ABSTRACT
BACKGROUND/AIMS: The mortality of hospitalized patients undergoing treatment with an intra-aortic balloon pump (IABP) due to cardiogenic shock is well known as quite high. The aim of this study was to evaluate the outcome of percutaneous coronary intervention (PCI) with an IABP in patients with acute coronary syndrome (ACS) and cardiogenic shock and identify the predictors of in-hospital mortality. METHODS: 134 patients who underwent PCI with IABP due to ACS complicated by cardiogenic shock were consecutively enrolled. Outcomes were obtained and analyzed during hospitalization and after 1 year. RESULTS: The incidence of all-cause mortality was 35.8% (in-hospital mortality, 34.3%; 1-year mortality, 1.5%). The nonsurvival group exhibited higher peak levels of creatine kinase MB; lower ejection fractions; and higher incidences of ST elevation myocardial infarction, ventricular arrhythmia, and use of an assistive device than did the survival group. Aging (hazard ratio 2.839; 95% confidence interval 1.408-5.723; p = 0.004), the use of a temporary pacemaker (2.035; 1.114-3.720; 0.021), the use of a mechanical ventilator (4.376; 1.852-10.341; 0.001), and the performance of cardiopulmonary resuscitation (CPR) (2.219; 1.017-4.839; 0.045) were independent predictors for in-hospital mortality. However, out-of-hospital mortality among in-hospital survivors was not affected by predictors of in-hospital mortality. CONCLUSIONS: The incidence of in-hospital mortality was high, as expected in patients undergoing PCI with IABP due to ACS with cardiogenic shock. Aging, CPR, and additional procedures such as pacemaker use and mechanical ventilation were predictors of in-hospital mortality. However, the patients who were successfully discharged after the complex procedure showed acceptable 1-year outcomes.
Subject(s)
Humans , Acute Coronary Syndrome , Aging , Arrhythmias, Cardiac , Cardiopulmonary Resuscitation , Creatine Kinase , Hospital Mortality , Hospitalization , Incidence , Intra-Aortic Balloon Pumping , Mortality , Myocardial Infarction , Percutaneous Coronary Intervention , Respiration, Artificial , Self-Help Devices , Shock, Cardiogenic , Survivors , Ventilators, MechanicalABSTRACT
BACKGROUND AND OBJECTIVES: The risk of contrast-induced nephropathy (CIN) is significantly influenced by baseline renal function and the amount of contrast media (CM). We evaluated the usefulness of the cystatin C (CyC) based estimated glomerular filtration rate (eGFR(CyC)) in the prediction of CIN and to determine the safe CM dosage. SUBJECTS AND METHODS: We prospectively enrolled a total of 723 patients who received percutaneous coronary intervention (PCI) and investigated the clinical factors associated with the development of CIN. Renal function was calculated as eGFR(CyC) and a modified diet in the renal disease (MDRD) equation, respectively. Systemic exposure of CM was calculated as CM volume to eGFR ratio. We conducted a regression analysis to evaluate the predictive role of CM volume to eGFR(CyC) for the risk of CIN. RESULTS: The incidence of CIN was 4.0% (29/723). The patients with CIN had a lower hemoglobin level, decreased renal function, and a higher CyC value, and had greater CM exposure. Through multivariate regression analyses, hemoglobin {odds ratio (OR) 0.743, p=0.032}, CM volume/eGFR(CyC) (OR 1.697, p=0.006) and CM volume/MDRD (OR 2.275, p<0.001) were found to be independent predictors for CIN. In the receiver operating characteristic curve analysis, fair discrimination for CIN was found at a CM volume/eGFR(CyC) level of 4.493 (C-statics=0.814), and at this value, the sensitivity and specificity were 79.3% and 80.0%, respectively. CONCLUSION: Both the CM volume/MDRD and CM volume/eGFR(CyC) method would be simple, useful indicators for determining the safe CM-dose based on eGFR value before PCI. However, there was no significantly different predictive value between creatinine and CyC based GFR estimations.
Subject(s)
Humans , Acute Kidney Injury , Contrast Media , Creatinine , Cystatin C , Diet , Discrimination, Psychological , Glomerular Filtration Rate , Hemoglobins , Incidence , Percutaneous Coronary Intervention , Prospective Studies , ROC Curve , Sensitivity and SpecificityABSTRACT
BACKGROUND: The reprocess by citric acid and heat is an alternative to chemical reprocess for reusing dialyzers. However, there are little experience and data on the effect of reprocess by citric acid and heat on the solute clearance. METHODS: In the 34 chronic hemodialysis patients using low flux dialyzers, solute clearance was measured after reprocessing high-flux dialyzers by citric acid and heat. Dialyzers were reprocessed using 1.5% citric acid solution heated to 95degrees C for 20 hours. The clearance and reduction rate of urea, beta2-microglobulin, osteocalcin and myoglobin were measured at single use and during reuses for 5,10,15,20 and 25 times. RESULTS: The clearance and reduction rate of urea, beta2-microglobulin, osteocalcin and myoglobin were significantly greater with high-flux dialyzer compared with low flux dialyzer, which were maintained after dialyzer reuse. beta2-microglobulin clearance was increased at 10th and 20th reuse and beta2-microglobulin reduction rate was increased at 10th, 20th and 25th reuse compared with the single use. Myoglobin clearance and reduction rate were increased after the 5th reuse compared with the single use. Albumin loss to dialysate was gradually increased following reuses. Of the 34 dialyzers studied, 14 were discarded before the 25th reuse because of inadequate performance test. CONCLUSION: Reprocessing high flux dialyzers by citric acid and heat increases middle and large molecule clearance and was safe.
