Mean Creatine Phosphokinase Level Research Articles

The optimized tourniquet versus no tourniquet in total knee arthroplasty. Analysis of muscle injury, functional recovery, and knee strength

BackgroundTourniquet is widely used in total knee replacement surgery because it reduces intraoperative hemorrhage and provides a comfortable surgical area for the surgeon. It's possible that its use could lead to impaired postoperative functional and motor recovery, as well as local and systemic complications. Our goal was to compare the outcomes of total knee replacement without ischemia using an optimized protocol, consisting of tourniquet inflation before skin incision and deflation after cementing, with a pressure of one hundred millimeters above systolic blood pressure and without postoperative articular suction drains.). We believed that tourniquet effectively would result in no additional muscle damage and no functional or knee strength impairment compared to no tourniquet. MethodsIn a prospective and randomized study, 60 patients with osteoarthritis were evaluated for total knee replacement, divided in two groups: 'without tourniquet' and 'optimized tourniquet'. Outcomes were mean creatine phosphokinase levels, Knee Society Score and knee isokinetic strength. Data were considered significant when p < 0.05. ResultsCreatine phosphokinase levels and functional score were similar between groups. There were no differences between groups regarding knee extension strength on the operated limbs, although the knee flexors' peak torque in the operated limb in the optimized tourniquet group was significantly higher at 6 months relative to preoperative and 3 months assessments. ConclusionsThe optimized tourniquet protocol use in total knee replacement combines the benefits of tourniquet use without compromising functional recovery and without additional muscle damage and strength deficits compared to surgery without its use.

Telbivudine Plus Adefovir Versus Lamivudine Plus Adefovir for Lamivudine-Resistant Chronic Hepatitis B: TeSLA Randomized Trial

Background: In countries with unavailable tenofovir, a combination of lamivudine (LMV) and adefovir (ADV) is recommended for the treatment of LMV-resistant chronic hepatitis B (CHB). Considering that telbivudine (L-dT) was demonstrated to be superior to LMV in previous studies, L-dT and ADV combination therapy is expected to show better antiviral efficacy than the combination of LMV and ADV in patients with LMV-resistant CHB. Methods: This was a prospective randomized multicenter study. The primary endpoint was Hepatitis B Virus (HBV) DNA reduction after 52 weeks of treatment. The secondary endpoints were HBV DNA undetectability, hepatitis B e antigen seroconversion, the incidence of virological and biochemical breakthroughs, and safety during the study period. Results: A total of 43 LMV-resistant CHB patients were enrolled. Twenty-one were treated with LMV + ADV and 22 with L-dT + ADV. After 52 weeks of antiviral treatment, the HBV DNA reduction showed no significant intergroup difference (-4.54 ± 1.23 log IU/mL in the LMV + ADV group, -4.24 ± 1.46 log IU/mL in the L-dT + ADV group, P = 0.475). There were no significant intergroup differences in HBV DNA undetectability rates, mean HBV DNA level, or hepatitis B e antigen seroconversion rate at 13, 26, 39, and 52 weeks of treatment. In terms of safety, the mean creatine phosphokinase level was significantly higher in the L-dT + ADV group. Conclusions: In the treatment of LMV-resistant CHB, the combination of L-dT and ADV did not show any clinical benefit compared to the combination of LMV and ADV.

Outcome of Benign Acute Childhood Myositis: The Experience of 2 Large Tertiary Care Pediatric Hospitals.

The aims of the study were to determine the evolution of benign acute childhood myositis in children and to assess the relationship between creatine phosphokinase (CPK) values and myoglobinuria. A retrospective study of patients with benign acute childhood myositis seen in 2 tertiary care university-affiliated pediatric hospitals during overlapping 4-year periods. Demographic data, historical details, clinical, and laboratory results were extracted from the charts of children younger than 16 years with a CPK greater than 3 times normal. Complications, treatments, and outcomes were recorded. Fifty-four children were included, 43 (80%) were male, and mean age was 7.3 years (median [range], 6 [3-16] years), none showed abnormal neurological findings, manifested hematuria, or developed renal failure. Mean CPK level at presentation was 1872 IU/L (range, 511-8086 IU/L). None developed renal failure, and there were no adverse outcomes on follow-up. Acute childhood myositis is a predominantly benign disease. Neurological examination is usually normal and rhabdomyolysis is rare. Although severe pathological comorbid conditions must be excluded, a complete history and examination, coupled with simple blood and urine tests, can help minimize unnecessary diagnostic investigations.

