Creatine kinase isoenzymes in human cerebrospinal fluid and brain

Extracts of normal brains obtained at autopsy and cerebrospinal fluid (CSF) from patients with global brain ischemia were analyzed for creatine kinase (CK; EC 2.7.3.2) isoenzymes. We used both qualitative and quantitative assays (electrophoresis and immunoinhibition). Brain extracts contained CK-BB isoenzyme and mitochondrial CK. In 54 CSF samples free of blood contamination and with total activities ranging from 7 to 2010 U/L (mean 202 U/L), virtually all of the CK activity was due to CK-BB, and none to CK-MM or CK-MB. We conclude that brain contains CK-BB and mitochondrial CK, but lacks CK-MM and CK-MB. After cardiac arrest, CK-BB is released into the CSF. Any CK-MM in the CSF is probably from blood contamination, in which case immunoinhibition with anti-CK-M antibodies accurately quantifies CK-BB.     

Stabilization of creatine kinase isoenzymes in the cerebrospinal fluid in cranio-cerebral trauma

Stabilization with dithiothreitol, together with optimization of Mg2+ and EDTA concentrations in the reaction mixture and storage of the CSF samples for 24 hrs at +4 degrees C, has been carried out for the first time to improve the sensitivity of the technique for measuring the activities of creatine kinase (CK) and its isozymes in the CSF of 38 patients during the first 24 hrs of craniocerebral injury. Dithiothreitol promoted mostly an increase of the CK-BB isozyme; the content of this isozyme in the cerebral tissue is rather high, and it is considered as the cerebral tissue marker. Generally stabilization augmented the CSF total CK activity by 2.2 times on an average (from 50.6 to 113.2 U/l), and the CK-BB activity by 3.5 times on an average (from 21.6 to 74.8 U/l). The method used in this work will help improve the diagnostic sensitivity of the CSF CK-BB measurements, this being significant for the detection of the cerebral tissue minute injuries after traumas and neurosurgery.     

Bioluminescence assay of creatine kinase and its isoenzymes in serum and cerebrospinal fluid.

We examined the sensitivity of bioluminescence for the determination of very low concentrations of creatine kinase brain-type subunit (CK-BB) in serum and in cerebrospinal fluid. To optimize the sensitivity of CK-isoenzyme assays and eliminate possible sources of error, we separated the isoenzyme fractions by using inhibiting anti-MM and precipitating anti-MM and anti-BB antibodies. The results with the bioluminescence assay correlated with spectrophotometric values such that r = 0.97 for the total CK activity and r = 0.98 for the CK-B activity. The reproducibility of the present method was comparable with the spectrophotometric method and was even better at low enzyme activities. The within-series precision for assay of total CK activity at 2 U/L corresponded to a CV of 9%; at 13 U/L the CV was 5.8%. All the assays were carried out at 25 degrees C. Even at this low temperature, CK activities as low as 0.2 U/L could be determined. In eight patients without any evidence of cerebral cell damage, total CK activity in cerebrospinal fluid was x = 1.05 +/- 0.6 U/L, and CK-BB activity was x = 0.7 +/- 0.4 U/L. In sera of these patients CK-BB activity was x = 0.6 +/- 0.5 U/L. Differences in CK and CK-BB activities in four patients with transient or progressive brain-cell damage are discussed.     

Elevated serum CK-BB levels in patients with cerebral transtentorial herniation after ischemic stroke

We examined the time course of CK and its isoenzymes in 15 patients with severe ischemic stroke. Patients with cerebral transtentorial herniation (n = 7) had the highest CK-BB activity during herniation (1.54 +/- 0.6 U/L, mean +/- SD; range: 1.0-2.6 U/L). These values were distinctly above the values of a control group of 20 patients with non-neurological diseases (0.39 +/- 0.2 U/L, mean +/- SD). In patients with smaller lesions without herniation (n = 8) the maximum CK-BB increase was lower (0.56 +/- 0.26 U/L, mean +/- SD).     

