Serum butyrylcholinesterase activities in patients with non-alcoholic fatty liver disease. Comparison with liver proteosynthetic function and liver fibrosis.

BACKGROUND: We aimed to determine how does butyrylcholinesterase (BChE) activity change in the serum of NAFLD patients, whether there was a relationship between BChE and the severity of NAFLD and whether BChE could be used to distinguish the patients with simple hepatic steatosis from the patients with non-alcoholic steatohepatitis. METHODS: The study group consisted of 64 patients with NAFLD. Patients were examined for fatty liver index and in the serum, we investigated BChE activities and the concentrations of prealbumin, cholesterol, HDL-cholesterol, triacylglycerols and hyaluronic acid (HA). We also used FIB-4 index to evaluate liver fibrosis. RESULTS: BChE activity was significantly increased in NAFLD patients compared to the controls (4711 U/l vs 4028 U/l). Patients with higher concentrations of serum triacylglycerols and non-HDL cholesterol had also significantly higher activities of BChE. The comparison of BChE activity and parameters of liver fibrosis (HA and FIB-4) showed a significant negative correlation between these parameters. Patients with an increased concentration of HA had significantly lower BChE than the controls (3111 U/l vs 4028 U/l). CONCLUSIONS: Our results showed increased BChE values in NAFLD patients. The comparison of changes in BChE activity with the changes in prealbumin levels and changes of both fibro markers showed that the examination of BChE activity could help to differentiate NAFLD patients with a simple hepatic steatosis from those with an advanced disease (Tab. 1, Fig. 7, Ref. 28). Text in PDF www.elis.sk Keywords: butyrylcholinesterase, non-alcoholic fatty liver disease, hyaluronic acid, FIB-4, fatty liver index.

Central systolic blood pressure (cSBP) to brachial systolic blood pressure (brachSBP) ratio reproducibility during antihypertensive therapy.

OBJECTIVES: Higher CSBP than brachial SBP in individual patient increases cardiovascular (CV) risk. For follow-up it is important to assess the reproducibility of such measurements. The aim of this study was to assess the reproducibility of these differences, expressed as a CSBP/BrachSBP ratios. SUBJECTS AND METHODS: Eighty-three patients on antihypertensive therapy were analysed for the reproducibility of such ratios after time interval of several month up to several years. For CSBP estimation, we used the Arteriograph (Tensiomed Ltd.), based on blood pressure measurements by cuff on oscillometric principle, using pulse wave analysis (PWA) for assessment of CSBP. RESULTS: The proportion of patients retained the same characteristics (either higher central or higher peripheral SBP) between the first and second measurement was 71.1 %. The association between 1st and 2nd measurement, was statistically significant, p < 0.001. CONCLUSION: In our study, a high proportion (60 %) of treated hypertensive patients had CSBP higher than brachial SBP, which may adversely influence their prognosis. This characteristic is highly reproducible. Taking into the account these differences may increase the exactness of CV risk estimation and may contribute to explanation of residual risk of individual patient (Tab. 3, Fig. 1, Ref. 28).

Can alpha-1-acid glycoprotein affect the outcome of treatment in a cancer patient?

Alpha-1-acid glycoprotein (AGP) is a glycoprotein found in the alpha-1 globulin fraction of human plasma proteins. AGP is an important representative of acute-phase proteins. Although numerous articles have been devoted to AGP, its exact biological function remains obscure. AGP levels increase with a number of diseases. One of them is a tumor disease. In our paper, we discuss the role of increased AGP levels in cancer patients. We deal with the role of AGP as a drug-binding protein and its effect on the efficacy of chemotherapy in oncological patients. Other problems that are discussed in our paper include the role of AGP as an immunomodulatory protein and its relationship to angiogenesis because angiogenesis plays an important role in the progression of cancer (Ref. 57). Keywords: alpha-1-acid glycoprotein, orosomucoid, cancer, disease marker, immunomodulatory protein,drug-binding protein.

