Résumé
Flash pulmonary edema typically exhibits sudden onset and resolves rapidly. It generally is associated with bilateral renal artery stenosis or unilateral stenosis in conjunction with a single functional kidney. We describe a patient who presented with flash pulmonary edema treated by percutaneous therapy with stent implantation. Our case is unique in that the flash pulmonary edema occurred in the setting of unilateral renal artery stenosis with bilateral functioning kidneys.
Sujets)
Humains , Sténose pathologique , Rein , Oedème pulmonaire , Artère rénale , Occlusion artérielle rénale , EndoprothèsesRésumé
BACKGROUND: The N-terminal fragment of pro Brain Natriuretic Peptide (NT-pro BNP) is a neuro-hormone synthesized in the cardiac ventricles in response to increased wall tension. The purpose of this study was to assess the correlation between the NT-pro BNP levels and the New York Heart Association function class (NYHA Fc) of dyspnea and echocardiographic findings for the patients who visited our cardiology departments. METHODS: From October, 2002 to April, 2003, serum NT-pro BNP levels were measured in 348 patients who visited the Samsung Medical Center and the Jong Koo Lee Heart Clinic. RESULTS: The NT-pro BNP levels were increased with the progression of NYHA Fc of dyspnea (p< 0.001 by ANOVA), the increase in the systolic left ventricular internal dimension (p< 0.05), and the decrease in the ejection fraction (p< 0.01). For the NYHA Fc I patients, the NT-pro BNP levels were positively correlated with age (p< 0.001) and left atrial size (p< 0.001). For the patients with ischemic heart disease, the NT-pro BNP levels were also positively correlated with the NYHA Fc (p< 0.001 by ANOVA). The NT-pro BNP levels were increased with the increase in the systolic (p< 0.001) and diastolic pressure (p=0.017), the left ventricular internal dimension as well as the decrease in the ejection fraction (p< 0.001). The area under the receiver operating characteristic (ROC) curve for the NT-pro BNP levels was 0.994 (95% confidence interval, 0.979-0.999), and the most reliable cut-off level for the NT-pro BNP was 293.6 pg/mL. CONCLUSION: The NT-pro BNP levels were positively correlated with the NYHA Fc of dyspnea and the systolic dysfunction for the patients who visited our cardiology departments. A 300 pg/mL value for the NT-pro BNP cut-off point appears to be a sensitive level to differentiate dyspnea originating from an ailing heart or not for the patients who visited our cardiology departments.
Sujets)
Femelle , Humains , Mâle , Adulte d'âge moyen , Dyspnée/physiopathologie , Défaillance cardiaque/sang , Protéines de tissu nerveux/sang , Fragments peptidiques/sang , Études prospectives , Indice de gravité de la maladie , Débit systolique/physiologie , Systole/physiologie , Dysfonction ventriculaire gauche/physiopathologieRésumé
BACKGROUND: N-terminal fragment of pro Brain Natriuretic Peptide (NT-pro BNP) is a neuro-hormone synthesized from the cardiac ventricles in response to increased wall tension. The purpose of this study was to assess the correlation between NT-pro BNP levels and New York Heart Association function class (NYHA Fc) and echocardiographic findings in patients, who visited cardiology department. METHODS: From October, 2002 to April, 2003, serum NT-pro BNP levels were measured in 348 patients, who visited Samsung Medical Center and Jong Koo Lee Heart Clinic. RESULTS: NT-pro BNP levels were increased with the progression of NYHA Fc of dyspnea (p<0.001 by ANOVA) as well as with the increase in systolic left ventricular internal dimension (p<0.05) and the decrease in ejection fraction (p<0.01). In NYHA Fc I patients, NT-pro BNP levels were positively correlated with age (p<0.001) and left atrial size (p<0.001). In patients with ischemic heart disease, NT-pro BNP levels were also positively correlated with NYHA Fc (p<0.001 by ANOVA). NT-pro BNP levels were increased with the increase in systolic (p<0.001) and diastolic (p=0.017) left ventricular internal dimension as well as the decrease in ejection fraction (p<0.001). The area under the receiver operating characteristic (ROC) curve for NT-pro BNP levels was 0.994 (95% confidence interval, 0.979-0.999), and the most reliable cut-off level of NT-pro BNP was 293.6 pg/mL. CONCLUSION: NT-pro BNP levels were positively correlated with NYHA Fc of dyspnea and systolic dysfunction in patients, who visited cardiology department. A 300 pg/mL of NT-pro BNP level appears to be a sensitive level to differentiate dyspnea of heart origin or not in patients, who visited cardiology department.
