Risk factors for complications after duodenopancreatectomy. Initial results after implementing a standardized perioperative protocol.

INTRODUCTION: During 1993-2008 period, in the Surgical Clinic III were conducted several retrospective studies, in order to identify risk factors for complications after cephalic duodenopancreatectomy(DP). As a result of these studies, a preoperative protocol was developed for preparation of patients proposed for DPC, as well as a number of intraoperative technical changes in order to improve postoperative morbidity and mortality. Implementation of the protocol was gradually and inomogenic done in our service. METHODS: The study is prospective, conducted in 2009-2012, ina group of 180 patients and aims to evaluate immediate results after DPC for periampular malignancy, looking to analyze the effects of implementation of the protocol mentioned above.We analyzed the rates of complications (pancreatic fistula,blunt pancreatitis, bleeding from the pancreatic blunt, delayed gastric emptiness), and the factors that might influence their occurrence. RESULTS AND CONCLUSIONS: of the 180 patients, 10 (5.5%) developed pancreatic fistula and 24 (13.3%) had delayed gastric emptiness. Among the factors that have been significant associated with these complications we mention: the pancreatico-jejunalanastomosis and gastro-jejunal transmesocolic assembly. With the implementation of the protocol, the risk factors previously identified in retrospective studies performed in our service(elevated transaminases, experienced surgical team, etc.) have lost significance, but they have not disappeared entirely, due to fact that the conduit proposed was not entirely followed. We believe that the homogeneous application of a perioperative guide, together with a standardized surgical technique, will lead to improve immediate results after DP.

[Evaluation of prognostic factors for colon cancer]. / Evaluarea factorilor de prognostic în cancerul de colon.

INTRODUCTION: Colon cancer represents a major health problem in the world. The outcome of newly diagnosed cases predominantly relies on stage as defined by the UICC-TNM and American Joint Committee on Cancer classifications. AIMS: The aim of this retrospective study was to identify the additional prognostic factors for patients with colon cancer. PATIENTS AND METHODS: We retrospectively analyzed the incidence and significance of 8 clinical and pathological factors in 225 patients treated over a 2-year period in Surgery Clinic No. III, Cluj-Napoca. In order to avoid selection bias, all cases with a prior diagnostic of colon cancer and intervention for recurrence or metastasis, as well as cases lacking more than 20% of necessary datawere excluded. The candidate variables were analyzed using the Cox Proportional Hazards Model in order to select those who influence the outcome. RESULTS: The overall 5-year survival rate was 42%. Patients treated with resection of the primary tumor had a survival rate of 50%, ranging from 82% in patients with stage I malignancy to 11% in the presence of metastatic disease. 21% of all patients underwent emergency operation for obstruction or perforation but this did not significantly influence survival (p = 0.1). TheTNM stage of the tumor (HR = 1.2-8.4), grade of tumor differentiation (HR = 2.1) and perineural invasion (HR = 1.8) were independent negative prognostic factors. Venous invasion and status of resection margins were found to influence the outcome on univariate analysis, but were discarded when integrated in the multivariate model. The number of lymph nodes analyzed (p = 0.9) and the tumor location (p = 0.3) did not significantly affect the outcome of patients. CONCLUSION: These results suggest that the prognosis of newly diagnosed cases of colon cancer is influenced by the TNM stage, the degree of tumor differentiation and the presence of perineural invasion.

Multi-organ resections for colorectal cancer: analysis of potential factors with role in the occurrence of postoperative complications and deaths.

AIM: Multi-organ resection for colorectal malignancy is a topic of interest nowadays as it raises the issue of benefits versus increased morbidity. This study aims to identify factors that may influence the development of postoperative complications and death following multivisceral resection. METHODS: The study included 107 patients hospitalized in the Surgical Clinic III of Cluj-Napoca, who underwent multivisceral resections for colorectal cancer pathology. This is a retrospective study covering the period between 2006 and 2010. This study compares the morbidity and mortality following multi-organ resections for locally advanced colorectal cancer, with results in patients with uncomplicated colorectal resections. The study also highlights the impact that certain factors have on the development of postoperative complications. RESULTS: This study shows a higher incidence of death and postoperative complications in the case of multiorgan resections. The differences were found to be statistically significant as follows: postoperative complications: 26% after multiorgan resection and 14% after uncomplicated resection respectively (p = 0.001); postoperative death: 11% after multi-organ resection and 3% after uncomplicated resection respectively (p < 0.001). The factors that have influenced in a negative way the postoperative evolution of the patients were: diabetes, personal history of malignant disease, associated heart disease, major abdominal surgery prior enrolling, the number of resected organs and increased intraoperative blood loss (over 500 ml). CONCLUSION: In cases of locally advanced colorectal neoplasm, multiorgan resection should become the standard indication, as it offers patients their only chance of survival, comparable to that obtained in less advanced stages of the disease. This indication is underlined by the high resecability rate (R0) accomplished in our service. Preoperative compensation of the associated pathologies, the surgery performed by experienced teams, as well as providing an adequate intensive care are required to reduce the postoperative risks.

