Serum Concentrations Of Enzymes Research Articles

Biochemical serum profile of equines subjected to team penning

Understanding the biochemical changes associated with various types of exercises is important, since they affect the function of different systems and the type of energy used. Analyzed separately, the clinical signs of distinct muscular alterations have a limited diagnostic value and require the use of complementary laboratory exams. Such exams are also used to evaluate the animal’s training, clinical state or athletic capacity. This study determined the serum concentrations of proteins, metabolites, minerals and serum enzymes in equines subjected to team penning contests, correlating these data with sex and frequency of physical activity. A puncture was made in the external jugular vein to collect 5 mL of blood from 29 equines, 18 males and 11 females, at rest (Group I) and after exercising (Group II). The biochemical serum analyses were carried out with a Micronal B-280 spectrophotometer using commercial kits and an automatic multichannel analyzer (Abbott Diagnostics—ARCHITECT c8000) using specific kits. The animals were divided into Groups A, B, C and D according to the number of times they participated in the contest. The serum albumin concentrations, A:G ratio and iron declined significantly (p < 0.05) after exercising, unlike the concentrations of total proteins, globulins, total calcium, uric acid, urea, creatinine, aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and creatine kinase (CK), which increased. Females showed a higher increase of creatinine. Moreover, the rise in total protein, globulins, creatinine, AST, LDH and CK levels differed among groups A, B, C, and D. It was concluded that the team penning contest causes alterations in the biochemical serum profile of equines, and that sex and the number of participations in the contest are interferential variables.

A Comparison of Beating Heart and Arrested Heart Techniques for Mitral Valve Replacement Surgery

Introduction There is growing interest in beating heart cardiac surgery (mainly myocardial revascularization) without aortic cross-clamping and, if possible, without the use of a cardiopulmonary bypass (CPB) pump, since better results can be obtained with this procedure than with conventional myocardial protection techniques using cardioplegic solutions. This led us to considerer mitral valve replacement (MVR) with beating heart and continuous coronary perfusion as a surgical option at the Cardiology and Cardiovascular Surgery Institute (ICCCV) in Havana, Cuba. Objective To assess the safety and potential benefits of beating heart MVR with continuous coronary perfusion compared to the conventional cardioplegic arrested heart MVR procedure. Methods A randomized, controlled intervention study was conducted with a sample of 64 patients referred to the ICCCV for isolated MVR between January 2001 and December 2002. Patients were randomly divided into 2 groups: control group A and study group B. Each group received a specific myocardial protection technique during surgery. Group A underwent MVR using the arrested heart technique with administration of a cold crystalloid cardioplegic solution and with moderately hypothermic CPB. Group B underwent MVR using the beating heart technique with normothermic CPB and continuous coronary perfusion. The following variables were assessed: serum enzyme (CK and CK-MB) and lactate concentrations; duration of aortic cross clamping, CPB, mechanical ventilation support, drainage, postoperative bleeding, stay in the surgical intensive care unit (SICU), and total operation time; amount of blood lost, blood adminstered, and postoperative complications. Quantitative variables were determined using Wilcoxon-Mann-Whitney add Student's t-tests. Results Differences between the two techniques were not found to be statistically significant, which suggests that both are equally safe. However, the differences found are clinically important and favor the beating heart technique, since patients who underwent beating heart MVR had lower serum concentrations of total CK, CK-MB and lactate; less total blood loss, and less need for transfusion. They also required less time on mechanical ventilation support in the SICU, spent fewer days in the hospital, and presented fewer postoperative complications compared to patients who underwent arrested heart MVR. Conclusion The beating heart technique with continuous coronary perfusion proved to be as safe as the conventional arrested heart technique with cardioplegic solutions for MVR surgery in patients with low surgical risk. This procedure is recommended as an alternative method of myocardial protection for this type of surgery in Cuba and may be considered as an option in other limited-resource settings.

