CPK Increase Research Articles

FRI0389 First report of anti-mda5 antibodies in a cohort of italian patients with dermatomyositis: clinical and serologic correlations

BackgroundPolymyositis/dermatomyositis (PM/DM) are autoimmune diseases characterized by skin and muscle inflammation, internal organs involvement and presence of myositis-specific antibodies (MSAs). In recent years, new MSAs have been identified in association...

COMPARATIVE ANALYSIS OF BIOCHEMICAL PARAMETERS OF MUSCLE TISSUE ALTERATION DEPENDING ON APPROACHES FOR TOTAL HIP ARTHROPLASTY

The results of the comparative analysis of biochemical alterations of muscle tissue in the blood serum of patients who underwent primary total hip replacement. In this study, we consider the data of 75 patients who underwent total hip arthroplasty (75 operations) from November 2010 to April 2012 to analyze the data was divided into 3 groups of patients: the first - using a minimally invasive technique MIS AL (22 operations), the second - with the use of the modified approach Muller (pending on the invention) - (29 operations), and the third - with approach by Hardinge (26 operations). The levels of glutamic oxaloacetic transaminase, creatinine phosphokinase, lactate dehydrogenase, myoglobin, creatinine, and C-reactive proteine in serum were determined preoperatively and at 3, 5, 7, 9 days after surgery. CRP included in the study as an indicator of non-specific inflammation of the tissues. When comparing the biochemical indicators in three types of approaches to the hip joint, the highest increase in GOAT, LDH, CPK, CRP, and myoglobin was detected at surgery approach by Hardinge. The results of this study may indicate a decrease in the degree of tissue trauma during surgery using a minimally-invasive approaches, which is characterized by the retention of attachment to the middle gluteal muscle of the femur.

A non-comparative assessment of tolerability and efficacy of duloxetine in the treatment of depressed patients with Parkinson's disease

Objective: Depression is a comorbidity affecting quality of life (QoL) in patients with Parkinson's disease (PD) and requires appropriate treatment. This study evaluated the tolerability, safety, and efficacy of duloxetine 60 mg once daily for 12 weeks in PD patients with major depressive disorder (MDD).Research and design methods: Non-comparative, open-label, multi-center study.Main outcome measures: Tolerability was evaluated by discontinuation rate (acceptable if ≤ 19%) due to treatment-emergent adverse events (TEAEs) and motor symptoms (UPDRS). Safety measures were TEAEs, the UKU side effect rating scale, vital signs, weight, laboratory tests, and ECG. Efficacy measures included HAMD-17, BDI, CGI-S, PGI-I, and pain VAS. QoL was measured by PDQ-39.Results: Of the 151 patients enrolled, 8.6% (95% upper CI: 13.3%) discontinued the study due to TEAEs. Worsening in PD-related tremor and rigidity was not observed, activities of daily living significantly improved and UKU subscales progressively decreased. Clinically significant abnormalities in laboratory findings were limited to four cases of hypercholesterolemia and one increase of total bilirubin, CPK, and fasting glucose. Blood pressure, weight, and ECG did not change from baseline. HAMD-17 and PDQ-39 total score and individual domains, BDI, CGI-S, and PGI-I total scores significantly improved.Conclusions: Duloxetine seems well tolerated and likely effective in the treatment of depression associated with PD, with no detrimental effects in PD signs and symptoms.

88 Use of Statins in Children

IntroductionReferring to the use of statins for hyperlipemia in children, it is not yet clearly defined who must be treated (recent recommendations focused on older than 8 years) and also...

