Abnormal liver function tests associated with severe rhabdomyolysis

Rhabdomyolysis is a syndrome of skeletal muscle injury with release of cellular constituents such as potassium,phosphate,urate and intracellular proteins such as myoglobin into the circulation,which may cause complications including acute kidney injury,electrolyte disturbance and cardiac instability.Abnormal liver function tests are frequently observed in cases of severe rhabdomyolysis.Typically,there is an increase in serum aminotransferases,namely aspartate aminotransferase and alanine aminotransferase.This raises the question of liver injury and often triggers a pathway of investigation which may lead to a liver biopsy.However,muscle can also be a source of the increased aminotransferase activity.This review discusses the dilemma of finding abnormal liver function tests in the setting of muscle injury and the potential implications of such an association.It delves into some of the clinical and experimental evidence for correlating muscle injury to raised aminotransferases,and discusses pathophysiological mechanisms such as oxidative stress which may cause actual liver injury.Serum aminotransferases lack tissue specificity to allow clinicians to distinguish primary liver injury from muscle injury.This review also explores potential approaches to improve the accuracy of our diagnostic tools,so that excessive or unnecessary liver investigations can be avoided.     

Responses of CDKs and p53 in Delayed Ischemic Neuronal Death

Stroke is a debilitating disease that affects millions each year.While in many cases cerebral ischemic in jury can be limited by effectivw resuscitation or thrombolytic treatment,the injured neurons wither in a process known as delayed neuronal death(DND).Mounting evidence indicates that DND is not simply necrosis played out in slow motion but apoptosis is triggered.Of particular interest are two groups of signal proteins that participate in apoptosis-cyclin dependent kinases(CDKs) and p53-among a myriad of signaling events after an ischemic insult.Recent investigations have shown that CDKs,a family of enzymes initially known for their role in cell cycle regulation,are activated in injured neurons in DND.As for p53,new reports suggest that its up-regulation may represent a failed attempt to rescue in jured neurons,although its up-regulation was previously considered an indication of apoptosis.These observations thus rekindle an old quest to identify new neuroprotective targets to minimize the stroke damage.In this review,the author will examine the evidence that indicates the participation of CDKs and p53 in DND and then introduce pre-clinical data to explore CDK inhibition as a potential neuroprotective target.Finally,using CDK inhibition as an example,this paper will discuss the pertinent criteria for a viable neuroprotective strategy for ischemic in jury.     

Grenzen und Möglichkeiten der Glaskörperchirurgie bei diabetischer Retinopathie

Hintergrund: Verschiedene Indikationen für glask?rperchirurgische Eingriffe bei Komplikationen der diabetischen Retinopathie haben sich etabliert. Jedoch gibt es wenig Daten zu der Frage, in welchen Situationen auf einen Eingriff wegen aussichtsloser funktioneller Prognose verzichtet werden sollte. Material und Methode: Die Krankengeschichten von 389 Patienten, die zwischen 1990 und 1994 in unserer Klinik wegen Komplikationen der diabetischen Retinopathie vitrektomiert worden sind, wurden retrospektiv analysiert. Die Nachbeobachtung betrug mindestens 6 Monate, im Median 26 Monate. Mit multivariaten, logistischen Regressionsanalysen wurden Faktoren ermittelt, die mit schlechten postoperativen, funktionellen Ergebnissen korrelieren. Ein mathematisches Modell wurde entwickelt, welches die Einsch?tzung der Prognose für verschiedene Ausgangssituationen erlaubt. Ergebnisse: Bei 45 Augen (12%) stieg der postoperative Visus nicht über 1/50. Risikofaktoren waren Ablatio der Makula, Ausdehnung der Ablatio, Rubeosis und Dauer der Visusminderung. ?hnliche Risikofaktoren gelten auch für Revisionsoperationen. Bei einem Auge mit totaler Traktionsablatio von über 6 Monaten Dauer und Rubeosis liegt die berechnete Wahrscheinlichkeit für einen postoperativen Visus über 1/50 lediglich bei 2%. Schlu?folgerungen: Bei totaler Traktionsablatio, insbesondere bei Rubeosis und l?ngerem Bestehen der Ablatio, ist die Prognose extrem schlecht. Auf operative Ma?nahmen sollte hier verzichtet werden.      

Respiratory tract infections due to different rhinovirus serotypes and the influence of maternal antibodies on the clinical expression of the disease in infants.

Rhinoviruses were isolated from nasopharyngeal secretions of 49 children hospitalized because of severe respiratory tract infection. The isolates were typed using 90 type-specific antisera. No obvious relation between certain serotypes and the severity of illness was found. Serum samples were drawn from all children simultaneously with the nasopharyngeal secretions and screened for the presence of type-specific neutralizing antibodies. Children aged 1 week to 6 months had higher neutralizing antibody titers and revealed a lower degree of morbidity than older children. The decline of neutralizing serum antibodies with increasing age was correlated with a higher incidence of severe disease in those aged 7-12 months. Nevertheless, also in this age group children with mild clinical courses of disease were observed despite a low concentration or an absence of neutralizing serum antibodies. This indicates that not only neutralizing serum antibodies, but other factors also influence the clinical expression of RHV-induced disease.     

Combined high-efficiency hemodialysis and charcoal hemoperfusion in severe N-acetylprocainamide intoxication.

Several extracorporeal techniques have been used to remove N-acetylprocainamide (NAPA), the major metabolite of procainamide, in patients intoxicated with this substance. We report a patient with life-threatening NAPA intoxication who was rapidly and successfully treated with combined high-efficiency hemodialysis and charcoal hemoperfusion. The hemodialyzer and hemoperfusion cartridge were placed in series such that the patient's blood was dialyzed before reaching the cartridge. Overall clearance of NAPA was 153 mL/min, with clearance due to hemodialysis averaging 102 mL/min and that due to hemoperfusion averaging 88 mL/min. Thus, addition of the hemoperfusion cartridge into the extracorporeal circuit resulted in a 50% increase in clearance over that obtainable by high-efficiency hemodialysis alone. In comparison to other modalities, this technique is more effective than either hemodialysis or charcoal hemoperfusion alone and can achieve a more rapid reduction of serum NAPA levels than that observed with slow continuous hemofiltration or hemodiafiltration.