Effect of acute lindane and alcohol intoxication on serum concentration of enzymes and fatty acids in rats

This study examines possible synergistic effects of lindane and ethanol on inducing liver injury and serum fatty acid derangement in adult male Wistar rats. When administered together, ethanol and lindane-induced even more pronounced increase of alanine aminotransferase (165±10U/L) and gamma-glutamyltranspeptidase activity (10.3±0.6U/L) than after isolated administration of either substance. In addition, separate administration of lindane and ethanol was followed by a significant decrease of linoleic acid level in the serum (301±38mg/L, 276±35mg/L vs. 416±48mg/L). However, when ethanol administration was followed by lindane injection, serum linoleic acid was at the similar level found in the control group (516±62mg/L). Ethanol-treated rats that received lindane 30min after ethanol administration have shown a marked increase of palmitic (421±27mg/L) and linolic acid level (43±5mg/L) in comparison with rats that have been treated only with ethanol (316±26mg/L for palmitic and 32±2mg/L for linolic acid) or lindane (295±26mg/L for palmitic and 301±38mg/L for linolic acid). Linolic acid level was significantly greater in comparison with control group (29±1mg/L). In conclusion, this study found enough evidence to support the hypothesis that acute ethanol intoxication potentiates lindane-induced liver injury and enhances lipid derangement.

Effects of Formalin Feeding or Administering into the Crops of White Leghorn Cockerels on Hematological and Biochemical Parameters

Formalin administered (15 and 20 mL) into the crops of White Leghorn cockerels resulted in behavioral alterations, included depression, dullness, staggering, somnolence, anorexia, and decreased frequency of crowing. A significant decrease was observed in red blood cell counts, hemoglobin concentration, packed cell volume, and leukocyte counts in birds fed higher levels of formalin. Decreasing and increasing trends in concentrations of serum proteins and enzymes, respectively, were observed with increases in formalin doses. Significantly lower blood glucose and testosterone levels and significantly (P < 0.05) higher blood urea and creatinine concentrations were observed in birds fed higher formalin levels. No gross or microscopic lesions were observed in the birds fed different levels of formalin mixed in feed. These changes suggested that the formalin mixed in feed might have evaporated, and, hence, the amount ingested might have been too low to induce pathological changes. It was concluded from the present study that formalin mixed up to 5 mL/kg of feed, corresponding to 10 mL/ bird of 3% formalin in drinking water by crop tube had no adverse effects on the health of White Leghorn cockerels.

Effects of the Fusarium toxin deoxynivalenol from naturally contaminated wheat given subchronically or as one single dose on the in vivo protein synthesis of peripheral blood lymphocytes and plasma proteins in the pig

Trichothecenes, such as deoxynivalenol (DON), are known to inhibit the protein synthesis in vitro by binding at the 60S subunit of eukaryotic ribosomes. Therefore, cells and tissues with high protein turnover, such as lymphocytes and the liver (albumin and fibrinogen synthesis), were suggested to react most sensitively to DON. However, to the author’s knowledge this observation was not proven in vivo in pigs, which were regarded as the farm animals most susceptible to DON. A total of 31 castrated male, crossbred German Landrace × Pietrain pigs weighing approx. 40 kg were fed a DON contaminated diet (5.7 mg/kg) either acutely (one single dose) or subchronically (⩾4 weeks) or a control diet (0.1 mg/kg). In addition, one group received an intravenous injection of 53 μg DON/kg LW. One hour after feeding, a “flooding dose” of the stable isotope l-[ 2H 5]-phenylalanine (125 mg/kg LW) was given and frequent blood samples (permanent catheter) were collected over a 60 min period. The molar percent excess (MPE) of plasma free and protein-bound phenylalanine were measured by GC/MS. No differences could be observed in the plasma concentrations of total protein, albumin, fibrinogen and serum enzymes between the groups. On the other hand, fractional synthesis rates (FSR, %/d) of albumin were significantly decreased by 43%, 45% and 26% and FSR of lymphocytes declined by 27%, 19% and 24%, whereas fibrinogen was not significantly affected after subchronic or one single oral and intravenous DON exposure, respectively. Additionally, the absolute synthesis rate (ASR, g/d) of albumin and the proportion of albumin to total body protein synthesis were reduced in the same manner, whereas the albumin secretion time ranged between 6.8 and 34.4 min and was not affected by treatment. In conclusion, the flooding dose technique appeared to be suitable for distinguishing DON-related effects on the protein synthesis, while determination of plasma protein concentrations seemed not to be an appropriate parameter.

