Cholinesterase Concentration Research Articles

Effect of normal and pre-eclamptic pregnancies on plasma cholinesterase in Nigerian women

Background: Pre-eclampsia can be devastating and life-threatening for both mother and baby, particularly in developing countries. It is a major cause of maternal and foetal mortality and morbidity. Early diagnosis and management are very important to the reduction of mortality and morbidity. A sensitive diagnostic and prognostic marker will therefore be of great value. There is paucity of data on the effect of pre-eclamptic pregnancy on plasma cholinesterase activity especially in Nigerians. Objective: Our aim was to determine the changes in plasma cholinesterase concentration in normal and pre-eclamptic pregnancies in Nigerians. Setting: Antenatal Clinic and Prenatal Diagnostic and Therapy Centre in a Tertiary University Teaching Hospital in Lagos. Patients and Methods: Plasma cholinesterase concentration was determined using a colorimetric method in 30 healthy non-pregnant, 30 healthy pregnant, 30 and 27 pregnant women with mild and severe pre-eclampsia, respectively, between 28 and 41 weeks of gestation. Cholinesterase activity was re-assessed 6 weeks postpartum. Results: The mean plasma cholinesterase levels in healthy non-pregnant women, women with normal pregnancy, pregnant women with mild pre-eclampsia and those with severe pre-eclampsia were 3594±1042, 2135±422, 1781±330 and 1630±326 (m/L), respectively. Six weeks postpartum, the mean cholinesterase levels in the normal pregnant, mild eclamptic and severe eclamptic groups were 3212±346, 3157±750 and 2864±700 (/L), respectively. Conclusions: Our study suggests that normal pregnancy, mild and severe pre-eclampsia cause a significant (p< 0.01) reduction in plasma cholinesterase activity compared to non-pregnant state, with the greatest decrease in severe pre-eclamptic pregnancy. This decline does not return to normal non-pregnant state in subjects with severe pre-clampsia within six weeks postpartum. The place of plasma cholinesterase concentration as a diagnostic and prognostic marker in pre-eclamptic and eclamptic pregnancies should be further explored. Keywords: Cholinesterase, Eclampsia, Pre-eclampsia, Pregnancy, Succinylcholine.

A snack enriched with oral branched-chain amino acids prevents a fall in albumin in patients with liver cirrhosis undergoing chemoembolization for hepatocellular carcinoma

Nutritional support may play an important role in management of liver cirrhosis (LC) associated with unresectable hepatocellular carcinoma (HCC). Total protein and albumin deteriorate in patients with LC undergoing trans-arterial chemoembolization (TACE). Therefore, in this study, we examined the hypothesis that short-term administration of branched-chain amino acids (BCAA) will prevent a fall in total protein and albumin in the perioperative period. The subjects were 56 patients who underwent TACE for HCC between 2004 and 2005 at Nagasaki University Hospital. The patients were randomly placed in the BCAA group (n = 28) or a control group (n = 28). The patients in the BCAA group consumed a snack containing 50 g of BCAA once a day at 10:00 pm starting 1 day before TACE and continuing until 2 weeks after TACE. A comparison of baseline and end point data showed greater decreases in the concentrations of total protein, albumin, cholinesterase, and total cholesterol and in the red blood cell count in the control group compared to the BCAA group. Ammonia levels decreased in the BCAA group and increased in the control group. Our findings indicate that a BCAA supplement taken orally as a late evening snack prevents suppression of liver function by TACE in patients with LC complicated with HCC during the 2-week period after TACE.

