Diagnostic value of determining hemoglobin in cerebrospinal fluid in acute cerebral circulatory disorders

The results of hemoglobin determination in the CSF by the method of fluorescence microscopy in 195 patients speaks in favor of relative diagnostical importance of hemoglobin in the supra fall-out CSF for establishing the character of the stroke. The following circumstances testify to this fact: 1) in an artificial admixture of blood in the CSF in some cases there may be hemolysis of "passing" erythrocytes; 2) in a genuine admixture of blood, tests of hemoglobin in the centrifugate of the CSF may be negative since in some cases the transition of hemoglobin into bilirubin in the subarachmoid space occurs more rapidly than the hemolysis of erythrocytes. Thus, the hemoglobin does not accumulate in the liquid in quantities, sufficient enough to be measured by the existing methods; 3) in a large amount of artificial blood admixture, even without a hemolysis of "passing" erythrocytes the hemoglobin tests in the centrifugate of the CSF may be positive at the expense of hemoglobin of the blood plasma.     

Effect of deep hyperventilation on lactate concentration in cerebrospinal fluid and brain tissue

Deep hyperventilation (HV)--pCO2 less than 15 mm Hg--was applied in rabbits with normal intracranial pressure (ICP) and in cats with experimental brain oedema developed after epidural balloon compression. In animals with normal ICP there was an increase of CSF and tissue lactate concentration as soon as after 45 min. of HV. The lactate concentration was increasing all the time during HV. The resumption of normoventilation (2 h) after 10 h of HV was sufficient to bring the lactate level down near normality. Electron microscope studies showed only slight ultrastructural changes without destruction, even after 10 h HV. In animals with increased ICP, brain oedema was the main factor raising the lactate level, while the effect of HV was negligible.     

Long-term monitoring of CSF lactate levels and lactate/pyruvate ratios following subarachnoid haemorrhage

Ventricular cerebrospinal fluid (CSF) lactate concentrations and lactate/pyruvate (L/P) ratios were measured daily in 20 patients from day 1 to day 12 after subarachnoid haemorrhage due to ruptured aneurysms. Patients without symptomatic vasospasm were classified in Group 1, patients with symptomatic vasospasm were classified in Group 2, and patients who were Hunt and Kosnik grade 4 on admission clinically were classified in Group 3. Patients in all three groups had high CSF lactate concentrations on day 1, and, especially in Group 3, the high lactate was accompanied by an increased L/P ratio and a decreased CSF bicarbonate. Lactate concentrations in Group 1 decreased throughout the observation period. Lactate concentrations in Group 2 also decreased but then began to increase again on days 5 to 7, correlating well with the onset of cerebral vasospasm. The delayed increase of CSF lactate in Group 2 was also accompanied by increases in the CSF pyruvate level and the CSF L/P ratio. Daily monitoring of CSF lactate may thus serve as a chemical marker for cerebral vasospasm.     

Prostaglandin D synthase concentration in cerebrospinal fluid and serum of patients with neurological disorders

Prostaglandin D synthase (PGD synthase) or beta-trace protein is a major constituent of human cerebrospinal fluid (CSF) representing-3% of the total CSF protein. We have recently developed a highly specific immunofluorometric assay for PGD synthase, which enabled us to quantify the presence of PGD synthase in fluids and tissues not associated with the CNS. In this report we provide quantitative data of the presence of PGD synthase in CSF and serum from 302 subjects with various neurological diseases and symptoms. PGD synthase levels in CSF are approximately 35-fold higher than those of serum, with a median concentration of 11,299 micrograms/L. A statistically significant association of PGD synthase concentration in CSF was observed with both patient age and gender. There was no correlation between PGD synthase concentration in serum and patient age or gender. To evaluate the clinical utility of PGD synthase in diagnosing neurological diseases, the distribution pattern of PGD synthase in CSF and serum was examined for each neuropathology of 268 patients whose diagnosis was known. No statistical difference was observed between PGD synthase concentration in the CSF (129 cases) or the serum (94 cases) of multiple sclerosis afflicted subjects in comparison to all other patients studied. The distribution pattern was also not different for PGD synthase levels in CSF of patients with HIV/AIDS related neuropathies, viral meningitis and fibromyalgia. We conclude that PGD synthase measurement presents no clinical utility in diagnosing neurological disorders in adulthood. PGD synthase may have a physiological and/or pathological role in the developing brain and in neurodegenerative diseases.     

