Effect of Herpes Zoster Treatment and Sudden Sensorineural Hearing Loss Using National Health Insurance Claims Data of South Korea.

Background and objectives: Herpes zoster (HZ) is caused by the reactivation of a pre-existing latent varicella zoster virus, which is one of the viruses that causes hearing loss, and hearing loss may occur due to a systemic immune response even if it does not invade the auditory nerve. This study aimed to determine the correlation between sudden sensorineural hearing loss (SSNHL) in older adult patients who received HZ treatment. Materials and Methods: We used the cohort data of patients aged 60 years and above (n = 624,646) between 2002 and 2015 provided by the National Health Insurance Service. The patients were divided into two groups: those who were diagnosed with HZ between 2003 and 2008 (group H, n = 36,121) and those who had not been diagnosed with HZ between 2002 and 2015 (group C, n = 584,329). Results: In the main model (adjusted HR = 0.890, 95% CI = 0.839-0.944, p < 0.001) adjusted for sex, age, and income, and the full model (adjusted HR = 0.894, 95% CI = 0.843-0.949, p < 0.001) adjusted for all comorbidities, group H had a lower risk of SSNHL than group C. Conclusions: This study showed that patients who received HZ treatment had a lower incidence of SSNHL within five years after diagnosis.

Inhaled nitric oxide therapy was not associated with postoperative acute kidney injury in patients undergoing lung transplantation: A retrospective pilot study.

Inhaled nitric oxide (iNO) therapy is commonly used in lung transplantation (LT) recipients during the perioperative periods. However, previous studies report that the use of iNO may increase the risk of renal dysfunction. Post-LT acute kidney injury (AKI) can lead to critical situations, including prolonged intensive care unit or hospital stays and increased morbidity and mortality. Accordingly, the aim of this study was to investigate the relationship between iNO therapy and incidence of post-LT AKI in LT recipients.The medical data of 36 patients who underwent LT surgery from January 2012 to July 2017 in a single university hospital setting were retrospectively collected and analyzed. Patients were divided into 2 groups: iNO (n = 14) and control (n = 19). The demographic data, anesthetic methods, complications, and perioperative laboratory test values of each patient were assessed. Patients were categorized according to changes in plasma creatinine (Cr) concentration levels within 48 hours after LT using Acute Kidney Injury Network criteria.There was no significant difference in the occurrence (P = .13) and severity (P = .9) of post-LT AKI between iNO and control groups. The mean serum Cr levels after surgery were 0.91 ±â€Š0.44 and 0.81 ±â€Š0.37 mg/dL in the iNO and control groups, respectively (P = .50).AKI plays a critical role in the prognosis of LT recipients. Our results revealed that iNO therapy was not associated with the incidence of post-LT AKI. Therefore, if iNO treatment is indicated, active use under close monitoring of renal function is recommended in LT-patients concerned about AKI after surgery.

Pulmonary aspiration during intubation in a high-risk patient: A video clip and clinical implications.

We report a case of pulmonary aspiration during induction of general anesthesia in a patient who was status post esophagectomy. Sudden, unexpected aspiration occurred even though the patient had fasted adequately (over 13 hours) and received rapid sequence anesthesia induction. Since during esophagectomy, the lower esophageal sphincter is excised, stomach vagal innervation is lost, and the stomach is flaccid, draining only by gravity, the patient becomes vulnerable to aspiration. As the incidence of perioperative pulmonary aspiration is relatively low, precautions to prevent aspiration tend to be overlooked. We present a video clip showing pulmonary aspiration and discuss the literature concerning the risk of aspiration and its preventive strategies.

Severe postoperative dyspnea caused by neglected massive intraperitoneal fluid collection during laser enucleation and morcellation of the prostate: a case report.

Laser enucleation and morcellation of the prostate is an increasingly used surgical management of benign prostatic hyperplasia. However, it can cause several complications including capsular perforation, ureteral orifice injury, and bladder mucosal morcellation injury. Herein, we report a case of severe postoperative dyspnea caused by neglected massive intraperitoneal fluid collection during laser surgery of the prostate. The patient experienced massive abdominal distension and severe respiratory difficulty after the procedure. Although immediate postoperative cystogram showed no leakage of contrast dye, the computed tomography scan of the abdomen and pelvis showed massive fluid collection in the abdominal pelvic cavity suggesting bladder wall injury. After percutaneous drainage of intraperitoneal fluid, abdominal distention and dyspnea were relieved.

