Evaluation of prognostic value of selected biochemical markers in surgically treated patients with acute mediastinitis.

BACKGROUND: Monitoring of biochemical markers of inflammation in acute mediastinitis (AM) can be useful in the modification of treatment. This study was a retrospective evaluation of selected biochemical parameters with negative impact on the prognosis in surgically treated patients. MATERIAL/METHODS: There were 44 consecutive patients treated surgically due to AM of differentiated etiology. Selected biochemical markers (WBC, RBC, HGB, HCT, PLT, CRP, PCT, ionogram, protein and albumins) were assessed before surgery and on the 3rd day after surgery. ANOVA was applied to find factors influencing observations. Numerical data [laboratory parameters] were compared by means of medians. RESULTS: The overall hospital mortality rate was 31.82%. In the group of dead patients, there were observed statistically significant lower mean preoperative values of RBC [p=0.0090], HGB [p=0.0286], HCT [p=0.0354], protein [p= 0.0037], albumins [p=0.0003] and sodium [p<0.0001] and elevated values of CRP [P=0.0107] and PCT p<0.0001]. High level of inflammatory markers on day 3 after surgery was found to increase the risk of death - for WBC (by 67%), for CRP (by 88%) and for PCT (by 100%). CONCLUSIONS: Poor prognosis was more frequent in patients with preoperative high levels of CRP, PCT, anemia, hypoproteinemia and hyponatremia. The risk of death increases significantly if in the immediate postoperative period no distinct decrease in WBC count and of the CRP and PCT level is observed. In such a situation the patients should be qualified earlier for broadened diagnostic workup and for reoperation.

[Evaluation of clinical usefulness of selected laboratory markers in the prediction of myocardial infarction in patients under secondary prevention]. / Ocena uzytecznosci klinicznej wybranych wskazników laboratoryjnych w predykcji zawalu miesnia sercowego u chorych objetych prewencja wtórna.

UNLABELLED: The aim of the study was to evaluate the range of chronic inflammation in patients after second or subsequent myocardial infarction, and to compare it with its range in patients after first MI. MATERIAL AND METHODS: C-reactive protein measurement clinical value was examined by high sensitivity CRP method (hsCRP) and compared to clinical value of other heart attack risk factors: total cholesterol (TC) and cholesterol in HDL fraction (HDL-C), triglycerides (TG) and fibrinogen (FBG). The research included 120 patients in two investigated groups: Z2--30 patients undergoing secondary prevention after second (subsequent) heart attack, and Z1--30 patients with first myocardial infarction. There were two reference groups: KOR--30 people undergoing planned coronarography and K--30 healthy individuals. Groups Z2, Z1 and KOR patients were treated with PCI (percutaneous coronary intervention). RESULTS: HsCRP medians for group Z2 (2.65 mg/I) and groups Z, (2.25 mg/) and KOR (2.35 mg/l) were significantly higher than in group K (1.10 mg/dl). CONCLUSIONS: Highest clinical value of hsCRP in coronary attack prediction was confirmed. Relative area under ROC curve (AUC) was highest in group 2, higher than in group Z1 (0.778 and 0.711, respectively). In patients undergoing secondary prevention, group Z2, hsCRP measurement showed higher clinical value in subsequ ent myocardial infarction prediction than in first one. In groups Z2 and Z1, HDL-C measurement also shows high diagnostic value for coronary risk assessment. AUC are 0.875 and 0.782, respectively. However, in treatment with statins, high AUC values do not necessarily reflect myocardial infarction risk.

[Evaluation of dynamic cardiac troponin I concentrations and C-reactive protein in the monitoring of myocardial infarction in patients with repeated myocardial infarction]. / Ocena dynamiki stezen sercowej troponiny I oraz bialka C-reaktywnego w monitorowaniu zawalu miesnia sercowego u chorych z powtórnym zawalem.

