High-sensitivity cardiac troponin T in young, healthy adults undergoing non-cardiac surgery.

BACKGROUND: It is unclear if isolated postoperative cardiac-troponin elevation, often referred to as myocardial injury, represents a pathological event, as control studies in otherwise healthy adults are lacking. METHODS: In this single-centre prospective observational cohort study, serial high-sensitivity cardiac troponin T (hscTnT) plasma concentrations were obtained from young, healthy adults undergoing elective orthopaedic surgery at three time points: before operation, 2-6 h, and 18-30 h after surgery. End points were hscTnT increases after surgery: ≥20% (exceeding analytical variability), ≥50% (exceeding short-term biological variability), and ≥85% (exceeding long-term biological variability). The secondary end point was myocardial injury, defined as new postoperative hscTnT elevation >99th % upper reference limit (URL) (women >10 ng litre-1; men >15 ng litre-1). RESULTS: Amongst the study population (n=95), no hscTnT increase ≥20% was detected in 68 patients (73%). A hscTnT increase between 20% and 49% was observed in 17 patients (18%), 50-84% in seven patients (7%), and ≥85% in three patients (3%). Twenty patients (21%) had an absolute ΔhscTnT between 0 and 2 ng litre-1, 12 patients (13%) between 2 and 4 ng litre-1, three patients between 4 and 6 ng litre-1, and one patient (1%) between 6 and 8 ng litre-1. Myocardial injury (new hscTnT elevation >99th%) was diagnosed in one patient (1%). The median hscTnT concentrations did not increase after operation, and were 4 (3.9-5, inter-quartile range) ng litre-1 at baseline, 4 (3.9-5) ng litre-1 at 2-6 h after surgery, and 4 (3.9-5) ng litre-1 on postoperative day 1. CONCLUSIONS: One in four young adult patients without known cardiovascular disease developed a postoperative hscTnT increase, but without exceeding the 99th% URL and without evidence of myocardial ischaemia. These results may have important ramifications for the concept of postoperative myocardial injury, as they suggest that, in some patients, postoperative cardiac-troponin increases may be the result of a normal physiological process in the surgical setting. CLINICAL TRIAL REGISTRATION: NCT 02394288.

Exposure to Echinococcus multilocularis, Toxocara canis, and Toxocara cati in Austria: a nationwide cross-sectional seroprevalence study.

Despite emerging risks for the spread of zoonotic diseases, data on human exposure to Echinococcus multilocularis and Toxocara spp., the causative parasites of the two most important helminthozoonoses in Central Europe, are limited. To investigate risk factors and exposure, we conducted a nationwide, cross-sectional serological study in 1046 healthy individuals, of which 425 were soldiers and 621 were civilians. Serum samples and information on possible risk factors for exposure, including previous foreign military assignments, residential area, animal contact, and regular outdoor activities, were obtained. Immunoglobulin G antibodies against Echinococcus multilocularis and Toxocara spp. were examined with an enzyme-linked immunosorbent assay (ELISA). Samples reactive in the ELISA for antibodies against Echinococcus multilocularis were considered positive only after confirmation by western blot. Overall, 66 (6.3%) individuals tested positive in the serologic screening for Toxocara spp. Occupational animal contact was the only risk factor significantly associated with a higher risk for being seropositive. None of the individuals were positive for antibodies against Echinococcus multilocularis. In conclusion, the present study demonstrates that exposure to Toxocara spp. is widespread in Austria and occupational animal contact is a risk factor for seropositivity.

Clinical aspects of 2009 pandemic influenza A (H1N1) virus infection in Austria.

PURPOSE: To describe the clinical features, risk factors for severe disease and effectiveness of oseltamivir in patients with 2009 pandemic influenza A (H1N1) virus infection. METHODS: In a prospective, cross-sectional, multicentre study, data on 540 patients with confirmed 2009 H1N1 infection from seven Austrian hospitals were collected using a standardised online case-history form. RESULTS: The median age of the patients was 19.3 years (range 26 days-90.8 years); point-of-care testing yielded false-negative results in 60.2% of the 176 cases tested. The most common symptoms were fever, cough, fatigue and headache. Overall, 343 patients (63.5%) were hospitalised, 49 (9.1%) were admitted to an intensive care unit (ICU) and 14 (4.1%) died. Case fatality rates were highest (9.1%) in those aged 65 years or older. Factors significantly associated with a higher risk for ICU admission included age, neurological disease, adipositas, and both interstitial pathology and lobular pathology on chest X-ray. No association with pregnancy, malignancy or immunosuppressive therapy was detected. Antiviral treatment significantly reduced the duration of fever by 0.66 days and lowered the risk of ICU admission, but had no significant benefit on survival. CONCLUSIONS: During the 2009 H1N1 influenza pandemic, elderly or obese patients and those with neurological disease had an increased risk for severe H1N1 infection in Austria. Pregnancy was not associated with a higher risk for severe disease in the later phase of the 2009 H1N1 pandemic. Antiviral treatment provided a minimal effect on the symptoms of influenza but reduced the risk of admission to an ICU.