Adenylate kinase activity in the cerebrospinal fluid of hypoxic newborns

Adenylate kinase (AK) activity in the cerebrospinal fluid (CSF), described as a marker of brain edema and lesions in adults, was studied in 79 newborns with severe respiratory distress within 24 h after admission to the Intensive Care Unit (ICU). The CSF-AK activity was compared with CSF lactate concentration, CSF lactate dehydrogenase activity (LDH), and CSF and serum creatine kinase isoenzyme BB (CK-BB) activity. Newborns were divided into Group I with moderate to severe brain dysfunction and Group II with mild or no detectable brain dysfunction on discharge from the ICU. Mean CSF-AK activity (11.31 U/L) in Group I was significantly (p less than 0.001) higher than in Group II (2.82 U/L). Correlation between CSF-AK and CSF lactate was r = 0.714, p less than 0.01 and between CSF-AK activity and CSF-LDH activity was r = 0.550, p less than 0.01 in Group I. Preliminary data indicate that CSF-AK activity within 24 h after ischaemia is an indicator of hypoxic brain lesions in newborns. Its prognostic value for the infant's development remains to be determined by further study.     

成年人脑脊液CK,AST,LDH和GPx活性检测对脑血管病的鉴别诊断价值

目的 研究脑脊液(CSF)肌酸激酶(CK)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)和谷胱甘肽过氧化物酶(GPx)四种酶的活性水平变化对脑血管病的鉴别诊断价值。方法 利用日立7600全自动生化分析仪检测脑血管病患者、疾病对照组(颅脑损伤、脑出血和颅内感染)及健康对照组CSF上述四种酶的活性水平。结果 脑血管病、颅脑损伤、脑出血、颅内感染的CK,AST和LDH酶活性均有不同程度升高,其中LDH在脑血管病患者CSF中升高最为显著(P<0.05),其诊断界值为79.37 U/L(P<0.05),约登指数为0.673; GPx仅在脑血管病患者CSF中出现显著降低(P<0.05),其诊断界值为13.56 U/L(P<0.05),约登指数为0.648; CK和AST在脑血管病患者鉴别诊断中无显著性诊断价值(P>0.05)。结论 CSF中LDH和GPx在脑血管病的诊断与鉴别诊断及评估损伤和氧化应激状态中具备潜在价值,值得进行更大标本量和更多疾病种类的研究。     

Mitochondrial and cytoplasmic isoenzymes of aspartate aminotransferase in sera of patients after myocardial infarction

Mitochondrial and cytoplasmic isoenzymes of aspartate aminotransferase (AST) were studied in the sera of 42 patients following acute myocardial infarction and compared to creatine kinase (CK), lactate dehydrogenase (LDH) and alanine aminotransferase (ALT). Mitochondrial AST( ASTm ) was detected in 93% (39/42) of patients. Maximum recorded ASTm activity was 59.5 +/- 8.8 U/l and was found 39.4 +/- 3.5 hours after the onset of symptoms (chest pain) of myocardial infarction. In contrast the maximum recorded cytoplasmic AST ( ASTc ) activity was greater (327 +/- 23 U/l) and it occurred earlier (33.5 +/- 2.2 hours) after onset of infarction compared to ASTm . ASTm correlated significantly (p less than 0.05) with ASTc , LDH and ALT but not with total CK or CK-MB. ASTc correlated significantly (p less than 0.05) with total CK, CK-MB and LDH but not ALT. Maximum recorded ASTm activity was significantly associated with the clinical assessment of left ventricular failure ( Killip classification) but not with ventricular arrhythmias. In a subset of 15 patients evaluated with invasive hemodynamic measurements of cardiac output and pulmonary capillary wedge pressure. ASTm correlated significantly (p less than 0.05) and better than CK-MB with the hemodynamic assessment of left ventricular dysfunction. Thus ASTSm can be readily identified in sera of patients after acute myocardial infarction and may be of value in the evaluation of patients with acute myocardial infarction.     

