Semih HOT, Nüvit DURAKER, Ayhan SARI, Kenan ÇETİN

The Value of D-Dimer in Diagnosis of Acute Mesenteric Ischemia and Differential Diagnosis from Acute Pancreatitis and Acute Cholecystitis

Objective: Because of its poor prognosis and high mortality rate, early diagnosis of acute mesenteric ischemia (AMI) is a challenge. The value of serum markers in the diagnosis of AMI is limited and the studies related with the D-dimer test carried out in recent years. In this prospective study we investigated the value of the level of plasma D-dimer in the diagnosis of AMI and the differential diagnosis from acute pancreatitis and acute cholecystitis.Methods: We included 89 patients who admitted to our emergency department with abdominal pain. The number and the diagnosis of the patients were 17 AMI, 42 acute pancreatitis and 30 acute cholecystitis, respectively. We measured the levels of plasma D-dimer of all patients by using a latex agglutination ‘immunoassay’ method. Eventually we calculated the sensitivity and specificity of D-dimer test in the diagnosis of AMI.Results: We determined the specificity of the D-dimer test in the differential diagnosis of AMI as 50% from acute pancreatitis, 70% from acute cholecystitis, 58.3% from all the control group and the sensitivity was 100%.Conclusion: The measurement of plasma D-dimer concentration may be useful in the differential diagnosis of AMI from acute pancreatitis and acute cholecystitis. However, to reveal the diagnostic value of D-dimer test more clearly, further studies with larger series are needed, where cut-off value is highly defined, and other patients with acute abdominal pain are added into the control group.Key words: Acute mesenteric ischemia, diagnosis, D-dimer

Anahtar Kelimeler:

Akut mezenterik iskemi, tanı, D-dimer

Determining a Safe Time for Oral Intake Following Pediatric Sedation

Objective: While there are suggestions for oral hydration times after general anesthesia, there is no published study with regard to sedation. The aim of this prospective study was to determine a safe time for oral intake after pediatric sedation and its association with nausea and vomiting after discharge.Methods: A total of 180 children (aged 1 month to 13 years) sedated for magnetic resonance imaging were randomly assigned into three groups. All patients fasted for 6 hours and were allowed to take clear fluids until 2 hours before sedation with thiopental (3 mg/kg). After the patients were transported to the recovery room, we allowed the patients to drink as much clear fluids as they wanted prior to discharge in group I, 1 hour after the patients met the discharge criteria for group II, and 2 hours after the patients met the discharge criteria for group III. All patients were assessed for vomiting in the recovery room until 1 hour after their first oral hydration. The parents were then telephoned the next day and questioned regarding nausea/vomiting and any unanticipated hospital admission.Results: There were no statistically significant intergroup differences with respect to age, sex, weight, or the ASA status. There was no nausea and vomiting in either the recovery or post discharge period in any group. In the telephone questionnaire, no hospital admissions were reported.Conclusion: Oral hydration just before discharge is safe, and fasting children after discharge for a period of time is unnecessary for patients sedated with thiopental.Key words: Sedation, oral intake, postoperative nausea and vomiting