Technetium-99m-GSA clearance in mice under long-term dietary restriction

Dietary restriction (DR) without malnutrition is widely acknowledged to prolong lifespan in laboratory animals. Evidence suggests that DR retards age-related decline in protein turnover of most organs. However, there has been no report about hepatic serum glycoprotein catabolism under DR. In the current study, we evaluate the hepatic uptake of asialoglycoprotein in ICR mice with DR by measuring the plasma clearance of technetium-99m galactosyl human serum albumin (Tc-GSA). The amount of food supplied to the restricted mice was 70% of that consumed by the mice fed ad libitum (AL). The regimen was initiated at the age of 7 weeks and terminated after the age of 44 weeks. The plasma clearance of Tc-GSA was measured at the age of 7 weeks, 14 weeks, 28 weeks, and 42 weeks. The restricted animals showed a marked decrease in their body and liver weight, and hepatic uptake of Tc-GSA per liver weight in the restricted mice was greater than that in the mice fed AL. On the other hand, the Tc-GSA plasma clearance in the mice fed AL was stable during the study period, and that in the restricted mice showed no change with age either, and those in the two groups were similar. In addition to the receptor function, there was no difference in the expression of mRNAs of the asialoglycoprotein receptor between the two groups. Serum concentrations of cholinesterase and hepatic mRNAs of glutamine synthetase in the restricted mice were higher than those in the mice fed AL. Serum levels of amino acids in the restricted mice were lower than those in the mice fed AL. The data presented here show that the DR did not affect the capacity of hepatic serum glycoprotein catabolism, whereas several protein metabolic pathways were affected.

The relation of plasma cholinesterases to response to clinical doses of succinylcholine

The plasma cholinesterase of a normal adult is capable of destroyingin vitro up to 120 mg. per minute of succinylcholine chloride. This great speed of destruction cannot be obtainedin vivo, yet the normal plasma cholinesterase can effectively cope with a considerable excess of succinylcholine. The rate of destruction of succinylcholine for any given concentration of succinylcholine is proportional to the concentration of plasma cholinesterase. On slow intravenous infusion of succinyldicholine, the plasma cholinesterase must be assumed always to cause an accumulation of succinylmonocholine so that the concentration of succinylmonocholine exceeds by about 40 times the concentration of succinyldicholine. It is not yet clear whether this accumulation of succinylmonocholine is prevented by factors other than plasma cholinesterase, or whether this accumulation escapes clinical detection. In order to exert its action at the neuromuscular junction, succinylcholine must enter the extravascular space where it is not exposed to plasma cholinesterase. Thus one cannot expect die esterase to be responsible for all abnormal reactions towards succinylcholine. The sera of three patients are described, in these cholinesterase activity towards succinylcholine is too low to be measured. In all three cases the esterase has some peculiarities which are not fully explained. In one of these patients injection of 5 mg. of succinylcholine chloride was found to cause profound relaxation and 15 minutes’ apnoea.

Hubungan status pestisida dengan status gangguan akibat kekurangan yodium (GAKY) anak SD pada daerah endemik GAKY Kabupaten Dairi

Background: Thyroxin plays important role in the metabolism of carbohydrate, protein and cholesterol, and in the process of growth. Iodine deficiency disorder not only can be caused by lack of iodine substance but also another competition factor, which is a pollutant substance which is goitergenic (pesticide). This goitergenic substance interferes hormonogenesis of thyroid causing enlargement of thyroid gland known as goiter.Objective: This study was aimed at examining the relationship between status of pesticide and status of iodine deficiency disorders (urinary iodine excretion) of elementary school children and the difference between them based on level of their endemic in Dairi District.Methods: This was an observational study using a cross-sectional design. Palpation of thyroid gland was made to determine the level of endemic; concentration of blood cholinesterase was determined using tinto meter kit; urinary iodine excretion was analyzed with the ammonium persulfate digestion method. Data was analyzed with chi square and anova.Results: Chi square test indicated that the relationship between the concentration of blood cholinesterase and urinary iodine excretion was significant (p&lt;0.05) with OR 11.1 and the relationship between concentration of cholinesterase and iodine deficiency disorders (palpation) was not significant (p&gt;0.05) with OR 1.3. Anova test, based on endemic, indicated that there was a significant difference between the concentration of blood cholinesterase and urinary iodine excretion (p&lt;0.05).Conclusion: There was significant relationship between status of pesticide (concentration of blood cholinesterase) and status of iodine deficiency disorder based on urinary iodine excretion and there was no significant relationship between concentration of cholinesterase and iodine deficiency disorders based on the result of palpation. There was a difference in the average status of pesticide and iodine deficiency disorders status among the elementary school children based on their endemic.

