Sex-based differences in serum cardiac troponin I, a specific marker for myocardial injury, after cardiac surgery.

BACKGROUND: Prevalence and causes of sex-based differences in morbidity and mortality secondary to cardiovascular disease remain controversial. Cardiac troponin I (cTnI) is a sensitive and specific marker for myocardial injury. Serial cTnI measurements have been used to identify perioperative myocardial cell injury. OBJECTIVE: To determine whether sex influences the extent of myocardial injury during cardiac surgery, we measured perioperative cTnI in male and female patients. DESIGN: A total of 17 male and 17 female patients were prospectively studied in an age- and case-matched manner. Arterial cTnI were obtained preinduction, 30 mins after the application of the aortic cross-clamp, at arrival to the intensive care unit, and on postoperative day 1. SETTING: Tertiary cardiac surgery center at a major teaching hospital. RESULTS: There was no difference between men and women in body mass index (kg/m2), duration of cardiopulmonary bypass, and aortic cross-clamp times. Preoperative cTnI measurements were similar in men (0.24 +/- 0.15 ng/mL) and women (0.25 +/- 0.13 ng/mL, mean +/- sem). The maximum serum cTnI occurred on postoperative day 1 in all patients, and it was 3-fold higher in men (18.5 +/- 5.7 ng/mL) compared with women (6.4 +/- 1.0 ng/mL). CONCLUSIONS: Men had markedly higher serum cTnI compared with women, although they were case matched with respect to age and cardiac risk factors. Our results may suggest there may be sex-related differences in the myocardial response to ischemia and reperfusion injury or intrinsic differences between the male and female myocardium.

An automated biotin-streptavidin procedure for progesterone evaluation.

An automated biotin-streptavidin procedure for measuring progesterone in serum is described. The method is linear up to 98.3 nmol/L and the calibration curve is stable for at least 14 days. The lower limit of progesterone detection is 0.70 nmol/L. Although serum is the preferred specimen, progesterone levels can be measured in EDTA, heparin, or citrated plasma. There is no interference from samples with monoclonal proteins or from hemoglobin and bilirubin at concentrations of 9.62 g/L and 899 mumol/L, respectively. Lipemic samples will lower the progesterone levels. Total imprecision of the method in the range of 19-80.4 nmol/L gave CVs between 4.6 and 7.3%. Progesterone values obtained with this biotin-streptavidin procedure agreed with those obtained by the DPC RIA assay (r = 0.991). The biotin-streptavidin procedure can be used as an alternative to RIA for measurement of progesterone.

[Follicular cysts of the mandible. The diagnostic problems]. / Cisti follicolare della mandibola. Problemi diagnostici.

The authors describe a case of follicular cyst of the jaw diagnosed in a male infant who was 2 years and 4 months old. The authors discuss recent advances in the classification of this disorder and the difficulties that arise in performing differential diagnosis; some peculiar features of the described case are discussed.

Lymphoma, motor neuron diseases, and amyotrophic lateral sclerosis.

We studied 9 patients with motor neuron disease and lymphoma. The following several observations have not been recognized in the past: (1) Motor neuron syndromes are associated with either Hodgkin's disease or non-Hodgkin's lymphoma. (2) The syndromes are not restricted to lower motor neuron disorders; 8 of 9 patients had definite or probable upper motor neuron signs as well, qualifying for the diagnosis of amyotrophic lateral sclerosis. Corticospinal tracts were affected in both postmortem examinations. (3) The combination of motor neuron disease and lymphoma is often accompanied by paraproteinemia (3 of 7 patients studied), increased cerebrospinal fluid protein content (6 of 9 patients), and cerebrospinal fluid oligoclonal bands (3 of 9 patients). (4) In 2 patients, asymptomatic non-Hodgkin's lymphoma was found only because the discovery of paraproteinemia gave impetus to examine the bone marrow. (5) Patients with both upper and lower motor neuron signs (amyotrophic lateral sclerosis) may show physiological evidence of conduction block in peripheral nerves or autopsy abnormalities in peripheral nerves. The cause of this syndrome is not known. Both lymphoma and motor neuron disease could have a common cause, possibly a retroviral infection. The frequency of paraproteinemia suggests that an immunological disorder may play a role in the pathogenesis of the neurological disorder.

