[Severe Henoch-Schonlein purpura in a patient with multiple myeloma]. / Púrpura de Schönlein-Henoch grave en un paciente con mieloma múltiple.

A Multiple Myeloma (MM), IgG-lambda stage III-A was diagnosed in a 41-year-old-man. After VAD cycles IgG decreased from 7.5 to 2.4 g/dL. were mobilized with cyclophosphamide and 10 micrograms/Kg G-CSF. Three days after the collection of peripheral stem cell, the patient had fever, nausea, vomiting, liquid stools, shoulder and knee arthralgia and dehydration. Upper GI endoscopy showed esophageal candidiasis and ulcerative necrotic lesions both in stomach and duodenum; the biopsy confirmed necrosis. Simultaneously, the appearance of purpura with maculopapular lesions of diverse sizes appeared in the feet progressing to the limbs and trunk. Hematuria and proteinuria were also observed. Skin biopsy showed leukocytoclastic vasculitis. Renal biopsy showed focal and segmental glomerulonephritis. Serum ANCA, cryoglobulins, anti-HCV and RF were negative, and serum monoclonal IgG was 1290 mg/dL. Daily treatment with i.v. methylprednisolone pulses for 3 days improved skin lesions and digestive involvement. Macroscopic hematuria and proteinuria improved after two months of steroid treatment.

Emergency department use of aspirin in patients with possible acute myocardial infarction.

BACKGROUND: Efforts have been made to improve the suboptimal use of aspirin after hospitalization. OBJECTIVE: To assess the frequency and timing of aspirin administration in emergency department patients with possible myocardial infarction. DESIGN: Retrospective record review. SETTING: Emergency departments of four hospitals affiliated with the same university. PATIENTS: All patients who were admitted to the four hospitals in 1994 for evaluation and treatment of suspected acute myocardial infarction. MEASUREMENTS: The frequency and timing of aspirin administration and the definitive diagnosis established before discharge from the hospital. RESULTS: Aspirin was not given to 253 of 463 emergency department patients (55%) who had a definitive diagnosis of acute myocardial infarction. Seventy-eight percent of patients who did receive aspirin received it more than 30 minutes after arrival in the emergency department. CONCLUSION: Aspirin therapy is underutilized as the first intervention in patients who are admitted with suspected myocardial infarction.

Managing acute myocardial infarction in a renal transplant recipient.

We describe the management of a patient, with a 13-year-old cadaveric renal transplant, who presented with acute myocardial infarction. Successful primary angioplasty was performed to the left anterior descending artery. It was complicated by transient renal failure and pseudoaneurysm of the femoral artery which was managed conservatively.