Effect of ß-Adrenergic Antagonists on In-Hospital Mortality after Ischemic Stroke.

BACKGROUND: Ischemic stroke accounts for 85%-90% of all strokes and currently has very limited therapeutic options. Recent studies of ß-adrenergic antagonists suggest they may have neuroprotective effects that lead to improved functional outcomes in rodent models of ischemic stroke; however, there are limited data in patients. We aimed to determine whether there was an improvement in mortality rates among patients who were taking ß-blockers during the acute phase of their ischemic stroke. METHODS: A retrospective analysis of a prospectively collected database of ischemic stroke patients was performed. Patients who were on ß-adrenergic antagonists both at home and during the first 3 days of hospitalization were compared with patients who were not on ß-adrenergic antagonists to determine the association with patient mortality rates. RESULTS: The study included a patient population of 2804 patients. In univariate analysis, use of ß-adrenergic antagonists was associated with older age, atrial fibrillation, hypertension, and more-severe initial stroke presentation. Despite this, multivariable analysis revealed a reduction in in-hospital mortality among patients who were treated with ß-adrenergic antagonists (odds ratio, .657; 95% confidence interval, .655-.658). CONCLUSIONS: The continuation of home ß-adrenergic antagonist medication during the first 3 days of hospitalization after an ischemic stroke is associated with a decrease in patient mortality. This supports the work done in rodent models suggesting neuroprotective effects of ß-blockers after ischemic stroke.

Spontaneous Tumor Lysis Syndrome due to Uterine Leiomyosarcoma with Lung Metastases.

Tumor lysis syndrome (TLS) is an oncologic emergency characterized by a combination of metabolic derangements (hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia) caused by rapid turnover from cell destruction in certain cancers. These metabolic derangements can lead to seizures, cardiac arrhythmias, renal failure, and death. TLS is usually seen after the initiation of chemotherapy for hematologic malignancies. TLS occurring spontaneously, without initiation of chemotherapy, is rare and its occurrence in solid tumors is rarer still. We report a case of spontaneous TLS in a patient with leiomyosarcoma of the uterus, with metastasis to lung. Such a case has never been reported before.