Alpha-2-macroglobulin and hyaluronic acid as fibromarkers in patients with chronic hepatitis C.

BACKGROUND: Liver fibrosis is the final common pathway of chronic liver diseases of various etiology. From the practical standpoint, it would be ideal to have a noninvasive fibromarker. The aim of our study was to investigate the levels of alpha-2-macroglobulin, potential fibromarker, in correlation to histological staging and another potential fibromarker, hyaluronic acid, in patients with chronic hepatitis C. METHODS: Population groups in this study consisted of 51 healthy volunteers and 54 patients with chronic hepatitis C. Liver biopsies were obtained under ultrasound guidance. Alpha-2-macroglobulin was determined by electroimmunodiffusion and hyaluronic acid with enzyme-linked binding protein assay. RESULTS: Both potential fibromarkers, alpha-2-macroglobulin and hyaluronic acid, were increased in patients with chronic hepatitis C. The alpha-2-macroglobulin levels were not significantly increased in the groups F0-F1. In the groups F2-F4, alpha-2-macroglobulin levels were significantly higher than in the control group. The changes of hyaluronic acid were similar to changes of alpha-2-macroglobulin. Regression analysis showed a significant correlation between hyaluronic acid and alpha-2-macroglobulin levels. CONCLUSIONS: According to the results of our study, it can be concluded that alpha-2-macroglobulin and hyaluronic acid might be useful markers of liver fibrosis (Tab. 2, Ref. 15).

Paraoxonase activity in sera of patients with non-alcoholic fatty liver disease.

The results of our study showed significantly decreased levels of PON1 in patients with chronic liver diseases (controls 185 ± 14 U/l, NAFLD 160 ± 15 U/l, chronic hepatitis 99 ± 18 U/l, cirrhosis 52 ± 11 U/l). There were significant correlations of PON activities with standard liver function tests (Tab. 1, Ref. 5).

Peroxisomal enzymes in the liver of rats with experimental diabetes mellitus type 2.

Diabetes mellitus is relatively frequently associated with fatty liver disease. Increased oxidative stress probably plays an important role in the development of this hepatopathy. One of possible sources of reactive oxygen species in liver is peroxisomal system. There are several reports about changes of peroxisomal enzymes in experimental diabetes, mainly enzymes of fatty acid oxidation. The aim of our study was to investigate the possible changes of activities of liver peroxisomal enzymes, other than enzymes of beta-oxidation, in experimental diabetes mellitus type 2. Biochemical changes in liver of experimental animals suggest the presence of liver steatosis. The changes of serum parameters in experimental group are similar to changes in serum of patients with non-alcoholic fatty liver disease. We have shown that diabetes mellitus influenced peroxisomal enzymes by the different way. Despite of well-known induction of peroxisomal beta-oxidation, the activities of catalase, aminoacid oxidase and NADH-cytochrome b(5) reductase were not significantly changed and the activities of glycolate oxidase and NADP-isocitrate dehydrogenase were significantly decreased. The effect of diabetes on liver peroxisomes is probably due to the increased supply of fatty acids to liver in diabetic state and also due to increased oxidative stress. The changes of metabolic activity of peroxisomal compartment may participate on the development of diabetic hepatopathy.

The role of oxidative stress in anti-tumor necrosis factor antibody treatment in Crohn's disease.

