食管癌三野根治术围术期心肌损伤标志物的变化

目的 了解行三野根治术的食管癌患者围术期心肌损伤标志物的动态变化,评估其监测围术期心肌损伤的价值. 方法 对96例术前心肌损伤标志物正常的食管癌患者,于术前、术毕、术后1～3 d采集静脉血,分别进行谷草转氨酶(AST)、肌酸激酶(CK)、乳酸脱氢酶(LDH)、肌酸激酶MB同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)等心肌损伤标志物的测定,并对检测结果进行统计分析. 结果 7例围术期≥1次血清cTnI水平超过参考值范围,其中4例被确诊为心肌损伤.余89例均未发现心肌损伤,但术后1 d血清AST、LDH、CK及CK-MB均高于术前. 结论 食管癌患者围术期心肌损伤的生化监测首选心肌肌钙蛋白.     

大明胶囊对大鼠心肌梗死预防性保护作用的研究

目的观察大明胶囊对大鼠心肌梗死的预防性保护作用。方法对大鼠预防性给予大明胶囊1wk后,结扎其左冠脉前降支造成心肌梗死。通过测量心肌梗死面积,观察心肌酶学指标、病理形态学和组织超微结构的改变,评价大明胶囊对心肌梗死的预防性保护作用。结果心梗染色面积和心肌酶学指标显示(与模型组相比),大明胶囊灌胃后心肌梗死面积减少(P<0.05),乳酸脱氢酶(LDH)和肌酸激酶(CK)的含量降低(P<0.05)。心肌形态学和超微结构显示,大明胶囊减轻了左冠脉前降支结扎所造成的心肌损伤。结论通过心梗面积、心肌酶学指标、形态学和超微结构的观察,大明胶囊能预防性保护心肌梗死所造成的损伤。这提示大明胶囊可能应用于心肌梗死治疗。     

Elevated aminotransferase as a presenting finding in a patient with occult muscle disease

We report a patient with occult muscle disease who presented with raised serum aminotransaminases. This case report emphasises the importance of considering muscle disease in the differential diagnosis of raised serum aminotransaminases, as it may negate the need for invasive investigations such as liver biopsy.     

Maternal serum creatine kinase does not predict tubal pregnancy

Purpose: Our purpose was to validate prospectively the predictive value of maternal serum creatine kinase in the evaluation of ectopic pregnancy. Methods: Fifty-one consecutive pregnant first-trimester patients who presented for suspected abnormal pregnancy were enrolled. Maternal serum samples were obtained and assayed for creatine kinase. Patients were subsequently evaluated for abnormal pregnancy by serial quantitative hCG levels, transvaginal ultrasonography, and surgery when appropriate. A receiver operating characteristic (ROC) curve was generated comparing intrauterine to extrauterine (ectopic) pregnancy. Results: Of 51 patients, 18 had an ectopic pregnancy, 16 had a spontaneous abortion, and 17 had an ongoing intrauterine pregnancy. The ROC curve revealed that maternal serum creatine kinase had no ability to predict ectopic pregnancy. Conclusions: Maternal serum creatine kinase is not a reliable predictor of tubal pregnancy.Presented at the Forty-Second Annual Meeting of the Society for Gynecological Investigation, March 15–18, 1995, Chicago, Illinois.     

The importance of serum creatine phosphokinase level in the early diagnosis and microbiological evaluation of necrotizing fasciitis

BACKGROUND: Necrotizing fasciitis (NF) due to group A beta-haemolytic streptococci (GAS) is a rare but still life-threatening soft-tissue infection characterized by rapidly spreading necrosis of the muscle fascia and of the surrounding tissues. NF other than that due to GAS involves the participation of one or more anaerobes and/or of non-group A streptococci, Staphylococcus aureus, enteric organisms, and may be associated with a better outcome. Early diagnosis and treatment, consisting of surgical debridement along with appropriate antibiotic therapy, are required to reduce morbidity and mortality rates. OBJECTIVES: The aim of the study was to analyse the clinical and laboratory findings of patients with GAS NF and with non-GAS NF, and to identify which characteristics could help to diagnose NF in the early stages of infection. METHODS: We retrospectively analysed the clinical and laboratory findings of 43 cases of GAS and non-GAS NF that occurred in Belgium (n = 32) and at Saga Medical School (Japan) (n = 11) between May 1984 and December 2001. RESULTS: GAS NF more frequently occurred in previously healthy individuals than NF due to other pathogens (P < 0.05) but was associated with a poorer prognosis. Both for patients with GAS NF and with non-GAS NF, the first clinical manifestations often suggested a diagnosis of erysipelas or cellulitis and rarely evoked the correct diagnosis (12% and 15% of the cases, respectively). However, we found that creatine phosphokinase (CPK) values were far higher in patients with GAS NF than in those with non-GAS NF. CONCLUSIONS: Our data suggest that GAS may exert particular tropism and/or toxicity for muscle, responsible for early muscle necrosis. This indicates that elevated levels of CPK in a patient with erysipelas or cellulitis-like symptoms should clearly prompt the clinician to exclude the diagnosis of GAS NF.     

