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Jun Bean Park,Jin Hyeok Hwang,Hae Ryoung Kim,Hyung Sim Choe,Yu Kyeong Kim,Hong Bin Kim,Soo Mee Bang 대한내과학회 2007 The Korean Journal of Internal Medicine Vol.22 No.2
Castleman disease (CD) is a rare lymphoproliferative disorder of unknown etiology with different clinical manifestations. A previous healthy 50 year-old man was hospitalized for right upper quadrant (RUQ) abdominal pain. He had jaundice and a 1 cm-sized lymph node in the right supraclavicular area. Pancreas and biliary computed tomography (CT) showed masses at the right renal hilum and peripancreatic areas. Positron emission tomography (PET) showed widespread systemic lymphadenopathy. Excisional biopsy of the right supraclavicular node revealed a hyaline vascular variant of CD. Corticosteroid therapy was started and the extent of disease decreased. We here report a case of multicentric CD, the hyaline vascular variant, presenting with jaundice, diagnosed by excisional biopsy and successfully treated with corticosteroids.
Park, Jun-Bean,Kang, Do-yoon,Yang, Han-Mo,Cho, Hyun-Jai,Park, Kyung Woo,Lee, Hae-Young,Kang, Hyun-Jae,Koo, Bon-Kwon,Kim, Hyo-Soo The European Society of Cardiology 2013 European heart journal Vol.34 No.12
<P><B>Aims</B></P><P>The association between alkaline phosphatase (ALP) and mortality was reported in several subgroups of patients. But, the role of ALP in overall coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI) remains unknown. The aim of this study was to examine the prognostic value of the ALP level in patients with CAD who underwent PCI with drug-eluting stent (DES).</P><P><B>Methods and results</B></P><P>We prospectively included CAD patients who underwent PCI with DES. After exclusion of patients with liver disease and cancer, 1636 patients were selected for the analysis of clinical outcomes (median duration of follow-up; 762 days, inter-quartile range; 494–1068 days), and were classified into tertiles by baseline measurements of ALP (<63, 63–78, and >78 IU/L). After adjustment of potential confounders including angiographic data, the independent and dose-dependent association was observed between tertile of ALP and the adjusted hazard ratio (HR) of all-cause mortality (<I>P</I> for trend < 0.0001). Specifically, compared with the lowest ALP tertile, the adjusted HR of all-cause mortality in the highest tertile was 4.21 (95% confidence interval 2.03–8.71). In subgroup of patients with stable or unstable angina, a similar association was noted (<I>P</I> for trend < 0.0001). In terms of cardiovascular mortality, myocardial infarction, and stent thrombosis, the adjusted HRs in the highest ALP tertile were 3.92 (1.37–11.20), 1.98 (0.91–4.29), and 2.73 (1.33–5.61), respectively, compared with the lowest tertile. Furthermore, evaluation of both ALP and C-reactive protein provided better predictive value than either alone. Interesting result suggesting the mechanism was that ALP was significantly associated with the presence of angiographic coronary calcification (<I>P</I> for trend = 0.046).</P><P><B>Conclusion</B></P><P>Our study demonstrated that the higher serum ALP level is an independent predictor of mortality, myocardial infarction, and stent thrombosis in CAD patients after PCI with DES.</P>
Park, Jun-Bean,Hwang, In-Chang,Lee, Whal,Han, Jung-Kyu,Kim, Chi-Hoon,Lee, Seung-Pyo,Yang, Han-Mo,Park, Eun-Ah,Kim, Hyung-Kwan,Chiam, Paul T.L.,Kim, Yong-Jin,Koo, Bon-Kwon,Sohn, Dae-Won,Ahn, Hyuk,Kang, Elsevier 2018 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.259 No.-
<P><B>Abstract</B></P> <P><B>Background</B></P> <P>Limited data exist regarding the impact of aortic valve calcification (AVC) eccentricity on the risk of paravalvular regurgitation (PVR) and response to balloon post-dilation (BPD) after transcatheter aortic valve replacement (TAVR). We investigated the prognostic value of AVC eccentricity in predicting the risk of PVR and response to BPD in patients undergoing TAVR.</P> <P><B>Methods</B></P> <P>We analyzed 85 patients with severe aortic stenosis who underwent self-expandable TAVR (43 women; 77.2±7.1years). AVC was quantified as the total amount of calcification (total AVC load) and as the eccentricity of calcium (EoC) using calcium volume scoring with contrast computed tomography angiography (CTA). The EoC was defined as the maximum absolute difference in calcium volume scores between 2 adjacent sectors (bi-partition method) or between sectors based on leaflets (leaflet-based method).