Prospective, Multicenter Phase I–II Pilot Trial to Evaluate Efficacy and Safety of Lenalidomide Plus Rituximab-CHOP21 (LR-CHOP21) for Elderly Patients with Untreated Diffuse Large B-Cell Lymphoma (DLBCL): Interim Analysis of the Intergruppo Italiano Linfomi (IIL) REAL07 Study

AbstractAbstract 2871 Introduction.The addition of Rituximab to standard CHOP chemotherapy has improved outcome of DLBCL; however, 30–40% of patients do not response or relapse after induction treatment. The use of Lenalidomide, as single-agent in relapsed or refractory aggressive NHL has been encouraging, with an overall response rate (ORR) of 19% for DLBCL. Preclinical evidence suggests that Lenalidomide may be synergistic with Rituximab. However the safety and efficacy of Lenalidomide combined with R-CHOP is not yet fully evaluated. Aims.On these basis, the IIL is running a prospective multicenter dose finding phase I-II pilot trial to evaluate efficacy and safety of Lenalidomide treatment plus R-CHOP21 (LR-CHOP21) for elderly patients with untreated DLBCL (registered at http://www.clinicaltrials.gov, NCT00907348). The primary endpoint for the phase I part of the study was: definition of Dose Limiting Toxicity (DLT) considered as the maximum dose inducing any grade ≥3 non-hematologic toxicity, or a >15 days delay of planned cycle date. The primary endpoint for the phase II part of the study was: complete response (CR) and ORR. Herein we report the results of phase I. Patients and Methods.Inclusion Criteria were: age 60–80; histologically proven CD20+ DLBCL; no prior chemotherapy and no prior malignancies in the last 3 years; Ann Arbor stage II, III, IV; International Prognostic Index (IPI) at low-intermediate, intermediate-high or high risk score. Treatment consisted of 6 courses of R-CHOP21 in association with Lenalidomide for days 1–14 at the established dose level (5, 10, 15, 20 mg), with Peg-Filgrastim support and prophylactic sc. low-molecular weight heparin. Phase I of the study was planned to define the Maximum Tolerated Dose (MTD) that is the dose that achieves a DLT in 33% or less patients evaluated after the first three courses of LR-CHOP21. The study was designed with the Continual Reassessment Method, a Bayesian “memory design” that begins with a subjective prediction of the dose-response relationship and uses, as dose allocation rule of the sequentially incoming patients, the re-estimated probability of toxicity based on the results obtained for the patients already observed. Four doses of Lenalidomide were tested: 5, 10, 15 and 20 mg. By decision of the steering committee of the study, a dose of 10 mg was administered to the first cohort of 3 patients; in the light of the observed toxicity the probability model assigned the next cohort to the dose with the higher probability to met the required MTD. At the end of each cohort, the dose level associated with an updated DLT probability closest to 33% was recommended to be administered to the next patient cohort. Results.In phase I, from May 2008 to February 2010, 21 patients were enrolled. Median age was 69 years (61-78), stage II/III/IV were 4/4/13 respectively, B symptoms in 11, PS 2 in 8, bone marrow involvement in 6, abnormal LDH in 8, intermediate-high or high IPI score in 15. Patient allocation by Lenalidomide dose was: none patients received 5 mg/day, nine patients received 10 mg/day, nine patients 15 mg/day and three patients 20 mg/day on days 1–14 of each LR-CHOP21 courses. The flow of the dose allocation and the observed DLTs are shown in figure 1. DLTs in the first three courses were recorded in seven patients (see figure 1 for details). These data, according to the continual reassessment method, determined Lenalidomide 15 mg as MTD in association to R-CHOP21. One-hundred-fifteen courses of LR-CHOP21 were performed in the whole series of 21 patients. Overall hematological toxicity was moderate: grade III or IV thrombocytopenia occurred in 10%, anemia in 4% and neutropenia in 28% of the courses. Extra-hematological toxicities were mild: only one patient with grade IV (increase of CPK), two patients with grade III cardiac, three with grade III neurological toxicities, and three patients with grade III infections (two pneumonias and one febrile neutropenia with diarrhea). At the end of six LR-CHOP21 courses, 15/21 patients achieved CR, 1/21 partial remission and 5/21 were not responsive. Conclusions.Lenalidomide 15 mg on days 1–14 in association with R-CHOP21 is the MTD for LR-CHOP. This schedule is safe and well tolerated in a population of elderly DLBCL patients. Preliminary efficacy results are promising. The ongoing phase II part of the LR-CHOP21 trial aims at evaluating the efficacy of 15 mg of Lenalidomide in association with R-CHOP21. [Display omitted] Disclosure:Vitolo:Roche Italy: advisory committee; Celgene Italy: advisory committee; Janssen-Cilag: lecture-fee. Off Label Use: The use of Lenalidomide is off-label in untreated DLBCL.

