Biopsy-Proven Immune Complex Glomerulonephritis Associated with Sunitinib in a Patient with a Gastrointestinal Stromal Tumor / 대한신장학회지

Sunitinib, a multi-targeted tyrosine kinase inhibitor, is used for the treatment of renal cell carcinoma and gastrointestinal stromal tumors. Many adverse effects associated with sunitinib, including hypertension, proteinuria, and thrombotic microangiopathy, have been reported; however, the other forms of glomerulonephritis are very rare. We report a case of biopsy-confirmed immune complex glomerulonephritis in a patient with a gastrointestinal tumor who received sunitinib treatment. The proteinuria subsided partially after sunitinib was discontinued, but when the drug was reintroduced, it recurred.

Clinical Outcome and ECG Change in Patients with Acute Myocardial Infarction and Prodromal Angina

BACKGROUND AND OBJECTIVES: Ischemic preconditioning reduces the size of myocardial infarct in animal models, however its role in humans remains unclear. Clinical data suggests that episodes of angina immediately before acute myocardial infarction may be associated with a protective effect on the human myocardium. We performed an analysis on the effect of prodromal angina on infarct size, in-hospital outcome and newly developed Q-wave in patients with acute myocardial infarction. SUBJECTS AND METHODS: 65 patients who had received thrombolytic therapy were enrolled in the study. Eleven patients (17%) had experienced previous angina within 24 hours prior to acute myocardial infarction (group I), and the remaining 54 patients (83%) did not have a history of previous angina (group II). Killip class, cardiac enzyme, ECG findings, echocardiographic data and in-hospital outcomes were compared between the two groups. RESULTS: Group I tended to have lower peak creatine kinase (CK) and CK-MB levels, although the difference between the two groups in regards to the level of cardiac enzyme was statistically insignificant. Despite similar patient characteristics, Group I showed a lower incidence of heart failure during hospitalization than group II. 6/11 patients (55%) in group I and 47/54 (87%) in group II had a Q-wave at discharge ECG. Group I showed better left ventricular systolic function during admission. None of the DM patients (14 patients) had prodromal angina and 13 of 14 patients (93%) demonstrated Q-wave infarction. CONCLUSION: Prodromal angina prior to acute myocardial infarction as a marker of ischemic preconditioning may also confer beneficial effects in terms of in-hospital outcomes. Further studies concerning the long term outcomes of such cases are needed.

Changes in Hemodynamics and Local Myocardial Perfusion in the Acute Phase of Coronary Reperfusion by Using Nicardipine in Korean Mongrel Dogs / 대한마취과학회지

BACKGROUND: The measurement of perfusion is very important to understanding the physiology in the ischemic and reperfused tissue. However, no studies have been reported using a beating heart with a real time-continuous perfusion measurement system (QFlow(TM)400) to check local tissue perfusion so far. In this study, the changes in hemodynamics and local myocardial perfusion (LMP) after coronary reperfusion with nicardipine (a calcium channel blocker) administration were evaluated. METHODS: A total of 10 mongrel dogs were divided into two groups; group I (control group, n = 5), group II (nicardipine group, n = 5). After femoral arterial, pulmonary arterial and left ventricular catheterization, a left thoracotomy was performed. Next, the left anterior descending coronary artery (LAD) was exposed, and a thermal diffusion microprobe was inserted in the myocardium to measure LMP. RESULTS: In group II, blood pressure and systemic vascular resistance after LAD reperfusion were significantly decreased compared to group I. Cardiac output and stroke volume were more rapidly increased in group II, while left ventricular stroke work was decreased in group II. In group I, the LMP after LAD reperfusion did not recover to the baseline level, but the LMP did recover 20 minutes after LAD reperfusion and was increased more compared to the baseline level at 30 minutes after LAD reperfusion in group II. There were no significant differences in dP/dt between the two groups. CONCLUSIONS: We found that the LMP did not recover to the baseline level in the early state of LAD reperfusion; however, nicardipine administration increased the LMP after the early reperfusion period. Cardiac output and stroke volume were also more rapidly increased when nicardipine was administrated.

The Effect of Spinal Anesthesia for Cesarean Section on Hemodynamics in Patients with Severe Preeclampsia / 대한마취과학회지

BACKGROUND: Epidural anesthesia is thought to be relatively indicated for cesarean section in patients with severe preeclampsia. In contrast, avoidance of spinal anesthesia is recommended, postulating excessive hypotensive risks. In addition, general anesthesia is often avoided in this population because malignant hypertension following tracheal intubation is common and risks for difficult airway management are excessive. METHODS: In this study, we compared hemodynamic changes in patients with severe preeclampsia and normal pregnant women during spinal anesthesia for elective cesarean section. Spinal anesthesia was performed with 10 mg of 0.5% heavy bupivacaine mixed with 25 microgram fentanyl in 18 patients with severe preeclampsia and 17 normal pregnant women. We compared MAP, CI, and SVRI changes before and after spinal anesthesia. RESULTS: MAP responses following induction of spinal anesthesia for elective cesarean section in patients with severe preeclampsia and normal pregnant women showed a statistically significant decrease from 2 min after spinal anesthesia. CI responses following induction of spinal anesthesia in patients with severe preeclampsia showed a statistically significant increase from 8 min after and normal pregnant women also showed a statistically significant increase from 4 min after spinal anesthesia. SVRI responses from induction of spinal anesthesia in patients with severe preeclampsia and normal pregnant women showed a statistically significant decrease from 2 min after spinal anesthesia. Incidence of hypotension before delivery and used total dose of ephedrine during operation were statically insignificant between severe preeclamptic and normal pregnant women. CONCLUSIONS: We conclude that changes of MAP, CI and SVRI following spinal anesthesia for elective cesarean section in the severely preeclamptic and normal pregnant women are clinically similar. We suggest that spinal anesthesia for cesarean section is not contraindicated in the severely preeclamptic patient.

A Comparison of the Effect of Propofol and Thiopental on the Hemodynamic parameters in Valvular Replacement Surgery / 대한마취과학회지

Propofol is a short acting, rapidly metabolized intravenous anesthetic agent. It cause a decrease in arterial pressure after induction of anesthesia and a decrease in heart rate. Hypertension, tachycardia during induction of anesthesia or in response to tracheal intubation is undesirable in high-risk patients, Propofol might attenuate the pressor to tracheal intubation than thiopental. In this study we compared propofol with thiopental for induction of anesthesia. Forty patients of ASA class III scheduled to undergoing valvular replacements divided two groups. Twenty patients were induced with thiopental, twenty patients were induced with propofol and maintained using 50% nitrous oxide in oxygen. Cardiovascular parameters were checked before induction, after propofol or thiopental injection, after succinylcholine injection, after tracheal intubation, after isoflurane mixed inhalations. The aim of this study is to examine a camparison of hemodynamic effects between propofol and thiopental for valvular replacement. The results were as follows. 1) There is little change in heart rate with thiopental group, but heart rate was decreased in propofol group. 2) There is slightly deaeased in arterial pressure with thiopental group, but markedly decreased in propofol group. 3) There is no difference of central venous pressure between two groups.