Pentraxin 3 as a Novel Marker Predicting Congestive Heart Failure in Subjects With Acute Coronary Syndrome

BACKGROUND AND OBJECTIVES: Pentraxin 3 (PTX3) was shown to be elevated in the acute phase of acute myocardial infarction (AMI) and to have prognostic significance in AMI patients. The aim of this study was to estimate whether the value of PTX3 could be used as a prognostic biomarker, with the global registry of acute coronary events (GRACE) risk assessment tool, in patients with acute coronary syndrome (ACS). SUBJECTS AND METHODS: Between July 2007 and June 2008, 137 patient subjects (mean age : 61+/-12 years, M : F=108 : 29) with ACS who underwent coronary intervention, but did not have a prior percutaneous coronary intervention (PCI) and/or follow-up coronary angiogram, were enrolled. We estimated the all-cause mortality or death/MI, in-hospital and to 6 months, using the GRACE risk scores and compared these estimates with serum PTX3 concentrations. RESULTS: The serum PTX3 concentration showed a significant increase in ST segment elevation myocardial infarction (STEMI) greater than the unstable angina pectoris (UAP) group (2.4+/-2.1 ng/mL vs. 1.3+/-0.9 ng/mL, p= 0.017, respectively), but did not show a significant difference between non-ST segment elevation myocardial infarction (NSTEMI) and the UAP group (1.9+/-1.4 ng/mL vs. 1.3+/-0.9 ng/mL, p=0.083, respectively). The serum PTX3 concentration was closely related to death/MI in-hospital (r=0.242, p=0.015) and death/MI to 6 months (r=0.224, p=0.023), respectively. The serum PTX3 concentration was not related to all-cause mortality in-hospital (r=0.112, p=0.269) and to 6 months (r=0.132, p=0.191), respectively. Among the parameters determining the GRACE risk scores, the degree of Killip class in congestive heart failure (CHF) was independently associated with the supramedian PTX3 concentration [odds ratio: 2.229 (95% confidence interval: 1.038-4.787), p=0.040]. CONCLUSION: The serum PTX3 level provides important information for the risk stratification of CHF among the parameters determining the GRACE risk scores in subjects with ACS.

A Case of Infectious Abdominal Aortic Aneurysm Rupture Due to Staphylococcus aureus Infection in a Hemodialysis Patient / 대한신장학회지

Infectious aneurysms in hemodialysis patients are very rare. It is assumed that injuries on atherosclerotic vessel walls are involved in the development of aneurysms associated with septicemia. Rupture of infectious aneurysms carries a high mortality rate because it often leads to hemorrhagic shock. Here we report the case of a hemodialysis patient with rupture of an abdominal aortic infectious aneurysm secondary to Staphylococcus aureus septicemia. A 72 year-old male hemodialysis patient presented with diarrhea and fever. Staphylococcus aureus was identified in his blood culture. On the sixth day after admission, he developed sudden abdominal pain, distension and hypotension, so we assumed hypovolemic shock due to intraabdominal hemorrhage. On abdominal CT, he was found to have a ruptured, 2.4x2 cm infrarenal abdominal aortic aneurysm with a large amount of retroperitoneal hemorrhage. His final diagnosis was rupture of an infectious aneurysm based on the presence of Staphylococcal bacteremia. He underwent a percutaneous stent graft in the infrarenal aorta successfully. However, two weeks later, he developed septic shock due to a newly developed intestinal perforation and died of multiorgan failure.

A Case of Hemichorea of Unknown Cause in a Hemodialysis Patient / 대한신장학회잡지

Uremic patients undergoing hemodialysis (HD) therapy are prone to develop encephalopathy, but the cause is often unclear. Clinical signs of encephalopathy in the uremic patient often overlap with several other affections causing neurological disorders. Chorea or hemichorea occurs very rare, when basal ganglia are injured in HD patients. We hereby report a case of hemichorea of unknown cause in a hemodialysis patients. A 57-year-old diabetic HD patient was presented with sudden onset of right hemichorea. We could not find causes of hemichorea such as hyperglycemia, hepatic failure, drug, hyponatremia, and thiamine deficiency. T1-weighted MRI demonstrated hyperintense lesion limited to the left basal ganglion. Hemichorea disappeared completely 6 months after the onset with support care.