The Impact of Cardiac Surgery with Deep Hypothermic Circulatory Arrest on Systemic Inflammatory Response and Postoperative Morbidity in Adults

BACKGROUND: The inflammatory response to cardiopulmonary bypass (CPB) surgery is believed to play an important role in the end organ dysfunction after open heart surgery. The effect of temperature on the post-bypass inflammatory response has been studied in normothermic and hypothermic patients. This study compared the influence on the systemic inflammatory response and postoperative morbidity in hypothermic cardiopulmonary bypass patients with those in patients in deep hypothermic circulatory arrest. METHODS: Fifty patients undergoing elective redo-valvular replacement or double valve replacement using a hypothermic cardiopulmonary bypass (26-28oC, H Group) and 9 patients undergoing an elective ascending aortic aneurysm replacement using deep hypothermic circulatory arrest (16oC, D Group) were prospectively investigated. The serum samples were collected to estimate the interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha levels immediately after induction, 30 min after the initiation of the CPB, 30 min after weaning from the CPB, 2 hours after the CPB, 24 hours after the CPB. RESULTS: Patients preoperative and intraoperative characteristics (age, gender, aortic cross clamping time, cardiopulmonary bypass time) were not similar in the two groups. The serum level of IL-6 and TNF-alpha were also similar in the two groups. There were no statistical differences in the intubation time, ICU stay and oxygenation index (arterial PO2/inspired fraction of oxygen). There were also no statistical differences in the incidence of systemic inflammatory response syndrome and the APACHE II scores. CONCLUSIONS: Deep hypothermic circulatory arrest was not shown to produce a more profound inflammatory response or influence the postoperative morbidity than a hypothermic cardiopulmonary bypass.

Transthoracic Echocardiographic Assessment of Adriamycin-induced Cardiomyopathy in Rats with a 15 MHz Transducer

BACKGROUND: Adriamycin (doxorubicin) is one of the widely used drugs in the treatment of a variety of solid and hematologic malignancies. However, the adriamycin-induced cardiomyopathy limits the prolonged use of this effective drug. Transthoracic echocardiography is the excellent tool in early detection and follow-up studies of adriamycin-induced cardiomyopathy. The aim of this study was to assess the cardiac function and morphology using a 15 MHz high-frequency imaging in rats. METHODS: Adriamycin was administrated intraperitoneally by six equal injections at a dose of 2.5 mg/kg over a period of 2 weeks for total cumulative dose of 15 mg/kg body weight in 12 male Sprague-Dawley rats (weight 367+/-39 g). Transthoracic echocardiography with a 15 MHz linear-array transducer was performed at baseline and additionally at 3 weeks to measure the left ventricular wall thickness and dimension from the parasternal short axis view with 2D guided M-mode and pulsed Doppler signals of mitral inflow. Within 2 days of echocardiography, the heart was harvested for electron microscopic evaluation after potassium-induced cardiac arrest. RESULTS: 1) The mortality rate during the experimental period was 0%. 2) Transthoracic echocardiography provided adequate 2D guided M-mode images and pulsed Doppler signals of mitral inflow in all rats. 3) In follow-up echocardiography, pericardial effusion was detected in 7out of 12 rats (58%). 4) Compared to baseline, end-diastolic dimensions were increased from 7.01+/-0.69 to 7.74+/-1.25 mm (p<0.001), end-systolic dimensions were increased from 4.13+/-0.69 to 5.22+/-1.12 mm (p<0.05), and interventricular septal and posterior wall thickness at end-systole and end-diastole were significantly decreased (p<0.05, respectively). 5) Fractional shortening was decreased from 43.0+/-6.8 to 32.7+/-8.0%, compared to baseline (p<0.05). 6) E/A ratio of mitral inflow changed significantly from 1.63+/-0.36 to 2.78+/-1.0, compared to baseline (p<0.05). CONCLUSION: Adriamycin administration at total cumulative dose of 15 mg/kg body weight over 2 weeks creates a reliable model of non-ischemic dilated cardiomyopathy in rats with a high success rate. Transthoracic echocardiography using a 15 MHz transducer provides adequate images for assessing the cardiac function and morphology in follow-up studies in adriamycin-induced cardiomyopathy of rats. These results suggest that transthoracic echocardiography using a 15 MHz Transducer is a promising tool for an assessment of adriamycin-induced cardiomyopathy in small animals.

Cognitive Behavior Therapy of Bulimia Nervosa in a Male Patient: A Case Report / 신경정신의학

Bulimia nervosa is a disorder that is defined as binge eating combined with inappropriate ways of stopping weight gain. It is significantly more common in females than in males. Males in bulimia account for 10-15% of all bulimic patients. There are many methods of treatment, including drug therapy, or psychotherapy. Among them cognitive behavior therapy is reported to be the most effective method of improving the binge eating behavior and the cognitive distortion about body weight and body image. In this case, a male bulimic patient, who was hospitalized in the closed ward involuntarily, was treated with modified Fairburn's cognitive behavior therapy model. After 6 weeks of treatment, binge eating and self-induced vomiting behaviors were controlled and weight gain was nearly successful.

A Case of Autoimmune Hemolytic Anemia & Pericardial Effusion Developed in Hashimoto's Thyroiditis Patient / 대한내분비학회지

Hashimotos thyroiditis has been associated with a various autoimmune disorders. The immunologic mechanisms involved in the pathogenesis of these disorders have not always been thought to be the same. Although it was demonstrated that there were high prevalence of abnormal thyroid function and autoantibody in autoimmune hemolytic anemia(AIHA) and Fisher-Evans syndrome(FES), AIHA combined with Hashimotos thyroiditis is rare in Korean literature. It was suggested that a common immunologic mechanism may be involved in the pathogenesis of both disease and the possibility of multiple autoimmune syndrome might present in autoimmune hematologic disorders. We experienced a 74-year old woman with a 12-year history of a hypothyroidism due to Hashimotos thyroiditis was hospitalized with sudden development of warm AIHA with positive Direct & Indirect Coombs test and pericardial effusion. Her thyroid function test showed subclinical hypothyroidism with the maintenance dosage of levothyroxine(100pg/day). With glucocorticoid and plasmapheresis, AIHA and pericardial effusion were corrected successfully. It is suggested that the prudent immunologic study is needed for the anemia developed in patients with Hashimotos thyroiditis with or without hypothyroidism.

A Case of SIADH Related to Drug-indeced Generalized Maculopapular Rash / 대한내분비학회지

Syndrome of inappropriate antidiutetic hormone(SIADH) secretion is the most common cause of hyponatremia in clinical medicine. Before diagnosis of the SIADH is made, other causes for a decreased diluting capacity and nonosmotic stimuli for AVP release need to be rule out. Disorders associated with SIADH can be divided into 4 major etiologic groups: malignancies, pulmonary diseases, central nervous disorders, and drugs. A 45-year-old woman was admitted due to maculopapular skin eruption and fever after taking medications for fever and myalgia. Generalized tonic clonic seizure was developed nine days later, and laboratory results showed marked hyponatremia. During the evaluation, treatment, and subsequent follow-up, the diagnosis of SIADH was confirmed, but the definitive cause was obscure. With fluid restriction, sodium replacement and demeclocycline therapy, she recovered completely 6 months later. We suggest that the SIADH might be related to drug-induced generalized maculopapular rash via menmgitis-like reaction in CSF as one of systemic adverse side effects to drugs rather than direct effect of related drugs.