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

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 flora. 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 confirmed 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 fixed in 10 % formol. DISCUSSION: As a result, in rats with SMA occlusion serum D-dimer levels were not increased significantly 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 significantly 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

Equivalence of Hamiltonian and Lagrangian Path Integral Quantization: Effective Gauge Theories

The equivalence of correct Hamiltonian and naive Lagrangian (Faddeev--Popov) path integral quantization (Matthews's theorem) is proven for gauge theories with arbitrary effective interaction terms. Effective gauge-boson self-interactions and effective interactions with scalar and fermion fields are considered. This result becomes extended to effective gauge theories with higher derivatives of the fields.Comment: 14 pages LaTeX, BI-TP 93/40, August 199

Increased plasma levels of growth hormone, insulin-like growth factor (IGF)-I and IGF-binding protein 3 in pregnant rats with exercise.

Growth hormone (GH) and insulin-like growth factor-I (IGF-I) are closely related molecules. Insulin-like growth factor-binding protein-3 (IGFBP-3) is a main molecule that binds IGF-I. GH, IGF-I and IGFBP-3 have important roles in growth and development. In this study, we investigated the effects of exercise during pregnancy on maternal plasma levels of GH, IGF-I and IGFBP-3 and on fetal development. We also recorded the weights of placenta, lengths of umbilical cord, fetal body weights, fetal heights, and weights of fetal tissues. Pregnant Wistar Albino rats were divided into two groups: exercise and control groups (n = 7 for each). A treadmill exercise was performed as 20 m/min for 20 min/day, once per day for 19 days in exercise group. Blood samples were collected from pregnant rats on 0, 7th, 14th and 20th days of gestation (D) under anesthesia with intracardiac puncture, and maternal plasma levels of GH, IGF-I and IGFBP-3 were determined. Fetuses were taken with cesarean section on D20, and various parameters for fetal growth were measured. Plasma GH and IGF-I levels were elevated in exercising pregnant rats on D14 and D20, respectively, when compared to controls, and IGFBP-3 levels were increased on D14 and D20. Among the growth parameters examined, only fetal body weights and weights of fetal liver were significantly decreased in the exercise group (p < 0.01 and p < 0.05, respectively). These results indicate that maternal exercise significantly increases plasma levels of GH, IGF-I and IGFBP-3 in the late period of pregnancy but causes adverse effects on fetal growth

Evaluation of soluble transferring receptor levels in children with iron deficiency and beta thalassemia trait, and in newborns and their mothers.

In this study we first aimed to investigate the value of soluble transferrin receptor levels (sTfR) in healthy, iron deficient and beta thalassemia trait children and to determine whether sTfR is a useful indicator of iron deficiency. Secondly, we investigated the effects of iron supplementation of sTfR levels in a group of iron deficient children. Third was to describe sTfR in newborn infants and determine whether or not maternal iron deficiency is an important predictor of infant sTfR. Six groups were formed: Children with iron deficiency (n=22), post-iron therapy (n=16), beta thalassemia traits (n=19), healthy children (n=19), full-term newborns (n=20), and their mothers (n=19), Complete blood count (CBC), serum iron, iron-binding capacity, ferritin and sTfR levels were measured. sTfR/log ferritin indexes were calculated. sTfR levels of children with iron deficiency and with beta thalassemia trait were found to be significantly higher than those of healthy children (p<0.0001 and p<0.001). Children with iron deficiency showed a greater increase in the levels of sTfR than those with beta thalassemia traits (p=0.008). Although sTfR levels of subjects having iron therapy decreased, the levels still remained high compared to controls (p=0.002). Newborns had significantly higher levels of sTfR than controls (p<0.0001). Although sTfR levels of mothers with iron deficiency were higher than those of mothers having no iron deficiency (p=0.009), there was no difference in the levels of sTfR between newborns of both groups of mothers (p=0.790). sTfR is a useful parameter which shows body iron status as well as erythropoietic activity in children. It is independent of mother's iron status, and is due to erythropoietic activity in newborns

Effects of aluminum on insulin-like growth factor I levels and antioxidant status.

