Are CSF neopterin levels a marker of disease activity in multiple sclerosis?

The study aimed to evaluate neopterin levels in cerebro-spinal fluid (CSF) as a marker of disease activation and progression of multiple sclerosis (MS). Neopterin, a substance known to be released from macrophages and monocytes at increased rates in cellular immune reactions, was investigated by radioimmunoassay, in the CSF of 19 patients with MS during exacerbations of the disease, in 34 patients with other neurological diseases (OND) and in 20 normal subjects used as controls. Poser's criteria were used for the diagnosis of MS. Although elevated neopterin levels in the CSF of patients with MS during exacerbations have been reported by other investigators, we found such elevation in only 4 out of 19 patients with MS (21%), in 5 out of 34 patients with OND (14.7%), and in none of the control group. Student's t-test was used for statistical analysis. There was no significant difference in the CSF values of the MS patients, the patients with OND (p > 0.05) or the controls. These results indicate that neopterin levels in CSF may not be considered a marker of disease activity in MS.

Difference in symptom profile between generalized anxiety disorder and anxiety secondary to hyperthyroidism.

OBJECTIVE: The differential diagnosis between subclinical hyperthyroidism and Generalized Anxiety Disorder (GAD) is often a difficult problem to solve without laboratory examination. The aim of this pilot study was to assess whether there are differences in the symptom profile between these two disorders. METHODS: Fifty patients took part in the study: Twenty-five were hyperthyroid patients, and twenty-five were GAD patients. The diagnosis was based on the TSH values and the DSM-IV criteria, respectively. The Hamilton Anxiety Scale (HAS) and the list of fifty-one symptoms produced by the detailed expansion of HAS items were used to quantify the anxiety symptomatology. The differences in the frequencies between the two diagnostic groups were calculated at each categorical response for every item of both scales. Forward Stepwise Discriminant Function Analysis was performed twice using HAS items and the fifty-one-list items. RESULTS: The symptoms of anxiety in subclinical hyperthyroidism were not identical to those of GAD. Four Hyperthyroid/Anxiety Indices (HAI I-IV) were developed. These indices reach optimum classification of patients (3 of them reach 100% sensitivity and specificity). CONCLUSION: The results of the current study suggest that it is possible to differentiate between GAD and subclinical cases of hyperthyroidism by the careful study of clinical symptomatology. This may be of particular help in isolated areas without laboratory support, but replication of the indices in other samples is indicated.

Stability of serum TSH concentration after non refrigerated storage.

BACKGROUND: The ignorance of how sensitive serum samples for defined assays may be, can lead to overprotecting measures. This attitude not only increases cost and labor in everyday routine but may be responsible for not evaluating series of measurements if performed in serum samples not well stored. METHODS: Thyrotropin (TSH) concentration in serum was tested in three pooled samples drawn from various patients, before and after four days storage at freezing (-15 degrees C), low (4 degrees C), and room temperature (18-22 degrees C). TSH concentration was measured in each part, in 22 replicates using a commercial assay. RESULTS: The variation of the measured values due to the storage conditions was less than 10%, not exceeding the accepted between assay variation. CONCLUSIONS: For the estimation of TSH concentration, patient serum samples may be stored up to four days at 4 degrees C or even at room temperature without significant loss of measurement accuracy.

Stability of serum TSH concentration after non refrigerated storage.

BACKGROUND: The ignorance of how sensitive serum samples for defined assays may be, can lead to overprotecting measures. This attitude not only increases cost and labor in everyday routine but may be responsible for not evaluating series of measurements if performed in serum samples not well stored. METHODS: Thyrotropin (TSH) concentration in serum was tested in three pooled samples drawn from various patients, before and after four days storage at freezing (-15 degrees C), low (4 degrees C), and room temperature (18-22 degrees C). TSH concentration was measured in each part, in 22 replicates using a commercial assay. RESULTS: The variation of the measured values due to the storage conditions was less than 10%, not exceeding the accepted between assay variation. CONCLUSIONS: For the estimation of TSH concentration, patient serum samples may be stored up to four days at 4 degrees C or even at room temperature without significant loss of measurement accuracy.