Prognostic Factors of Organophosphate Poisoning Between the Death and Survival Groups

In this prospective case series study, we consider the different factors between death and survival groups of organophosphate poisoning. Patients in tertiary-care medical center who had been exposed to organophosphate were included in the study. Pralidoxime (PAM) was discontinued after atropine had controlled the clinical situation. We recorded the demographic data, amount of organophosphate consumption, duration of coma, duration of ventilator use, duration of hospitalization, findings of chest X-ray, white blood cell count, acetylcholinesterase concentration, plasma cholinesterase concentration, total atropine amount, duration of atropine use, total PAM amount, duration of PAM use, urine organophosphate peak concentration, duration of urine organophosphate and mortality rate. Urine was collected every 8 hours and was analyzed by gas chromatography equipped with a flame photometric detector and gas chromatography with mass spectrometer detector for organophosphate determination. The urine organophosphate peak concentration was recorded. Wilcoxon rank sum test was used to compare the factors between death and survival groups. Fisher's exact test was used to compare the different findings of chest X-ray between the death and survival groups. Evidently, the death group had a higher amount of organophosphate consumption, duration of coma, and higher white blood cell count than those in the survival group. Also, the death group had lower duration of hospitalization, and decreased concentrations of acetylcholinesterase and plasma cholinesterase. Total PAM amount use and duration of PAM use were lower. However, the duration of ventilator use, findings of chest X-ray, total atropine amount, duration of atropine, urine organophosphate peak concentration and duration of urine organophosphate were similar in both groups. The mortality rate of our 50 cases was 20%. As stated earlier, the cases of the death group had insufficient PAM therapy. The maximum duration of PAM use was shorter than the maximum duration of urine organophosphate, although the medians of duration of PAM use were more than the medians of duration of urine organophosphate in both the survival and death groups. Prolonged coma duration, lower level of acetylcholinesterase and lower level of plasma cholinesterase were related to the poor prognosis of the patients.

Cholinesterase and monoamine oxidase activity in relation to mercury levels in the cerebral cortex of wild river otters

Mercury (Hg) is a global pollutant that is neurotoxic to many mammalian species. The present study was conducted to determine if the bioaccumulation of Hg by wild river otters (Lontra canadensis) could be related to variations in the activities of key neurochemical enzymes. River otters were collected from Ontario and Nova Scotia (Canada) during the trapping seasons, spanning 2002-2004, and their brains were dissected into the cerebral cortex and cerebellum. The activities of cholinesterase (ChE) and monoamine oxidase (MAO) were measured from each sample and correlated with concentrations of brain Hg from the same animal. Significant negative correlations were found between concentrations of brain Hg and ChE (total Hg: r= -0.42; MeHg: r= -0.33) and MAO (total Hg: r= -0.31; MeHg: r= -0.42) activity in the cerebral cortex. The scatterplots relating concentrations of brain Hg and enzyme activity in the cerebral cortex were wedge-shaped, and could be fitted with quantile regression modeling, suggesting that Hg may act as a limiting factor for ChE and MAO activity. No relationships were found in the cerebellum. These data suggest that environmentally relevant concentrations of Hg may influence the activities of ChE and MAO in the cerebral cortex of river otters, and by extension, other fish-eating mammals.

Open-heart surgery in patients with liver cirrhosis

This retrospective study was designed to examine morbidity and mortality rates and to find predictors of outcome in patients with liver cirrhosis (LC) undergoing open-heart surgery. Between May 1996 and June 2005, 24 patients with LC underwent an open-heart surgery in our institution. There were 14 females and 10 males. Their age ranged from 36 to 72 (average 53+/-13) years. Seventeen cases were classified as having Child-Pugh class A cirrhosis, six as having class B cirrhosis, and one as having class C cirrhosis. The mean cardiopulmonary bypass (CPB) time and the cross-clamp time were 160+/-53 and 90+/-42 min, respectively. In the first 24h after operation, the mean chest tube output was 1080+/-320 ml. Mean duration of mechanical ventilation was 32+/-22 h and mean intensive care unit stay time was 11+/-8 days. Sixty-six percent of the patients experienced significant morbidity. Fifty-three percent of patients with class A cirrhosis and 100% of those with class B and C cirrhosis suffered postoperative complications. The overall mortality rate was 25%. Postoperative mortality of patients with Child-Pugh class A cirrhosis, class B cirrhosis, and C cirrhosis were 6, 67, and 100%, respectively. Preoperative serum total bilirubin (TB), cholinesterase (ChE), and CPB time were defined as predictors to differentiate survivors and nonsurvivors. Child-Pugh class is related to morbidity and mortality after open-heart surgery in patients with LC. But CPB surgery is associated with higher morbidity and mortality in patients with advanced LC. The increased serum level of TB and the low serum concentration of ChE preoperatively, and the prolonged CPB time were found to be predictors of outcome in patients with LC undergoing open heart surgery.

