High BNP level as risk factor for acute kidney injury and predictor of all-cause mortality in STEMI patients

OBJECTIVES

The aim of this study was to evaluate the predictive value of brain natriuretic peptide (BNP) in the development of acute kidney injury (AKI) and 6-month all-cause mortality after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in a modest-risk population.

BACKGROUND

The prognostic value of BNP has been well documented in patients with acute coronary syndrome. However, its value in development of AKI and 6-month all-cause mortality in patients with STEMI undergoing primary PCI remains unclear.

METHODS

We prospectively enrolled 424 consecutive STEMI patients (mean age 53.6 ± 12.1 years) undergoing primary PCI. The population was divided into two groups: a high (n = 110) and a low (n = 314) admission BNP group according to the cut-off value (> 88.7 pg/ml) determined by ROC analysis to have the best predictive accuracy for 6-month all-cause mortality. The clinical characteristics as well as the in-hospital and 6-month outcomes of patients undergoing primary PCI were analyzed.

RESULTS

Cox multivariate analysis showed that a high-admission BNP value (> 88.7 pg/ml) was an independent predictor of AKI development (odds ratio, 1.002; 95 % confidence interval, 1.000–1.003; p = 0.02) and 6-month all-cause mortality (odds ratio, 1.003; 95 % confidence interval; 1.001–1.004; p = 0.004).

CONCLUSION

These results suggest that a high-admission BNP level is associated with an increased risk of AKI development and 6-month all-cause mortality in patients with STEMI undergoing primary PCI.

Single-port Laparoscopic Total Hysterectomy and Bilateral Salpingo-oopherectomy Combined with Burch Colposuspension

Recently, scarless surgery has become a widely used surgical technique and many laparoscopic surgeons have attempted to reduce incisional morbidity and improve cosmetic outcomes by using fewer and smaller ports. Laparoscopic combined procedures permit simultaneous treatments for multiple pathologies. In single time anaesthesia, these combined minimally invasive procedures gives the advantages of less pain and morbidity, faster recovery and shorter hospital stay. Moreover, these combined procedures can be performed with a single incision and can have additional benefits for the patients and the hospital. Here we describe a single port laparoscopic total hysterectomy and bilateral salpingo-oopherectomy combined with Burch colposuspension. The operation was completed laparoscopically with single port, without intra-operative or postoperative complications, in a single session. The patient was discharged the following morning. With a single incision multidisciplinary laparoscopic approaches can offer suitable, effective and safe treatments.

One day surgery for pilonidal disease

BACKGROUND

There are numerous surgical options for pilonidal disease. We practice "D" excision technique with a suction drain under local anesthesia as a 1 day surgery procedure.

METHODS

54 patients had pilonidal surgery between March 2001 and December 2003. "D" excision with a suction drain under local anesthesia was performed. An attention was given not to make a wide excision. Tracks lying outside the excised area were removed by the same technique with small "D" incisions. Subcutaneous tissues were sutured with absorbable interrupted sutures in layers. The wound was closed subcutaneously with running monofilament non-absorbable suture. All the operations were performed as 1 day surgery procedure. 33 of 54 patients had been reached by call on March 2009.

RESULTS

Recurrence was seen in four of 54 patients (7.4%). Follow-up of two of these four patients have been uneventful after the second operation. Infection developed in two patients (3.7%) and caused a wound dehiscence. Both patients healed without any problems. All of the patients were able to return to their daily activities on the 3-5 postoperative day.

CONCLUSION

"D" excision technique as a 1 day surgery procedure for pilonidal disease is performed with a low complication and recurrence rate (Ref. 19).

Transient neurological symptoms after spinal anaesthesia with levobupivacaine 5 mg/ml or lidocaine 20 mg/ml

BACKGROUND

Transient neurological symptoms (TNS) after spinal anaesthesia have been reported most commonly in association with lidocaine, but have been observed with other local anaesthetics. The aim of this prospective, randomized, double-blind study was to investigate the incidence of TNS after spinal anaesthesia with either levobupivacaine or lidocaine.

METHODS

Patients undergoing inguinal hernia, appendectomy, varicose vein or minor orthopaedic operations were included in the study (60 patients; 47 male, 13 female, overall mean age 30 years). All patients had an American Society of Anesthesiologists score of I or II. The patients were randomly assigned to receive spinal anaesthesia with either 20 mg isobaric levobupivacaine (5 mg/ml) or 80 mg isobaric lidocaine (20 mg/ml). Onset of sensory and motor block and side effects were recorded. On post-operative days 1, 2, and 3, patients were interviewed by an investigator blinded to the spinal anaesthetic used. The patients were classified as having TNS if, following recovery from anaesthesia, there was pain in the buttocks, thighs and/or lower limbs.

RESULTS

In the levobupivacaine group, one patient (3.33%) experienced TNS, whereas in the lidocaine group, eight (26.6%) experienced TNS (P=0.002). Maximum times to arrival of sensory blocks were shorter with lidocaine (P<0.001). The levobupivacaine and lidocaine groups did not differ significantly in terms of the highest dermatome included in sensory block or motor block grade.

CONCLUSION

After spinal anaesthesia with levobupivacaine, the incidence of TNS was much less than after lidocaine. However, it appears that TNS may occur in association with levobupivacaine.