The predictive value of CKMB mass concentration in unstable angina pectoris: preliminary report.

Unstable angina pectoris is a common clinical problem, and the diagnosis is based on clinical symptoms. However, these symptoms cannot identify high-risk patients. Holter monitoring can identify patients at high risk, but analysis of a large number of patients is time- and resource-consuming, as is angiographic examination. We determined whether creatine kinase MB isoenzyme mass concentration could predict the prognosis for patients with unstable angina pectoris. A total of 101 consecutive patients were studied, and blood samples were collected three times a day for 48 h after admission. Patients with unstable angina and elevated CKMB (but still within the normal range) had a significantly higher risk of developing acute myocardial infarction or requiring revascularization during 6 months of follow-up than patients without elevated CKMB. We conclude that CKMB analysis is a valuable tool that may be of use in selecting high-risk patients with unstable angina pectoris. This finding needs to be confirmed by more extensive studies.     

Dissociation,unfolding and inactivation of creatine kinase in urea solutions

It was previously reported that, during unfolding of creatine kinase in guanidinium chloride or urea solutions, inactivation occured before noticeable conformational change could be detected, suggesting that the conformation at the active site is more easily perturbed and, hence, more flexible than the molecule as a whole [Tsou (1986) Trends Biochem. Sci. 11 , 417–429]. In the present paper, the urea-gradient electrophoresis and the isoenzyme hybrid of creatine kinase has been studied. The results show that at low urea concentrations, creatine kinase is still in the dimeric state or only slightly dissociated. The dissociation and inactivation of creatine kinase during denaturation by urea are also compared. It was found that the enzyme was nearly inactivated in low urea concentrations before noticeable dissociation was detected. It therefore appears that in low urea concentrations, inactivation of creatine kinase is not due to the dissociation of the active dimer. The present result supports the hypothesis of the conformational flexibility of the active site in this enzyme. © Munksgaard 1996.     

Effects of autotransfusion of mediastinal shed blood on biochemical markers of myocardial damage in coronary surgery

BACKGROUND: Previous studies have shown conflicting results regarding the effect of autotransfusion of mediastinal shed blood after coronary artery bypass grafting (CABG) on the serum levels of myocardial band (MB) isoenzymes of creatine kinase (CK-MB) and cardiac troponins. The effect of autotransfusion on serum levels of human heart fatty acid binding protein (H-FABP), another marker of myocardial necrosis, has not been studied. The aim of the present study was to investigate the effects of autotransfusion of mediastinal shed blood on the serum levels of CK-MB, cardiac troponin T (cTnT), and H-FABP after uncomplicated primary CABG. METHODS: Fifty patients were randomized to post-operative autotransfusion of mediastinal shed blood or no autotransfusion. Blood samples for the analysis of the biochemical markers of myocardial damage were drawn pre-operatively and 1, 4, 12, 24, 48, and 72 h after the termination of cardiopulmonary bypass. Samples from the mediastinal shed blood were collected after 1 and 4 h. RESULTS: The levels of the biochemical markers of myocardial injury were all markedly elevated in mediastinal shed blood. Autotransfusion did not significantly affect the serum levels of cTnT or H-FABP. However, during the early post-operative hours, there was a trend towards a higher level of cTnT and H-FABP in the autotransfusion group. During the first 24 h after surgery, the autotransfusion group had a significantly higher serum level of CK-MB. CONCLUSION: Post-operative autotransfusion of mediastinal shed blood may contribute to elevated serum levels of biochemical markers of myocardial injury.     

Inclusion body myositis

The clinical features of inclusion body myositis (IBM) were of minor importance in the design of consensus diagnostic criteria, mainly because of controversial views on the specificity of signs and symptoms, although some authors reported "typical" signs. To re–assess the clinical spectrum of IBM, a single investigator using a standard protocol studied a cohort of 64 patients cross–sectionally. Symptom onset was before the age of 50 years in 20% of cases. Only a few patients (14 %) started with weakness other than that of quadriceps, finger flexor or pharyngeal muscles. The sequence of power loss was erratic, but onset of symptoms with quadriceps weakness predicted an earlier onset of dysphagia in older patients (≥ 56 years) compared with younger ones (< 56 years) (p = 0.02). Despite widespread weakness patients had favourable scores on three commonly used function scales and they kept their employment. Complete wheel–chair dependency was rare (3 %). A dominant characteristic was the anatomical distribution of afflicted muscles: ventral extremity muscle groups were more affected than dorsal muscle groups and girdle muscles were least affected, the latter preserving postural stability. Ankylosis, especially in extension of the fingers,was frequently present. Together with the sparing of intrinsic hand muscles it was helpful in the preservation of many skilful movements. IBM has a unique distribution of muscle weakness. Ankylotic contractures are common. We feel that their joint impact on daily functioning is characteristic for the disease.