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Reversal of Catabolism by Beta-Blockade after Severe Burns
Patients with severe burns have catecholamine-mediated hypermetabolism, including pronounced muscle-protein catabolism, that adversely affects recovery. In a prospective, randomized study, 13 children with severe burns were given oral propranolol for up to four weeks in an attempt to interrupt this process, and 12 served as controls. Beta-blockade decreased resting energy expenditure and increased net muscle-protein balance by 82 percent, as compared with a 27 percent decrease in net muscle-protein balance in the control group.
Propranolol decreases hypermetabolism and reverses muscle-protein catabolism when given for an extended time during hospitalization for burns, an effect that may facilitate overall healing.
Related Editorial
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Blood Transfusion in Elderly Patients with Acute Myocardial Infarction
Anemia may be detrimental in patients with coronary artery disease. This observational study, in which data on a large number of elderly patients with acute myocardial infarction were analyzed, found that blood transfusion was beneficial when the hematocrit on admission was 30 percent or lower. Transfusion was not beneficial, and may even have been harmful, in patients with hematocrit values higher than 33 percent.
These data support the practice of giving transfusions to elderly patients with acute myocardial infarction when the hematocrit is 30 percent or lower. Although the data do not derive from a clinical trial, they are sufficiently strong to affect practice patterns.
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Comparison of the Survival of Shipped and Locally Transplanted Cadaveric Renal Allografts
This study examined the effect on survival of shipping cadaveric renal allografts from one region to another. Shipment was associated with an overall increase in the rate of allograft failure. The risk of failure during the first year after transplantation was 17 percent higher for shipped kidneys, after adjustment for HLA mismatches, than for similar kidneys transplanted locally.
Strategies for sharing cadaveric renal allografts should consider the increased risk of allograft failure associated with the shipment of organs, particularly allografts with more HLA mismatches.
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Estrogen Replacement after Ischemic Stroke
Some observational studies have suggested that women who are receiving estrogen-replacement therapy have a lower risk of stroke and death than others. The Women's Estrogen for Stroke Trial was a double-blind, placebo-controlled trial of estradiol-17 in 664 women with a recent cerebrovascular event. Estrogen therapy did not reduce the risk of stroke or death in these women and was associated with a borderline increase in the risk of fatal stroke; this therapy was also associated with adverse effects on the endometrium.
This study adds to the growing body of data from randomized trials that have failed to confirm a cardiovascular benefit of estrogen-replacement therapy. Estrogen should not be prescribed for the secondary prevention of cerebrovascular disease.
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BK-Related Polyomavirus Vasculopathy in a Renal-Transplant Recipient
Human polyomaviruses include JC virus, which can cause progressive multifocal leukoencephalopathy, and BK virus, which can cause severe allograft dysfunction in renal-transplant recipients. This report describes a renal-transplant recipient in whom a disseminated BK virus infection with vascular tropism developed, resulting in systemic vasculopathy, the capillary leak syndrome, and death.
In this carefully studied case, a new clinical syndrome related to systemic infection with BK polyomavirus is described. The virus had unusual tropism for vascular endothelium, resulting in extensive endothelial infection, particularly in the heart and skeletal muscles.
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Clinical Practice: Mild Asthma
A 26-year-old man with an eight-year history of asthma has shortness of breath and cough about three times a week. He wheezes routinely with exercise, but his asthma does not usually bother him at night. Office spirometry shows that the forced expiratory volume in one second is 85 percent of his predicted value. How should he be treated?
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