Serum Creatine Research Articles

EFFECTS OF DIFFERENT DOSES OF THIOPENTONE ON THE INCREASE IN SERUM MYOGLOBIN INDUCED BY SUXAMETHONIUM IN CHILDREN

We have studied the effects of different doses of thiopentone on the increase in serum myoglobin after administration of suxamethonium during inhalation induction of anaesthesia in children. Forty-three children were anaesthetized with halothane and nitrous oxide in oxygen and allocated to four groups: group S received suxamethonium 1 mg kg-1 to facilitate intubation; group ST2 received thiopentone 2 mg kg-1 and group ST4 received thiopentone 4 mg kg-1, before administration of suxamethonium 1 mg kg-1; group N did not receive thiopentone or suxamethonium. Serum myoglobin and creatine kinase (CK) concentrations were measured until 60 min after the injection of suxamethonium. Both myoglobin and CK concentrations increased in the three groups receiving suxamethonium. There were no significant differences between groups S and ST2, but the myoglobin concentration was less in group ST4 than in groups S and ST2. A significant difference in CK concentration was found only between groups ST2 and ST4 at 60 min. In group N, both values remained reasonably constant. Thiopentone 4 mg kg-1, but not 2 mg kg-1, attenuated the increase. The results indicate that to prevent a marked elevation in serum myoglobin after administration of suxamethonium, thiopentone 4 mg kg-1 should be administered.

Muscle disease, HIV and zidovudine: the spectrum of muscle disease in HIV-infected individuals treated with zidovudine.

Eleven patients with AIDS or AIDS-related complex who developed muscle-related symptoms whilst taking zidovudine were investigated. The clinical details of a further ten patients who did not undergo muscle biopsy are also outlined. The clinical features, quantitative muscle strength testing, electromyographic findings, serial creatine kinase levels, muscle biopsy appearance on light microscopy and the effects of zidovudine withdrawal and rechallenge are described. The spectrum of muscle disease encountered included four cases of frank myopathy diagnosed using clinical, electrophysiological and histological criteria, four patients with mild weakness and myalgia in whom muscle biopsies were normal, three patients with myalgia only and a mild increase in the interstitial cell infiltrate shown by biopsy. The patients presenting with myopathy showed no improvement on withdrawal of zidovudine but responded to immunosuppressive therapy with steroids and, in one case, thalidomide prescribed incidentally. At present, it is not yet possible to clinically define a specific zidovudine-induced myopathy that is distinct from the other effects of HIV infection on muscle structure and function. Our experience suggests that zidovudine may be implicated as a myotoxin in some patients, particularly those with myalgia and mild weakness. In those patients with severe weakness, and with biopsy findings of necrosis and inflammation, the drug effects may be difficult to separate from the primary effects of HIV.

Non-invasive diagnosis of arterial patency after thrombolytic treatment and its relation to prognosis.