The importance of cerebrospinal fluid lactate in the evaluation of congenital lactic acidosis

Bilioma is a rare complication of traumatic liver injury, and the precise site of bile leak is often difficult to demonstrate with a non-invasive technique. We report a case of post-traumatic bile leak in a 15-year-old girl in whom spiral CT after intravenous cholangiography allowed excellent preoperative demonstration of the extent of the liver rupture and an exact location of the bile leak. We think that spiral-CT cholangiography could be an accurate, non-invasive technique to investigate the biliary system in cases of paediatric liver trauma.     

Elevation of human cerebrospinal fluid clusterin concentration is associated with acute neuropathology

Clusterin is a serum glycoprotein which is an inhibitor of complement and is expressed in many tissues in cell injury and death. It has been identified normal and pathological brain tissue and is a component of normal human cerebrospinal fluid (CSF). We have measured the clusterin concentration of 115 abnormal and normal human CSF samples and related these data to the patient's clinical diagnoses. CSF clusterin levels in patients with neurodegenerative and meningeal disease were within the normal range. Twelve of 15 patients with demyelination, however, had significant elevation of CSF clusterin concentration. This was not a specific finding for multiple sclerosis as elevated clusterin levels were also seen in patients with other acute neuropathology. Determination of CSF clusterin concentration may be of clinical value in neurological diagnosis.     

Ion concentration in the cerebrospinal fluid in multiple sclerosis

The concentrations of electrolytes Na, K, Ca, Mg, and Cl and trace elements Cu and Zn were determined in the lumbar cerebrospinal fluids of forty patients with multiple sclerosis. Metal ion concentrations were measured using atomic absorption spectroscopy and flame photometry, respectively. Compared with corresponding values obtained from a control group, statistically significant increases in concentration of Na, Cl, Ca, and Zn have been found. Also reported are the results of determinations of ion concentrations in cerebrospinal fluids obtained from patients suffering from diseases other than multiple sclerosis. Possible causes of deviations from the norm are discussed.     

Lactate, lactate/pyruvate ratio and catecholamine interrelations in cord blood at delivery in complicated pregnancies

Fucosyltransferases are the enzymes transferring fucose from GDP-Fuc to Gal in an alpha1,2-linkage and to GlcNAc in alpha1,3-, alpha1,4-, or alpha1,6-linkages. Since all fucosyltransferases utilize the same nucleotide sugar, their specificity will probably reside in the recognition of the acceptor and in the type of linkage formed. A search of nucleotide and protein databases yielded more than 30 sequences of fucosyltransferases originating from mammals, chicken, nematode, and bacteria. On the basis of protein sequence similarities, these enzymes can be classified into four distinct families: (1) the alpha-2-fucosyltransferases, (2) the alpha-3-fucosyltransferases, (3) the mammalian alpha-6-fucosyltransferases, and (4) the bacterial alpha-6-fucosyltransferases. Nevertheless, using the sensitive hydrophobic cluster analysis (HCA) method, conserved structural features as well as a consensus peptide motif have been clearly identified in the catalytic domains of all alpha-2 and alpha-6-fucosyltranferases, from prokaryotic and eukaryotic origin, that allowed the grouping of these enzymes into one superfamily. In addition, a few amino acids were found strictly conserved in this family, and two of these residues have been reported to be essential for enzyme activity for a human alpha-2-fucosyltransferase. The alpha-3-fucosyltransferases constitute a distinct family as they lack the consensus peptide, but some regions display similarities with the alpha-2 and alpha-6-fucosyltranferases. All these observations strongly suggest that the fucosyltransferases share some common structural and catalytic features.     

The value of cerebrospinal fluid immunoglobulin analysis in clincial neurology

The IgG index (formula: see text) corrects for the influence of serum protein abnormalities as well as a bloodbrain barrier damage and is, therefore, a better measure for the presence of an IgG elevation in CSF due to IgG synthesis, when compared with other IgG quotients commonly used. Agar gel electrophoresis of CSF for demonstration of oligoclonal IgG is probably superior to the determination of the IgG index when a diagnosis of MS is suspected. Determination of kappa and lambda light chain antigenic determinants in CSF, and calculation of the kappa/lambda ratio may also be used to demonstrate the occurrence of oligoclonal CSF immunoglobulins. An abnormal ratio can, however, be demonstrated only in 50% of MS patients and has, therefore, at present no place as a routine diagnostic method when MS is suspected.     