The relationship between myocardial enzyme and apoptosis of peripheral blood lymphocytes in children with acute virus myocarditis

目的 探讨外周血淋巴细胞凋亡在病毒性心肌炎发病中的作用.方法选择临床诊断病毒性心肌炎患儿和正常小儿各25例,采用Annexin V/PI双参数法经流式细胞仪定量检测两组小儿外周血淋巴细胞凋亡百分率.结果心肌炎组患儿外周血淋巴细胞凋亡百分率[(0.697 6±0.1109)%]较正常对照组[(0.128 8±0.1069)%]明显升高(t=18.459,P＜0.001),且与心肌酶CK-MB、LDH、CK、HBDH升高程度均呈明显正相关(r=0.817,P＜0.01;r=0.785,P＜0.01;r=0.726,P＜0.01;r=0.712,P＜0.01).结论病毒性心肌炎患儿外周血淋巴细胞凋亡增加,且与心肌损害程度相关。

FIBRONECTIN PREVENTS D-galactosamine/Lipopolysaccharide-induced lethal hepatic failure in mice

Plasma fibronectin (FN) has a broad range of biological functions involved in cellular adhesion, motility, differentiation, apoptosis, hemostasis, wound healing, reticuloendothelial system function, and ischemic injury. In this study, we examined the effects of FN on D-galactosamine (GalN)/lipopolysaccharide (LPS)-induced fulminant liver failure in mice. Female Balb/c mice received intraperitoneal injection of 50 mug/kg of LPS and 400 mg/kg of GalN simultaneously. Thirty minutes before GalN/LPS administration, human plasma FN (FN group) or the same dose of human serum albumin (control group) was given intravenously. GalN/LPS induced a marked decrease in plasma FN, which was reversed by FN pretreatment. The survival rate of the FN group was markedly improved in a dose-dependent manner compared with that of the control group (survival rate 0%). FN prevented increases in the concentrations of serum enzymes and total bilirubin related to liver injury. FN pretreatment significantly suppressed tumor necrosis factor (TNF)-alpha, interferon (IFN)-gamma, and interleukin (IL)-6 levels, and enhanced IL-10 levels in serum and liver tissue compared with the control group. Moreover, TUNEL staining, caspase 3 and 8 activities, and necrosis in the remnant liver were significantly decreased in the FN-treated rats compared with the controls. Furthermore, FN pretreatment inhibited the activation of nuclear factor (NF)-kappaB and increased the expression of Bcl-xL protein in liver tissue. These results suggest that FN protected against GalN/LPS-induced liver failure by a mechanism involving inhibition of NF-kappaB activation, which caused down-regulation of TNF-alpha and involved up-regulation of IL-10, and elevation of Bcl-xL induced a blockage of apoptotic signals, by which apoptosis of hepatocytes caused by GalN/LPS was suppressed.

Pancreatic exocrine and endocrine events occur concomitantly but independently during the course of fulminant type 1 diabetes

Although pancreatic exocrine enzymes are often elevated in patients with fulminant type 1 diabetes, the onset of this elevation and its significance in disease development remain unclear. We therefore investigated the significance of elevated serum enzyme concentrations and pancreatic swelling in the development of fulminant type 1 diabetes. Serum pancreatic exocrine enzymes, including amylase, elastase-I, lipase and trypsin, were measured during the course of the disease in 11 patients with fulminant type 1 diabetes (3 men and 8 women; a range of age 24–73 years, median 33 years; a range of HbA 1c at onset 4.5–6.7%, median 6.0%), all of whom developed ketotic diabetes requiring intensive insulin therapy within a month. At least one pancreatic exocrine enzyme was elevated in each patient during the course of the disease. The concentration of enzymes on admission could not be correlated with urinary excretion of C-peptide. The time course of increase in serum amylase varied in these patients. In conclusion, neither the level of serum amylase nor the swelling of pancreas was associated with the onset or severity of fulminant type 1 diabetes. The pancreatic exocrine and endocrine events may occur concomitantly but independently during the course of fulminant type 1 diabetes.