To validate a simple noninvasive method with serial creatine kinase measurements for diagnosis of early patency of the infarct related artery after thrombolytic treatment with streptokinase. To investigate the relation between early patency of the infarct related artery and prognosis. Patients under 76 years of age and seen within six hours of the start of prolonged chest pain and ST segment elevation were treated with streptokinase (1.5 x 10(6) U) intravenously over 30-60 minutes. Blood for measurement of total creatine kinase activity was taken at baseline and at 1, 2, 3, 4, 8, 12, 16, 20, and 24 hours after starting treatment. The rise in enzyme activity at each time from baseline was expressed as a proportion of the total rise from baseline to peak. Patients studied were in the following groups: (a) Sixty patients took part in a validation study with angiographic determination of patency of the infarct related coronary artery at 2.6 (0.3) hours (mean (SD)) after starting streptokinase. (b) A further 258 patients did not have early arteriography, but data were added to those from the 60 validation patients to find the relation between enzymatically determined early patency of the infarct related artery and 30 day mortality. (c) A further subset of 232 patients with first infarctions (including patients from groups (a) and (b) had angiocardiography at three weeks after infarction, and data were used to investigate the relation between early patency of the infarct related artery and left ventricular function. Normalised rate of rise of creatine kinase activity at three hours after starting streptokinase in relation to angiographic patency of the infarct related coronary artery at 2.5 hours; 30 day cardiac mortality; and left ventricular function at three weeks in survivors of first infarction. In the validation study, a rise in three hour creatine kinase activity of > 20% of peak occurred in 34/37 patients with initially patent infarct related coronary arteries (sensitivity 92%), and a rise to < 20% of peak occurred in 21/23 patients with initially occluded arteries (specificity 91%). In the prognostic study, 30 day mortality was 2.1% in the 191 patients with three hour creatine kinase > 20% of peak and 8.7% in the 127 patients with three hour creatine kinase < 20% of peak (p < 0.01). Angiocardiography in three week survivors of anterior infarction (n = 95) showed better left ventricular function when three hour creatine kinase was > or = 20% than when it was < 20% of peak (mean (SEM) end systolic volume 71 (5) v 96 (9) ml, p < 0.02; ejection fraction 56% (2%) v 51% (2%), NS). Non-invasive determination of early patency of the infarct related artery by the normalised rate of rise of creatine kinase activity at three hours seems to be reliable, and may be prognostically important and of value for use in clinical trials.

Infrainguinal reconstruction for patients with chronic renal insufficiency

Purpose: The efficacy of autogenous infrainguinal reconstruction for patients with varying degrees of chronic renal insufficiency was reviewed because it has not been well defined.Methods: Pertinent data were retrieved from hospital records and the vascular registry for all patients with chronic renal insufficiency (serum creatine > 2 mg/dl) who required surgical intervention for ischemic lower limbs during the past 15 years at Brigham and Women's Hospital.Results: During the past 15 years, 56 patients underwent 70 autogenous vein bypass procedures, and 31 underwent 42 primary major amputations. All patients had serum creatinine levels greater than 2 mg/dl. Limb salvage was the indication for intervention in 84% of reconstructed limbs, and 48% required infrapopliteal bypass. No significant difference was found in the operative mortality rate associated with primary amputation (17%) and reconstruction (11%), but overall 5-year survival for the group undergoing reconstruction (40%) was significantly superior to that observed in the group undergoing amputation (9%). The 5-year cumulative limb salvage rate for the group having reconstruction was 80%, with a primary graft patency of 74% and a secondary patency of 77%. Patients with diabetes had lower rates of both limb salvage (63%) and survival (21%). No patient on dialysis survived beyond the third-year interval, but the limb salvage rate after 2 years was 76%.Conclusion: Patients with chronic renal insufficiency achieved graft patency and limb salvage results comparable to those obtained in patients with normal kidney function, but they sustained higher perioperative morbidity and reduced survival.

Serial ECGs are less accurate than serial CK-MB results for emergency department diagnosis of myocardial infarction

Serial creatine kinase-MB (CK-MB) levels provide more accurate predictive information regarding myocardial infarction than serial ECGs in emergency department patients with chest discomfort and no ST-segment elevation on the initial ECG. Prospective, observational study. University hospital and university-affiliated Veterans Affairs Medical Center EDs. Two hundred sixty-one patients 30 years or older with chest discomfort warranting an ECG and consenting to observation. Exclusions included hemodynamic or rhythm instability and ST-segment elevation of 0.1 mV or more in two or more electrically contiguous leads at presentation. ECGs were obtained at presentation and three to four hours after presentation. Significant serial ECG changes sought on comparison of initial and three- to four-hour ECGs were 0.05 mV or more ST elevation or depression, Q-wave development, or T-wave inversion changes in two or more electrically contiguous leads. CK-MB levels were obtained at presentation and hourly for three hours (positive level, 8 or more ng/mL). Myocardial infarction was determined by record review and was based on independent CK-MB measurements. Twenty-eight (11%) patients were diagnosed with a myocardial infarction. Thirty-eight (15%) patients had a serial ECG change. Eleven of the myocardial infarction patients (39%) had a serial ECG change compared with 27 (12%) of the non-myocardial infarction patients (P < .001). Sensitivities and specificities of a serial ECG change versus serial CK-MBs for myocardial infarction were 39% versus 68% (sensitivity) and 88% versus 95% (specificity), respectively. Serial CK-MBs were more accurate than a serial ECG change for predicting myocardial infarction (P < .03). Serial changes in ECGs during a three- to four-hour interval were associated with the diagnosis of myocardial infarction but were infrequent and less accurate than serial CK-MB levels obtained for the same interval.