</P> <P><B>Results</B></P> <P>Total AVC load and bi-partition EoC, but not leaflet-based EoC, were significant predictors for the occurrence of ≥moderate PVR, and bi-partition EoC had a better predictive value than total AVC load (area under the curve [AUC]=0.863 versus 0.760, <I>p</I> for difference=0.006). In multivariate analysis, bi-partition EoC was an independent predictor for the risk of ≥moderate PVR regardless of perimeter oversizing index. The greater bi-partition EoC was the only significant parameter to predict poor response to BPD (AUC=0.775, <I>p</I> =0.004).</P> <P><B>Conclusion</B></P> <P>Pre-procedural assessment of AVC eccentricity using CTA as “bi-partition EoC” provides useful predictive information on the risk of significant PVR and response to BPD in patients undergoing TAVR with self-expandable valves.</P> <P><B>Highlights</B></P> <P> <UL> <LI> AV calcification has been suggested to be associated with PVR after TAVR. </LI> <LI> We developed a bi-partition method to assess eccentricity of AV calcification (EoC). </LI> <LI> Bi-partition EoC predicted the risk of PVR and response to balloon post-dilation. </LI> <LI> Bi-partition EoC had better predictive power than the conventional leaflet-based method. </LI> <LI> Measurement of the bi-partition EoC may be helpful in a patient undergoing TAVR. </LI> </UL> </P>
심박동기로 인한 삼첨판 역류 초대받은 손님, 초대받지 못한 합병증
박준빈 ( Jun Bean Park ),김용진 ( Yong Jin Kim ) 대한내과학회 2014 대한내과학회지 Vol.86 No.5
A permanent pacemaker is a mainstay treatment for symptomatic bradyarrhythmia, including atrioventricular node blocks and sick sinus syndrome. Although this device was introduced to aid electrical recovery, pacemakers can cause mechanical dysfunction of the tricuspid valve, resulting in significant tricuspid regurgitation (TR). Because pacemaker-related TR is a correctable cause of right heart failure, it is of paramount importance to assess the presence or severity of TR and its association with pacemakers. However, acoustic shadowing from the pacemaker wire hampers the accurate visualization of TR jets, and increases the risk of failing to detect severe TR. Accordingly, goal-directed imaging with a high index of clinical suspicion should be performed when patients present with right heart failure after pacemaker implantation. In this issue of the Journal, the authors sought to investigate the frequency of aggravated TR in patients after pacemaker implantation. They also explored the predictors of TR aggravation, which might provide valuable information for identification of patients who require meticulous follow-up to allow timely intervention. These data regarding the predictive variables for pacemaker-related TR can serve as a roadmap for future studies to identify strategies for reducing the risk of significant TR, such as a tailored approach based on heart rhythm (bradyarrhythmia only vs. combined atrial fibrillation), pacemaker mode (VVI vs. DDD), the location of the pacemaker lead (apical vs. base), and the use of state-of-the art techniques (classical lead vs. leadless). (Korean J Med 2014;86:573-576)
Jiesuck Park,Hyung-Kwan Kim,박은아,Jun-Bean Park,Seung-Pyo Lee,이활,Yong-Jin Kim,Dae-Won Sohn 대한영상의학회 2019 Korean Journal of Radiology Vol.20 No.5
Objective: To investigate the diagnostic validity of coronary computed tomography angiography (cCTA) in vasospastic angina (VA) and factors associated with discrepant results between invasive coronary angiography with the ergonovine provocation test (iCAG-EPT) and cCTA. Materials and Methods: Of the 1397 patients diagnosed with VA from 2006 to 2016, 33 patients (75 lesions) with available cCTA data from within 6 months before iCAG-EPT were included. The severity of spasm (% diameter stenosis [%DS]) on iCAGEPT and cCTA was assessed, and the difference in %DS (Δ%DS) was calculated. Δ%DS was compared after classifying the lesions according to pre-cCTA-administered sublingual nitroglycerin (SL-NG) or beta-blockers. The lesions were further categorized with %DS ≥ 50% on iCAG-EPT or cCTA defined as a significant spasm, and the diagnostic performance of cCTA on identifying significant spasm relative to iCAG-EPT was assessed. Results: Compared to lesions without SL-NG treatment, those with SL-NG treatment showed a higher Δ%DS (39.2% vs. 22.1%, p = 0.002). However, there was no difference in Δ%DS with or without beta-blocker treatment (35.1% vs. 32.6%, p = 0.643). The significant difference in Δ%DS associated with SL-NG was more prominent in patients who were aged < 60 years, were male, had body mass index < 25 kg/m2, and had no history of hypertension, diabetes, or dyslipidemia. Based on iCAG-EPT as the reference, the per-lesion-based sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of cCTA for VA diagnosis were 7.5%, 94.0%, 60.0%, 47.1%, and 48.0%, respectively. Conclusion: For patients with clinically suspected VA, confirmation with iCAG-EPT needs to be considered without completely excluding the diagnosis of VA simply based on cCTA results, although further prospective studies are required for confirmation.
