Plasma Beta-Glucuronidase Activity: A Novel Tool to Distinguish Type 1 from Type 2 Amiodarone-Induced Thyrotoxicosis?

BACKGROUND: Amiodarone-induced thyrotoxicosis (AIT) is a common and deleterious side effect of amiodarone use. There are two types of AIT, characterized by distinct pathogenic mechanisms and, hence, different treatments. Discriminating between type 1 (AIT1) and type 2 (AIT2) AIT is often very challenging. Beta-glucuronidase (ß-G) is a lysosomal enzyme released into the extracellular fluid during inflammation. OBJECTIVES: To examine whether the determination of the plasma activity of ß-G is useful in distinguishing AIT1 from AIT2. METHODS: The study included 67 subjects: 9 with AIT1, 9 with AIT2, 14 with hyperthyroidism due to Grave's disease or toxic multinodular goiter, 14 with subacute thyroiditis, and 21 euthyroid controls. Thyroid function tests and plasma ß-G activity were determined in all participants, while thyrotoxic patients also underwent thyroid ultrasound/scintigraphy and urine iodine excretion assessment. RESULTS: Plasma ß-G activity (expressed as mean ± SD in nmol 4-methylumbelliferone [4-MU]/mL plasma/h) in AIT2 was higher compared to AIT1 (2,263.6 ± 771 vs. 1,101.8 ± 201.9, p < 0.05) and similar to subacute thyroiditis (2,263.6 ± 771 vs. 2,083.2 ± 987.5, p = ns). ß-G activity did not differ significantly between AIT1 and controls (1,101.8 ± 201.9 vs. 954.6 ± 248.6, p = ns). ROC curve analysis revealed that ß-G activity had a high predictive value for destructive processes, namely AIT2 and subacute thyroiditis (AUC 0.846, 95% CI 0.748-0.943) and a cut-off value of 1,480.5 nmol 4-MU/mL plasma/h was able to discriminate between destructive and non-destructive thyroid conditions with 74% sensitivity and 82% specificity. CONCLUSION: In our study, plasma ß-G activity performed well in distinguishing AIT1 from AIT2. Further studies are warranted to establish its usefulness as a discriminator between the two AIT types.

Effect of prenatal tobacco smoke exposure on fetal growth potential.

AIM: to determine the independent effect of prenatal tobacco smoke exposure on fetal growth using customized birthweight norms. METHODS: demographic characteristics and data on exposure to tobacco smoke during pregnancy were obtained from singleton neonates ≥ 34 weeks' gestation. Centile Calculator software v62.2 (www.gestation.net) was used for calculating customized birthweight percentiles. RESULTS: of the 3227 neonates studied, 30.9% were exposed to maternal smoking during pregnancy, whereas involuntary maternal exposure was reported in 20.1%. Growth restriction was noted in 350 (10.8%). The odds ratio (OR) for fetal growth restriction was 1.49 (1.10-1.91) in passive smokers, and 2.34 (1.81-2.96) in smokers. A decrease in birthweight and an increase in the prevalence of growth restriction with the increasing number of cigarette consumption was observed. This effect was evident even in cases of a "minimal" consumption of 1-5 cigarettes per day. CONCLUSION: an essential adverse effect of tobacco smoke exposure on fetal growth in pregnancies exposed to passive smoking, as well as in those with "minimal" maternal cigarette consumption, was found. Since approximately 30% of growth restricted neonates could be independently attributed to active or passive maternal exposure, these findings reinforce the need for smoking preventive strategies in pregnant women and their environment.

The insulin-like growth factor-I (IGF-I) generation test as an indicator of growth hormone status.

OBJECTIVE: The aim of the study was to evaluate the IGF-I generation test (IGF-I gen) as a possible indirect test of Growth Hormone (GH) secretory status. METHODS: Sixty-five GH deficient (GHD 1 and 2) and 86 control children were studied. Children in the GHD-1 subgroup (n=33) had low GH values (<10 microg/L) after clonidine and levo-dopa while those in the GHD-2 subgroup (n=32) had normal GH values after pharmacologic provocation but low 24-hour GH secretory rates compared to 187 Normal Statured (NS) children. Of the 86 controls, who underwent IGF-I gen,50 were NS and 36 Short-Statured (SS). Serum IGF-I was measured prior to and daily during hGH administration (hGH 0.033 mg/kg/dayx4 days). RESULTS: The prepubertal and pubertal GHD-1 and GHD-2 children had low baseline IGF-I values but their peak IGF-I values during the IGF-I gen reached those of the controls. The percent increase of IGF-I during the test was greater in the GHD groups than in the controls; in the prepubertal groups: 516+/-58% in the GHD-1, 433+/-50% in the GHD-2, 106+/-12% in the NS, and 102+/-18% in the SS (p=0.001); in the pubertal groups: 191+/-28% in the GHD-1, 141+/-20% in the GHD-2, 48+/-8% in the NS, and 61+/-17% in the SS (p=0.003). CONCLUSIONS: The IGF-I response during the IGF-I gen seems to reflect the GH status in children.