Perforated appendix with periappendicular abscess in a inguinal hernia sac--Amyand's hernia.

Amyand's hernia is a rare form of inguinal hernia, where the appendix is included in the hernia sac. We present the emergency case of an 81-year-old patient with right inguinal pseudo-tumor, accompanied by marked local pain, nausea, low grade fever and bowel disorders. Emergency surgery is indicated due to a suspected incarcerated inguinal hernia with imminent strangulation. The intraoperatory findings reveal the presence of a periappendicular abscess as the cause of gangrenous appendicitis, perforated in the right indirect inguinal hernia sac. The practice includes the evacuation of the abscess, appendectomy and surgical cure of the inguinal hernia--Bassini's procedure, Douglas drainage and subcutaneous drainage. The postoperative outcome was favorable, the patient being discharged on the fifth postoperative day. Postoperative checks performed at 3 and 9 months have not revealed the presence of a hernia recurrence.

[Risk factors for anastomotic leakage following colorectal resection for cancer]. / Factorii de risc ai fistulelor anastomotice dupa chirurgia neoplaziilor colo-rectale.

PURPOSE: To identify the risk and prognosis factors and their predictive value for anastomotic leakage after colorectal resections following cancer. PATIENTS AND METHODS: 1743 consecutive patients who underwent colic resections or rectal resections for colo-rectal cancer between 1996-2005 in Surgical Clinic no. 3 (Cluj-Napoca, Romania) were retrospectively analysed. RESULTS: A total of 54 (3.09 percent) anastomotic leaks were confirmed. Univariate analisys showed that the preoperative variables significantly associated with anastomotic leakage included weight loss, smoking, cardiovascular disease, lung disease, hypoproteinemia, diabetes, anemia, leukocitosis, presence of two or more underlying diseases. Use of alcohol, cerebrovascular disease, bowel preparation, mode of antibiotic prophylaxis, type of handsewn anastomosis, tumor location, tumor stage and tumor histology were nonsignificant variables. Hipoproteniemia (S - proteins < 60g/dl) and anemia (S Hb < 11) remained significant in logistic regression model. CONCLUSIONS: Our study shows that a value of S-proteins lower than 60 g/l and s-Hb lower than 99 g/l can be consider as predictive marker for anastomotik leak deshiscence.

[Jejunal ischemic ulcer with perforation: a case report]. / Ulcer jejunal de tip ischemic, perforat. Prezentare de caz.

Ulcerative ischemic lesions of the small bowel represents a rare abdominal pathology. We present the case of a 68-year-old male who was admitted to our hospital for abdominal pain, nausea and vomiting. Ultrasound examination followed by upper endoscopy raised up the suspicion of a jejunal ulcerative perforated lesion. Surgery confirmed the diagnosis, revealing the jejunal ulcer, perforated and blocked by the adjacent enteral loops. Ischemic etiology of the ulceration was indicated by the mesenteric thrombus. The anatomopathologic finding together with the clinical and imagistic examinations lead us to the diagnosis of thromboangiitis obliterans, cause of the mesenteric ischemia; the future problems regarding this case are the long term follow up, in order to be able to recognise the visceral ischemic recurency that might occur.

[Surgical management of malignant large bowel obstructions]. / Managementul chirurgical in urgenta al ocluziilor prin cancere colonice si rectale.

