Serum Enzyme Determinations Research Articles

Alterations in antioxidant defense system in hepatic and renal tissues of rats following aspartame intake

Aspartame is one of the most common artificial sweeteners in use today worldwide. Aspartame has been implicated in many health problems. The study aimed to investigate whether aspartame consumption induces oxidative stress and whether it can threaten the antioxidant defense system in hepatic and renal tissues. The experiment was performed on adult male albino rats. They were distributed into 4 groups, group I represented the control animals and received orally water. The rest were given aspartame in a dose 50 mg/kg for 15, 30 and 60 days respectively. Blood was collected and centrifuged to obtain serum for the determination of serum enzymes. The tissue samples were homogenized, centrifuged and the clear supernatant was collected for further biochemical analysis. The results showed a significant increase in LPO level in liver and kidney. A remarkable reduction in GSH content was also observed in both hepatic and renal tissues. The activities of antioxidant enzymes SOD, CAT, GPx and GR were significantly reduced in both liver and kidney. In addition, the results also indicated a significant increase in activities of serum marker enzymes ALT, AST, ALP and GGT. The data provided in this study clearly point out that aspartame consumption at a dose of 50 mg/kg induces oxidative stress in hepatic and renal tissues by generation of free radicals.

Age- and Gender-Based Studies of Trace Metal Levels and Various Enzymes Associated with Myocardial Infarction

The present investigation deals with the determination of various serum enzymes known to be elevated during myocardial infarction (MI) and estimation of selected metals like Cu, Cr, Co, Fe, Pb, and Mg by flame atomic absorption spectrophotometry. The data obtained thereby were processed for the determination of correlation coefficient matrix among the cardiac enzymes and the serum metals. The study evidenced the accumulation of Pb during MI and reduction in the level of Fe. A significant negative correlation was observed between Cu and creatine kinase-MB. The data were also segregated into various groups to study the influence of age and gender on the levels of selected parameters. In both the genders, the age of the patients was found to be correlated significantly with various cardiac enzymes. In case of male patients, the most significant correlation was observed between age and blood sugar at random. The other significant correlations among the male patients included Cr-CPK, Cr-creatine kinase-MB, Fe-age, and others. In female patients, the pairs of studied parameters that exhibited significant correlations included age-lactic dehydrogenase, creatine phosphokinase isoenzyme-aspartate aminotransferase, lactic dehydrogenase-creatine phosphokinase isoenzymes, Pb-Fe, and Cu-Co in addition to others.

Quantitative electromyography in polymyositis and dermatomyositis.

Twelve patients with polymyositis or dermatomyositis were examined repeatedly during the course of the illness by muscle strength tests, serum enzyme determinations, frequency analysis of the electromyographic signal, and estimations of the spontaneous activity. All methods can be used to follow the course of the disease. Increasing muscle strength was correlated to decreasing serum enzyme values, decreasing spontaneous activity, and decreasing proportion of high-frequency components in the EMG signal, except during the initial period of treatment, when a temporary increase in high-frequency components was recorded.

Lactate dehydrogenase activity is increased in plasma of infants with advanced necrotizing enterocolitis

In infants with necrotizing enterocolitis (NEC), intestinal gangrene defines advanced disease. Since intestinal ischemia is considered a pathogenetic factor for intestinal gangrene, serum activity of mucosal and seromuscular enzymes may be elevated in these patients. Our aim was to evaluate if serum enzymes activity is increased in infants with NEC associated with intestinal gangrene. We performed a retrospective review of the case notes of infants operated on for NEC between 1998 and 2006. Patients with preoperative determination of serum enzymes were included in the study, and were divided into Group A and Group B based on the presence or absence of intestinal gangrene, respectively. Serum activities of alkaline phosphatase (ALP), glutamic oxaloacetic transaminase (GOT), creatine kinase (CK), and lactate dehydrogenase (LDH) were compared in the two Groups. Values are medians (interquartile range). Thirty-five infants were operated on for NEC in the study period. Eighteen patients fulfilled the inclusion criteria: 12 in Group A and six in Group B. Group A patients had significantly higher LDH activity [1131.0 (1092.0-1300.0) vs. 482.0 (440.0-624.5) IU/L; P < 0.005]. Our findings suggest that LDH activity may be increased in infants with NEC and intestinal gangrene. Its evaluation could be a further tool in the surgical decision making process in infants with NEC.

