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Biomedical subjects

P Urdal

Publications and source records attributed to P Urdal.

65 records · Page 4Linked to original sources
PubMed1984

The prognosis of patients with concussion and increased creatine kinase BB in the cerebrospinal fluid.

In a series of 93 emergency patients, 58 were classified as concussions on a clinical basis. Thirteen of the patients with concussion had increased levels of creatine kinase isoenzyme BB (CK-BB) in their cerebrospinal fluid (CSF). We performed a prospective, follow-up investigation comparing 10 patients with a CK-BB increase and 10 patients without a CK-BB increase after concussion. Within 24 hours, at 6 months and 3 years after concussion, each patient was subject to a special interview to obtain pre-concussional baseline data and post-concussional follow-up data concerning their complaints and capacity for daily activities. We found a definite change towards increasing disability in 8 of the 10 patients with a raised CK-BB, and in only 1 of the 10 patients with normal levels of CK-BB. A careful neuropsychological examination confirmed inferior performance in tests especially sensitive to brain injury in patients with a CK-BB increase. Our results suggest that increased levels of CK-BB after concussion signify a more severe injury which is not found in the clinical examination during the first days after the accident, and that these patients are a high-risk group for the development of post-concussional problems and symptoms.

Adolescent↗
PubMed1984

Enzymic assay for oxalate in unprocessed urine, as adapted for a centrifugal analyzer.

In this automated modification of the oxalate decarboxylase method, oxalate can be measured (12 per hour) in acidified but otherwise unprocessed urine. Standard curves are linear up to at least 2.5 mmol/L. When 0.50 mmol of oxalate was added per liter to samples of 18 patients' urines, a mean analytical recovery of 98.5% (SD 3.6%) was obtained. Within-series CVs were 3.4 and 1.0%, between-series CVs 7.3 and 2.7% (n = 15) for oxalate concentrations of 0.31 and 0.61 mmol/L. The lower limit of detection is 25 mumol/L. Concentrations measured with this "direct" method correlated well (r = 0.95) with those measured after precipitation with calcium and ethanol and resolubilization in dilute sulfuric acid. For 17 healthy volunteers the mean urinary excretion of oxalate was 0.37 (SD 0.14) mmol/24 h.

Carboxy-Lyases↗
PubMed1983

Cytoplasmic creatine kinase isoenzymes quantitated in tissue specimens obtained at surgery.

Because previous reports have given inconsistent results, we re-examined the catalytic concentrations of cytoplasmic creatine kinase (CK) and of CK isoenzymes in 38 biopsies obtained from 19 different tissues. After homogenization and centrifugation many tissues showed high CK catalytic concentrations; 11 of them contained activity exceeding 50 U/g wet weight (Scandinavian recommended method). The highest specific activities were found in skeletal muscle (2400 U/g), brain (530 U/g), and myocardium (460 U/g). The separate isoenzyme activities were estimated by electrophoretic, anion-exchange chromatographic, immunoinhibiting, and radioimmunological methods. CK-BB was present in all tissues and, in fact, was the only cytoplasmic CK isoenzyme in 16 of the 19 tissues examined. CK-MM was the major isoenzyme of skeletal muscle and myocardium and was in addition observed in placenta, in trace amounts. CK-MB was present in high catalytic concentrations in myocardium (20% of total CK) and in low catalytic concentrations in skeletal muscle (1.1% of total CK).

Autopsy↗
PubMed1982

The diagnostic value of measuring creatine kinase BB activity in cerebrospinal fluid following acute head injury.

During a period of 2 months the activity of creatine kinase BB (CK-BB) was measured in the cerebrospinal fluid (CSF) from 93 consecutive patients admitted as emergencies to the Neurosurgical Department. Fourteen of the 15 patients with verified brain contusion showed an increased activity of CK-BB in the CSF whereas all patients with various other acute neurological disorders, such as epilepsy and acute headache, had a normal CK-BB activity. Two of 5 patients with subarachnoidal haemorrhage and 13 of 58 patients classified as concussion also showed an increased CK-BB activity. Spinal fluid pressure, number of red cells and activity of CK (total) were less useful than CK-BB in diagnosing acute brain damage. Even diagnostic ventricular puncture with a Fisher cannula, producing a tiny (diameter = 2.8 mm) brain lesion, gave rise to an increased CK-BB activity. CSF sampled repeatedly from 10 other patients with brain contusion showed CK-BB activities that suggest the optimum period for sampling to be between one and 15 hours after head injury. The results obtained suggest that CK-BB is a reliable indicator of brain damage following head injury.

Brain Concussion↗
PubMed1982

Age-related reference intervals for creatine kinase BB in serum.

The mass concentration of creatine kinase BB (CK-BB) isoenzyme was measured in serum of 365 healthy children and adults with a CK-BB specific radioimmunoassay. Eight separate age groups (newborns, 4 days, and 1, 8, 14, 25, 40 and 65 years) were examined and the reference intervals for these groups were estimated. The concentration of CK-BB generally decreased with increasing age, most of the changes taking place within the first year of life. Thus, the median value at age 1 year (9.2 micrograms/l) was 1/15th of that observed at birth, 1/2 of that observed at age 4 days, but four times higher than that observed in adults. A transient increase in CK-BB concentration was observed in boys 14 years old. At this age in contrast to at all other ages the values measured in boys were significantly (P less than 0.005) higher than the values measured in girls In 27 of the sera from cord blood we also examined the relationship between estimates of CK-BB mass and activity, the latter being estimated by immuno-inhibition technique. The two estimates were highly correlated (r = 0.98), 2 micrograms of enzyme mass roughly equivalent to 1 U of enzyme activity.

