Guide wire fracture during percutaneous coronary intervention / 영남의대학술지

Guide wire fracture during percutaneous coronary intervention (PCI) is rare. It can cause fatal complications such as thrombus formation, embolization, and perforation. Guide wire fracture could occur during intervention for severely calcified stenotic lesions, and rarely from distal small branches of stenotic lesions. There are several methods for its management depending on the material character, position, length of the remnant, and the patient's condition. If percutaneous retrieval was not achieved, the surgical procedure should be considered for prevention of potential risks, although the remnant guide wire does not usually cause complications. We experienced a patient with a guide wire fracture during PCI, and managed to prevent its complications through surgical removal of the remnant wire. We report this case here.

Acute Myocardial Infarction with Simultaneous Thrombosis of Multiple Coronary Arteries

Simultaneous thrombosis of multiple coronary arteries in acute myocardial infarction is very rare in clinical settings. Its mechanism is not yet clear, but patients displaying multivessel simultaneous thrombosis tend to have poor clinical outcomes. Hence, it is important to recognize this condition and provide timely and proper management. We report a case of simultaneous thrombosis involving multiple coronary arteries in a patient with ST-segment elevation myocardial infarction.

Pseudo-Renal Failure with Severe Hyponatremia due to Spontaneous Bladder Rupture / 대한내과학회지

Spontaneous bladder rupture is rare. Such an occurrence may appear similar to renal failure because the resulting urine leakage into the peritoneal cavity and absorption across the peritoneum increases serum creatinine although glomerular filtration rate is normal. A 46-year-old man presented with abdominal distension for 7 days after consuming a large volume of alcohol. Initial laboratory tests showed a blood urea nitrogen level of 174.3 mg/dL, serum creatinine of 11.49 mg/dL, and serum sodium of 105 mmol/L. Abdominal distension resolved after draining 5,200 mL of urine through a bladder catheter. Computed tomography cystography revealed intraperitoneal leakage of contrast dye from the left dome of the bladder, suggesting an intraperitoneal bladder rupture. Azotemia was completely normalized on the third day of hospitalization. This case shows that pseudo-renal failure should be considered when caring for a patient with unexplained azotemia and ascites.

Acute Myocardial Infarction Occurred in Multivessel Disease Including Chronic Total Occlusion / 이화의대지

Simultaneous multi-vessel acute myocardial infarction is rare and has poor prognosis. We report a 70-year-old Korean man with an anteroseptal wall ST-elevation myocardial infarction presenting as ventricular tachycardia, sudden cardiac arrest and cardiogenic shock. After successful cardiopulmonary resuscitation, a coronary angiogram revealed three-vessel coronary disease; simultaneous total occlusions of the proximal left anterior descending artery (LAD) and the proximal left circumflex artery (LCX), and chronic total occlusion of the proximal right coronary artery. Primary percutaneous coronary intervention (PCI) of the LAD and LCX was successful and an intra-aortic balloon pump was inserted. Despite the timely and successful PCI result, he died on the 58th day in the hospital due to pneumonia with multiple organ failure.

A Case of Bronchonodal Fistula by Endobronchial Tuberculosis / 계명의대학술지

The Bronchial fistula is caused by infection, malignancy, trauma, inflammatory disease and foreign body. The bronchonodal fistula by endobronchial tuberculois is very rare complication. The authors present a 70-year-old man presented with hoarseness and sore throat. This patient diagnosed with endobronchial tuberculosis, which was complicated by bronchonodal fistula by sputum acid fast bacilli stain, bronchoscopy, and chest computed tomography. The patient was treated with antituberculosis therapy for 1 year, and follow up bronchoscopy and radiologic study showed regression of bronchonodal fistula.

A Case of Acute Kidney Injury Complicated During Therapy of Warfarin Anticoagulation after the Prosthetic Heart Valve Replacement / 계명의대학술지

A 58-year-old male patient was admitted with the weakness feeling of right upper extremity. The patient, who had been done the replacement of prosthetic mitral and aortic valves 17 years ago, is taking a warfarin to prevent the systemic thromboembolism. On admission, laboratory tests revealed that the prothrombin time international normalized ratio (PT INR) was abnormal as 6.21, serum creatinine level increased to 10.46 mg/dL. The renal biopsy was performed to find the cause of Acute Kidney Injury (AKI). Biopsy Specimens showed the evidence of acute tubular injury and glomerular hemorrhage: red blood cells (RBCs) in Bowman space and numerous occlusive RBC casts in tubules. We experience a case of AKI as a result of the inappropriate warfarin monitoring, which is developed by the glomerular hemorrhage and renal tubular obstruction through RBC casts. We suggest that patients with warfarin therapy need to monitor the kidney function and blood coagulation indicators carefully.