Sujets)
Humains , Cardiologie , Dyspnée , Échocardiographie , Défaillance cardiaque , Ventricules cardiaques , Coeur , Ischémie myocardique , Peptide natriurétique cérébral , Peptides natriurétiques , Courbe ROCRésumé
Metastasis of breast cancer to the stomach is relatively uncommon and typically occurs in patients with disseminated diseases. This may cause difficulty in differentiating it from primary gastric carcinoma. The correct diagnosis of the primary source is important, since the treatment and prognosis of metastatic breast cancer is quite different from those of metastatic gastric cancer. Immunohistochemical staining with GCDFP-15 (gross cystic disease fluid protein-15) can be used to differentiate primary gastric carcinoma and gastric metastasis from breast cancer. We report two cases of gastric metastasis of breast cancer by describing their clinical course, illustrating the histologic findings, and showing the results of immunohistochemical staining with GCDFP-15.
Sujets)
Humains , Tumeurs du sein , Région mammaire , Diagnostic , Métastase tumorale , Pronostic , Estomac , Tumeurs de l'estomacRésumé
Although Aspergillus endocarditis has rarely been reported, it can cause fatal complications in hematologic malignancy patients and allogeneic stem cell transplant recipients. We experienced two cases of aspergillus endocarditis developed in acute lymphoblastic leukemia patients. Case; A 19-year-old patient developed Aspergillus endocarditis after allogenic hemopoietic stem cell transplantation. He was treated with surgical intervention and liposomal amphotericin B. He died of recurred Aspergillus endocarditis and cerebral hemorrhage probably related with aspergillosis of central nervous system. Case 2; A 23-year-old patient developed invasive Aspergillus endocarditis after induction chemotherapy. Aspergillus endocarditis was successfully treated by surgical intervention and amphotericin B. He died of refractory neutropenic fever and sepsis after the third relapse of leukemia and repetitive chemotherapy. He probably had invasive pulmonary aspergillosis without evidence of endocarditis recurrence. Because the mortality of Aspergillus endocarditis is very high, early diagnosis and surgical intervention are very important for better outcome.
Sujets)
Humains , Jeune adulte , Amphotéricine B , Aspergillose , Aspergillus , Système nerveux central , Hémorragie cérébrale , Traitement médicamenteux , Diagnostic précoce , Endocardite , Fièvre , Tumeurs hématologiques , Chimiothérapie d'induction , Aspergillose pulmonaire invasive , Leucémies , Mortalité , Ostéomyélite , Leucémie-lymphome lymphoblastique à précurseurs B et T , Récidive , Sepsie , Transplantation de cellules souches , Cellules souches , TransplantationRésumé
Although Aspergillus endocarditis has rarely been reported, it can cause fatal complications in hematologic malignancy patients and allogeneic stem cell transplant recipients. We experienced two cases of aspergillus endocarditis developed in acute lymphoblastic leukemia patients. Case; A 19-year-old patient developed Aspergillus endocarditis after allogenic hemopoietic stem cell transplantation. He was treated with surgical intervention and liposomal amphotericin B. He died of recurred Aspergillus endocarditis and cerebral hemorrhage probably related with aspergillosis of central nervous system. Case 2; A 23-year-old patient developed invasive Aspergillus endocarditis after induction chemotherapy. Aspergillus endocarditis was successfully treated by surgical intervention and amphotericin B. He died of refractory neutropenic fever and sepsis after the third relapse of leukemia and repetitive chemotherapy. He probably had invasive pulmonary aspergillosis without evidence of endocarditis recurrence. Because the mortality of Aspergillus endocarditis is very high, early diagnosis and surgical intervention are very important for better outcome.
Sujets)
Humains , Jeune adulte , Amphotéricine B , Aspergillose , Aspergillus , Système nerveux central , Hémorragie cérébrale , Traitement médicamenteux , Diagnostic précoce , Endocardite , Fièvre , Tumeurs hématologiques , Chimiothérapie d'induction , Aspergillose pulmonaire invasive , Leucémies , Mortalité , Ostéomyélite , Leucémie-lymphome lymphoblastique à précurseurs B et T , Récidive , Sepsie , Transplantation de cellules souches , Cellules souches , TransplantationRésumé
Lupus myocarditis is usually treated using immunosuppressive agents, such as high-dose corticosteroids, azathioprine and cyclophosphamide. Viral myocarditis and enteroviruses have been identified as the most common causative agents of myocarditis in lupus patients. Although immunosuppressive therapy has an important role in the treatment of lupus myocarditis, it is not recommended in patients with infectious or post-infectious viral myocarditis, and supportive care is very important in these patients. A 25-year old female patient, with systemic lupus erythematosus, was admitted due to severe dyspnea, and diagnosed as having heart failure. She recovered 7 days after supportive care for heart failure, without Immuno-suppression. Her sera neutralized coxsackievirus B3 (CVB3) in neutralization test, with the horse anti-CVB3 antibody (Ab, ATCC V030-501-560) used as a positive control. The titers for the neutralizing Ab in her sera were 4 times higher than that of the standard control ATCC Ab.
