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A case of concomitant acute myocardial infarction and descending thoracic aorta pseudoaneurysm
김지현,권혁이,김보라,박성현,정재훈,정진선,서정훈,김도준,문다해,허애영,김용훈 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1
A 61-year-old female presented to ER with dull, anterior chest pain of one day duration. Her EKG demonstrated 0.5 mm ST elevation in leads III and aVF and 0.5 mm ST depression in leads I, aVL, V4-V6. Chest X-ray and cardiac biomarkers were normal. Chest CT scan was done to exclude acute aortic dissection and pulmonary thromboembolism because the patient complained severe chest pain with radiating back pain later. Chest CT scan showed blood leaks through the wall but contained by the adventitia at anteromedial portion of upper descending thoracic aorta. Six hours later, cardiacenzymes were elevated but EKG was unchanged. Attending interventional cardiologists and thoracic surgeons were discussed about the option of CAG and operation. The concern was CAG might progress the aortic pseudoaneurysm and cause clinical deterioration. Preparation was made for both CAG and thoracic endovascular aortic repair (TEVAR). CAG revealed total occlusion of the m-RCA. The LCA was normal. After balloon dilatation, an Orsiroi 3.5 × 30 mm stent was successfully deployed. Thereafter, the right common femoral artery was exposed and aortography was done. Valiantithoracic stent graft (32 × 117 mm) was deployed successfully. In the emergency department, more commonly one disease entity is the cause of the symptom and is given focus, however, as seen in this case, two disease entities were involved and were happening concomitantly. In conclusion, it is important to exclude acute aortic syndromes before reperfusion therapy in patients presenting with acute myocardial infarction.
Correlation between high platelet reactivity and periprocedural myonecorsis in patients with ACS
김용훈,정재훈,김보라,박성현,김지현,서정훈,허애영,권혁이,정진선,김도준,문다해 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1
Background: Growing evidences suggest that platelet are also important mediators of inflammation and play a central role in atherogenesis itself as well as blood clot formation. The purpose of this present study was to evaluate the correlation between high platelet reactivity (HPR) and the extent of coronary atherosclerosis and periprocedural myonecrosis in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Methods: A total of 485 patients underwent PCI for ACS was studied. HPR was defined as platelet reactivity units ≥230 in point-of-care P2Y12 testing by the VerifyNow assay. Results: The incidence of multi-vessel disease (MVD) was higher in patients with HPR than those with no HPR (56.2% vs 45.8%, p=0.023). The PRU values progressively increased with number of diseased coronary arteries (1-vessel disease 221.8±86.7; 2-vessel disease 239.3±90.1; 3-vessel disease 243.4±84.5; p=0.038 by ANOVA). Multivariate analysis revealed that HPR was independently associated with MVD (Odds ratio 1.50, 95% confidence interval 1.01-2.24, p=0.047). Patients with periprocedural myonecrosis showed significantly higher PRU value compared with those without myonecrosis (258.6±94.5 vs. 228.5±85.6, p=0.013). Conclusions: HPR is associated with MVD and periprocedural myonecrosis in patients with ACS and PCI. Thus, platelet reactivity after clopidogrel might be associated with not only blood clot formation but also increased coronary atherosclerotic burden.
박성현 ( Sung Hyun Park ),강창돈 ( Chang Don Kang ),박진명 ( Jin Myung Park ),김지현 ( Ji Hyun Kim ),정재훈 ( Jae Hoon Jung ),정진선 ( Jin Seon Jeong ),김도준 ( Do Jun Kim ),문다해 ( Da Hye Moon ) 대한췌담도학회 2017 대한췌담도학회지 Vol.22 No.2
위암의 전이는 주로 혈행성 전파, 림프절을 통한 전이, 주위 장기를 통한 직접 침윤과 복강내 파종을 통해 이루어지며 장기로는 주로 간, 폐, 뼈로 전이가 된다고 알려져 있다. 위암의 담낭 전이는 흔하지 않고 예후가 좋지 않으며 담낭염으로 발현한 경우 더 예후가 나쁘다고 알려져 있다. 본 저자들은 위암의 담낭으로의 전이와 담낭염이 동반된 증례를 경험하여 보고하는 바이다. Gastric cancer mainly spreads to the liver, peritoneum, and lymph nodes and rarely metastasizes to the gallbladder. The prognosis of gastric cancer with metastasis to the gallbladder is reported to be very poor, and presentation with cholecystitis is a prognostic factor. Herein, we present a case of gastric cancer with metastasis to the gallbladder, accompanied by acute cholecystitis. Korean J Pancreas Biliary Tract 2017;22(2):98-101