Cutoff value of serum procalcitonin as a diagnostic biomarker of infection in end-stage renal disease patients.

BACKGROUND/AIMS: Serum procalcitonin (PCT) levels are low in healthy individuals but are elevated in patients with a serious bacterial infection or sepsis. In this study, we examined the ability of serum PCT concentration to diagnose infections in end-stage renal disease (ESRD) patients, and sought to determine an appropriate threshold level. METHODS: Serum PCT levels were measured in ESRD patients on antibiotic therapy for a suspected bacterial infection (ESRD infection [iESRD] group, n = 21), and compared with those of ESRD patients on hemodialysis with no sign of infection (ESRD control [cESRD] group, n = 20). RESULTS: The mean serum PCT concentration of the iESRD group was significantly higher than in the cESRD group (2.95 ± 3.67 ng/mL vs. 0.50 ± 0.49 ng/mL, p = 0.006), but serum PCT concentrations did not correlate with severity of infection. The optimized threshold level derived for serum PCT was 0.75 ng/mL, rather than the currently used 0.5 ng/mL; this threshold demonstrated a sensitivity and specificity of 76.2% and 80.0% for infection and 100% and 60.6% for systemic inflammatory response syndrome, respectively, compared with the cutoff of 0.5 ng/mL. CONCLUSIONS: This study suggests that serum PCT at a cutoff value of 0.75 ng/mL is an appropriate indicator of infection in ESRD patients.

Relationship between Serum N-Terminal Pro-Brain Natriuretic Peptide Level and Left Ventricular Dysfunction and Extracellular Water in Continuous Ambulatory Peritoneal Dialysis Patients.

This study inquired the relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and left ventricular (LV) dysfunction and extracellular water in continuous ambulatory peritoneal dialysis (CAPD) patients. We conducted a cross-sectional study of 30 CAPD patients. Each patient was admitted to the department of internal medicine, Chosun University Hospital between February and October, 2006. Echocardiography was performed using HDI 5000, allowing M-mode, two-dimensional measurement. A multifrequency bioimpedance analyzer was used; extracellular water was calculated as a percentage of total body water and was understood as the index of volume load of CAPD patients. The mean age was 47±12 years. Underlying causes of renal failure were 14 with diabetes mellitus, 7 with hypertension, and 9 with chronic glomerulonephritis. The mean serum NT-proBNP level was 14236.56 (83-35,000) pg/mL. LV mass index and LV ejection fraction were 151.67±42.5 g/m(2) and 57.48±12.9%, respectively. The mean extracellular water was 35.97±1.04%. Serum NT-proBNP levels correlated positively with LV mass index (r=0.768, p=0.01) and extracellular water (r=0.866, p=0.01) and negatively with LV ejection fraction (r=-0.808, p=0.01). Serum NT-proBNP levels significantly correlated with LV mass index, LV ejection fraction, and extracellular water. Therefore, serum NT-proBNP levels can be a clinical predictive marker for LV hypertrophy, LV dysfunction, and volume status in CAPD patients.

Intradural lumbar disc herniation--is it predictable preoperatively? A report of two cases.

BACKGROUND CONTEXT: Intradural disc herniations are thought to be rare events, and there have been relatively few literature reports of intradural disc herniations available with regard to magnetic resonance imaging findings. PURPOSE: The authors describe two patients with intradural lumbar disc herniations, one with and one without preoperative diagnosis, who had different postoperative outcomes. STUDY DESIGN: Case study METHODS: The first patient underwent an extended L3 subtotal laminectomy followed by bilateral medial facetectomy and foraminotomy at L3-L4. A durotomy uncovered large disc fragments comprised of friable disc materials and end plates, after no clear disc herniation was found in the epidural space. The second patient underwent anterior lumbar interbody fusion after a preoperative diagnosis of intradural disc herniation. RESULTS: The first patient experienced a marked reduction of pain and progressive recovery of sensory disturbance, but neurologic examination showed right foot drop postoperatively. Two years after surgery, she can not walk without a cane because the neurologic deficit of the right ankle has shown no improvement. Two days after surgery, the second patient was allowed to ambulate with a lumbar orthosis. Neurologic examination showed no motor deficit. Twenty-one months after surgery, the patient reports minimal back pain when sitting on a chair for prolonged periods of time. CONCLUSION: Our cases highlight the importance of preoperative diagnosis in the treatment of intradural lumbar disc herniations. The potential presence of an intradural disc herniation must always be considered preoperatively on a patient whose magnetic resonance imaging study demonstrates the "hawk-beak sign" on axial imaging as well as abrupt loss of continuity of the posterior longitudinal ligament (PLL). This association results in an adequate surgical approach, thereby reducing the chance of postoperative neurologic deficit. Finally, anterior lumbar interbody fusion can be a reasonable alternative in the treatment of intradural lumbar disc herniations.

Risk factors of developing new symptomatic vertebral compression fractures after percutaneous vertebroplasty in osteoporotic patients.

Percutaneous vertebroplasty (PVP) is an efficient procedure to treat pain due to osteoporotic vertebral compression fractures (OVCFs). However, some patient populations experience recurrent vertebral fracture after initial successful procedure. There are a lot of literatures about the effectiveness of this procedure but few concerning the development of recurrent, new compression fracture. This is a retrospective review of all PVPs performed in author's institution from September 1999 to December 2001 to investigate the factors related to the development of new symptomatic OVCFs after PVPs. A retrospective review of 244 cases of PVP for symptomatic OVCFs at 382 levels was performed. Sociodemographic, clinical, radiologic, and procedural data were analyzed and compared between the two patient groups (control group : no further symptomatic OVCFs after the initial PVP, "new symptomatic fracture" group: with newly developed symptomatic OVCF). Statistical analysis was performed between the variables of the two groups. Survival analysis was performed using the Kaplan-Meier method. Over all, 38 among 244 treated patients (15.6%) had experienced newly developed symptomatic OVCF(s) during the follow up period (mean 52.5 months). Old age and the presence of multiple treated vertebrae at the initial PVP were assessed as a strong parameter for predicting new symptomatic OVCF. With increasing preoperative wedging deformity the risk of developing new symptomatic OVCF decreased. The Kaplan-Meier estimate of the 1 year fracture-free rate was 92.2%. The Kaplan-Meier curve showed that 7.8% of the patients would experience new symptomatic OVCF within 1 year after initial PVP. A preoperative only mild wedge deformity of the fractured vertebra(e) could indicate the increased risk of developing new symptomatic OVCF after vertebroplasty.