BACKGROUND: Cardiogenic shock is the most common cause of in-hospital mortality after acute myocardial infarction. Despite improvement in coronary care, the in-hospital mortality rate of cardiogenic shock is very high in conventional conservative therapy. Recently, it was suggested that coronary angioplasty may reduce the mortality associated with cardiogenic shock. METHOD: Thirteen consecutive patients with cardiogenic shock who underwent coronary angioplasty were studied. Shock was not induced by mechanical complications, arrhythmia, hypovolemia and other reversible cause. We collected and analyzed the clinical, hemodynamic survivor groups. RESULTS: Of 13 patients, 11 had successful reperfusion of the infarct-related coronary artery and 2 had unsuccessful reperfusion. Of 11 patients with successful angioplasty, 8 survived at the time of hospital discharge. All patents with unsuccessful angioplasty died in the hospital. Therefore overall hospital survival rate was 62% and the rate increased to 73% in patients with successful reperfusion. Survivor and non-survivor groups in clinical, hemodynamic and angiographic variables were similar except systolic blood pressure and the presence of successful reperfusion. CONCLUSION: In patients with cardiogenic shock, the patency of infarct-related coronary artery was strongly associated with in-hospital mortality. This findings support aggressive interventional strategy in patient with cardiogenic shock complicating acute myocardial infarction.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Arrhythmias, Cardiac ; Blood Pressure ; Coronary Vessels ; Hemodynamics ; Hospital Mortality ; Humans ; Hypovolemia ; Mortality ; Myocardial Infarction* ; Reperfusion ; Shock ; Shock, Cardiogenic* ; Survival Rate ; Survivors

BACKGROUND: Cardiogenic shock is the most common cause of in-hospital mortality after acute myocardial infarction. Despite improvement in coronary care, the in-hospital mortality rate of cardiogenic shock is very high in conventional conservative therapy. Recently, it was suggested that coronary angioplasty may reduce the mortality associated with cardiogenic shock. METHOD: Thirteen consecutive patients with cardiogenic shock who underwent coronary angioplasty were studied. Shock was not induced by mechanical complications, arrhythmia, hypovolemia and other reversible cause. We collected and analyzed the clinical, hemodynamic survivor groups. RESULTS: Of 13 patients, 11 had successful reperfusion of the infarct-related coronary artery and 2 had unsuccessful reperfusion. Of 11 patients with successful angioplasty, 8 survived at the time of hospital discharge. All patents with unsuccessful angioplasty died in the hospital. Therefore overall hospital survival rate was 62% and the rate increased to 73% in patients with successful reperfusion. Survivor and non-survivor groups in clinical, hemodynamic and angiographic variables were similar except systolic blood pressure and the presence of successful reperfusion. CONCLUSION: In patients with cardiogenic shock, the patency of infarct-related coronary artery was strongly associated with in-hospital mortality. This findings support aggressive interventional strategy in patient with cardiogenic shock complicating acute myocardial infarction.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Arrhythmias, Cardiac ; Blood Pressure ; Coronary Vessels ; Hemodynamics ; Hospital Mortality ; Humans ; Hypovolemia ; Mortality ; Myocardial Infarction* ; Reperfusion ; Shock ; Shock, Cardiogenic* ; Survival Rate ; Survivors

