was confirmed by IgM anti-hepatitis A antibody. Acute renal failure was developed and hemodialysis was urgently required. The patient had acute interstitial nephritis and IgA nephropathy diagnosed by kidney biopsy. Liver and kidney functions gradually recovered their normal conditions.

Portopulmonary hypertension in pregnancy: Treatment with sildenafil / 대한내과학회지

The mortality of pulmonary hypertension that complicates pregnancy is very high. The increased pulmonary vascular resistance combined with the normal physiological changes of pregnancy and delivery is difficult to manage. We describe here the case of a pregnant woman who presented with severe portopulmonary hypertension. A 30-yr-old woman presented with dyspnea at 8 weeks of pregnancy. The mean pulmonary artery pressures (PAP), as measured from a pulmonary artery catheter at 20 weeks gestation, were 71 mmHg. Sildenafil was used to reduce the PAP for 4 months. She responded to sildenafil therapy and successfully completed her pregnancy.