Diagnosis of acute myocardial infarction from sequential enzyme measurements obtained within 12 hours of admission to hospital

Article Abstract:

It is sometimes difficult to determine whether a patient with acute chest pain has had a heart attack. Electrocardiogram (ECG) results are often ambiguous, and over half of heart attacks must be diagnosed by other means. Usually this is done using a cardiac enzyme profile, which requires blood tests to be done on consecutive days, delaying diagnosis and often resulting in unnecessary hospital stays. By measuring changes in blood levels of the enzyme creatine kinase (CK), the diagnosis can be confirmed within 12 hours of the patient's admission to the hospital. To test this method, blood samples from 65 patients were obtained on admission, and also four, eight and 12 hours later. Thirty-four patients had heart attacks, while 21 were found to have other heart ailments. Ten had chest pain due to causes other than ischemia (reduced blood flow to the heart). Measurement of CK provided fast, accurate diagnosis. There was one false-negative result, that is, heart attack was not diagnosed when it had actually occurred. In some cases, muscle trauma from an intramuscular injection or surgery can cause false readings, and thrombolytic (clot-dissolving) therapy may also complicate diagnosis. Faster confirmation of a suspected heart attack means that treatment can be initiated more quickly, which is important in the use of thrombolytic therapy. Patients with other conditions can also be identified, permitting early intervention with angioplasty (opening of a blocked artery using a balloon catheter) or coronary artery bypass surgery. Also, when a heart attack is ruled out quickly, patients leave the cardiac intensive care unit sooner, resulting in a substantial cost saving, which may also be augmented by earlier discharge from the hospital. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Heart attack, Creatine kinase, Enzymes

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Is low proteinuria an early predictor of severity of acute pancreatitis?

Article Abstract:

Acute pancreatitis is an inflammation of the pancreas (a gland located behind the stomach), usually caused by alcoholism, injury, infection, or certain drugs. Most patients recover uneventfully, but about one out of five have more severe attacks, and about half of these patients die. Identification of those at high risk for severe pancreatitis is important in order to initiate more aggressive therapy, including surgery and peritoneal lavage (rinsing out of the abdominal cavity). However, scoring systems now in use to identify high-risk patients are cumbersome and slow. Twenty patients with acute pancreatitis were tested for low proteinuria (protein in the urine) to determine whether this measure would permit faster identification of high-risk patients. All urine passed after admission was saved for seven days. Excretion levels of immunoglobulin G (IgG, an antibody) were consistent with a diagnosis of acute pancreatitis. During the first day and a half after admission, urinary levels of IgG and albumin (a protein) were higher for the three patients who later developed major complications than for patients who had a routine recovery. How this happens is not clear. Although the sample size is small, this pilot study indicates that low proteinuria may be an early response to acute pancreatitis, and it may also provide an indication of the severity of the attack. Whether low proteinuria will prove to be a valuable predictor of the severity of acute pancreatitis is still under investigation, and which proteins will be most useful is yet to be determined. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Cases, Pancreatitis, Proteinuria, Predictive value of tests, Predictive value of tests (Medical)

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Prealbumin in the diagnosis of bronchopulmonary carcinoid tumours

Article Abstract:

Carcinoid tumors are formed from cells located in the intestinal tract, bile ducts, pancreas, bronchus, or ovary. Previous studies have reported that patients with carcinoid tumors have a protein called prealbumin present in their tumors. This protein is primarily made in the liver and can be detected in the blood. This article describes the results of a study designed to determine if prealbumin can be used as a marker for diagnosing carcinoid tumors in the lungs (bronchopulmonary carcinoid tumors). Samples from 60 lung carcinoid tumors were tested for prealbumin using a specific stain that allows the protein to be visualized when a thin slice of the tumor is examined with a microscope. For comparison, samples from three other types of lung tumors (squamous carcinoma, adenocarcinoma, and small cell carcinoma) were tested. Seventy-five percent of the carcinoid tumors tested positive for prealbumin. Prealbumin was not present in any of the adenocarcinomas, but was found in two of the small cell carcinomas and in five of the squamous carcinomas. It is concluded that testing for prealbumin is a useful method for diagnosing lung carcinoid tumors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Lung tumors, Carcinoid, Carcinoid tumor, Tumor proteins, Tumor markers

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