Functional recovery, complications and CT positioning of total hip replacement performed through a Röttinger anterolateral mini-incision. Review of a continuous series of 103 cases

Minimally invasive approaches entail an increased risk of malpositioning and peri-operative complications. Most studies analyzed these data only on plain X-ray rather than computed tomodensitometry (CT) in assessing implant positioning. A Röttinger minimally invasive anterolateral (MIS-AL) approach provides rapid complication-free functional recovery with reliable implant positioning on CT-scan. One hundred and three primary cemented total hip replacements (THR) performed by a single surgeon using a MIS-AL approach underwent clinical assessment at six weeks and three, six and 12 months on X-ray, including CT and postoperative myoglobinemia and creatine phosphokinase (CPK). Pain, on a visual analog scale, was graded less than 1 at 36 hours; canes ceased to be used at a mean three weeks; and mean Postel-Merle-D'Aubigné score at six months was 17.36 (range, 13-18). There were ten approach-related complications (9.7%: one femoral perforation, two dislocations, two femoral neck fissures, two cases of meralgia paresthetica and three of tensor tendinitis). Mean CPK level was 390.9 ± 252μg/L (range, 88-1095μg/L) at 24 hr postoperatively and 319 ± 256μg/L (95-1028 μg/L) at 48 hr. Mean postoperative myoglobinemia was 299 ± 152.6μg/L (75-914μg/L). Mean acetabular inclination and anteversion on CT were respectively 44.7° ± 4.6° (34° - 56°) and 9.2°±9.2° (-17°-35°) and mean femoral anteversion 23.5° ± 9.4° (2°-53°). Functional recovery was quick, but with an 8.7% complications rate (excluding four cases of spontaneously resolved tendon pain). CT showed reliable cup positioning, but a wide scatter in femoral anteversion. Elevated muscle enzyme levels possibly testified to approach-related tissue attrition. The MIS-AL approach involves a learning curve to avoid femoral perforation. It provided rapid functional recovery with reliable positioning, at least for the cup, and a low rate of associated complications. III, prospective continuous study.

CIRCADIAN VARIATIONS OF THE SERUM CREATINE KINASE LEVEL—A MASKING EFFECT?

Since the serum level of the enzyme creatine (phospho)kinase (CPK) is frequently used for diagnostic purposes and since circadian variations of this parameter have been observed under different stress conditions, it had to be determined whether they are induced by an endogenous circadian rhythm or whether they are activity-related masking effects. For this purpose, 15 untrained male test persons were examined for a period of 25h each under different conditions: lying constantly in a climatic chamber, everyday activity conditions, resting conditions with intermittent bicycle ergometer tests (1.4 W/kg body weight) between 09:00 and 11:30 or between 15:00 and 17:30. In addition, 5 sportsmen were included in the study under resting conditions and the bicycle ergometer tests in the forenoon. The serum CPK was determined at intervals of 2h or 4h, respectively. Under constant resting conditions, the mean serum CPK level decreased continuously (p <. 001, repeated measures analysis of variance [Rep. Mes. ANOVA]), and the final values amounted to approximately 80% of the initial values. In contrast, under everyday conditions, the mean CPK level rose during the activity phase and decreased again to below the initial values during subsequent rest (p <. 001, Rep. Mes. ANOVA). In the ergometer tests, the CPK blood level rose in each case after the activity phase and fell again continuously in the following resting period. However, in the calculation of the deviations from the linear trend, it was shown that certain daily variations in the CPK values can be detected under constant resting conditions; however, the amplitude was much smaller than the amplitude under everyday activity conditions. All in all, it can be stated that serum CPK levels are mainly dependent on the physical load conditions, and that the daily changes observed under everyday conditions disappear almost entirely under resting conditions. The daily variation of the serum creatine kinase level under everyday conditions can thus be regarded as a masking effect. These results are of practical significance for diagnosis to the extent that the physical activity that has taken place before the determination of the CPK level must be taken into account in the interpretation of the values. According to the results obtained so far, the CPK serum level may be used in chronobiology as an indicator of masking by physical activity. (Chronobiology International, 17(4), 583–590, 2000)

Hyperbaric oxygen and thrombolysis in myocardial infarction: The "HOT MI" Pilot study

Hyperbaric oxygen treatment (HBO) in combination with thrombolysis has been demonstrated to salvage myocardium in acute myocardial infarction in the animal model. Therefore a randomized pilot trial was undertaken to assess the safety and feasibility of this treatment in human beings. Patients with an acute myocardial infarction (AMI) who received recombinant tissue plasminogen activator (rTPA) were randomized to treatment with HBO combined with rTPA or rTPA alone. Sixty-six patients were included for analysis. Forty-three patients had inferior AMIs (difference not significant) and the remainder had anterior AMIs. The mean creatine phosphokinase level at 12 and 24 hours was reduced in the patients given HBO by approximately 35% ( p = 0.03). Time to pain relief and ST segment resolution was shorter in the group given HBO. There were two deaths in the control group and none in those treated with HBO. The ejection fraction on discharge was 52.4% in the group given HBO compared with 47.3% in the control group (difference not significant). Adjunctive treatment with HBO appears to be a feasible and safe treatment for AMI and may result in an attenuated rise in creatine phophokinase levels and more rapid resolution of pain and ST segment changes.

