Usefulness of an Implantable Loop Recorder in Diagnosing Unexplained Syncope and Predictors for Pacemaker Implantation

BACKGROUND@#An implantable loop recorder (ILR) is an effective tool for diagnosing unexplained syncope (US). We examined the diagnostic utility of an ILR in detecting arrhythmic causes of US and determining which clinical factors are associated with pacemaker (PM) implantation.@*METHODS@#This retrospective, multicenter, observational study was conducted from February 2006 to April 2018 at 11 hospitals in Korea. Eligible patients with recurrent US received an ILR to diagnose recurrent syncope and document arrhythmia.@*RESULTS@#A total of 173 US patients (mean age, 67.6 ± 16.5 years; 107 men [61.8%]) who received an ILR after a negative conventional workup were enrolled. During a mean follow-up of 9.4 ± 11.1 months, 52 patients (30.1%) had recurrent syncope, and syncope-correlated arrhythmia was confirmed in 34 patients (19.7%). The ILR analysis showed sinus node dysfunction in 24 patients (70.6%), supraventricular tachyarrhythmia in 4 (11.8%), ventricular arrhythmia in 4 (11.8%), and sudden atrioventricular block in 2 (5.9%). Overall, ILR detected significant arrhythmia in 99 patients (57.2%) irrespective of syncope. Among patients with clinically relevant arrhythmia detected by ILR, PM implantation was performed in 60 (34.7%), an intra-cardiac defibrillator in 5 (2.9%), and catheter ablation in 4 (2.3%). In a Cox regression analysis, history of paroxysmal atrial fibrillation (PAF) (hazard ratio [HR], 2.34; 95% confidence interval [CI], 1.33–4.12; P < 0.01) and any bundle branch block (BBB) (HR, 2.52; 95% CI, 1.09–5.85; P = 0.03) were significantly associated with PM implantation.@*CONCLUSION@#ILR is useful for detecting syncope-correlated arrhythmia in patients with US. The risk of PM is high in US patients with a history of PAF and any BBB.

Usefulness of an Implantable Loop Recorder in Diagnosing Unexplained Syncope and Predictors for Pacemaker Implantation

BACKGROUND@#An implantable loop recorder (ILR) is an effective tool for diagnosing unexplained syncope (US). We examined the diagnostic utility of an ILR in detecting arrhythmic causes of US and determining which clinical factors are associated with pacemaker (PM) implantation.@*METHODS@#This retrospective, multicenter, observational study was conducted from February 2006 to April 2018 at 11 hospitals in Korea. Eligible patients with recurrent US received an ILR to diagnose recurrent syncope and document arrhythmia.@*RESULTS@#A total of 173 US patients (mean age, 67.6 ± 16.5 years; 107 men [61.8%]) who received an ILR after a negative conventional workup were enrolled. During a mean follow-up of 9.4 ± 11.1 months, 52 patients (30.1%) had recurrent syncope, and syncope-correlated arrhythmia was confirmed in 34 patients (19.7%). The ILR analysis showed sinus node dysfunction in 24 patients (70.6%), supraventricular tachyarrhythmia in 4 (11.8%), ventricular arrhythmia in 4 (11.8%), and sudden atrioventricular block in 2 (5.9%). Overall, ILR detected significant arrhythmia in 99 patients (57.2%) irrespective of syncope. Among patients with clinically relevant arrhythmia detected by ILR, PM implantation was performed in 60 (34.7%), an intra-cardiac defibrillator in 5 (2.9%), and catheter ablation in 4 (2.3%). In a Cox regression analysis, history of paroxysmal atrial fibrillation (PAF) (hazard ratio [HR], 2.34; 95% confidence interval [CI], 1.33–4.12; P < 0.01) and any bundle branch block (BBB) (HR, 2.52; 95% CI, 1.09–5.85; P = 0.03) were significantly associated with PM implantation.@*CONCLUSION@#ILR is useful for detecting syncope-correlated arrhythmia in patients with US. The risk of PM is high in US patients with a history of PAF and any BBB.