Prospective analysis of possible myocardial damage or hemolysis occurring as a result of prolonged autoperfusion angioplasty in humans

Objectives. The purpose of this study was to further explore the procedural safety of prolonged (15-min) dilation using an autoperfusion coronary angioplasty balloon by assessing the degree of myocardial damage or hemolysis, if any, occurring as a result of the procedure.Background. Prolonged balloon inflation periods may be beneficial during percutaneous transluminal coronary angioplasty. The duration of standard balloon angioplasty is often limited by the occurrence of myocardial ischemia due to loss of anterograde blood flow. Autoperfusion angioplasty allows continued myocardial perfusion during balloon inflation and has previously been shown to reduce but not totally eliminate acute myocardial ischemia during prolonged (up to 15 min) balloon inflation. The risk of intravascular hemolysis as a result of autoperfusion angioplasty has not yet been fully delineated.Methods. Sixty-two consecutive patients (76% men; mean age 58 years) undergoing elective percutaneous transluminal coronary angioplasty of a single lesion were studied. Serial electrocardiographic and creatine kinase MB isoenzyme data were examined to detect evidence of myocardial damage. Tests for hemolysis (plasma free hemoglobin, serum haptoglobin and serum lactate dehydrogenase) were obtained in the 1st 24 consecutive patients.Results. Inflation time was 14 ± 4 min (mean ± SD) and the procedure was successful (≤ 50% residual lesion stenosis) in 59 patients (95%). Electrocardiographic evidence of myocardial infarction (> 1 mm persistent ST segment depression, > 1 mm ST segment elevation or new Q waves) was not observed in any patient. Cardiac enzyme assays were within the normal range in all patients. No evidence of hemolysis was found in the 24 consecutive patients studied.Conclusions. We conclude that prolonged autoperfusion angioplasty can be performed in patients without clinical evidence of myocardial damage or hemolysis.

Gemfibrozil-lovastatin therapy for primary hyperlipoproteinemias

The specific aim of this retrospective, observational study was to assess safety and efficacy of long-term (21 months/patient), open-label, gemfibrozil-lovastatin treatment in 80 patients with primary mixed hyperlipidemia (68% of whom had atherosclerotic vascular disease). Because ideal lipid targets were not reached (low-density lipoprotein (LDL) cholesterol <130 mg/dl, high-density lipoprotein (HDL) cholesterol > 35 mg/dl, or total chotesterol/HDL cholesterol <4.S mg/dl) with diet plus a single drug, gemfibrozil (1.2 g/day)-lovastatin (primarily 20 or 40 mg) treatment was given. Follow-up visits were scheduled with 2-drug therapy every 6 to 8 weeks, an average of 10.3 visits per patient, with 741 batteries of 6 liver function tests and 714 creatine phosphokinase levels measured. Only 1 of the 4,446 Ihrer function tests (0.02%), a gamma glurtamyl transferase, was ≥3 times the upper normal limit. Of the 714 creatine phosphokinase levels, 9% were high; only 1 (0.1%) was ≥3 times the upper normal limit. With 2-drug therapy, mean total cholesterol decreased 22% from 255 to 200 mg/dl, triglyceride levels decreased 35% from 236 to 154 mg/dl, LDL cholesterol decreased 26% from 176 to 131 mg/dl, and the total cholesterol/HDL cholesterol ratio decreased 24% from 7.1 to 5.4, all p ≤ 0.0001. Myositis, attributable to the drug combination and symptomatic enough to discontinue it, occurred in 3% of patients, and in 1% with concurrent high creatine phosphokinase (769 U/liter); no patients had rhabdomyolysis or myoglobinuria. Gemfibrozil-lovastatin treatment mandates careful clinical follow-up with serial creatine phosphokinase and liver function tests in reliable patients who (1) do not respond optimally to 1-drug therapy, (2) are well informed about possible myositis, and (3) are prepared to discontinue 2-drug therapy at earliest onset of myositis symptoms. Within this frame of reference, combined gemfibrozil-lovastatin treatment is safe and effective, reducing total and LDL cholesterol, triglycerides, and the total cholesterol/HDL cholesterol ratio to levels at which regression of coronary artery disease may occur.