Administration of anti-tumor necrosis factor alpha antibodies [anti-TNF]-alpha represents a therapeutic approach aimed to diminish the effects of tumor necrosis factor [TNF]- alpha in Crohn's disease [CD]. Blockade of its action should be related to various changes including those in immune and inflammatory response. There is a growing body of experimental data to suggest that the chronically inflamed intestine may be subjected to considerable oxidative stress. The aim of this study was to study the impact of therapy with anti-TNF [infliximab] on Crohn's disease activity index [CDAI], markers of inflammatory activity and oxidative stress. Fourteen patients with active CD received 5mg/kg of infliximab in a single intravenous infusion. CDAI, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], fibrinogen [FBG], alpha-1 antitrypsin [AAT], albumin [ALB], ceruloplasmin apoprotein [CP], ferroxidase activity of CP [FOACP], specific enzymatic activity of CP [SEACP] and conjugated dienes [DIE] were determined before treatment in month 0 [M 0], in 1st control period in month 1 [M 1] and in 2nd control period in month 5 [M 5] after treatment. In clinical activity a sustained significant decrease in CDAI was observed, with a significant drop in M 1, remaining in M 5. A significant decrease in ESR in M 1, accompanied by insignificantly reduced levels of CRP and FBG was present. During the further follow up in M 5 a slight increase of ESR, CRP and FBG was noticed. A significant decrease of AAT in M 1 was present; this decrease was followed by a significant increase in M 5. Ceruloplasmin apoprotein levels dropped in M 1, with further slight insignificant increase in M 5. A significant increase of ALB sustaining in M 5 was present. The levels of DIE slightly decreased in M 1 and significantly in M 5, together with the slight increase of the FOACP and SEACP in M 1 and significant increase in M 5. We conclude, that oxidative stress may be important in the pathogenesis and perpetuation of tissue injury in CD patients. The decreasing levels of DIE together with the increase of the FOCP and SEACP after infliximab treatment together with changes of markers of inflammatory activity, can participate in the improvement of clinical status of patients with CD.

Plasma copper and ceruloplasmin in patients with alcoholic liver steatosis.

BACKGROUND: In blood plasma, copper is transported in form of ceruloplasmin. Ceruloplasmin is not only a simple transport protein, it is a multifunctional protein with other various physiological functions. At least a part of these functions is connected with ceruloplasmin's enzymatic activity. AIM OF THE STUDY: The effect of alcoholic fatty liver on the metabolism of copper and ceruloplasmin was studied. MATERIAL AND METHODS: Patients suffering from alcoholic liver steatosis were enrolled in the study. The serum levels of copper, apoceruloplasmin and oxidase activity of ceruloplasmin were determined. RESULTS: The copper level in patients with liver steatosis was moderately decreased in comparison to healthy controls. The difference in apoceruloplasmin levels between patients with liver steatosis and healthy controls was not significant, but the specific activity of ceruloplasmin in patients was significantly decreased in comparison to controls (0.59 vs. 0.82, p<0.001). The decreased specific activity of ceruloplasmin in spite of normal levels of apoceruloplasmin in patients with alcoholic liver steatosis suggested some problems in copper metabolism in these patients. CONCLUSIONS: The results of our study showed disturbances in copper and ceruloplasmin metabolism in patients with alcoholic liver steatosis. We can conclude that the determination of blood plasma ceruloplasmin level on the basis of its enzymatic activity is better than a simple determination of apoceruloplasmin (Tab. 2, Ref. 14).

Serum magnesium levels in patients with alcoholic and non-alcoholic fatty liver.

INTRODUCTION: Magnesium is currently a subject of major interest in biology and medicine. Magnesium is intimately involved in over 300 enzymatic reactions. particularly in processes involving the formation and utilization of ATP. It is known that alcoholism is connected with hypomagnesemia. There are also several studies describing the disorders of magnesium balance in patients with liver diseases. THE AIM OF STUDY: was to investigate the serum magnesium levels in patients with liver steatosis. We compared the magnesium levels in patients with non-alcoholic and alcoholic fatty liver to estimate if alcoholism is the only cause of magnesium disorders or if also liver function disorders play any role in the development of magnesium dysbalance in patients with liver steatosis. PATIENTS AND METHODS: The studied group consisted of 44 patients with hepatic steatosis (25 non-alcoholic and 19 alcoholic). The control group consisted of 57 healthy subjects. Magnesium levels were assayed by atomic absorption spectrometry. RESULTS: Serum magnesium levels were significantly decreased in patients with alcoholic (0.67 +/- 0.10 vs 1.02 +/- 0.11 mmol.l(-1)) and also in patients with non-alcoholic liver steatosis (0.65 +/- 0.14 vs 1.02 +/- 0.11 mmol.l(-1)). There were also moderately increased activities of aminotransferases and gamma-glutamyltransferase. Plasma triacylglycerols were increased in both studied groups. Albumin and prealbumin levels were not changed in comparison to the control group. There was a slight increase in plasma levels of immunoglobulin A and immunoglobulin G. CONCLUSIONS: The results of our study showed hypomagnesemia in both studied groups. Decreased magnesium levels found also in patients with non-alcoholic fatty liver suggest that alcoholism cannot be the only cause of hypomagnesemia in patients with fatty liver. Hypomagnesemia is not only a laboratory symptom of fatty liver but due to its connection with increased oxidative stress it might be a risk factor in the progression of fatty liver to steatohepatitis (Tab. 3, Ref: 19).