Muscle symptoms and creatine phosphokinase elevations in patients receiving raltegravir in clinical practice: results from a multicenter study

7-11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK To further investigate CPK increases and muscle symptoms in a cohort of HIV-infected patients receiving raltegravir-based HAART compared with a control cohort with similar characteristics receiving darunavir-based HAART. The SCOLTA Project is a prospective, observational, multicenter study created to assess the incidence of adverse events in patients receiving new antiretroviral drugs in clinical practice. Muscle symptoms where classified according to the American Heart Association guidelines and CPK elevations were graded according to the DAIDS table. A total of 391 HIV-infected patients were included in the study, 258 (66.0%) males. CDC stage was C in 152 (38.9%) patients. Mean age at enrolment was 44.5 ± 9.0 years, mean CD4 cell count 348 ± 260 cell/µL and mean HIV-RNA 3.26 ± 1.54 log10 cp/ml; 135 (35.2%) patients were HCV Ab+ and 155 (39.6%) had a diagnosis of lipodystrophy. Sixteen (4.1%) were naive to antiretrovirals. No statistical difference was observed regarding baseline characteristics when comparing patients receiving raltegravir (n=293) and darunavir-based HAART (n=98). Thirteen patients (5.4%) receiving raltegravir referred muscle pain and 12 (5.0%) muscle weakness compared with 1 (1.1%) and 0 (0%) receiving darunavir (p=0.20 and p=0.04), respectively. Seventeen (5.8%) patients developed muscle pain and/or weakness in the raltegravir cohort in respect of 1 (1.0%) in the darunavir cohort (p=0.05). No statistical difference was observed when considering CPK increases (>200 U/L) that were reported in 26 (8.9%) patients treated with raltegravir and 11 (11.2%) receiving darunavir. No relation emerged between CPK increase and muscle pain/weakness. Of note, no patient discontinued raltegravir due to CPK elevations or worsening muscle symptoms and no cases of rhabdomyolysis were reported. CPK elevations occurred in >10% of patients receiving both raltegravir and darunavir suggesting a multifactorial aetiology in HIV-infected patients treated with HAART. Raltegravir-treated patients had a significantly higher proportion of muscle symptoms, especially muscle weakness. However, these symptoms did not cause therapy discontinuation, in our cases. Although the limited clinical significance to date, our data suggest the monitoring of muscle symptoms, including both pain and weakness, in patients receiving raltegravir and further diagnostic evaluations if they persist.

Acute renal failure due to multiple stings by Africanized bees. Report on 43 cases