Preoperative hypoalbuminemia and anemia as predictors of transfusion in radical nephrectomy for renal cell carcinoma: a retrospective study.

BACKGROUND: The only curative therapy for renal cell carcinoma is the complete removal of malignant tissue. Surgical bleeding during radical nephrectomy may require blood transfusion. Blood transfusion, however, is associated with postoperative morbidity and mortality. This study investigated predictive factors of transfusion requirement in patients undergoing radical nephrectomy, as well as the effects of transfusion on postoperative outcomes. METHODS: This study retrospectively enrolled 526 patients who underwent open radical nephrectomy for renal cell carcinoma between 2010 and 2012. Univariate and multivariate logistic regression analyses were used to determine independent predictive factors of a requirement for packed red blood cell (PRBC) transfusion. Postoperative outcomes included an admission to the intensive care unit (ICU) and lengths of ICU and hospital stay. RESULTS: Of the 526 patients, 93 (17.7 %) required PRBC transfusion, with these patients requiring a mean 5.5 units. Preoperative hypoalbuminemia (serum albumin <3.5 g/dL) was observed in 75 (14.3 %) patients, and preoperative anemia (hemoglobin <12.0 g/dL) in 121 (23.0 %). Multivariate logistic regression analysis showed that preoperative hypoalbuminemia, preoperative anemia, and a high cancer stage were independent factors significantly associated with PRBC transfusion in open radical nephrectomy. The transfused group had higher incidence of ICU admission and longer lengths of ICU and hospital stay than the non-transfused group. CONCLUSIONS: Preoperative hypoalbuminemia and anemia are important predictors of PRBC transfusion during radical nephrectomy for renal cell carcinoma. Furthermore, transfusion is associated with poor postoperative outcomes.

Preoperative hypoalbuminemia is a major risk factor for acute kidney injury following off-pump coronary artery bypass surgery.

PURPOSE: To investigate the association between preoperative low serum albumin level and acute kidney injury (AKI) after off-pump coronary artery bypass surgery (OPCAB) METHOD: We assessed preoperative and perioperative risk factors, and preoperative serum albumin concentration in 1,182 consecutive adult patients with preoperative normal renal function who underwent OPCAB surgery. Each patient was categorized by maximal Acute Kidney Injury Network (AKIN) criteria based on creatinine changes within the first 48 h after OPCAB. Logistic regression and propensity analyses were performed to evaluate the association between preoperative low serum albumin level and postoperative AKI. RESULTS: Of the 1,182 patients, 334 (28.3%) developed AKI. Risk factors for AKI were old age, diabetes mellitus, maximal cardiovascular component of the sequential organ failure assessment score, perioperative transfusion, and postoperative C-reactive protein concentration. The risk of AKI was negatively correlated with the volume of crystalloid infused during surgery. A preoperative serum albumin level of <4.0 g/dl was independently associated Ith postoperative AKI [multivariable logistic analysis: odds ratio (OR) 1.83, 95 % confidence interval (CI) 1.27-2.64; P = 0.001; propensity analysis: OR 1.62, 95 % CI 1.12-2.35; P = 0.011). AKI was associated with prolonged stay in the intensive care unit and hospital and a high mortality rate. CONCLUSIONS: Preoperative low serum albumin level is an independent risk factor for AKI, and postoperative AKI is associated with poor outcomes after OPCAB in patients with preoperative normal renal function.

Prognostic implications of preoperative E/e' ratio in patients with off-pump coronary artery surgery.

BACKGROUND: The ratio of early transmitral flow velocity to early diastolic velocity of the mitral annulus (E/e') correlates with left ventricular (LV) filling pressure. In particular, an E/e' ratio more than 15 is an excellent predictor of increased LV filling pressure. The authors evaluated the prognostic implications of preoperative estimated LV filling pressure, assessed by E/e' ratio, in patients undergoing off-pump coronary artery bypass graft surgery. METHODS: This observational study investigated 1,048 consecutive adults undergoing elective off-pump coronary artery bypass graft surgery. The primary outcome was occurrence of major adverse cardiac events (MACE), defined as a composite of death, myocardial infarction, malignant ventricular arrhythmia, cardiac dysfunction, or need for new revascularization. Logistic regression and survival analyses were performed. RESULTS: An E/e' ratio more than 15 was independently associated with 30-day MACE (odds ratio 2.4, 95% CI 1.4-3.9, P = 0.001) and 1-yr MACE (hazard ratio 2.1, 95% CI 1.4-3.1, P = 0.001), irrespective of underlying LV ejection fraction. MACE free 1-yr survival rate was significantly decreased in patients with E/e' >15, irrespective of underlying LV ejection fraction. CONCLUSIONS: Increased LV filling pressure, assessed by E/e' ratio, is an independent predictor of 30-day and 1-yr MACE in patients who undergo elective off-pump coronary artery bypass graft surgery. These findings indicate that measurements of E/e' may assist in preoperative risk stratification of these patients.