BACKGROUND: The aim of this research was to investigate the toxic effects of aluminum (Al) on plasma insulin-like growth factor I (IGF-I) levels and on the liver, the main production site of IGF-I. In addition, we analyzed the influence of Al on liver malondialdehyde (MDA) and glutathione (GSH) levels, and how the antioxidant vitamin E (vit E) affects the altered levels of these parameters. METHODS: Adult male rats (n = 28) were randomly divided into the following four groups: Al alone, Al + vit E, vit E alone, and untreated control group. The Al group received 1 mg/200 g body weight of aluminum sulfate (AlSO4) thrice weekly for two weeks. The Al + vit E group received the same dose of AlSO4 plus 100 mg/kg of vit E once daily. The Vit E group received a daily dose of vit E alone. Control animals received physiologic saline daily. RESULTS: Liver GSH levels were decreased in the Al group but recovered with vit E administration. Liver IGF-I levels significantly decreased in the Al group compared with the control. With the use of vit E, the liver IGF-I levels increased, but this increase was not statistically significant. CONCLUSIONS: The results of this study show that plasma and liver IGF-I levels decrease with Al use. Also liver GSH levels decreased with Al while this recovered with vit E use together with Al

C-reactive protein levels in non-obese pregnant women with gestational diabetes.

A low-grade systemic inflammation is concomitant in diabetes. There is a pathophysiological relation between gestational diabetes mellitus and type 2 diabetes mellitus, which was further supported by significantly elevated risk of type 2 diabetes in women with a history of previous gestational diabetes mellitus. We investigated the relation between low-grade systemic inflammation expressed as C-reactive protein and gestational diabetes in non-obese pregnant women. This study included 20 non-obese pregnant women with gestational diabetes mellitus and 30 non-obese pregnant women without gestational diabetes mellitus as a control group. The body mass index of all the subjects were < 25 kg/m2. During 26-28 gestational weeks 100-g oral glucose tolerance test was performed and simultaneously fasting C-reactive protein levels were measured. Serum median C-reactive protein level was higher in patients with gestational diabetes mellitus (p = 0.0001). C-reactive protein was strongly associated with glycemic parameters and weight gain during pregnancy. A model consisting of glucose intolerance, age, parity, and weight gain during pregnancy accounted for 61% of the variance in log C-reactive protein. We demonstrated that serum C-reactive protein level was related with gestational diabetes mellitus and weight gain during pregnancy in late second and early third trimesters

Hyperhomocysteinemia: a risk factor for retinal vein occlusion.

PURPOSE: The aim of the study was to investigate the plasma homocysteine levels in patients with retinal vein occlusion (RVO) in order to reveal whether hyperhomocysteinemia was a risk factor for RVO. METHODS: Thirty-three consecutive patients diagnosed to have RVO of any type and 25 age- and sex-matched controls without RVO were included in this prospective case-control study. Data regarding age, sex, history of hypertension, diabetes mellitus, other vascular events, glaucoma, medications and smoking habits were obtained from all subjects. Several laboratory tests relating to vascular disease including cholesterol, triglyceride and hematocrit were checked. The plasma total homocysteine (tHcy) level was measured by high-performance liquid chromatography (normal range: 5-15 micromol/l). Plasma folate, vitamin B(12) and creatinine levels were also studied since these vitamins and impairment of renal function might affect plasma tHcy values. RESULTS: Patients with RVO had a significantly higher tHcy level (median: 11.7 micromol/l, range: 7.2-25 micromol/l) compared to controls (median: 10.3 micromol/l, range: 6.7-13.4 micromol/l; p = 0.005). Nine of 33 patients with RVO (27.3%) had an elevated plasma tHcy level, whereas none of the controls had an abnormal tHcy value (p = 0.004). Plasma folate, vitamin B(12) and creatinine levels were comparable between the two groups (p > 0.05). CONCLUSIONS: The present study suggests an association between hyperhomocysteinemia and RVO. Further controlled studies with a large number of cases are needed to investigate the exact role of hyperhomocysteinemia in RVO

Are C-reactive protein and homocysteine cardiovascular risk factors in obese children and adolescents?