This study reports on acute renal failure (ARF) due to multiple stings by Africanized bees (AB) occurring in 43 cases collected between 1982 and 2007 (at the Nephrology Section, University of Antioquia School of Medicine and San Vicente de Paul University Hospital, Medellin, Colombia). No intervention on patient care was performed except for responding the Nephrology consult and prescribing dialysis. Data obtained from the medical records included demography; clinical presentation; laboratory results on admission; evolution of renal function to document improvement and normalization; intervals between stings and outcomes; number of dialysis sessions; length of follow-up and hospitalization; survival; and mortality. Not all patients had complete data and therefore, the number of observations is included where required. Mean age was 56 ± 26 yr (range 2-96); 37 (86%) were men; 38 (of 41 cases) came from rural areas (91%); 22 (of 39) were farmers (56.4%); 33 (of 41) lived in Medellin or in the department of Antioquia (80.5%). Number of stings per patient: ~ 900. Interval between stings and ARF < 48 hours: in 31 cases (72.1%; mean 2.6 ± 2.6 days; range 1-12); 37 (of 43) required dialysis (86%); mean number of sessions: 4.7 ± 3.3 (range 1-12). Survival occurred in 36 cases (83.7%) and mortality, in 7, all > 60 yr (16.3%). At last follow-up, renal function improvement was documented in 36 (83.7%) and normalization in 15 of them (41.7%). Interval until initiation of diuresis: 10.6 ± 6.8 days (range 1-25). Duration of hospitalization: 16.9 ± 8.7 days (range 1-39). 25.2 ± 18.3 days (range 1-75). Hematuria and oliguria occurred before 24 hours; there was an increase of CPK in 90%, of ALT in 96%, of AST in 89%, of DHL in 95%, and of BUN and creatinine in 100%. Based on our findings and on the review of the available information, we propose that this type of ARF occurs as a result of rhabdomyolysis with subsequent myoglobinuria, which lead to nephrotoxic acute tubular necrosis; a variable degree of direct nephrotoxicity, not quantifiable with current diagnostic methods, is also probably involved. A better knowledge of this entity by the medical community could improve care and prognosis of the patients who develop it.

Blood Biochemistry of Sea Turtles Captured in Gillnets in the Lower Cape Fear River, North Carolina, USA

ABSTRACT Mortality due to fisheries interactions has been implicated as a contributor to population decline for several species of sea turtle. The incidental capture of sea turtles in the coastal gillnet fisheries of North Carolina, USA, has received much attention in recent years, and mitigation measures to reduce sea turtle mortality due to gillnet entanglement are a high priority for managers and conservationists. Efforts to evaluate effects of gillnet entanglement on sea turtle populations are complicated by the lack of information on health status of turtles released alive from nets and postrelease mortality. We obtained blood samples from green (Chelonia mydas) and Kemp's ridley (Lepidochelys kempii) sea turtles captured in gillnets for 20–240 minutes to assess the impacts of gillnet entanglement on blood biochemistry and physiological status. We measured concentrations of lactate, corticosterone, ions (Na+, K+, Cl‐, P, Ca2+), enzymes (lactate dehydrogenase [LDH], creatine phosphokinase [CPK], aspartate aminotransferase [AST]), protein, and glucose in the blood and also performed physical examinations of turtles to document external indicators of health status (injuries, lethargy, muted reflexes). We evaluated the effects of entanglement time on blood biochemistry and to look for correlations between blood biochemistry and results of the physical examinations. We observed a significant increase in blood lactate, LDH, CPK, phosphorus, and glucose with increased entanglement time. Alterations in blood biochemistry were generally associated with a decline in health status as indicated by results of the physical examination. Although entanglement time plays an important role in determining the health status of sea turtles upon release from a gillnet, our results suggest that factors such as the depth and severity of entanglement may also have an effect on health status of turtles and the probability of postrelease survival. We were unable to set a maximum unattended gillnet soak time to minimize impacts on captured sea turtles, and therefore recommend that fisheries managers continue to enforce the net attendance regulations currently in place in the lower Cape Fear River, North Carolina, during the summer months.