ABSTRACT
BACKGROUND: The reprocess by citric acid and heat is an alternative to chemical reprocess for reusing dialyzers. However, there are little experience and data on the effect of reprocess by citric acid and heat on the solute clearance. METHODS: In the 34 chronic hemodialysis patients using low flux dialyzers, solute clearance was measured after reprocessing high-flux dialyzers by citric acid and heat. Dialyzers were reprocessed using 1.5% citric acid solution heated to 95degrees C for 20 hours. The clearance and reduction rate of urea, beta2-microglobulin, osteocalcin and myoglobin were measured at single use and during reuses for 5,10,15,20 and 25 times. RESULTS: The clearance and reduction rate of urea, beta2-microglobulin, osteocalcin and myoglobin were significantly greater with high-flux dialyzer compared with low flux dialyzer, which were maintained after dialyzer reuse. beta2-microglobulin clearance was increased at 10th and 20th reuse and beta2-microglobulin reduction rate was increased at 10th, 20th and 25th reuse compared with the single use. Myoglobin clearance and reduction rate were increased after the 5th reuse compared with the single use. Albumin loss to dialysate was gradually increased following reuses. Of the 34 dialyzers studied, 14 were discarded before the 25th reuse because of inadequate performance test. CONCLUSION: Reprocessing high flux dialyzers by citric acid and heat increases middle and large molecule clearance and was safe.
ABSTRACT
BACKGOUND: Static venous pressure (SVP) by Access Alert method has been known to be more strongly predictive of venous stenosis than dialysis venous pressure (DVP). This study was performed to compare Access Alert and drip chamber methods in measuring static intra-access pressure in hemodialysis patients. METHODS: Eighty-one patients on chronic hemodialysis via arteriovenous fistulas (AVF) or grafts (AVG) were included in this study. We measured SVP using both drip chamber and Access Alert methods. In drip chamber method, we measured venous drip chamber pressure (P(DC)) and the height from the venous needle to the top of the blood in the venous drip chamber (delta H). The pressure difference (delta P(H)) was estimated as delta H (cm) x 0.76 and SVP in AVF (PAVF) was calculated as sum of PDC and delta P(H). In Access Alert method, we measured SVP directly through venous cannulation of vascular access. Finally static intra-access pressure ratio (SIAPR) was calculated by SVP divided mean arterial pressure (MAP). RESULTS: Mean SVP measured by Access Alert and drip chamber methods were 0.28+/-0.21 (0.08-0.96) and 0.35+/-0.18 (0.13-0.92), respectively. Mean SIAPR by Access Alert method well correlated with mean SIAPR by drip chamber method (r=0.885, p< 0.001). CONCLUSION: This study suggests that Access alert method correlates highly with drip chamber method in measuring SVP and it can be useful method in detecting vascular access monitoring.
Subject(s)
Humans , Arterial Pressure , Arteriovenous Fistula , Catheterization , Constriction, Pathologic , Dialysis , Needles , Renal Dialysis , Transplants , Venous PressureABSTRACT
Malignant histiocytosis (MH) is characterized by an invasive, progressive proliferation of neoplastic histiocytes associated with jaundice, lymphadenopathy, refractory anemia, leukopenia, and often hepatic and splenic enlargement. As lymphoblastic leukemia and lymphoma are regarded as neoplasms of lymphoid cells, MH is thought to represent a malignant transformation of the macrophage and dendritic cells. A classification of malignant histiocytic disorders was oriented by cell lineage in the Histiocyte Society's 1987 version. So dendritic cell-related histiocytic sarcoma (localized or disseminated) and macrophage-related histiocytic sarcoma (localized or disseminated) are the recommended nosology. To establish the correct diagnosis, the major challenge seems to distinguish lymphoid from histiocytic cells. M-CSF receptor, lysozyme, Ki-M8, and S-100 protein, etc are useful markers for histiocytes and T-cell and B-cell lineage markers, such as CD3, CD20, and CD79, etc, for lymphocytes. We have experienced a patient with disseminated histiocytic sarcoma diagnosed by positive istiocytic markers, such as lysozyme, S-100 protein, and CD68.