Open-Heart Surgery in Patients with Liver Cirrhosis: Indications, Risk Factors, and Clinical Outcomes

Background: Because of recent advances in cardiopulmonary bypass (CPB) surgery, there are broadened indications to approach patients with a high operative risk. Meanwhile, there is an increasing number of patients with severe liver dysfunction subjected to open-heart surgery. This retrospective study was designed to evaluate the operative indications and clinical outcomes in patients with liver cirrhosis (LC) undergoing open-heart surgery. In addition, determinants influencing their prognosis were assessed. Patients and Methods: Between May 1996 and June 2005, 24 patients with LC underwent CPB open-heart surgery in our institution. The preoperative severity of the LC was determined according to the Child-Pugh classification. Their perioperative data were analyzed. Several perioperative factors were compared by multivariate logistic regression analysis between survivors and nonsurvivors to determine possible risk factors contributing to mortality. Results:There were 14 females and 10 males. Their age ranged from 36 to 72 (mean 53 ± 13) years. Seventeen cases were classified as having Child-Pugh class A LC, 6 as having Child-Pugh class B, and 1 as having Child-Pugh class C LC. All patients underwent CPB surgery. The mean operation time and the cross-clamp time were 160 ± 53 and 90 ± 42 min, respectively. During the first 24 h after the operation, the mean chest tube output was 1,080 ± 320 ml. The mean duration of mechanical ventilation was 32 ± 22 h, and the mean intensive care unit stay was 11 ± 8 days. Sixty-six percent of the patients experienced significant morbidity. Fifty-three percent of the patients with Child-Pugh class A LC and 100% of those with Child-Pugh class B and C LC suffered postoperative complications. The overall mortality rate was 25%. The postoperative mortality rates of the patients with Child-Pugh class A, B, and C LC were 6, 67, and 100%, respectively. Preoperative serum total bilirubin and cholinesterase levels and EuroSCORE (European System for Cardiac Operative Risk Evaluation) values along with CPB time were identified as the important predictors to differentiate between survivors and nonsurvivors by multivariate logistic regression analysis. Conclusions: The Child-Pugh class is associated with hepatic decompensation and mortality after open-heart CPB surgery in patients with LC. Such surgery can be performed safely in patients with a Child-Pugh class A LC. But cardiac interventions using CPB in patients with more advanced LC are associated with high mortality and morbidity rates. The preoperative total plasma bilirubin and cholinesterase concentrations as well as the EuroSCORE along with the CPB time are identified as statistically significant predictors of mortality after open-heart surgery in patients with LC. Our findings indicate that patients with chronic liver disease scheduled for open-heart surgery should be carefully evaluated before the operation and that the CPB duration should be as short as possible.

Lipid peroxidation is enhanced in Yusho victims 35 years after accidental poisoning with polychlorinated biphenyls in Nagasaki, Japan

Thirty-five years have passed since the accidental poisoning with polychlorinated biphenyls (PCB) in Japan and yet high concentrations of PCB are still detected in the serum of the victims. PCB produces superoxide and thus victims are considered to be in a persistent state of oxidative stress. Urinary concentrations of 8-isoprostane (8IP) in the victims and age-matched controls were measured to assess this hypothesis. The mean urinary concentration of 8IP was significantly higher than that in the controls. There was a positive correlation between urinary 8IP and serum concentrations of cholinesterase. It was considered that Yusho is an oxidative stress and 8IP is a useful tool for checking the oxidative condition in Yusho victims.