The Off-Pump Fontan Procedure by Simply Cross-Clamping the Inferior Caval Vein

We previously used the Fontan procedure, when applicable, by placing a temporary bypass from the inferior vena cava to the atrium. Alternatively, we have striven to achieve the procedure even without use of a temporary bypass in patients having collaterals between the inferior vena cava and the superior vena cava, so as to simplify the procedure. The azygous vein was intentionally left patent at the bidirectional Glenn procedure in the most recent 9 patients, expecting reasonable venovenous communication at Fontan completion. Surgical results will be described for the preliminary experience. Since 2001, this alternative technique has been attempted in 34 patients undergoing the staged Fontan procedure, and eventually used in 22. Duration between the staged procedures was 4 to 108 months (median, 10 months). We considered that the technique was feasible unless femoral venous pressure exceeded 20 mm Hg immediately after cross-clamping the inferior vena cava. Although catheterization before the Fontan completion illustrated development of venovenous collaterals in 14 patients, oxygen saturation remained greater than 80% throughout the period of the bidirectional Glenn physiology. In all 22 patients, the extracardiac channel was readily reconstructed with an excellent surgical field of view, without operative mortality. On cross-clamping the inferior vena cava, the systemic circulation could be well maintained by administration of dopamine. Oxygen saturation immediately became approximately 97% to 100%. Maximal pressure gradient was 11 +/- 5 mm Hg between the superior vena cava and the femoral vein. Postoperatively, serum concentration of enzymes did not critically increase (maximal aspartate transaminase, 96 +/- 89 U/L; alanine transaminase, 65 +/- 59 U/L; total bilirubin, 1.8 +/- 1.1 mg/dL; creatine kinase, 437 +/- 230 U/L). This alternative technique, when feasible under the current criteria, was simple and did not provide any clinically significant impediments.

Efficacy of Multislice Computed Tomography for the Detection of Acute Coronary Syndrome in the Emergency Department

The diagnosis of acute coronary syndrome (ACS), especially non-ST-elevation myocardial infarction and unstable angina in the emergency department (ED) still remains a challenge. Multislice computed tomography (MSCT) allows assessment of not only coronary artery stenoses and occlusions, but also assessment of coronary artery plaques and myocardial perfusion status. MSCT was performed in 31 patients who were admitted to the ED because of chest pain persisting at least 30 min and non-diagnostic ECG changes and normal serum enzyme concentrations. Using MSCT, ACS was defined by coronary artery stenosis > or = 75% accompanied by computed tomography (CT)-low-density plaques, and/or by the presence of myocardial perfusion defects. ACS was confirmed by coronary stenosis > or = 75% by coronary angiography and/or subsequent elevation of troponin I concentration. In total, 22 patients were diagnosed as having ACS. MSCT detected stenoses with CT-low-density plaques in 21 and non-transmural myocardial perfusion defect in 3 patients. There was 1 false-positive and 1 false-negative result. The sensitivity and specificity of MSCT to identify ACS was 95.5% and 88.9%, respectively. MSCT provides diagnostic operating characteristics suitable for triage of patients with ACS in the ED.

Protective effect of fibronectin for endotoxin-induced liver injury after partial hepatectomy in rats 1

Endotoxemia may occur after hepatectomy and become the cause of post-operative death. Fibronectins (Fns) are involved in a number of biological processes, such as cellular adhesion, motility, differentiation, apoptosis, hemostasis, wound healing, and ischemic injury. Studies were performed to determine whether Fn influences the survival rate of rats subjected to endotoxin-induced liver injury after partial hepatectomy. Lipopolysaccharide (LPS) was administered intravenously to male Sprague-Dawley rats within 48 h of 70% hepatectomy. Before LPS administration, plasma Fn or bovine serum albumin was given intravenously. The survival rate of the Fn-treated group was markedly improved compared with that of the controls. Fn prevented increases in the concentrations of serum enzymes and total bilirubin related to liver injury. The levels of inflammatory cytokines, including tumor necrosis factor-alpha, interleukin-1beta, and cytokine-induced neutrophil chemoattractant, in serum and liver tissue, also were significantly lower in the Fn-treated group than in the control group. Furthermore, the degree of apoptosis and necrosis in remnant liver was significantly decreased in the Fn-treated rats compared with the controls. These results indicate that Fn prevents endotoxin-induced liver injury after partial hepatectomy, at least in part through the inhibition of production of inflammatory cytokines, necrosis and apoptosis in the remaining liver.