Differences in oxygen content between mixed venous blood and cerebral venous blood for outcome prediction after cardiac arrest

Objective To assess the usefulness of differences in oxygen content between mixed venous blood and cerebral venous blood for predicting neurological outcome after cardiac arrest. Design Observational study. Setting Medical-surgical intensive care unit (IUC) in a university hospital. Patients and participants 34 acutely comatose patients who had been admitted to the ICU after cardiac arrest and successful cardiopulmonary resuscitation, classified according to outcome (group A, brain death; group B, vegetative state; group C, neurological recovery). Measurements and results Between 6 and 18h (mean 12±16.3 h) after hemodynamic stability and 24h later, the patient's neurological status was assessed by means of the Glasgow Coma Scale and blood gas analysis, partial pressure of O₂, oxygen content in venous blood from the jugular bulb and mixed venous blood, O₂ saturation, and lactate and creatine kinase activity (CK) in CSF were determined. Group C patients had significantly lower lactate and CK levels in CSF as compared with patients in groups A and B. Mean oxygen content in mixed venous blood was higher than that in cerebral venous blood in group C patients, whereas the opposite was found in patients with unfavourable outcome. A positive difference in oxygen content between mixed venous blood and cerebral venous blood showed a sensitivity of 95%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 92% for predicting recovery of consciousness. Conclusions Differences between oxygen content of blood samples from the pulmonary artery and the jugular bulb is a simple measurement that has provided good accuracy in the outcome prediction of brain damage after cardiac arrest treated by resuscitation.     

N末端脑钠肽前体与心肌酶谱联合检测在心力衰竭诊断及预后分析中的应用

目的探讨N末端脑钠肽前体(NT-proBNP)与心肌酶谱联合检测在心力衰竭(HF)诊断中的应用价值。方法选择2019年5月-2020年1月徐州医科大学附属第三医院收治的76例HF患者作为HF组,另外选择同期76例健康体检者作为健康对照组。比较两组的血清NT-proBNP、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(HBD)、肌酸激酶(CK)和肌酸激酶同工酶(CK-MB)水平。根据美国纽约心脏病学会(NYHA)心功能分级划分HF患者的病情严重程度等级,并对患者进行随访,观察预后,比较不同NYHA分级和不同预后患者的血清NT-proBNP、LDH、HBD、CK、CK-MB水平,分析上述指标与HF患者NYHA分级和不良预后的相关性。结果 HF组NT-proBNP、LDH、HBD、CK、CK-MB水平均明显高于健康对照组〔NT-proBNP(ng/L):534.02±73.24比68.91±8.29,LDH(μmol·s^-1·L^-1):5.81±0.79比2.67±0.53,HBD(U/L):319.82±41.08比95.31±13.29,CK(U/L):286.61±57.18比90.34±15.07,CK-MB(U/L):58.82±6.05比12.06±3.04,均P<0.05〕;NYHA分级≥Ⅲ级患者的NT-proBNP、LDH、HBD、CK、CK-MB水平均明显高于NYHA分级<Ⅲ级的患者〔NT-proBNP(ng/L):718.04±74.52比345.39±61.05,LDH(μmol·s^-1·L^-1):7.52±1.03比4.15±0.76,HBD(U/L):398.35±48.67比224.08±26.71,CK(U/L):388.26±61.08比179.74±30.43,CK-MB(U/L):78.61±9.07比39.34±5.82,均P<0.05〕;预后不良患者的NT-proBNP、LDH、HBD、CK、CK-MB水平均明显高于预后良好患者〔NT-proBNP(ng/L):759.35±79.17比291.24±56.82,LDH(μmol·s^-1·L^-1):8.04±1.12比3.79±0.67,HBD(U/L):410.04±51.81比209.18±24.86,CK(U/L):411.95±63.72比158.63±28.54,CK-MB(U/L):86.05±10.82比35.08±5.29,均P<0.05〕。Pearson相关性分析显示,NT-proBNP、LDH、HBD、CK、CK-MB与HF患者NYHA分级和不良预后均呈正相关(均P<0.05)。结论 NT-proBNP、LDH、HBD、CK、CK-MB联合检测在HF诊断中具有较高的应用价值,并能为患者病情及预后分析提供指导。     

Creatine kinase and lactate dehydrogenase isoenzymes in stage D prostatic carcinoma

Serum creatine kinase (CK) and lactate dehydrogenase (LD) isoenzymes were determined electrophoretically, along with various other biochemical markers of malignancy, in 19 patients with metastatic carcinoma of the prostate. Mitochondrial CK appeared in 15 patients, the CK-BB isoenzyme in 6. As a result, CK activity not inhibited by anti-M-subunit antibodies, CK non-M, was above the reference value in altogether 17 patients. There was a cathodic shift among the LD isoenzymes, significantly more prominent with increasing total LD, and a positive correlation between elevations of CK non-M and LD-5, suggesting a relation to tumour burden for both. An LD 'flip' (LD-1 greater than LD-2) was present in 10/15 patients. The frequency of CK non-M elevations was similar to--but not quantitatively correlated with--elevations of prostatic acid phosphatase and alkaline phosphatase. Thus, changes in CK and LD patterns are frequent in patients with prostatic cancer and must be taken into consideration when acute cardiac symptoms are evaluated in such patients.     

