The effect of anesthesia method on serum level of pro-brain natriuretic Peptide in patients undergoing orthopedic surgery.

BACKGROUND: Surgical stress response is among the most severe stress tolerated by the patient, which needs suppression by anesthesia. OBJECTIVES: We assessed the effect of three methods of anesthesia on postoperative levels of pro-brain natriuretic peptide (pro-BNP) to determine the most effective one in preventing surgical stress response. PATIENTS AND METHODS: In a randomized clinical trial, 120 patients who were 18 to 65 years old and met inclusion and exclusion criteria were selected and randomly allocated to three groups of 40:Group A, general anesthesia plus epidural catheter; Group B, general anesthesia and intravenous patient-controlled analgesia; and Group C, spinal anesthesia plus intravenous patient-controlled analgesia. RESULTS: There was no difference between three groups for basic characteristics and variables and baseline pro-BNP levels; however, postoperative pro-BNP levels in Groups A, B, and C were respectively63.8 ± 10.1, 83.2 ± 12.3, and 51.5 ± 8.5 ng/L (ANOVA, P = 0.01). CONCLUSIONS: The results of the current study suggested that spinal anesthesia plus intravenous patient-controlled analgesia have the most favorable cardiac effects regarding postoperative levels of pro-BNP.

Skull mass as the first manifestation of recurrent multiple myeloma in a renal transplant patient.

BACKGROUND: Although there are a few reports of recurrence of multiple myeloma in the transplanted kidney, recurrence of multiple myeloma (MM) presenting, as an isolated lesion in the brain, has been reported rarely. CASE REPORT: Here we present a 60-year-old woman who underwent a kidney transplantation following a rise in her BUN and creatinine, having shown advanced tubulo-interstitial nephritis in her native kidney microscopic biopsy examination. Two years following her renal transplantation, she presented with a skull mass which was regarded as a possible meningioma. A biopsy of her transplanted kidney was performed due to her constantly raised BUN/Cr which revealed "Myeloma cast nephropathy". CONCLUSION: We describe an unusual presentation of recurrent multiple myeloma, as a brain mass mimicking meningioma and simultaneously in the transplanted kidney, and discuss the differential diagnosis of the patient's primary disease.