The Role of Ischemia Modified Albumin and D-dimer as Early or Late Biochemical Markers in Ovarian Torsion

The Diagnostic Values of Ischemia-Modified Albumin in Patients with Acute Abdominal Pain and Its Role in Differentiating Acute Abdomen

Aim

The aim of this study was to evaluate the diagnostic value of serum ischemia-modified albumin (IMA) levels in patients presenting to the emergency department with acute abdominal pain and its use in differentiating acute surgical abdomen.

Methods

This single-center prospective cross-sectional study included 334 adult patients who presented to the emergency department. These consisted of 194 patients (Group 1) with nontraumatic abdominal pain commencing in the preceding week, who were definitely diagnosed and either hospitalized in a specific department or planned for discharge, and a control group of 140 patients (Group 2).

Results

The mean IMA value of the patients diagnosed with acute appendicitis was statistically significantly higher than that of the control group. The mean IMA value of the patients diagnosed with acute appendicitis, ovarian pathologies, and gastritis-peptic ulcer was statistically significantly higher than that of the nonspecific abdominal pain group.

Conclusion

Serum IMA levels can be used as a diagnostic marker in patients with acute appendicitis. Furthermore, serum IMA levels in patients presenting to the emergency department with abdominal pain may be indicative of patients requiring surgery or of complicated cases, particularly in terms of acute appendicitis and ovarian pathologies.

The effect of controlled reperfusion on experimental ovarian torsion

The objective of our research was to study the effect of controlled reperfusion on lactate and advanced oxidation protein products (AOPP) in experimental ovarian torsion (OT), and to evaluate the possibility to reduce the reperfusion injuries applying the ON-OFF technique of reperfusion. Material and Methods — Lactate and AOPP were measured in serum and ovarian homogenates of 70 females rats, divided equally into 7 groups: no intervention (nr. 1); laparotomy (nr. 2); 3 hours OT (nr. 3); 3 hours OT + 1 hour (nr. 4) or 24 hours (nr. 6) of simple reperfusion (SR); 3 hours OT + 1 hour (nr. 5) or 24 hours (nr. 7) of controlled reperfusion (ON-OFF). The results were analyzed using Welch's ANOVA. Results — OT produced an increase of serum (66%, p<0.001) and homogenate (38%, p=0.006) lactate, that tended to return to baseline in 24 hours despite the type of reperfusion. AOPP had grown in OT animals serum (20%, p=0.007) and homogenate (26%, p>0.05) and continued to rise in the serum after SR, while in ON-OFF technique groups – decreased by about 20% (p<0.01). Homogenate AOPP levels rised after reperfusion in all groups. Conclusion — Lactate is a biomarker for ischemia in OT. Increased AOPP in experimental groups indicates that there is a degree of oxidative stress that can affect the cells after the restoration of the blood flow. Therefore, the correct management of the condition that reduces reactive oxygen species production, such as controlled method of reperfusion, could be appropriate to prevent additional injuries.

Impaired thiol/disulfide homeostasis in patients with mild acute pancreatitis

BACKGROUND/AIMS

The aim of this study was to compare the dynamic thiol/disulfide (SS) homeostasis and ischemia-modified albumin (IMA) concentration between healthy subjects and patients with mild acute pancreatitis (AP).

MATERIALS AND METHODS

A total of 28 patients with AP (AP group) and 35 age- and sex-matched healthy individuals (control group) were included in this study. Serum thiols/SS and IMA concentrations were measured and compared between the two groups.

RESULTS

The mean serum native thiol (SH) and total thiol (TT) levels were significantly lower in the AP group than in the control group (224.7±80.3 μmol/L vs. 314.66±87.5 μmol/L, p<0.001 and 273.3±76.8 vs. 346.9±79 μmol/L, p<0.001, respectively). SS levels were significantly higher in the AP group than in the control group (24.2±11.1 μmol/L vs. 16.1±9.9 μmol/L, p<0.054). There were no differences in the IMA concentration and the mean IMA/albumin ratio (IMAR) between both the groups.

CONCLUSION

We found that mild AP may affect serum thiol and SS levels, and cause impaired thiol/SS homeostasis.

Ischemia modified albumin in experimental ovarian torsion with and without controlled reperfusion

Purpose: Ovarian torsion, being a gynecological emergency, requires to be rapidly diagnosed and treated with minimal consequences on ovarian function after the removal of torsion. As ischemia modified albumin (IMA) is considered a good biomarker in diverse ischemic diseases, the aim of our study was to determine the effect of different ovarian torsion/detorsion models on serum and ovarian homogenates levels of IMA in an experimental study.

Methods: IMA was measured in the serum and ovarian homogenates of 7 groups of female rats (10 animals in each group): 1 - control (no intervention); 2 - sham (only laparotomy); 3 - ischemia group: 3 hours ovarian torsion (OT); 4 - 3 hours OT (ischemia), 1 hour simple reperfusion; 5 - 3 hours ischemia, 1 hour controlled reperfusion that was assured during the first two minutes by opening and closing the clips on the ovarian pedicles in 10 seconds intervals, followed by simple reperfusion; 6 - 3 hours ischemia, 24 hours simple reperfusion; 7 - 3 hours OT, 24 hours controlled reperfusion. The results were analyzed by Welch’s ANOVA and Spearman correlation.

Results: Ischemia increases the IMA in both serum and ovarian homogenates compared to control and sham groups. The controlled reperfusion groups had a statistically significant lower IMA in serum compared to simple reperfusion groups. IMA was found to be higher in the ovarian homogenates of simple reperfusion compared to controlled reperfusion groups.

Conclusion: Our results suggest that controlled reperfusion prevent the processes that increase the IMA in ovarian torsion.

Serum ischemia modified albumin level and its relationship with the thiol/disulfide balance in placenta percreta patients

The pathogenesis of placenta percreta (PP) is not very well known. This study was designed to analyse the oxidative stress (OS), the thiol/disulphide balance, and ischaemia-modified albumin (IMA) the women with PP. The study included 38 pregnant women with PP and 40 similarly aged healthy pregnant women in their third trimester of gestation. We measured the IMA, native and total thiols, and disulphide concentrations in the maternal sera of all of the participating women. The IMA levels were higher and the native and total thiols were lower in the PP group than in the control group. However, there was no statistical significance with respect to the thiol/disulphide balance between the two groups. The results of this study suggest that an increase in the ischaemia and OS and a decrease in the antioxidant status may contribute to the pathogenesis of PP. Impact statement What is already known on this subject? Placenta percreta (PP) is a serious complication of pregnancy. Although there are several studies investigating the pathophysiological mechanism of PP, whether the pathology results from a lack of decidua or from the over-invasiveness of trophoblasts remains controversial. The pathology of PP is poorly understood. What do the results of this study add? This prospective study has shown an increased ischaemia modified albumin (IMA) and a decreased antioxidant capacity in the patients with placenta percreta. The results from 38 women with PP suggest that the serum concentrations of IMA and the oxidative stress parameters may be able to predict PP in cases of uncertainty. What are the implications of these findings for clinical practice and/or further research? The implication of these findings shed light on understanding the pathogenesis of PP for further research.