Transient increase in serum creatine kinase isoenzyme BB activity after prostatectomy in a patient with massive benign prostatic hyperplasia

The activity of creatine kinase isoenzyme BB (CK-BB) in serum is rarely abnormally high (i.e., detectable). An increase in immunoreactive CK-BB or CK-BB activity in patients with prostatic disease has been proposed as an indication of prostatic adenocarcinoma. Here we report the case of an elderly man with massive benign prostatic hyperplasia but no clinical or pathological evidence of prostatic adenocarcinoma, whose serum CK-BB activity was found by agarose gel electrophoresis to be 1 U/L (normal: 0%), 10% of his total CK activity. Serum CK-BB activity was further increased to 16 U/L (20% of total CK activity) 1 h after prostatectomy, but became undetectable by the second day after the operation. The findings suggest that: (a) the source of the serum CK-BB activity was the enlarged prostate gland; (b) abnormally high CK-BB activity in serum of men with prostatic disease does not necessarily indicate the presence of prostatic adenocarcinoma; and (c) myocardial injury could be erroneously diagnosed postoperatively in prostatectomy patients if CK isoenzyme methods are used that do not consistently separate "heart-specific" CK-MB from CK-BB.     

SARS患者的肝脏损害

目的　研究严重急性呼吸综合征 (SARS)患者肝脏功能和肝组织病理学的变化 ,探讨 SARS患者肝脏损害的可能机制及其临床意义。方法　依据中华人民共和国卫生部诊断标准 ,选择 2 0 0 3年 2— 6月收治的 SARS患者 110例检测肝脏功能 ,其中 8例死亡者行肝组织病理学检查 ;并与健康体检者 35例进行比较。结果　 SARS组患者血清丙氨酸转氨酶 (AL T)、天冬氨酸转氨酶 (AST)、总胆红素 (TBil)、乳酸脱氢酶(L DH)水平均显著高于对照组 ,分别为 (91.6 1± 5 0 .5 3) U/ L 比 (32 .91± 10 .5 6 ) U/ L,(78.6 8± 33.32 ) U/ L 比(2 9.4 3± 8.89) U/ L,(11.6 7± 4 .2 6 ) μmol/ L 比 (8.4 4± 3.86 ) μmol/ L,(42 9.95± 188.94 ) U/ L 比 (2 0 0 .83±4 4 .86 ) U / L ,P均 <0 .0 0 1;白蛋白 (AL B)和前白蛋白 (PAB)均明显低于对照组 ,分别为 (34.4 0± 5 .13) g/ L比(42 .0 9± 6 .79) g/ L和 (0 .2 0± 0 .0 6 ) g/ L比 (0 .34± 0 .0 5 ) g/ L ,P均 <0 .0 0 1;血清直接胆红素 (DBil)、总胆汁酸 (TBA)、γ谷氨酰转肽酶 (GGT )、碱性磷酸酶 (AL P)水平与对照组无差异 (P均 >0 .0 5 )。 AL T、AST、GGT、L DH变化范围较大 ,为正常范围 4～ 9倍 ,其余各项变化范围较小。AL T、AST和 PAB异常率达 80 .0 %以上 ,AL     

Neurotensin-induced hypothermia improves neurologic outcome after hypoxic-ischemia