A Case of Neuroleptic Malignant Syndrome Induced by Risperidone in a Schizophrenic Woman

We report a case of neuroleptic malignant syndrome in a woman who assumed risperidone for schizoaffective disorders. A 45-year-old woman affected by schizoaffective disorders was admitted to Infectious Disease unit of Crotone Hospital because of a diagnosis of a fever of unknown origin. Clinical evaluation documented confusion and dysphoria, whereas chemical blood evaluation revealed acidosis and liver dysfunction. After few days she was transferred to the Operative Unit of Internal Medicine of San Giovanni in Fiore Hospital because of an increase in liver transaminases. Clinical evaluation showed the persistence of fever (38.8 degrees Celsius), with an increase in CPK, and liver enzymes. Pharmacological evaluation indicated a probable relationship between risperidone and NMS and led to a diagnosis of neuroleptic malignant syndrome associated with risperidone in a woman with schizophrenia. About seven days later, we recorded a complete resolution of her psychiatric symptoms. We postulate a possible interaction between risperidone and neuroleptic malignant syndrome and we suggest to use risperidone with caution in both young and middle aged people.

Phase I combination study of plitidepsin and carboplatin in advanced solid tumours

2558 Background: Plitidepsin is a cyclic depsipeptyde isolated from the marine tunicate Aplidium albicans, nowadays manufactured by synthesis. It is a rapid and potent inductor of apoptosis. In phase I trials, muscle (myalgia and CPK increase) and liver toxicities were dose-limiting and preliminary activity was observed in malignant melanoma, renal, head and neck, lung, neuroendocrine, colorectal and hematological malignancies. Preclinical synergism with carboplatin (CBCDA) against solid tumors and acute leukaemia suggest plitidepsin can reverse platinum chemoresistance in vivo through reduction of glutathione levels. This phase I trial was initiated in order to evaluate the safety, pharmacokinetics (PK) and antitumour activity of the combination of CBCDA and weekly administration of plitidepsin (Recommended dose (RD) in monotherapy: 3.2 mg/m2). Methods: Patients (pts) with advanced solid tumours and good performance status (WHO PS = 2) were enrolled. Plitidepsin was given over 1 hr infusion on days 1 , 8 and 15 every 4 weeks followed by CBDCA (AUC 5) as a 1 hr infusion on day 1. Dose levels planned for plitidepsin were 1.8, 2.4 and 3.0 mg/m2 in cohorts of 3 pts. PK sampling was performed during the first cycle (cy) of treatment. Results: 18 pts have been treated to date (8M/10F). Median age (range): 59 (39–73) yrs. WHO PS&gt;0: 3pts. Tumour types included colorectal (5), malignant melanoma (4), ovary (2), other gastrointestinal tumors (7). No DLT was observed at plitidepsin 1.8 and 2.4 mg/m2 (3 pts treated in each cohort). Two out of 5 pts exhibited DLT at pltidepsin 3.0 mg/m2, consisting of delay of second cy &gt;2 weeks (grade 3 transaminitis and grade 3 thrombocytopenia) and omission of second infusion in first cy (grade 3 ALT increase). Plitidepsin at 2.4 mg/m2 was expanded to 8 pts. There were 4 pts with stable disease (cholangio, liver, colorectal, gatro-esophageal junction and esophagus carcinomas). Conclusions: The RD for the combination is plitidepsin 2.4 mg/m2 (0.8 mg/m2 lower than in monotherapy) days 1, 8 and 15 every 4 weeks followed by CBDCA (AUC 5). DLTs of the combination at the highest dose were different vs single plitidepsin (liver and haematological vs muscular). PK analyses from the three cohorts to detect interactions and updated safety data for the RD cohort are in progress. [Table: see text]

Effects of lipoprotein lipase and statins on cholesterol uptake into heart and skeletal muscle

Regulation of cholesterol metabolism in cultured cells and in the liver is dependent on actions of the LDL receptor. However, nonhepatic tissues have multiple pathways of cholesterol uptake. One possible pathway is mediated by LPL, an enzyme that primarily hydrolyzes plasma triglyceride into fatty acids. In this study, LDL uptake and tissue cholesterol levels in heart and skeletal muscle of wild-type and transgenic mice with alterations in LPL expression were assessed. Overexpression of a myocyte-anchored form of LPL in heart muscle led to increased uptake of LDL and greater heart cholesterol levels. Loss of LDL receptors did not alter LDL uptake into heart or skeletal muscle. To induce LDL receptors, mice were treated with simvastatin. Statin treatment increased LDL receptor expression and LDL uptake by liver and skeletal muscle but not heart muscle. Plasma creatinine phosphokinase as well as muscle mitochondria, cholesterol, and lipid droplet levels were increased in statin-treated mice overexpressing LPL in skeletal muscle. Thus, pathways affecting cholesterol balance in heart and skeletal muscle differ.

