Association of Pre- and Post-Donation Renal Function with Midterm Estimated Glomerular Filtration Rate in Living Kidney Donors: A Retrospective Study

Purpose@#The estimated glomerular filtration rate (eGFR) at 6 months after donation (eGFR 6m) is strongly associated with the risk of end-stage renal disease in living kidney donors. This study aimed to investigate the incidence of eGFR 6m <60 mL/min/1.73 m 2 eGFR 6m <60) and identify the risk factors that can predict the occurrence of eGFR 6m <60 in living kidney donors. @*Materials and Methods@#Living kidney donors who underwent nephrectomy at Severance Hospital between January 2009 and December 2019 were identified. We excluded 94 of 1233 donors whose creatinine values at 6 months after donation were missing. The risk factors for eGFR 6m <60 were assessed using multivariate regression analysis. The optimal cutoff points for candidate risk factors for predicting eGFR 6m <60 occurrence were determined using the Youden index. @*Results@#The eGFR 6m <60 occurred in 17.3% of the participants. Older age (≥44 years), history of hypertension, lower preoperative eGFR (<101 mL/min/1.73 m 2 ), and degree of increase in creatinine levels on postoperative day 2 compared to those before surgery (ΔCr2_pre) (≥0.39 mg/dL) increased the risk of eGFR 6m <60. The addition of ΔCr2_pre to preoperative eGFR yielded a higher predictive accuracy for predicting eGFR 6m <60 than that with preoperative eGFR alone {area under the receiver operating characteristic curve=0.886 [95% confidence interval (CI), 0.863–0.908] vs. 0.862 (95% CI, 0.838–0.887), p<0.001}. @*Conclusion@#The incidence of eGFR 6m <60 was 17.3%. Older age, lower preoperative eGFR, history of hypertension, and greater ΔCr2_pre were associated with the occurrence of eGFR 6m <60 after living donor nephrectomy. The combination of preoperative eGFR and ΔCr2_pre showed the highest predictive power for eGFR 6m <60.

Lung Ultrasound in the Critically Ill / 대한중환자의학회지

No abstract available.

Lung Ultrasound in the Critically Ill / 대한구급학회지

No abstract available.

Evaluation of Informed Consent for Withholding and Withdrawal of Life Support in Korean Intensive Care Units / 대한중환자의학회지

BACKGROUND: The goal of this study was to analyze the process and characteristics of withholding or withdrawal of life support (WLS) in Korean intensive care units (ICUs). METHODS: This was a single-centered retrospective analysis of patients who died in the ICUs of a tertiary hospital in Korea from January to December 2012. WLS informed consents and clinical data were analyzed. RESULTS: Of 285 deaths during the study period, informed consents for WLS were obtained from 228 patients (80.0%). All WLS decisions were made by family members after the patient's loss of decision-making capacity. Decisions were made most frequently by the patient's son (50.6%). Patients in the WLS group were older than those in the non-WLS group, and older age was associated with the WLS decision. Thirty-seven patients (16.2%) died within one hour of WLS approval, and 182 patients (79.8%) died on the day of WLS approval. The most frequently withheld life support modality was chest compression (100%), followed by defibrillation (95.9%) and pacemaker insertion (63.3%). CONCLUSIONS: Aggressive and invasive life support measures were those most frequently withheld or withdrawn by decision-makers in Korean ICUs. The most common proxy was the son, rather than the spouse.

Evaluation of Informed Consent for Withholding and Withdrawal of Life Support in Korean Intensive Care Units / 대한구급학회지

BACKGROUND: The goal of this study was to analyze the process and characteristics of withholding or withdrawal of life support (WLS) in Korean intensive care units (ICUs). METHODS: This was a single-centered retrospective analysis of patients who died in the ICUs of a tertiary hospital in Korea from January to December 2012. WLS informed consents and clinical data were analyzed. RESULTS: Of 285 deaths during the study period, informed consents for WLS were obtained from 228 patients (80.0%). All WLS decisions were made by family members after the patient's loss of decision-making capacity. Decisions were made most frequently by the patient's son (50.6%). Patients in the WLS group were older than those in the non-WLS group, and older age was associated with the WLS decision. Thirty-seven patients (16.2%) died within one hour of WLS approval, and 182 patients (79.8%) died on the day of WLS approval. The most frequently withheld life support modality was chest compression (100%), followed by defibrillation (95.9%) and pacemaker insertion (63.3%). CONCLUSIONS: Aggressive and invasive life support measures were those most frequently withheld or withdrawn by decision-makers in Korean ICUs. The most common proxy was the son, rather than the spouse.

