Is D‐dimer a Predictor of Strangulated Intestinal Hernia?

İçöz, Gökhan; Makay, Özer; Sözbılen, Murat; Gurcu, Baris; Çalışkan, Cemil; Fırat, Özgür; Kurt, Zahide; Ersin, Sinan

doi:10.1007/s00268-006-0138-x

Cited by 39 publications

(36 citation statements)

References 33 publications

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“…D-dimer is a fi brin degradation product and it can rise in conditions like disseminated intravascular coagulation (DIC), deep vein thrombosis and pulmonary embolism as a stable component of the fi brinolytic system (10,12,15,16). L-lactate is constantly produced from pyruvate via the enzyme lactate dehydrogenase (LDH) during anaerobic glycolysis (14).…”

Section: Introductionmentioning

confidence: 99%

The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia

Aydın¹,

Ozban²,

Serinken³

et al. 2015

BLL

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INTRODUCTION: Acute mesenteric ischemia (AMI) is an abdominal-vascular emergency which is rare and has high mortality rates (60-80 %) due to late diagnosis (1-3). Although it is known that extravascular reasons like intestinal intussusception, volvulus, strangulated hernias and obstructions can cause intestinal gangrene, these are rarely the cause of AMI (1). MATERIALS AND METHODS: In this study, we used male Wistar-Albino rats weighing 250-300 grams obtained from Pamukkale University Experimental Research Laboratory. Animals were exposed to light-dark cycles for 12 hours and had free access to food and water. They were kept in cages for 7 days to stabilise their intestinal fl ora. In animals of group I, nothing was made other than taking 0.5 ml blood intracardially. In other animals, abdomen was reached with midline laparotomy and superior mesenteric artery (SMA) was located. In group II (operative control group), SMA was isolated and manipulated but was not ligated. In Group III (intestinal ischemia group), SMAwas isolated and ligated with 3/0 silk tie distally to the aorta. After this process, intestinal ischemia was achieved which was confi rmed by paleness and pulselessness of intestines, caecum and right colon. Later on, abdomen was closed with double 3/0 polyglactin sutures. At postoperative 1st, 4th and 6th hours 0.5 ml blood was taken intracardially from the animals in groups II and III in order to quantify D-dimer and L-lactate levels. LABORATORY TESTS: D-dimer: Blood samples which were put into tubes containing sodium citrate, were seperated from plasma with centrifugation at 4000 rpm for 7 minutes. L-lactate: Blood L-lactate levels were determined from blood taken into capillary tubes with the help of immobilised enzyme electrode technology using YSI 1500 Sport portative lactate analyzer (Yellow Springs Instruments Inc., Ohio-USA). HISTOPATHOLOGIC VERIFICATION: Two cm long intestinal samples were taken from animals in which SMA was ligated in order to achieve mesenteric ischemia and these samples were fi xed in 10 % formol. DISCUSSION: As a result, in rats with SMA occlusion serum D-dimer levels were not increased signifi cantly when compared either in the group or with the basal values of the control group and values in operative control group. Therefore, it is concluded that D-dimer is not a useful marker for early diagnosis of AMI. On the other hand, it is revealed that blood L-lactate levels began to increase signifi cantly following 4th hour of mesenteric ischemia and it is shown that this increase continued at the 6th hour. In addition, considering the utmost importance of the early diagnosis in patients with the clinical suspicion of AMI, L-lactate seems to be a suitable marker to use in emergency departments because it is achieved with a portable device that gives fast and accurate results. Nevertheless, our results are need to be supported by clinical studies with larger patient series (Tab. 2, Fig. 11, Ref. 39). Text in PDF www.elis.sk.

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Section: Introductionmentioning

confidence: 99%

The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia

Aydın¹,

Ozban²,

Serinken³

et al. 2015

BLL

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“…However, the traditional diagnosis methods for diagnosing IMI in patients with the above-mentioned diseases, especially AIO, on the basis of fever, chills, peritonitis, tachycardia, leukocytosis and acidosis, are notoriously unreliable, even in the hands of experienced surgeons (17,18). Several serum biomarkers including D-lactate (19)(20)(21), α-glutathione S-transferase (α-GST) (22,23), intestinal fatty acid binding proteins (I-FABP) (24,25), D-dimer (26,27), cobalt-albumin binding assay (28), diamine oxidase (DAO) (29) and urine biomarkers, including I-FABP (24) and thromboxane B2 (TXB2) (30) for IMI, were investigated; however, none of these biomarkers was proven clinically useful because of poor sensitivity and specificity. Therefore, identification of novel and effective biomarkers for the prognosis of IMI and the response to treatment in patients with AIO is urgently required.…”