Creatine phosphokinase levels in children with severe developmental disturbances.

Serum creatine phosphokinase (CPK) levels were studied in individuals: 40 psychotic children suffering from childhood autism, atypical personality development, and childhood schizophrenia; five children with childhood aphasia; 22 children with severe personality disorders; 29 normal children and normal siblings of psychotic children; and 14 normal parents of psychotic children. Creatine phosphokinase levels from the entire population of adults and children were normally disturbed, and the mean CPK levels for the eight diagnostic groups were within normal limits. Those 22 children with personality disorders had significantly higher CPK levels than the other diagnostic groups. This relatively higher level of CPK may be related to vulnerability to later development of schizophrenic spectrum disorders. There was no apparent relationship between CPK levels and motor activity, nor was there any change in the level of CPK during a trial of psychoactive medication. Creatine phosphokinase levels remained relatively stable on test-retest determination.

Myocardial Balance of Inorganic Phosphate and Enzymes in Man

The effects of atrial pacing on the cardiac balance of inorganic phosphate (P i ) were studied during control, atrial pacing, and recovery periods in 29 patients. Group A (n = 18) who had roentgenographically demonstrated coronary artery disease (CAD) developed angina during pacing, and showed mean myocardial lactate (L) production, abnormal left ventricular end-diastolic pressure (LVEDP) and ST segment depression. Group NA (n = 11), composed of six patients with CAD and five subjects with no demonstrable cardiac disease, had normal lactate metabolism, LVEDP, and ST segments during pacing. In addition, blood levels of two enzymes were determined: creatine phosphokinase (CPK) in nine patients of Group A and six patients of Group NA, and glutamic oxaloacetic transaminase (GOT) in eight patients of each group. During control, small uptake of P i was observed in both groups. During pacing, Group A showed first a fall and then abolition of mean P i uptake, and during the early recovery period, a small loss of this ion was observed. Although there was a good correlation between L and P i uptakes ( r = 0.86, P &lt; 0.001) throughout the study, P i loss, which occurred in 55% of patients in Group A, appeared to be a less reliable index of myocardial anaerobiosis than L production, which occurred in 72%. No consistent changes in P i balance were observed in Group NA. The only significant enzymatic change was the small but sudden and significant rise of mean CPK levels in coronary sinus (CS) blood above the arterial levels in five patients of Group A during the first 6 min of pacing. These data show that during pacing-induced angina the human heart loses P i . In addition, these preliminary observations on the CS CPK levels during pacing in the angina patients suggest that the stress of tachycardia and ischemia may facilitate the escape of this enzyme from the heart.

Factors affecting serum creatine phosphokinase levels in normal adult females

The serum creatine phosphokinase (CPK) levels of a group of female subjects were investigated in an attempt to define those factors which were responsible for inter- and intra-personal variation of CPK level.Three venous samples of blood were taken at arbitrary intervals from 42 normal, healthy volunteers. Information on the socio-economic and physical condition of each subject was obtained by means of a questionnaire completed when each sample was taken. The CPK level of each sample and mean CPK level for each individual was found and statistically analysed against this information.Factors which appeared to significantly affect CPK levels were alcohol consumption, oral contraceptive intake, age, marital status and parity. The influence of such factors in the assessment of possible female carriers of the sex-linked form of pseudohypertrophic muscular dystrophy is discussed.

Factors affecting serum creatine phosphokinase (CPK) in healthy adult females

Three venous blood samples were taken at arbitrary periods from 42 healthy female volunteers. Information on the socio-economic and physiological condition of each subject was obtained when each sample was taken. The CPK level of each sample and the mean CPK level for each person was statistically analysed against this information. This analysis showed that age, marital status, parity, and whether she took oral contraceptives or alcohol, were all significantly associated with the personal mean CPK level. Of these factors age, marital status, and having children, were all dependent in our sample group. The CPK level of individual serum samples was found only to be associated with the time of the menstrual period during which the sample was taken and, contrary to the findings of other workers, was not associated with recent exercise by the subject nor the time of day the sample was taken.