OBJECTIVE: External cooling is commonly used to force induction of mild hypothermia but requires equipment, has a slow onset of action, and must be prolonged to provide permanent neurologic benefits after hypoxic-ischemia. It is unknown whether the method for inducing mild hypothermia affects neurologic outcome after near-drowning. The objective of the study was to induce mild hypothermia with neurotensin analog NT77 or external cooling in a rat model of near-drowning. We hypothesize that NT77 would be more effective for improving neurologic outcome than external cooling of the same duration. DESIGN: Rats were randomized to a normothermic control, neurotensin-induced hypothermia, brief external cooling, or prolonged external cooling group after asphyxial cardiac arrest. SETTING: Laboratory investigation. SUBJECTS: Forty-eight rats. INTERVENTIONS: Mild hypothermia was induced by external cooling for 4 hrs (brief external cooling) or 24 hrs (prolonged external cooling) or by neurotensin-induced hypothermia administration 30 mins after asphyxial cardiac arrest in rats. MEASUREMENTS: Outcome was assessed by a neurologic deficit score, the Morris water maze, and CA1 hippocampus histology 15 days after resuscitation. MAIN RESULTS: Neurologic deficit score at 72 hrs after asphyxial cardiac arrest was lower with neurotensin-induced hypothermia (score, 0) and prolonged external cooling (score, 0) vs. normothermic control (score, 20) and brief external cooling (score, 18; p <.05). Latency time in the Morris water maze 15 days after asphyxial cardiac arrest was decreased with neurotensin-induced hypothermia (14+/-11 secs) and prolonged external cooling (18+/-9 secs) vs. normothermic control (74+/-17 secs) and brief external cooling (78+/-18 secs, p <.05). There was less ischemic neuronal damage with neurotensin-induced hypothermia (28+/-24%) and prolonged external cooling (21+/-14%) vs. normothermic control (61+/-32%) and brief external cooling (51+/-32%). CONCLUSIONS: Neurotensin-induced hypothermia improved neurologic outcome after asphyxial cardiac arrest in rats vs. brief external cooling but was comparable to prolonged external cooling.     

The effect of cardiopulmonary bypass resuscitation on cardiac arrest induced lactic acidosis in dogs

The adequacy of end organ blood flow following a cardiac arrest varies depending on the artificial reperfusion technique utilized and may critically affect patient outcome. Both oxygen consumption (VO2) and arterial lactate values have previously been used to assess tissue perfusion. Cardiopulmonary bypass resuscitation (CPB) is a reperfusion technique capable of providing near normal end organ blood flow. The purpose of this investigation was to study the effect of femoro-femoral veno-arterial CPB resuscitation compared to standard CPR on VO2 and arterial lactic acid values after a prolonged cardiac arrest. Ten mongrel dogs were electrically fibrillated and left in cardiopulmonary arrest without therapy for 12 min. Resuscitation was attempted according to a standardized protocol utilizing either CPB (n = 5) or standard external CPR (n = 5). Oxygen consumption values and arterial lactic acid samples were obtained at baseline, at timed intervals throughout resuscitation and after return of spontaneous circulation in successfully resuscitated dogs. Baseline hemodynamic and biochemical measurements were similar in both treatment groups (P greater than 0.05). Oxygen consumption (440 +/- 50 ml/min/M2) and mean arterial lactic acid values (7.44 +/- 2.25 mmol/l) were significantly higher at 1 min of resuscitation in CPB-treated dogs compared to dogs treated with CPR (60 +/- 10 ml/min/M2) (3.16 +/- 0.69 mmol/l) respectively (P less than 0.05). Mean arterial lactic acid values rose significantly at each sampling interval during CPR (P less than 0.05) but began to decrease after 5 min of resuscitation in the CPB animals and were not significantly different than baseline after 60 min of bypass (P greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

alpha-tocopherol supplementation reduces the elevated 8-hydroxy-2-deoxyguanosine blood levels induced by training in basketball players.

BACKGROUND: The aim of the present study was to investigate the effect of alpha-tocopherol (alpha-Te) supplementation on DNA oxidative damage induced by heavy training in basketball players. METHODS: Blood was obtained from 10 players before (group A) and after training (group B) and after 1 month on alpha-Te (200 mg/day, orally) supplementation, before (group C) and after training (group D). Total antioxidant status (TAS), muscle enzyme activities and the biomarker of DNA oxidation, 8-hydroxy-2-deoxyguanosine (8-OHdG), were measured using commercial kits. alpha-Te and catecholamine blood levels were determined using HPLC methods. RESULTS: TAS was higher in the groups with alpha-Te (groups C and D). Levels of 8-OHdG and muscle creatine kinase (CK) and lactate dehydrogenase (LDH) were remarkably lower (0.20+/-0.03 ng/mL, 120+/-15 U/L and 430+/-90 U/L, respectively) in the group with alpha-Te (group D) than in group B (0.42+/-0.05 ng/mL, 286+/-12 U/L and 688+/-88 U/L, respectively; p<0.001). 8-OHdG levels were negatively correlated to TAS and positively to CK levels. CONCLUSIONS: alpha-Te supplementation may reduce DNA oxidation induced by training by protecting muscle cell "death" from glutamate entry and/or by elevation of TAS via amelioration of lipid peroxidation.     