Bezafibrates Cause Moderate, Reversible Impairment in Renal Function in Patients without Prior Renal Disease

Background/Aims: To determine whether bezafibrates have adverse effects on renal function. Methods: (1) A 3-year retrospective survey of 526 patients who were on bezafibrate for a while and 614 controls following fluctuations of serum creatinine levels. (2) A prospective study on 33 patients with previous evidence of bezafibrate-induced elevation in serum creatinine. The patients were examined after 3 months on bezafibrate 400 mg/day and then after 3 months without bezafibrate. Eight patients repeated the tests after 3 months on bezafibrate 200 mg/day. Results:Retrospective: 295 bezafibrate-treated patients (56%) and 67 controls (11%) demonstrated fluctuations ≧0.2 mg/dl in serum creatinine levels (p < 0.001); 113 patients (21%) and 16 controls (3%) showed fluctuations ≧0.3 mg/dl (p < 0.001). Prospective: bezafibrate 400 mg/dl increased serum creatinine from 1.16 ± 0.19 to 1.42 ± 0.2 mg/dl (p < 0.001) and urea from 37 ± 8 to 44 ± 8 mg/dl (p < 0.001); creatinine clearance (C_cr) decreased from 104 ± 23 to 82 ± 27 ml/min (p < 0.001). CPK increased from 82 ± 32 to 130 ±58 mg/dl (p < 0.0001) and urinary myoglobin increased from 95.4 ± 21 to 199 ± 99 mg/dl (p < 0.0001). The 8 patients given bezafibrate 200 mg/dl experienced similar dose-dependent changes. Conclusions: Bezafibrate causes quiet common, dose-dependent and reversible changes in serum creatinine in patients with normal renal function, associated with a significant increase in serum CPK and urine myoglobin, suggestive of drug-induced mild subclinical skeletal muscle injury compromising renal function.

MYOCARDIAL PROTECTION BY ISCHEMIC PRECONDITIONING AND ENFLURANE ANESTHESIA DURING CORONARY SURGERY WITHOUT CARDIOPULMONARY BYPASS

Introduction. Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) is gaining popularity as an alternative technique of myocardial revascularization of one or two vascular grafts. Technical and anesthetic techniques were proposed to support the surgical team during the procedure, but specific methods for protection of the myocardium are also mandated. We examined how methods such as myocardial ischemic preconditioning (IP) or administration of enflurane anesthesia may protect the heart from the injurious effect of ischemia and subsequent reperfusion. Methods. With IRB approval and patient informed consent, a prospective randomized study was conducted on 24 patients undergoing single - graft CABG via mid - sternotomy. All patients were managed in similar fashion in regard to anesthesia and fluid management. Three groups of patients: control, enflurane anesthesia, and IP (5 min ischemic interval) were evaluated for hemodynamic data by arterial and pulmonary artery catheters, and by biochemical analysis of arterial and coronary sinus venous blood. Enflurane, 1.7% or 0.8% if blood pressure dropped, was given 15 min prior-, to 10 min after ischemia. The study also examined production of hydroxyl ([center dot]OH) free radicals from the ischemic myocardium using the method of [center dot]OH radicals - mediated conversion of salicylate to its 2,3- and 2,5-dihydroxybenzoate (DHBA) derivatives. For this purpose the patient received 1gr aspirin P.O. with premedication. The DHBAs were analyzed by HPLC with electrochemical detection. Data analysis (mean +/- SEM) was performed by ANOVA; p value < 0.05 was considered statistically significant. Results. With no significant change in blood pressure and in the filling pressures between groups, a significant decrease in cardiac index (CI) was observed only in control group. Oxygen content values in coronary sinus blood (cO2 cs) indicate that O2 utilization by the myocardium was preserved in the presence of IP and enflurane anesthesia. The acute increase in CPK, myoglobin, 2,3- and 2,5- DHBAs production was also attenuated in both study groups. Table 1Table 1Discussion. The present study confirms that both interventions, IP and enflurane anesthesia have been effective in attenuating the deleterious effects of ischemia and reperfusion on cardiac performance, metabolic status and free radical production. It supports the approach of including physiologic and pharmacological interventions against cardiac depression during off-bypass coronary revascularization. Supported by grants from the Hebrew University and Hadassah and the Administrator General office.