Effect of maternal smoking on cord blood estriol, placental lactogen, chorionic gonadotropin, FSH, LH, and cortisol.

AIM: To determine the effect of maternal cigarette smoking on cord blood concentrations of E3, hPL, beta-hCG, FSH, LH, and cortisol. METHODS: Hormone concentrations were measured in term neonates of 100 smoking and 100 non-smoking mothers. RESULTS: The median E3, hPL, beta-hCG, FSH, LH and cortisol cord blood concentrations in the non-smoking mothers' offspring were 212 ng/mL, 2.00 microg/mL, 57.5 mIU/mL, 0.10 mIU/mL, 0.20 mIU/mL, and 14.3 microg/mL, respectively; in the smoking they were 163, 1.39, 45.4, 0.10, 0.20, and 25.1, respectively (P=0.008, 0.004, 0.037, 0.498, 0.286, 0.004, respectively). There was a significant but poor negative correlation between number of cigarettes/day and E3 (r=-0.163, P=0.021), hPL (r=-0.191, P=0.007), and beta-hCG (r=-0.143, P=0.044), whereas the correlation with cortisol was positive (r=0.259, P<0.0001). Multiple linear regression analyses showed that maternal smoking is a determinant of cord blood E3, hPL, beta-hCG, FSH, and cortisol concentrations. CONCLUSIONS: Tobacco smoking is associated with a reduction in cord blood E3, hPL, and beta-hCG concentrations, whereas it is associated with increased cortisol concentrations. The disturbed endocrine equilibrium of the fetus induced by tobacco smoking could have adverse consequences on the fetus and child since fetal brain is a target organ for hormonal actions.

Impact of maternal smoking on birth size: effect of parity and sex dimorphism.

BACKGROUND: Maternal smoking during pregnancy causes a delay of intrauterine growth. OBJECTIVE: To examine the effect of maternal smoking during pregnancy on fetal growth in relationship to maternal parity, age and number of cigarettes smoked/day, and offspring's gender. SUBJECTS: We studied 2,108 term newborns (1,102 male, 1,006 female) delivered at the General University Hospital of Patras from 1994 to 2004. The 1,443 were born to mothers who did not smoke and 665 to mothers who smoked during pregnancy. METHODS: Birth weight, length and head circumference were measured prospectively in all newborns. Also, maternal smoking status and number of cigarettes smoked per day, age, and parity were recorded. For the analysis, t test, one-way ANOVA, Mann-Whitney U test, Spearman rank correlation, and factorial MANOVA with covariates were used. RESULTS: With increasing parity, in the neonates of nonsmoking mothers there was a gradual increase of growth, whereas in neonates of smoking mothers there was a gradual decrease of growth. This effect was more pronounced in males. A significant negative main effect on growth resulted from the interaction of smoking with parity (p = 0.013), and with gender and parity (p = 0.001). There was a significant negative correlation between number of cigarettes smoked per day and growth, the strength of which increased with parity, mainly in males. CONCLUSION: Maternal smoking during pregnancy causes a delay in fetal growth, which is greater in male offspring, an effect that is enhanced with parity but is independent of maternal age.

Combined growth hormone-releasing hormone and growth hormone-releasing peptide-6 test for the evaluation of growth hormone secretion in children with growth hormone deficiency and growth hormone neurosecretory dysfunction.