The Na(+)/H(+) exchange inhibitor: a new therapeutic approach for hepatic ischemia injury in rats

Background Na(+)/H(+) exchanger (NHE) is one of the major mechanisms for restoring pH after ischemia-induced intracellular acidosis. However, activation of NHE during ischemia and reperfusion (I/R) is also involved in the paradoxical induction of cell injury. This study was designed to evaluate the effects of 5-( N-ethyl- N-isopropyl)-amiloride (EIPA), an NHE inhibitor, on hepatic I/R injury. Methods Partial hepatic ischemia was induced in male Wistar rats by cross-clamping the hepatic arterial and portal venous branches to the left lateral and median lobes of the liver for 120 minutes. The caudate and right lateral lobes were removed immediately after reperfusion. The concentrations of serum enzymes and ATP levels and energy charge in the live tissue were examined after 1-hour reperfusion. Result EIPA afforded considerable protection against I/R injury, as demonstrated by decreased transaminase release and reduced histologic hepatocyte damage and increased energy charge. The 7-day survival rate was significantly improved from 15.4% to 55.6% ( P < .05). Conclusions This study shows for the first time that NHE may play an important role in the hepatic I/R injury and that EIPA should be considered as a new therapeutic approach to prevent hepatic I/R injury.

The effect of micronised fenofibrate on paraoxonase activity in patients with coronary heart disease

To evaluate the effect of micronised fenofibrate on serum paraoxonase (PON) and lipoprotein levels in coronary heart disease patients with type IIb hyperlipidemia. Fifty-two patients were investigated for the three-month effect of 200 mg per day micronised fenofibrate on the serum enzyme activity and concentration of PON and their relationship with serum lipids, high-density lipoprotein (HDL-C) parameters. Serum paraoxonase activity was lower in CHD patients with type IIb hyperlipoproteinemia. During the three-month study it was observed that following treatment with micronised fenofibrate, serum triglyceride and cholesterol levels decreased, while HDL-C increased significantly (p<0.001). Low-density lipoprotein (p<0.05) and apolipoprotein B-100 (p<0.01) decreased, while HDL constituent apolipoprotein A-I (p<0.05) increased after micronised fenofibrate treatment. The HDL-associated paraoxonase specific activity increased significantly (p<0.05). To assess whether the increased PON activity was due to elevated HDL and apoA-I level, we standardized PON activity for HDL and apoA-I concentrations. The standardized values for HDL (PON/HDL) increased (p<0.05) while the PON/apoA-I ratio did not change significantly. Three months of treatment with micronised fenofibrate is thought to normalize lipid profile and improve antioxidant status by increasing serum paraoxonase activity in these patients.

Perflubron emulsion in prolonged hemorrhagic shock: influence on hepatocellular energy metabolism and oxygen-dependent gene expression.

Liver dysfunction as a result of impaired oxygen availability frequently occurs following hemorrhage and contributes to delayed mortality. Artificial oxygen carriers may improve oxygen supply to vital organs while avoiding the need for allogeneic transfusion. Rats were subjected to hemorrhagic hypotension (mean arterial pressure = 35-40 mmHg for 120 min) and were subsequently resuscitated with (1) stored whole rat blood, (2) pentastarch, or (3) pentastarch combined with perflubron emulsion (PFE; 2.7 or 5.4 g/kg body weight), a second-generation artificial oxygen carrier. Recovery of liver adenosine triphosphate, hepatocellular injury, and expression of glutamine synthetase 1, a gene that is induced by exposure of hepatocytes to low partial pressure of oxygen, were studied at 4 h of resuscitation. Stored whole blood or pentastarch failed to restore liver adenosine triphosphate concentrations after prolonged shock as compared to sham controls and resulted in increased gene expression of glutamine synthetase 1. Addition of 2.7 g PFE/kg restored liver adenosine triphosphate to control, whereas 5.4 g PFE/kg resulted in adenosine triphosphate concentrations significantly above control. Improved hepatocellular oxygen supply was also confirmed by restoration of the physiologic expression pattern of glutamine synthetase 1. Serum enzyme concentrations were highest after resuscitation with stored blood, whereas addition of PFE failed to further decrease enzyme concentrations as compared to pentastarch alone. Resuscitation with PFE is superior to stored blood or asanguineous resuscitation with respect to restoration of hepatocellular energy metabolism. The improved hepatocellular oxygen availability is reflected in normalization of oxygen-dependent gene expression. However, improved oxygen availability failed to affect early hepatocellular injury.

