Blood lactate determined by a portable device in critically ill patients.

Patients with tissue perfusion deficit usually have lactic acidosis or hyperlactacidemia and blood lactate level has been used to diagnose this condition and to monitor the disease progression. We conducted a study to examine the diagnostic accuracy of capillary and arterial lactate (C LAC and strip A LAC) obtained by using a portable lactate analyzer (Accusport) compared with the standard method (A LAC) in this condition. Forty eight patients were included in the study. Strong correlation between C LAC and A LAC as well as strip A LAC and A LAC were demonstrated (r = 0.89 and 0.98 respectively, p <0.05). When determining agreement between C LAC and strip A LAC with the standard method, all but 2 of C LAC - A LAC differences and 2 of strip A LAC - A LAC differences were within the agreement limits (mean +/- 2SD). We conclude that capillary and arterial lactate determined by the tested device, when used and interpreted cautiously, can substitute arterial lactate in the diagnosis of hyperlactacidemia and monitoring the effectiveness of therapy.

Leber's hereditary optic neuropathy (LHON) with mitochondrial ND4 gene mutation (11778) in a Thai patient.

Leber's hereditary optic neuropathy (LHON) is a maternally transmitted disease, characterized by bilateral optic atrophy predominantly in healthy young males. This disorder has shown to be associated with DNA mutation in mitochondrial genome of the patients. We report here a young man who came to the hospital with subacute visual loss in one eye, followed by the other eye within two months. His echocardiogram was normal. A G-->A base substitution at nucleotide position 11,778 which changes a conserved arginine to histidine at amino acid position 340 of ND4, a protein subunit of respiratory chain enzyme complex I in oxidative phosphorylation system, was detected in his leucocyte mitochondrial genome.

Establishment of OVS1 and OVS2 monoclonal antibodies recognizing human ovarian mucinous cystadenocarcinoma.

Two newly established murine monoclonal antibodies (MAbs), OVS1 and OVS2, to human ovarian mucinous cystadenocarcinoma were further characterized for diagnostic efficacy. The specific SA-1 antigen, purified from the tumor extract was identified as a glycoprotein of 29 kDa. A double determinant biotinstreptavidin alkaline phosphatase immunoassay system, containing OVS1 and OVS2 MAbs was used to determine the SA-1 levels in serum. The OVS1 MAb was used as a first antibody because of its high specificity of 96% while OVS2 MAb, with a lower specificity of 8% but greater sensitivity of 78%, was chosen as a second antibody. Matched sera of 64 healthy controls and 90 patients with definite diagnoses of 25 benign diseases, 14 nonovarian cancer and 51 ovarian cancer, were simultaneously measured together with CA 125 values. At cut-off levels of 220 and 360 units/ml, the SA-1 test showed 63% and 43% positive rates respectively in all types of ovarian cancer, compared to 65% and 57% positive rates for CA 125 at cut-off levels of 35 and 60 units/ml, respectively. Sensitivity for SA-1 at 220 units/ml cut-off level in mucinous ovarian cancer was 75% and increased significantly to 85% when the test was combined with CA 125 at 35 units/ml cut-off level. Furthermore, The combination of both tests significantly increased the positive rates to 86% in all types of early stage ovarian cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Mitochondrial genome analysis in Kearns-Sayre syndrome.

We analysed the mitochondrial genome of one patient with chronic and progressive bilateral ophthalmoplegia. This patient also had abnormal EKG showing cardiac conduction defects and pigmentary retinopathy, suggestive of the Kearns-Sayre syndrome. On muscle biopsy, with Gomori trichrome stain, the fibers showed an increase in red-staining material in the intermyofibrillary network and the subsarcolemmal region. On electron microscopy, aggregations of abnormal mitochondria were demonstrated, confirming the diagnosis of mitochondrial myopathy. Analysis of mitochondrial DNA (mtDNA) from the patient and her mother showed no deleted mtDNA.

Significance of ascitic fluid white blood cells, pH, lactate, and other chemistry in immediate diagnosis of spontaneous bacterial peritonitis.

From 1989 to 1991, 68 cirrhotic patients, 47 with uninfected ascites and 21 with SBP were studied for the significance of ascitic fluid pH, lactate, PMN count and other chemistry for immediate diagnosis of SBP. It was revealed that ascitic fluid PMN count if over 500 per mm3, the increased lactate, or decreased glucose level, strongly supported the diagnosis of SBP. In cases of suspecting SBP but with low PMN count the ascitic values of lactate, glucose and pH will guide the diagnosis. If the ascitic lactate plus glucose, or lactate plus pH are above the cut off levels (lactate > 25 mg/dl; glucose < 60 mg/dl and pH < 7.35) the diagnosis is strongly suggestive. The ascitic fluid pH and A-AF pH gradient were not of diagnostic value due to instability of pH after tapping. For other chemistry in the ascitic fluid, there was a slight increase in ADA level in SBP, but for glucose, protein and glutamine levels, there was no difference among the groups with and without SBP.

Immuno-histological characterization of OVS1 and OVS2 monoclonal antibodies recognizing human ovarian mucinous cystadenocarcinoma.

OVS1 and OVS2 monoclonal antibodies (MAbs) were established by fusing murine myeloma cell line NS1/1-Ag4-1 with mouse spleen cells immunized with fresh human ovarian mucinous-cystadenocarcinoma tissue. The selection of the MAbs was assayed by an immuno-histological (streptavidin-biotin) staining of the specific antigen antibody reaction localized on frozen sections of the same tumor. Other paraffin sections and established cell lines were also screened by immuno-histological staining in order to characterize the specificity and sensitivity of these two MAbs. OVS1 MAb showed 96% specificity and 67% sensitivity to mucinous cystadenocarcinoma with no cross reactions to normal tissue, benign tissue, other cancers, or any established cell lines. OVS2 MAb revealed only 8% specificity but 78% sensitivity to mucinous cystadenocarcinoma, however, a cross reaction to some normal and benign tissues or other cancers was shown. The data suggested that OVS1 and OVS2 MAbs could be used in combination to detect ovarian mucinous cystadenocarcinoma.

Lactate and sports.

Blood lactate level was determined in two groups of athletes consisting of 12 male runners and 13 male swimmers. Before their performances, blood lactate level was 1.51 + 0.35 mM/L and within 5 minutes after 400 metre speedy running and 100 metre speedy swimming the levels had risen to 13.07 + 2.98 and 12.71 + 2.11 mM/L. Blood lactate level decreased within 30 minutes after exercise and the level were analysed under 3 different resting condition: oxygen inhalation, normal saline solution ingestion, and normal resting, were 5.68 + 1.49, 5.26 + 1.68, and 6.3 + 1.63 mM/L, respectively. There was no statistically significant difference in blood lactate level between the two groups of athletes, and among the three condifions of resting. These data suggest that workload done by 400 metre speedy running is equivalent to 100 metre speedy swimming. Oxygen inhalation or saline solution ingestion after exercise does not cause any better benefit to blood lactate removal than normal resting.