Usefulness of an Implantable Loop Recorder in Diagnosing Unexplained Syncope and Predictors for Pacemaker Implantation

Multimodality Imaging of Anomalous Left Coronary Artery from the Pulmonary Artery

No abstract available.

Medical Findings in Women with Anorexia Nervosa in a Korean Population

OBJECTIVE: Eating disorders are a common clinical problem among young women in Asian countries. The aim of this study is to determine the medical effects of anorexia nervosa (AN) in the Korean population. METHODS: We comprehensively investigated medical complications including haemodynamic, haematologic, endocrine, and bone density abnormalities in 67 Korean women with AN, together with 194 healthy Korean women of comparable age with a cross-sectional design. RESULTS: In AN, 36.9% were anaemic, 50.8% were leukopenic, 35.5% were hypoproteinemic, 7.9% were hypokalemic, 9.5% had increased alanine aminotransferase, 6.3% were hyperbilirubinemia, 14.5% were hypercholesterolemia, 14.8% had decreased triiodothyronine. Osteopenia at any one site was identified in 43.3% and an additional 13.4% had osteoporosis. The lowest-ever body mass index was the main determinant of bone mineral density. CONCLUSION: Our data in Korean patients with AN show high frequencies of laboratory abnormalities for medical complications. This study emphasizes the importance of recognizing AN as a medical risk in young Korean women.

A Delayed, Unusual Non-Cardiogenic Pulmonary Edema after Intravascular Administration of Non-Ionic, Low Osmolar Radiocontrast Media for Coronary Angiography

Non-cardiogenic pulmonary edema (NCPE) is a rare adverse reaction to iodinated radiocontrast media (RCM), in which all previous cases were immediate reactions. A 56-year-old male was given iopamidol, a non-ionic, low osmolar RCM, during coronary artery angiography. He developed pulmonary edema and fever a day after the procedure. Despite diuretic therapy, the patient's pulmonary edema worsened and his high fever persisted. The patient's pulmonary edema was eventually resolved with intravenous steroid treatment. We interpreted the patient's condition as NCPE manifesting as a delayed reaction to RCM. To our knowledge, our case is the first to show NCPE as a delayed hypersensitivity reaction.

Successful Resection of a Giant Left Ventricular Pseudoaneurysm Developed Later after Mitral Valve Replacement

We present a case of successful surgical resection of a giant left ventricular (LV) pseudoaneurysm that developed 5 yr after mitral valve replacement (MVR). A 59-yr-old female was admitted with exertional chest pain radiating to left arm and back. 64-slice multidetector computed tomography (MDCT) revealed significant stenosis on the ostium of the first diagonal branch of the left anterior descending coronary artery and also a huge pseudoaneurysm compressing the right atrium and the inferior vena cava. She underwent resection of the pseudoaneurysm, and the pseudoaneurysm tunnel was repaired from the inside of LV cavity by removing the previously inserted prosthetic valve, followed by redo MVR together with coronary arterial bypass grafting (CABG) for a single-vessel disease. At the 6-month follow-up, the patient continued to do well without any complications.

Congenital Angiodysplasia in a Woman Presenting with Idiopathic Jejunal Varicosis on Angiography

Angiography is a useful diagnostic tool in cases with massive gastrointestinal bleeding such as angiodysplasia and varicosis when endoscopy is not available. Angiodysplasia and varicosis have distinguishable characteristic features on angiography, such as the presence of a nidus, visible late-draining veins, and the typical vascular tuft. We recently treated a rare case of congenital angiodysplasia without the characteristic angiodysplasia features on angiography. Instead, the patient presented with a very rare case of idiopathic jejunal varicosis. A 42-year-old woman visited the emergency room with the chief complaint of melena for three days and a hemoglobin level of 5.9 g/dL. An abdominal CT angiogram showed varicosis at the jejunal mesentery. Angiography of the superior and inferior mesenteric arteries showed tortuous and dilated jejunal and ileal branches during the venous phase, suggesting a vascular malformation such as varicosis of the jejunum. Surgical exploration with intraoperative endoscopy revealed diffuse engorged veins and a 1.0-cm-diameter superficial ulcer covered with a blood clot that was 70 cm from the ligament of Treitz. A 100-cm segment of jejunum was resected. Histological examination revealed that the lesion was angiodysplasia, not varicosis. The final diagnosis was congenital angiodysplasia.

