Usefulness of liver function tests in postmortem samples.

Liver function tests have been investigated in the forensic setting in several biological fluids collected at autopsy. Nevertheless, the results of these investigations have provided diverging information on postmortem stability of liver function markers and postmortem reliability of liver function assessment. The first aim of this study was to determine gamma-glutamyltransferase, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total bilirubin, total proteins, and albumin in antemortem and postmortem serum samples in a series of cases that underwent forensic investigations and had both samples available. The second aim was to measure total bilirubin and gamma-glutamyltransferase in cerebrospinal fluid. Preliminary results indicated that femoral (and cardiac) blood postmortem serum concentrations of bilirubin, total proteins, and albumin, as well as femoral blood postmortem serum concentrations of gamma-glutamyltransferase, can be considered to reliably reflect antemortem serum concentrations, thus suggesting that postmortem values could be used as surrogates for antemortem levels. Measurable bilirubin levels were demonstrable in cerebrospinal fluid samples in both preservative-free and sodium fluoride tubes, though with levels varying widely and unpredictably, irrespective of liver disease severity.

Evaluation of enzymes in pyogenic and tuberculous meningitis.

OBJECTIVES: Lactic dehydrogenase (LDH), creatine kinase (CK) and gamma glutamyl transpeptidase (GGTP) were measured serially in cerebrospinal fluid (CSF) and serum in twenty five cases of meningitis and an equal number of age and sex matched healthy control subjects with an aim to find out their diagnostic and prognostic significance in cases of meningitis. METHODS: The enzymatic activity was measured serially (day 0, 4th and 7th) in cerebrospinal fluid (CSF) and serum in twenty-five cases of meningitis consisting of fifteen cases of pyogenic meningitis (PM) and ten of tuberculous meningitis (TBM) and an equal number of age and sex matched healthy control. The clinical details including the level of consciousness and neurological deficit were correlated with the enzymatic activity and prognosis. RESULTS: The levels of these enzymes were significantly elevated in all the cases of meningitis in serum as well as CSF as compared to control subjects. The activity was significantly higher in pyogenic than tuberculous meningitis (p<0.001) and it was higher in CSF than in serum (p<0.001). The maximum elevation in activity of GGTP and LDH were seen on the first day whereas CK was highest on 4th day and thereafter, the activity of all the enzymes declined in the majority of cases who had shown clinical improvement. However, in three cases of pyogenic and five cases of tuberculous meningitis, the enzymatic activity on subsequent estimation, increased serially. All these eight cases died. Further, the basal enzymatic activity in all these eight cases that died was higher as compared to those who survived. Of all the enzymes, CSF GGTP levels correlated best with the clinical picture. CONCLUSIONS: It is concluded that GGTP, CK and LDH were significantly elevated in cases of meningitis. It was not possible to differentiate the type of meningitis on the basis of enzymatic activity in any of them. However, it was possible to predict prognosis because higher basal activity and serial rise were associated with poor prognosis.

[Enzyme activity in the cerebrospinal fluid in patients with brain gliomas]. / Aktivnost' fermentov v likvore u bol'nykh s gliomami golovnogo mozga.

The spinal fluid activities of aspartate aminotransferase (AAT), alkaline phosphatase (AP), and gamma-gluthamyl transferase were studied in 32 patients with cerebral gliomas to clarify the diagnostic role of these enzymes. There were different changes in their activities in groups of patients with low-differential and differential gliomas. Its was ascertained that higher AAT activity was due to the fact that blood had entered spinal fluid; increased AP activity may be regarded to be an indicator of higher permeability of the blood-brain barrier.

Enzymatic changes in the cerebrospinal fluid in patients with infections of the central nervous system.

Enzymatic determinations in cerebrospinal fluid (CSF) of aspartate aminotransferase (AST), lactic dehydrogenase (LDH), gammaglutamyl transpeptidase (GGT), creatine phosphokinase (CPK) and creatine kinase BB (CK-BB) were performed in 16 patients with aseptic meningitis (AM), in 25 children with bacterial meningitis (BM) and in 15 patients with meningism. The activity of AST and GGT was significantly higher in patients with BM on admission compared with those with AM and meningism (p < 0.05 and p < 0.005, respectively) and decreased with therapy. The highest concentration of AST and LDH appeared in patients with poor outcome as well as in those with ventriculomegaly on neurosonography (p < 0.05). The concentration of CK-BB increased in all patient groups on admission and remained higher on termination of therapy. The present study confirms the high activity of AST and GGT in BM patients in the CSF whereas the increased activity of AST and LDH reflects the extent of brain injury. Nevertheless, the prognosis for individual patients cannot be established on the basis of enzyme activity alone, but depends on several factors.

[Changes in the biochemical composition of the cerebrospinal fluid in acute carbophos poisoning]. / Izmeneniia biokhimicheskogo sostava tserebrospinal'noi zhidkosti pri ostrom otravlenii karbofosom.

