Serum creatine phosphokinase in chronic alcoholism

Troponin T concentrations 72 hours after myocardial infarction as a serological estimate of infarct size

BACKGROUND

After acute myocardial infarction, the structural protein T is released considerably longer than cytosolic creatine kinase (CK), CK MB isoenzyme (CK-MB), or lactate dehydrogenase (LDH) and late troponin T release (> 48 hours after onset of chest pain) appears to be less affected by early coronary reperfusion.

OBJECTIVE

To investigate the precision of a single measurement of circulating troponin T concentrations 72 hours after onset of chest pain compared with standard scintigraphic and enzymatic estimates of myocardial infarct size.

METHODS

Quantitative single photon emission computed tomography thallium-201 scintigraphy at rest was performed in 37 patients 2-3 weeks after myocardial infarction (group 1: 14 patients without early coronary reperfusion; group 2: 23 patients with early reperfusion achieved by thrombolytic therapy, by percutaneous transluminal coronary angioplasty, or by both).

RESULTS

In both groups, the number of myocardial segments with abnormal thallium-201 uptake indicating the individual extent of irreversible myocardial damage correlated significantly with the troponin T concentrations 72 hours after infarction as well as with peak concentrations of CK, CK-MB, and LDH.

CONCLUSION

The data show that a single measurement of circulating troponin T 72 hours after onset of chest pain--independent of reperfusion--is superior for the estimation of myocardial infarct size to measurement of peak CK, CK-MB, or LDH, which require serial determinations and depend on coronary reperfusion.

Recovery of muscular energy status in chronic alcoholics after 2 weeks of abstinence

Repeated and excessive consumption of alcohol leads to pathophysiological disorders in skeletal muscles. A successful management of this syndrome requires a strict abstinence and a nutritionally adequate diet. We propose here a simple and noninvasive investigation using 31P magnetic resonance spectroscopy (MRS) to monitor the recovery of the basal energy status of eminence thenar muscles from documented chronic alcoholic patients during a controlled 15-day period of abstinence. Cessation of alcohol abuse induced a significant recovery of the PCr/(PCr+P(i)) ratio otherwise depressed before the abstinence. On the contrary, the relative level of free inorganic phosphate decreased, whereas intracellular pH was not affected. These results demonstrate (a) the rapid improvement of basal muscular energy metabolism during abstinence for patients with a chronic and heavy alcohol consumption, and (b) the feasibility of a follow-up of this recovery by serial examinations using 31P MRS.

Identification of human ventricular myosin heavy chain fragments with monoclonal antibody 2F4 in human sera after myocardial necrosis

An ELISA assay with monoclonal antibody (Mab 2F4) raised against human ventricular myosin heavy chains was developed and used to investigate human sera after myocardial infarction. The monoclonal antibody 2F4 was selected for its high affinity to soluble fragments of myosin heavy chains (subfragment-1) and for its appropriate tissue specificity. By including Mab 2F4 in a simple and rapid dot immunobinding assay sera from patients with acute chest pain and of persons without a history of heart disease were tested. Myosin was detected only in the sera of the patients with myocardial necrosis, confirmed by electrocardiographic data. Negative reactions in all control cases were found. The serum myosin fragments reactive with Mab 2F4 were characterized by immunoblot experiments and protein bands in the region about 43 kDa were found. It was concluded that the myocardial infarction can be demonstrated by detection of cardiac myosin heavy chain fragments in the patients' sera.

A study of three groups of urban men from the general population with different alcohol habits and drug use and their serum levels of liver-related enzymes and haematological variables

A sample of 200 men from the general population was investigated concerning alcohol consumption in relation to laboratory findings. The relation between symptoms of alcoholism (subjective relative loss of control over drinking, blackouts and morning drinks) and the alcohol consumption was also studied. The subjects were divided into three groups: (1) a group with low alcohol consumption without symptoms of alcoholism, (II) an intermediate group with low, moderate or high alcohol consumption and one or more alcohol symptoms and (III) a heavy-drinking group with two or more symptoms. The heavy-drinking group had significantly higher serum bilirubin, aspartate amino-transferase (ASAT), creatine kinase and lactate dehydrogenase values than the other two groups. Gamma-glutamyl transpeptidase (GGT) showed no relation to alcohol consumption. The use of liver-metabolized drugs was investigated. Ten of the 53 heavy drinkers were taking such drugs, because of illness, and the other 43 were not. The heavy drinkers taking drugs showed pathological laboratory values throughout, in contrast to the subjects of the other subgroups. Serum GGT was high in the drug-using groups but was not significantly elevated in the groups taking only alcohol and no drugs.

