ABSTRACT
Serum gamma-glutamyl transpeptidase was determined in 123 alcoholic patients and found elevated in all patients with liver disease but in only 52% of patients without significant liver disease. In patients without clinically obvious liver disease, the elevations were two to three times the upper limit of normal and decreased to normal in 80% of patients, eight weeks after abstinence. By contrast, in patients with liver disease, the elevations of serum gamma-glutamyl transpeptidase were of the order of eight to 10 times above normal and persisted at these high levels following eight weeks of abstinence. The degree of abnormality of the serum enzyme did not correlate with the daily amount of alcohol ingested or with the total length of time of alcohol consumption in these alcoholic patients. This study shows that serum gamma-glutamyl transpeptidase is persistently elevated in patients with clinically obvious liver injury, but only in 22% of chronic alcoholics without significant liver disease.
Subject(s)
Alcoholism/enzymology , Liver Diseases, Alcoholic/metabolism , gamma-Glutamyltransferase/metabolism , Adult , Aged , Alanine Transaminase/metabolism , Alkaline Phosphatase/metabolism , Aspartate Aminotransferases/metabolism , Bilirubin/blood , Female , Humans , Male , Middle AgedABSTRACT
A 64-year-old man developed severe hyperbilirubinemia of predominantly conjugated fraction in 1978, eight years after a myocardial infarction and development of congestive heart failure. In 1975, he was admitted elsewhere for symptoms suggestive of chronic hepatitis, but liver biopsy revealed replacement of hepatocytes by red blood cells which was interpreted as a result of left-sided cardiac failure. In 1978, liver biopsy showed congestive liver disease with cardiac sclerosis. Despite initial improvement, his condition deteriorated, he became encephalopathic, and died in a coma. This case is reported to illustrate that chronic congestive heart failure can present with severe jaundice and terminate in hepatic coma.
Subject(s)
Heart Failure/complications , Hepatic Encephalopathy/etiology , Hyperbilirubinemia/etiology , Cholestasis/etiology , Cholestasis/pathology , Chronic Disease , Hepatic Encephalopathy/pathology , Humans , Hypoxia, Brain/etiology , Liver/pathology , Male , Middle Aged , Pulmonary Embolism/complicationsABSTRACT
To determine any potential benefit of feeding increased amounts of protein to hypermetbolic burned patients, 18 children with burns averaging 60% total surface area were randomized into two matched groups and studied serially for at least six weeks: the first group was given a normal diet with a balanced nutritional supplement, and the second group was supplemented with milk whey protein. The normal protein group received 87.1% of their desired caloric intake with 16.5% of calories from protein compared to 77.7% of desired caloric intake with 23.0% of calories from protein for the high protein group. Despite a higher caloric intake, the normal protein group had a worse opsonic index compared to the high protein group (0.42 +/- 0.04 vs. 0.62 +/- 0.05, p < 0.0007), lower levels of C3 (1371 +/- 55 vs. 1585 +/- 64 micrograms/ml, p < 0.01), lower levels of IgG (805 +/- 52 vs. 975 +/- 56 micrograms/ml, p < 0.03), lower levels of transferrin (200 +/- 10 vs. 283 +/- 18 mg/dl, p < 0.0001), lower levels of total serum protein (5.5 +/- 0.1 vs. 6.3 +/- 0.2 g/dl, p < 0.005), more bacteremic days (11% vs. 8%, p < 0.005) and worse survival (5/9--56% vs. 9/9--100%, p < 0.03). Patients receiving the high protein diet had significantly higher plasma levels of valine, lysine, threonine, leucine, aginine, isoleucine, proline, serine, asparagine, tryptophane, and tyrosine. Asparagine levels were significantly (p < 0.01) associated with better neutrophil function and opsonic index. Except for phenylalanine, significant associations were found for serum levels of each of the amino acids with concentrations of one or more serum proteins. These studies provide evidence that many immunologic functions are dependent upon optimal availability of specific amino acids, and that routine diets do not provide sufficient protein to satisfy the needs of seriously burned children.
Subject(s)
Burns/diet therapy , Dietary Proteins/therapeutic use , Age Factors , Amino Acids/immunology , Burns/complications , Burns/immunology , Child , Complement C3/immunology , Energy Intake , Humans , Immunoglobulin G/immunology , Opsonin Proteins/immunology , Sepsis/complications , Transferrin/immunologyABSTRACT
Decreased GFR and TmG and increased beta-2-microglobulin excretion were found in a worker with a nine-year exposure to cadmium. The patient's recent marked weight loss and other multiple symptoms could not be explained on these abnormalities or by results of other specialized studies. Increased urinary beta-2-microglobulin without proteinuria but with elevated blood and urine cadmium levels in this patient raises questions about which biological indicators will prove to be most helpful in effectively monitoring cadmium workers.
