Fiona Myint

The effect of short-term treatment with simvastatin on renal function in patients with peripheral arterial disease

The objective of this study was to investigate the effects of lipid-lowering treatment on renal function in patients with peripheral arterial disease (PAD). This was a retrospective study of hyperlipidemic claudicants referred to a vascular surgery and risk modification clinic. Serum creatinine and urate concentrations and the fasting lipid profile were measured pretreatment and after 3-4 months of treatment with 20 mg/day simvastatin. In 103 consecutive patients with PAD (57 men; 46 women), median age 67 years (range: 51 to 83) there was a significant decrease in serum creatinine from a mean (SD) of 87 (12) μmol/L pretreatment to 84 (12) μmol/L post-treatment (p<0.0001). This difference was more marked in the tertile of patients with the highest baseline creatinine levels. There was also a significant reduction in serum urate from 0.37 (0.07) mmol/L to 0.35 (0.07) mmol/L (p<0.0001). Both these effects were independent of the degree of total cholesterol (TC) or low-density lipoprotein (LDL) cholesterol reduction. There was a significant reduction in TC from 6.6 (1.0) to 5.2 (0.8) mmol/L and LDL cholesterol from 4.3 (1.0) to 2.8 (0.7) mmol/L; both p<0.0001. Significant improvement also occurred in the high-density lipoprotein cholesterol and triglyceride levels. Cholesterol lowering with simvas tatin 20 mg/day improved indices of renal function after 3-4 months of treatment in hyper lipidemic patients with PAD. Further studies are needed to establish and define the clinical relevance of these findings, especially in patients with different degrees of renal failure.

Recurrent Laryngeal Nerve Injury: A Complication of Central Venous Catheterization A Case Report

This case report highlights the emergence of new complications associated with old procedures as the frequency of their use increases. A 29-year-old man with aplastic anemia was admitted for a bone marrow transplant. Before this procedure, a Hickman line was inserted. This was followed by hoarseness of voice. An examination revealed an immobile left vocal cord. Further investigations did not show any cause for this complication. Therefore, the hoarseness and vocal cord paralysis was attributed to trauma associated with the insertion of the Hickman line.

Migration of superior vena cava stent

There has been a recent increase in the use of endovascular prostheses resulting in complex surgical and interventional complications not previously recognised. We report a case of Superior vena cava stenosis treated with a wallstent which migrated to the right atrium, necessitating a combined radiological and surgical approach to retrieve it.