Continuous 48-h treatment with C1-inhibitor provides safe and effective inhibition of complement activation after reperfused acute myocardial infarction and may reduce myocardial injury.

We determined serum ferritin, C-reactive protein (CRP), fibrinogen, and the erythrocyte sedimentation rate (ESR) in 73 patients with anemia of chronic disease. Nomograms of CRP, ESR, or fibrinogen vs ferritin concentrations were constructed and used to estimate the iron store in bone marrow. Iron stores estimated from the nomograms were compared with the results of staining cytological bone marrow smears for iron, the reference method for evaluating iron in bone marrow. In contrast to the results of Witte et al. (Clin Chem 1985;31:1011; Am J Clin Pathol 1986;85:202-6 and 1988;90:85-7), we observed that nomograms of CRP, fibrinogen, or ESR (i.e., acute-phase reactants not influenced by changes in iron metabolism) vs ferritin are not suitable to correct for the acute-phase component of changes in ferritin concentrations. For ferritin concentrations less than 70 micrograms/L, we found that iron deficiency, as judged from bone marrow iron stain, apparently was always present.

The clinical usefulness of laboratory tests was examined in 258 patients admitted to the emergency room with the general practitioner's tentative diagnosis, acute appendicitis. Acute appendectomy was perfonned on 91 patients. Histological examination of the appendix confirmed the diagnosis in 69 cases (acute appendicitis 20, phlegmonous appendicitis 36, Perforation 13). Seven patients with appendicular infiltrate were not subjected to Operation but the diagnosis was clear from clinical examination. On close examination/ Operation by the surgical team, 96 admitted patients were excluded from the primary diagnosis, acute appendicitis, and served äs a cpntrol group.Receiver Operating Characteristic curves (ROC-curves) showed that the sensitivity and specificity and hence diagnostic efficiency for total white blood cell count, number of segmented leukocytes and C-reactive protein concentration for the detection of acute appendicitis were higher than for erythrocyte Sedimentation rate, oc r antiproteinase concentration and body temperature. We observed that when all three parameters, C-reactive protein, white blood cell count and segmented leukocytes, are within the normal ränge the diagnosis, acute appendicitis is highly unlikely.The diagnostic value of the different laboratory parameters appears, moreover, to be highly dependent on the degree of inflammation/pefforation and the development of appendicular Infiltration. However, diagnostic efficiency can be irnproved, and unnecessary surgery prevented, by perfofmance of an appropriately selected combination of laböfatory tests combined with evalUation of clinical Symptoms.

B BA AL L f fl lu ui id d L LD DH H a ac ct ti iv vi it ty y a an nd d L LD DH H i is so oe en nz zy ym me e p pa at tt te er rn n i in n l li ip po oi idIn addition to " "foamy" " alveolar macrophages, bronchoalveolar lavage (BAL) fluid analysis showed an increased number of neutrophils. Moreover, lactate dehydrogenase (LDH) and alkaline phosphatase activities were elevated. The increase seen in LDH activity both in serum and BAL fluid was accompanied by shifts in the isoenzyme pattern in similar directions for both fluids. These findings suggest a pulmonary source for the temporary serum as well as BAL fluid LDH increase.This case indicates the usefulness of bronchoalveolar lavage fluid analysis as a probe to detect pulmonary injury caused by a pneumotoxicant and, probably, to monitor recovery or deterioration. Eur Respir J., 1996Respir J., , 9, 2416 Case report A 30 year old man was transferred to our hospital from a local hospital. Eight hours before admission he had attempted suicide by injecting 10 mL of lamp oil (liquid paraffin) into a vein in his left elbow. On admission, no abnormalities were found. Over the following hours, the patient's respiratory condition deteriorated requiring mechanical ventilation.Chest radiography revealed a diffuse reticulonodular infiltrative process. A bronchoalveolar lavage (BAL) was performed 2 days after admission. Simultaneously, blood samples were taken. No bacteria were seen on Gramstained preparations and culture of BAL fluid remained sterile. Further analysis of the BAL fluid revealed an increased number of cells (32×10 4 cells·L -1 ; reference value for nonsmokers 10.3±1.5×10 4 cells·L -1 ), predominantly polymorphonuclear neutrophils (52%; reference value for nonsmokers 1.3±0.2%) [1].Cell-free supernatant from BAL fluid as well as serum were assayed for lactate dehydrogenase (LDH) and alkaline phosphatase activities. Additionally, protein and albumin contents were determined in cell-free BAL fluid and serum. In serum, the total protein and albumin levels were decreased (table 1). LDH activity was increased in serum to 795 U·L -1 (reference range 200-450 U·L -1 ) [2,3], as well as in BAL fluid (115 U·L -1 ; reference range 20-59 U·L -1 ) (table 1). Alkaline phosphatase activity in BAL fluid was high (145 U·L -1 ; reference range 0-25 U·L -1 ), whereas in serum it was within normal limits (table 1). At this moment, all other laboratory tests including liver function tests were normal. Moreover, on cytocentrifuged preparations of the BAL fluid stained with May-Grünwald-Giemsa (MGG; Merck, Darmstadt, Germany) numerous lipid-laden, "foamy" alveolar macrophages were seen.The diagnosis lipoid pneumonia was based on the clinical picture and the cytological analysis of BAL fluid.

Serum lactate dehydrogenase (LDH) activity, a marker of cell damage, is increased in several pulmonary disorders, especially when fibrosis is involved. In rats exposed to silica, high levels of LDH activity were found. A rise of serum LDH3 has been associated with lung tissue injury. The aim of this study was to investigate the serum LDH isoenzyme pattern after coal-dust exposure and the possible relation to pulmonary function tests. Ex-coalminers (n = 201), with a history of coal-dust exposure more than 20 yr ago, were admitted to the authors' hospital for a medical check-up and were included in the study. The serum LDH activity was found to be elevated in 79.1% of the ex-coalminers (634 +/- 245 U I-1). Moreover, in 196 of the 201 cases (97.5%), a high LDH3 level (31 +/- 4%) was demonstrated. A moderate negative relation was found between the forced expiratory volume in 1 s (FEV1) and the LDH activity (r = -0.26; P < 0.001), as well as between FEV1 and LDH3 activity (r = -0.23; P < 0.001), even in the subgroup (n = 42) with a normal LDH. All other liver function tests were within normal limits. These results suggest that coal-dust, even many years after the actual exposure, causes an increase in the total serum LDH activity and changes in the LDH-isoenzyme pattern, mainly characterized by a high LDH3 activity.