119 research outputs found
Cystatin C, a marker for successful aging and glomerular filtration rate, is not influenced by inflammation
Abstract Background. The plasma level of cystatin C is a better marker than plasma creatinine for successful aging. It has been assumed that the advantage of cystatin C is not only due to it being a better marker for glomerular filtration rate (GFR) than creatinine, but also because an inflammatory state of a patient induces a raised cystatin C level. However, the observations of an association between cystatin C level and inflammation stem from large cohort studies. The present work concerns the cystatin C levels and degree of inflammation in longitudinal studies of individual subjects without inflammation, who undergo elective surgery. Methods. Cystatin C, creatinine, and the inflammatory markers CRP, serum amyloid A (SAA), haptoglobin and orosomucoid were measured in plasma samples from 35 patients the day before elective surgery and subsequently during seven consecutive days. Results. Twenty patients had CRP-levels below 1 mg/L before surgery and low levels of the additional inflammatory markers. Surgery caused marked inflammation with high peak values of CRP and SAA on the second day after the operation. The cystatin C level did not change significantly during the observation period and did not correlate significantly with the level of any of the four inflammatory markers. The creatinine level was significantly reduced on the first postoperative day but reached the preoperative level towards the end of the observation period. Conclusion. The inflammatory status of a patient does not influence the role of cystatin C as a marker of successful aging, nor of GFR
Reference values for serum creatinine in children younger than 1 year of age
Reliable reference values of enzymatically assayed serum creatinine categorized in small age intervals are lacking in young children. The aim of this study was to determine reference values for serum creatinine during the first year of life and study the influence of gender, weight and height on these values. Serum creatinine determinations between 2003 and 2008 were retrieved from the hospital database. Strict exclusion criteria ensured the selection of patients without kidney damage. Correlation analysis was performed to evaluate the relation between height, weight and serum creatinine; the Mann–Whitney test was used to evaluate the relation between gender and serum creatinine. A broken stick model was designed to predict normal serum creatinine values. Mean serum creatinine values were found to decrease rapidly from 55 μmol/L on day 1 to 22 μmol/L in the second month of life; they then stabilized at 20 μmol/L until the seventh month, followed by a slight increase. No significant relation was found between serum creatinine and gender, weight and height. We present here reference values of serum creatinine in infants not at risk of decreased renal function. The absence of a relationship with gender, weight and height confirms that height-based equations to estimate glomerular filtration rate are less useful in patients of this age group
Recent Innovations & Daily Problems. A new prosthesis in inguinal hernia repair:preliminary results of a pilot study.
Introduction: Elective surgery for inguinal hernia is affected by very
low mortality « 1 per 10000 operation); in contrast, when surgery
is carried out for complicated inguinal hernia, risks of postoperative
complication are higher. TAPP is a world-wide accepted surgical practice
in the treatment of elective bilateral or recurrent inguinal hernia,
above all in young patients. Few exploratory studies were published on
laparoscopic approach in the treatment of urgent complicated inguinal
hernia. Aim of this study was to analyze feasibility (operative time,
conversion rate), safety (postoperative morbidity, length of hospital
stay) and quality of life (acute and chronic pain, return to work) of
trans-abdominal pre-peritoneal laparoscopic hernia repair in acute
incarcerated inguinal hernia. Rationale of laparoscopic trans-abdominal
approach is the easier hernia reduction under vision and a better
exploration of the abdominal cavity.
Methods: from September 2012 to September 2013, 15 consecutive
patients admitted in emergency at the Division of General Surgery of
University "Sapienza", Polo Pontino, for acute incarcerated inguinal
hernia were submitted to TAPP using 3 trocars (1 of 10 mm and 2 of
5mm) and polyester prosthesis fixed by fibrin glue. Exclusion criteria
for laparoscopic approach were age III, previous
abdominal surgery, signs of strangulated hernia. All of them were
evaluated for operative time, conversion rate, postoperative morbidity,
organ resection or other surgery required. All patients were scored for
pain by Visual Analogic Scale (VAS) during postoperative in hospital
stay at 7 days, 1,6 and 12 months after surgery.
Results: median follow-up was 16 months and 12 as minimum. In all
cases reduction of hernia was always possible and none conversion
to open surgery was recorded, median operative time was 89 minutes
(55-137 as range), omental resection was carried out in one patient
(6,6%), no other organ resections needed, whereas contralateral hernia
was diagnosed and repaired at the same time in 4 patients (26,6%). No
major complications were observed, median blood loss was 100 ml,
minor morbidity was contained to 18% represented by fever and
wound infection of surgical umbilical scar. Median in hospital stay
was 1,5 days with 1-5 days as range. Postoperative median acute pain,
measured by visual analogic scale (VAS), was 2 (range:0-4), none
patient referred any pain during follow-up. Median time of return to
work was 6,5 days, ranged between 3 to 15 days. Patients' compliance
to treatment and to follow-up was complete as well their satisfaction. Conclusions: In centres skilled for laparoscopy in emergency, TAPP
could be considered a feasible and safe technique. In well-selected
patients (especially if emolled in controlled clinical trial) TAPP could
represent an alternative surgical approach for complicated incarcerated inguinal hernia to conventional open surgery even in urgency. The
main advantages of laparoscopic approach are the ability to perform
surgical hernia reduction under vision, a better exploration and evaluation
of abdominal cavity and diagnosis and treatment of eventual
contralateral defect of wall, otherwise often missed. Finally, the good
control of acute and chronic pain, faster return to normal activity and
work, better aesthetic results contributed to total satisfaction and compliance
of the patients
Dosing adjustment and renal function: Which equation(s)?
Le choix de la formule d’estimation du de´ bit de filtration glomérulaire (DFG) a` utiliser pour l’adaptation posologique fait encore de´ bat, principalement entre la formule de Cockcroft et les équations plus récentes, MDRD (pour Modified Diet in Renal Disease) et CKD-EPI (pour Chronic Kidney Disease Epidemiology). Les arguments mis en avant en faveur de l’utilisation de la formule de Cockcroft sont : qu’elle a été préférentiellement utilisée pour décider des adaptations posologiques avant la mise sur le marché des médicaments, qu’elle permettrait une meilleure prédiction du risque de survenue des effets indésirables a` l’accumulation des médicaments, qu’elle permettrait de limiter le surdosage médicamenteux chez la personne âgée. Dans cet article d’opinion, nous discutons les faiblesses de
l’argumentaire des partisans du maintien de l’utilisation de la formule de Cockcroft dans le contexte de l’adaptation posologique, ainsi que les limites et le manque de fiabilité de cette formule. Nous soutenons la recommandation de la Haute Autorité de sante´ (HAS) sur l’utilisation systématique, en 2015, de l’équation CKD-EPI pour l’estimation du DFG. Lorsque le DFG est e´ value´ dans le but d’adapter la posologie d’un médicament, la désindexation de la surface corporelle est préférable. Compte tenu des difficultés d’estimation du DFG chez la personne âgée et chez les individus a` gabarit hors norme, nous
recommandons d’utiliser en priorité dans ces populations, des médicaments pour lesquels un suivi pharmacologique est disponible, ou d’avoir recours à une méthode de référence de mesure du DFG
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