Serum cholinesterase activity and proteosynthetic function of liver in patients with diabetes mellitus.

INTRODUCTION: Diabetes mellitus is associated with a lot of changes in intermediary metabolism and several authors reported on higher frequency of liver diseases in patients with diabetes. AIM OF THE STUDY: Was to establish the changes of blood serum cholinesterase, prealbumin and albumin, parameters which are accepted as an index of liver proteosynthetic function, in patients with diabetes mellitus. PATIENTS AND METHODS: The study group consisted of 207 patients with diabetes mellitus (83 patients with type I and 124 patients with type II diabetes mellitus). Control group consisted of 179 healthy subjects. The activity of cholinesterase was assayed by the kinetic method, concentrations of prealbumin and albumin were determined immunochemically. RESULTS: Activity of serum cholinesterase was significantly higher in group of patients with diabetes mellitus than in control group (65.05 vs 73.33 microkat/l). The concentration of prealbumin was lower in blood serum of patients with diabetes than in controls (308.10 vs 285.85 mg/l). Serum levels of albumin were not different in both studied groups. After dividing of patients according to the type of diabetes, 80 % of abnormal values of cholinesterase and prealbumin were present in patients with type II diabetes. CONCLUSIONS: The results of our study showed abnormal values of determined liver tests approximately in 22 % of patients with diabetes mellitus. The character of laboratory changes--increased activity of cholinesterase, decreased concentration of prealbumin and normal levels of albumin, suggests development of liver steatosis in these patients. The most of pathological findings were in patients with diabetes type II (Tab. 3, Ref. 20).

Macroenzymes and their clinical significance.

Macroenzymes are serum enzymes that have higher molecular mass than the corresponding enzyme normally found in serum under physiologic or pathophysiologic conditions. They are formed either by self-polymerization or by association with other serum components. Because they are cleared much more slowly than the usual enzymes, macroenzymes accumulate in the plasma and thus cause an increase in the activity of the corresponding enzyme in blood samples. Biochemically macroenzymes can be classified into two groups (macroenzymes type 1 and type 2). The importance of macroenzymes in this time is mainly in the possibility of misinterpretation of blood plasma enzyme activities. Macroenzymes are interesting also because of their association with several diseases and are being investigated as possible diagnostic markers. (Tab. 2, Ref. 20.).

Diagnostic significance of urinary enzymes in nephrology.

The study of urinary excretion of some enzymes is a sensitive test for the detection of early stages of renal disease. The first part of this review describe the sources of urinary enzymes and discuss the preanalytical and analytical problems with estimation of enzymatic activities in the urine, mainly the problem of quantitative expression of excretion of urinary enzymes. After the description of main characteristics of diagnostically most important enzymes excreted in the urine the diagnostic validity of the measurement of urinary enzyme activities in patients with inflammatory renal diseases, kidney damage due to nephrotoxic substances, diabetic nephropathy and in early detection of the complications after kidney transplantation is discussed. (Ref. 25.).

Changes in acute phase proteins after anti-tumor necrosis factor antibody (infliximab) treatment in patients with Crohn's disease.

