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Abstract-The effect of piroxicam on polymorphonuclear neutrophils (PMN) functions induced by several stimuli was evaluated in vitro. Preincubation of rabbit or human PMN with piroxicam inhibited the cellular responses elicited by N-formylmethionyl-leucyl-phenylalanine (FMLP) such as superoxide anion (O2-) generation, granule enzyme release and chemotaxis. The effectiveness of piroxicam on each response was superior to those of indomethacin and ibuprofen. Also when either concanavalin A, zymosan-treated serum or ionophore A23187 was used as stimuli, piroxicam inhibited O2-generation of PMN. The inhibitory effect of piroxicam on FM LP-induced O2-generation was dependent on the concentration of stimuli and was reversed, by increasing the extracellular calcium concentration.In addition, piroxicam had no effect on the activity of a chymotrypsin-like esterase, N-acetylphenylalanine-8-naphthyl esterase, isolated from rabbit PMN. These results suggest that at least some of the anti-inflammatory effects of piroxicam may be mediated by affecting PMN functions, and the inhibition of Of generation of PMN by piroxicam may be related to its capacity to modulate the association of calcium with these cells.

A 54-year-old man was referred to a local hospital, located about 90 km from our hospital, with cardiogenic shock due to left main coronary artery infarction (LMCA-MI). Percutaneous coronary intervention (PCI) was performed under intra-aortic balloon pumping (IABP) support, but resulted in insufficient reperfusion and his condition worsened. The helicopter emergency medical service (HEMS) rapidly transported the patient to our hospital. After percutaneous cardio-pulmonary support system (PCPS) insertion, PCI could establish the coronary flow. A series of intensive therapies saved the patient. The cooperation of medical and emergency service system following revascularization and intensive care saved the patient with LMCA-MI accompanied by cardiogenic shock.Key words: cardiogenic shock, acute myocardial infarction, percutaneous cardio-pulmonary support system, trans-radial percutaneous coronary intervention, helicopter emergency medical service Case ReportA 54-year-old man was referred to the emergency department of Minamata City Hospital and Medical Center with severe chest pain lasting one hour, which had never been felt before. He had smoked 20 cigarettes a day for twenty years and was treated for hypertension and diabetes mellitus. His usual blood pressure was >150/90 mmHg using valsartan 80 mg daily, betaxolol hydrochloride 10 mg daily, long acting nifedipine 40 mg daily and his HbA1c was >7.5% using glimepiride 4 mg daily.In the emergency department of Minamata City Hospital and Medical Center, he felt clammy and seemed anxious. His blood pressure was 110/60 mmHg, pulse rate was 92 beats per minute (bpm), and respiration was shallow and rapid at 36 per minute. Arterial oxygen saturation was 99% during oxygen breathing at 3 L/min through a nasal cannula. Electrocardiogram (ECG) showed a sinus rhythm, right bundle branch block, left axis deviation, and ST-segment elevation in leads I, aVL, aVR, V1 through V6, and ST-segment depression in leads II, III, aVF (Fig. 1). He was diagnosed as acute myocardial infarction with cardiogenic shock and emergency cardiac catheterization was performed.A 6 Fr sheath was inserted through the right radial artery. The coronary angiogram showed total occlusion of the left main coronary artery (LMCA) without collateral supply and severe stenosis at the distal right coronary artery (Fig. 2). Intra-aortic balloon pumping (IABP) was inserted through the right femoral artery and trans-radial percutaneous coronary intervention (PCI) was carried out. First of all, two coronary soft guidewires were successfully passed into the

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