Body Compositional Changes in Response to Testosterone

In Reply. —We wish to respond to the points raised by Coodley et al in their comments on our article. 1 We did not state or imply that anabolic steroids are a safe, reasonable approach for normal healthy men to increase muscle mass. The normal volunteers reported in JAMA were monitored closely. As reported earlier, 2 there were no changes in serum cholesterol or serum triglyceride levels, or liver function tests. Serum creatinine and creatine kinase levels, and hematocrit rose significantly while plasma follicle-stimulating hormone, luteinizing hormone, and thyroxine levels fell. Subjects were interviewed and evaluated monthly for side effects. Acne and weight gain were the only changes. Not reported previously were the facts that blood pressure, mood, and muscle strength as measured with a hand dynamometer did not change significantly and consistently in this short-term study. The normal men were studied concurrently with adult ambulatory men with myotonic dystrophy

Body Compositional Changes in Response to Testosterone-Reply

In Reply. —We wish to respond to the points raised by Coodley et al in their comments on our article. 1 We did not state or imply that anabolic steroids are a safe, reasonable approach for normal healthy men to increase muscle mass. The normal volunteers reported in JAMA were monitored closely. As reported earlier, 2 there were no changes in serum cholesterol or serum triglyceride levels, or liver function tests. Serum creatinine and creatine kinase levels, and hematocrit rose significantly while plasma follicle-stimulating hormone, luteinizing hormone, and thyroxine levels fell. Subjects were interviewed and evaluated monthly for side effects. Acne and weight gain were the only changes. Not reported previously were the facts that blood pressure, mood, and muscle strength as measured with a hand dynamometer did not change significantly and consistently in this short-term study. The normal men were studied concurrently with adult ambulatory men with myotonic dystrophy

Acute myocardial infarction in chest pain patients with nondiagnostic ECGs: Serial CK-MB sampling in the emergency department

This study tested the hypothesis that serial creatine phosphokinase (CK)-MB sampling in the emergency department can identify acute myocardial infarction (AMI) in patients presenting to the ED with chest pain and nondiagnostic ECGs. Patients more than 30 years old who were evaluated initially in the ED and hospitalized for chest pain were studied. Serial CK-MB levels were analyzed prospectively using a rapid serum immunochemical assay for identification of AMI patients in the ED. Presenting ECGs showing new, greater than 1-mm ST elevation in two or more contiguous leads were considered diagnostic for AMI. All other ECGs were considered nondiagnostic ECGs. CK-MB levels were determined at ED presentation and hourly for three hours (total of four levels). Patients with at least one level of more than 7 ng/mL were considered to have a positive enzyme study. The in-hospital diagnosis of AMI was determined by the development of typical serial ECG changes or separate standard cardiac enzyme changes after admission. Eight tertiary-care medical center hospitals. Of the 616 study patients, 108 (17.5%) were diagnosed in the hospital as AMI; 69 of these AMI patients (63.9%) had nondiagnostic ECGs in the ED. Of the patients with nondiagnostic ECGs, 55 (sensitivity, 79.7%) had a positive ED serial CK-MB enzyme study within three hours after presentation. Combining serial ED CK-MB assay results with diagnostic ECGs yielded an 88.4% sensitivity for AMI detection within three hours of ED presentation. The predictive value of a negative serial ED enzyme study for no AMI was 96.2% (specificity, 93.7%). Serial CK-MB determination in the ED can help identify AMI patients with initial nondiagnostic ECGs. Use of serial CK-MB analysis may facilitate optimal in-hospital disposition and help guide therapeutic interventions in patients with suspected AMI despite a nondiagnostic ECG.

