Serum neurone-specific enolase concentrations in patients with neurological disorders

A radioimmunoassay (RIA) has been developed for neurone-specific enolase (NSE) and used to measure serum levels in patients with a range of neurological disorders. Serum NSE levels were within the normal range in 21 patients with multiple sclerosis and 4 patients with Guillain-Barre syndrome. Normal serum NSE levels were also recorded in patients with motor neurone disease, anterior spinal thrombosis, multi-infarct disease, benign intracranial hypertension and peripheral neuropathy. However, two patients in coma, one as a result of encephalitis, the other due to subarachnoid haemorrhage (SAH) had elevated serum NSE. In the former, serum NSE levels appeared to predict a deterioration in clinical state, levels later returning to normal before an improvement in clinical condition. In the patient with SAH, levels were elevated on admission and remained elevated until death. Serum NSE levels may be of use in predicting outcome in patients with acute neurological disease.     

Serum neurone-specific enolase as an indicator of stroke volume

Serum neurone-specific enolase (NSE) and computerized tomography (CT) stroke volume were compared in patients admitted within 24 h of an acute stroke. Serum samples were obtained on admission and daily for the next 4 days. Of 163 patients, CT scans revealed 25 with intracerebral haemorrhages, one haemorrhagic infarct and 83 measurable acute infarcts. The serum NSE levels of those with infarcts was significantly higher than in those with haemorrhages at 48 ( P  = 0.0003) and 72 h ( P  = 0.04). The maximum serum NSE value tended to occur later in those with large infarcts ( P  = 0.0035). There was a significant correlation between infarct volume and serum NSE at 48 h ( r  = 0.27, P  = 0.015) and 96 h ( r  = 0.27, P  = 0.015) and with the maximum serum NSE over the 4 days ( r  = 0.36, P  = 0.001). There was no significant correlation between haemorrhage volume and NSE. In conclusion, serum NSE may be a useful marker of infarct volume in studies of therapy in acute stroke. Sampling for NSE should continue, at least in those with large infarcts, for longer than 4 days. Serum NSE cannot be used to distinguish between haemorrhage and infarction in patients with an acute stroke.     

急性CO中毒患者血清神经元特异性烯醇化酶的变化及临床检测意义

目的 探讨急性CO中毒患者血清神经元特异性烯醇化酶(NSE)的变化及临床检测意义.方法 采用ELISA法测定102例急性CO中毒入院时血清NSE浓度,对其中76例急性CO中毒患者于治疗30 d后再次复查血清NSE浓度,比较治疗前后血清NSE浓度变化. 结果病例组血清 NSE浓度较对照组明显增高,差异有统计学意义(P<0.001);治疗后明显下降(P=0.003),与对照组比较差异无统计学意义(P>0.05).结论 血清NSE测定可作为反映急性CO中毒患者中毒程度及预后的参考指标.     

Serum cholesterol levels in neutropenic patients with fever.

Hypocholesterolemia, which often accompanies infectious diseases has been suggested to serve as a prognostic marker in hospitalized patients. Even though patients with chemotherapy-induced leukopenia are at high risk of infection and mortality, only limited information is available on serum cholesterol levels in these patients. We therefore measured serum cholesterol levels in 17 patients with hematological malignancies during chemotherapy-induced neutropenia and correlated it with clinical outcome. Patients with fever (>38.5 degrees C) showed a significant decrease in serum cholesterol levels within 24 hours. Eight days after onset of the fever non-survivors had significantly lower serum cholesterol levels (median 2.09 mmol/l, range 0.49-2.79, n=6) compared to survivors (median 3.23 mmol/l, range 1.68-4.86, n=11). Cholesterol levels in survivors returned to baseline levels at the time of discharge from the hospital. At the onset of fever, serum levels of inflammatory cytokines interleukin-6, tumor necrosis factor (TNF) and soluble TNF receptors p55 and p75 were elevated in all patients, but only TNF and TNF receptor p75 levels were significantly different in survivors and non-survivors. Our data suggest that a decrease in serum cholesterol levels is a prognostic marker in neutropenic patients with fever. Release of inflammatory cytokines may in part be responsible for hypocholesterolemia in these patients.     

