An Unusual Case of Guide Wire Fracture during Coronary Artery Stenting for Bifurcation Lesion

The complications associated with the use of a guide wire, used during angioplasy, are rare and often go unrecognized. However, occasionally the guide wire itself may cause serious complications such as perforation or dissection of the distal coronary artery. A guide wire fracture during angioplasty is a rare complication, however entrapment and uncoiling of the guide wire can cause fracture. We report a case of guide wire fracture that developed by entrapment of the distal bending portion during stenting for bifurcation lesion. The broken free end of the guide wire remained within the stent strut, and urgent surgical intervention was necessary for its retrieval. We experienced a case of entrapment and fracture of the guide wire during stenting that was successfully surgically removed.

Prospective Study of the Immunologic Factors Affecting the Prognosis of Severe Community-Acquired Pneumonia / 결핵

BACKGROUND: In the severe community-acquired pneumonia, it has been known that the immune status is occasionally suppressed. This study was performed to identify the immunologic markers related with the prognostic factors in severe community-acquired pneumonia. METHODS: 23 patients with severe community-acquired pneumonia were involved in this study, and divided into survivor (16) and nonsurvivor (7) groups. In this study, the medical history, laboratory tests(complete blood counts, routine chemistry profile, immunoglobulins, complements, lymphocyte subsets, cytokines, sputum and blood culture, urine analysis), and chest radiographs were scrutinized. RESULTS: 1) Both groups had lymphopenia(total lymphocyte count 995.6±505.7/mm2 in the survivor and 624.0±287.6/mm2 in the nonsurvivor group). 2) The T-lymphocyte count of the nonsurvivor group(295.9±203.0/mm2) was lower than the survivor group(723.6±406.5/mm2) (p<0.05). 3) The total serum protein(albumin) was 6.0±1.0(2.7±0.7) g/dl in the survivor and 5.2±1.5(2.3±0.8)g/dl in the nonsurvivor group. The BUN of the noncurvivor group(41.7±30.0mg/dl) was higher than that of the survivor group(18.9±9.8mg/dl)(p<0.05). The creatinine concentration was higher in the nonsurvivor group(1.8±1.0mg/dl) than that in the survivor group(1.0±0.3mg/dl)(p<0.05). 4) The immunoglobulin G level was higher in the survivor group (1433.0±729.5mg/dl) than in the nonsurvivor group(849.1±373.1mg/dl)(p<0.05). 5) The complement C3 level was 108.0±37.9mg/dl in the survivor group and 88.0±32.1mg/dl in the nonsurvivor group. 6) A cytokine study showed an insignificant differenne in both groups. 7) Chronic liver disease, DM, and COPD were major underlying diseases in both groups. CONCLUSION: These results suggest that decreased a T-lymphocyte count and immunoglobulin G level, and an increased BUN and creatinine level may be associated with the poor prognosis of severe community-acquired pneumonia.

A Case of Nonspecific Interstitial Pneumonia Associated with Systemic Lupus Erythematosus / 결핵

Systemic lupus erythematosus frequently has thoracic involvement among connective tissue diseases. One of the pleuropulmonary manifestations is diffuse interstitial lung disease including nonspecific interstitial pneumonia(NSIP). NSIP if a newly classified disease among interstitial lung diseases. Systemic lupus erythematosus has a better prognosis than usual interstitial peumonia(UIP) and responds well to steroids. In this report, a 34 year-old woman who complained of a dry cough, and exertional dyspnea for 2 months is described. The chest X-ray showed fine reticular opacities and a mild honeycomb appearance in both basal lungs. High resolution computed tomography(HRCT) showed bilateral patchy areas of ground-glass attenuation and a mild honeycomb appearance in the subpleural of both the lower and the middle portion of the lung fields. An open lung biopsy showed prominent lymphocytic interstitial inflammation and fibrosis with small are as with a honeycomb appearance. This case was diagnosed as NSIP associated with systemic lupus erythematosus and was managed with oral steroids. Here we report a case of nonspecific interstitial pneumonia associated with systemic lupus erythematosus confirmed by HRCT and an open lung biopsy with a review of the relevant literature.