INTRODUCTION: Despite significant progress, the management of acute colonic obstruction still remains a challenging problem. The purpose of this study was represented by the evaluation of the clinical results of different techniques of resection for malignant colorectal (primary or staged) obstruction. METHODS: We performed a non-randomized clinical study. 590 patients with malignant colorectal occlusion who underwent surgery treatment an 3rd Surgical Clinic Cluj-Napoca between 1996-2005 were included. RESULTS: Patients with large bowel obstruction underwent one-stage primary resection with anastomosis in 267 cases or staged interventions in 323 cases. The groups were matched in: age, sex, comorbidities, tumor staging, serum preoperative levels of hemoglobin and proteins. The analysis of mortality and morbidity following surgical treatment for large bowel obstruction returned no significant difference among the two groups (p > 0.05). Moreover, the presented results showed a higher incidence of mortality (11.45% vs 9.33 %), morbidity (25.38% vs 14.6%) and increased hospitalization period (p = 0.029) among the patients that undergone seriate resections. CONCLUSIONS: One stage primary resections with anastomosis of the large bowel can be performed safely in case of emergency whenever patient comorbidities and local conditions do not stand as major restrictions.

Use of cerebrospinal fluid biomarkers in diagnosis of dementia across Europe.

BACKGROUND AND PURPOSE: Cerebrospinal fluid (CSF) biomarkers have been reported to be useful in dementia diagnosis. Not much is known about their use in clinical practice in Europe. METHODS: We analyzed data from a survey on the use of CSF biomarkers in the diagnosis of dementia across Europe using a questionnaire which was filled out by representatives of the 25 member countries of the European Federation of Neurological Societies (EFNS). RESULTS: Cerebrospinal fluid beta-amyloid, total tau, and phosphorylated tau proteins are frequently evaluated in the majority of the countries (in 18 out of 23 countries). No major technical or ethical issues were found that would hamper the procedure's ability to become routine in early and differential diagnostics of Alzheimer's disease. Cut-off values for beta-amyloid (median 500, range 300-849 pg/ml), total tau (367; 195-450 pg/ml) and phosphorylated tau (60; 40-85 pg/ml) varied considerably amongst countries and even within every country. CONCLUSIONS: Cerebrospinal fluid analysis of beta-amyloid, tau, and phosphorylated tau is frequently used in Europe. However, the use of various cut off values seriously hampers comparability and yields a potential threat to an interpretation and balanced use in clinical practice. We recommend that each laboratory establishes normative data and that multi-centered studies should be organized to explore the reasons for any differences.

Cerebrospinal fluid and serum antibodies against neurofilaments in patients with amyotrophic lateral sclerosis.

BACKGROUND: The aim of the study was to assess autoimmune involvement in amyotrophic lateral sclerosis (ALS). METHODS: We measured IgG antibodies against light (NFL) and medium (NFM) subunits of neurofilaments using ELISA in paired cerebrospinal fluid (CSF) and serum samples from 38 ALS patients and 20 controls. RESULTS: Serum levels of anti-NFL were higher in ALS patients than in controls (P < 0.005). Serum anti-NFL antibodies and intrathecal anti-NFM antibodies were related to patient disability (serum anti-NFL: P < 0.05; intrathecal anti-NFM: P < 0.05). Anti-NFL levels were significantly correlated with anti-NFM levels in ALS (P < 0.001) and the control group (P < 0.0001) in the CSF, but not in serum. Anti-NFL and anti-NFM antibodies significantly correlated between serum and CSF in the ALS group (anti-NFL: P < 0.0001; anti-NFM: P < 0.001) and in the control group (anti-NFL: P < 0.05; anti-NFM: P < 0.05). CONCLUSIONS: Autoimmune humoral response to neurocytoskeletal proteins is associated with ALS.

Relationship between ALS and the degree of cognitive impairment, markers of neurodegeneration and predictors for poor outcome. A prospective study.

INTRODUCTION: Amyotrophic lateral sclerosis (ALS) is a common neurodegenerative disease affecting motor neurons and may be associated with impaired cognition. Reliable prognostic factors for ALS patients are still missing. METHODS: We prospectively included 67 patients, 42 women and 25 men, with clinically defined ALS. The disease severity was assessed and the patients underwent SPECT, lumbar puncture with determination of tau, hyperphosporylated tau (p-tau) and beta-amyloid and a detailed neuropsychological assessment using a standardized test battery. In patients who died, a detailed neuropathologic evaluation was performed. RESULTS: The mean survival duration was 26.8 months. The delay between the first signs and confirmation of the diagnosis was 12.75 months. Cognitive impairment did not have an impact on the evolution of the disease. There was no correlation between neuropsychological and SPECT findings. Higher age at onset, more pronounced handicap and elevated beta-amyloid in the CSF were associated with shorter survival times. In brain tissue from nine of the deceased patients with ALS and dementia, all showed signs of comorbidity, six had hallmarks of frontotemporal lobar degeneration (FTLD) and three showed Alzheimer disease pathology. Brain tissues form 11 deceased ALS patients who did not show signs of dementia, had only changes compatible with a diagnosis of motor neuron disease. CONCLUSION: In our prospective study, age, disease severity and CSF beta-amyloid levels taken together were a risk factor suggesting shorter survival times. Dementia is relatively frequent in ALS and may be a consequence of either FTLD or result from co-existing Alzheimer disease.