UNLABELLED: Significant progress in diagnosis and treatment of heart attack led European Society of Cardiology (ESC) and American College of Cardiology (ACC) to develop in 2007 a document on contemporary criteria for diagnosis of fresh myocardial infarction. In the case of percutaneous coronary intervention (PCI) in patients with initially normal serum concentrations of biomarkers troponin increase above the 99th percentile upper limit of the reference points to the occurrence of myocardial necrosis dislodgement. Conventionally assumed that the increased levels of biomarkers of value in excess of 3 x 99th percentile upper reference requires identification of MI in conjunction with PCI. THE AIM OF THE STUDY: To evaluate the dynamic of troponin concentrations and C-reactive protein in patients with the second or subsequent myocardial infarction undergoing percutaneous coronary intervention (PCI) and comparing the results obtained with the results obtained in patients with first myocardial infarction, in patients undergoing elective coronary angiography and the healthy control group. MATERIAL AND METHODS: The study involved a total of 120 patients who entered in four groups: study group Z2 and three comparative groups: Z1, the NRA and C. Z2 study group consisted of patients admitted to hospital because of second or subsequent myocardial infarction. Z1 group consisted of patients with first myocardial infarction. Patients groups Z2 and Z1 underwent PCI. The group included people the NRA people with a history of previous myocardial infarction, who underwent elective coronary angiography and after noting the time of surgery of coronary arteries was performed in one PCI slot. Control group C consisted of healthy, free from recognized risk factors for heart attack, in which there were no previous episodes of acute heart. Patients groups Z2 and NRA received statins and ASA before hospitalization. The material in patients with suspected myocardial infarction (study group Z2 and Z1 and in the group NRA represented the blood clot, taken on at the time of notification to the patient to the hospital, between 6 and 9 h, in 16 h, 24 and 48 h hospitalization. In the control group C blood samples were taken at one time. In plasma the concentrations of cardiac troponin I (cTnl), and serum CRP. RESULTS: The dynamics of median concentrations of cTnl for the test group Z2 and control group Z1 are comparable. Median concentrations are very close to each other (with the exception of point 1) in any of the measuring points, there was no statistically significant differences. Between 6 and 9 time of infarction in group Z1 median concentrations were significantly higher than in Z2. Significant differences were found between the Z1 and Z2 group and the NRA in all. measuring points, at the time of admission, between 6 and 9 time, the 16th, 24th and 48 time of onset of stroke (point 0, p = 0.027, points 1, 2, 3, and 4 p = 0.0000). The reference group of people from the NRA who previously underwent selective coronary heart attack and surgery PCI, 7 patients were observed a slight increase in troponin I concentrations (usually between the 9th and 24th h hospitalisation), not exceeding three times the value of the decision, which permits the exclusion of myocardial. Median concentrations of CRP in 16 h, 24 and 48 h MI showed significant differences between the group and the NRA Z2 (section 2, p = 0.001, section 3 and 4--p < 0.001) and between the group and the NRA Z1 (section 2, p = 0.028, section 3 and 4--p < 0.001). Median values in the group Z2 versus Z1 showed similar dynamics in the time points 0, 1, 2 and 3. Higher median values in the fourth time point were observed in the group Z2. Median CRP at the time of admission to hospital was the highest in the group Z2 (2.65 mg/l), and reference groups Z1 and NRA was 2.25 mg/l and 2.35 mg/l. Median CRP in the groups Z2, Z1 and CRV were significantly higher against the group C (1.20 mg/l). In group C the lowest percentage observed in the results of CRP >3 mg/l (indicating the risk of ACS) of 16.7%. In the other groups this proportion was 30-40% and was highest in the group Z2. CONCLUSIONS: The concentration of cardiac troponin I in the first hours of the course of myocardial infarction (between 6 and 9 h) in patients who have made a second heart attack tends to lower its growth levels compared to people with first MI. It can be assumed that the myocardial inflammatory response to repeated defense system reduces the area of necrosis and less ejection from the troponin myocardial cells. In patients who underwent myocardial infarction in the past and were subjected to selective coronary angiography, and its treatment by PCI, troponin I, did not exceed three times the 99th percentile of the healthy population, suggesting that the proper emergency procedures cardiac surgeons performing PCI.

[Selected laboratory risk factors for cardiovascular diseases in a group of healthy professionally active policemen in the Lodz region]. / Badania wybranych laboratoryjnych czynników ryzyka chorób sercowo-naczyniowych u zdrowych czynnych zawodowo policjantów województwa lódzkiego.

The aim of the study was to estimate cardiovascular diseases risk based on the concentration of total blood cholesterol, HDL-cholesterol, triglycerides, glucose, C-reactive protein determined by high sensitivity assay and platelet count. The study was carried out in a group of healthy professionally active policemen in the Lodz region. The significant factors of atherosclerosis are: life style including diet and physical activity. Policeman profession requires a greater physical activity and good physical condition. The study group consisted of 836 policemen aged 31-63 years, mean 43,5 +/- 4,9 years. The mean value of total cholesterol was 217,7 mg/dl (69% > 200 mg/dl), cholesterol HDL--53,6 mg/dl (8% < 40 mg/dl), TG--168,8 mg/dl (47% > 150 mg/dl), CRP--1,95 mg/l (median 1,30 mg/l), 19,3% > 3 mg/l, a 7,4% > 5 mg/l, glucose--92,6 mg/dl (median 91 mg/dl), 7,2% > or = 110 mg/dl, a 20% > or = 100 mg/dl. The platelet count was 245,8 (median 244 x 103/microl), 99% < 350 x 103/microl. The concentration of lipids parameters is similar both for population of Lodz region and another population. In respect to proper values of the total cholesterol and HDL-cholesterol observed for Polish population including Lodz, the number of people with abnormal values is lower. The contrary tendency concerns to triglycerides.

[Assessment of malonyldialdehyde concentration as a product of lipid peroxidation and lipid metabolism in patients on chronic dialysis]. / Ocena stezenia malonylodialdehydu jako produktu peroksydacji lipidów a gospodarka lipidowa u chorych przewlekle dializowanych.

