Emergency diagnosis of upper gastrointestinal bleeding by detection of haemoglobin in nasogastric aspirate.

OBJECTIVE: To determine the accuracy of the Faecal Occult Blood-Transferrin test (FOB-T; Certest Biotec, San Mateo de Gállego, Spain) for detection of blood in nasogastric aspirate, and its emergency diagnostic value for upper gastrointestinal bleeding (UGIB). METHODS: Nasogastric aspirate was collected from patients with haematemesis on admission to hospital. Haemoglobin was quantified on admission and after 12 h. FOB-T test was used to assess each nasogastric aspirate sample for the presence of haemoglobin and transferrin. RESULTS: Of 64 patients included in the study, 28 (43.8%) were hospitalized for UGIB based on physical examination, haemoglobin level. 24 were confirmed with endoscopy findings. Four were excluded from study due to lack of endoscopic confirmation. The remaining 36 patients had no clinical evidence of UGIB. FOB-T test findings were positive in 26/60 patients, including all 24 patients with UGIB. The FOB-T test had sensitivity 100%, specificity 94.4%, positive predictive value 92.3% and negative predictive value 100% for UGIB. CONCLUSIONS: A negative FOB-T test may be sufficient to exclude the possibility of UGIB without other diagnostic tests.

Diagnostic value of plasminogen activity level in acute mesenteric ischemia.

AIM: To investigate the changes in plasminogen activity level during mesenteric ischemia. METHODS: We performed laparotomy in 90 female Wistar-Albino rats (average weight 230 g). In sham groups (SL) (Groups I and II) the superior mesenteric artery (SMA) and vein (SMV) were explored, but not tied. In SMA groups (Groups III and IV) the SMA was ligated, and in SMV groups (Groups V and VI) the SMV was ligated. On re-laparatomy 2 mL of blood was drawn at 1 h in groups I, III and V, and at 3 h in groups II, IV and VI. Plasminogen levels were assessed and comparisons were made between groups and within each group. RESULTS: The mean plasminogen activity in the SL group was significantly higher than SMA (25.1 +/- 10.8 vs 11.8 +/- 4.6, P < 0.001) or SMV (25.1 +/- 10.8 vs 13.7 +/- 4.4, P < 0.001) groups both at 1 h and at 3 h (29.8 +/- 8.9 vs 15.1 +/- 5.7, P < 0.0001; 29.8 +/- 8.9 vs 14.2 +/- 2.9, P < 0.0001). There were no significant differences between the values of SMA and SMV groups at 1 h (P = 0.28) and at 3 h (P = 0.71). In each group, plasminogen activity levels did not change significantly between the two measurements performed at 1 h and 3 h. CONCLUSION: We conclude that blood plasminogen activities decrease during early phases of both arterial and venous mesenteric ischemia which may be a useful marker for early diagnosis.