Subject(s)
Humans , Anemia, Refractory , B-Lymphocytes , Cell Lineage , Classification , Dendritic Cells , Diagnosis , Histiocytes , Histiocytic Disorders, Malignant , Histiocytic Sarcoma , Jaundice , Leukopenia , Lymphatic Diseases , Lymphocytes , Lymphoma , Macrophage Colony-Stimulating Factor , Macrophages , Muramidase , Precursor Cell Lymphoblastic Leukemia-Lymphoma , S100 Proteins , T-LymphocytesABSTRACT
Renal papillary necrosis(RPN) is a 4bointerstitial nephropathy accompanied by compromised medullary blood flow that ultimately results in a focal or diffuse ischemic necrosis of segments of the renal medulla. Renal papillary necrosis is infrequently reported as complication of fungal infections. Underlying condi- tions such as prematurity, immunosuppressive therapy, neoplastic disease, previous antibiotic therapy, diabetes mellitus, extensive burn and indwelling vascular catheters were found in candidal RPN. Candidal renal papillary necrosis is a extremely rare and fatal disease. Only 20 cases were reported over the past. There were only three survivors which were diagnosed were treated with antifugal agents early in the clinical course. As far as we know, this case is the first case of candidal RPN treated with bilateral nephrectomy. We report a case of candidal renal papillary necrosis in a 66-year-old diabetic woman treated with bilateral nephrectomy, along with review of the literatures.
Subject(s)
Aged , Female , Humans , Burns , Candida tropicalis , Candidiasis , Diabetes Mellitus , Necrosis , Nephrectomy , Survivors , Vascular Access DevicesABSTRACT
Idiopathic hypereosinophilic syndrome (IHS) can be diagnosed when prolonged eosinophilia and organ involvement are evident without specific etiologic factors. Budd-Chiari syndrome (BCS) is hepatic venous outflow obstruction, regardless of the cause or level of obstruction. Budd-Chiari syndrome associated with idiopathic hypereosinophic syndrome seems to be very rare, and only a few reports of such cases have been published. We experienced a 27-years-old man presented as BCS associated with idiopathic hypereosinophilic syndrome. Liver pathology revealed sinosoidal dilation, extravasated red blood cells and some degree of fibrosis. Liver sonogram, CT and inferior venocavogram didn't show visualization of hepatic vein and a short segmental narrowing of IVC. We present a case of BCS associated with IHS with review of literatures.
Subject(s)
Budd-Chiari Syndrome , Eosinophilia , Erythrocytes , Fibrosis , Hepatic Veins , Hypereosinophilic Syndrome , Liver , PathologyABSTRACT
Background and Objects: Tc-99m tetrofomsin is a recently developed myocardial perfusion agent. We examined the diagnostic accuracy of dipyridamole Tc-99m tetrofosmin SPECT. MATERIALS AND METHOD: 61 patients underwent one-day rest/dipyridamole Tc-99m tetrofosmin SPECT. 26 patients had history of myocardial infarction. Coronary angiography, performed within 1 week after SPECT study, revealed normal coronary arteries or insignificant coronary artery stenosis in 19 and 22 patients (when considering > or = 50% or > or = 70% reduction of luminal diameter as significant stenosis). RESULTS: Number of male was 39 (63.9%) and mean age was 59 (range 32 - 84). The diagnostic accuracy of dipyridamole Tc-99m tetrofosmin SPECT for detection of coronary artery disease (> or = 50% and > or = 70% coronary artery stenosis, respectively) was as follows: sensitivity 90.5%, 90.0%, specificity 73.7%, 66.7%, positive predictive value 88.4%, 83.7%, negative predictive value 77.8%, 77.8% and predictive accuracy was 85.2%, 81.9% respectively. The overall sensitivity and specificity of dipyridamole Tc-99m tetrofosmin SPECT for detection of individual coronary stenosis (> or = 50% and > or = 70% coronary stenosis by coronary angiography) were 64.6%, 64.1% and 86.4%, 85.7% respectively. In patients without myocardial infarction, sensitivity 76.5%, specificity 76.5%, positive predictive value 83.3%, negative predictive value 76.5% and predictive accuracy was 80.0%. CONCLUSION: One-day rest/stress dipyridamole Tc-99m tetrofosmin myocardial SPECT is a useful noninvasive method for detection of coronary artery disease.
Subject(s)
Humans , Male , Coronary Angiography , Coronary Artery Disease , Coronary Stenosis , Coronary Vessels , Dipyridamole , Myocardial Infarction , Perfusion , Phenobarbital , Sensitivity and Specificity , Tomography, Emission-Computed, Single-PhotonABSTRACT
Granulocytic sarcoma is localized myeloblastic cell tumor and has been described for many years in the literature as a rare manifestation of granulocytic leukemia. Although this tumor may involve anywhere in the body and give rise to a variety of signs and symptoms, there are several case reports of granulocytic sarcoma in Korea which described involvements at the lymph node, orbit, vagina, cervix, breast and mediastinum. We have experienced a case of granulocytic sarcoma only involving duodenum without hematologic evidence of leukemia and report this case with review of literature.
Subject(s)
Female , Breast , Cervix Uteri , Duodenum , Granulocyte Precursor Cells , Korea , Leukemia , Leukemia, Myeloid , Lymph Nodes , Mediastinum , Orbit , Sarcoma, Myeloid , VaginaABSTRACT
No abstract available.
ABSTRACT
No abstract available.