Frequency Of Abnormal Values Research Articles

High-sensitive cardiac troponin T in patients with idiopathic inflammatory myopathies

Abstract Introduction Patients with idiopathic inflammatory myopathies (IIM) may have positive blood tests of cardiac troponin in absence of clinically detected cardiac disease. This situation is more common using high-sensitive cardiac troponin T (hs-cTnT) but there is limited information of the expected results according to type of IIM and prognostic value of this test in this group of patients. Methods Prospective study with 32 healthy controls and 61 patients with IIM without known cardiac condition. These patients with IIM were followed for 25 months. High-sensitive cardiac troponin T (Roche Elecsys hs-cTnT) was measured at baseline in both groups and a value of 14 pg/ml was the percentile 99th and considered the upper limit of normality (ULN). Results The median value of hs-cTnT was higher in patients with myopathies [12.0 (5.0; 35.0) vs. 5.0 (4.0; 6.2) P< 0.001] and the frequency of abnormal values were also more common in patients with IIM compared to controls (45.9% vs 6.2%, p<0.001). The frequency varied according to the type of myositis: Inclusion Body Myosytis (75%), Polymyositis (66.7%) , Dermatomyositis (42.1%) and Antisynthetase syndrome (38.5%). In terms of magnitude, 57% had mild elevations (1 to 3 x ULN) while 11% had levels 3 to 5 times ULN and 32% had troponin values > 5x ULN (Figure 1). Among patients with IIM, elevated levels of hs-cTnT were not associated with left ventricle global longitudinal strain < 18% or lower ejection fraction and was not associated with cardiovascular events during 25 months of follow-up (Figure 2). Conclusion Abnormal values of high-sensitive cardiac troponin T are common in patients with idiopathic inflammatory myopathies including levels similar to myocardial infaction. This elevation was not associated with echocardiographic abnormalities or cardiovascular events in patients with IIM.Figure 1Figure 2

【表6.2.d.1】腫瘍マーカーの異常値頻度 【図6.2.d.2】CEAとCA19-9との相関 【図6.2.d.3】DUPAN2とCA19-9との相関 【図6.2.d.4】SPAN1とCA19-9との相関 【図6.2.d.5】CA19-9と膵管内腫瘍組織型分類の相関 【図6.2.d.6】CEAと膵管内腫瘍組織型分類の相関 【図6.2.d.7】DUPAN2と膵管内腫瘍組織型分類の相関 【図6.2.d.8】SPAN1と膵管内腫瘍組織型分類の相関

【表6.2.d.1】腫瘍マーカーの異常値頻度 【図6.2.d.2】CEAとCA19-9との相関 【図6.2.d.3】DUPAN2とCA19-9との相関 【図6.2.d.4】SPAN1とCA19-9との相関 【図6.2.d.5】CA19-9と膵管内腫瘍組織型分類の相関 【図6.2.d.6】CEAと膵管内腫瘍組織型分類の相関 【図6.2.d.7】DUPAN2と膵管内腫瘍組織型分類の相関 【図6.2.d.8】SPAN1と膵管内腫瘍組織型分類の相関

【表3.2.d.1】腫瘍マーカーの異常値頻度 【図3.2.d.2】CEAとCA19-9との相関 【図3.2.d.3】DUPAN2とCA19-9との相関 【図3.2.d.4】SPAN1とCA19-9との相関 【図3.2.d.5】CA19-9とJPS T因子の相関 【図3.2.d.6】CA19-9とJPS N因子の相関 【図3.2.d.7】CA19-9とJPS M因子の相関 【図3.2.d.8】CA19-9とJPS Stageの相関 【図3.2.d.9】CEAとJPS Stageの相関 【図3.2.d.10】DUPAN2とJPS Stageの相関 【図3.2.d.11】SPAN1とJPS Stageの相関 【図3.2.d.12】Stage I, IIにおけるCA19-9と組織型分類の相関 【図3.2.d.13】Stage IVaにおけるCA19-9と組織型分類の相関 【図3.2.d.14】Stage I, IIにおけるCEAと組織型分類の相関 【図3.2.d.15】Stage IVaにおけるCEAと組織型分類の相関

【表3.2.d.1】腫瘍マーカーの異常値頻度 【図3.2.d.2】CEAとCA19-9との相関 【図3.2.d.3】DUPAN2とCA19-9との相関 【図3.2.d.4】SPAN1とCA19-9との相関 【図3.2.d.5】CA19-9とJPS T因子の相関 【図3.2.d.6】CA19-9とJPS N因子の相関 【図3.2.d.7】CA19-9とJPS M因子の相関 【図3.2.d.8】CA19-9とJPS Stageの相関 【図3.2.d.9】CEAとJPS Stageの相関 【図3.2.d.10】DUPAN2とJPS Stageの相関 【図3.2.d.11】SPAN1とJPS Stageの相関 【図3.2.d.12】Stage I, IIにおけるCA19-9と組織型分類の相関 【図3.2.d.13】Stage IVaにおけるCA19-9と組織型分類の相関 【図3.2.d.14】Stage I, IIにおけるCEAと組織型分類の相関 【図3.2.d.15】Stage IVaにおけるCEAと組織型分類の相関