Serum paraoxonase activity decreases in rheumatoid arthritis

Objective: To estimate the alterations of paraoxonase 1 (PON1) and high-density lipoprotein (HDL) in rheumatoid arthritis (RA). Design and Methods: We investigated the serum enzyme activity and concentration of PON1 and their relationship with serum lipids, high-density lipoprotein (HDL) parameters, and acute phase reactants of serum amyloid A (SAA) and C-reactive protein (CRP) in patients with RA. Results: Serum paraoxonase (PON) activity was significantly decreased in RA patients (n = 64, 131 ± 53 μmol/min/L) compared with healthy subjects (n = 155, 164 ± 59) despite the absence of any difference in serum lipid levels between the two groups. This decrease of serum PON activity in RA patients was found in every genotype (Q/Q, Q/R, R/R) of PON1 at 192 Q/R. There was a different distribution in PON1 Q/R genotypes between RA patients and healthy subjects, and RA patients exhibited less (44%) positive PON1-Q than did the healthy subjects (66%). In a further investigation of age- and gender-matched subgroups of RA (n = 25) and healthy subjects (n = 25), not only serum PON activity, but also lecithin-cholesterol acyltransferase (LCAT) was found to be significantly decreased in RA patients (125 ± 61 μmol/min/L, 63.2 ± 17.2 nmol/ml/hr/37 °C) than in healthy subjects (169 ± 67, 74.7 ± 19.5), respectively. PON1 and LCAT as well as HDL constituent apolipoprotein (apo) AI and apo AII, were altered significantly in RA patients. Conclusions: Acute-phase HDL, which is remodeled structurally and functionally in RA, might be less anti-atherogenic due to the impairment of original HDL function. These alterations of HDL in RA patients may explain in part the reported increase in cardiovascular mortality in patients with RA.

Acute changes in selected serum enzyme and metabolite concentrations in 12- to 14-yr.-old athletes after an all-out 100-m swimming sprint.

The purpose of this study was to investigate the acute effects of an all-out 100-m swimming sprint on changes in serum enzyme and calcium ion concentrations in young (12 to 14 years) male and female swimmers. Changes in serum enzyme concentrations of creatine kinase (CK), lactate dehydrogenase (LDH), glutamic pyruvate transaminase (GPT), glutamic oxaloacetate transaminase (GOT), serum glucose (GL), and calcium ion ((Ca2+) concentrations were measured in 23 elite swimmers (13 boys and 10 girls) before and after a 100-m freestyle all-out sprint. Analysis showed (1) there were significant sex differences in serum CK concentration at baseline (Pretest); (2) significant sex differences in serum CK and LDH concentrations after the 100-m spring; (3) no significant differences in Ca2+ concentration after the 100-m spring; and (4) significant increase in Serum GOT and blood glucose concentrations after the 100-m sprint, suggesting that these might both be useful indicators of anaerobic exercise stress in young swimmers.

Minimal protection of the liver by ischemic preconditioning in pigs

Ischemic preconditioning (IP) protects the rat liver. In pigs, in which hepatic tolerance to ischemia is similar to that in humans, information on IP is lacking. Therefore, in enflurane-anesthetized pigs, hepatic vessels were occluded for 120 min (protocol 1) or 200 min (protocol 2) without (control) and with IP (3 times 10 min ischemia-reperfusion each). In protocol 1, cumulative bile flow (CBF) during reperfusion was greater in IP (47.3 +/- 5.2 ml/8 h) than in control (17.1 +/- 7.8 ml/8 h, P < 0.05). ATP content tended to recover toward normal during reperfusion in IP, whereas it remained at ischemic levels in control. Serum enzyme concentrations increased similarly during reperfusion, and <1% hepatocytes were necrotic or stained terminal deosynucleotidyl transferase-mediated dUTP nick-end labeling-positive in control and IP groups. In protocol 2, no differences in CBF, ATP, or serum enzyme concentrations during reperfusion were measured between control and IP groups, except for a somewhat reduced lactate dehydrogenase in IP. The number of necrotic or terminal deosynucleotidyl transferase-mediated dUTP nick-end labeling-positive hepatocytes tended to be greater in the IP than the control group. Thus IP provides some functional protection against reversible ischemia but no protection during prolonged ischemia in pigs.

Postoperative blood salvage and reinfusion in spinal surgery: blood quality, effectiveness and impact on patient blood parameters.