Intravenous streptokinase infusions in acute myocardial infarction. Restoring patency of occluded thrombotic coronary vessels (author's transl)

Intravenous treatment over 30 minutes with 500 000 U streptokinase was given to 21 patients with acute myocardial infarction. Serial measurements of serum CK-MB activity made recanalisation of the infarcted artery likely in 3 patients. Selective coronarography was performed in 18 patients during the acute infarction phase. Angiographic follow-up investigations were done 24 hours and after 3 weeks. In 3 cases only subtotal occlusion of the infarcted coronary artery was seen during the acute phase. A thrombus demonstrated in two patients could be lysed. In 8 out of 15 patients with complete coronary artery occlusion the infarcted vessel was reopened 20-60 minutes after onset of intravenous streptokinase infusion. In a further 4 patients recanalisation was observed 60-140 minutes after passing a guide wire or during an additional intracoronary infusion of streptokinase. The infarcted vessel remained occluded in 3 patients, one of whom died following myocardial rupture. In 12 patients with recanalisation of the infarcted artery during the acute phase a premature maximum of serial CK-MB serum activity was seen after 13.5 +/- 2.9 hours in comparison with 20.9 +/- 5.3 hours in 122 patients treated conventionally. Serial enzyme determinations allow indirect conclusions as to a rapid recanalisation of an infarcted blood vessel.

Endograft repair of spontaneous infrarenal abdominal aortic dissection

A 71-year-old man with a history of hypertension and a recent myocardial infarction experienced a sudden periumbilical and back pain. Abdominal tenderness was found at physical examination, with no changes in electrocardiogram and serial enzyme determinations. Computed tomographic angiography (CTA) showed a normal thoracic aorta, an infrarenal aortic dissection extending into the left common iliac artery and a contralateral iliac occlusive disease (A, Cover). Although antihypertensive therapy was administered, the patient had persistent pain; subsequently, he underwent endovascular repair with a bifurcated stent graft (Talent, Medtronic Ave, Santa Rosa, Calif) introduced via the left femoral artery through the introducer sheath. Because the contralateral iliac artery was not suitable for iliac limb deployment, an occluding covered stent was then positioned, and a 8-mm ePTFE femorofemoral bypass grafting was done to perfuse the right leg. The patient was discharged on postoperative day 4. A CTA postprocedural scan was performed with a multidetector device; a complete exclusion of dissection (B) and patency of femorofemoral bypass was observed. At 6 months, he remains symptom-free; the CTA scans with 3-dimensional volume rendering reconstruction show a normal morphology of abdominal aorta and femorofemoral reconstruction, with retrograde filling of right iliac arteries (C).

Enzimologia Clínica Veterinária. Parte I: fatores que interferem na interpretação dos resultados

A enzimologia clínica veterinária tem assumido um importante papel nos tempos atuais, principalmente no que se refere ao auxílio diagnóstico de diversas enfermidades. Este trabalho teve por objetivo apresentar uma revisão sobre os principais fatores que interferem na determinação das enzimas no soro e no plasma e que podem acarretar uma interpretação inadequada dos resultados

CHRONIC PANCREAS ALLOGRAFT REJECTION: MORPHOLOGICAL FINDINGS AND CLINICAL CORRELATION

538 Histological findings in pancreatectomies from failed grafts (ressumption of insulin therapy with no evidence of insulin resistance) are well established. These are extensive fibrosis with proportional loss of the exocrine component and marked transplant arteriopathy. The purpose of this study is to describe the morphological features of the different stages of chronic allograft rejection (CR) in serial biopsies. Out of 252 technically successful pancreas transplants 18 grafts were lost to CR after a mean follow up of 21 months. 9 of these grafts had histological evidence of CR in serial biopsies. These 48 biopsies were done due to acute allograft dysfunction 3 to 38 months (mean 14 months) post-transplant. Each patient had 3-7 biopsies(mean 4.1) Clinical follow-up for 11 to 36 months (mean 22.6 months) included serial serum enzyme and glucose determinations. CR was graded as 0 (no fibrosis), I (accentuation of fibrous septa with only focal evidence of acinar atrophy in the periphery of the lobules), II (fibrous septa representing 30-40% of the needle core and acinar atrophy affecting most lobular areas), III (fibrous septa representing > 50% of the tissue core and marked acinar atrophy) and IV (fibrous tissue with isolated acini or islets). Transplant arteriopathy was seen depending on the sample. The histological findings were compared to 30 protocol biopsies performed at 3-19 months (mean 11) from 22 patients with normal graft function after 6-24 months of follow up (mean 14 months). The protocol biopsies from normal functioning grafts were grade 0 (22) and grade I (8). The biopsies (n=48) from failed grafts were 13 grade II, 22 grade III and 13 grade IV. Increase in septal fibrosis was seen in all cases starting at 4-19 months (mean 9 months) with all grafts showing grade III or IV biopsies 6-8 months before graft loss. Pancreatectomy specimens available in 4 patients showed findings correlating with the last needle biopsy. Concurrent acute allograft rejection(mixed inflammatory infiltrates, venous and arterial endotheliitis, arteritis and acinar cell damage) was seen in 87% of the biopsies. In conclusion, progressive fibrosis and acinar loss consistent with developing CR can be seen early in the post-transplant course and may progress to graft failure. These findings may be predictive of ultimate graft failure.