Unexplained Transient Postoperative Myocardial Dysfunction in a Previously Healthy Child

Unexplained Transient Postoperative Myocardial Dysfunction in a Previously Healthy Child

犬にみられたオーエスキー病の1例

The affected dog was examined the day following the onset of clinical signs suchas abdominal pain and nausea with profuse salivation and no appetite or vigor. Six hr after the first examination, the dog showed vomiting with grdual gloomy condition and pruritus was observed seven and a half hr later. The animal made a gesture of scratching the posterior of the right shoulder joint with its right hind paw. Eight hr later, there were pyrexia and some loss of consciousness. A tentative diagnosis of Aujeszky's disease (AD) was made. Thirteen hr later, heart hypofunction was suspected and blood examination revealed a remarkable increase in CPK, LDH, GOT, ALP, PCV and WBC (neutrophil) and a decrease in β-globulin. Vomiting was noted intermittently, from white frothy to black brown water consistency at the time of death. The animal died 21hr after the first examination. Histopathological, microbiological virological examination were made. The medulla oblongata showed non-suppurative encephalitis accompanied by formation of intranuclear inclusion bodies. AD virus was isolated from the lung.Based on the present findings, a diagnosis of AD was made.

術後発症した亜型悪性高熱症の１例

A 59-year-old man underwent total gastrectomy under general anesthesia uneventfully. On the second day after the operation, he developed a fever of over 39°C accompanied by tachycardia, metabolic acidosis, and oliguria which was resistant to conservative treatment. At the same time he complained of muscle pain and slight rigidity of the extremities. A detailed examination revealed a significant increase in serum CPK, LDH, GOT, GPT levels, and leucopenia below 2, 500/mm3, suggesting intraperitoneal infection and necrosis of the intestine. On the third postoperative day, an emergency operation was performed. However we could not obtain any abnormal findings in the peritoneal cavity. During the operation port wine-like myoglobulinuria was observed, so we suspected malignant hyperthermia. Intravenous dantrolene was effective in preventing renal failure and disseminated intravascular coagulopathy. Stress in the postoperative period may have been the triggering factor responsible for this reaction.

