Macrolipasaemia in a patient with pancreas divisum and acute abdominal pain: a case report.

This study describes a rapid increase of serum lipase activity during an episode of severe abdominal pain in a female patient with macrolipasaemia and pancreas divisum. Serum lipase activity was persistently elevated in the patient with simultaneously low levels of amylase activity which only increased in association with endoscopic retrograde cholangiopancreatography. Polyethylene glycol precipitation experiments, as well as the results of exclusion chromatography, demonstrated that the high lipase activity was due to a macromolecule of approximately 200000 Da. Affinity chromatography and immunological investigations further indicated that the atypical time-course of lipase activity was not due to alterations of the patient's lipase, but due to lipase-binding autoantibodies resulting in the formation of immune complexes between lipase and immunoglobulin G lambda. Our results show that macrolipasaemia must be considered as a possible cause in patients with unexplained raised serum lipase activity.

[Diagnostic and prognostic significance of massively increased serum glutamate dehydrogenase activity]. / Diagnostische und prognostische Bedeutung massiv erhöhter Glutamat-Dehydrogenase-Aktivität im Serum.

In a retrospective analysis of case reports of 115 patients with glutamate-dehydrogenase (GLDH) activity in serum of more than 100 U/l in 1979-1981, the most common causes of this increase were: acute right heart failure (28 patients), protracted septic-toxic circulatory failure (20), obstructive jaundice (18) and severe respiratory insufficiency (16), i. e. diseases causing perfusion or excretion disorders in the liver. The ratio of GLDH activity to transaminase activity provided a reliable separation of acute viral hepatitis, but not of different forms of perfusion disorders. The correlation between GLDH activity and death rate, especially in acute right-heart failure, is of prognostic value.

The Szasz-ratio (CK/GOT) as example for the diagnostic significance of enzyme ratios in serum.

The diagnostic significance of enzyme and isoenzyme ratios in serum relies on their different distribution at various levels: from organs to subcellular structures. Factors which modify the ratios are the molecular properties of enzymes and isoenzymes and their turnover in the cells and in the extracellular space. These pathophysiological principles are considered with respect to the Szasz ratio CK/GOT and its application for the differential diagnosis of acute myocardial infarction.

Creatine kinase (EC-No.2.7.3.2) and creatine kinase isoenzymes during pregnancy and labor and in the cord blood.

Total CK and CK isoenzyme activity in serum was investigated during pregnancy, labor and after delivery as well as in cord blood. Total CK was decreased in the second trimester of pregnancy but increased in late pregnancy. Low CK-MB activity in serum was found in patients with early labor pains. CK-BB activity could never be detected during pregnancy. Total CK and isoenzyme activity increased after delivery. The rise of total CK and CK-MB in maternal serum is directly correlated with the following: type of delivery, duration of labor, parity of the mother, and birth weight. From this it can be deduced that postpartum CK levels depend on skeletal muscle activity as well as on the activity of uterine muscle. Prematures and infants "small for date" have significantly lower total CK and slightly more elevated CK-BB activity in cord blood than children of normal maturity. CK-BB activity is much more pronounced in high risk patients with low Apgar score.

Macro-creatine kinase-BB: observations on 6 patients.

From 2000 sera with elevated total creatine kinase (EC 2.7.3.2) activity the sera of 6 patient showed a persistent high and anamnestically inexplicable creatine kinase activity level. The serum isoenzyme pattern was analyzed by four different methods. Electrophoresis revealed an atypical creatine activity band located between creatine kinase-MM and creatine kinase-MB. An adequate estimation of the persistent enzyme activity could only be achieved by immunotitration (immunoprecipitation), which identified the creatine kinase activity as due primarily to the isoenzyme creatine kinase-BB. Other methods (immunoinhibition and column chromatography) may lead to misinterpretations. The atypical serum creatine kinase-BB showed a higher molecular weight (Mr = 250,000) and altered substrate affinity as compared to native creatine kinase-BB. Both properties are attributable to the binding of creatine kinase-BB to immunoglobulins.

[Creatine kinase: reference values and clinical aspects of the revised standard method (author's transl)]. / Kreatinkinase. Uberarbeitete Standardmethode: Referenzwerte und Klinik.

Reference values for the revised standard method for determining N-acetylcysteine (NAC) activated creatine kinase (CK) activity in serum are presented, based on samples from 432 out-patients and 423 in-patients of either sex. CK activity was not age-related. The suggested range of normal values for serum CK activity, measured by the revised standard method at + 25 degree C, is 10--70U/l for females and 10--80U/l for males. Where an elevation of serum CK activity is of uncertain cause, the CK/GOT ratio had been recommended, additional to the CK-MB isoenzyme, for distinguishing between damage to heart and skeletal muscle. The significance of this ratio was checked with the revised standard CK method and the optimized GOT determination. The point of separation between myocardial and skeletal muscle damage is 10 by this methods. In order to use this ratio, total CK activity must be over 150 U/l and liver disease or secondary liver involvement must have been excluded. The CK/GOT ratio gains in importance through findings which limit the specificity of CK-MB as a purely myocardial (infarct)-specific isoenzyme.

[Determination of creatine kinase and CK-MB in heart failure (author's transl)]. / Bestimmung der Creatinkinase und des Isoenzyms Creatinkinase-MB bei Herzinsuffizienz.

Serum activity of creatine kinase and creatine kinase-MB have been investigated in 129 patients of various etiology in overt heart failure. Elevations in CK-MB were found in 19 patients, most frequently in patients with inflammatory heart disease. We found no correlation between CK-MB activity in serum and the severity of heart failure. CK-MB elevation in patients with chronic heart failure may be interpreted as a sign of progressive as well as regressive processes in the myocardium.