CHRONIC PANCREAS ALLOGRAFT REJECTION: MORPHOLOGICAL FINDINGS AND CLINICAL CORRELATION

538 Histological findings in pancreatectomies from failed grafts (ressumption of insulin therapy with no evidence of insulin resistance) are well established. These are extensive fibrosis with proportional loss of the exocrine component and marked transplant arteriopathy. The purpose of this study is to describe the morphological features of the different stages of chronic allograft rejection (CR) in serial biopsies. Out of 252 technically successful pancreas transplants 18 grafts were lost to CR after a mean follow up of 21 months. 9 of these grafts had histological evidence of CR in serial biopsies. These 48 biopsies were done due to acute allograft dysfunction 3 to 38 months (mean 14 months) post-transplant. Each patient had 3-7 biopsies(mean 4.1) Clinical follow-up for 11 to 36 months (mean 22.6 months) included serial serum enzyme and glucose determinations. CR was graded as 0 (no fibrosis), I (accentuation of fibrous septa with only focal evidence of acinar atrophy in the periphery of the lobules), II (fibrous septa representing 30-40% of the needle core and acinar atrophy affecting most lobular areas), III (fibrous septa representing >50% of the tissue core and marked acinar atrophy) and IV (fibrous tissue with isolated acini or islets). Transplant arteriopathy was seen depending on the sample. The histological findings were compared to 30 protocol biopsies performed at 3-19 months (mean 11) from 22 patients with normal graft function after 6-24 months of follow up (mean 14 months). The protocol biopsies from normal functioning grafts were grade 0(22) and grade I (8). The biopsies (n=48) from failed grafts were 13 grade II, 22 grade III and 13 grade IV. Increase in septal fibrosis was seen in all cases starting at 4-19 months (mean 9 months) with all grafts showing grade III or IV biopsies 6-8 months before graft loss. Pancreatectomy specimens available in 4 patients showed findings correlating with the last needle biopsy. Concurrent acute allograft rejection (mixed inflammatory infiltrates, venous and arterial endotheliitis, arteritis and acinar cell damage) was seen in 87% of the biopsies. In conclusion, progressive fibrosis and acinar loss consistent with developing CR can be seen early in the post-transplant course and may progress to graft failure. These findings may be predictive of ultimate graft failure.

Chronic nonpathological hyperamylasemia of pancreatic origin

BACKGROUND & AIMS: Pancreatic hyperamylasemia is usually an expression of pancreatic disease. This study describes pancreatic hyperamylasemia in the absence of pancreatic disease. METHODS: Eighteen subjects with this form of hyperamylasemia were referred to our unit from January 1987 to June 1991. Amylase and pancreatic isoamylase as well as serum lipase and trypsin concentrations were determined, and ultrasonography and computed tomography were performed in all patients. After initial evaluation, they were seen annually for clinical assessment, ultrasonography, and serum enzyme determination until December 1995. At the final evaluation, all underwent a pancreatic function study. RESULTS: In 14 of the 18 subjects, all enzyme levels assessed were abnormally elevated; in 3 subjects, all but the lipase level were abnormally elevated, and in the remaining subject, all but the trypsin level were abnormally elevated. The increase over the upper normal limit was in the range of 1.4-4.1-fold for amylase, 1.8-6-fold for pancreatic isoamylase, 1.5-7.7-fold for lipase, and 1.6-13.9-fold for trypsin. During follow-up, enzyme concentrations remained elevated, although wide fluctuations and occasional transient normalization were observed. No subjects had evidence of pancreatic disease either at initial evaluation or during follow-up. CONCLUSIONS: This is the first detailed description of chronic nonpathological pancreatic hyperamylasemia as a distinct entity. The reasons for this enzyme alteration are unknown. (Gastroenterology 1996 Jun;110(6):1905-8)