Serum Cystatin C for the Prediction of Glomerular Filtration Rate With Regard to the Dose Adjustment of Amikacin, Gentamicin, Tobramycin, and Vancomycin

Dosage regimes of aminoglycosides and vancomycin are modified according to the glomerular filtration rate (GFR). In 130 hospitalized patients who were administered amikacin, gentamicin, tobramycin, and vancomycin by intermittent intravenous infusion, we compared the predicted GFR values from the serum concentrations of creatinine (Cockcroft and Gault. Nephron. 1976;16:31-41) and cystatin C (Larsson et al. Scand J Clin Lab Invest. 2004;64:25-30) with respect to their relevance for proper dosage. In 83% and 67% of the cases, respectively, the serum levels of albumin and cholinesterase were below the corresponding lower limit of the reference range. The ratio of creatinine/cystatin C concentrations presented significant correlations with the predicted rate of creatinine production (r=0.762, P<0.001), serum albumin concentration (r=0.205, P<0.05), and catalytic serum concentrations of cholinesterase (r=0.207, P<0.05), gamma glutamyltransferase (r=-0.273, P<0.01), and alkaline phosphatase (r=-0.289, P<0.01). The GFR (mean+/-SD; median) predicted by the serum creatinine (84.0+/-35.1 mL/min/1.73 m; 82.6 mL/min/1.73 m) was significantly higher (P<0.001) than that predicted by the serum cystatin C (53.1+/-30.2 mL/min/1.73 m; 44.9 mL/min/1.73 m). The ratio between the GFR values predicted by creatinine and cystatin C had a highly significant negative correlation with the rate of creatinine production (r=-0.912, P<0.001). Furthermore, significant differences were found for the peak concentrations and clearances of amikacin and vancomycin estimated by means of the Abbottbase Pharmacokinetic Systems program, and using the GFR values predicted by the serum creatinine and cystatin C (P<0.005). In patients with hepatic dysfunction, the clearance of creatinine predicted by the Cockcroft-Gault formula leads to a significant overestimation of the GFR. Cystatin C seems to be a valid alternative as a GFR marker with regard to drug dose adjustment in these cases.

Cardiac Toxicity from 3% 2-Chlorprocaine

Drs. Shroff and Mayhew are concerned that the epidural loading dose of 3% 2-chloroprocaine was too large because plasma cholinesterase concentrations are reduced in neonates and infants.1However, the half-life of 2-chloroprocaine is of such short duration that increasing the dose has no significant clinical impact on complications. In our case report, we reported the half-life of chloroprocaine to be 1–4.5 min.2However, others have reported the plasma half-life to be less than 60 s.3,4Plasma chloroprocaine concentrations have been measured in pediatric patients receiving continuous epidural infusions. Former preterm infants undergoing inguinal hernia repair received loading doses of 1 ml/kg 2-chloroprocaine, 3% (30 mg/kg), via an indwelling caudally placed epidural catheter and were then given infusions at a minimum rate of 30 mg · kg−1· h−1.5The mean cumulative dose of 2-chloroprocaine infused over 95 ± 35 min was 84 ± 30 mg · kg−1· h−1. The plasma chloroprocaine concentrations were 0 mg/ml in four patients and 0.5 mg/ml in one patient, and there was no evidence of neurotoxicity or cardiovascular toxicity.5Suggested loading doses of epidurally administered 2-chloroprocaine in the pediatric regional literature have ranged from 30 to 60 mg/kg.3,4Based on the above data, the loading dose of 30 mg/kg was clearly appropriate. However, as we highlighted in our case report, pediatric epidurals should be tested before administration of a loading dose of local anesthetic to minimize the risk of unintentional intravascular injections and subsequent toxicity.* University of Pittsburgh School of Medicine, The Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania. cladfp@anes.upmc.edu

Evaluation of cholinesterase level in an endemic population exposed to malathion suspension formulation as a vector control measure.

The manuscript describes a study on the blood cholinesterase (ChE) level in an exposed population at different interval of time after spraying with malathion suspension (SRES) use for kala-azar vector control in an endemic area of Bihar, India. The toxicity of a 5% malathion formulation in the form of a slow release emulsified suspension (SRES) was assessed by measuring serum ChE levels in spraymen and in the exposed population. The study showed a significant decrease in ChE levels in the spraymen (p < 0.01) after one week of spraying and in exposed population one week and one month after of spraying (p < 0.01), but was still within the normal range of ChE concentration, one year after spraying, the ChE concentration in the exposed population was the same as prior to spraying (p > 0.01). On no occasion was the decrease in ChE level alarming. A parallel examination of the clinical status also showed the absence of any over toxicity or any behavioural changes in the exposed population. Hence, it may be concluded that 5% malathion slow release formulation, SRES, is a safe insecticide for use as a vector control measure in endemic areas of kala-azar in Bihar, India so long as good personal protection for spraymen is provided to minimize absorption and it can substitute the presently used traditional DDT spray.