Experimental acute alcoholic myopathy--a histochemical study

The histochemical features of muscle injury and repair were examined in an experimental form of acute alcoholic myopathy in the rat. Typical features of rhabdomyolysis were found, which were indicated by scattered muscle fiber necrosis followed by sequential phases of fiber degeneration, phagocytosis, and regeneration. Nests of small, regenerated, or split fibers remained 2 months after the episode of acute myopathy. Vulnerability of type 1 fibers to alcohol-induced muscle injury was evident by selective involvement of muscles with type 1 fiber predominance and by the fact that regenerating fibers were virtually exclusively type 1. The histologic features of myopathy in this model closely parallel those in human acute alcoholic myopathy.

The acute effects of alcohol on plasma creatine kinase (CK) activity in the rat

The acute effect of a single intraperitoneal dose of alcohol (2 g kg-1 body weight) was studied in normally fed rats anaesthetised with sodium pentabarbitone . Rapidly achieved high blood alcohol levels were accompanied by an equally rapid but transient 4-fold increase in the total creatine kinase (CK) activity in the arterial plasma of animals of both sexes. Resting CK activity was significantly lower in female animals and although the magnitude of the alcohol-induced CK increase was the same in both sexes, the duration of the response was shorter in female rats. Electrophoresis showed the skeletal muscle-associated MM isoenzyme of CK to be predominant in resting plasma and also to account solely for the alcohol-induced increase in total CK activity. These results indicate that alcohol has a direct toxic action on skeletal muscle, causing transient loss of cellular integrity which permits the leakage of normally intracellular enzymes into the circulation.

Skeletal muscle disease in alcoholism

Acute alcoholic myopathy, a syndrome of sudden muscle necrosis, occurs as a result of binge drinking, whereas chronic alcoholic myopathy is a more indolently evolving syndrome of proximal weakness and muscle atrophy that accompanies prolonged alcohol abuse. The characteristic features and management of these disorders are highlighted.

Clinical assessment of serum myosin light chains in the diagnosis of acute myocardial infarction

Serum myosin light chain levels were quantitated with radioimmunoassay in patients admitted to the coronary care unit. In this study there were 29 patients with acute myocardial infarction, 84 with chest pain but without myocardial infarction and 5 with chest pain but with preexisting electrocardiographic abnormalities that could not be interpreted using standard criteria. Values for human cardiac light chains in normal human sera averaged less than 2 ng/ml, and values in the 84 patients without myocardial infarction fell into this category. The 29 patients with myocardial infarction all had elevated light chain concentrations (average 10.9 +/- 1.3 ng/ml; range 4 to 35 ng/ml). In this study there were no false positive or false negative results. Use of this assay has permitted separation of patients with and without myocardial infarction. The assay for cardiac light chains provides a biochemical marker of high sensitivity and specificity that is useful in the diagnosis of infarction.

Serum creatine phosphokinase activity in newly admitted chronic alcoholics

Serum CPK activity was measured for a total of 33 cases of chronic alcoholics who were admitted to the mental hospital from April, 1975 to January, 1976. The result was examined in relation to the manifestation of the psychotic symptoms in the patients: (1) Twenty six (78.8%) out of 33 cases showed increased serum CPK activity within 48 hours of admission. (2) In most cases that showed abnormal CPK activity, CPK value was the highest at the moment of admission, and then began to fall rapidly, and after one or two weeks settled to the normal CPK level. (3) There was a positive correlation between abnormal CPK activity and the manifestation of the psychotic symptoms in the month before and after entering hospital. In this cases of those having more than 101 IU in serum CPK value, the rate of presenting the psychotic symptoms in a month before or after admission was 90.5% and 71.4%, respectively. The author has given here a report on the above-mentioned results and made some considerations as to pathogenesis of abnormal CPK activity in chronic alcoholism.

Hypokalemic myopathy due to chronic alcoholism

A patient with hypokalemic myopathy occurring in the context of chronic alcoholism was reported. A 56-year-old male patient, heavy drinker for 20 years, complained of marked weakness and acutely developing pains in his limbs. The principal clinical findings were weakness and tenderness of the proximal limbs and girdle muscle. He was unable to lift his head or any extremities from the bed. Deep tendon reflexes were diminished, but not absent. There was no sensory disturbance except for muscle tenderness. These clinical manifestations disappeared gradually by abstinence from drinking, and potassium administration therapy, and the patient recovered completely on the 26th day after onset. On the day after admission (8th day), serum potassium value was 2.2 mEq/L, and serum CPK activity was 4270 IU. The ECG pattern was consistent with a diagnosis of low potassium content in serum, and the EMG pattern was consistent with a diagnosis of myopathy. These electrophysiological findings had a tendency to recover from this pattern to normal range correspondingly with clinical improvement. The repeated muscle biopsies showed that vacuolation, hyaline degeneration and significant phagocyte infiltration were observed in the muscle on the 9th day after the onset of muscle weakness, and that these pathological findings disappeared almost completely three weeks later. The frequently repeated examinations of potassium content and CPK activity in sera showed that there was a close correlation between these biochemical abnormalities and clinical improvement. The pathogenesis of alcoholic myopathy and significance of CPK abnormality in chronic alcoholism were discussed.