Does Low Total Creatine Kinase Rule Out Myocardial Infarction?

Letters15 March 1992Does Low Total Creatine Kinase Rule Out Myocardial Infarction?Laura Bilodeau, MD, Lynne M. Preese, MBA, Fred S. Apple, PhDLaura Bilodeau, MDSearch for more papers by this author, Lynne M. Preese, MBASearch for more papers by this author, Fred S. Apple, PhDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-116-6-523_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editors: Serial creatine kinase and creatine kinase-MB measurements with clinical history findings, physical examination findings, and electrocardiographic (ECG) changes are the standards for diagnosing acute myocardial infarction (1, 2). Whether creatine kinase-MB measurements should be quantified when total creatine kinase activity never rises above the upper limit of the normal range is unclear (3, 4). We wondered whether there truly was an upper limit of the normal range for creatine kinase-MB measurements and whether percent relative index (creatine kinase-MB mass concentration/ total creatine kinase activity) might misdiagnose acute myocardial infarction when the total creatine kinase activity is normal....

Use of rapid serial sampling of creatine kinase MB for very early detection of myocardial infarction in patients with acute chest pain

To determine how early myocardial infarction can be detected, serial creatine kinase MB concentrations were sampled in 313 patients during triage of acute (<12 hours) chest pain. Serum was sampled on hospital arrival (baseline) and hourly for 3 hours (total of four samples). Creatine kinase MB concentrations were subsequently analyzed for their ability to detect infarction. Infarction was present in 70 patients (22%) and was diagnosable from the index electrocardiograms in 27 of these (39%). Sensitivity and specificity for detection of infarction were 76% and 72%, respectively, as determined from baseline MB values only and increased with each additional sample to a maximum of 92% and 96%, respectively, in all four samples. Analysis of two serum samples taken 2 hours apart showed a sensitivity of 94% and a specificity of 91%. If these results are confirmed, improved initial diagnostic accuracy with this rapid assay technique in acute chest pain may (1) conserve resources when initial suspicion of infarction is low, (2) identify patients with infarction appropriate for early intervention, and (3) avoid premature hospital discharge of patients with infarction.

Serum creatine kinase activity and sensing characteristics after intraoperative arrhythmia induction using implantable defibrillator rate sensing leads.

In 29 patients (24 men, 5 woman, mean age 57 +/- 14 years) we evaluated the effect of intraoperative arrhythmia induction during implantable defibrillator (ICD) placement using alternating current (AC) applied through the epicardial rate sensing leads on acute and chronic pacing thresholds, electrogram amplitudes, slew rates and serum creatine kinase levels. In 15 patients undergoing new ICD implantation, pacing thresholds, electrogram amplitudes, slew rates, and resistances were measured before and following at least three inductions of ventricular fibrillation (VF) using AC applied through the epicardial rate sensing leads. Fourteen patients who underwent VF induction using AC through the epicardial leads during initial implant (mean time of 31 months previously) underwent ICD pulse generator replacement only with parameters measured as above before and after at least two inductions, and these compared to the values at initial implant. In all 29 patients serum creatine kinase levels were obtained before, immediately following, and at 8, 16, and 24 hours after surgery. No significant change in acute pacing threshold, electrogram amplitude, slew rate or resistance occurred. Chronically there was an expected 154% increase in pacing threshold but no significant change in electrogram amplitude or resistance. Serial serum creatine kinase and MB isoenzyme determinations demonstrated no evidence of myocardial necrosis. We conclude that intraoperative arrhythmia induction during ICD implantation using AC applied through the rate sensing leads is a safe and effective technique.