Cerebrospinal fluid lactate dehydrogenase as a potential predictor of neurologic outcomes in cardiac arrest survivors who underwent target temperature management

PurposeCerebrospinal fluid (CSF) lactate dehydrogenase (LDH) levels increase in patients with brain injury. We investigated neurologic outcomes associated with CSF LDH levels in out-of-hospital cardiac arrest (OHCA) survivors who underwent target temperature management (TTM).Materials and methodsThis was a prospective single-centre observational study from April 2018 to May 2019 on a cohort of 41 patients. CSF and serum LDH samples were obtained immediately (LDH₀) and at 24 (LDH₂₄), 48 (LDH₄₈), and 72 h (LDH₇₂) after return of spontaneous circulation (ROSC). Neurologic outcomes were assessed at 3 months after ROSC using the Cerebral Performance Category scale.ResultsTwenty-one patients had a poor neurologic outcome. CSF LDH levels were significantly higher in the poor neurologic outcome group at each time point. The area under the curve (AUC) of CSF LDH₄₈ was 0.941 (95% confidence interval [CI], 0.806–0.992). With a cut off value of 250 U/L, CSF LDH₄₈ had a high sensitivity (94.1%; 95% CI, 71.3–99.9) at 100% specificity.ConclusionsCSF LDH level at 48 h was a highly specific and sensitive marker for 3-month poor neurologic outcome. This may constitute a useful predictive marker for neurologic outcome in OHCA survivors treated with TTM.     

Effective lactate clearance is associated with improved outcome in post-cardiac arrest patients

INTRODUCTION: Early, effective lactate clearance has been shown to be associated with improved mortality in patients with trauma, burns, and sepsis. We investigated whether early, high lactate clearance was associated with reduced mortality in post-cardiac arrest patients. METHODS: We performed a retrospective analysis of post-cardiac arrest patients in an urban emergency department. Inclusion criteria included pre-hospital cardiac arrest patients over the age of 18. Exclusion criteria were traumatic arrest, successful resuscitation prior to the arrival of emergency medical services, and cardiac arrest in the presence of pre-hospital providers. Primary endpoints consisted of survival to 24h and survival to hospital discharge. RESULTS: A total of 79 patients were analyzed with a mean age of 64+/-17 and mean APACHE II score of 37.7+/-5. Of the 79 patients, 27 (34%) died within 24h and 66 (84%) died during the hospital course. The mean initial lactate level for the overall group was 15+/-5.2mmol/dl with a mean lactate of 14.4+/-5.1mmol/dl in the survivors and 16+/-5.3mmol/dl in the non-survivors (p>0.05). Lactate clearance at both 6 and 12h was significantly higher for both 24-h and overall in-hospital survival (p<0.05). A multivariable analysis showed that high lactate clearance at 12h was predictive of 24-h survival (p<0.05). CONCLUSIONS: Early, effective lactate clearance is associated with decreased early and overall in-hospital mortality in post-cardiac arrest patients. These findings suggest that post-arrest tissue hypo-perfusion plays in an important role in early as well as overall mortality.     

Effects of pretreatment with propranolol on potassium, calcium, and magnesium shifts after ventricular fibrillation in dogs