Serum neurone specific enolase (NSE) levels as an indicator of neuronal damage in patients with cerebral infarction

A radioimmunoassay has been developed and used to measure serum neurone specific enolase (NSE) concentrations in 24 patients, following cerebral infarction. A significant correlation between cerebral infarct volume and maximum serum NSE concentration was observed (P = 0.047). Serum NSE was also assayed at times 24, 48, 72 and 96 h post ictus. At 72 h a significant correlation existed between serum NSE levels and infarct volume (P = 0.012), and levels appeared to be approaching statistical significance at 48 h (P = 0.067). No correlation existed at 24 and 96 h. In addition serum concentrations of NSE were compared to clinical outcome as determined by the Glasgow Outcome Score. Using the Mann-Whitney U test, there was no significant difference in maximum NSE level between patients graded 1-3 on the Glasgow Outcome Score and those graded 4 and 5. However, further studies are required on a larger population to more completely assess this. NSE may prove to be a useful marker of neuronal damage in the study of stroke, with particular application in the assessment of treatment.     

Serum cholesterol levels in patients with cancer

Epidemiological surveys indicate an inverse relationship between cancer occurrence and serum cholesterol. Low serum cholesterol might be either a risk factor for cancer or the effect of factors associated with cancer itself, such as biological properties of malignant cells, tumor mass, and poor nutritional status. We have measured serum cholesterol in 975 selected patients admitted to our hospital; 496 (272 males, 224 females) had solid tumors and 479 (253 males, 226 females) had non-neoplastic diseases. Serum cholesterol was positively correlated with body mass index, serum albumin, hemoglobin, and cholinesterase in both cancer and non-cancer subjects. Cholesterol was significantly lower in cancer patients than in age- and sex-matched non-cancer subjects. After adjustment for nutritional variables (analysis of covariance), the difference in cholesterol level between cancer and non-cancer subjects lost statistical significance in all but patients with tumors of the upper gastrointestinal tract. No difference was found in adjusted mean serum cholesterol between cancer patients subdivided according to the extension of the tumor was defined by the TNM system. In patients with solid tumors, serum cholesterol seems to be more related to the nutritional status than the presence and extension of cancer.     

Atrophic gastritis and gastric carcinoid tumours

During recent decades an increasing number of case reports have pointed at a relation between atrophic gastritis type A and gastric carcinoid. This relation has now been quantitatively documented in endoscopic screening studies. Among patients with pernicious anaemia the prevalence of gastric carcinoid was 2-9%. Many of these carcinoids, however, remain subclinical. The majority are broadbased polypoid tumours. Most are situated in the gastric body or fundus. Of 95 patients with atrophic gastritis and gastric carcinoid reported in the literature, 60 (63%) had multicentric tumours and 13 (14%) lymph node and/or hepatic metastases. Microscopically, the tumours, which are frequently of the enterochromaffin-like cell type, show various structural differentiations, glandular differentiation indicating malignant potential. Purely intramucosal carcinoids have been described. The precurser lesion to such "early carcinoids", as well as to infiltrating carcinoids, is probably hyperplasia of endocrine cells in the atrophic fundic mucosa. Such hyperplasias, whether nodular or diffuse, are quantitatively related to hypergastrinaemia, which is a typical feature of antrum sparing (type A) atrophic gastritis. Most tumours can be treated endoscopically, although antrectomy with abolition of hypergastrinemia may be the definitive treatment. It seems that the risk of developing gastric carcinoid 'per se' does not justify regular gastric screening in patients with type A atrophic gastritis. However, as these patients also run an increased risk of developing several benign diseases, gastric adenocarcinoma, and probably also pancreatic malignancy, regular survey in selected cases is indicated.     

Determination of urine neuron-specific enolase levels in neuroblastoma patients

Urine levels of neuron-specific enolase were determined in 3 neuroblastoma patients (1 in an advanced state and 2 in remission), 25 control children, 37 control adults and 4 children with hematuria by means of the double-antibody inhibition radioimmunoassay specific to the gamma subunit of enolase isozymes. The levels of neuron-specific enolase mean +/- S.D. ng/creatinine mg in an advanced neuroblastoma patient were elevated (1.25 +/- 0.29 before or after treatment and range 1.61-74.2 during treatment) when compared with those of control subjects (0.51 +/- 0.26 in children and 0.36 +/- 0.17 in adults). The levels in 2 neuroblastoma patients in remission were within normal range. Urine samples with hematuria were not used for the assay.     