Acute phase proteins and markers of proteosynthetic activity reflect the clinical activity in Crohn's disease (CD). The impact of anti-tumor necrosis factor antibody (anti-TNF) therapy on serum levels of acute phase proteins and proteosynthetic markers was studied. Fourteen patients with active CD were treated with 5 mg per kg of anti-TNF in intravenous infusion. Clinical activity (assessed by Crohn's disease activity index - CDAI), alpha-1-acid glycoprotein, haptoglobin, cholinesterase and prealbumin were assessed before and in months 1 and 5 after treatment. A sustained decrease in CDAI was observed. This was accompanied by a significant decrease in alpha-1-acid glycoprotein and haptoglobin in month 1 (p=0.005 and p=0.01, respectively) while in month 5 the levels of both acute phase proteins rose significantly (p=0.003 for alpha-1-acid glycoprotein and p=0.02 for haptoglobin). Cholinesterase and prealbumin significantly increased in month 1 after the treatment (p=0.02 and p=0.0006, respectively), the increase was sustained in cholinesterase while prealbumin levels diminished in month 5. We conclude that the clinical improvement after anti-TNF therapy for CD is accompanied by changes of acute phase proteins and proteosynthetic markers. The assessment of these laboratory markers may be useful in the management of CD patients treated with anti-TNF.

Different patterns of serum interleukin 10 response to treatment with anti-tumor necrosis factor alpha antibody (infliximab) in Crohn's disease.

Administration of anti-tumor necrosis factor antibody (anti-TNF, infliximab) down-regulates T helper 1 (Th 1) cytokines production in intestinal mucosa of patients with Crohn's disease (CD). Interleukin 10 (IL-10) is thought to be involved in CD pathogenesis through regulation of the Th 1 response. The aim of this study was to determine the IL-10 response in CD patients treated with anti-TNF. Fourteen patients with active CD received 5 mg/kg of infliximab; clinical activity assessed by Crohn's Disease Activity Index (CDAI), alpha1-acid glycoprotein and serum IL-10 were determined before and after treatment, in month 0, 1 and 5. In the group with a good clinical response, IL-10 levels diminished significantly in month 1 (p<0.05) and remained decreased in month 5. The group with a lower response showed a significant increase in IL-10 levels in month 1 (p<0.05). alpha1-acid glycoprotein levels obtained before treatment were significantly elevated in the group with a good clinical response (p<0.05) and a significant decrease in month 1 was observed in this group (p<0.05). These observations suggest that a pattern of IL-10 response might be related to the clinical response to anti-TNF treatment in CD.

Plasma lipid parameters in patients with alcoholic fatty liver after treatment with essential phospholipids.

BACKGROUND: Fatty liver is the earliest and most common response to alcohol. The accumulation of lipid particles in hepatocytes alters the ultrastructure of cellular membranes. The purpose of our study was to investigate the effect of the administration of essential phospholipids on plasma lipid parameters in patients with alcoholic fatty liver. METHODS: Our open clinical trial was performed in patients suffering from alcoholic fatty liver. The investigated group consisted of 29 patients. Two capsules of Essentiale forte were administered 3 times daily for 3 months. Individual biochemical parameters were examined each month. Values of total cholesterol, HDL- and LDL-cholesterol, triacylglycerols, apoprotein A and B were determined. RESULTS: The therapy with essential phospholipids had positive effects on the parameters of hepatocyte integrity. The levels of total cholesterol, triacylglycerols and apoprotein B were significantly higher in patients with fatty liver than in the controls. The concentration of HDL-cholesterol was also higher before the therapy than in the control group. There was no difference in levels of apoprotein A and LDL-cholesterol between the patients and the controls. There was no significant therapeutic effect on plasma lipid parameters in the group of patients with fatty liver. CONCLUSIONS: The effects of treatment of alcoholic fatty liver with essential phospholipids were studied. The therapy had positive effects on the parameters of hepatocyte integrity. There was no significant therapeutic effect of the therapy on plasma lipid parameters. (Tab. 2, Fig. 1, Ref. 20).

