Purpose. To evaluate the predictive effect of IMA in incarcerated hernias. Methods. Three groups ( ) of rats were operated. Group I aimed to mimic incarceration, group II aimed the strangulation, and group III was the sham group. IMA and LDH measurements were made. Results. IMA levels were significantly higher in strangulation mimicking group and IMA levels were normal at postoperative 6th hour in incarceration mimicking group. LDH levels were significantly higher in both incarceration and strangulation mimicking groups. Conclusion. IMA seems to be an effective marker in incarcerated hernias to predict necrosis. But we need further studies to generalise this hypothesis. 1. Introduction Among all emergency cases the ratio of incarcerated/strangulated hernias differs across the countries. But it is well known that hernia is the common cause of small bowel obstruction, and mortality and morbidity rates increase in case of strangulation. During acute ischemic conditions, metal binding capacity of albumin is modified and a metabolic variant with reduced transition metal binding occurs. This change is quantifiable and commonly known as ischemia modified albumin (IMA). Recently, IMA measurement has been proposed as a sensitive marker for the diagnosis of myocardial ischemia presenting with typical acute chest pain [1]. However, IMA levels are also known to increase in other ischemic conditions, as well as to be an indicator of oxidative stress, and may not be specific for cardiac ischemia. Recently, Turedi et al. [2] showed that the level of IMA may be of use in the diagnosis of pulmonary embolism, another ischemic condition. Incarceration is the state of an external hernia which cannot be reduced into the abdomen. Implying an increased risk of obstruction and strangulation, incarceration has great importance [3]. Incarcerated external hernias are the second most common cause of small intestinal obstructions [4]. Roughly 5% of all patients having an operation for external hernia are explored as an emergency. Strangulated external hernia is a relatively common and serious surgical emergency and accounts for most of the deaths from this condition [5]. Clinical validation of any test for ischemia is difficult as there is no accepted diagnostic gold standard. And the preoperative diagnosis or prediction of ischemia is important for surgeons because ischemia changes the operative strategy. Thus we planned this study and aimed to show relation between the intestinal ischemia and IMA. 1.1. Materials and Methods Our study was initiated after ？anakkale Onsekiz Mart
References
[1]
D. Roy, J. Quiles, G. Aldama et al., “Ischemia modified albumin for the assessment of patients presenting to the emergency department with acute chest pain but normal or non-diagnostic 12-lead electrocardiograms and negative cardiac troponin T,” International Journal of Cardiology, vol. 97, no. 2, pp. 297–301, 2004.
[2]
S. Turedi, A. Gunduz, A. Mentese et al., “Value of ischemia-modified albumin in the diagnosis of pulmonary embolism,” The American Journal of Emergency Medicine, vol. 25, no. 7, pp. 770–773, 2007.
[3]
H. B. Devlin, Management of Abdominal Hernias, Butterworths, London, UK, 1988.
[4]
M. A. Smith and N. J. Soper, “Small intestine,” in The Washington Manual of Surgery, G. M. Doherty, J. B. Meko, J. A. Olson, et al., Eds., pp. 216–227, JB Lippincott, Philadelphia, Pa, USA, 2nd edition, 1999.
[5]
N. J. Andrews, “Presentation and outcome of strangulated external hernia in a district general hospital,” British Journal of Surgery, vol. 68, no. 5, pp. 329–332, 1981.
[6]
D. Bar-Or, E. Lau, and J. V. Winkler, “A novel assay for cobalt-albumin binding and its potential as a marker for myocardial ischemia—a preliminary report,” Journal of Emergency Medicine, vol. 19, no. 4, pp. 311–315, 2000.
[7]
D.-H. Lee, H.-K. Jeon, H.-J. Park et al., “Change in ischemia-modified albumin and its clinical significance during exercise stress testing,” Circulation Journal, vol. 74, no. 3, pp. 484–489, 2010.
[8]
E. Sbarouni, P. Georgiadou, and V. Voudris, “Ischemia modified albumin changes—review and clinical implications,” Clinical Chemistry and Laboratory Medicine, vol. 49, no. 2, pp. 177–184, 2011.
[9]
A. Wudkowska, J. Goch, and A. Goch, “Ischemia-modified albumin in differential diagnosis of acute coronary syndrome without ST elevation and unstable angina pectoris,” Kardiologia Polska, vol. 68, no. 4, pp. 431–437, 2010.
[10]
N. V. Bhagavan, E. M. Lai, P. A. Rios et al., “Evaluation of human serum albumin cobalt binding assay for the assessment of myocardial ischemia and myocardial infarction,” Clinical Chemistry, vol. 49, no. 4, pp. 581–585, 2003.