A Case of Burkholderia cepacia Pneumonia after Lung Transplantation in a Recipient without Cystic Fibrosis / 대한구급학회지

Burkholderia cepacia is a highly virulent pathogen known to cause opportunistic infections in immunocompromised patients. It accelerates lung disease and causes necrotizing pneumonia with associated severe sepsis, known as cepacia syndrome. In particular, lung transplant recipients infected with Burkholderia cepacia show higher mortality after lung transplantation than those who are not infected with this organism. Due to broad-spectrum antibiotic resistance, a combination therapy should be used according to the results of the susceptibility test. This bacterial infection is rare in Korea, and no case was reported in lung transplant recipients. However, we report a case of pneumonia caused by Burkholderia cepacia after lung transplantation. As Burkholderia cepacia was grown from a sputum culture, the patient was treated initially with a combination of meropenem and trimethoprim/sulfamethoxazole and then ceftazidime and trimethoprim/sulfamethoxazole as a result of leukopenia. After antibiotics treatment for 20 days, sputum cultures became negative for Burkholderia cepacia and the patient successfully recovered.

Effect of a single bolus of methylene blue prophylaxis on vasopressor and transfusion requirement in infective endocarditis patients undergoing cardiac surgery / 대한마취과학회지

BACKGROUND: The accentuated nitric oxide (NO) release that is induced by the systemic inflammatory response associated with infective endocarditis (IE) and cardiopulmonary bypass (CPB) may result in catecholamine refractory hypotension (vasoplegia) and increased transfusion requirement due to platelet inhibition. Methylene blue (MB) is an inhibitory drug of inducible NO. We aimed to evaluate the effect of prophylactic MB administration before CPB on vasopressor and transfusion requirements in patients with IE undergoing valvular heart surgery (VHS). METHODS: Forty-two adult patients were randomly assigned to receive 2 mg/kg of MB (MB group, n = 21) or saline (control group, n = 21) for 20 min before the initiation of CPB. The primary end points were comparisons of vasopressor requirements serially assessed after weaning from CPB and hemodynamic parameters serially recorded before and after CPB. The secondary endpoint was the comparison of transfusion requirements. RESULTS: Two patients in the control group received MB after weaning from CPB due to norepinephrine and vasopressin refractory vasoplegia and were thus excluded. There were no significant differences in vasopressor requirements and hemodynamic parameters between the two groups. The mean number of units of packed erythrocytes transfused per transfused patient was significantly less in the MB group. The numbers of patients transfused with fresh frozen plasma and platelet concentrates were less in the MB group. CONCLUSIONS: In IE patients undergoing VHS, prophylactic MB administration before CPB did not confer significant benefits in terms of vasopressor requirements and hemodynamic parameters, but it was associated with a significant reduction in transfusion requirement.

Anesthetic experience of a patient with Ohtahara syndrome: A case report / 대한마취과학회지

Ohtahara syndrome (OS) is a rare epileptic encephalopathy that is characterized by an abnormal electroencephalogram (EEG) and intractable seizures in the neonatal and early infantile period. The patient of this reported case was delivered normally at 39 weeks of gestation without any complication. One week after birth, seizures that were refractory to anticonvulsants started with repetitive clustered tonic spasms. The child had no abnormal findings on the initial laboratory investigations. But he was diagnosed with OS according to the frequent tonic spasms, an abnormal EEG pattern of suppression-burst and magnetic resonance imaging of cortical dysplasia. He was planned to undergo an operation for brain lesion. This report describes our experience with the general anesthetic management when we performed craniotomy and right hemispherotomy for a patient with OS.