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Kassahun WT, Schulz T, Richter O, Hauss J. Unchanged high
mortality rates from acute occlusive intestinal ischemia: six year review. Langenbecks Arch Surg 2008; 393:163-171.
Yasuhara H. Acute mesenteric ischemia: The challenge of
gastroenterology. Surg Today 2005;35:185-195.
Schneider TA, Longo WE, Ure T, Vernava AM. Mesenteric
ischemia: Acute arterial syndromes. Dis Colon Rectum 1994;37:1163-1174.
Kaleya RN, Boley SJ. Acute mesenteric ischemia. Crit Care Clin 1995;11:479-512.
Brondt LJ, Boley SJ. AGA technical review on intestinal ischemia. American Gastrointestinal Association. Gastroenterology. 2000;118:954-968.
Acosta S, Nilsson T. Current status on plasma biomarkers for acute mesenteric ischemia. J Thromb Thrombolysis 2012;33:355-361.
Acosta S, Nilsson TK, Björck M. D-dimer testing inpatients with suspected acute thromboembolic occlusion of the superior mesenteric artery. Br J Surg 2004;91:991-994.
Block T, Nilsson TK, Björck M, Acosta S. Diagnostic accuracy of plasma biomarkers for intestinal ischemia. Scand J Clin Lab Invest 2008;68:242-248.
Thuijls G, van Wijck K, Grootjans J, et al. Early diagnosis of intestinal ischemia using urinary and plasma fatty acid binding proteins. Ann Surg 2011;253:303-308.
Gündüz A, Türkmen S, Turedi S, et al. Time-dependent variations in ischemia-modified albumin levels in mesenteric ischemia. Acad Emerg Med 2009;16:539-543.
Kanda T, Fujii H, Tani T, et al. Intestinal fatty acid binding protein is a useful diagnostic marker for mesenteric infarction in humans. Gastroenterology 1996;110:339-343.
Acosta S, Nilsson TK, Björck M. Preliminary study of Ddimer as a possible marker of acute bowel ischaemia. Br J Surg 2001;88:385-388.
Akyıldız H, Akcan A, Oztürk A, et al . The correlation of the D-dimer test and biphasic computed tomography with mesenteric computed tomography angiography in the diagnosis of acute mesenteric ischemia. Am J Surg 2009;197:429-433.
Chiu YH, Huang MK, How CK, et al. D-dimer in patients with suspected acute mesenteric ischemia. Am J Emerg Med 2009;27:975-979.
Yücedağ E, Uysal A, Burma O, et al. Comparison of ventilation/
perfusion scintigraphy and multi-detector computerized tomography in diagnosis of asymptomatic pulmonary embolism after deep vein thrombosis. Dicle Med J 2014;41:179-186.
Duman A, Salt Ö, Özkan S, et al. Demographic characteristics
of patients with pulmonary thromboembolism. J Clin Exp Invest 2015;6:10-15.
Adam SS, Key NS, Greenberg CS. D-dimer antigen: current
concepts and future prospects. Blood 2009;113:2878-2887.
Boley SJ, Feinstein FR, Sammartano R, Brandt LJ, Sprayregen
S. New concepts in the management of emboli of the superior mesenteric artery. Surg Gynecol Obstet 1981;153:561-569.
Lobo-Martinez E, Merono CE, Sacco O, Martinez ME. mbolectomy
in mesenteric ischemia. Rev Esp Enferm Dig 1993;83:351-354.
Block T, Acosta S, Björck M. Endovascular and open surgery
for acute occlusion of the superior mesenteric artery. J Vasc Surg 2010;52:959-966.
Björnsson S, Björck M, Block T, et al. Thrombolysis for acute occlusion of the superior mesenteric artery. J Vasc Surg 2011;54:1734-1742.
Acosta S, Alhadad A, Svensson P, Ekberg O. Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg. 2008;95:1245-1251.
Yılmaz S, Topçu F, Şen H.S, et al. Combination of Wells clinical score and high D-dimer levels in the in diagnosis of pulmonary embolism. J Clin Exp Invest 2014;5:557-562.
Acosta S, Björck M. Acute thrombo-embolic occlusion of the superior mesenteric artery: a prospective study in a well-defined population. Eur J Vasc Endovasc Surg 2003;26:179-183.
Kurt Y, Akin ML, Demirbas S, et al. D-dimer in the early diagnosis
of acute mesenteric ischemia secondary to arterial occlusion in rats. Eur Surg Res 2005;37:216-219.
Altınyollar H, Boyabatli M, Berberoğlu U. D-dimer as a marker for early diagnosis of acute mesenteric ischemia. Thromb Res 2006;117:463-467.
Kulacoglu H, Kocaerkek Z, Moran M, et al. Diagnostic value of blood D-dimer level in acute mesenteric ischemia in the rat: an experimental study. Asian J Surg 2005;28:131-135.
Akyıldız H, Sözüer E, Akcan A, et al. The value of D-dimer test in the diagnosis of patients with nontraumatic acute abdomen. Ulus Travma Acil Cerrahi Derg 2010;16:22-26.