【表7.2.d.1】腫瘍マーカーの異常値頻度 【図7.2.d.2】粘液性嚢胞腫瘍におけるCEAとCA19-9との相関 【図7.2.d.3】粘液性嚢胞腫瘍におけるDUPAN2とCA19-9との相関 【図7.2.d.4】粘液性嚢胞腫瘍におけるSPAN1とCA19-9との相関 【図7.2.d.5】CA19-9と膵管内腫瘍組織型分類の相関 【図7.2.d.6】CEAと膵管内腫瘍組織型分類の相関 【図7.2.d.7】DUPAN2と膵管内腫瘍組織型分類の相関 【図7.2.d.8】SPAN1と膵管内腫瘍組織型分類の相関

【表7.2.d.1】腫瘍マーカーの異常値頻度 【図7.2.d.2】粘液性嚢胞腫瘍におけるCEAとCA19-9との相関 【図7.2.d.3】粘液性嚢胞腫瘍におけるDUPAN2とCA19-9との相関 【図7.2.d.4】粘液性嚢胞腫瘍におけるSPAN1とCA19-9との相関 【図7.2.d.5】CA19-9と膵管内腫瘍組織型分類の相関 【図7.2.d.6】CEAと膵管内腫瘍組織型分類の相関 【図7.2.d.7】DUPAN2と膵管内腫瘍組織型分類の相関 【図7.2.d.8】SPAN1と膵管内腫瘍組織型分類の相関

【表8.2.d.1】腫瘍マーカーの異常値頻度 【図8.2.d.2】CA19-9と内分泌腫瘍組織型分類の相関 【図8.2.d.3】CEAと内分泌腫瘍組織型分類の相関 【図8.2.d.4】DUPAN2と内分泌腫瘍組織型分類の相関 【図8.2.d.5】SPAN1と内分泌腫瘍組織型分類の相関

【表8.2.d.1】腫瘍マーカーの異常値頻度 【図8.2.d.2】CA19-9と内分泌腫瘍組織型分類の相関 【図8.2.d.3】CEAと内分泌腫瘍組織型分類の相関 【図8.2.d.4】DUPAN2と内分泌腫瘍組織型分類の相関 【図8.2.d.5】SPAN1と内分泌腫瘍組織型分類の相関

GALL BLADDERMOTILITY IN CHILDREN WITH FUNCTIONAL CONSTIPATION.

Introduction: Evidences have been accumulated that impaired colonic motility in some patients with functional constipation is part of a generalized motility defect. The aim of this study was to investigate gall bladder motility in children with functional constipation. Methods: Eighty-two consecutive patients with chronic functional constipation referred to a pediatric tertiary outpatient clinic and the same number of controls were evaluated in a cross-sectional study. Using real-time ultrasonography and the ellipsoid method, gall bladder volumes were measured: after overnight fast and 60 minutes after the ingestion of a standard fatty meal. Residual volumes and contractility indexes were calculated. Results: Considering values ≥25% as normal values for contractility index, the frequency of abnormal values was superior in constipated children (p < 0.001). Gall bladder dismotility was observed in 21 of 82 (25.6%) patients and in 14 of 82 (17%) age and gender matched controls. Contractility indexes distributions were different between groups, with superior values found in controls (p < 0.05). Conclusion: Contractility indexes for gall bladder emptying in constipated children were different from indexes in healthy children.

Which hormone tests for the diagnosis of polycystic ovary syndrome?

Objective To assess the frequency of abnormal values for hormone measurements commonly used in the biochemical diagnosis of polycystic ovary syndrome (PCOS). Design Hormone measurements in 63 unselecled women with clinical and ultrasound diagnosis of PCOS attending gynaecological and general endocrine clinics in a District General Hospital were compared with those from a group of 20 normal ovula-tory controls in the early follicular phase of their cycles. Measurements Serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH ratio, total testosterone, derived free testosterone, sex hormone binding globulin, androstenedione, and dehydroepiandrosterone (DHEA) were measured by radioimmunoassays. LH and FSH measured by two different assays. Results The mean serum LH and LH/FSH ratio were significantly (P<0.01) higher in the women with PCOS compared with the normal group, but these two measurements were in the abnormal range for only 35% and 41–44%, respectively. Absolute gonadotrophin values were significantly different using the two assay methods, which employed the same reference preparation as standard. Mean serum total testosterone concentration was significantly higher in the PCOS group and was the most frequently (70%) abnormal biochemical marker for PCOS. Sex hormone binding globulin (SHBG) did not differ significantly between the two groups but showed a negative correlation with body mass index in women with PCOS. The combination of SHBG and testosterone to derive a free testosterone value did not further aid the biochemical diagnosis of PCOS. Androstenedione was significantly higher in the PCOS group than in the control group, with a frequency of 53%. There was no significant difference in DHEA-S between the two groups. Conclusion When typical ovarian ultrasound appearances plus the clinical features of oligomenorrhoea and/or hirsuitism were used to define PCOS total testosterone was the best single hormonal marker of the condition. Testosterone, androstenedione or LH, either alone or in combination, were raised in 86% of women with PCOS and these should be the definitive hormonal tests. Using LH/FSH ratio as a biochemical criterion for diagnosis of PCOS should be abandoned because of its low sensitivity. To be of value the normal range for all hormones should be precisely defined in a group of regularly ovulating women in the early follicular phase of the cycle for the assay used in each laboratory.