A Case of Fabry Cardiomyopathy

In the absence of hypertension, hypertrophic cardiomyopathy is the most common cause of left ventricular hypertrophy (LVH). However, it has been reported that up to 3% of males with unexplained LVH have Fabry disease, an X-linked disorder of glycophospholipid metabolism that is due to a deficiency in the lysosomal enzyme alpha-galactosidase A (alpha-Gal A). A 44-year-old man was admitted to our hospital with palpitations. He had a history of chronic renal failure diagnosed at age 33 followed by kidney transplantation performed at our institution 2 years later, as well as long-standing hypohidrosis. His medications included prednisolone (5 mg daily), mycophenolate mofetil (1,000 mg, bid), and cyclosporine (150 mg, bid). On hospital day two, an echocardiogram demonstrated increased left ventricular wall thickness (septal wall thickness of 28 mm, posterior wall thickness of 20 mm). Diastolic dysfunction was noted on transmitral flow patterns and tissue Doppler imaging. The patient was found to have low plasma alpha-Gal A activity. A previously reported H46R missense mutation was detected in his alpha-Gal A gene and the patient was subsequently diagnosed with Fabry disease.

A Case of Hemolytic Anemia Following Mitral Valve Repair

Hemolytic anemia is one of the findings representative of prosthesis dysfunction after valve surgery. A 67-year-old man, who underwent mitral annular ring plasty one week ago, was admitted with shortness of breath and fatigue. Hematological studies revealed a Coombs'-negative hemolytic anemia with a hemoglobin 7.9 g/dl, hematocrit of 17.1%, haptoglobin of 1.0 mg/dl, LDH 5148 U/L, total bilirubin of 3.1 mg/dl (direct of 0.71 mg/dl), and a peripheral blood smear demonstrating mechanical hemolysis with red cell fragmentation. Transesophageal echocardiogram revealed a turbulent jet of mitral regurgitation hitting the annuloplasty ring. The patient returned to the operating room for mitral valve replacement, and thereafter which the hemolytic anemia resolved.

A Case of Endoscopic Polypectomy Using a Hand-Made Detachable Snare Made of Nylon Fishing Line / 대한소화기내시경학회지

Hemorrhage is the most common complication of polypectomy. Though most bleeding stops spontaneously and can be managed with conservative therapies, some may necessitate intensive therapies. The detachable snare was firstly introduced in 1986. It has been reported that the use of detachable snare can effectively prevent both immediate and delayed bleeding. The detachable snare has been reformed, and now a commercial article is used in practice. But, it is expensive and cannot be used in larger polyps measuring over its fixed size of loop. A hand-made detachable snare made of nylon fishing line was introduced to prevent postpolypectomy bleeding in 2003. We have further improved it and experienced a case of successful removal of a large colonic polyp using our hand-made snare. The hand-made detachable snare is inexpensive and seems to be practical in ligating the polyp regardless of its size.

Enteric Fever with Bowel Perforation Caused by Nontyphoidal Group D Salmonella

The case of enteric fever and bowel perforation caused by nontyphoidal Salmonella spp. is extremely rare. We report a case of a 28-year-old man who suffered from enteric fever with complicated a small bowel perforation, which is a known complication of S. typhi and S. paratyphi infections. The culprit later proved to be nontyphoidal group D Salmonella spp. in our case.

Enteric Fever with Bowel Perforation Caused by Nontyphoidal Group D Salmonella

The case of enteric fever and bowel perforation caused by nontyphoidal Salmonella spp. is extremely rare. We report a case of a 28-year-old man who suffered from enteric fever with complicated a small bowel perforation, which is a known complication of S. typhi and S. paratyphi infections. The culprit later proved to be nontyphoidal group D Salmonella spp. in our case.