UNLABELLED: Chronic hemodialysis in patients with renal insufficiency is a factor significantly intensifying oxidative stress, resulting in increased lipid and lipoprotein peroxidation. It intensifies atherosclerotic activity. Malonyldialdehyde (MDA) concentration in serum, and isolated fraction of low density lipoprotein is indicators of lipid peroxidation intensification and therefore arteriosclerosis development. THE AIM OF THE STUDY: Assessment of MDA concentration as a product of lipid peroxidation and lipid metabolism in patients on chronic dialysis. MATERIALS AND METHODS: The study included 48 dialyzed patients, age 22-68 undergoing chronic dialysis for, on average, 56 months. On account of dialysis period the patients were included into 3 subgroups: group 1 (n = 17) dialysis period 2 years, group 2 (n = 13) dialysis period 2-5 years and group 3 (n = 18) dialysis period longer than 5 years. Control group consisted of 30 healthy subjects. We assessed: malonyldialdehyde in serum and isolated fraction of low density lipids (LDL) and high density lipid (HDL) and cholesterol (CH) and triglycerides (TG), phospholipids (PL) in serum and isolated lipoprotein fractions. RESULTS: Significantly decreased levels of HDL, LDL fractions and increased triglicerides and elevated levels of MDA in serum and isolated LDL fraction were found in patients on chronic dialysis in comparison to control group (p < 0.05). CONCLUSION: Our results indicate apparent normalization of lipid metabolism in patients on chronic dialysis and suggest that MDA assessment is better marker for arteriosclerosis risk estimation in long-term dialyzed patients.

[Does the assay of acute phase protein concentrations in cerebrospinal fluid and/or in serum in patient with viral meningitis have a diagnostic value? Part II. Lymphocytic meningitis caused by echo 30 virus]. / Czy oznaczanie stezen bialek ostrej fazy w plynie mózgowo-rdzeniowym lub/i w surowicy w wirusowym zapaleniu opon mózgowo-rdzeniowych u dzieci ma znaczenie diagnostyczne? Czessc II. Limfocytarne zapalenie opon mózgowo-rdzeniowych wywolane wirusem ECHO 30.

The aim of the study was to evaluate dynamics of selected acute phase proteins in serum and cerebrospinal fluid (CSF) in children with viral meningitis and to assess diagnostic power of protein determination for detection and treatment monitoring. 51 children with viral meningitis caused by ECHO 30 virus were included in the study group. Concentration of C-reactive protein (CRP), alpha 1-antitrypsin (AAT), alpha1-acid glycoprotein (AAG), alpha2-haptoglobin (HPT) and C3 complement fragment were determined in serum and CSF at entry and at day 14 after admittance to hospital. Control group for serum determination consisted in 30 healthy children (Group K1) and control group for CSF determination consisted in 19 hospitalized children in whom the diagnosis of meningitis was not confirmed (group K2). The greatest rise of acute phase proteins concentration was observed in children in case of HPT, AAG and C3 complement when determined in serum. Meningitis in children that was caused by ECHO 30 virus produces slight acute phase reaction that is more evident in serum than in CSF. It is confirmed by remarkable increase of AAG, HPT, C3 complement in serum and HPT in CSF either at entry or at the day 14. The determination of AAG, HPT and C3 complement in serum have diagnostic power that is strong enough to meningitis diagnostics and monitoring of treatment.

[Does the estimation of acute phase protein concentrations in cerebrospinal fluid and/or in serum in patients with viral meningitis carry diagnostic importance? Part I. Lymphocytic meningitis caused by epidemic parotitis]. / Czy oznaczanie stezen bialek ostrej fazy w plynie mózgowo-rdzeniowym lub/i w surowicy w wirusowym zapaleniu opon mózgowo-rdzeniowych u dzieci ma znaczenie diagnostyczne? Czesc I. Limfocytarne zapalenie opon mózgowo-rdzeniowych wywolane wirusem nagminnego zapalenia przyusznic.

OBJECTIVE: We examined whether an acute phase reaction could occur in children with lymphocytic meningitis of homogeneous etiology (parotitis epidemic from the Paramyxoviridae family), a sign of which would be an increase in concentrations of acute phase proteins (APP's) in cerebrospinal fluid (CSF) and/or in blood serum. We also tested the usefulness of the determination of selected APP's concentrations in CSF and serum in diagnosis and monitoring of the course of the disease, provided that an increase in concentrations of selected APP's were discernible. METHODS: Cases were 78 children with lymphocytic meningitis as a complication of parotitis epidemic. Controls were 30 healthy children (control group K1) and 19 children hospitalized with suspected meningitis (control group K2). The following APP's presence in CSF and serum were tested: C-reactive protein (CRP), alpha-2-haptoglobin (HPT), alpha-1-antitripsin (AAT) and alpha-1-acid glycoprotein (AAG), alpha-2-ceruloplasmin (CER) and alpha-2-macroglobulin (AMG). The results were compared and analyzed. RESULTS: The results of the research show a significant increase in all APP's determined, except for CRP and AAG, in children with parotidal meningitis. CONCLUSIONS: Determination of CRP concentration either in CSF or in serum is not useful in diagnosis of parotidal meningitis and in differentiation of lymphocytic and bacterial forms of the disease.