Accidental intradural injection during attempted epidural block: A case report / 대한마취과학회지

Several cases of accidental subdural injection have been reported, but only few of them are known to be accidental intradural injection during epidural block. Therefore we would like to report our experience of accidental intradural injection. A 68-year-old female was referred to our pain clinic due to severe metastatic spinal pain. We performed a diagnostic epidural injection at T9/10 interspace under the C-arm guided X-ray view. Unlike the usual process of block, onset was delayed and sensory dermatomes were irregular range. We found out a dense collection of localized radio-opaque contrast media on the reviewed X-ray findings. These are characteristic of intradural injection and clearly different from the narrow wispy bands of contrast in the subdural space.

Thrombopoietin Level and Bone Marrow Megakaryocyte Colony Formation in Various Diseases with Thrombocytopenia / 대한소아혈액종양학회지

PURPOSE: Thrombocytopenia is a serious life threatening consequence in patients with bone marrow failure syndrome. Thrombopoietin (TPO), recently cloned by several groups has been shown to be a key regulation of megakaryopoiesis and thrombopoiesis. Recent studies have demonstrated a positive or negative relationship between TPO levels and platelet counts due to underlying disease states. To clarify the role of TPO in thrombocytopenic condition we determined plasma TPO levels and megakaryocyte colony assay. METHPDS: TPO levels were measured in thrombocytopenic patient with aplastic anemia, chemotherapy induced bone marrow failure, idiopathic thrombocytopenic purpura (ITP) and in newborn by ELISA (QuantikineTM, R&D System, USA). Controls were short statured normal children with normal platelet counts. Plasma was preserved in 20oC until test. CFU-mega was determined by MegaCultTM (Stem Cell Tech. Inc., Canada). Ficoll separated mononuclear cells were cultured for 10~12 days with TPO or stem cell factor (SCF) in 37degrees C 5% CO2 atmosphere, colonies were fixed, stained and examined with inverted microscope. Results were analysed by Student-t test. RESULTS: TPO levels were markedly increased in aplastic anemia and chemotherapy induced thrombocytopenia compared to those of normal controls. Patients with ITP had decreased level of plasma TPO. There was inverse relationship between platelet count and TPO levels for patients with aplastic anemia and chemotherapy induced thrombocytopenia. There was no definite relationship between platelet counts and TPO levels but inverse relationship between platelet counts and PDW levels in neonates was noted. The levels of TPO were increased after improvement of platelet in thrombocytopenic neonate. Megakaryocyte colonies were increased in the mononuclear cells of the patients with ITP and chemotherapy induced thrombocytopenia. There was little colony formation in aplastic anemia. TPO had no definite effect in megakaryocyte colony formation but SCF increased colony formation. CONCLUSION: TPO levels were increased in aplastic anemia and chemotherapy induced thrombocytopenia but decreased in ITP. There was inverse relationship between platelet count and TPO levels in aplastic anemia and chemotherapy induced thrombocytopenia. Thus TPO could be useful for differentiate the etiology of thrombocytopenia. Megakaryocyte colony was increased in ITP and chemotherapy induced thrombocytopenia, but decreased in aplastic anemia. SCF was effective in megakaryocyte colony formation. TPO and SCF will be helpful to increase platelet in thrombocytopenic patients. However, further study will be needed.

A Case of Impotence due to Pituitary Adenoma / 대한비뇨기과학회지

The endocrine cause of impotence is about 10-15% of all impotence. If hyperprolactinemia is noted, the pituitary adenoma should be suspected. Usually, the early symptom of pituitary adenoma is impotence and other symptoms of CNS appear later. So impotence is a very important clinical symptom not to be neglected. It had taken 8 years to diagnose the pituitary adenoma, whose early symptom was impotence. He received operation and radiotherapy and has been taking care of his sustaining hyperprolactinemia. When we review his past history. it is not overemphasized that impotence is important to diagnose pituitary adenoma."