BACKGROUND: Several prospective epidemiological studies have demonstrated that high-sensitivity C-reactive protein (hsCRP) and plasma homocysteine (hcy) are predictors of future coronary events among healthy men and women. The aim of the present study was therefore to investigate a possible relationship between hsCRP, hcy levels and body mass index (BMI), relative weight (RW), serum leptin levels, and cardiovascular risk factors in obese children and adolescents. METHODS: The study involved 28 obese children and adolescents (13 girls, 15 boys; BMI>95 per thousand for age and sex), 4.5-15 years of age (mean 10.7 +/- 0.6 years), who attended hospital for a basic obesity check-up. The association between hsCRP, hcy levels and BMI, RW, serum leptin levels, and cardiovascular risk factors such as blood pressure (BP), lipid profile, serum fasting insulin levels, and insulin resistance indexes, was investigated. RESULTS: Serum hsCRP level was positively correlated with BMI (r = 0.512, P < 0.01), RW (r = 0.438, P < 0.05), systolic and diastolic BP (r = 0.498, P < 0.01), serum leptin levels (r = 0.457, P < 0.05), but not with serum lipid, glucose, fasting insulin, plasma hcy levels or insulin resistance indexes. For hcy level, in contrast, no correlation was found with BMI, RW, systolic and diastolic BP, serum lipid levels, leptin, hsCRP, glucose, fasting insulin levels, or insulin resistance indexes. CONCLUSIONS: hsCRP is correlated with BMI, RW, BP and leptin, which are risk factors for coronary heart disease, which supports the relationship between obesity, inflammation and atherosclerosis. hsCRP in childhood obesity might be a useful index to predict possible atherosclerotic events

Influence of acute exercise on urinary protein, creatinine, insulin-like growth factor-I (IGF-I) and IGF binding protein-3 concentrations in children.

Insulin-like growth factor-I (IGF-I) is a polypeptide hormone and present in human urine. Insulin-like growth factor binding protein-3 (IGFBP-3) is the major form of binding protein in human circulation and functions as a carrier for IGF-I. Our goal was to determine the effects of volleyball exercise on the concentrations of urine protein, creatinine, IGF-I, and IGFBP-3 in children and to find out whether these effects differ between boys and girls. Volunteer children (13 females and 14 males), aged 10-13 years old were included in this work. Weight and height of the subjects were measured, and urine samples of their were collected before and after 2 hours of exercise. Urinary protein, creatinine, IGF-I and IGFBP-3 levels were analysed. Urinary protein, creatinine and IGF-I concentrations were increased after two hours of exercise wheres urinary IGFBP-3 concentrations did not change. In addition, no statistically significant difference in all parameters analysed was observed between boys and girls of similar age and body mass index

Effects of chronic aluminum administration on blood and liver iron-related parameters in mice.

In this study, the effects of chronically administered aluminum on iron metabolism-related parameters of liver and blood of mice were investigated. An additional purpose to determine how chronic aluminum administration together with vitamin E as an antioxidant to mice changed the parameters related to iron metabolism. For these purposes, we used 21 adult female Balb-c mice in this study. The animals were divided into three groups: one group with aluminum administered chronically, another group with aluminum plus vitamin E administered chronically, and the control group. Serum levels of hemoglobin, ferritin, iron, transferrin, hematocrit, total iron binding capacity (TIBC), as well as percentage of transferrin saturation were determined in all groups. In addition, the liver tissue levels of ferritin and iron were analyzed. Hemoglobin and hematocrit levels of the aluminum group and aluminum plus vitamin E group were significantly decreased compared to the control. In conclusion, no changes occurred in the serum iron related parameters although Al induced anemia in mice when Al administered chronically. There was an increase in the levels of liver iron and ferritin with Al, but Vit E had no effect on the changes of all blood and liver parameters caused by Al