OBJECTIVES: Percutaneous renal biopsy may be carried out in several ways. Recently, the use of a spring-loaded biopsy gun has become popularized. There have been much controversies on the tissue adequacy and the incidence of complications when compared to the manual biopsy. The present study was performed to compare tissue adequacy and the incidence of complications between manual biopsy and automated biopsy. METHODS: We have studied 108 patients in whom the method of renal biopsy was assigned to one of the two methods[14G Tru-cut needle manual bx (group I) and 18G automated gun biopsy(group II)] according to their national resident's identification number in a randomized and prospective manner. RESULTS: There were 50 patients in group I and 58 patients in group II. There was no difference in gender, age, hemoglobin, prothrombin time, partial thromboplastin time, diastolic and systolic blood pressure pre-biopsy in group I and II. Indications for biopsies were proteinuria accompained by hematuria (37%), proteinuria(34.3%), acute renal failure (9.3%), SLE (8.3%), chronic renal failure (5.6%), hematuria only (5.6%). In Group I the number of passes was 2.4+/-0.8, the glomeruli obtained were 25.3+/-13.2 and the number of glomeruli per pass were 11.6+/-6.5, and in Group II 3.4+/-1.1, 19.4+/-10.8, and 6.8+/-4.0, respectively. These showed a significant difference (p<0.05). In all cases pathological diagnosis were possible. The histology showed IgA nephropathy in 27.8%, MCNS in 14.8%, lupus nephritis in 11.1, MGN in 11.1%, MPGN in 7.4%, and others. The incidence and area of perinephric hematoma demonstrated on ultrasound 24 hours post-biopsy was increased in group I (24%, 937.7+/-640.0mm2 compared to 10.3%, 372.4+/-327.4mm2 in group II) although no statistically significant difference existed. There was no significant difference in gender, age, prothrombin time, partial thromboplastin time, systolic and diastolic blood pressure between the group with and without hematomas. Hematocrit levels before and after biopsy showed a significant difference (34.5+/-8.2, 33.5+/-8.1, p<0.05) in group I, but no significant difference was observed in group II (34.7+/-6.4, 34.8+/-6.4). CONCLUSION: Both techniques rendered adequate tissue sampling, but the extent of bleeding seems to be more severe with manual 14G Tru-cut needle biopsy.
Acute Kidney Injury ; Biopsy* ; Biopsy, Needle ; Blood Pressure ; Diagnosis ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Hematocrit ; Hematoma ; Hematuria ; Hemorrhage ; Humans ; Incidence ; Kidney Failure, Chronic ; Lupus Nephritis ; Needles ; Partial Thromboplastin Time ; Prospective Studies* ; Proteinuria ; Prothrombin Time ; Ultrasonography

Primary amyloidosis has been reported to develop in 6 to 15% of patients with multiple myeloma and especially in 20 to 24% of patients with light chain myeloma. Although deposition of amyloid in the gastric mucosa is common in primary systemic amyloidosis(AL), gastric amyloidosis in AL type is rarely symptomatic. Also, pathologic fracture of the femur secondary to plasmacytoma is quite rare for the first manifestation of multiple myeloma. A case of gastric amyloidosis associated with gastric outlet obstruction and femur plasmacytoma in multiple myeloma is reported with review of literatures.
Acute Kidney Injury* ; Amyloid ; Amyloidosis* ; Femur* ; Fractures, Spontaneous* ; Gastric Mucosa ; Gastric Outlet Obstruction ; Humans ; Multiple Myeloma* ; Plasmacytoma*

BACKGROUND AND OBJECTIVES: Nicorandil has pharmacologic effects similar to nitroglycerin and potassium in respect to the channel opening action in vascular smooth muscle cells. We examined hemodynamic changes in patients following nicorandil infusion. We investigated the action mechanism of nicorandil, and whether nicorandil affects hemodynamic changes in patients receiving antianginal medication. SUBJECTS AND METHODS: A total of 17 patients (11 normal control group, 6 coronary artery disease group) undergoing cardiac catheterization for investigation of chest pain participated in this study. During cardiac catheterization, nicorandil was infused into the pulmonary artery at a dose of 80 microgram/kg over a period of 1 min. Hemodynamic parameters were measured before and at 5, 10 and 20 minutes after nicorandil infusion. RESULTS: Five minutes after nicorandil infusion, the maximal changes in preload and afterload hemodynamic parameters were observed in both the coronary artery disease and control group. Changes of preload parameters were sustained longer than those of afterload parameters, and were maintained until 20 minutes after the infusion. Afterload parameters (heart rate and cardiac output), were slowly normalized five minutes after the infusion. In the coronary artery disease group with antianginal medication, additive hemodynamic changes were also seen after the infusion, although the degree of changes were small. CONCLUSION: Following nicorandil infusion, both the preload and afterload hemodynamic parameters decreased, and the preload parameters showed a larger decrease for a longer period than the afterload parameters. In the coronary artery disease group with antianginal medication, additive hemodynamic changes were also seen following nicorandil infusion.
Angina Pectoris ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Coronary Artery Disease* ; Coronary Vessels* ; Hemodynamics* ; Humans ; Muscle, Smooth, Vascular ; Nicorandil* ; Nitroglycerin ; Potassium ; Pulmonary Artery*