Habitual binge/purge behavior influences circulating ghrelin levels in eating disorders

Previous studies have reported that fasting plasma ghrelin concentrations play an important role in the pathophysiology of eating disorders. The purpose of this study was to examine the relationship between plasma ghrelin levels and frequency of abnormal eating behaviors, nutritional parameters in eating disorders. Fasting blood samples were obtained in 40 female anorexia nervosa (AN) patients, 21 restricting type (AN-R) and 19 binge-eating/purging type (AN-BP), in 31 bulimia nervosa (BN) patients, 18 purging type (BN-P) and 13 nonpurging type (BN-NP), in 15 female healthy volunteers (control) before the initiation of active treatment. The fasting plasma ghrelin concentrations in all subjects were negatively correlated with nutritional parameters such as body mass index, percent body fat and serum cholinesterase concentration. The mean plasma ghrelin level in BN-P was higher than that in both BN-NP and controls despite similar nutritional parameters. The plasma ghrelin levels in both AN-R and AN-BP did not differ from BN-P despite difference of nutritional parameters. For both AN-BP and BN-P patients with habitual binge/purge behavior, there were significant correlations among plasma ghrelin values, frequencies of binge/purge cycles and serum amylase values. In BN-NP, there were no significant correlations among plasma ghrelin values, frequencies of binge-eating episodes and serum amylase values. These results suggest that habitual binge/purge behavior may have some influence on circulating plasma ghrelin levels in both BN-P and AN-BP. Habitual binge/purge cycles with vomiting as opposed to binge-eating episodes without vomiting may have a greater influence on fasting plasma ghrelin concentration in eating disorders.

Cholinesterase Activity in Female Greenhouse Workers—Influence of Work Practices and Use of Oral Contraceptives

Cholinesterase Activity in Female Greenhouse Workers—Influence of Work Practices and Use of Oral Contraceptives: Jesper B Nielsen, et al. Environmental Medicine, University of Southern DenmarkObjectivesAssociations between serum butyryl cholinesterase activity in female greenhouse workers and information from a questionnaire on work, use of personal protective equipment, and lifestyle were evaluated.MethodsData were gathered for 571 female greenhouse workers by means of a questionnaire and serum cholinesterase analyses (butyrylthiocholin‐assay).ResultsThe mean concentration of butyryl cholinesterase in serum was 6.50 kU/l. Serum butyryl cholinesterase activity was significantly decreased by the use of oral contraceptives (p&lt;0.001). Among women with re‐entry intervals less than 24 h, serum butyryl cholinesterase activities were significantly reduced. Within this group of women, only those not using gloves during the manual handling of plant cultures had significantly reduced serum butyryl cholinesterase activities (p=0.028).ConclusionsUse of oral contraceptives is an important confounder in studies on serum butyryl cholinesterase activity. If re‐ entry intervals were below 24 h, serum butyryl cholinesterase activity was significantly inhibited, but use of gloves protected the women from such exposures.

Independent effects of intestinal parasite infection and domestic allergen exposure on risk of wheeze in Ethiopia: a nested case-control study

Why asthma is rare in rural subsistence societies is not clear. We tested the hypotheses that the risk of asthma is reduced by intestinal parasites or hepatitis A infection, and increased by exposure to dust-mite allergen or organophosphorus insecticides in urban and rural areas of Jimma, Ethiopia. From 12876 individuals who took part in a study of asthma and atopy in urban and rural Jimma in 1996, we identified all who reported wheeze in the previous 12 months, and a random subsample of controls. In 1999, we assessed parasites in faecal samples, Der p 1 levels in bedding, hepatitis A antibodies, serum cholinesterase (a marker of organophosphorus exposure), total and specific serum IgE, and skin sensitisation to Dermatophagoides pteronyssinus in 205 cases and 399 controls aged over 16 years. The effects of parasitosis, Der p 1 level, hepatitis A seropositivity, and cholinesterase concentration on risk of wheeze, and the role of IgE and skin sensitisation in these associations, were analysed by multiple logistic regression. The risk of wheeze was independently reduced by hookworm infection by an odds ratio of 0.48 (95% CI 0.24-0.93, p=0.03), increased in relation to Der p 1 level (odds ratio per quartile 1.26 [1.00-1.59], p=0.05), and was unrelated to hepatitis A seropositivity or cholinesterase concentration. In the urban population, D pteronyssinus skin sensitisation was more strongly related to wheeze (9.45 [5.03-17.75]) than in the rural areas (1.95 [0.58-6.61], p for interaction=0.017), where D pteronyssinus sensitisation was common, but unrelated to wheeze in the presence of high-intensity parasite infection. High degrees of parasite infection might prevent asthma symptoms in atopic individuals.