Hypokalemia and other electrolyte changes have been observed after resuscitation from ventricular fibrillation. We studied the effect of propranolol on postresuscitation electrolytes in a canine model of ventricular fibrillation and cardiac resuscitation by randomizing 40 anesthetized dogs to four groups: ventricular fibrillation--no drug (VF), ventricular fibrillation--propranolol pretreatment (VF-prop), control-no drug (NoVF), control--propranolol (NoVF-prop). We measured serum electrolytes at baseline and periodically for 3 hours. In VF dogs, serum potassium decreased from 3.9 +/- 0.4 to 3.2 +/- 0.2 mEq/L 60 minutes after resuscitation (p less than 0.001). The decrease in potassium was prevented (p less than 0.001) by propranolol. Serum calcium decreased from 10.6 +/- 0.8 to 10.2 +/- 0.8 mg/dl in VF dogs 15 minutes after resuscitation (p less than 0.05); this decrease was not blocked by propranolol (p = NS). Serum magnesium increased from 1.5 +/- 0.2 to 1.8 +/- 0.1 mEq/L in VF dogs 7 minutes after resuscitation (p less than 0.001); this rise was partially blocked by propranolol (p less than 0.01). Serum glucose increased from 105 +/- 6 to 183 +/- 27 mg/dl in VF dogs 7 minutes after resuscitation (p less than 0.001); this increase was diminished by propranolol (p less than 0.001). Thus propranolol prevents the decrease in serum potassium after ventricular fibrillation in this canine model, providing evidence that postresuscitation hypokalemia is caused by the beta-adrenergic effects of catecholamines secreted in response to cardiac arrest. Propranolol blocks the rise in magnesium and glucose but does not block the decrease in calcium after resuscitation.     

Creatine kinase isoenzymes in the diagnosis of acute cranio-cerebral trauma

The cerebrospinal fluid (CSF) creatine kinase (CK) activity and isozymic spectrum (EC 2.7.3.2) have been examined in patients with craniocerebral injuries of varying severity. The CK activity has been elevated in all the patients. Three isoforms have been detected: CK-BB, CK-MB, and CK-MM. CK-BB has been detected in all the patients in the presence of the total CK activity; this is explained by the isozyme release from the brain tissue during the injury and as a result of functional and structural impairment of the cellular membranes in intensification of lipid peroxidation. The CK-MM activity is due to blood admixture in the CSF and to impaired hematoencephalic barrier during the injury. The presence of CK-MB in the CSF of patients without cardiac symptoms probably results from a recombination of CK-BB and CK-MM isoforms and is of no diagnostic significance. Measurements of the total and isozymic CK activity in the CSF of patients with craniocerebral injuries may become a test for the laboratory diagnosis of the trauma severity and course.     

Arginine vasopressin in advanced cardiovascular failure during the post-resuscitation phase after cardiac arrest

Arginine vasopressin (AVP) has been employed successfully during cardiopulmonary resuscitation, but there exist only few data about the effects of AVP infusion for cardiovascular failure during the post-cardiac arrest period. Cardiovascular failure is one of the main causes of death after successful resuscitation from cardiac arrest. Although the "post-resuscitation syndrome" has been described as a "sepsis-like" syndrome, there is little information about the haemodynamic response to AVP in advanced cardiovascular failure after cardiac arrest. In this retrospective study, haemodynamic and laboratory variables in 23 patients with cardiovascular failure unresponsive to standard haemodynamic therapy during the post-cardiac arrest period were obtained before, and 30 min, 1, 4, 12, 24, 48, and 72 h after initiation of a supplementary AVP infusion (4 IU/h). During the observation period, AVP significantly increased mean arterial blood pressure (58+/-14 to 75+/-19 mmHg, p < 0.001), and decreased noradrenaline (norepinephrine) (1.31+/-2.14 to 0.23+/-0.3 microg/kg/min, p = 0.03), adrenaline (epinephrine) (0.58+/-0.23 to 0.04+/-0.03 microg/kg/min, p = 0.001), and milrinone requirements (0.46+/-0.15 to 0.33+/-0.22 microg/kg/min, p < 0.001). Pulmonary capillary wedge pressure changed significantly (p < 0.001); an initial increase being followed by a decrease below baseline values. While arterial lactate concentrations (95+/-64 to 21+/-18 mg/dL, p < 0.001) and pH (7.27+/-0.14 to 7.4+/-0.14, p < 0.001) improved significantly, total bilirubin concentrations (1.12+/-0.95 to 3.04+/-3.79 mg/dL, p = 0.001) increased after AVP. There were no differences in the haemodynamic or laboratory response to AVP between survivors and non-survivors. In this study, advanced cardiovascular failure that was unresponsive to standard therapy could be reversed successfully with supplementary AVP infusion in >90% of patients surviving cardiac arrest.