Sujets)
Adulte , Femelle , Humains , Hormones corticosurrénaliennes , Azathioprine , Cyclophosphamide , Dyspnée , Enterovirus , Défaillance cardiaque , Equus caballus , Immunosuppresseurs , Lupus érythémateux disséminé , Myocardite , Tests de neutralisationRésumé
Mesenchymal hamartoma of the liver (MHL) is a rare benign tumor usually found in childhood, especially during the first two years. MHL is extremely rare in adults. Most reported cases present with a slow growing abdominal mass. It is thought to be a developmental anomaly and consists of bile ducts, hepatocytes and mesenchymal tissue. We report a case of mesenchymal hamartoma of the liver in an adult male with a brief review of the literature.
Sujets)
Adulte , Humains , Mâle , Hamartomes/diagnostic , Maladies du foie/diagnosticRésumé
Serous cystadenoma of the pancreas is a rare disease and is usually benign. Mucinous cystadenoma, another cystic neoplasm of the pancreas, has a malignant potential. Serous cystadenoma is usually composed of many small cysts lined by small, cuboidal or flattened cells containing abundant glycogen. With the finding of endoscopic retrograde pancreatography, a communication between the cyst and pancreatic duct is observed occasionally in the mucinous cystadenoma, but rarely in the case of serous cystadenoma of the pancreas. We experienced a case of serous cystadenoma of the pancreas that had a communication between a cyst and the pancreatic duct.
Sujets)
Adulte , Femelle , Humains , Cystadénome séreux/complications , Fistule digestive/complications , Maladies du pancréas/complications , Conduits pancréatiques , Tumeurs du pancréas/complicationsRésumé
Neuroendocrine carcinoma of the colon is a very rare entity. However, this type of tumor is known to have aggressive progression and poor prognosis. A case of a 72-year-old male is presented in this report. A 3 cm sized tumor was found on the rectum with multiple liver metastases. The pathological findings including a positive immunohistochemical staining for synaptophysin and cytokeratin done with colonoscopic biopsy and liver biopsy confirmed the tumor as a neuroendocrine carcinoma. The nomenclature and definition of this disease still remains somewhat unclear, and not a small population of this disease may thus have been misdiagnosed and treated as other less aggressive entities, such as carcinoid tumor. The necessity to make an accurate differential diagnosis in such cases is thus emphasized because of different treatments and clinical courses. For its rarity and clinical significance, we report this case with a review of the literatures.
Sujets)
Sujet âgé , Humains , Mâle , Biopsie , Tumeur carcinoïde , Carcinome neuroendocrine , Côlon , Diagnostic différentiel , Kératines , Foie , Métastase tumorale , Pronostic , Rectum , SynaptophysineRésumé
Neuroendocrine carcinoma of the colon is a very rare entity. However, this type of tumor is known to have aggressive progression and poor prognosis. A case of a 72-year-old male is presented in this report. A 3 cm sized tumor was found on the rectum with multiple liver metastases. The pathological findings including a positive immunohistochemical staining for synaptophysin and cytokeratin done with colonoscopic biopsy and liver biopsy confirmed the tumor as a neuroendocrine carcinoma. The nomenclature and definition of this disease still remains somewhat unclear, and not a small population of this disease may thus have been misdiagnosed and treated as other less aggressive entities, such as carcinoid tumor. The necessity to make an accurate differential diagnosis in such cases is thus emphasized because of different treatments and clinical courses. For its rarity and clinical significance, we report this case with a review of the literatures.
Sujets)
Sujet âgé , Humains , Mâle , Biopsie , Tumeur carcinoïde , Carcinome neuroendocrine , Côlon , Diagnostic différentiel , Kératines , Foie , Métastase tumorale , Pronostic , Rectum , SynaptophysineRésumé
Granular cell tumor (GCT), first described by Abrikossoff in 1926, is relatively uncommon, usually benign and solitary neoplasm. The most frequently involved organs include the tongue, skin, breast, and digestive tract. Until now, less than 200 cases of GCTs of the digestive tract have been reported in the esophagus, and less than 50 cases in the large intestine, stomach, biliary tract in the world. Only less than 20 cases of GCT of the rectum have been reported in the world. It is believed that there have been no reported cases of GCT of the rectum in Korea. Recently, the incidence of granular cell tumor has been slowly rising since endoscopy has been used more commonly as a diagnostic tool. We report a case of granular cell tumor in the rectum in a 49-year-old male patient, which was confirmed by microscopic examination after colonoscopic polypectomy.