NT-proBNP for prognostic and diagnostic evaluation in patients with acute coronary syndromes.

BACKGROUND AND AIM: N terminal-proB-type natriuretic peptide (NT-proBNP) is synthesised and secreted from the ventricular myocardium. This marker is known to be elevated in patients with acute coronary syndromes (ACS). We evaluated NT-proBNP asa significant diagnostic marker and an important independent predictor of short-term mortality (one month) in patients with ACS. METHODS: NT-proBNP and cardiac troponin I (cTI) were assessed in 134 consecutive patients (median age 66 years, 73% male)hospitalised for ACS in a cardiological university department. The patients were classified into ST-elevation ACS (STE-ACS, n = 74) and non-ST-elevation ACS (NSTE-ACS, n = 60) groups based on the ECG findings on admission. Patients with Killip class ≥ II were excluded. RESULTS: The serum level of NT-proBNP on admission was significantly higher (p < 0.0005), while there was no difference in cTI serum level in the NSTE-ACS patients compared to STE-ACS patients. There was a significant positive correlation between NT-proBNP and cTI in the NSTE-ACS (r = 0.338, p = 0.008) and STE-ACS (r = 0.441, p < 0.0005) patients. There was a significant difference in NT-proBNP (p < 0.0005) and cTI (p < 0.0005) serum level between ACS patients who died within 30 days or who survived after one month. The increased NT-proBNP level is the strongest predictor of mortality in ACS patients, also NT-proBNP cut-point level of 1,490 pg/mL is a significant independent predictor of mortality. CONCLUSIONS: We demonstrated the differences and the correlation in the secretion of NT-proBNP and cTI in patients with STE-ACS vs. NSTE-ACS. Our results provide evidence that NT-proBNP is a significant diagnostic marker and an important independent predictor of short-term mortality in patients with ACS.

[Term pregnancy after minimally invasive surgical treatment of Herlyn-Werner-Wunderlich syndrome].

INTRODUCTION: Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis represents a complex congenital anomaly, also known in the literature as Herlyn-Werner-Wunderlich (HWW) syndrome. CASE OUTLINE: A 16-year-old patient presented with secondary amenorrhoea and abdominal pain. Her history revealed anorexia nervosa; she had menarche at the age of 14; her menstrual cycles were regular, with progressive dysmenorrhoea. Nine months after the explorative laparotomy performed at the regional healthcare center there was no a definitive diagnosis. Pelvic examination showed a paravaginal pelvic mass located on the right side. Magnetic resonance imaging of the abdomen and pelvis confirmed the diagnosis of HWW syndrome. Transvaginal excision and marsupialisation of the vaginal septum were performed. Regular menstrual cycles were resumed after four years following the treatment of anorexia nervosa. Twelve years after the operation, the patient conceived spontaneously; pregnancy developed in the left non-obstructed uterus. She underwent Cesarean section at the 37th gestational week and gave birth to a healthy female infant. CONCLUSION: HWW syndrome is an uncommon cause of abdominal pain and progressive menstrual discomfort shortly after menarche. It is therefore essential to maintain a high index of suspicion of the existence of this syndrome in such cases, since prompt and adequate treatment prevents the development of complications and allows for preservation of the reproductive potential of both hemi-uteri.

[Metastatic brain tumour in pregnancy: a case report].

INTRODUCTION: Malignant tumours of the central nervous system in pregnancy are rare and are most frequently diagnosed in the second part of pregnancy. Of all malignant tumours which may occur in pregnancy, intracranial tumours bear the highest risk of maternal and foetal morbidity and mortality. CASE OUTLINE: A 29-year-old primipara was admitted to our hospital as an emergency in the twenty-ninth week of pregnancy due to headache, right eye sight disorders (double vision), nausea and vomiting. The patient had a total thyroidectomy and a dissection of lymph glands of the neck at the age of seven years due to papillary carcinoma of the thyroid glands. The clinical and sonographic test revealed regular foetal growth and morphology. The MRI showed expansive changes in the brain parenchyma corresponding to metastatic lesion with the subtentorial herniation of the uncus of the hippocampus by compressive effect onto the right cerebral peduncle of the mesencephalon. Emergent neurosurgical intervention was indicated. Having in mind the age at pregnancy, it was decided to perform a caesarean operation. Alive female child was born weighing 1,370 grams. The post-operative procedure was normal. The patient was transferred to the neurosurgery department on the first post-operative day, where she underwent emergent surgery. Immunohistochemistry confirmed the metastatic tumour originating from the primary papillary adenocarcinoma of the thyroid gland. CONCLUSION: Neurosurgical diseases in pregnancy simultaneously jeopardize two lives and represent both medical and ethical problem. Upon confirming the presence of intracranial malignancy in pregnancy, further procedure is very individual and it implies cooperation of gynaecologists, neurologists, neurosurgeons, oncologists, anaesthesiologists and neonatologists.

["Basics of delivery" by Dr Miladin Velickovic, the first text-book on obstetrics in our country].

INTRODUCTION: In order to establish the School of Medicine in Belgrade it was necessary, among other things, to prepare textbooks for undergraduate studies in Serbian language. Considering the gynaecology and obstetrics in general, it is interesting to mention that the manuscript "Basics of delivery", which may be considered the first textbook of obstetrics in our country, was prepared to be published in 1925 by Dr. Miladin Velickovic, a Head of Gynaecology Department of the State Hospital in Novi Sad. that is, the author who had never been engaged in teaching activities. BOOK REVIEW AND DISCUSSION: This text of 502 pages and 220 pictures encompassed the teaching material in obstetrics and basics of neonatology in such a way that it fulfilled the void in this kind of literature in our milieu. Three years later, Dr. Velickovic had his book "Gynaecological haemorrhages and menstrual disorders" published, which was meant to assist medical students to study gynaecology more comprehensively. Dr. Velickovic was inspired to write this text by emotional reasons as well. Namely since he had been granted the scholarship by baroness 'Eufemija Jovic' Fund, he was sent to study medicine in Budapest. Without sufficient knowledge of Hungarian, he realized the importance of having the textbooks for medical students in their native language, and therefore, he did his best to achieve this vision. CONCLUSION: This paper includes the review of book, "Basics of delivery", which may be considered the first textbook of obstetrics in our country, as well as biographical data of Dr. Velickovic, whose personality has been gradually falling into oblivion.