Cocaine and Chest Pain

Letters1 January 1992Cocaine and Chest PainMahesh Amin, MD, Gary Gabelman, MDMahesh Amin, MDSearch for more papers by this author, Gary Gabelman, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-116-1-91 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editors:The article by Gitter and colleagues (1) presents findings similar to those from our own study (2). The authors, however, have placed undue importance on the 0% myocardial infarction rate in their cohort of patients hospitalized for chest pain after cocaine use. Their retrospective analysis has many inherent problems (as they acknowledge)—for example, incomplete electrocardiographic (ECG) data (41%) and the lack of serial creatine kinase-MB fraction measurements (9%). Because criteria for the diagnosis of acute myocardial infarction include a typical history, serial ECG changes, and an elevated creatine kinase-MB fraction, some of their patients may indeed have...

Guanidino compounds in the elderly

To examine the metabolism of guanidino compounds in the elderly, we measured the serum concentrations of urea nitrogen, creatinine (Cr), guanidinoacetic acid (GAA) and creatine (CR) in middle-aged and elderly subjects. We also measured muscle mass in the elderly. The elderly subjects tended to have lower serum GAA concentrations than middle-aged subjects. On the contrary, CR concentrations of elderly subjects were higher than those of middle-aged subjects. Bedridden elderly subjects tended to have lower serum GAA concentrations and lighter muscle mass than ambulatory elderly subjects. On the contrary, serum CR concentrations of bedridden subjects were higher than those of ambulatory subjects. CR is an essential substance for muscle energy metabolism. These results indicate that high serum CR concentrations due to low CR metabolism in skeletal muscle might suppress glycine amidinotransferase (GAT) activity, resulting in decreased GAA production in the elderly.

Changes in serum potassium, calcium and creatine kinase following suxamethonium administration in children with and without strabismus

The immediate changes in serum potassium and calcium and 24-h changes in creatine kinase (CK) following suxamethonium administration were compared in children undergoing strabismus repair or tonsillectomy following induction of anaesthesia with thiopentone or halothane. A separate group of children were anaesthetized with isoflurane and did not receive suxamethonium. There was a significant increase (P < 0.05) in serum potassium of 0.26 and 0.56 mmol?−1 following halothane-suxamethonium induction and a significant decrease (P < 0.05) of 0.35 and 0.13 mmol?−1 after thiopentone-suxamethonium induction in the strabismus and tonsillectomy groups respectively. There was an increase in the 24 h CK values of 624 and 694 u?l−1 (P < 0.05) in patients receiving halothane-suxamethonium induction and of 43 (NS) and 247 u?−1 (P < 0.05) in patients receiving thiopentone-suxamethonium induction in the strabismus and tonsillectomy groups respectively. Suxamethonium administration was associated with a small but sometimes significant (P < 0.05) decrease in total serum calcium concentrations (0.036 to 0.049 mmol?−1). Changes in all indices were minimal in children anaesthetized with isoflurane. It is concluded that the administration of halothane and suxamethonium is the main cause for the changes in serum potassium and CK and not the presence of strabismus.