Magnetic Resonance Imaging for Detection of Prostate Cancer Metastatic to Bone

The diagnosis of prostate cancer metastatic to bone currently is made with plain x-rays, radionuclide bone scans, and acid and alkaline phosphatases. We used magnetic resonance imaging (MRI) in 18 patients with known prostate cancer to resolve conflicting evidence of metastases found on bone scans, plain films and serum enzyme determinations. Of 8 bone scans interpreted as positive MRI was read as negative for metastatic disease in 2. Of 5 negative bone scans 1 MRI study was interpreted as positive. All 5 equivocal bone scans demonstrated no osseous lesions on MRI. In addition, in 6 patients with evidence of bone metastases the serial MRI scans following hormonal therapy demonstrated radiographic and clinical improvement. We conclude that MRI is helpful in the diagnosis of metastatic prostate cancer when other radiographic examinations are enigmatic and that MRI can be used to determine the response to hormonal treatment.

Reply

It is beneficial to be able to estimate the extent of atherosclerosis by simple external observations. Therefore, the association between earlobe creases (ELC) and coronary heart (CHD) has often been investigated since the first description of this topic by Frank.1 Although the results of these studies have sometimes been contradictory within the same ethnic group, Mongoloids2–4 as well as Caucasians,1,5–9 it is difficult to compare these results directly because not only the subjects studied but the methods used vary widely. Case-selection biases in the comparison between CHD and “normal” patients may be unavoidable under the usual clinical situations. In such clinical studies, coronary angiography may be one of the desirable objective methods to identify the stenotic site within the artery;3,5,8,10–12 however, this method cannot demonstrate the vascular wall but only the vascular lumen from some angles. In addition, in a published comparison between macroscopic coronary atherosclerosis in patients dying of CHD, but not of CHD in six race/location groups, there were significant differences in the mean extent of macroscopically raised lesions in the CHD cases in all six.13 The atherosclerosis grading method used in our study2 is recognized as sensitive enough to detect the changes of atherosclerosis under various conditions.14,15 Even in the study based on a large number of the Chinese subjects4 cited by Dr. Cheng, some methodological problems might have remained because ECG, coronary angiography, and serum enzyme determination had not been done to define the presence of myocardial infarction. We attempted to address all such methodological problems in our recent paper.2 Our results clearly indicate the association of ELC with atherosclerosis as well as with serum total cholesterol level. In our opinion, ELC should be interpreted as one of the markers expressing the extent of atherosclerosis.

Relationship between serum GOT ofCyprinus carpio and biotic index of diatom in the diagnosis of water quality

Many studies have been conducted in which fish were experimentally stressed and the ensuing changes in serum enzyme activities were recorded. Serum enzymes in rainbow trout were proposed as tools in the diagnosis of water quality. The examination of diatom flora was also proposed as an indicator of water quality. Diatom flora bioassay is time-consuming and uneconomical, but serum enzyme determination is easy and time-saving. It there is some relationship between the two aspects in water quality determination, the idea that serum enzyme in fish is an indicator in the diagnosis of water quality will be further supported.

The in-hospital development of cardiogenic shock after myocardial infarction: Incidence, predictors of occurrence, outcome and prognostic factors

The incidence, outcome and predictors of the in-hospital development of cardiogenic shock and its prognostic significance were analyzed in 845 patients presenting with acute myocardial infarction. Cardiogenic shock developed after hospitalization in 60 patients (7.1%). In half of these patients, cardiogenic shock developed at least 24 h after hospital admission. The in-hospital mortality rate was >15 times higher for patients with cardiogenic shock than for patients without shock (65.0% versus 4.3%, respectively, p < 0.001). Enzymatic evidence of infarct extension occurred in 23.3% of the patients with shock compared with 7.4% of those without shock (p < 0.0001).Multivariate analysis indicated that independent predictors for the in-hospital development of cardiogenic shock were age >65 years (p = 0.007), left ventricular ejection fraction on hospital admission <35% (p = 0.007), large infarct as estimated from serial enzyme determinations (that is, peak creatine kinase-MB isoenzyme >160 IUhiter (p = 0.008), history of diabetes mellitus (p = 0.011) and previous myocardial infarction (p = 0.012). Patients with three, four or five of these risk factors had a 17.9%, 33.7% or 54.4% probability, respectively, of developing cardiogenic shock after hospital admission. Left ventricular function, as reflected by left ventricular ejection fraction (p = 0.04) and severity of left ventricular wall motion abnormality (p = 0.04), was the most important determinant of in-hospital mortality in the patients with cardiogenic shock.