Lung carcinoma imaging using a synthetic laminin derivative radioiodinated peptide YIGSR.

UNLABELLED: The synthetic laminin pentapeptide tyrosyl-isoleucyl-glycyl-seryl-arginine (YIGSR) binds to a metastasis associated high-affinity laminin receptor. The aim of this study was to investigate if the radiolabeled peptide can be considered as a basis for a potential tumor-imaging radiopharmaceutical. METHODS: Iodine-131-labeled YIGSR was injected in mice inoculated with Lewis Lung carcinoma, as well as in normal controls. The experimental animals were imaged on a gamma camera 10 hr after peptide administration. The same peptide was also labeled with 125I and administered to tumor-bearing and normal mice. At various time-points after peptide administration, the experimental animals were killed, and the radioactivity in the tumor, lung, liver and spleen was measured. Microscopic autoradiography was performed in histological sections of the same tissues. RESULTS: The tumor and the spleen of tumor-bearing animals were imaged on a gamma camera. No significant blood-pool background was detected. No other organ except urinary bladder and thyroid was imaged in normal animals. The peptide was retained on tumor and spleen of tumor-bearing animals. Twenty-four hours after peptide administration, the tumor, lung, liver and spleen of animals with tumors contained significantly more radioactivity than the same tissues of equally treated normal controls. The radiolabeled peptide YIGSR was detected by microscopic autoradiography on the surface of certain tumor cells, but not on the surface of any normal cell. CONCLUSION: Although extensive research is still required, the peptide YIGSR can be considered as a basis for the development of a receptor specific radiopharmaceutical useful for the in vivo estimation of the metastatic potential of tumors. This radiopharmaceutical may be helpful in staging and prognostic-related decisions on cancer treatment.

Evaluation of [14C]aminopyrine breath test, peripheral clearance of [99mTc]EHIDA, and serum bile acid levels in liver function and disease.

The purpose of this study is to evaluate the diagnostic value of the following tests in the assessment of patients with chronic liver disease (CLD) and cholestatic syndrome (CS): (1) aminopyrine breath test, measuring 14CO2 excretion in the expired air, (2) peripheral clearance of [99mTc]EHIDA, and (3) postprandial levels of glycocholic acid (GCA) and glycochenodeoxycholic acid (GCDCA). The results indicate that: (1) 14CO2 2-hr excretion rate is a specific and sensitive marker of liver function, with good correlation with postprandial bile acid levels, [99mTc]EHIDA retention, and the conventional tests of serum albumin and prothrombin time. (2) Peripheral clearance and retention of [99mTc]EHIDA increased in both groups of CLD and CS vs controls, but it does not discriminate between the two. (3) Postprandial bile acids were elevated in CLD, particularly those of GCDCA, whereas GCA levels were significantly elevated in CS compared with CLD. This may be due to increased synthesis and entry into the blood. (4) The combination of [14C]aminopyrine breath test and postprandial levels of GCDCA enhance the diagnostic value, specificity, and sensitivity in the assessment of patients with CLD.

Phenytoin plasma levels after intraoperative administration, for the prevention of post-craniotomy seizures.

Since in a previous study (preliminary report) (18) the iv. administration of 15 mg X kg-1 of phenytoin (PNT) over 30 min in men produced toxic levels (25 micrograms/ml), a smaller iv. dose of 7 mg X kg-1 was given during anaesthesia to 80 patients under going craniotomy, for the prevention of post-operative seizures. Plasma PNT concentrations were studied in 22 patients before its iv. infusion 20 min, 40 min, and 1, 2, 3, 5, 8 and 12 hours later. Mean serum phenytoin levels were 9.3, 31.9, 27.8, 25.5, 19.4, 17.2, 15.4 and 19.2 micrograms/ml respectively. In this study it appeared that although the initial dose was 50% smaller than before, toxic levels were still encountered one hour after PNT administration (therapeutic range 10-25 micrograms/ml). Bearing in mind that in both our studies PNT appeared to have approximately the same efficacy in seizure prevention (from 95-97%), we suggest, that 7-10 mg X kg-1 would be adequate if administered as an intraoperative iv. infusion over an hour and that whenever possible serial serum levels should be monitored.