As far as the pathogenesis of poisonings with organophosphorus pesticides is concerned, in addition to irreversible inhibition of acetylcholinesterase (AGE) in tissues, of importance are changes in the other systems which essentially determine the outcome of intoxication. The purpose of the present study was to examine the nature of changes occurring in total protein and protein fractions, free amino acids (aspartic and glutamic acids, glycine, isoleucine, leucine) and in certain enzymes (AST, ALT, CP, GGTP, GDH) in the cerebrospinal fluid (CSF) of patients with acute Malathion insecticide poisoning. 137 patients aged 20 to 50 years were placed under observation. There were 77 men and 60 women. 40 persons had poisoning of medium gravity and 97 were severely poisoned. The intake of the CSF was performed on days 1, 3, 10, 14 and 21 since the disease onset. It has been established that in acute Malathion insecticide poisoning, the CSF content of the stimulating mediator amino acids, aspartic and glutamic, rises within the early periods, whereas the concentration of the inhibitory mediator glycine decreases. The changes in protein fractions of the CSF are characterized by a fall of the content of globulins and a rise of albumins, thus attesting to the predominance of pathological processes in the brain, especially in the initial period of intoxication, and to the impairment of the blood-brain barrier. The development of intoxication is associated with activation in the CSF of LDN, CP, GGTP and GDH as well as by activation of LDH isozymes which is viewed as the result of the membranotoxic effect of a Malathion insecticide.

[Various biochemical indicators of the cerebrospinal fluid in acute carbophos poisoning]. / Nekotorye biokhimicheskie pokazateli tserebrospinal'noi zhidkosti pri ostrom otravlenii karbofosom.

The study was performed to evaluate the levels of some enzymes (AST, ALT, HGTP, LDG) and free amino acids (aspartic, glutaminic, glycine, isoleucine, leucine) in liquor of 37 subjects who got poisoned with a Malathion insecticide. Their condition was diagnosed as moderate and severe. The liquor was obtained on poisoning day 1, 3, 10, 14 and 21. The liquor levels of enhancement mediatory amino acids, aspartic and glutaminic, rise early in poisoning, while concentration of inhibition mediator glycine tends to decline. Progress of intoxication brings about a rise in LDG and GGTP activity attributed to a membranotoxic effect of the insecticide.

[Enzymologic diagnosis of cerebral lesions in generalized forms of meningococcal infection in the acute period]. / Enzimologicheskaia diagnostika porazhenii golovnogo mozga pri generalizovannykh formakh meningokokkovoi infektsii v ostrom periode zabolevaniia.

Cerebrospinal fluid was tested for several enzymes (CPK, AST, GGTP, BP, BG, AK) in 97 patients with generalized meningococcal infection with prevalent CNS affliction. Marked changes were detected even in the absence of clinical signs of cerebral lesion that was typical only of meningococcemia. Nevertheless, most pronounced changes were observed in a group of patients with cerebral edema and swelling. The changes in cerebrospinal fluid enzyme levels coincided with a reduced glucose and increased protein contents. In these cases, CSF hypertension increased CSF pressure to maximal levels. Most informative indices were singled out and their levels characteristic of acute phase of the disease established.

Evaluation of enzymes in serum and cerebrospinal fluid in cases of cerebrovascular accidents.

Gamma glutamyl transpeptidase (GGTP), glutamic oxaloacetic transaminase (GOT), and glutamic pyruvic transaminase (GPT) were measured serially in the serum and cerebrospinal fluid (CSF) of 22 patients with fresh stroke and an equal number of age- and sex-matched healthy control subjects. It was observed that levels of these enzymes in the CSF of control subjects were very low but were significantly elevated (p less than 0.001) in both serum and CSF in patients with stroke. The elevation was greater in the CSF than in the serum and was maximum during the first four days of stroke. Thereafter, the enzymatic activity declined. Of all these enzymes, GGTP in CSF correlated best with the clinical picture. It was possible to differentiate between the ischemic and hemorrhagic type of stroke on the basis of CSF levels of GGTP (greater than 60.0 units in hemorrhagic stroke). There was no correlation between GGTP levels in CSF and serum or among GOT, GPT, and GGTP in CSF. It can be concluded, therefore, that estimation of GGTP in CSF is helpful not only in predicting the degree of cerebral damage and functional outcome of the patient following stroke but also in differentiating the type of stroke.

[Clinical picture and changes in the activity of several cerebrospinal fluid enzymes in stroke]. / Klinicheskaia kartina i izmeneniie aktivnosti nekotorykh fermentov spinnomozgovoi zhidkosti pri mozgovykh insul'takh.

Having studied the clinical picture and changes in the activity of various enzymes in the cerebrospinal fluid (CSF) in 140 patients with cerebral strokes, the authors showed a diagnostic and prognostic value of determining the activity of LDH and GGTP in the CSF. The activity of these enzymes increased in hemorrhagic stroke and in cases of unfavourable outcome. Their activity was lower in ischemic stroke and in cases of a favourable course of the disease.