血清神经元特异性烯醇化酶对重型颅脑损伤患者功能预后的评价

目的颅脑损伤后伤情及功能预后的评估目前尚缺乏一种可靠的生化指标。通过对重型颅脑损伤患者的血清神经元特异性烯醇化酶(NSE)进行动态检测,旨在探讨NSE与重型颅脑损伤患者功能预后的关系。方法选择苏州大学附属第三医院神经外科2001-01/06重型颅脑损伤(GCS≤8)患者41例,男32例,女9例,年龄19～92岁,平均45岁。正常对照组20例,男10例,女10例,年龄20～52(平均33)岁,均经本院健康体检无异常。应用ELISA法测定41例重型颅脑损伤(GCS≤8)患者血清NSE并动态观察其变化的规律。结果预后不良的患者NSE初始值及峰值犤(66±10)μg/L,(94±14)μg/L犦均明显高于预后良好患者犤(32±4)μg/L,(34±4)μg/L犦,t值分别为3.090,4.207,P<0.01。初测NSE>60μg/L者,预后不良为75%(6/8),初测NSE<60μg/L者,预后良好为85%(28/33),χ2=22.586,P<0.001;初测NSE与预后负相关,r=-0.501,P<0.01。预后良好患者NSE值3d内迅速降至正常,而预后不良患者NSE值可持续高达5d以上;NSE持续高(初测NSE>60μg/L,下降缓慢)或继发性升高(初测NSE<60μg/L,NSE峰值>60μg/L)的患者预后不良占90%(9/10),NSE持续低(初测NSE<60μg/L)或迅速下降(初测NSE>60μg/L)的患者预后良好占94%(29/31),χ2=22.797,P<0.001。结论重型颅脑损伤后急性期血清NSE水平     

Serum vaspin and adiponectin levels in patients with prolactinoma

Background: Studies investigating serum vaspin and adiponectin levels in patients with prolactinoma are inconclusive. The aim of this study was to evaluate serum vaspin and adiponectin levels in patients with prolactinoma and healthy controls. Methods: A total of 42 prolactinoma patients (Group 1, 21 patients; Group 2, 21 patients) and 30 healthy controls were enrolled in the study. Group 1 consisted of newly diagnosed patients who were never treated or had not received a dopamine agonist (DA) within 6 months prior to screening. Group 2 consisted of prolactinoma patients who were on DA treatment for at least 6 months at the time of screening. The control group (group 3) consisted of healthy controls. Results. Patients with prolactinoma had higher homeostasis model assessment of insulin resistance and lower quantitative insulin sensitivity check index values in comparison to healthy controls (p?p?p?p?>?0.05) and 5.041 (1.191–21.339; p?Conclusion: This is the first study to demonstrate the presence of low vaspin levels in patients with prolactinomas. Further studies are needed to help establish the roles of vaspin and adiponectin in prolactinoma patients.     

Serum levels of progesterone in patients with preeclampsia

In a matched pair-study study we investigated the hitherto controversially discussed serum levels of progesterone in 40 women with severe preeclampsia (PE) and 40 normotensive controls. Serum levels were determined by applying a sandwich enzyme-linked immunosorbent assay (ELISA). Median serum levels of progesterone in preeclamptic women and in controls were not statistically significant (P = 0.73). Our study indicates that the absence of altered serum levels of progesterone may not reflect the potential role of this hormone in preeclampsia.     

Serum zinc levels and urinary zinc excretion in patients with renal transplants.

An investigation into serum and plasma zinc levels and the urinary excretion of zinc in renal allotransplant patients was undertaken. A remarkable number (53%) of low serum and plasma levels of zinc was obtained as well as a distinct increase (37%) in urinary excretion in the 33 patients investigated. Because of the general tendency in these cases to depletion of body stores of zinc, oral supplementation may prove of value.     

Primary hepatic carcinoid tumours: clinical features with an emphasis on carcinoid syndrome and recurrence

This study sought to determine the clinical profiles and optimal management of primary hepatic carcinoid tumours. The clinical features of nine Chinese patients and 64 patients reported in the English-language literature were characterized. Recurrence rate and survival analysis were performed with the Kaplan-Meier method. The impact of surgical resection and post-operative recurrence on survival was determined by means of the log-rank test. Carcinoid syndrome complicated 10 cases (14%). Sixty-two patients (85%) underwent surgical resection. Actuarial 5- and 10-year survival rates for resected patients were 80% and 75%, respectively. Twelve patients experienced recurrences: the recurrence rate at 5 years post-operatively was 26%. All patients with resectable recurrent disease achieved good long-term survival and no significant relationship was found between recurrence and survival. Owing to the high incidence of recurrence, long-term follow-up is necessary and it is recommended that recurrent cases should be managed with judicious surgical resection.     