BACKGROUND: The combined growth hormone-releasing hormone and growth hormone-releasing peptide-6 (GHRH + GHRP-6) test is most potent in evaluating GH secretion. AIMS: To assess its capability in children with GH deficiency and low spontaneous GH secretion (GH neurosecretory dysfunction). METHODS: 35 children with GH <10 microg/l after levo-dopa/clonidine (GHD), 15 with normal provocative tests but abnormal 24-hour spontaneous GH secretion (GHND), and 20 controls (C) were given 1 microg/kg of GHRH and GHRP-6 i.v. and GH (microg/l) was measured at -15, 0, 5, 10, 15, 30, 45 and 60 min. RESULTS: Six were nonresponders to the combined test, with significantly lower peak GH 20.7 (7.8-31.8) than C and the rest of the patients (responders). Peak GH was similar between prepubertal (PP) controls 167 +/- 88, GHD 202 +/- 110 and GHND 155 +/- 83. Pubertal (P) controls had higher peak GH 328 +/- 149 than P-GHD 203 +/- 105 and P-GHND 186 +/- 105. While P-C had higher peak GH than PP-C, PP and P children had similar responses within the GHD and GHND groups. CONCLUSIONS: The GHRH + GHRP-6 test detects children with severe GH insufficiency. Patients with GHD respond similarly to those with GHND, indicating a possible hypothalamic GH neuroregulatory dysfunction in GHD. Responders to the combined test may be eligible for treatment with a synthetic GH secretagogue.

Association of secondary sex ratio with smoking and parity.

OBJECTIVE: To assess the sex ratio in offspring of smoking and nonsmoking mothers in relationship to parity. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): The authors studied 2,108 term singleton neonates born between 1993 and 2002, 665 from smoking mothers and 1,443 from nonsmoking mothers. INTERVENTION(S): A prospective recording of maternal age, parity and smoking status, and gender of neonates delivered over a 10-year period. MAIN OUTCOME MEASURE(S): Secondary sex ratio in regard to maternal smoking and parity. RESULT(S): The offspring sex ratio in the total sample studied was 1.09; in the offspring of smoking and nonsmoking mothers, it was 1.26 and 1.03, respectively, a statistically significant difference. In the offspring of smoking women who had parity 1, 2, and >or=3, it was 1.47, 1.35, and 0.92, whereas in those of nonsmoking women, it was 1.04, 1.00, and 1.03, respectively (the differences of the parity 1 and 2 groups between the offspring of smoking and nonsmoking mothers were statistically significant). Logistic regression analysis showed that the possibility of a boy being delivered by a mother who smoked was significantly greater in primiparous women than in women who had parity >or=3, independent of the maternal age. Conversely, parity did not affect significantly the sex ratio in the offspring of nonsmoking women. CONCLUSION(S): The findings suggest that among women who smoked, significantly more male than female offspring are born from primiparous women, whereas women who had parity >or=3 gave birth to more female offspring; biparous women give birth to significantly more male offspring, but the offspring sex ratio declined with the number of cigarettes when the mothers smoked >or=10 cigarettes per day.

Smoking, psychosocial factors, psychopathologic behavior, and other related conditions in hospitalized youth suicide attempters.

BACKGROUND: Comorbidity of suicidal behavior with various risk factors has been reported. This study examines the combined effect and the interactions of the most prominent risk factors in hospitalized suicide attempters. METHOD: Seventy-six successive hospitalized suicide attempters and 76 matched control subjects, 9 to 20 years old, were subjected to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I and Axis II diagnoses and were interviewed for the use of licit and illicit substances. Also, 18 control subjects with the same psychiatric disorders diagnosed in the attempters were examined. Logistic regression analysis was applied to determine the independent effect of the risk factors to suicide attempts. RESULTS: The findings showed an 18-fold greater frequency of psychiatric disorders, a 14-fold greater frequency of other conditions that may be a focus of clinical attention (mainly relational problems), a 9.7-fold greater frequency of smoking, and a 4.7-fold greater frequency of psychosocial and environmental problems in the attempters than in the control subjects. The independent association of these factors with increased suicide risk persisted after adjusting for the effect of other factors. CONCLUSIONS: Psychopathologic behavior, psychosocial factors, and smoking are independently associated with increased risk for serious suicide attempts.

Course of growth during the first 6 years in children exposed in utero to tobacco smoke.

OBJECTIVES: Postnatal growth in children exposed in utero to tobacco smoke is not well understood. This study investigated growth during the first 6 years in children whose mothers smoked during pregnancy. MATERIALS AND METHODS: Weight, length, and head circumference were measured annually for 6 years in 100 children in each group of smoking (study) and nonsmoking (control) mothers. RESULTS: Weight and head circumference were significantly smaller in the neonates whose mothers smoked >or=15 cigarettes/day, but the difference disappeared by 3 years of life. Length was significantly smaller in the study neonates at birth, followed by increasing divergence from normality up to 2 years, when the mean difference of children whose mothers smoked >or=15 cigarettes/day from control children was -3.4 cm (p

Vibroacoustic stimulation in abnormal biophysical profile: verification of facilitation of fetal well-being.