[Monoethylglycinexylidide--a metabolite of lidocaine--as an index of liver function in chronic hepatic parenchymal diseases]. / Monoetylglycínxylidid--metabolit lidokaínu--ako index funkcie pecene pri chronických ochoreniach pecenového parenchýmu.

The changes of biotransformation enzyme system (b.e.s.) activity and capacity in liver diseases significantly influence the metabolism of various xenobiotics. Lidocaine is metabolised through oxidative N-deethylation by b.e.s. resulting in the production of monoethylglycinexylide (MEGX). The aim of this study was the determination of serum MEGX concentration as a model substance for indirect evaluation of liver b.e.s. function in patients with liver steatofibrosis and cirrhosis and the assessment of the possibilities to use it as a quantitave test of liver functional state. The study group consisted of 53 patients, 36 of them with liver disease of different etiology (postviral, ethyltoxic, cryptogenic, liver cirrhosis on the basis of autoimmune hepatitis, liver cirrhosis induced by primary sclerosing cholangitis, primary biliary cirrhosis in the stage of cirrhosis, Wilson's disease in the stage of cirrhosis), 7 patients with liver steatofibrosis and 10 control persons. After intravenous administration of lidocaine (1 mg/kg of body weight), concentration of MEGX was assessed by fluorescence polarization immunoassay (FPIA) using Tdx system in venous blood. The concentration was assesed prior to administration of lidocaine and 15 and 30 minutes after. In the group of liver steatofibrosis the concentrations in the 15th minute after administration were lower comparing to controls, in the 30th minute the difference was less significant. The values of MEGX in cirrhosis group were significantly decreased 15 and 30 minutes after lidocaine administration in comparison with control group. The cirrhosis group was divided into two subgroups: compensated (Ci c) and decompensated (Ci d) and independently of this division into three parts according to score system of Child-Pugh classification (Ci A, Ci B, Ci C). The concentrations 15 and 30 minutes after lidocaine administration in patients with Ci c and Ci d were significantly different, similarly there were statistically significant differences among Ci A, Ci B and Ci C. Statistically significant differences were also between the group of steatofibrosis and whole group of cirrhosis. The concentration of MEGX 15 and 30 minutes after lidocaine administration correlated significantly with the values of albumin, prothrombin time, cholinesterase, Child-Plugh score and bilirubin. MEGX test represents an appropriate and rapid method for the determination of functional liver capacity in patients with liver cirrhosis and liver steatofibrosis, not yet used in Slovak republic. It is a noninvasive test, low time consuming, and when repeated it may provide prognostic information about further development of the disease. MEGX test is an appropriate index of liver function and may contribute to early treatment of chronic liver diseases. (Tab. 9, Fig. 10, Ref. 47.)

[Alpha 2-macroglobulin in the blood of patients with diabetes mellitus]. / Alfa2-makroglobulín v sére pacientov s diabetes mellitus.

Human alpha 2-macroglobulin, a plasma glycoprotein, traps and inhibits proteolytic enzymes which participate in inflammation and homeostasis. There is no doubt about the significant role of alpha 2-macroglobulin in immunoregulatory processes. The aim of the present study was to investigate the levels of alpha 2-macroglobulin in patients with diabetes mellitus and to investigate whether an association exists between alpha 2-macroglobulin level and the type of diabetes (type I or type II) or alpha 2-macroglobulin and diabetic complications. The patient population consisted of 48 patients with diabetes mellitus type I (average age 36.5 years) and 50 patients with diabetes type II (average age 55.3 years). Patients were divided into three groups according to the presence of complications (group I--patients without complications, group II--patients with diabetic retinopathy, group III--patients with several complications). alpha 2-macroglobulin was determined by electroimmunoassay according to Laurell. alpha 2-macroglobulin levels were significantly raised in group of diabetics type I (3190 mg/l vs. 1880 mg/l). In the group of diabetics type II alpha 2-macroglobulin levels are within the normal range (2030 mg/l vs. 1880 mg/l). After dividing of diabetics according to the presence of diabetic complications, alpha 2-macroglobulin levels in patients with diabetic complications were significantly higher than in the group of diabetics without complications (3180 mg/l vs. 2040 mg/l). The possible explanations of elevated alpha 2-macroglobulin levels in diabetics and possible participation of elevated a2-macroglobulin in the development of diabetic angiopathy are discussed. (Fig. 2, Ref. 14.)