Serum sulfate levels in patients with cystic fibrosis

Patients with cystic fibrosis (CF) secrete copious amounts of mucous material which is viscous, tends to accumulate in the respiratory tract and contains larger than normal amounts of sulfate. The present investigation was designed to measure sulfate levels in the serum of patients with cystic fibrosis by ion chromatography of protein-free serum aliquots. The level of inorganic sulfate in the serum of non-cystic fibrosis pediatric patients averaged 0.29 ± 0.03 mmol/l while patients suffering from cystic fibrosis had an average serum sulfate value of 0.27 ± 0.03 mmol/l which was not significantly different from controls. No differences were observed in serum sulfate levels among males and females of either group of patients. There was a tendency for serum sulfate levels to decrease with age, but there was no statistically significant difference in serum sulfate levels between cystic fibrosis patients and normals as a function of age. These findings indicate that the highly sulfated mucoid materials secreted by cystic fibrosis patients are not reflected in abnormal serum sulfate levels.     

Serum antioxidant and cholesterol levels in patients with different types of cancer.

Serum antioxidant (urate, alpha-tocopherol) activity and cholesterol concentration in 142 patients of Indian and Arab (Kuwaitis and other Arabs) origin with different types of cancer (breast, colon, stomach, thyroid, oral, rectal, pancreatic, and renal) were compared to 100 age- and sex-matched control subjects. Values were expressed as medians (interquartile range). Urate concentration was significantly decreased in male patients compared to male controls (P < 0.0001) and in female patients and female breast cancer cases compared to female controls; P < 0.0001 and P = 0.001, respectively. Alpha-tocopherol concentration decreased significantly in total cancer, stomach, colon, rectal, and breast cancer cases than the controls; P < 0.0001, P < 0.0001, P < 0.0001, P = 0.012, and P = 0.022, respectively. Cholesterol concentration decreased significantly in stomach, oral, colon, and total cancer cases compared to the controls; P < 0.0001, P < 0.0001, P = 0.002, and P = 0.012, respectively. Among controls, females had significantly (P < 0.0001) lower concentrations of alpha-tocopherol than males. Among patients, cholesterol, urate, and alpha-tocopherol concentrations decreased significantly in smokers than in nonsmokers; P < 0.0001, P = 0.004, and P = 0.047, respectively. Generally, changes in alpha-tocopherol/cholesterol ratios mimicked changes in alpha-tocopherol concentration. Concentrations of all parameters decreased significantly in male patients compared to male controls. Age was positively associated with all three analytes with respect to the controls. Alpha-tocopherol correlated with cholesterol in cancer patients (r = 0.367; P < 0.0001) and with urate in the controls (r = 0.342; P < 0.0001). The data suggest cancer-related diminished synthesis of cholesterol and, generally, a greater antioxidant burden for alpha-tocopherol than urate in cancer-generated oxidative stress. The increased incidence of pancreatic cancer in Kuwaitis warrants further study.     

High levels of immunoreactive nervous system-specific enolase in sera of patients with neuroblastoma

Serum levels of nervous system-specific enolase (NSE, γγ form plus ay form) in patients with neuroblastoma and in control subjects were determined with a sensitive solid-phase sandwich enzyme immunoassay system. Serum levels of NSE in healthy adults ranged from 1.4–5.7 ng/ml (2.87 ± 1.18 ng/ml, n = 20), and in control children (1–7 years old) from 2.6 to 10.8 ng/ml (5.76 ± 2.42 ng/ml, n = 20). Serum samples (n = 13) from patients with neuroblastoma contained high levels of NSE, range 13.6 to 330 ng/ml (mean 96 ng/ml); however those (n = 7) from ganglioneuroblastoma patients were within a normal range (3.0–25.0 ng/ml; mean 8.3 ng/ml). These results suggested that the NSE in serum might be a valuable marker substance for screening and therapeutic monitoring of neuroblastoma.     

Serum prolactin levels in eighty patients with sarcoidosis

Serum prolactin levels were measured by radioimmunoassay in eighty patients (thirty-four males, forty-six females) with sarcoidosis before treatment. In twelve patients (15%) serum prolactin levels were more than two standard deviations above the mean of normal subjects. Hyperprolactinaemia was found most frequently (22%) in patients with radiological stage II; however, 14% of patients with stage I also had elevated serum prolactin levels. In most cases serum prolactin levels fell to within the normal range after treatment with corticosteroid in parallel with improvement of intrathoracic lesions. These findings suggest that hyperprolactinaemia may be due to hypothalamic involvement by sarcoid granulomata. We conclude that the measurement of basal serum prolactin levels using radioimmunoassay is a sensitive and practical method for screening patients with sarcoidosis for hypothalmic lesions.