[11]
A. Gunduz, S. Turkmen, S. Turedi et al., “Time-dependent variations in ischemia-modified albumin levels in mesenteric ischemia,” Academic Emergency Medicine, vol. 16, no. 6, pp. 539–543, 2009.
[12]
J.-P. Laussac and B. Sarkar, “Characterization of the copper(II)- and nickel(II)-transport site of human serum albumin. Studies of copper(II) and nickel(II) binding to peptide 1–24 of human serum albumin by 13C and 1H NMR spectroscopy,” Biochemistry, vol. 23, no. 12, pp. 2831–2838, 1984.
[13]
E. Mcgugan, H. Burton, S. J. Nixon, and A. M. Thompson, “Deaths following hernia surgery: room for improvement,” Journal of the Royal College of Surgeons of Edinburgh, vol. 45, no. 3, pp. 183–186, 2000.
[14]
B. Kulah, A. Polat Duzgun, M. Moran, I. H. Kulacoglu, M. Mahir Ozmen, and M. S. F. Coskun, “Emergency hernia repairs in elderly patients,” The American Journal of Surgery, vol. 182, no. 5, pp. 455–459, 2001.
[15]
B. Kulah, I. H. Kulacoglu, M. T. Oruc et al., “Presentation and outcome of incarcerated external hernias in adults,” The American Journal of Surgery, vol. 181, no. 2, pp. 101–104, 2001.
[16]
B.-J. Ge, Q. Huang, L.-M. Liu, H.-P. Bian, and Y.-Z. Fan, “Risk factors for bowel resection and outcome in patients with incarcerated groin hernias,” Hernia, vol. 14, no. 3, pp. 259–264, 2010.
[17]
H. Nilsson, G. Stylianidis, M. Haapam？ki, E. Nilsson, and P. Nordin, “Mortality after groin hernia surgery,” Annals of Surgery, vol. 245, no. 4, pp. 656–660, 2007.
[18]
N. A. Bickell, A. H. Aufses Jr., M. Rojas, and C. Bodian, “How time affects the risk of rupture in appendicitis,” Journal of the American College of Surgeons, vol. 202, no. 3, pp. 401–406, 2006.
[19]
H. Derici, H. R. Unalp, A. D. Bozdag, O. Nazli, T. Tansug, and E. Kamer, “Factors affecting morbidity and mortality in incarcerated abdominal wall hernias,” Hernia, vol. 11, no. 4, pp. 341–346, 2007.
[20]
G. P. McEntee, A. O'Carroll, B. Mooney, T. J. Egan, and P. V. Delaney, “Timing of strangulation in adult hernias,” British Journal of Surgery, vol. 76, no. 7, pp. 725–726, 1989.
[21]
G. Ohana, I. Manevwitch, R. Weil et al., “Inguinal hernia: challenging the traditional indication for surgery in asymptomatic patients,” Hernia, vol. 8, no. 2, pp. 117–120, 2004.
[22]
W. Silen, M. F. Hein, and L. Goldman, “Strangulation obstruction of the small intestine,” Archives of Surgery, vol. 85, pp. 121–129, 1962.
[23]
T. Maeda, H. Yuasa, T. Arimura, S. Endou, K. Akashi, and K. Ashikawa, “Value of the level of serum creatine phosphokinase for early diagnosis of strangulation ileus,” The Japanese Journal of Gastroenterological Surgery, vol. 26, pp. 1007–1012, 1993.
[24]
S. Ohira, H. Hasegawa, S. Ogiso, et al., “Clinical study of the strangulated Ileus without previous abdominal operation,” The Japanese Society for Emergency Medicine, vol. 21, pp. 687–693, 2001.
[25]
J. A. álvarez, R. F. Baldonedo, I. G. Bear, J. A. S. Solís, P. álvarez, and J. I. Jorge, “Incarcerated groin hernias in adults: presentation and outcome,” Hernia, vol. 8, no. 2, pp. 121–126, 2004.
[26]
D. C. Lewis, C. G. Moran, and K. D. Vellacott, “Inguinal hernia repair in the elderly,” Journal of the Royal College of Surgeons of Edinburgh, vol. 34, no. 2, pp. 101–103, 1989.
[27]
D. V. Young, “Comparison of local, spinal, and general anesthesia for inguinal herniorrhaphy,” The American Journal of Surgery, vol. 153, no. 6, pp. 560–563, 1987.