The diagnostic and prognostic value of immunophenotyping in acute leukemia

Immunophenotyping with monoclonal antibodies to leucocyte differentiation antigens has an established diagnostic role in the laboratory investigation of acute leukemia. In the vast majority of cases, a hemopoietic lineage can be confidently assigned; namely, acute myeloid leukemia (AML), or the precursor-B and precursor-T variants of acute lymphoblastic leukemia (ALL). The areas of greatest practical importance are in morphologically difficult or undifferentiated cases, and in distinguishing between the major variants of precursor-B and T-ALL. Cases with aberrant patterns of marker expression (acute mixed lineage leukemia, lineage infidelity) are frequently encountered in both ALL and AML, and can lead to diagnostic confusion. However, correlation with morphology and other clinicopathologic features, and careful consideration of the weight of phenotyping evidence almost always allows the correct lineage to be identified. The prognostic value of phenotypic information in acute leukemia is generally limited. Recognition of the major variants of ALL is still of clinical importance, but the significance of myeloid antigen positivity in ALL is controversial, and may not have prognostic value. Patterns of myeloid antigen expression in AML have limited prognostic significance, while the relationship between lymphoid antigen expression and treatment response in AML remains highly controversial. Careful evaluation of the predictive power of immunophenotype in large controlled clinical trials in acute leukemia is still required.     

Age and features of adrenal cortical function in cerebral circulatory disorders

The indices of glucocorticoid and androgen activity in the adrenal cortex (the level of circulating eosinophils, the daily urine excretion of 17 OCS and 17 CS) and the functional reserve after an ACTH loading was studied in 2 groups of patients with disorders of cerebral circulation under 45 years of age (247 cases) and over 55 (234 cases). In the acute period of a cerebral stroke there was an increase of the glucocorticoid activity which was more definitely expressed in the younger group and a certain inhibition of the androgen function seen mainly in the older group. In transient disorders of cerebral circulation significant age difference in the functioning of the adrenal cortex was not established. In the period following a stroke the established and potential reserves of the adrenocortical glands were distinctly decreased in patients above 55 years and practically unchanged in the younger group.     

The potassium concentration in cerebrospinal fluid in young and adult rats following complete brain ischemia. Effects of pretreatment with hypoxia

The potassium concentration in the cisternal cerebrospinal fluid (CSF) was measured following brain ischemia in rats of different ages which has been kept at normoxia or pretreated with hypoxia (PIO2 = 70 mmHg) for 24 h. In all age groups the potassium concentration rose following ischemia. The rate of rise was relatively slow in the 4-day rat and faster in 16- and 24-day rats; beyond this age the rate of rise became slower. Pretreatment with hypoxia significantly diminished the rate of rise in CSF potassium in 4- and 8-day rats, while no effect was observed in the older age groups. It is suggested that the rate of rise in CSF potassium is inversely correlated with the capacity of surviving a period of oxygen deprivation.     

Fluorometric determination of pyruvate and alpha-ketoglutarate in cerebrospinal fluid and plasma of infants and children. A simple test that screen for metabolic disorders

Levels of pyruvate and alpha-ketoglutarate in the cerebrospinal fluid (CSF) of 26 children, aged 4 months to 5 1/2 years, with febrile seizures and of 19 children, aged 4 months to 14 years, with the diagnosis of epilepsy were not different from values seen in 119 "normal" children 8 days to 14 years of age. The CSF samples from 24 adults, 24 to 81 years of age, suspected of having a herniated disk were also examined. In the pediatric age group, the data showed a highly significant downward trend of CSF and plasma alpha-ketoglutarate values with age; pyruvate values did not change. A correlation of the values of the two keto acids in the blood and CSF of 42 other children without apparent neurologic disease was also made. Findings in a child with thiamine deficiency suggest that CSF alpha-ketoglutarate may be a more sensitive indicator of deficiency than plasma alpha-ketoglutarate or pyruvate. Measurements of these keto acids in plasma and CSF may be diagnostically useful in a variety of metabolic disorders. Findings in 155 children from birth (20 minutes) to 17 years of age without neurologic disease are submitted as a standard of reference.     