Spectral analysis of systemic arterial pressure and heart rate signals of patients with acute respiratory failure induced by severe organophosphate poisoning.

Spectral analysis of systemic arterial pressure (BP) and heart rate (HR) signals may be an alternative prognostic tool for predicting patient outcome in the intensive care unit (ICU). We evaluated the applicability of the same analysis in the emergency department for predicting mortality in patients with acute respiratory failure induced by severe organophosphate poisoning. Prospective collection of data from 14 emergency service patients. Emergency service at a large, university-affiliated medical center. Consecutive patients who, after attempting suicide by ingesting organophosphates, were admitted to the ICU of the emergency service with acute respiratory failure and remained for > or =2 days None. Demographic and survival data and day 1 Acute Physiology and Chronic Health Evaluation (APACHE) II and Glasgow Coma Scale scores were recorded. Continuous, on-line, real-time spectral analysis of BP and HR signals was carried out during the first 12 hrs after admission. We then computed the total sum of power density during this period of the low-frequency (0.04-0.15 Hz) and very low-frequency (0.004-0.04 Hz) components in the BP and HR spectra, along with the averaged values of mean BP and HR. Eight patients who recovered exhibited vigorous power in the low-frequency and very low-frequency components of their BP and HR signals. There was a significant reduction in the power density of those four spectral components in three patients who eventually died. Three patients discharged in a vegetative state manifested significantly reduced power in the low-frequency component in their BP spectra, with maintained power in the other three spectral components. APACHE II and Glasgow Coma Scale scores of the recovered patients were discernibly different from those of patients who eventually died or who became vegetative. None of the 14 patients showed appreciable differences in mean BP, mean HR, erythrocyte or plasma cholinesterase concentration, or atropine requirement during the first 24 hrs. The low-frequency and very low-frequency components of BP and HR signals may be a sensitive alternative index for early prediction of mortality in patients with acute respiratory failure induced by severe organophosphate poisoning.

Tissue Concentration of Platelet-Derived Endothelial Cell Growth Factor in Colorectal Cancer

Background: Angiogenesis is essential for the continuous growth of tumour cells under unfavourable conditions in patients. Experimentally, platelet-derived endothelial cell growth factor (PD-ECGF) promotes tumour proliferation by stimulating angiogenesis. However, the clinical significance and regulating mechanism of its production in colorectal cancer are not well understood. Methods: The tissue concentration of PD-ECGF in colorectal neoplasm and normal mucosa was determined. The systemic oxygenation and nutritional status of the patients were also evaluated. Results: The mean concentration of PD-ECGF in the cancer was significantly higher than that in the normal mucosa or adenoma. The tissue concentration of PD-ECGF in the cancer was associated with the clinicopathologic findings, including the tumour size, serosal invasion, lymphatic vessel involvement, and lymph node metastasis. It was also correlated with the patient's age, levels of PO2 and O2 saturation in arterial blood, and the variables reflecting nutritional status. The multivariate regression model showed that the serum concentration of cholinesterase, the arterial level of PO22, lymph node metastasis, and the tumour size were the independent factors that influenced the tissue concentration of PD-ECGF in colorectal cancer. In contrast, these factors were not associated with the PD-ECGF concentration in normal mucosa. Conclusions: PD-ECGF may play an important role in the progression of colorectal cancer. Systemic deterioration of oxygenation and nutritional condition in wasted patients may also lead to local activation of PD-ECGF specifically in the cancer tissue. PD-ECGF may be indispensable for maintaining relentless growth of colorectal cancer, and the control of its expression may be of therapeutic importance.

