Significance of Creatine Kinase Isoenzymes for Neurologic Outcome in Perinatal Asphyxia

PURPOSE: To investigate the usefulness of the serum Creatine kinase(CK), especially brain typical creatine kinase(CK-BB) as an indicator of brain damage extent, mortality and long term nurologic sequelae, the study was done. METHODS: CK and CK isoenzyme activites were measured at 6-10 hours after birth in 160 asphyxiated newborn infants who admitted in Eulji General Hospital from August 1990 to July 1994. Infants were followed up for 1 years after birth to evaluate survival and neurologic outcome. RESULTS: 1) There was low correlation between CK-BB and 5 minute Apgar score(r=0.245, p=0.0026). 2) There was intermediate correlation between CK-BB and Lactic dehydrogenase (LDH)(r=0.470, p<0.0001). 3) Infants who died within 24 hours after birth had significantly higher CK-BB activity(144.9+/-98.5U/L) than survivors(82.2+/-159U/L), (p=0.0160). Infants who died within 72 hours after birth had significantly higher CK-BB activity(130.2+/-108.4U/L) than survivors(80.5+/-161.1U/L), (p=0.0209) 4) Infants who died within 24 hours after birth had significantly higher CK-BB%(23.4+/-17.4%) than survivors(9.6+/-11.9%), (p=0.0042). Infants who died within 72 hours after birth had significantly higher CK-BB%(20.0+/-15.4%) than survivors(9.3+/-11.8%), (p= 0.0027). Infants who died within 28 days after birth had significantly higher CK-BB% (12.7+/-13.4%) than survivors(9.7+/-12.3%), (p=0.0500). 5) In the cases of neonatal seizure in 24-48 hours after birth, CK-BB was higher than in the cases of no seizure or seizure in 48 hours after birth. 6) CK-BB was well correlated to the grade of hypoxic ischemic encephalopathy. 7) CK-BB, CK-BB% and 5 minute Apgar score showed similar positive and negative predictive values for survival rate, abnormal findings of imaging studies and neurologic outcomes. CONCLUSIONS: CK-BB is a good predictive value for the death within 24 and 72 hours after birth and the neonatal seizure in 24-48 hours after birth. CK-BB% is a good predictive value of the death within 24, 72 hours and 28 days after birth. CK-BB, CK-BB% and 5 minute Apgar score showed similar predictivity for neurologic outcomes during 1 years after birth.

A Case of Septo-Optic Dysplasia

Septo-optic dysplasia, as first described by de Morsier, is a rare developmental anomaly involving optic nerve hypolasia, midline anomalies of the brain and variable hypothalamic-pituitary dysfunction. We experienced a case of septo-optic dysplasia in 56-day old male infant who presented with prolonged jaundice. A magnetic resonance imaging of the brain showed absence of the septum pellucidum and the ophthalmoscopic examination disclosed left optic nerve hypoplasia. Thus, we reported it with a brief review of literatures.

Plasma Lipid Alteration in Leukemia and Solid Tumor

PURPOSE: A sensitive, specific blood test to detect cancer would be of great value but the search for such a test has been fruitless so far. In actual practice, there is often a considerable interval between the point at which a tumor could have been detected and the point at which it produces symptoms as a result of tumor growth. The research has been largely directed toward the identification of tumor-specific subtances that are liberated into body fluid. These tumor markers will not only indicate the presence of a cancer but also identify its site of origin and morphology. The available tumor markers, including the oncofetal antigen, placental hormones and enzymes, do not have enough tumor specificity or sensitivity to be used in diagnosis, but they do have a selective role monitoring the progression of tumor growth and assessing the response to treatment. Plasma lipid abnormality occurs regularly in many experimental animal tumor system. In some cases, their pattern and pathogenesis as well as their correlation with tumor volume and histologic features have been well characterized. Since both in vivo and in vitro celluar lipid alterations have been studied most intensively and found most commonly in lymphoproliferative and myeloproliferative disease, these form a particularly interesting group of malignancies for further investigation. In this study, we prospectively evaluated 26 patients with leukemia and 10 patients with solid tumor with full plasma lipid profiles. METHODS: Plasma lipids and lipoproteins were studied in 36 patients with acute leukemia and solid tumor at initial presentation or relapse and lipid studies were regularly repeated during a period of clinical remission. Patients were admitted to the department of pediatrics Eulji general hospital between March 1988 and June 1992 and they had no drugs known to alter lipid metabolism. No patient had a history of thyroid disease or diabetes and none had evidence of hepatic or renal dysfunction. Full serum chemistry analysis was performed utilizing Automated Analyzer and total serum lactic acid dehydrogenase was used as an additional parameter of tumor burden in all patients. Lipoprotein concentrations in plasma were measured b electrophoresis, and total lipid, phospholipid and free fatty acid by enzyme immunoassay. RESULTS: A consistent and predictable pattern of alterations in plasma lipid and lipoproteins were found. This pattern consisted of a marked decrease in aloha-lipoprotein(p=0.0001) and total cholesterol(p=0.0066), and increase in beta-lipoprotein(p=0.0001). Changes in triglyceride, phospholipid, free fatty acid and pre-beta-lipoprotein levels were net significant. The degree of lipid abnormality was directly related to the underlying tumor burden in leukemia. Among the lipid and lipoprotein alteration, aloha-lipoprotein appeared to be most sensitive indicator for the presence of tumor. CONCLUSIONS: The result suggest that an abnormality in systemic lipid metabolism, possibly in cholesterol clearance, is present in cancer patient. There appeared to be a direct relationship between magnitude of lipid abnormality and the amount of tumor burden but at the present time the exact mechanism of tumor-host interaction and its possible clinical implications remain to be determined.

Indirect measurement of blood pressure in neonates using an automatic noninvasive oscillometric monitor

The measurement of blood pressure in neonates is an important diagnostic procedure. But the measurement of blood pressure has not been performed routinely because of difficulty in measuring blood pressure and variable normal range according to measuring apparatus. Recently some accurate and convenient apparatus of measuring blood pressure have been introduced in neonatal care, so the reference values of neonatal blood pressure may be obtainable. The authors measured systolic and diastolic blood pressure using a noninvasive oscillometric monitor instrument on 1,3,6,12,24,48,72 hours of life in 200 neonates born at Eulji General Hospital, Taejon. And we analysed the results according to birth weight, gestational age, delivery type, sex, meconium stain, preeclampsia and hypocalcemia. The following results were obtained: 1) On the 1st day of life, systolic and diastolic blood pressure were 65.611.7 mmHg and 36.7+/-5.8 mmHg in the normal birth weight neonates, and 56.2+/-6.7 mmHg and 34.14.2 mmHg in the low birth weight neonates, respectively. So the blood pressure of normal birth weight neonates were higher than that of low birth weight neonates. 2) On the 1st day of life, systolic and diastolic blood pressure were 65.5+/-11.8 mmHg and 36.6+/-5.8 mmHg in the fullterm neonates, and 57.6+/-5.2 mmHg and 35.6+/-3.8 mmHg in the preterm neonates, respectively. So the blood pressure of full term neonates were higher than that of preterm neonates. 3) The difference of blood pressure in analysis according to birth weight were wider than that according to gestational age. 4) The blood pressure of neonates were lowest on the 3 hours of life and increased gradually during 72 hours of life. 5) The blood pressure of neonates did not show any significant difference in analysis according to sex. delivery type, Meconium stain, preeclampsia, and hypocalcemia.