OBJECTIVES: To verify the effect of vibroacoustic stimulation on biophysical profile score, with a prospective randomised study. STUDY DESIGN: All women with singleton pregnancy, gestational age >or=30 weeks, intact membranes and biophysical profile score

Increased cortisol concentrations in the cord blood of newborns whose mothers smoked during pregnancy.

AIM: To investigate the effect of tobacco smoke on cord blood cortisol concentrations. METHODS: Cortisol concentrations were measured in cord blood from 211 term newborns of smoking and 211 term newborns of nonsmoking mothers; 48 and 36 newborns were delivered by cesarean section, respectively. In 16 cases, in addition to cord blood, maternal venous blood was obtained at delivery. RESULTS: The median cord blood cortisol concentration in neonates of the smoking and the nonsmoking mothers was 23 and 13 microg/dL, respectively (P<0.0001). Cortisol concentrations were greater in the newborns whose mothers smoked, when compared to corresponding controls, whether they were delivered vaginally or by cesarean section. In the newborns delivered by cesarean section, there was a positive correlation between number of cigarettes smoked/day and cortisol concentrations, as well as a negative correlation between cortisol concentrations and neonatal length. There was no significant correlation between cortisol concentrations and birth weight or head circumference. Cortisol concentrations in the cord blood of neonates whose mothers were smokers and nonsmokers were by 29% and 45% lower from those measured in their mothers, respectively. CONCLUSIONS: Although a causal relationship between maternal smoking and high cortisol concentrations in cord blood was not established, the findings are in accordance with previous reports indicating elevated stress-hormones in newborns whose mothers smoked during pregnancy.

Growth hormone/JAK-STAT axis signal-transduction defect. A novel treatable cause of growth failure.

Primary cultured fibroblasts of four patients with idiopathic short stature and severe growth delay, which displayed normal growth hormone receptor expression presented a reduced ability for activation of signal transducer and activator of transcription-3 (STAT3). Impaired STAT3 activation was accompanied by cell-cycle arrest at the Go /G1 phase. Increased levels of the cyclin-dependent kinase inhibitor, p21(WAF/CIPI), and reduced levels of cyclins were also detected in these patients. High concentrations of human growth hormone (1000 ng x mL(-1)) added to the culture medium induced activation of STAT3 and reduced the levels of p21(WAF/CIPI) in the fibroblasts of the four idiopathic short stature children. Treatment of these children with exogenous human growth hormone significantly augmented their growth velocity. Overall, our study provides the first evidence linking the idiopathic short stature phenotype with a functional aberration in the growth hormone signal transduction cascade which can be successfully overcome by exposure to high doses of growth hormone.

Effects of two nebulization regimens on heart rate variability during acute asthma exacerbations in children.

Analysis of heart rate variability (HRV) has been used to evaluate changes in sympathovagal balance. The present study was designed to investigate the influence of two therapeutic regimens on autonomic cardiovascular regulation during acute asthma exacerbations (AAE). Twenty children, 7-13 years of age, with moderate or severe AAE were randomized in two equal groups to receive either 0.15 mg/kg/dose salbutamol (group 1) or a combination of lower-dose salbutamol (0.10 mg/kg/dose) and ipratropium bromide (5 mcg/kg/dose) (group 2). Exacerbations were treated with three nebulizations (Tx) of either regimen given 20 minutes apart. HRV indices [total power, high-frequency component (HF), low-frequency component (LF), and LF:HF ratio] were analyzed at specific time intervals during the management of AAE. Therapy had a significant time-dependent main effect on total power (p = 0.001), LF (p < 0.0001), and HF (p = 0.005) but reached only borderline significance for LF:HF ratio (p = 0.053). The decrease in LF was more pronounced in group 2 vs. group 1 at 10 minutes post-Tx1 (p = 0.034) and at 10 minutes post-Tx2 (p = 0.05), but there was no significant difference between groups at 10 and 20 minutes post-Tx3. There were no significant differences between groups in any of the other HRV indices. Both regimens improved FEV1 (p = 0.0001) to the same magnitude. During AAE, three consecutive inhalation treatments with either high-dose salbutamol-only or lower-dose salbutamol plus ipratropium bromide combination, resulting in similar FEV1 improvement, cause domination of sympathetic over parasympathetic nervous system of similar overall magnitude but distinct patterns of HRV indices.