[Activity of gamma-glutamyltransferase in the cerebrospinal fluid in various forms of cerebral arachnoiditis]. / Aktivnost' gamma-glutamiltransferazy v spinnomozgovoi zhidkosti pri razlichnykh formakh tserebral'nogo arakhnoidita.

Measurement of activity of gamma-glutamyl transferase (GGTF) in the cerebrospinal fluid (CSF) revealed a sharp elevation in the cytosis and activity of GGTF in the ventricular portion of the CSF, which points to dystrophic changes in nerve cells and damage of their membranes and, consequently, to an increase in the permeability of the blood-brain barrier. Determination of GGTF activity in the CSF may be recommended as a supplemental method of the differential diagnosis of cerebral meningites.

[Possible pathways of changes in the activity of a number of enzymes in spinal fluid in stroke]. / O vozmozhnykh putiakh izmeneniia aktivnosti riada fermentov v likvore pri mozgovykh insul'takh.

Examination of 234 cases with cerebral stroke showed that the activity of enzymes in the cerebrospinal fluid (CSF) of these patients increased as compared to the control group. In hemorrhagic strokes their activity was considerably higher than in ischemic ones. In 92 cases the results of examination were compared to sectional findings. The activity of enzymes was affected by numerous factors including the speed of stroke development, its nature, the size of the focus, the distance of the latter from the CSF pathways, and the severity of brain oedema.

Effects of short-term and prolonged aerogenic hypoxia on gamma-glutamyl transpeptidase activity in the brain, liver, and biological fluids of young rats.

Posthypoxic fluctuations in the levels of two excitatory amino acids, glutamate and aspartate, may be related to changes in mechanism(s) which are responsible for their reuptake. As gamma-glutamyl transpeptidase (GGT) plays a role in mediating the uptake of glutamate and aspartate into various compartments of the brain, we studied changes in the activity of this enzyme in main regions of the brain in young and adult rats. We found a posthypoxic increase in bound GGT activity in some brain regions of 18-day-old animals after acute exposure, but no changes were observed after prolonged altitude hypoxia, with the exception of a decrease in cortical GGT activity. In contrast, acute hypoxia decreased GGT activity in the cortical capillaries to 59%, but prolonged hypoxic exposure was ineffective. However, the activity of soluble GGT in the cerebrospinal fluid of both groups of rats was several-times elevated in comparison with controls. At the same time, bound GGT activity was increased in the liver after acute or prolonged altitude hypoxia. The soluble GGT activity in plasma was only increased after prolonged exposure. Ninety days after prolonged hypoxic exposure the bound GGT activity was reduced in all brain regions to about 60-70% of controls (significantly higher in females than in males) as long-term developmental sequel from early postnatal hypoxia.

[Changes in some cerebrospinal fluid enzyme activities in patients with various neurological diseases]. / Comportamento di alcune attività enzimatiche del liquor in pazienti con malattie neurologiche diverse.

The authors have examined the activities of the enzymes GOT, CPT, CK, LDH, gamma-GT, PCHE and ALP in the cerebrospinal fluid of 50 patients with various neurological diseases. The results obtained show that many activities constantly and remarkably increase in few diseases of the nervous system. Particularly, GOT, GPT, LDH and ALP demonstrated raised values in the meningitis; LDH, CK, GOT, GPT in the brain tumors; CK and LDH in the hydrocephalus. A comparison between the results of the protein and enzyme determinations in the cerebrospinal fluid of the same patients, revealed in the enzymologic reactions a more precocious and sensitive indicator of initial brain lesions.

[Activity of gamma-glutamyltranspeptidase in spinal fluid in diseases of the nervous system]. / Aktivnost' gamma-glutamiltranspeptidazy v spinnomozgovi zhidkosti pri zabolevaniiakh nervnoi sistemy.

Gamma-Glutamyltranspeptase (gamma-GTP) activity was studied in cerebrospinal fluid (CSF) of 131 patients with varying diseases of the nervous system. The enzyme activity proved to be drastically high in patients with cerebral stroke, cerebral or spinal tumors, disseminated encephalomyelitis, and depended on the disease severity, its activity and connection of the pathologic foci with the liquor paths. The diagnostic and prognostic importance of gamma-GTP evaluation in CSF is shown.

Cortisol regulation of gamma-glutamyl transpeptidase in liver, choroid plexus, blood plasma and cerebrospinal fluid of developing chick embryo.

A relationship between membrane-bound gamma-glutamyl transpeptidase (GGT) in liver and choroid plexus and the soluble GGT in blood plasma and cerebrospinal fluids is indicated by a decrease of the former activity in the organs and a concomitant increase of the latter in the body fluids of the embryonic chick between day 11 and hatching. Starting on day 15, the administration of cortisol caused a marked increase in the activity of soluble GGT in blood plasma and cerebrospinal fluid which might be related to an increase of the membrane-bound activity of this enzyme by the glucocorticoid in liver, brain and choroid plexus during the same developmental period. However, before day 15 cortisol reduced GGT activity in the liver and choroid plexus suggesting a biphasic effect of the steroid on the activity of membrane-bound GGT.