Hyperamylasemia in bulimia nervosa.

To determine the value of total serum amylase levels and salivary and pancreatic isoenzyme levels as biologic indices of behavioral disturbance in bulimia nervosa, the authors monitored these levels in 40 bulimic patients participating in a placebo-controlled trial of desipramine and in 25 controls. In the patients, the total and salivary amylase levels were significantly elevated and a significant correlation existed between the frequencies of binge eating and vomiting and the level of salivary amylase. However, the ability to discriminate patients from controls on the basis of serum amylase levels was limited. In addition, a significant positive relationship between binge frequency and level of serum amylase was observed in less than one quarter of 22 patients with five or more amylase determinations. Therefore, although hyperamylasemia is associated with bulimia nervosa, we believe that serum amylase determinations have limited utility in the assessment of patients with this syndrome.

Quantitation of hemoglobin with the Vision Analyzer by use of the alkaline hematin reaction.

Blood is drawn into capillary tubes containing saponin and the tubes placed into the reagent packs. Hemoglobin is denatured by mixing the hemosylate with a reagent containing lithium hydroxide and a non-ionic detergent. The absorbance is measured bichromatically at wavelengths of 577 and 633 nm. The calibration curve is stable and can be stored for at least 30 days. There are no interferences from fetal hemoglobin, glycosylated hemoglobin (20 percent), hemoglobin S, samples with hematocrits up to 0.55, paraproteins, and lipemia. Specimens with rouleau formation, nucleated and fragmented red blood cells, target cells, ovalocytes, teardrop cells, spherocytes, leukocyte counts of 29 X 10(9) per L and reticulocyte counts of 0.32; Howell-Jolly bodies did not interfere with the assay. The within run and between run precision gave average coefficient or variations of 2.3 and 1.9 percent, respectively. Comparison of the hemoglobin results obtained in 149 samples with the Vision (y) and Coulter Counter System (x) gave r = 0.987, Y = 1.01X - 1.89 g per L.

Antibodies to sulfated glucuronic acid containing glycosphingolipids in neuropathy associated with anti-MAG antibodies and in normal subjects.

Serum of patients with neuropathy and IgM monoclonal antibodies (M-proteins) that bind to the myelin-associated glycoprotein (MAG) were tested for binding to the major cross-reactive sulfated glucuronic acid containing glycosphingolipid, sulfated glucuronic acid paragloboside (SGPG). IgM binding to the glycolipid was detectable at serum dilutions of 1:10,000 and reactivity was greatest at 4 degrees C. Low titers of IgM binding to the glycolipid were also detected in sera from normal subjects and from patients with neurologic or rheumatologic diseases without serum M-proteins. Binding activity was present in 25% of the sera tested, and titers ranged between 1:25 and 1:400. One patient with peripheral neuropathy, however, had a measurable titer of 1:12,800 in the absence of monoclonal gammopathy. The study indicates that cold reacting anti-SGPG IgM antibodies are frequent constituents of the normal human antibody repertoire, and that monoclonal or polyclonal expansion of B cells that secrete these antibodies, is associated with peripheral neuropathy.

A novel CK isoenzyme migrating between CK-MB and CK-BB.

A CK isoenzyme migrating between CK-MB and CK-BB was detected in the serum of three patients with metastatic prostatic carcinoma. CK-BB was detected in the serum of all three patients and mitochondrial CK in two of the patients. Total CK activity was either normal or elevated, and the atypical CK isoenzyme, CK-BB and the mitochondrial CK isoenzyme were present in serum for up to 1.5 months. This atypical CK isoenzyme was not CK-MB, an albumin-ligand complex, or adenylate kinase, and was not bound to an immunoglobulin. This atypical CK isoenzyme did not contain immunologically normal CK-M subunits but had some CK-B subunits and could be a variant CK-BB or CK-MB isoenzyme. Its appearance in serum could be indicative of a serious illness.

