The combined clinical impact of red blood cell distribution width and vascular calcification on cardiovascular events and mortality in patients with endstage kidney disease

Little is known about how the interaction between red blood cell distribution width (RDW) and vascular calcification (VC) affects cardiovascular (CV) events and mortality in end-stage kidney disease (ESKD) patients. This study investigated the combined prognostic effect of RDW and VC in ESKD patients starting dialysis. Methods: A retrospective single-center study of 582 ESKD patients was conducted. VC was assessed by calculating the aortic calcification index (ACI) using computed tomography. Patients were divided into low ACI-low RDW, low ACI-high RDW, high ACI-low RDW, and high ACI-high RDW groups based on median ACI (17.12) and RDW (14.3) values. The association between RDW and VC and the composite endpoint of CV events and death was analyzed. Results: During a median follow-up of 3.1 years (range, 1.5–5.5 years), 165 CV events (28.4%) and 124 deaths (21.4%) occurred. Cox regression showed that the low ACI-high RDW (adjusted hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.04–2.66; p = 0.03) and high ACI-low RDW (adjusted HR, 1.95; 95% CI, 1.21–3.14; p = 0.006) groups had a greater risk of CV events and death than the low ACI-low RDW group. The high ACI-high RDW group had the greatest risk (adjusted HR, 2.23; 95% CI, 1.42–3.52; p = 0.001). The effect of the interaction between ACI and RDW on CV events and mortality was statistically significant (p = 0.005). Conclusion: High RDW and VC interact to increase the risk of CV events and death in ESKD patients.

Central Pontine Myelinolysis after Liver Transplantation: A case report / 대한마취과학회지

Central pontine myelinolysis (CPM) is a demyelinating disorder that almost exclusively affects the central portion of basis pontis and occurs in patients with malnutrition, chronic debilitating disorders and electrolyte abnormalities. CPM after liver transplantation is considered that had the relationship to rapid correction of hyponatremia and shift in osmolality. Our first case of 4 liver transplantations altered consciousness at the 5th day after transplantation and did not recover fully until 14 months. At first, atrial fibrillation and atelectasis due to left main broncheal obstruction were thought the causes of impaired consciousness as postoperative hypoxic event. At that time, CT scan showed diffuse brain atropy that suggested previous hepatic encephalopathy and/or hypoxic ischemic encephalopathy. After that, MRI revealed CPM and diffuse cortical atropy. We concluded that CPM associated with rapid correction of hyponatremia perioperatively alter patient's consciousness with hypoxic brain injury.

An Analysis of the Process to Organ Donation in Brain-dead Patients / 대한이식학회지

Organ procurements were performed in 9 brain-dead patients at our hospital since 1995. They were 7 males and 2 females. The causes of brain death were trauma in 7 patients and CVA in 2 patients. When brain death was confirmed, hypernatremia over 145 mEq/L was showed in 6 and hypothermia in all. Blood transfusion was done in 6 patients for correction of anemia preoperatively. The time intervals from brain death confirmation to organ procurement were from 1 hour to 2 days. Multi-organ harvests were done in 4 patient, 60 year-old female and 2 patients who received the cardioversion before harvest were given up to procure liver and heart preoperatively. And 2 patients were not procured heart and liver because of pathologic findings of intraoperative frozen biopsy. Among 22 recipients, 1 kidney recipient died postoperatively. We conclude that the intensive care should be performed in the brain dead donor for multi-organ harvest and better results of organ transplantations. Beside the organ procurement and transplantation team, another intensive care team for brain dead donor should be composed if possible.

Effects of Propofol in Combination with Ephedrine on the Hemodynamic Effects during Anesthesia Induction / 대한마취과학회지

BACKGROUND: Propofol is a useful induction agent, but it can cause hypotention and bradycardia. Meanwhile, ephedrine has alpha-vasoconstriction and beta-cardiac stimulant effect. The purpose of this study was to assess the hemodynamic effects of adding various doses of ephedrine to propofol to obtund adverse hemodynamic response and to determine the optimal dose. METHODS: Unpremedicated 120 ASA physical status I adult patients (20~50yrs) scheduled for elective surgery were randomly allocated into four groups according to the doses of ephedrine added to propofol (1%, 20 ml). Group 1 (control group) was given propofol alone and 10, 15 and 20 mg of ephedrine was added to propofol in Group 2, 3 and 4, respectively (n=30 for each group). Propofol was loaded at 150 ml/hr using a syringe pump and no response to verbal command was ascertained as the end-point of induction. Vital signs and SpO2 were checked every 1 min during the induction period. RESULTS: In group 1, there was a significant decrease in both systolic and diastolic pressure prior to intubation. Group 2 and 3 showed relatively stable hemodynamic changes and significant systolic or diastolic changes occured only in the pre or post 1 min periods of intubation. But, in pulse rate, group 3 showed significant change 1 and 2 min after intubation, in contrary to group 2. Group 4 showed significant changes in systolic and diastolic pressure 1 and 2 min after intubation, and in pulse rate throughout the postintubation period. CONCLUSIONS: Ephedrine 10mg may be safely employed to reduce the hemodynamic changes during induction preiod with propofol.

A study on the urinary estriol levels in the preeclamptic women / 대한산부인과학회잡지

No abstract available.