Section: Introductionmentioning

confidence: 99%

Histidine Decarboxylase Is Identified as a Potential Biomarker of Intestinal Mucosal Injury in Patients with Acute Intestinal Obstruction

Yang

Zhāng

et al. 2011

Mol Med

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Various biomarkers currently used for the diagnosis of intestinal mucosal injury (IMI) in patients with acute intestinal obstruction have low sensitivity and specificity. In the present study, IMI, as indicated by the impaired expression of tight junction proteins, including zonula occludens-1, occludin and claudin-1, and inflammation were determined in colonic tissues of patients with 45 strangulated intestinal obstruction (STR-IO) and the adjacent "normal" colonic tissues of 35 patients with colon cancers by quantitative real-time polymerase chain reaction (QRT-PCR), Western blotting, immunohistochemistry and histological examination, respectively. Then, two-dimensional fluorescent difference gel electrophoresis coupled with linear trap quadrupole mass spectrometry was used to screen for potential biomarkers of IMI in the serum samples of 10 STR-IO, 10 simple intestinal obstruction (SIM-IO) and 10 normal healthy controls. A total of 35 protein spots were differentially expressed among the serum samples, and six of the proteins were identified as potential biomarkers. Among the six proteins, histidine decarboxylase (HDC) and ceruloplasmin (CP) were elevated significantly in patients with STR-IO, compared with patients with SIM-IO and healthy controls. Thus, HDC and CP were further validated by QRT-PCR, Western blotting, immunohistochemistry and enzyme-linked immunosorbent assay, respectively, in colonic tissues, serum and urine samples. Finally, the receiver operating characteristic curves were used to show the area under the curves of HDC, CP and several established biomarkers, followed by the determination of the appropriate cutoff values and their sensitivities and specificities. It was shown that for serum and urine, HDC levels achieved sensitivities and specificities compatible to or even greater than those of established biomarkers for the diagnosis of IMI in patients with acute intestinal obstruction, although further validation in a larger cohort is required.

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“…[9] When the degree of the intestinal injury is estimated, it can be decided that whether any additional therapeutic interventions such as resection of necrotic intestine are necessary. Intracellular enzymes can be useful for estimating tissue damage.…”

Section: Figmentioning

confidence: 99%

“…It discriminates our study from the others. [4,9,15] Lesions of the intestinal submucosa are healed by regeneration. However, when the necrosis reaches the muscular layer in transmural necrosis, more complications develop such as perforation or peritonitis.…”

Section: Figmentioning

confidence: 99%

“…In recent studies, it has been suggested that serum D-dimer levels might be used for early diagnosis of intestinal infarction. [4,9] The aim of this study was to assess the relevance of some serum biochemical parameters such as LDH, CPK, ALP, AST, ALT levels and analysis of whole blood count as a possible reliable marker for the diagnosis of intestinal ischemia.…”

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confidence: 99%

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Correlation Of Biochemical Markers With Histopathological Findings In Experimental Strangulated Hernia

Peker¹,

Yıldız²,

Zeybek³

et al. 2009

TUTFD

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Objectives: This study was planned to evaluate whether possible changes in the hematological parameters and the biochemical markers can be used to detect obstruction-induced (strangulated) intestinal ischemia. Materials and Methods:Forty rats divided into five groups underwent the following procedures: Group 1 rats were treated with only laparotomy (sham-operated controls). To the strangulated hernia groups surgical induction of strangulated intestinal obstruction was performed. Tissue and blood samples were taken at 30 minutes (group 2), 2nd hour (group 3), 4th hour (group 4) and 6th hour (group 5) respectively, and then LDH, CPK, ALP, AST, ALT, D-dimer levels and blood cells counts were measured and histopathological examination was done.Results: Focal mucosal necrosis accompanied was confirmed by histological findings in the strangulated intestinal ischemia group after second hour. Serum D-dimer, ALT, ALP, CPK levels and neutrophil count became elevated at second hour, which was statistically significant. Conclusion:In patients with hernia, after reduction of the intestinal hernia, raised levels of serum D-dimer, ALT, ALP, CPK levels and neutrophil count may indicate the presence of a bowel ischemia. However, more comprehensive clinical studies are required to evaluate the potential survival benefit by using the laboratory tests as a marker and/or a useful diagnostic tool of the need for laparotomy.

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Is D‐dimer a Predictor of Strangulated Intestinal Hernia?

Cited by 39 publications

References 33 publications

The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia

The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia

Histidine Decarboxylase Is Identified as a Potential Biomarker of Intestinal Mucosal Injury in Patients with Acute Intestinal Obstruction

Correlation Of Biochemical Markers With Histopathological Findings In Experimental Strangulated Hernia

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