The effects of exercise on liver function in patients with chronic liver disease

This study examined the effect of exercise on liver function in patients with chronic liver disease (CLD). 1) Twenty-five patients with CLD (21 with chronic hepatitis (CH) and 4 with liver cirrhosis (LC] and 10 healthy subjects were administered an exercise test employing a treadmill. The load applied was 6.5 Mets and was administered for a period of 10 min. The serum levels of S-GOT, S-GPT, LDH, CPK, triglyceride, GOTm and GLDH were measured before exercise and 1 h, 24 h and 7 days after exercise in the patients with CLD, and before and 24 h after exercise in the healthy subjects. i. The patients with CLD showed an increase in GLDH 24 h after exercise (p less than 0.005), a decline in LDH 1 h (p less than 0.05) and 24 h (p less than 0.01) after exercise, and a decrease in triglyceride 24 h after exercise (p less than 0.005) as compared with pre-exercise values. No significant changes were observed in S-GOT, S-GPT, CPK or GOTm levels. ii. The mean values and standard deviations (SD) of S-GOT and S-GPT during the 3-month period immediately preceding the study were calculated for all 25 patients. Increases in S-GOT of more than 1 SD were observed after exercise in 5 patients (20%); another 5 patients (20%) showed similar increases in S-GPT. The number of overlapping cases in which increases in both S-GOT and S-GPT were observed was 2 (8%). iii. No significant differences were found in mean HR during exercise/predicted max HR, or mean BP during exercise between patients with increased S-GOT and those without, or between patients with increased S-GPT and those without. iv. In the healthy subjects, there was a significant increase in GOTm (p less than 0.05) following exercise, but no such increase in S-GOT, S-GPT, CPK or GLDH. 2) The number of steps taken per day measured by a pedometer was selected as a parameter of daily exercise and examined in 14 patients with CLD (9 with CH and 5 with LC). No significant correlation was found between mean number of walking steps and S-GOT and S-GPT levels for patients with either type of CLD. The results of this study indicate that moderate exercise was well tolerated in the majority of patients with CLD.(ABSTRACT TRUNCATED AT 400 WORDS)

心筋炎と胸部X線上異常陰影を認めない肺炎を合併した思春期麻疹の1例

A 18-year-old man was admitted with fever, dry cough, erythema, conjunctivitis, and dyspnea. The case was diagnosed as measles because of the typical clinical course and the increase of measles viral antibody titre. Electrocardiogram showed transient ST-T abnormalities and the laboratory data showed transient increase of CPK. Therefore myocarditis was considered. However chest roentgenogram showed no abnormal findings. Arterial oxygen was low. The Ga scintigram revealed diffused uptake in both lungs. Microscopic examination of the transbronchial lung biopsy revealed alveolitis. In view of he above, measles pneumonia was diagnosed in this case.

Rhabdomyolyse après position génu-pectorale prolongée

Two cases are described of surgery for spondylolisthesis requiring prolonged knee-chest position (5 h 20 min and 4 h 30 min); acute renal failure with anuria occurred early in one case (within the first 24 h postoperatively), and later in the other case (on the 8th day). The diagnosis of rhabdomyolysis was made on the increase of CPK and myoglobin blood levels. Post-haemodialysis evolution was satisfactory. The possible mechanism was muscle compression against the rests. Diagnosis must be made quickly; the only treatment is early fasciotomy, with the supplying of alkali to prevent acute renal failure. It would appear that the knee-chest position can be kept a maximum of 3 h without any problem.

Etude des créatine-phosphokinases et de la myoglobine sanguine et urinaire après intervention en position génu-pectorale prolongée pour cure de spondylolisthésis

Rhabdomyolysis following the knee-chest position was studied in 15 patients scheduled for surgery for spondylolis-thesis. A comparison was made between 11 patients scheduled for orthopaedic surgery : ligamentoplasty (6 patients), total hip prosthesis (5 patients) and 11 patients scheduled for long oral surgery. The measurements carried out were blood CPK before surgery, 4, 8, 12 and 24 h after the beginning of surgery, and at days 2, 3 and 4. Blood and urinary myoglobin were measured at days 1, 2, 3 and 4 after surgery. The results were tested with the Mann and Whitney test. There was no statistical change in CPK and myoglobin in the test population. Following the knee-chest position, there was a statistical increase of CPK in all patients, with great individual variations. Myoglobinaemia and myoglobinuria were observed in six patients, these not being correlated with the variations of CPK. Nevertheless, the maximal increase of CPK and myoglobin was seen in one patient, without any modification of diuresis but with an increase of creatininaemia at 220 mmol · l −1. In this series, rhabdomyolysis was real. CPK was not a good index of the release of haematic pigments, the only dangerous ones. A qualitative search for myoglobinuria is suggested, this being followed, or not, by alkalization to prevent acute renal failure.