Motor neuron disease and plasma cell dyscrasia.

In the years 1977 to 1984, 10 of 206 patients (4.8%) with motor neuron disease (MND) had M proteins; 4 had IgM and 6 had IgG. Among 100 control patients with other neurologic diseases, only 1 had an M protein. We later added six cases of MND and M proteins, as well as three with polyclonal IgM elevations and two with Bence-Jones proteins. Including other reports, there are now 37 known cases of MND with monoclonal and 5 with polyclonal gammopathy. There is evidence that plasma cell dyscrasia is often undetected; the actual incidence of serum immunoglobulin abnormality in patients with MND may be greater than our figure.

Evaluation of a fluorescence polarization immunoassay procedure for quantitation of methotrexate.

A fluorescence polarization immunoassay (FPIA) procedure for measuring methotrexate was evaluated. The dynamic range of the assay is from 0.05 to 810 microM, and the calibration curve can be stored for at least 2 weeks. The FPIA procedure is automated and rapid; one result can be obtained in 18 min and five results in 25 min. There was no interference from hemoglobin (800 mg/dl), triglycerides (500 mg/dl), bilirubin (20 mg/dl), and protein (12.1 g/dl). Cross-reactivity with 7-hydroxy methotrexate and 2,4-diamino-N-methylpteroic acid was 0.6 and 44%, respectively. The coefficient of variation for the within-run and between-run precision was less than 5.0%. For the comparison studies, the samples were divided into four groups. The methotrexate concentrations in group 1 were 0.05-2.1 microM; in group 2, 2.2-9.3 microM; in group 3, 10-80 microM; and in group 4, greater than 80 microM. Linear regression analysis of the results obtained with the FPIA procedure and the enzyme multiplied immunoassay gave a correlation coefficient of at least 0.95 for all groups.

Fluorometric measurement of serum magnesium with a centrifugal analyzer.

We developed a rapid fluorometric assay for measurement of serum magnesium using the ligand, 8-hydroxy-quinoline-5-sulfonate and adapted the procedure to the Multistat Fluorescence Light Scattering Centrifugal Analyzer. The standard curve extends from 0.26 to 4.11 mmol/l. There was no interference from calcium or inorganic phosphorus at concentrations of 4.95 and 5.0 mmol/l, lead, iron, zinc or copper at twice the normal levels found in serum, bilirubin at concentrations of 10 mg/dl, or lipemic samples with triglyceride concentrations of 2400 mg/dl. Citrate and EDTA lowered magnesium concentrations in serum. Analytical recovery of magnesium added to four serum specimens averaged 97%. Between-run and within-run precision of the assay gave CVs which ranged from 2.9 to 7.6%. Magnesium concentrations, measured by our fluorometric procedure, were compared with those obtained by atomic absorption and colorimetric procedures. Correlation coefficients of 0.91 and 0.88 were obtained.

Nephelometric measurement of ceruloplasmin with a centrifugal analyzer.

We describe a rapid nephelometric assay for measurement of ceruloplasmin in serum with the Multistat centrifugal analyzer. In establishing the optimum conditions, the concentration of polyethylene glycol was critical. With a 30 g/L solution of polyethylene glycol, the calibrators and samples react at the same rate, while with a 60/L solution the calibrators react faster than the samples. The reaction rate was not affected by temperatures of 30 or 37 degrees C or pHs between 6.0 and 8.4. There was no interference from bilirubin at a concentration of 180 mg/L, hemoglobin at a concentration of 5000 mg/L, or lipemic serum. The standard curve extends from 50 to 1300 mg/L. Analytical recovery of ceruloplasmin added to four serum specimens averaged 97%. The within-run precision (n = 17) gave CVs of 5.4, 6.1, and 4.0% for samples containing ceruloplasmin at concentrations of 240, 360, and 650 mg/L. Ceruloplasmin concentrations measured by our procedure were compared with those obtained by nephelometric, radial immunodiffusion, and enzymic procedures; the correlation coefficients were 0.93, 0.88, and 0.86.