Chronic ovine evaluation of a totally implantable electrical left ventricular assist system.

The totally implantable Novacor left ventricular assist system (LVAS) comprises a pump/drive unit (VAD), electronic control and power subsystem (ECP), variable volume compensator (VVC), and belt skin transformer (BST). The system is now undergoing chronic in vivo evaluation. Cumulative animal testing of VAD, VVC, and BST subsystems are 12.1, 4.9, and 43 years, respectively. The longest implants were 279 days for the VAD, 767 days for the VVC, and 1,148 days for the BST. A chronic implant of the total system was electively terminated at 260 days. The LVAS was powered via the BST. Continuously monitored hemodynamic and pump parameters have demonstrated normal hemodynamics and LVAS operation. Periodic VVC determinations suggest a 0.8 ml/day diffusive gas loss. Tether-free operation has been demonstrated with an Ag-Zn battery backpack. The animal was healthy and free of infection as indicated by routine hematologic, biochemical and serum enzyme determinations. Hemolysis is minimal (plasma free hemoglobin less than 5 mg%). Pump output ranged from 7 to 8 L/min. Severe valve calcification was the reason for elective termination at 260 days. This preclinical in vivo experience, and in vitro reliability studies, demonstrate efficacy of the total system.

Chronic Ovine Evaluation of a Totally Implantable Electrical Left Ventricular Assist System

The totally implantable Novacor left ventricular assist system (LVAS) comprises a pump/drive unit (VAD), electronic control and power subsystem (ECP), variable volume compensator (VVC), and belt skin transformer (BST). The system is now undergoing chronic in vivo evaluation. Cumulative animal testing of VAD, VVC, and BST subsystems are 12.1, 4.9, and 43 years, respectively. The longest implants were 279 days for the VAD, 767 days for the VVC, and 1,148 days for the BST. A chronic implant of the total system was electively terminated at 260 days. The LVAS was powered via the BST. Continuously monitored hemodynamic and pump parameters have demonstrated normal hemodynamics and LVAS operation. Periodic VVC determinations suggest a 0.8 ml/day diffusive gas loss. Tether-free operation has been demonstrated with an Ag-Zn battery backpack. The animal was healthy and free of infection as indicated by routine hematologic, biochemical and serum enzyme determinations. Hemolysis is minimal (plasma free hemoglobin <5 mg%). Pump output ranged from 7 to 8 L/min. Severe valve calcification was the reason for elective termination at 260 days. This preclinical in vivo experience, and in vitro reliability studies, demonstrate efficacy of the total system.

Usefulness of lactate dehydrogenase and lactate dehydrogenase isoenzymes for diagnosis of acute myocardial infarction

The usefulness of lactate dehydrogenase (LD) and LD isoenzymes in the diagnosis of acute myocardial infarction (AMI) is controversial. The present study reviewed 507 consecutive patients in whom creatine kinase, creatine kinase isoenzymes, LD and LD isoenzymes were ordered over a 1-month period. Of these, 249 had an insufficient number of serial enzyme determinations to establish a laboratory diagnosis of AMI. After excluding an additional 11 patients for other reasons, 247 patients remained for analysis. Of these, only 2 (0.8%) had myocardial infarction by standard clinical criteria with normal creatine kinase and creatine kinase-MB but elevated LD and abnormal LD isoenzymes. Seven patients (7 of 247, 2.8%) had false-positive LD isoenzymes. Thus, the routine use of LD and LD isoenzymes was of no use in most patients (96%) and led to the incorrect diagnosis of AMI more than 3 times as often as it helped with a correct diagnosis. Total 1-month charges for all the LD and LD isoenzymes obtained equalled $42,450. Therefore, it appears that LD and LD isoenzymes are not routinely useful in the diagnosis of AMI and may result in considerable unnecessary expense. It is suggested that LD and LD isoenzymes be ordered only under suspicion of late presentation (>48 hours) of AMI.