Preoperative treatment with an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker has no beneficial effect on the development of new-onset atrial fibrillation after off-pump coronary artery bypass graft surgery.

BACKGROUND: The present study investigated whether preoperative angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) use affected the incidence of postoperative atrial fibrillation (POAF) in patients undergoing off-pump coronary artery bypass graft (OPCAB). HYPOTHESIS: Preoperative use of ACEI or ARB was related to POAF in patients undergoing OPCAB. METHODS: This retrospective, observational, cohort study involved 1050 patients who underwent OPCAB from January 2006 to December 2009. RESULTS: ACEI or ARB, ACEI alone, and ARB alone did not exert beneficial effect on the occurrence of POAF, and ACEI or ARB use was rather associated with an increased incidence of POAF (ACEI or ARB: odds ratio [OR]: 1.66, 95% confidence interval [CI]: 1.04-2.62, P = 0.03; ACEI alone: OR: 1.30, 95% CI: 0.57-2.97, P = 0.53; ARB alone: OR: 1.57, 95% CI: 0.93-2.64, P = 0.09). CONCLUSIONS: ACEI or ARB, ACEI alone, and ARB alone did not favorably influence the occurrence of POAF in patients undergoing OPCAB.

The prophylactic use of recombinant factor VIIa in a patient with DeBakey type III aortic dissection -A case report-.

Little is known about the prophylactic use of recombinant factor VIIa (rFVIIa) in patients undergoing surgery for a bleeding aorta employing cardiopulmonary bypass. We report the successful use of rFVIIa in a patient undergoing hypothermic circulatory arrest and prolonged cardiopulmonary bypass for repair of a DeBakey type III aortic dissection.

Temporary bilateral sensorineural hearing loss following cardiopulmonary bypass -A case report-.

Sudden sensorineural hearing loss has been reported to occur following anesthesia and various non-otologic surgeries, mostly after procedures involving cardiopulmonary bypass. Unilateral sensorineural hearing loss resulting from microembolism is an infrequent complication of cardiopulmonary bypass surgery that has long been acknowledged. Moreover, there are few reports on the occurrence of bilateral sensorineural hearing loss without other neurologic deficits and its etiology has also not been determined. We describe here a rare case of bilateral hearing loss without other neurologic deficits in an otherwise healthy 27-year-old woman who underwent cardiopulmonary bypass surgery for repair of severe mitral valve stenosis. The patient suffered from profound sensorineural hearing loss in both ears that was recognized immediately upon extubation, and audiometry tests confirmed the diagnosis. Without any treatment, her hearing recovered almost completely by the time of her discharge one week after surgery.

Effects of propofol and etomidate on hydrogen peroxide-induced oxidative damage in hepatocyte.

BACKGROUND: The present investigation was undertaken to evaluate the protective effect of propofol and etomidate against hydrogen peroxide (H2O2) induced oxidative damage in human hepatic SNU761 cells by measuring lactate dehydrogenase (LDH). METHODS: The cell line of human hepatocellular carcinoma was grown for 24 hours in dissociated cell culture. They were divided into eight groups: negative control (NC) group with no drug administration, positive control (PC) group with H2O2 250 micrometer and other groups pretreated with propofol (P; 1, 10, 50 micrometer) or etomidate (ET; 1, 10, 50 micrometer) followed H2O2 administration. After 7 hours, cell death was assessed by morphology under the light microscope and quantified by measuring the LDH in the culture media. RESULTS: In the light microscopic findings, the intact cells were increased in all three propofol groups compared to group PC. H2O2-induced LDH production was also significantly suppressed in all three propofol groups compared to group PC (P < 0.001). There were no significant differences in the microscopic findings and LDH production between the etomidate groups and group PC. CONCLUSIONS: These results suggest that the propofol has protective effect on the hepatocyte against H2O2-induced oxidative stress.