The Relationship between Recipients Age on the Development of Acute Rejection and Graft Survival in Kidney Transplantation / 대한신장학회지

PURPOSE: Previously, acute rejection (AR) episode in the elderly recipients was reported to be lower compared to that of young recipients. However, the relationship between the recipients age, incidence of AR, and graft survival has not been reevaluated recently. METHODS: Four hundred thirty-one recipients who had the first kidney transplantation were recruited, and we performed a retrospective study evaluating the incidence of AR, infectious episodes in one year, and graft and patient survival rates at 1 and 5 years. We divided recipients into 2 groups (age< 50, n=340 and age=50, n=91) and compared the outcomes. RESULTS: The incidence of AR was 18.8% in the younger group and 24.2% in the elderly group (p=NS). The incidence of infectious episodes was 24.7% in the younger group and 24.2% in the elderly group (p=NS). Five-year graft survival in the elderly was not significantly different from that in the younger group (90.8% vs. 91.8%). However, the patient survival at five year was different between the younger and the elderly groups (99.1% and 92.2%, respectively, p<0.05). CONCLUSION: Our findings suggest that recipients age would not influence the incidence of AR and graft survival. Therefore, the immunosuppression should be applied according to the conditions of recipients, not to recipients age.

A Case of Multiple Myeloma with Pulmonary Thromboembolism Diagnosed by Transthoracic Echocardiography

Cancer is a major risk factor for pulmonary thromboembolism. Occasionally, the thromboembolic event occurs before the diagnosis of cancer. We report a rare case of massive pulmonary thromboembolism with multiple myeloma diagnosed by transthoracic echocardiography.

A case of the changes of 2-dimensional strain after percutaneous coronary intervention for myocardial bridge / 대한내과학회지

The myocardial bridge of the coronary arteries is observed by coronary angiography at a rate of <5 % and ordinarily does not constitute a hazard. Occasionally, the compression of a coronary artery by a myocardial bridge can be associated with the clinical manifestations of myocardial ischemia during strenuous physical activity and might even result in a myocardial infarction or initiate malignant ventricular arrhythmias. A few cases of percutaneous coronary intervention for a myocardial bridge have been reported. However, there are few reports of the changes in the 2-dimensional strain in the myocardial bridge. We encountered a case of a myocardial bridge in a 48-year-old male patient who had refractory angina despite continuous medication with a beta-blocker and calcium channel blocker. The 2-dimensional strain of the patient changed after percutaneous coronary intervention with stents. We report the first case in Korea with a review of the relevant literature.

Assessment of Left Ventricular Function in Symptomatic Patients with Myocardial Bridge using Two-Dimensional Strain

BACKGROUND AND OBJECTIVES: We wanted to perform quantitative echocardiographic assessment of myocardial function in the patients with myocardial bridge by measuring 2-dimensional strain with using newly developed software. SUBJECTS AND METHODS: Novel computer software was used for tracking heart tissue on echocardiography, and we conducted an advanced wall-motion analysis for 18 symptomatic patients (mean age: 57.1+/-9.7 years, 10 female) with myocardial bridging of the left anterior descending coronary artery and also 20 age-matched healthy controls. The conventional wall-motion scoring was normal in all the patients, and the software was able to adequately track their heart tissue. RESULTS: The maximal angiographic systolic lumen diameter reduction within the myocardial bridges was 71+/-12.6% at rest, with a persistent diameter reduction of 31.2+/-11.3%. The radial strain and displacement of the anterior segments were more significantly reduced than that of the posterior segments at the level of the papillary muscle (30.9+/-13.8% vs. 51.8+/-17.3% and 4.8+/-0.9 vs. 5.9+/-1.5, respectively, all p<0.05), and this showed a plateau (39% and 33%, respectively) or biphasic (50% and 56%, respectively) pattern. The time from the R wave on electrocardiography to the transition from regional systole to early diastolic lengthening (Tr) was significantly delayed in the patients with myocardial bridge more than that for the controls (497+/-20.4 ms vs. 348+/-12.5 ms, respectively, p<0.05). CONCLUSION: Delayed systolic contraction and diastolic relaxation are important mechanisms that contribute to ischemia in the patients with myocardial bridge. 2-dimensional strain can be used to achieve real-time wall-motion analysis, and it has the potential to improve the identification and functional quantification of myocardial Bridge.