Hepatic portal venous gas due to polystyrene sulfonate-induced enteritis

A 78-year-old man with acute right lower abdominal pain and nausea was referred to our hospital. Computed tomography (CT) demonstrated hepatic portal venous gas and a thickened wall of the terminal ileum, and colonoscopy demonstrated ulcers and erosions of the ileocecal region. Histological examination of biopsy samples revealed basophilic crystals consistent with the component of calcium polystyrene sulfonate (CPS). This patient started taking CPS 2 months prior for chronic hyperkalemia. The symptoms resolved soon after ceasing CPS, and subsequent imaging studies confirmed the disappearance of the portal venous gas and ileocolitis.

C3435T polymorphism of the MDR1 gene is not associated with blood levels of hypothalamus-pituitary-adrenal axis hormones in healthy male subjects

In vitro studies have shown that multidrug resistance protein 1 (MDR1) has an affinity for cortisol; however, in vivo association studies on the relationship between MDR1 gene polymorphisms and blood cortisol levels have produced inconsistent results. Therefore, we examined the effects of the C3435T polymorphism of the MDR1 gene on blood levels of hypothalamus-pituitary-adrenal (HPA) axis hormones such as cortisol and adrenocorticotropic hormone (ACTH) in healthy subjects. The subjects comprised 30 healthy Japanese males. Ten subjects were recruited for each of the C3435T MDR1 genotypes: C/C, C/T, and T/T. Blood samples were taken at 6:00 pm on two occasions with an interval of 2 weeks. Blood levels of cortisol and ACTH were determined by an electrochemiluminescence immunoassay. There were no significant differences in the blood levels of the HPA axis hormones among the MDR1 genotypes. The present study suggests that the C3435T MDR1 polymorphism does not affect blood levels of HPA axis hormones in healthy Japanese males.

[Approach to examining hypercalcemia in the clinical laboratory]

The investigation of hypercalcemia is carried out routinely in our laboratory to detect primary hyperparathyroidism (PHPT). In a retrospective study, seven patients with PHPT and fifty-one patients with non-parathyroid hypercalcemia (NPHC) were chosen in a particular year. To obtain a screening index for PHPT, discriminant analysis, using a stepwise variable select method, was applied to eight biochemical parameters in these patients. A discriminant function (F1) was derived from three biochemical parameters and then another discriminant function (F2) was also derived from three biochemical parameters in the F1-positive patients. In combination of these two functions (F1 and F2), the final sensitivity was 100% and specificity was 98% in diagnosing PHPT. This screening method was tested prospectively in fifty-six consecutive specimens of hypercalcemia (PHPT 4, NPHC 52) over the following six months. The result was also satisfactory with a sensitivity of 100% and specificity of 98%. It was proven that our screening method using discriminant functions (F1 and F2) was very useful for diagnosing patients with PHPT from the survey of hypercalcemia. Among these patients with hypercalcemia, the high ratio (54%) of those with malignancy was remarkable. This interesting result required us to investigate potential hypercalcemia, since the serum calcium concentration was masked by a lower level of serum albumin, which was frequently seen in these malignant patients. As the next step, we tried to adjust the serum calcium concentration based on the serum albumin concentration. A formula for adjusting the calcium concentration was derived from a linear structural relationship between calcium and albumin in 6,821 specimens within a +/- 2.5 second principal component score in 7,021 consecutive specimens in whom both calcium and albumin were measured in a particular year; Adjusted Calcium = Calcium - Albumin + 4. After adjustment using this formula, the calcium concentrations were elevated above the upper limit of the reference interval in 320 of 5,203 specimens (6%) within the reference interval and elevated to the reference interval in 1,390 of 1,579 specimens (88%) below a lower limit of reference interval. A prospective study was performed over the following three months. Fifty patients with hypercalcemia were screened using this formula. It was a surprise that thirty-one patients (62%) showed abnormal values after adjustment. These results suggest that calcium adjustment is necessary for interpreting the calcium concentration of patients with a reduced albumin concentration such as patients with malignancy.

[Aging effects on blood biochemical parameters in aged women: a longitudinal study using principal component analysis]

In order to examine the aging effects on blood biochemical parameters, 25 aged females (70 +/- 8 years old at the beginning of this investigation) were studied prospectively for 7 years. Biochemical parameters were measured in 1982, 1985, 1987, and 1989. Component scores were obtained by principal component analysis applied to all of these 100 data. The data of 13 biochemical parameters and 4 component scores were analyzed for aging, cohort, and time effects by utilizing 3 types of approach i.e., longitudinal, cross-sectional, and time-series. Positive aging effects were observed on blood urea nitrogen and 4th component score. Fourth component score had positive relations to blood urea nitrogen and total bilirubin, and a negative relation to total protein. This 4th component score increased with longitudinal age changes among all cohorts divided by decade, and it increased markedly over 70 years old. These results suggest that the aging effects on biochemical parameters are related with both the decrease in glomerular and hepatocellular functions and the increase in breakdown of tissue protein.

[A screening index for primary hyperparathyroidism using discriminant functions]

In order to obtain a useful screening index for primary hyperparathyroidism (PHPT), seven patients with PHPT and fifty-one patients with nonparathyroid hypercalcemia (NPHC) were studied retrospectively. Serum calcium, inorganic phosphate (IP), alkaline phosphatase, albumin (Alb), chloride (Cl), total protein, urea nitrogen and creatinine (Cre) were analyzed at the same time. Discriminant analysis using a stepwise variable select method was applied to these patients. A discriminant function (F 1) was derived from three laboratory tests; F 1 = -0.660 x [IP] + 0.142 x [Cl] + 0.564 x [Alb] - 14.4 (PHPT: F 1 greater than 0.641). F 1 had sensitivity of 100% and specificity of 72.5% (14 false positives) in diagnosing PHPT. Next, another discriminant function (F 2) was derived from PHPT and the false positive patients; F 2 = -2.61 x [IP] + 0.286 x [Cl] - 4.24 x [Cre] - 19.3 (PHPT: F 2 greater than 0.412). When F 2 was applied to positive patients by F 1, final sensitivity was 100% and specificity was 98%. This screening method was tested prospectively in fifty-six consecutive samples of hypercalcemia (PHPT 4, NPHC 52), resulting in sensitivity of 100% and specificity of 98%. It was proved that our screening method using two step discriminant functions was very useful to diagnose PHPT.