Auricular acupuncture for postoperative pain after gynecological surgery: a randomized controlled trail.

BACKGROUND: Acupuncture for postoperative pain remains controversial. Potential sources of bias are failures in patient-blinding and therapist-patient interactions. Our study investigates the effects of electrical auricular acupuncture (AA) on postoperative pain in patients undergoing laparoscopy with an emphasis on patient-blinding and the exclusion of therapist-patient interactions. METHODS: With institutional review board approval and written informed consent, we included 40 female patients undergoing laparoscopy. Patients were randomly assigned to receive AA (shen men, thalamus and one segmental organ-specific point) or electrodes only and an electrical stimulation device. All patients received this intervention under general anesthesia guaranteeing patient blinding and excluding therapist-patient interactions. Needles and devices were removed 72 hours postoperatively. Postoperatively, patients received 1,000 mg paracetamol every 6 hours. Additional piritramide was given on demand. A blinded observer obtained the VAS scores at 0, 2, 24, 48, and 72 hours as well as the postoperatively administered doses of piritramide. RESULTS: There was no difference in VAS scores or the consumption of piritramide during the first 72 hours postoperatively between groups (acupuncture versus placebo: 2.32 [1.40-3.25] versus 2.62 [1.89-3.36] average pain on VAS 0-10; 15.3 [12.0-18.6] mg versus 13.9 [10.5-17.3] mg piritramide). Values are expressed as mean [CI]. CONCLUSION: Our study shows no reduction in postoperative pain or an opioid sparing effect of auricular acupuncture in women undergoing laparoscopic procedures. Because we emphasized blinding of the patients and the exclusion of therapist-patient interactions, our study suggests that electrical auricular acupuncture has no effect on postoperative pain.

Influence of cumulative number of marginal donor criteria on primary organ dysfunction in liver recipients.

BACKGROUND: The aim of this cohort study was to assess the cumulative effect of marginal donor criteria on initial graft function and patient survival after liver transplantation. METHODS: We included 734 consecutive patients who underwent orthotopic liver transplantation at the Vienna General Hospital between January 1993 and December 2003. We employed the local registry of the Department of Transplant Surgery, where variables of all patients are routinely and prospectively recorded. Primary outcome was initial graft function, secondary outcome was patient survival. RESULTS: Cumulative number of marginal donor criteria was significantly and linearly associated with an increased rate of primary dysfunction (PDF; p = 0.005). In patients with more than three cumulative marginal donor criteria the rate of PDF was 36%. Patient survival was not influenced by the cumulative number of donor criteria (log-rank test, p = 0.81). Independent marginal donor criteria to predict PDF were cold ischemia time >10 h [odds ratio (OR) 0.56; 95% CI 0.32-0.98] and donor peak serum sodium >155 mEq/L (OR 0.44; 95% CI 0.26-0.77), as assessed in a multivariate regression model. CONCLUSIONS: The use of marginal liver donors with more than three marginal donor criteria shows deleterious effects on initial graft function. Noteworthy, patient survival was not associated with marginal donor criteria, which may be explained by early and successful retransplantation of liver recipients with primary non-function.

Admission for syncope: evaluation, cost and prognosis.

BACKGROUND: Despite extensive in-hospital evaluation the cause of syncope remains unexplained in up to 40% of patients. AIMS: To determine the application and cost of diagnostic tests, cost of hospital stay, success of evaluation and prognosis of patients admitted via the emergency department after syncope. METHODS: A retrospective cohort study including all consecutive patients admitted via the emergency department for evaluation of syncope between 1 January 1994 and 31 December 1998. The findings obtained from clinical history, physical examination and diagnostic tests were reviewed systematically. The costs of specific tests and hospital stay were analysed. Patients were followed until 31 December 1998. RESULTS: 127 patients underwent a median of 4 diagnostic tests (interquartile range, 3 to 6) over 12 days (IQR 8 to 17). The overall median cost of syncope evaluation was 106,728 ATS/7,756 EUR (IQR 70,860 to 143,583 ATS) per patient; the cost of diagnostic tests per patient was 6,863 ATS/499 EUR (IQR 3,345 to 11,969 ATS); hospital maintenance and in-hospital care accounted for the major part of these costs [median 97,680 ATS/7,099 EUR (IQR 65,120 to 138,380 ATS)]. At the time of hospital discharge, syncope remained unexplained in 48 patients (38%). The strength of agreement between the emergency department diagnosis and the discharge diagnosis was moderate (kappa = 0.49, 95% confidence interval 0.36 to 0.61). None of the patients had recurrent syncope or died during the hospital stay. Within the first 30 days after the index event 2 patients (2%) died due to known pre-existing diseases. CONCLUSION: The emergency department diagnosis markedly influenced the work-up of syncope, but not the cost of evaluation. The moderate diagnostic yield, high cost of in-hospital evaluation and good short term prognosis indicate the need for alternative strategies of in-hospital evaluation.