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Biochemical markers of cerebrospinal ischemia after repair of aneurysms of the descending and thoracoabdominal aorta.

AbstractOBJECTIVE:
To investigate the clinical potential of several markers of spinal cord ischemia in cerebrospinal fluid (CSF) and serum during aneurysm repair of the descending thoracic or thoracoabdominal aorta.
DESIGN:
Observational study of consecutive patients. Nonblinded, nonrandomized.
SETTING:
University hospital thoracic surgical unit.
PARTICIPANTS:
Eleven consecutive elective patients.
INTERVENTIONS:
Distal extracorporeal circulation and maintenance of CSF pressure <10 mmHg until intrathecal catheter removal.
MEASUREMENTS AND MAIN RESULTS:
CSF and serum levels of S100B (and its isoforms S100A1B and S100BB), neuronal-specific enolase (NSE), and the CSF levels of glial fibrillary acidic protein (GFAp) and lactate were determined. Two patients had postoperative neurologic deficit. One with a stroke showed a 540-fold increased GFAp, a 6-fold NSE, and S100B increase in CSF. One with paraplegia had a 270-fold increase in GFAp, a 2-fold increase in NSE, and 5-fold increased S100B in CSF. One patient without deficit increased GFAp 10-fold, NSE 4-fold, and S100B 23-fold in CSF. CSF lactate increased >50% in 6 of 9 patients without neurologic deficit. Serum S100B increased within 1 hour of surgery in all patients without any concomitant increase in CSF. S100A1B was about 70% of total S100B in both serum and CSF in patients with or without neurologic defects. S100B in CSF increased 3-fold in 3 of 9 asymptomatic patients.
CONCLUSIONS:
In patients with neurologic deficit, GFAp in CSF showed the most pronounced increase. Biochemical markers in CSF may increase without neurologic symptoms. There is a significant increase in serum S100B from surgical trauma alone without any increase in CSF.
AuthorsRussell E Anderson, Anders Winnerkvist, Lars-Olof Hansson, Olle Nilsson, Lars Rosengren, Göran Settergren, Jarle Vaage
JournalJournal of cardiothoracic and vascular anesthesia (J Cardiothorac Vasc Anesth) Vol. 17 Issue 5 Pg. 598-603 (Oct 2003) ISSN: 1053-0770 [Print] United States
PMID14579213 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Biomarkers
  • Glial Fibrillary Acidic Protein
  • Nerve Growth Factors
  • S100 Calcium Binding Protein beta Subunit
  • S100 Proteins
  • S100B protein, human
  • Lactic Acid
  • Phosphopyruvate Hydratase
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • Aortic Aneurysm, Abdominal (blood, cerebrospinal fluid, surgery)
  • Aortic Aneurysm, Thoracic (blood, cerebrospinal fluid, surgery)
  • Biomarkers (blood, cerebrospinal fluid)
  • Cerebrospinal Fluid (chemistry, metabolism)
  • Elective Surgical Procedures
  • Female
  • Glial Fibrillary Acidic Protein (blood, cerebrospinal fluid)
  • Humans
  • Lactic Acid (blood, cerebrospinal fluid)
  • Male
  • Middle Aged
  • Nerve Growth Factors (blood, cerebrospinal fluid)
  • Paraplegia (blood, cerebrospinal fluid, etiology)
  • Phosphopyruvate Hydratase (blood, cerebrospinal fluid)
  • Postoperative Complications (blood, cerebrospinal fluid, etiology)
  • Reoperation
  • S100 Calcium Binding Protein beta Subunit
  • S100 Proteins (blood, cerebrospinal fluid)
  • Severity of Illness Index
  • Spinal Cord Ischemia (blood, cerebrospinal fluid, etiology)
  • Statistics as Topic
  • Stroke (blood, cerebrospinal fluid, surgery)
  • Time Factors
  • Treatment Outcome

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