Two dosages of clarithromycin for five days, amoxicillin/clavulanate for five days or penicillin V for ten days in acute group A streptococcal tonsillopharyngitis.

BACKGROUND: Short course antimicrobial therapy is suggested for group A streptococcal tonsillopharyngitis. METHODS: The bacteriologic and clinical efficacies of clarithromycin [30 or 15 mg/kg/day twice daily (b.i.d.)] or amoxicillin/clavulanate (43.8/6.2 mg/kg/day b.i.d.) for 5 days or penicillin V (30 mg/kg/day 3 times a day) for 10 days were compared. In a randomized, open label, parallel group, multicenter study, 626 children (2-16 years old) with tonsillopharyngitis were enrolled; 537 were evaluable for efficacy. Follow-up evaluations were performed at 4-8 and 21-28 days after therapy. RESULTS: At enrollment, 26% of the Streptococcus pyogenes isolates were clarithromycin-nonsusceptible. All regimens had an apparently similar clinical efficacy. The long term S. pyogenes eradication rates were 102 of 123 (83%) with amoxicillin/clavulanate and 88 of 114 (77%) with penicillin V. In the 30- and 15-mg/kg/day clarithromycin groups, eradication occurred in 71 of 86 (83%) and 59 of 80 (74%) of the clarithromycin-susceptible isolates (P = 0.33), and in 4 of 28 (14%) and 5 of 26 (19%) of the clarithromycin-resistant isolates, respectively (clarithromycin-susceptible versus -resistant, P < 0.0001). Both clarithromycin dosages were well-tolerated. CONCLUSIONS: In group A streptococcal tonsillopharyngitis, 5 days of clarithromycin or amoxicillin/clavulanate treatment had clinical efficacy comparable with that of 10 days of penicillin V treatment; however, amoxicillin/clavulanate and penicillin V were bacteriologically more effective than clarithromycin because of its failure to eradicate the clarithromycin-resistant S. pyogenes isolates. The 5-day clarithromycin regimens are not recommended for treatment of streptococcal tonsillopharyngitis in areas where in vitro resistance of group A streptococci to clarithromycin is common.

Correlation of cerebrospinal fluid beta-glucuronidase activity with plasma methotrexate concentrations in leukemic children receiving high-dose methotrexate.

BACKGROUND: The activity of lysosomal enzymes is increased in body fluids during inflammation, in which cellular malfunction and cellular death occurs. Because chemotherapy also causes cell malfunction and death, for identifying a neurologic effect, we studied the activity of beta-glucuronidase in the cerebrospinal fluid (CSF) of leukemic children during treatment. PROCEDURE: The beta-glucuronidase activity in CSF was determined in 13 patients with B-precursor acute lymphoblastic leukemia (ALL) treated with the medium risk arm of ALL Berlin-Frankfurt-Munster (BFM) 95 protocol. Plasma methotrexate (MTX) levels were determined at 24 and 48 hr after the infusion of high-dose (5 g/m(2)/24 hr) MTX (MCA phase). RESULTS: The mean (SD) beta-glucuronidase activity prior to the onset of chemotherapy was 19.9 (5.6) nmoles/4-methylumbelliferone/ml/hr. No significant changes in activity were noted during the phases of the protocol except of the MCA3. The activity was 24.4 (6.8) on MCA2, 28.4 (9.3) on MCA3, and 24.1 (9.5) on MCA4. The beta-glucuronidase activity was positively correlated with the plasma MTX levels at both 24 hr (r = 0.483, P = 0.006) and 48 hr (r = 0.676, P < 0.0001). No progressive changes were noted during the different phases of the protocol. The greatest beta-glucuronidase activity was measured in two patients with neurotoxicity. CONCLUSIONS: The beta-glucuronidase activity is increased in the CSF of leukemic children receiving high-dose MTX and particularly in neurotoxicity. It is positively correlated with plasma MTX levels. No cumulative effect of the chemotherapy was observed. The increased beta-glucuronidase activity is most likely due to enzyme leakage through the cell membranes caused mainly by a toxic effect of MTX on the cells of the central nervous system (CNS).

Growth up to 2 years in relationship to maternal smoking during pregnancy.