Evidence for endothelial dysfunction and enhanced vasoconstriction in myocardial bridges

Myocardial bridges are a common angiographic and necropsy finding. Although generally considered to be an incidental finding with a benign prognosis, myocardial bridges have been associated with angina, malignant arrhythmia, myocardial infarction, and sudden cardiac death.‘-” The mechanism whereby myocardial bridges induce myocardial &hernia is unclear. We report two cases in which myocardial bridges were associated with pronounced coronary vasoconstriction following infusion of the endothelium-dependent vasodilator, acetylcholine, suggesting that myocardial bridges are associated with dysfunctional coronary endothelium. Loss of functioning coronary endothelium and endothelial-derived relaxing factor (EDRF) at sites of myocardial bridging might contribute to coronary vasospasm and myocardial ischemia. Case No. I. A 34-year-old man presented complaining of squeezing chest pain, radiating to the left shoulder, of approximately 4 hours’ duration. He smoked cigarettes occasionally but denied hypercholesterolemia, hypertension, or diabetes mellitus, and had no family history of coronary artery disease. He took no medications. Physical examination on admission revealed a blood pressure of 122/72 mm Hg, a pulse of 84 beats/min, and a temperature of 37’ C. The physical examination, including cardiac examination, was unremarkable. Admission laboratory tests including complete blood count (CBC), blood chemistries, and coagulation studies were within normal limits. His lipid profile included a total cholesterol of 184, with a high-density lipoprotein (HDL) cholesterol of 33 and a low-density lipoprotein (LDL) cholesterol of 102. Serum triglycerides were 304. An admission electrocardiogram showed normal sinus rhythm, with nonspecific T wave inversions. No prior electrocardiograms were available for comparison. Serial creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) enzymes revealed no evidence of acute myocardial infarction. The patient underwent coronary angiography, which revealed no evidence of atherosclerotic coronary artery disease. Systolic compression consistent with a myocardial bridge was noted in the mid-left anterior descend-

Prevention of succinylcholine-induced myalgia with lidocaine pretreatment.

We studied the effects of 3 mg.kg(-1) lidocaine iv on the succinylcholine (SCh)-induced myalgia in 94 unpremedicated ambulant patients undergoing dilatation and curettage of the uterus. The post-SCh myalgia was confirmed through interview by telephone. The data were correlated with the degree of fasciculation and changes in the serum electrolytes and creatine kinase (CK) levels following SCh administration. Pretreatment with lidocaine, 3 mg.kg(-1) iv, significantly reduced the incidence of myalgia from 40.4% of control group to 12.8% lidocaine-treated group, but not the CK levels. The severity of myalgia was not related to the intensity of fasciculation assessed by visual observation. The pretreatment with lidocaine had no untoward effect on the circulation, although the peak arterial and peak venous lidocaine levels achieved were 29.6 +/- 23 micro g.ml(-1) and 10.1 +/- 3.3 micro g.ml(-1) respectively. These finding indicated that the pretreatment with lidocaine, 3 mg.kg(-1) iv, was effective in prevention of SCh-induced myalgia.

Renal lesion characterization with gadolinium-enhanced MR imaging: efficacy and safety in patients with renal insufficiency.

Five patients with renal insufficiency were studied with T1-weighted magnetic resonance (MR) imaging before and after intravenous administration of gadopentetate dimeglumine (0.1 mmol/kg) to characterize renal lesions that were detected with nonenhanced computed tomography (CT) and were considered indeterminate. Four patients demonstrated renal lesions that enhanced after gadolinium administration. A total of five lesions in these four patients were surgically resected and found to be renal cell carcinoma at pathologic examination. The fifth patient was spared surgery because a hyperattenuated lesion noted at nonenhanced CT did not enhance with intravenous gadolinium, indicating a benign cyst. Five incidentally occurring benign cysts removed at the time of nephrectomy in two of the patients did not demonstrate enhancement with gadolinium on MR images. Serial serum creatine levels were obtained before and after gadolinium administration in all patients; no changes were noted after gadolinium administration. Gadolinium-enhanced MR imaging is an effective method for characterizing renal lesions in patients with renal insufficiency. At the usual dosage, there appears to be no nephrotoxic reaction in these patients.

Failure of serum myoglobin and creatine kinase isoforms kinetics to predict early coronary patency after thromsolysis in time for rescue angioplasty

Failure of serum myoglobin and creatine kinase isoforms kinetics to predict early coronary patency after thromsolysis in time for rescue angioplasty