Carrier assessment for mothers and sisters of isolated Duchenne dystrophy cases: the importance of serum enzyme determinations.

DNA studies (restriction fragment length polymorphism linkage analysis and deletion analysis with pERT87) and serum creatine kinase/pyruvate kinase (CK/PK) measurements were done to determine the carrier status of 59 mothers and sisters of isolated Duchenne dystrophy (DD) cases. The results of DNA studies modified the carrier risks for 34 of the 59 (58%), but the derived risks often did not differ importantly from risks calculated by conventional methods. Elevated CK/PK provided strong evidence of the carrier state for 24 of the 59 (41%), and CK/PK frequently provided data unavailable through DNA studies. Serum enzyme determinations remain an important means of evaluating DD carrier suspects and are especially valuable in isolated-case families. Enzyme testing should be combined with DNA studies to achieve the best estimate of carrier risk.

Myoglobin as an early indicator of acute myocardial infarction

The ECG and the determination of serum enzymes creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) may be falsely normal early in acute myocardial infarction. Myoglobin, an oxygen-carrying protein found in cardiac muscle and striated skeletal muscle, presents an attractive alternative to CPK and LDH in the emergency department setting for identification of acute myocardial infarction. Myoglobin levels may be elevated in the serum within one hour after myocardial cell death with peak levels reached within four to six hours. We report a study of 59 patients presenting to a community hospital with chest pain and subsequent hospitalization. Twenty-one had an acute myocardial infarction. Presenting (0 hour) myoglobin determination was positive in 13 of 21 individuals, while CPK-MB was positive in only three. Serum myoglobin elevation at three hours identified all 21 patients with myocardial infarction with the CPK-MB determination positive in 19. Serum myoglobin elevation may permit early identification of myocardial infarction, with subsequent verification using CPK-MB determination, allowing appropriate intensive care admission for careful monitoring of these patients.

Use of Enzymes for the Diagnosis of Alcohol-Related Organ Damage

Elevated levels of serum enzymes are frequently associated not only with alcohol-related organ damage but also with excessive alcohol consumption and alcoholism without significant tissue injury. However, both in the early detection of alcoholism as well as also in the diagnosis of alcohol-related diseases the sensitivities and specificities of these enzyme markers vary considerably. They may be influenced by nonalcohol-related diseases, enzyme-inducing drugs, nutritional factors, metabolic disorders, age, smoking, etc. Consequently, we have neither a single laboratory test--enzyme marker--nor a test combination that is reliable enough for the exact diagnosis between alcohol- and nonalcohol-related organ damage. In most cases it is possible to determine the tissue from which the elevated enzyme is derived, but only occasionally enzyme changes reflect the quantity of the tissue injury. Gamma-glutamyltransferase (GGT) is the most widely used laboratory marker of alcoholism and heavy drinking, detecting 34-85% of problem drinkers and alcoholics. However, the unspecificity of increased serum GGT limits its use for general screening purposes. Its value in the follow-up of various treatment programs, however, is well established. An elevated level of serum aspartate aminotransferase (ASAT) and alanine aminotransferase (ALAT) in an alcoholic or a heavy consumer indicates alcohol-induced organ damage. The use of test combinations significantly improves the information received with single serum enzyme determinations. An ASAT/ALAT ratio greater than 1.5 can be considered as highly suggestive for the alcoholic etiology of the liver injury. Still better discrimination between alcoholic and nonalcoholic origin of the liver disease may be achieved by the determination of the ratio of GGT to alkaline phosphatase. If this ratio exceeds 1.4 the specificity of the finding in favor for alcoholic liver injury is 78%. The determination of the mitochondrial isoenzyme of ASAT also improves the diagnostic value of ASAT determination. The ratio of mitochondrial isoenzyme to total over 4 is highly suggestive for alcohol-related liver injury. In general, however, the determination of serum activities of other enzymes such as ornithine carbamyl transferase, lactate dehydrogenase, isocitrate dehydrogenase, sorbitol dehydrogenase, alcohol dehydrogenase, guanase, aldolase, alkaline phosphatase or glutathione S-transferase do not significantly improve the diagnostic information obtained with more conventional laboratory markers of liver injury.(ABSTRACT TRUNCATED AT 400 WORDS)