( Seohyun Park ),( Jung Ho Kim ),( Yong Duk Jeon ),( Hea Won Ahn ),( Jin Young Ahn ),( Sun Bean Kim ),( Nam Su Ku ),( Sang Hoon Han ),( Geu Ru Hong ),( Jun Young Choi ),( Young Goo Song ),( June Myung 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1
Abiotrophia defectiva (A. defectiva), a nutritionally variant streptococcus can causes bacteremia, brain abscess, septic arthritis and rarely infective endocarditis, of which it only accounts for about < 1% of all cases. A. defectiva is characteristically difficult to diagnose and the mortality, morbidity and complication rates are high. We experienced a case of infective endocarditis caused by A. defectiva following a tooth extraction. A 62-year old woman had previously undergone prosthetic mitral valve replacement and was successfully cured with antimicrobial chemotherapy and surgical treatments including a redo mitral valve replacement. This is the first case report of infective endocarditis caused by A. defectiva in Korea. This case shows that A. defectiva might be considered as a causative organism of infective endocarditis in Korea.
Lee, Heesun,Park, Jun-Bean,Yoon, Yeonyee E.,Park, Eun-Ah,Kim, Hyung-Kwan,Lee, Whal,Kim, Yong-Jin,Cho, Goo-Yeong,Sohn, Dae-Won,Greiser, Andreas,Lee, Seung-Pyo Elsevier Science B.V. Amsterdam 2018 JACC CARDIOVASCULAR IMAGING Vol.11 No.7
<P><B>Abstract</B></P> <P><B>Objectives</B></P> <P>The aim of this study was to evaluate whether native T1 value of the myocardium on cardiac magnetic resonance (CMR) could predict clinical events in patients with significant aortic stenosis (AS).</P> <P><B>Background</B></P> <P>Although previous studies have demonstrated the prognostic value of focal fibrosis using late gadolinium enhancement (LGE) by CMR in AS patients, the prognostic implication of diffuse myocardial fibrosis by noninvasive imaging remains unknown.</P> <P><B>Methods</B></P> <P>A prospective observational longitudinal study was performed in 127 consecutive patients with moderate or severe AS (68.8 ± 9.2 years of age, 49.6% male) and 33 age- and sex-matched controls who underwent 3-T CMR. The degree of diffuse myocardial fibrosis was assessed by noncontrast mapping of T1 relaxation time using modified Look-Locker inversion-recovery sequence, and the presence and extent of LGE were also evaluated. The AS patients were divided into 3 groups by the native T1 value. Primary endpoint was a composite of all-cause death and hospitalization for heart failure.</P> <P><B>Results</B></P> <P>Native T1 value was higher in AS patients, compared with control subjects (1,232 ± 53 ms vs. 1,185 ± 37 ms; p = 0.008). During follow-up (median 27.9 months), there were 24 clinical events including 9 deaths (6 pre-operative and 3 post-operative), the majority of which occurred in the patients in the highest T1 tertile group (2.4% vs. 11.6% vs. 42.9% for lowest, mid-, and highest tertile groups; p < 0.001 by log-rank test). The total number of events for both pre- and post-operative events also occurred more frequently in patients in the highest T1 tertile group. EuroSCORE II, the presence and/or extent of LGE, and the native T1 value were predictors of poor prognosis (adjusted hazard ratio for every 20-ms increase of native T1: 1.28; p = 0.003). In particular, the highest native T1 value provided further risk stratification regardless of the presence of LGE.</P> <P><B>Conclusions</B></P> <P>High native T1 value on noncontrast T1 mapping CMR is a novel, independent predictor of adverse outcome in patients with significant AS.</P> <P><B>Graphical abstract</B></P> <P>[DISPLAY OMISSION]</P>