D-dimer as a marker for early diagnosis of acute mesenteric ischemia.

INTRODUCTION: Acute obstruction of mesenteric artery generally has an unfavorable prognosis because of late diagnosis. In this study we evaluated the diagnostic value of plasma D-dimer level as an early indicator in acute mesenteric ischemia in rats caused by ligation of superior mesenteric artery. MATERIALS AND METHODS: Twenty-eight mature male Wistar rats were used in the study. These were divided into four groups, each consisting of seven rats. In group I, after performing a simple laparotomy, blood was sampled at minute 30. In group II, first the superior mesenteric artery was ligated, and blood samples were taken at the 30th minute. Group III consisted of rats undergoing a simple laparotomy and blood samples were taken 7 h later. From the subjects in group IV blood samples were obtained 7 h after the ligation of their superior mesenteric artery. RESULTS: Plasma D-dimer levels of the ligated groups were significantly higher both at the 30th minute and the 7th hour compared to the levels of those having undergone simple laparotomies (p<0.002). Likewise, this level was higher in the 7th hour blood samples of the ligated group than in the 30th minute (p<0.008). CONCLUSIONS: In rats undergoing acute mesenteric ischemia by ligation of superior mesenteric artery, plasma D-dimer levels increase with the duration of the intestinal ischemia period. This finding suggests that the measurement of the plasma D-dimer levels might be a useful tool for the early diagnosis of acute mesenteric obstruction.

Prognostic factors for sporadic medullary thyroid carcinoma.

INTRODUCTION: Medullary thyroid carcinoma (MTC) originates from the thyroid parafollicular cells and accounts for 3% to 10% of all thyroid malignancies. Approximately 84% of cases are sporadic. The aim of this study was to evaluate the outcomes of treatment for sporadic medullary thyroid carcinoma (SMTC) and define the prognostic factors for overall survival. METHODS: The records of 32 SMTC patients treated at Ankara Oncology Education and Research Hospital between September 1993 and April 2003 were retrospectively evaluated. The effects of age, gender, tumor localization, extent of the primary surgical resection, tumor size, capsule invasion, lymph node metastasis, extranodal extension, tumor stage, local recurrence, and distant metastasis on the overall survival rate were evaluated by univariate and multivariate analyses. RESULTS: There were 32 patients (19 females, 13 males) with a median age of 45 years (21-76 years). Altogether, 22 patients had undergone complete resection and 10 patients incomplete resection. The median follow-up was 48 months (9-111 months), and the overall 5-year survival rate was 51%. Based on the univariate analysis, the extent of primary surgical resection, pathologic tumor size, capsule invasion, lymph node invasion, extranodal extension, tumor stage, local recurrence, and distant metastasis were factors that significantly affected survival. In the multivariate analysis, however, only the extent of the primary surgical resection, capsule invasion, and distant metastasis were found to be statistically significant factors. CONCLUSIONS: The extent of the primary surgical resection significantly influences the survival of patients with SMTC. Capsule invasion and distant metastasis were additional factors affecting the prognosis.