Hyperhomocysteinemia is a risk factor for obstructive large-vessel disease. Here, we studied plasma concentrations of homocysteine and vitamins in patients suffering from subcortical vascular encephalopathy (SVE), a cerebral small-vessel disease leading to dementia. These results were compared to the homocysteine and vitamin plasma concentrations from patients with cerebral large vessel disease and healthy control subjects.Plasma concentrations of homocysteine, vascular risk factors and vitamin status (B 6 , B 12 , folate) were determined in 82 patients with subcortical vascular encephalopathy, in 144 patients with cerebral large-vessel disease and in 102 control subjects. Patients with SVE, but not those with cerebral large-vessel disease, exhibited pathologically increased homocysteine concentrations in comparison with control subjects without cerebrovascular disease. Patients with SVE also showed lower vitamin B 6 values in comparison to subjects without cerebrovascular disease. Logistic regression analysis showed that homocysteine is associated with the highest risk for SVE (odds ratio 5.7; CI 2.5-12.9) in comparison to other vascular risk factors such as hypertension, age and smoking.These observations indicate that hyperhomocysteinemia is a strong independent risk factor for SVE.

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Remarkably elevated levels of phospholipase A 2 (PLA 2 ) are measurable in human blood samples in cases of acute pancreatitis. The source of the enzyme was first thought to be exclusively the pancreas, but now it is generally accepted that two isoenzymes − the pancreatic PLA 2 , group I, and the extrapancreatic PLA 2 , group II − contribute to the raised activity. In contrast to the group II-PLA 2 , the pancreatic PLA 2 is heat-resistant for 1 hour at 60 °C. The catalytically inactive proenzyme of the pancreatic PLA 2 can be activated by trypsin. The aim of our study was to evaluate the diagnostic value of PLA 2 isoenzyme activity measurements to identify patients with severe complications in acute pancreatitis. Blood samples from patients suffering from acute pancreatitis were analyzed for catalytically active pancreatic PLA 2 on day 1 and 2 of hospitalization with a modified radiometric Escherichia coli-based PLA 2 assay. In 10 of 41 patients clearly elevated values of catalytically active, heat-resistant pancreatic PLA 2 (7.2 to 81.2 U/l) were observed. This group of patients was characterized by severe complications (necrotizing pancreatitis, shock, sepsis, respiratory problems) of which two patients subsequently died. Patients with low or undetectable activity (<7 U/l) of pancreatic PLA 2 recovered rapidly. According to these results the presence of catalytically active pancreatic PLA 2 in serum is associated with severe complications of acute pancreatitis. In contrast to total serum-PLA 2 , the catalytic concentration of pancreatic PLA 2 can serve as a prognostic marker in acute pancreatitis. Clin Chem Lab Med 2002; 40(3):293-297

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