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N-terminal prohormone of brain natriuretic peptide: a useful tool for the detection of acute pulmonary artery embolism in post-surgical patients.

Acute pulmonary embolism (APE) is an important clinical problem in patients after major surgery and often remains a difficult diagnosis because of unspecific clinical symptoms. Therefore, we investigated the role of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) for the detection of APE.

METHODS: In 44 patients with suspected APE referred to the intensive care unit after major surgery, serum NT-proBNP, troponin-I, and D-dimers were measured according to the standard hospital protocol. To definitively confirm or exclude APE, all patients underwent an angiographic CT scan of the thorax.

RESULTS: APE was confirmed in 28 and excluded in 16 patients by CT scan. NT-proBNP was significantly (P<0.01) higher in patients with APE [4425 (sd 8826; range 63-35 000) pg ml(-1)] compared with those without [283 (sd 327; range 13-1133) pg ml(-1)]. The sensitivity of the NT-proBNP screening was 93%, specificity 63%, positive predictive value 81%, and negative predictive value 83%. There were no significant (P = 0.96) differences in D-dimers between subjects with and without APE [confirmed APE: 511 (sd 207; range 83-750) μg litre(-1); excluded APE: 509 (sd 170; range 230-750) μg litre(-1)]. Troponin-I levels were not elevated in 32% of the patients with APE.

CONCLUSIONS: D-dimer levels are frequently elevated in post-surgical patients and not applicable for confirmation or exclusion of APE. In contrast, NT-proBNP appears to be a useful biomarker for APE diagnosis in the postoperative setting. In the case of NT-proBNP levels below the upper reference limit, haemodynamically relevant APE is unlikely. Troponin-I in contrast is not considered to be helpful.

Malignant Effusions

Pleuritis, Ascites, PericarditesMalignant effusions (pleurites, ascites and pericardites) are some of the most frequent manifestations of dissemination process of malignant tumors. Accumulation of the malignant fluid in serous cavities results in impairment of respiratory and cardiac functions, however long-term evacuation of the fluid leads to severe disorders of homeostasis that may directly cause the patient’s death.  The ... (Source: Springer Biomedical Sciences titles)

What Are Indications for Allergy Testing?

Discussion When to send a patient to an allergist/immunologist sometimes is very clear such as a patient with angioedema and respiratory problems after an insect sting or contact with latex, but many common problems may need appropriate followup and monitoring before a referral is considered. Allergists are trained to perform and interpret diagnostic information that may not be available to generalists such as specific in vitro testing, skin testing and can perform provocative challenges such as methacholine challenges for asthma. Additionally, an allergist/immunologist makes daily and emergency management plans and gives education to carry out those plans for challenging patients such as those with potential anaphylaxis or immune deficiency. Other treatment modalities available include ...

Objective response rate promising after crizotinib for NSCLC

More than half of the latest evaluated participants from the ongoing phase II PROFILE 1005 trial of crizotinib against ALK-positive advanced non-small-cell lung cancer, achieved an objective tumor response, report researchers. (Source: MedWire News - Respiratory)

The impact of long‐term treatment with low‐dose inhaled corticosteroids on the bone mineral density of Chronic Obstructive Pulmonary Disease patients: Aggravating or Beneficial?

Conclusions:  Long‐term administration of low‐dose inhaled corticosteroids decelerates the annual BMD loss in bronchitic patients, possibly by reducing both pulmonary and systemic chronic inflammation caused by COPD.© 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology (Source: Respirology)

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