Prognostic value of myocardial lactate dehydrogenase subunit ratio in heart transplant recipients

BACKGROUND: Allograft coronary artery disease (CAD) is a major long-term complication in heart transplant recipients. Unfortunately, methods for early estimation of the likelihood of development of the disease are not currently available. Lactate dehydrogenase (LDH) is composed of heart and muscle subunits. The prevalence of these subunits in LDH isoenzymes (LDH1 through LDH5) is an accurate indicator of myocardial metabolism and allows indirect estimation of oxygen availability to cardiocytes. This study investigated the prognostic value of myocardial LDH composition for the occurrence of morbid events in patients with severe allograft CAD. METHODS: Eighty-eight heart transplant recipients were followed up for a median of 4.3 years. The isoenzymes of LDH and the ratio of the heart and muscle subunits (H/M) were determined in 526 endomyocardial biopsy samples. RESULTS: Eleven patients (12%) died from allograft CAD during follow-up. They had significantly lower H/M ratios compared with event-free patients, with clear differences as early as 6 months after operation. A threshold value of 2.75 was derived from receiver operating characteristic curve analysis. Patients showing H/M values < or =2.75 had a significantly higher mortality rate than did those with higher values (p=.0003). Importantly, the H/M ratio emerged as the most powerful independent prognostic factor of death by allograft CAD (p=.001) in a multivariate model. CONCLUSIONS: Poor myocardial aerobic metabolism estimated through low H/M values was highly predictive of cardiac death resulting from severe allograft CAD. Analysis of LDH isoenzyme profile in routine endomyocardial biopsies might be of clinical value.     

Role of genotypic and environmental factors in the origin of cerebral circulatory disorders in young persons

The paper is concerned with the results of a comparative analysis of clinical signs in cerebral crises, strokes and other symptoms seen in 2 groups of patients younger than 45 years of age, and differing only in the presence (104 cases) or absence (108 cases) of hereditary-familial aggravation by a cardio-vascular pathology. Although in the first group of patients there was a certain tendency towards a more severe disorder of cerebral circulation, it was not possible to mark any statistically significant differences in the clinico-biochemical indices. At the same time different negative environmental influences (alcohol abuse, brain injuries, severe acute and chronic mental traumatization, frequent exacerbations of focal chronic infections of the ENT and the lungs, etc.) and a combination of 2 or 3 of them were significantly more frequently seen in patients without hereditary aggravation (34.8%) rather then with it (10.7%). A conclusion is being made that genotypical factors do not play a decisive role in the etiology of cerebral vascular disorders in young people. They only condition a lesser stability of the organism to unfavourable environmental factors and their different combinations.     

S-100 protein concentration in the cerebrospinal fluid of patients with Creutzfeldt-Jakob disease

We evaluated S-100 levels in paired cerebrospinal fluid (CSF) and serum samples in a group of 135 patients referred to the German Creutzfeldt-Jakob disease (CJD) surveillance unit from June 1993 to May 1995. The patients were seen in a prospective case control study. The diagnosis of probable CJD during life was made in any patient presenting with rapidly progressive dementia of less than 2 years' duration, typical periodic sharp wave complexes (PSWCs) in the EEG and at least two of the following findings: myoclonus, visual/or cerebellar symptoms, pyramidal and/or extrapyramidal signs and/or akinetic mutism. Patients presenting with the above clinical signs and symptoms but without PSWCs were classified as possible, while those with a dementia of a duration exceeding 2 years and without PSWCs were classified as other. S-100 was determined in paired CSF and serum samples by a commercially available enzyme-linked immunosorbent assay. In a group of 76 patients with definite and probable CJD, S-100 concentration (median 25 ng/ml, range 2-117) in CSF was significantly higher (P < 0.0001) than in 32 patients diagnosed as other (median 4 ng/ml, range 1-19). Serum levels of S-100 were below 0.5 ng/ml in all groups. At a cut-off of 8 ng/ml an optimum sensitivity of 84.2% with a specificity of 90.6% for the diagnosis of CJD by the determination of S-100 in CSF is obtained. S-100 levels exceeding 8 ng/ml in CSF support the diagnosis of CJD in any patient presenting with rapidly progressive dementia.