[Laparoscopic treatment of a large trichobezoar in the stomach with gastric perforation and abdominal wall abscess]. / Tratamentul laparoscopic al unui tricobezoar gastric de mari dimensiuni complicat cu perforatie gastrica blocata in peretele abdominal anterior.

Trichobezoar represents a mass of swallowed hair inside the stomach. Here we report a 17-year-old girl who presented in our department with symptoms of gastric ulcer. Ultrasound examination followed by upper endoscopy revealed a large trichobezoar in the stomach with simultaneous gastric perforation. Laparoscopy also revealed a penetration into the anterior abdominal wall accompanied by abscess at this level. We performed a laparoscopic gastrotomy with trichobezoar extraction and laparoscopic treatment of perforation and abdominal wall abscess. The postoperative evolution was normal and the patient was discharged on the fifth postoperative day. We show that laparoscopic approach may be safely used in the treatment of the large gastric complicated trichobezoar. Several laparoscopic approaches were described for the treatment of tricobezoar and its complications but as far as we know this is the first report of laparoscopic treatment of large tricobezoar and associate gastric perforation.

Easy Identification of Optimal Coronal Slice on Brain Magnetic Resonance Imaging to Measure Hippocampal Area in Alzheimer's Disease Patients.

INTRODUCTION: Measurement of an- hippocampal area or volume is useful in clinical practice as a supportive aid for diagnosis of Alzheimer's disease. Since it is time-consuming and not simple, it is not being used very often. We present a simplified protocol for hippocampal atrophy evaluation based on a single optimal slice in Alzheimer's disease. METHODS: We defined a single optimal slice for hippocampal measurement on brain magnetic resonance imaging (MRI) at the plane where the amygdala disappears and only the hippocampus is present. We compared an absolute area and volume of the hippocampus on this optimal slice between 40 patients with Alzheimer disease and 40 age-, education- and gender-mateched elderly controls. Furthermore, we compared these results with those relative to the size of the brain or the skull: the area of the optimal slice normalized to the area of the brain at anterior commissure and the volume of the hippocampus normalized to the total intracranial volume. RESULTS: Hippocampal areas on the single optimal slice and hippocampal volumes on the left and right in the control group were significantly higher than those in the AD group. Normalized hippocampal areas and volumes on the left and right in the control group were significantly higher compared to the AD group. Absolute hippocampal areas and volumes did not significantly differ from corresponding normalized hippocampal areas as well as normalized hippocampal volumes using comparisons of areas under the receiver operating characteristic curves. CONCLUSION: The hippocampal area on the well-defined optimal slice of brain MRI can reliably substitute a complicated measurement of the hippocampal volume. Surprisingly, brain or skull normalization of these variables does not add any incremental differentiation between Alzheimer disease patients and controls or give better results.

Synergy of serum and cerebrospinal fluid antibodies against axonal cytoskeletal proteins in patients with different neurological diseases.

Autoantibodies against different axonal cytoskeletal proteins [the light (NFL) and medium (NFM) subunit of neurofilament and tubulin (TUB)] in serum and cerebrospinal fluid may be generated in response to the release of cytoskeleton from damaged neurons. We studied the relationships among these autoantibodies. Paired cerebrospinal fluid (CSF) and serum samples were obtained from 47 multiple sclerosis (MS) patients, 14 patients with neurodegenerative diseases, 21 patients with various neurological diseases and 16 normal control subjects. Levels of antibodies against NFL, NFM and TUB were related to each other in CSF in all groups, whereas close association of anti-cytoskeletal antibodies in serum was found in the MS group only. A concordant spectrum of anti-cytoskeletal antibodies is present in serum of MS patients, unlike in other neurological patients. The synergy between the spectrum of anti-cytoskeletal antibodies in serum and CSF might be one of the immunological features typical for the MS patients.

Cerebrospinal fluid antibodies to tubulin are elevated in the patients with multiple sclerosis.

