Cardiac arrest caused by nafamostat mesilate

A 65-year-old man was transferred from the Department of Vascular Surgery to Nephrology because of cardiac arrest during hemodialysis. He underwent incision and drainage for treatment of a buttock abscess. Nafamostat mesilate was used as an anticoagulant for hemodialysis to address bleeding from the incision and drainage site. Sudden cardiac arrest occurred after 15 minutes of dialysis. The patient was treated in the intensive care unit for 5 days. Continuous veno-venous hemodiafiltration was started without any anticoagulant in the intensive care unit. Conventional hemodialysis was reinitiated, and nafamostat mesilate was used again because of a small amount of continued bleeding. Ten minutes after hemodialysis, the patient complained of anaphylactic signs and symptoms such as dyspnea, hypotension, and facial swelling. Epinephrine, dexamethasone, and pheniramin were injected under the suspicion of anaphylactic shock, and the patient recovered. Total immunoglobulin E titer was high, and skin prick test revealed weak positivity for nafamostat mesilate. We first report a case of anaphylactic shock caused by nafamostat mesilate in Korea.

Huge Extramedullary Plasmacytoma of the Retroperitoneum / 대한내과학회지

Extramedullary plasmacytoma (EMP) represent 3% of plasma cell neoplasms. Approximately 80-90% of EMPs involve the mucosa-associated lymphoid tissue of the upper airways and 75% of these involve the nasal and paranasal regions, while renal or retroperitoneal infiltration is very rare. EMPs are highly radiosensitive, with excellent results. The local control rate of radiotherapy can reach 90-97% and the 5-year overall survival rate can be 57-61%. EMP has an indolent course and the prognosis is generally favorable, with 70% of the patients remaining disease free for 10 years. However, about 30% may progress to plasma cell myeloma or relapse. Here, we report a case of a huge retroperitoneal solitary extramedullary plasmacytoma that grew rapidly.

Simple Management of Radial Artery Perforation during Transradial Percutaneous Coronary Intervention / 대한내과학회지

Radial artery perforation is one of the major complications of transradial percutaneous coronary intervention (PCI). Previous reports have suggested that sealing the perforation with a smaller guiding catheter may be possible. In one such study, the perforated segment was sealed with a 0.014- or 0.021-inch guidewire, and PCI was successfully completed. In this study, we describe a radial artery perforation that occurred after diagnostic coronary angiography and during insertion of a 6 French (FR) guiding catheter. PCI and the perforation were successfully managed through the use of a 5 Fr guiding catheter and a 0.035-inch guidewire.

Successful Endovascular Stent-Graft Repair for Complicated Type B Aortic Dissection Developed in a Patient with Polycystic Kidney Disease

Polycystic kidney disease (PCKD) is rarely associated with aortic dissection (AD), which is a life-threatening disease. Although endovascular stent-graft repair tends to show better outcomes than conventional therapies in complicated type B AD (TBAD), successful endovascular intervention of TBAD with malperfusion in a patient with PCKD has not been reported. This case shows a 37-year-old male who had sudden onset of sharply stabbing epigastric pain with severe hypertension, who was diagnosed with TBAD and PCKD by a computed tomography and initially underwent medical treatment. Four days after discharge, he was rehospitalized with left leg pain and paresthesia due to left lower leg malperfusion. Thoracic endovascular stent-graft repair covering the primary tear site of dissection was performed successfully, leading to a decrease in false lumen and improvement of symptoms. We report the case of complicated TBAD in a patient with PCKD treated with endovascular stent-graft repair.