Association of blood glucose at admission with outcomes in patients treated with therapeutic hypothermia after cardiac arrest.

BACKGROUND: It is well known that hyperglycemia is associated with poor outcomes in critically ill patients. We investigated the association between blood glucose level at admission and the outcomes of patients treated with therapeutic hypothermia (TH) after cardiac arrest. METHODS: A total of 883 cardiac arrest patients who were treated with TH were analyzed from the Korean Hypothermia Network retrospective registry. We examined the association of blood glucose at admission with survival and neurologic outcomes at hospital discharge. Favorable neurologic outcomes were defined as Cerebral Performance Category scores of 1 and 2. RESULTS: The mean age of the sample was 56.7 ± 16.2 years, 69.5% of subjects were male, and the mean blood glucose at admission was 14.1 ± 7.0 mmol/L. After adjustment for sex, age, history of diabetes mellitus, hypertension, renal disease and stroke, time from arrest to return of spontaneous circulation, initial rhythm, witness status, bystander cardiopulmonary resuscitation, cause of arrest, and cumulative dose of adrenaline, the associations between glucose and outcomes were as follows: for favorable neurologic outcomes, an odds ratio of 0.955 (95% confidence interval, 0.918-0.994); and for survival, an odds ratio of 0.974 (95% confidence interval, 0.952-0.996). CONCLUSION: These results show that blood glucose level at admission is associated with survival and favorable neurologic outcomes at hospital discharge in patients treated with TH after cardiac arrest. Blood glucose level at admission could be a surrogate marker of ischemic insult severity during cardiac arrest. However, randomized, controlled evidence is needed to address the significance of tight glucose control during TH after cardiac arrest.

Evaluation of HOXB13 as a molecular marker of recurrent prostate cancer.

Many patients with prostate cancer have disease recurrence following surgical removal of tumors and fail to respond to androgen ablation therapy. Despite the existence of a number of clinical/pathological factors, it is not possible to predict which patients will fall into this category. The results of our previous studies demonstrated that the HOXB13 homeodomain protein plays a key role in the development of prostate cancer and the progression of this malignancy. In addition, HOXB13 has been reported to predict estrogen-resistant breast cancer tumors. The purpose of this study was to investigate whether HOXB13 could be used as a molecular marker to predict prostate cancer recurrence. To examine the role of HOXB13 as a molecular marker with clinical/pathological data, the expression of HOXB13 was compared using immunohistochemistry in 57 organ-confined prostate cancer tumors obtained by radical prostatectomy. There was no significant correlation between the expression of HOXB13 and most clinical/pathological parameters, including tumor margin, invasion, pathological stage and risk level. The HOXB13 expression levels correlated with the Gleason score and there was a positive correlation with the pre-operative prostate specific antigen (PSA) levels. Accordingly, the tumor specimens from 4 patients who ultimately had biochemical failure (PSA >0.2 ng/ml), all showed a high expression of HOXB13, while their risk levels were either intermediate or high. This is the first study to report that HOXB13, together with other clinical/pathological factors, can be used as a molecular marker to predict the progression of prostate cancer.

Isolated bilateral vocal cord paralysis with intermediate syndrome after organophosphate poisoning.

INTRODUCTION: Muscular weakness affecting predominantly the proximal limb muscles and neck flexors is the cardinal feature of intermediate syndrome with cranial nerve palsies occasionally accompanied. Following acute cholinergic phase of organophosphate poisoning (OPP), only a few isolated cases of vocal cord paralysis have been reported in the past. We describe a case of bilateral vocal cord paralysis which occurred in the wake of a clinical recovery from acute cholinergic crisis in OPP. CASE REPORT: A 32-year-old woman presented with severe cholinergic crisis after ingestion of an unknown amount of dichlorvos in a suicide attempt. The patient was improved from cholinergic crisis by administration of antidotes. On day 4, she complained of progressive dyspnea and dysphonia after removal of the endotracheal tube. Needle electromyography for neuromuscular confirmation was normal. However, laryngeal electromyography (LEMG) findings were consistent with bilateral laryngeal paralysis suggesting the vagus nerve involvement. Her vocal cord movements were restored to near normal with time and she was discharged on the 20th day after admission. CONCLUSIONS: Physicians should account for the neurotoxic effects of organophosphate poisoning during the first line management of exposed patients. Isolated bilateral vocal cord paralysis (BVCP) should be excluded as a cause, if dysphonia or respiratory distress occurs after extubation in patients with intermediate syndrome. LEMG in such cases can be an important diagnostic adjunct.