Macro CK type 1 as a marker for autoimmunity in coronary heart disease

In a group of 3000 hospital patients the prevalence of immunoglobulin bound creatine kinase (macro CK type 1) was 4.3%. The relative frequency was greater in the older age categories. The highest prevalence was found in patients with rheumatic and cardiac diseases.

In a group of 556 cardiac patients selected for coronary angiography a prevalence of 13.8% was observed. No significant correlation was obtained between the findings of the coronary angiography and the activity of macro CK type 1. CK MB results determined by ion-exchange or immuno-inhibition techniques in macro CK type 1 positive patients are falsely positive. Macro CK type 1 may be seen as an antigen-antibody complex against CK BB, which originates at least partly from the vascular wall.     

病毒性肝炎患者CK,CK—MB及CK—MB／CK总活力百分比的研究

对107例病毒性肝炎(以下简称肝炎)患者血清CK、CK-MB水平及CK-MB/CK总活力百分比进行了检测,并与正常人对照,发现肝炎患者血清CK总活力平均水平比正常人明显下降(P<0.001);CK-MB均值与正常人无显著差异.对临床不同型别肝炎及不同程度黄疸分组作进一步研究发现,各组CK总活力水平无显著差异(P>0.05),但CK-MB/CK总活力百分比有显著差异(P<0.01),它们是:慢重肝>肝硬化失代偿>慢活肝>急性肝炎>慢迁肝;高黄疸>低黄疸>无黄疸;这一比值随肝损害程度加重而呈进行性上升,可能反映了肝炎并发心脏的损害。     

Macro CK in patients with elevated troponin I levels

CK-MB activity levels can be falsely elevated by the presence of macro CK, especially if immune-inhibition assays are used in the measurement. In patients with macro CK and cardiac pathology that could result in an elevated CK-MB activity, the diagnostic challenge lies in determining the true cause of the elevated CK-MB activity. We present two case reports of patients with elevated CK-MB activity and troponin I levels, but who subsequently had CK-MB activity higher than total CK activity, raising the suspicion of the presence of macro CK.     

Glycogenosis type IV as a seldom cause of cardiomyopathy - report about a successful heart transplantation]

We report about a 17 year old male patient with a cardiomyopathy secondary to type IV glycogenosis (Andersens disease) and class II immunoglobulin deficiency who underwent cardiac transplantation.The patient first developed symptoms of heart failure at the age of twelve. The histologic diagnosis was cardiomyopathy secondary to glycogenosis. In addition, the patient suffered recurrent pulmonary infections and developed bronchiectases in the left lower lobe. This region was atelectatic since he was eleven.The patient did have two younger brothers who died of congestive heart failure at the age of nine and ten. Neither his parents nor anybody else of his relatives had a history of heart failure or glycogenosis. Since the patient suffered recurrent cardiac decompensations with the need for catecholamines he was accepted for cardiac transplantation although several relative contraindications to transplantation such as cachexia, myopathy, immunglobulin deficiency and bronchiectases had been present. The patient was transplanted successfully. The postoperative weaning from the respirator was markedly prolonged and complicated by pulmonary infection. Furthermore, mobilization was retarded. One year after transplantation, he is in a good condition without pulmonary or systemic infection. Right ventricular endomyocardial biopsies did not show recurrence of glycogenosis in the donor organ.     

Hepatocellular carcinoma as a leading cause of cancer-related deaths in Japanese type 2 diabetes mellitus patients

Journal of Gastroenterology - We reported a cross-sectional study on causes of liver injury in Japanese type 2 diabetes mellitus (T2D) patients (JG 2013). We assessed overall and cause-specific...     

Reduction of CK and CK-MB enzyme levels as indicators of infarct size by intravenous nitroglycerin (author's transl)

Intravenous nitroglycerin has beneficial effects on hemodynamics and on myocardial ischemia. The aim of the present study was to investigate whether it also reduces final infarct size. In 60 patients with myocardial infarction serial blood samples were tested for creatine kinase (CK) and its isoenzyme CK-MB activity for infarct size calculations. Hemodynamic parameters were measured every 4 hours. Patients were randomized to a control (n = 29) and a nitroglycerin group (n = 31). In the early intervention group continuous perfusion of nitroglycerin for 48 hours was started < 8 hours (mean 4.5 hours) after onset of symptoms, and in the late intervention group > 8 hours (mean 12.8 hours) after onset of symptoms. In early intervention (n = 22) peak CK activity was 871 U/l in control patients and 544 U/l (p < 0.05) in the nitroglycerin group. The rate of CK release was reduced from 79 to 33 U/l x h, i.e. by a total of 58%, as was total CK and CK-MB release (p < 0.02). Calculated CK infarct size was 69 g equiv. in controls and 48 g equiv. in the nitroglycerin group. (CK-MB: 68 versus 43 g equiv., p < 0.05). In late intervention (n = 28) the differences were less pronounced. Nitroglycerin reduced left ventricular filling pressure significantly and increased cardiac output. Blood pressure changed insignificantly and peripheral vascular resistance decreased. In conclusion, nitroglycerin reduces CK and CK-MB release and hence calculated infarct size, particularly when treatment is begun within the first 8 hours after onset of symptoms.     

Hemorrhagic erosion as a cause for gastrointestinal hemorrhages]

It is necessary in clinical diagnosis more than hitherto done to take into consideration haemorrhagic erosions as the most frequent cause of gastrointestinal haemorrhages. They are found as concomitant diseases of certain basic diseases, whereby the spectre of causes deviates in adults and children. In adults dominate heart insufficiency and cerebral diseases including skull-brain trauma, in children, however, infections of the respiratory and digestive tract, followed by cerebral affections and haemoblastoses. A differentiation concerning age and sex cannot be proved.     

Dramatic increase in bilirubin after ERCP - pethidine as a possible cause of drug-induced hepatitis

We report on a 68-year-old female patient who was admitted with abdominal pain. Elevated lipase and CRP caused us to suspect pancreatitis. Because an enlarged pancreas head was found on ultrasound, an endoscopic retrograde cholangio- and pancreaticography was performed with a pethidine-containing premedication. Thereafter, bilirubin, gamma-glutamyl transpeptidase and alkaline phosphatase increased dramatically. There was also a moderate elevation of aspartate aminotransferase and alanine aminotransferase. A second endoscopic retrograde cholangio- and pancreaticography with the same premedication was performed in order to exclude an undetected concretion. This led to a further increase of bilirubin. An association with the drugs given as premedication was therefore suspected, and in fact, a hypersensitivity reaction towards pethidine was confirmed by the lymphocyte transformation test. We thus conclude that pethidine caused an immunologically mediated hepatic injury.