Value of heart-type fatty acid-binding protein (H-FABP) for emergency department patients with suspected acute coronary syndrome.

OBJECTIVE: The aim of this study is testing the value of H-FABP in the early diagnosis of ACS alone or with routinely used biomarkers such as myoglobin, CK-MB, and cTn I in patients who admitted to emergency department (ED) with complaint of chest pain and suspected acute coronary syndrome. MATERIAL AND METHODS: This prospective and cross-sectional study was performed at the Emergency Department of University hospital between June 2009 and September 2010. Patients who were admitted with chest pain within first 48 hours and suspected ACS were enrolled to the study. Blood samples were taken for CK-MB, myoglobin, cTnI and H-FABP The patients were divided into two groups (ACS and non ACS). Statistical analyse were used for relation of biomarkers with diagnosis of ACS. RESULTS: A 66 patients were included to the study. H-FAPB values were positive in 15.2% patients. When H-FABP was added to routinely used biomarkers in the diagnosis of ACS, increasing was observed in all sensitivity, specificity, PPV and NPV values. However, this increase was not statistically significant. CONCLUSION: H-FABP did not provide any significant change in early diagnosis and exclusion of ACS diagnosis when used either alone or combination with routinely used biomarkers.

Massive intracranial hemorrhage associated with the ingestion of dimethyl sulfoxide.

Dimethyl sulfoxide (DMSO) has been widely used in the treatment of arthritis and certain inflammatory diseases, and is also considered an alternative remedy for cancer even if not supported by concrete evidence. This report illustrates the first case of a fatal complication following the illicit use of this agent. A 55-y-old man who reportedly ingested 500 mg acetaminophen and approximately 1 ml DMSO solution was brought to the emergency department after experiencing 2 tonic-clonic seizures. He had been diagnosed with lung mesotelioma with brain metastases which caused no neurologic deficit. The ingested DMSO was the first dose within the last 3 mo. Examination revealed right-sided hemiplegia. Unenhanced computed tomography of the head showed 3 hemorrhagic areas with blood-cerebrospinal fluid at the left parietal, occipital and frontal regions accompanied by a midline shift. Despite initial resuscitation, 2 units of fresh frozen plasma and antiedema treatment, the patient experienced cardiac arrest that did not respond to resuscitative measures. DMSO can cause massive intrametastatic hemorrhage, and neurologic deterioration can be profound in patients with metastatic brain lesions.