Liver scintigraphy is useful for selecting candidates for preoperative transarterial chemoembolization among patients with hepatocellular carcinoma and chronic liver disease

Background: The indications for preoperative hepatic transarterial chemoembolization (TACE) have not been clarified by recent studies in patients with hepatocellular carcinoma (HCC) complicated by chronic liver diseases. The aim of the present study was to investigate which patients benefit most from preoperative TACE on the basis of hepatic functional reserve. Technetium-99m diethylenetriamine pentaacetic acid-galactosyl human serum albumin (Tc-GSA) liver scintigraphy was used to assess hepatic functional reserve before and after TACE. Patients and methods: Liver scintigraphy was performed before and several weeks after TACE in 64 patients with HCC complicated by chronic hepatitis or cirrhosis. The ratio of liver to heart-plus-liver radioactivity of Tc-GSA 15 minutes after injection (LHL15) was calculated. Conventional hepatic functional tests were also performed. Whether to perform hepatectomy after TACE was decided mainly on the basis of the previously reported value of LHL15 ≥0.91. Results: LHL15, prothrombin time, and serum concentration of cholinesterase significantly decreased after TACE in patients with LHL15 ≥0.91 ( P <0.01, P <0.05, and P <0.05, respectively). In patients with LHL15 <0.91, LHL15 and functional liver volume significantly increased after TACE (both P <0.05). Eight patients with LHL15 ≥0.91 did not undergo hepatectomy because LHL15 decreased to less than 0.91 after TACE, whereas 7 patients with LHL15 <0.91 underwent hepatectomy because LHL15 increased to more than 0.91 after TACE. Three major postoperative complications occurred in patients with LHL15 ≥0.91, and no major complications occurred in patients with LHL15 <0.91. Conclusions: The results suggest that preoperative TACE should be performed in HCC patients only when LHL15 is less than 0.91, and that preoperative TACE is not an appropriate treatment for patients with LHL15 ≥0.91 when HCC is resectable.

Predictive value of preoperative serum cholinesterase concentration in patients with liver dysfunction undergoing cardiac surgery.

There are an increasing number of patients with severe liver dysfunction subjected to open heart surgery. This retrospective study was designed to assess operative results and clarify the degree of liver injury in patients with liver dysfunction undergoing open heart surgery. In addition, determinants influencing their prognosis were assessed. In a 9-year period from 1988 to 1996, we operated on 31 patients with posthepatitis liver dysfunction and 16 with chronic passive congestion of the liver. This group was 2.3% and 1.6% of the 1368 patients undergoing cardiac surgery in the same period. We compared several perioperative factors between survivors and nonsurvivors to determine risk factors affecting mortality. In the group with posthepatitis liver dysfunction, the postoperative course of 5 patients among 31 (16.1%) was poor. Serum cholinesterase concentration was lower only in the nonsurvivor group (nonsurvivor vs survivor: 1979+/-949 vs 3515+/-1424 IU/I, p < 0.05). All patients with cholinesterase < 2000 IU/L died. The duration of CPB (212+/-53 vs 150+/-54 minutes, p < 0.03) and ACC time (151+/-38 vs 96+/-40 minutes, p < 0.02) was longer in the nonsurvivor group. In the group with chronic passive congestion, the postoperative course of 5 of 16 (31.3%) patients with valvular disease was poor. Serum cholinesterase concentration was lower only in the nonsurvivor group (nonsurvivor vs survivors: 2006+/-435 vs 3483+/-1442 IU/L, p < 0.02), and all patients with cholinesterase < 2000 IU/L died. Postoperative bleeding was greater in the nonsurvivor group (3327+/-2106 vs 1428+/-643 mL, p < 0.05). Multivariate logistic regression analysis including the described pre- and intraoperative factors identified only serum cholinesterase concentration (F = 9.18) as significant. A low value of preoperative serum cholinesterase (< 2,000 IU/L) is thought to be the predictor of prognosis after open heart surgery in patients with severe posthepatitis and congestive liver dysfunction. Operative factors (cardiopulmonary time in posthepatitis liver dysfunction and postoperative bleeding in the congestive liver dysfunction) also influenced the prognosis.