Smoking during pregnancy causes intrauterine growth retardation, but the subsequent growth of these children is not well understood. Two hundred four newborns of mothers who smoked during pregnancy and 204 control neonates were studied. Children were re-examined at 1 and 2 years. Newborns of mothers who smoked 1-9 cigarettes/day had similar anthropometric parameters with the controls. Significant retardation in weight, length, and head circumference was present in the newborns whose mothers smoked > or = 10 cigarettes/day. At follow-up, in children of smoking mothers the retardation of weight improved, head circumference remained stable, and length retardation increased even in children whose mothers smoked < 10 cigarettes/day.

Antimicrobial susceptibility and macrolide resistance inducibility of Streptococcus pneumoniae carrying erm(A), erm(B), or mef(A).

Erythromycin-resistant Streptococcus pneumoniae isolates from young carriers were tested for their antimicrobial susceptibility; additionally, inducibility of macrolide and clindamycin resistance was investigated in pneumococci carrying erm(A), erm(B), or mef(A). Of 125 strains tested, 101 (81%) were multidrug resistant. Different levels of induction were observed with erythromycin, miocamycin, and clindamycin in erm(B) strains; however, in erm(A) strains only erythromycin was an inducer. Induction did not affect macrolide MICs in mef(A) strains.

Antimicrobial use and serotype distribution of nasopharyngeal Streptococcus pneumoniae isolates recovered from Greek children younger than 2 years old.

The serotype distribution of 781 nasopharyngeal pneumococcal isolates recovered from 2448 unselected children aged 2-23 months was studied. Only 3.9% of the children for whom cultures were performed attended day care centers. The proportions of pneumococcal isolates that belonged to serotypes related to the 7-, 9- and 11-valent conjugate pneumococcal vaccine were 65%, 66%, and 70%, respectively. The pneumococcal carriage rate among untreated children was 34%; the rates among children treated with antibiotics during the periods 1-30 or 31-60 days before the time of nasopharyngeal sampling were 25% and 36%, respectively. There was a significant positive association between antimicrobial use and carriage of antibiotic-resistant pneumococci, which belonged mainly to vaccine-related serotypes. The proportion of isolates that belonged to vaccine-related serotypes in untreated carriers was 72%; however, the proportions in carriers treated 1-30 days or 31-60 days before sampling were 66% and 56%, respectively. In the nasopharynx, antimicrobial use selects for antibiotic-resistant pneumococci, mainly of vaccine-related serotypes, whereas it may promote an increase in the frequency of colonization with nonvaccine serotypes.

Increased activity of lysosomal enzymes in the peritoneal fluid of bacterial peritonitis.

OBJECTIVE: The activity of lysosomal enzymes is increased in the cerebrospinal fluid of bacterial meningitis, suggesting that inflammation may cause leakage of lysosomal enzymes into the extracellular fluid. Our objective was to study the activity of 3 lysosomal enzymes in cell-free peritoneal fluid of patients with peritoneal inflammation. METHODS: The beta-galactosidase, beta-glucuronidase, and alpha-mannosidase activity (nmol 4-methylumbelliferone/mL/h); the total, polymorphonuclear, and mononuclear cell number; and chemical parameters were determined in the peritoneal fluid of 26 patients with culture-positive acute bacterial peritonitis, 13 patients (under antibiotic treatment) with culture-negative bacterial peritonitis, 6 patients with acute mesenteric lymphadenitis, and 26 control subjects who were operated on for surgical conditions without peritoneal inflammation. RESULTS: The median beta-galactosidase activity in the culture-positive bacterial peritonitis, mesenteric lymphadenitis, and controls was 175 (range: 63--2210), 50 (range: 37--56), and 16 (range: 8--32), respectively. The beta-glucuronidase was 488 (range: 79--998), 53 (range: 27--98), and 15 (range: 3--22), respectively. The alpha-mannosidase was 801 (range: 100-3172), 78 (range: 33--157), and 41 (range: 16--63), respectively. The differences of the enzyme activities among the groups of the subjects studied were significant, with the exception of the alpha-mannosidase activity between mesenteric lymphadenitis and controls. There was no significant correlation between the enzyme activities and the cytologic or chemical parameters studied. CONCLUSIONS: The elevation of the lysosomal enzymes' activity in the peritoneal fluid of patients with bacterial peritonitis seems to be a reliable index of peritoneal infection. Of the enzymes studied, the beta-glucuronidase and beta-galactosidase activities provide the best means for diagnosing bacterial inflammation of the peritoneal cavity.