[Ischemia-reperfusion liver injury]. / Ischemicko-reperfúzne poskodenie pecene.

Reperfusion injury represents an accentuation of the hypoxic injury caused by the restoration of oxygenated blood flow to the liver after a period of anoxia or hypoxia. Reoxygenation injury may occur after any ischaemic episode, but the most dramatic form in clinical hepatology occurs during orthotopic liver transplantation and after unclamping of the portal vessels during liver resection. Reactive oxygen radicals appear to play an important role in the development of such injury, as has been demonstrated by direct measurements of their release and by the protective effects of antioxidants. The relative contribution of the various liver cell types to the release of reactive oxygen species and the differences in sensitivity to ischemic and reperfusion injury between liver cell subtypes are discussed. (Fig. 3, Ref. 31.)

[Hemodynamic changes in liver cirrhosis]. / Hemodynamické zmeny pri cirhóze pecene.

Portal hypertension represents a key moment in the dynamic course of chronic liver disease. It is defined as permanent increase of portal pressure above 12 mmHg. The authors discuss the pathological-anatomical consequences of intrahepatic portal hypertension and subsequent haemodynamic changes which may be helpful in explanation of liver parenchyma functional disturbances. Modern imaging techniques are helpful in detection of portal hypertension consequences such as portal-caval anastomoses, arterial-portal anastomoses, predominance of arterial supply and other morphological abnormalities. Hyperkinetic circulation, reduced portal flow, changes of gastric and lienal circulation and other humoral and neural factors represent the introductory pathophysiologic mechanisms of cirrhotic clinical manifestation. We try to evaluate these pathological changes with the help of modern biochemical, imaging and endoscopic investigations in order to assess the degree of parenchymatous damage, the degree of portal hypertension, with certain probability the course and the prognosis, the risks of haemorrhage from esophageal varices, e.t.c. The understanding of clinical manifestations pathomechanisms in cirrhosis is necessary for further development of new investigation methods and improvement of existing imaging and endoscopic techniques. (Fig. 6, Ref. 33.)

[Cerebrospinal fluid proteins in the diagnosis of disorders of the blood-cerebrospinal fluid barrier in central nervous system diseases]. / Bielkoviny likvoru v diagnostike porúch hematolikvorovej bariéry pri niektorých ochoreniach CNS.

BACKGROUND: Many neurological diseases are connected with the dysfunction of blood-CSF barrier. The quantitative determination of CSF proteins has already been used in the diagnosis of barrier impairments and inflammatory diseases of the central nervous system. PATIENTS: Serum and CSF, totaling 264 samples, were obtained from 15 controls and 117 patients with various diseases of the nervous system. Laurell's electroimmunoassay was used for estimation of albumin and IgG levels in serum and CSF. CSF-protein profile was evaluated according to Reiber's graph for the evaluation of the CSF-protein profile. RESULTS: The graph for the protein profile can be divided into 5 functionally different parts (1--normal range, 2, 3, 4--different types of barrier dysfunctions and 5--local humoral response in CNS without any barrier impairment). There was a good correlation of CSF-protein profiles and neurological diseases in our group of patients. CONCLUSIONS: According to our results, Reiber's graph was helpful for the diagnosis of blood-CSF-barrier dysfunctions. The graph has the following advantages: a) possibility of simultaneous assessment of the functional state of blood-CSF-barrier and the inflammatory response of the CNS, b)sensitivity for the determination of pathological local IgG-production in CNS and c) minimal number of protein assays necessary.