BACKGROUND AND PURPOSE: The aim of this study was to compare the levels of anti-tubulin antibodies (anti-TU) in cerebrospinal fluid (CSF) and serum using bovine tubulin as the antigen in one enzyme-linked immunosorbent assay (ELISA) method (anti-TUb antibodies) and a synthetic neuron-specific octapeptide of tubulin in a second ELISA method (anti-TUs antibodies). METHODS: Paired CSF and serum samples were obtained from 34 multiple sclerosis (MS) patients, 13 patients with various other neurological diseases (control diseases) and 17 normal control patients (CN). RESULTS: CSF levels of anti-TUs and anti-TUb antibodies were significantly lower in the CN group when compared to those in the MS group. On the contrary, serum levels of anti-TU antibodies did not differ among groups. The intrathecal synthesis of anti-TUs antibodies in comparison with anti-TUb was significantly increased in all groups. Significant correlations between anti-TUb and anti-TUs antibodies were observed in the CSF of all three groups. However, with regard to serum, a similar relationship was only found in the MS group. CONCLUSIONS: The estimation of anti-TU in CSF can contribute to the overall assessment of axonal damage; on the contrary serum anti-tubulin antibodies were not useful for differential purposes in MS. The antibodies to the neuron-specific portion of tubulin seemed to be synthesised predominantly intrathecally.

Guidelines on routine cerebrospinal fluid analysis. Report from an EFNS task force.

A great variety of neurological diseases require investigation of cerebrospinal fluid (CSF) to prove the diagnosis or to rule out relevant differential diagnoses. The objectives were to evaluate the theoretical background and provide guidelines for clinical use in routine CSF analysis including total protein, albumin, immunoglobulins, glucose, lactate, cell count, cytological staining, and investigation of infectious CSF. The methods included a Systematic Medline search for the above-mentioned variables and review of appropriate publications by one or more of the task force members. Grading of evidence and recommendations was based on consensus by all task force members. It is recommended that CSF should be analysed immediately after collection. If storage is needed 12 ml of CSF should be partitioned into three to four sterile tubes. Albumin CSF/serum ratio (Qalb) should be preferred to total protein measurement and normal upper limits should be related to patients' age. Elevated Qalb is a non-specific finding but occurs mainly in bacterial, cryptococcal, and tuberculous meningitis, leptomingeal metastases as well as acute and chronic demyelinating polyneuropathies. Pathological decrease of the CSF/serum glucose ratio or increased lactate concentration indicates bacterial or fungal meningitis or leptomeningeal metastases. Intrathecal immunoglobulin G synthesis is best demonstrated by isoelectric focusing followed by specific staining. Cellular morphology (cytological staining) should be evaluated whenever pleocytosis is found or leptomeningeal metastases or pathological bleeding is suspected. Computed tomography-negative intrathecal bleeding should be investigated by bilirubin detection.

Effects of glucagon and insulin on plasma glucose, triglyceride, and triglyceride-rich lipoprotein concentrations in laying hens fed diets containing different types of fats.

The influence of dietary fat supplementations differing in the ratio of n-6 to n-3 polyunsaturated fatty acids (PUFA) on the effects of glucagon and insulin on plasma glucose, triglyceride (TG), and TG-rich lipoprotein concentrations was investigated in laying hens. Birds were fed either a low-fat control diet (LF) or diets supplemented with 4% pumpkin seed oil (PO; rich in n-6 PUFA) or 4% cod liver oil (CO; rich in n-3 PUFA). After 4 wk feeding of the experimental diets, hens were implanted with wing vein catheters and injected with porcine glucagon (20 microg/kg BW) and porcine insulin (0.5 IU/kg BW), 2 to 5 h after oviposition. Plasma glucose, TG, and TG-rich lipoprotein concentrations were determined from 10 min pre-injection to 60 min post-injection. PO diet resulted in a prolonged plasma glucose response to glucagon administration and altered hypoglycemic response to insulin. However, CO diet did not influence plasma glucose response to either glucagon or insulin administration compared to LF diet. The effects of glucagon and insulin on plasma TG and TG-rich lipoproteins were similar for all diets regardless of the amount or type of fat. The results suggest that feeding dietary fats with high n-6 to n-3 PUFA ratio alters the glucagon and insulin sensitivity of plasma glucose in laying hens. Fats rich in n-3 PUFA seem to have no influence on the plasma glucose response to glucagon and insulin.

Effect of supplementation with methionine and different fat sources on the glutathione redox system of growing chickens.