Although reinfusion of salvaged shed blood has become popular in major orthopaedic procedures, this blood saving technique is still controversial. In an effort to assess the functional and metabolic status of shed blood erythrocytes and the impact of postoperative shed blood reinfusion on allogenic blood requirements and patient's blood parameters, analyses of perioperative blood samples were performed in 28 consecutive orthopaedic patients undergoing spinal fusion, in which postoperative shed blood was collected and reinfused with the ConstaVac CBC II device. In comparison with a previous series of 31 patients, this procedure reduced allogenic blood requirements by almost 30% (P < 0.05), without any increase in postoperative complications. Postoperative shed blood presented lower haematological values and higher plasma-free haemoglobin (PFHB) levels than preoperative blood, without any disturbance in morphology, median corpuscular fragility (MCF) or erythrocyte adenosine triphosphate (ATP) and diphosphoglycerate (DPG) content. Serum concentrations of enzymes--glutamate-oxalacetate aminotransferase (GOT), glutamate-piruvate aminotransferase (GPT), creatine kinase (CK), lactate dehydrogenase (LDH)--and inflammatory cytokines (IL-1beta, IL-6) were elevated in shed blood. After reinfusion, there was no alteration in coagulation parameters or cytokine levels. Serum levels of some enzymes increased at the end of surgery and remained elevated at postoperative day 2 (CK) or 7 (GOT, LDH), with a higher increase if postoperative autotransfusion was used as a blood saving method. Therefore, caution should be taken when these serum enzyme levels are used for diagnosis. In conclusion, salvaged shed blood in orthopaedic procedures of the spine seems to be an excellent source of red cells which are not significantly damaged, keeping a normal functional and metabolic status, and reduces allogenic blood requirements without significant side effects.

Factors associated with osteonecrosis in the femoral head in chronic alcoholism.

While alcohol abuse is a possible etiologic factor in osteonecrosis in the femoral head (ON), the relationship between alcoholic liver dysfunction and ON is uncertain. Among 336 patients with alcoholic liver dysfunction who had radiographic examination of the hip at two hospitals for alcohol abuse treatment in southern Japan, the records for 291 men and 1 woman (mean age, 47.8 years; range, 24 to 72 years) had adequate information available concerning daily and cumulative alcohol intake, duration of intake, serum concentrations of liver enzymes, and platelet count. These variables were investigated for any correlation between the 8 patients with radiographic evidence of ON and the 284 without. Liver biopsy was performed in 223 patients. Except for alanine aminotransferase, liver enzyme concentrations were significantly lower in patients with ON than in those without. Histologically, 2 patients with ON were diagnosed with cirrhosis; 1 with pre-cirrhotic changes; and 2 with fibrosis. These results suggested that ON occurred in the late stages of liver disease when serum enzyme concentrations had returned to normal or were only mildly elevated.

THE RESIDUAL EFFECTS OF ACUTE ALCOHOL CONSUMPTION ON MUSCLE DAMAGE

186 The primary purpose was to determine if there was a residual effect of alcohol consumption on muscle damage beyond what would normally be found following exercise. A secondary purpose was to determine alcohol's residual effect on the time course of delayed onset muscle soreness (DOMS). Ten males (22 - 30 yrs), control (5) and alcohol (5), were matched on V02max. (alcohol: 50.12 ml·kg−1·min·−1 ±7.78; control: 51.42 ml·kg−1·min−1 ±7.40; means ± SD). Subjects completed The Self-Administered Alcoholism Screening Test and a personal questionnaire to eliminate alcohol abusers. The alcohol group consumed 4.44 ml of vodka per liter of total body water (TBW) estimated from skin folds and bio-electrical impedance to reach an intended blood alcohol level (BAL) of 0.15 g/dl. Subjects remained in the lab overnight and then performed the exercise bout the following morning (12 hrs post peak BAL; 9, 5-min bouts of running at 70% VO2max, −8% grade). Serum enzyme concentrations were measured pre-exercise, post-exercise, and on days 1, 2, 4, & 6 (creatine kinase (CK), serum glutamic oxalacetic transaminase (SGOT), and lactate dehydrogenase (LDH)). There were no significant differences (p<0.05) between the two groups. No time course of DOMS could be determined due to immediate onset of muscle soreness, but perceived soreness was greater (p=0.04) in the alcohol group across time (alcohol: 1.92 ± 0.33; control: 1.48 ± 0.43). Alcohol consumption prior to an exercise bout (12 hrs) did not produce an increase in muscle damage. Perceived soreness was greater and more prolonged in the alcohol group. Supported by The Ohio AHPERD