Serum concentrations of CA 125 and aminoterminal propeptide of type III procollagen (PIIINP) in patients with endometrial carcinoma

Serum CA 125 (a marker of coelomic epithelial cells) and aminoterminal propeptide of type III procollagen (PIIINP; an indicator of collagen metabolism) concentrations were measured in 148 patients with endometrial carcinoma. An initial serum concentration of CA 125 was pathologic in 17% of the patients, the frequency of abnormal values being higher (P = 0.0001) in advanced (63%) than in early disease (10%). The serum PIIINP concentration was increased in 35% of the patients and more often (P less than 0.05) so in advanced (63%) than in early disease (31%). Among all the patients, at least one of the tumor markers was increased in 43% of the cases. In early disease 12 of 108 patients contracted recurrent cancer. The accuracy of the pathologic CA 125 (9%) and PIIINP (18%) concentrations in their prediction was poor. In the total material, pathologic CA 125 and PIIINP concentrations appeared simultaneously in 11 patients, of whom eight had poor prognoses. In monitoring of treatment response of 24 patients, regression was accompanied by normal or decreasing CA 125 and PIIINP values. The persistence of pathologic CA 125 and/or PIIINP concentration predicted relapse of the malignancy. In progressive disease, CA 125 and PIIINP concentrations together or separately remained at a pathologic level or increased continuously. In clinically stable endometrial carcinoma, CA 125 gave false-negative results in 71% of the determinations and PIIINP only in 12%. The current results suggest the use of CA 125 and PIIINP, simultaneously, in monitoring the clinical course of advanced endometrial carcinoma.

Interpretation of serum total calcium: effects of adjustment for albumin concentration on frequency of abnormal values and on detection of change in the individual.

Serum total calcium was measured in 1693 patients during a four-month period. We examined the effects of adjustment for albumin concentration on the interpretation of single measurements of serum total calcium and on the variation of series of measurements in individual patients. Markedly abnormal total calcium concentrations--2.75 mmol/l (11.0 mg/100 ml) or more, or 2.00 mmol/l (8.0 mg/100 ml) or less--were found in 115 patients, but only 24 (21%) remained markedly abnormal after adjustment for albumin. Three patients, two with malignant disease and one with primary hyperparathyroidism, had significant hypercalcaemia which was masked by hypoalbuminaemia. The serum total calcium measured on a subsequent occasion had changed 0.15 mmol/l (0.6 mg/100 ml) or more in 60 patients, but after adjustment for albumin this number was reduced to 27 (45%). The within-person standard deviation for serum total calcium was calculated in 26 patients with normal mean adjusted calcium concentrations who had had six or more sequential measurements. The mean standard deviation was 0.148 mmol/1 (0.59 mg/100 ml) and, after adjustment for albumin, this was reduced to 0.100 mmol/1 (0.40 mg/100 ml). We conclude that adjustment of serum total calcium concentration for albumin is essential to detect abnormal values and to assess changes in a value.

Serum gamma glutamyl transferase and alkaline phosphatase activities in epileptics receiving anticonvulsant therapy

1. 1. Serum gamma glutamyl transferase (γGT) and alkaline phosphatase (ALP) activities have been estimated in 49 epileptic patients taking anticonvulsant drugs. 2. 2. Serum γGT activity was clearly elevated in 12 of the patients and borderline in 8, giving a 40% frequency of abnormal values. 3. 3. Total serum ALP activity was elevated in 7 out of 33 adult patients and 2 of 16 juveniles. 4. 4. Electrophoresis on polyacrylamide gel showed that the bone isoenzyme was responsible for most of the increased serum ALP activity and that even when the total was not elevated, the contribution of the bone isoenzyme was greater than normal. 5. 5. There was no correlation between total serum ALP and γGT activities but elevations of serum γGT were often accompanied by an increase in the proportion of the bone enzyme in the total serum ALP activity.

Rickets Associated With Long-Term Anticonvulsant Therapy in a Pediatric Outpatient Population

Over a 12-month period, an ambulatory pediatric population receiving long-term anticonvulsants was surveyed for the presence of biochemical and radiologic rickets. There were 74 treated children and 95 matched controls. Elevations of serum alkaline phosphatase activity occurred in 31 of the 74 (42%) treated children (23 of 47 children between 2 and 10 years and 8 of 21 children between 10 and 16 years). This frequency of abnormal values was significantly greater than that which occurred in our control population. Calcium and phosphorus abnormalities were minimal in both treated and control populations. Radiologic rickets occurred in 6 of the 74 (8%) of the treated children and in none of the control population. Neither the severity of the rickets nor the degree of hyperalkaline phosphatasemia were correlated with age of the patient, duration, and/or dose of anticonvulsant therapy.