Biochemical Markers (Multimarker Index) in the Diagnosis of Acute Cerebral Infarction with a Combination of Usability Tests: A Prospective Randomized Controlled Study

PURPOSE: We examined the utility of biochemical markers in the diagnosis of acute cerebral infarction and the relationship between panel results and the extent and severity of the infarct. METHODS: Group-wise comparisons were made between a group (Group 1) consisting of 38 subjects who were shown through medical screening between April 2007 and March 2008 to have no past history of cerebral disorders and a group (Group 2) consisting of 55 subjects who had visited the ER (during the same period) within 24 hours after the onset of neurologic symptoms and who were diagnosed with stroke through magnetic resonance imaging. Tests were carried out using the Multimarker Index, which is based on the principle of immunofluorescence. B-type natriuretic peptide, D-dimer, matrix metalloproteinase-9, and S100beta were examined, and the Multimarker Index (MMX) was derived. The extent of the infarct lesion was assessed using a volumetry program. RESULTS: The average MMX value was 2.27 in group I and 4.14 in group II, and the difference was statistically significant (p<0.05). For group II, the MMX value had a statistically significant correlation with both the extent of infarct lesion (r=0.46, p<0.001) and its severity (r=0.39, p<0.001). CONCLUSION: We believe that biomarker tests using the MMX should provide useful data in diagnosing strokes, and be of utility in making decisions regarding additional diagnostic tests and early treatment.

A Rare but Fatal Instance of Gastrointestinal Bleeding: Primary Aortoenteric Fistula

Primary aortoenteric fistula (PAEF) is a rare but catastrophic cause of gastrointestinal bleeding. The diagnosis of PAEF is difficult to make. The classic triad of symptoms, i.e. gastrointestinal bleeding, abdominal pain, and a pulsating abdominal mass is overemphasized, as it occurs in less than 11~25% of the patients. For two thirds of the patients, the diagnosis is made in the operating room. Endoscopic and radiographic studies are very helpful, but the absence of abnormalities can not exclude the diagnosis. PAEF is a clinical and surgical challenge associated with high mortality. A high index of suspicion, early diagnosis and prompt and appropriate surgical intervention are essential to patient survival. Two primary aortoenteric fistulas (aortoduodenal and aortoesophageal) cases are presented and the related literature are reviewed.