Adolescent↗
PubMed1981

The origin of creatine kanase BB occurring in serum during aortocoronary bypass surgery.

The serum concentration of creatine kinase (CK)-BB during and after coronary bypass surgery was measured by a sensitive and highly specific radioimmunoassay technique. All patients showed a distinct and temporary increase in CK-BB concentration shortly after the start of operation. Our results indicate that this increase has no connection with damage of the heart or the brain. Most probably the BB isoenzyme is liberated mainly from the saphenous vein as a consequence of the surgical manipulations during the heart operation.

Aged↗
PubMed1981

Macro creatine kinase BB isoenzyme in serum: most likely an antigen-autoantibody complex.

Nine sera containing an abnormal creatine kinase BB isoenzyme, "macro CK-BB", were examined. Immunoglobulin precipitation after addition of radiolabelled CK-BB suggested that in eight of the sera the enzyme was linked to an immunoglobulin G. Results obtained with papain-digested and with pepsin-digested IgG suggested that the binding of CK-BB occurred in the antigen-binding region (the "Fab-region") of IgG. Each of the two antigen-binding fragments of IgG, obtained by papain-digestion, were CK-BB specific, since they complexed this isoenzyme equally well when excess CK-MM and CK-MB was added. From Scatchard plots the affinity constant for binding of CK-BB to IgG and the BB-binding capacity of four of the sera was calculated. The affinity constant was high and differed little between the sera (range 0.7 x 10(11)-1.6 x 10(11)1/mol). The BB-binding capacity differed widely (range 21-900 microgram of CK-BB per litre of serum), but in each serum it roughly paralleled the activity of the macro CK-BB complex. The results suggest that in eight of the nine sera examined the BB-binding IgG is an antibody with activity directed towards CK-BB.

Aged↗
PubMed1981

Sensitive and specific radioimmunoassay for creatine kinase BB isoenzyme in serum, with use of an autoantibody.

We have developed an equilibrium radioimmunoassay for creatine kinase BB (CK-BB) isoenzyme in serum. We used as antibody a CK-BB binding immunoglobulin G isolated from serum of a patient with macro CK-BB. Free and antibody-bound tracer were separated by anion-exchange chromatography. The affinity constant, Keq, for the binding of CK-BB to immunoglobulin was calculated as 1.4 X 10(11) L/mol, which suggests that the immunoglobulin was an autoantibody. The assay may detect 1 microgram of enzyme per liter in a 100- microL sample. CK-MM and CK-MB isoenzymes did not cross react in the assay. Within-assay precision (CV) was 5%; between-assay precision was 14 and 15% at 6 and 14 microgram of CK-BB per liter, respectively. Of 45 sera from blood donors, 95% contained < 1.8 microgram of CK-BB per liter, whereas of 19 sera from unselected patients the corresponding figure was 2.8 microgram/L.

Autoantibodies↗
PubMed1979

Effects of Ca, Mg, and EDTA on creatine kinase activity in cerebrospinal fluid.

For one to obtain a precise estimate of creatine kinase (CK) activity in cerebrospinal fluid, the sample fraction is increased by about 10-fold over that used for serum. This increases the concentration of interfering substances, Ca being especially important. Therefore, the relationship between Ca, Mg, and EDTA was examined. Enzyme activity was maximal with 15 mmol of Mg per liter in the presence of 3 mmol of EDTA per liter, otherwise according to the (Scandinavian) recommended conditions for determination of CK activity in serum. These modifications increased the activity of CK by 35% for CK-MM and by 60% for CK-BB. Counteraction of Ca-induced inhibition was the main reason to this increase. We describe a practical and sensitive method for determining CK in cerebrospinal fluid.

Buffers↗
PubMed1979

Macro creatine kinase BB in serum, and some data on its prevalence.

We report the case of a patient with persistently above-normal activity of creatine kinase (CK) in serum, a major fraction of which on electrophoresis moved as a band between the MM and MB isoenzymes and on anion-exchange column chromatography eluted in the MB fraction. Measurements in the presence of specific M or B subunit-inhibitory antibodies indicated that 93% of the activity consisted of B-isomers. From these experiments we conclude that the abnormal CK is of BB nature. Gel filtration and immunoglobulin precipitation showed that the CK-BB was complexed with IgG. Normal CK-BB, when mixed with the patient's serum, was converted to macro CK-BB. In vitro stability of 37 degrees C of the abnormal enzyme was much greater than that of normal BB and MM isoenzymes. Following this finding, we then assessed 310 sera, received for enzyme assay by the clinical laboratory, for electrophoretically abnormally migrating CK isoenzymes. Of these, five (1.6%) contained such enzymes, all being of BB nature. They were of increased molecular mass, and at least three of them were complexed with IgG.

Aged↗