The effect of supplementary methionine and fats of different saturation levels on the glutathione redox system of growing broiler cockerels was studied. The diet of three groups of chicks was supplemented with corn germ oil, beef tallow and fish oil at the levels of 30 g/kg and 50 g/kg of feed, respectively. The diet of further three groups was supplemented with methionine (5 g/kg of feed) in addition to the different fat sources. Control chicks were fed with a compound feed without methionine and fat supplementation. Reduced glutathione (GSH) and glutathione disulphide (GSSG) content as well as glutathione peroxidase activity in the liver were determined and GSH/GSSG ratio was calculated at day old and then at one and three weeks of age. Our results indicate that supplementary methionine stimulates both the synthesis of the glutathione redox system and glutathione peroxidase activity in growing chickens in the first period of postnatal life, when the risk of lipid peroxidation is high due to feeding unsaturated fats in the diet.

[Determination of trace amounts of salicylic acid and acetylsalicylic acid in polopirin and other drugs containing acetylsalicylic acid]. / Oznaczanie sladowych ilosci kwasu salicylowego i kwasu acetylosalicylosalicylowego w polopirynie i innych lekach zawierajacych kwas acetylosalicylowy.

A liquid chromatography procedure has been employed for the quantitative determination of trace amounts of salicylic acid, acetylsalicylic salicylic acid and acetylsalicylic anhydride in several Polish drugs containing aspirin. The results were compared with those obtained by other workers for analogous foreign drugs.

Paraneoplastic opsoclonus-myoclonus syndrome associated with malignant fibrous histiocytoma: neuropathological findings.

Paraneoplastic syndromes related to soft tissue tumors are very uncommon and an association of paraneoplastic diseases with a malignant fibrous histiocytoma (MFH) has not been reported so far. Opsoclonus-myoclonus is a rare paraneoplastic nervous system syndrome, that was well documented in adult patients with neoplasms particularly of the lung and breast. A 77-year-old woman developed typical opsoclonus-myoclonus syndrome and rapidly progressed to coma. The opsoclonus and generalized myoclonus continued until the patient's death seven months later. An autopsy examination identified a pleomorphic MFH in the retroperitoneum without a metastatic spread. Microscopic examination of the cerebellum revealed an atrophy of the granular layer along with a marked patchy loss of Purkinje cells, and a loss of neurons in the cerebellar nuclei accompanied by distinct peridental demyelination and astrogliosis. A moderate loss of neurons and neuronal chromatolysis were observed also in the inferior olivary nuclei. However, the omnipause neurons of the nucleus raphe interpositus, that are supposed to be responsible for opsoclonus generation under pathological conditions, as well as ocular brain stem nuclei were all intact. We failed to prove the presence of known antineuronal anti-Yo, anti-Hu or anti-Ri autoantibodies in both serum and cerebrospinal fluid (CSF) of the patient. However, the confirmation of the intrathecal IgG synthesis by oligoclonal bands in CSF and the immunohistochemical detection of IgG deposits on membranes of Purkinje cells, neurons of cerebellar granular layer and in cerebellar nuclei in our case support the presumed autoimmune nature of the disease.

Avidity of anti-neurocytoskeletal antibodies in cerebrospinal fluid and serum.

Antibodies have different avidities that can be evaluated using modified enzyme-linked immunosorbent assay (ELISA) techniques. We determined levels and avidities of antibodies to light (NFL) and medium (NFM) subunits of neurofilaments and tau protein in serum and cerebrospinal fluid (CSF) from 26 patients and anti-tau antibody levels and their avidities in 20 multiple sclerosis (MS) patients and 20 age- and sex-matched controls. Each sample was analyzed using both standard ELISA and also using a similar ELISA protocol with the addition of urea. The avidities of anti-neurocytoskeletal antibodies were higher in the CSF than those in serum (anti-NFL, p < 0.0001; anti-tau, p < 0.01; anti-NFM, n.s.). There was no relationship between avidities in serum and CSF for individual anti-neurocytoskeletal antibodies. We did not observe the relationship among the avidities of various anti-neurocytoskeletal antibodies. The avidities of anti-tau antibodies in the CSF were significantly higher in the MS patients than those in the controls (p < 0.0001). The study demonstrates the differences in avidities of CSF or serum neurocytoskeletal antibodies measured as the urea resistance by ELISA method. Avidity determination of anti-neurocytoskeletal antibodies could contribute to the evaluation of the immunological status of patients.