The classic signs and symptoms of rhabdomyolysis are non-specific and not present in all cases, and mild cases might go unrecognized. We present a case of rhabdomyolysis recognized in a 68-year-old man after elevation of liver enzymes following prolonged urologic surgery. The patient's postoperative course was concerned with elevated serum aspartate aminotransferase and alanine aminotransferase without any clinical manifestations on the first postoperative day. After examining the serum creatine kinase and myoglobin levels, the patient was diagnosed with rhabdomyolysis. After 16 days, he was discharged with fully recovered liver enzymes and creatine kinase. We suggest that sufficient perioperative attentions should be given to patients at a higher risk of rhabdomyolysis.
Aged ; Alanine Transaminase ; Aspartate Aminotransferases ; Attention ; Creatine Kinase ; Humans ; Liver ; Myoglobin ; Rhabdomyolysis

BACKGROUND: It is important to recognize rhabdomyolysis in clinical settings, because 10~30% of rhabdomyolysis patients develop acute renal failure as a complication and patients with such complication have risk of high mortality. Recently, there have been frequent reports about healthy people who developed rhabdomyolysis after heavy exercise, but few prospective studies on exercise-induced rhabdomyolysis have been reported. METHODS: To evaluate the degree of muscle cell necrosis during the regular combat-police training, we examined the level of creatine kinase, plasma myoglobin and bone scan in 173 combat-police before the training and on fourth day after the training. Average ambient temperature and humidity during the study were 25degrees C and 78%, respectively. RESULTS: From the laboratory findings, 98 out of 173 combat-police were diagnosed as having rhabdomyolysis. Upon regressional analysis, an increase in amount of exercise correlated with the elevation of the levels of plasma creatine kinase and myoglobin. Among variables related to rhabdomyolysis only the levels of myoglobin, aspartate aminotransferase were significantly elevated. The level of plasma creatinine was elevated along with the elevation of plasma myoglobin. Bone scan not only provided detailed information on the location and degree of muscle cell damage, but also could be of diagnostic value in patients whose creatine kinase had been normalized. CONCLUSION: In people who developed rhabdomyolysis after heavy exercise, the level of plasma creatinine was elevated along with the elevation of plasma myoglobin. So early diagnosis of rhabdomyolysis and early detection of acute renal failure may be useful with monitoring of plasma myoglobin level.
Acute Kidney Injury ; Aspartate Aminotransferases ; Creatine Kinase ; Creatinine ; Early Diagnosis ; Humans ; Humidity ; Mortality ; Muscle Cells ; Myoglobin ; Necrosis ; Plasma ; Rhabdomyolysis*

PURPOSE: Benign acute childhood myositis (BACM) is a rare condition, characterized by severe lower extremity pain and acute-onset reluctance to walk in children. This study evaluated the clinical course of and laboratory findings related to BACM. METHODS: Patients with gait disturbance who had visited the Department of Pediatrics, Chungnam National University Hospital between March 2010 and May 2010 and who had been diagnosed with BACM were enrolled. The patients' medical records were examined retrospectively, and the clinical and laboratory data were recorded. RESULTS: Seven patients (six boys and one girl) were enrolled. Their median age was 7.3 years old. Four patients had leucopenia and five had mild thrombocytopenia and six had elevation of serum aspartate aminotransferase or alanine aminotransferase levels, or both. The median serum creatine phosphokinase level was 1,864 IU/L, (range 368-7,166 IU/L). All patients had elevated lactate dehydrogenase and no patients studied had any evidence of bacterial infections. Influenza B virus was detected in two patients. and all patients spontaneously recovered after one week. CONCLUSION: Self-limited BACM should be considered if acute gait disturbances with calf pain and elevated serum creatine phosphokinase levels are observed in otherwise healthy children with no neurological abnormalities.
Alanine Transaminase ; Aspartate Aminotransferases ; Bacterial Infections ; Child ; Creatine Kinase ; Gait ; Humans ; Influenza B virus ; L-Lactate Dehydrogenase ; Lower Extremity ; Medical Records ; Myositis ; Pediatrics ; Retrospective Studies ; Thrombocytopenia

We report a case of serum creatine kinase (CK) elevation in a 42-year-old man with schizoaffective disorder treated with olanzapine, aripiprazole, quetiapine, and modified electroconvulsive therapy (ECT). To elucidate the clinical meaning of serum CK elevation, we repeatedly measured psychotic severity and chemical data, including serum CK, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and cholesterol. Pearson's correlation analysis was performed between each measurement. The peak CK level during hospitalization was correlated with Clinical Global Impression (CGI) severity. Dissociation of CK level and myoglobinuria was observed, and elevated did not result in renal failure or any renal decompensation. Medication change among atypical antipsychotics could not terminate CK level, which did not seem to be associated with dosage or duration of use. The patient's mother showed similar CK level, which suggests genetic control of serum CK. Repeated measurement of serum CK is recommended for determining the clinical significance of CK level, which is not yet clear.
Adult ; Alanine Transaminase ; Antipsychotic Agents* ; Aspartate Aminotransferases ; Cholesterol ; Creatine Kinase* ; Creatine* ; Electroconvulsive Therapy ; Hospitalization ; Humans ; Mothers ; Myoglobinuria ; Psychotic Disorders ; Renal Insufficiency ; Aripiprazole ; Quetiapine Fumarate

BACKGROUND: The aim of this study is to define the cardioprotective effects (hemodynamic, cytochemical and ultrastructural of the newly developed Histidine-Tryptophan-Ketoglutarate (HTK) cardioplegia compared to DelNido cardioplegia. MATERIAL AND METHOD: Seventy-nine isolated rat hearts were divided into three groups on the basis of techniques of cardioplegia infusion. Twenty-eight hearts (Group 1) were flushed with cold DelNido cardioplegia with every 40 minutes for 2 hours. Twenty-seven hearts (Group 2) were flushed with cold HTK cardioplegia for once during the 2 hours. Twenty-four hearts (Group 3) were flushed with cold HTK cardioplegia with every 40 minutes for 2 hours. Heart rate, left ventricular developed pressure (LVDP), changes of +dp/dt max, coronary flow, and rate-pressure product value were measured at pre-ischemic, post-reperfusion 15 minutes, 30 minutes, and 45 minutes for hemodynamic study. Aspartate aminotransferase (AST), lactate dehydrogenase (LD), creatine kinase (CK), CK- MB, troponin-I, myoglobin, and lactate were measured at pre-ischemic and post-reperfusion 45 minutes for cytochemical parameters. Mitochondrial scores were counted in 3 cases from each group for ultrastructural assessment. RESULT: In hemodynamic study, there were no significant differences among group 1, group 2, and group 3. However, the decrease values of heart rate in group 2 and 3 exhibited significantly lower values than in group 1. In cytochemical study, there were no significant differences among group 1, group 2, and group 3. However, the increase values of lactate in group 2 and 3 exhibited significantly lower values than in group 1. In ultrastructural assessment, the mean myocardial mitochondria scores in group 1, group 2, and group 3 were 2.14+/-0.10, 1.52+/-0.57, and 2.10+/-0.16. CONCLUSION: HTK solution provides adequate myocardial protection with some advantages over DelNido solution in isolated rat hearts.
Animals ; Aspartate Aminotransferases ; Cardioplegic Solutions ; Creatine Kinase ; Heart Arrest, Induced* ; Heart Rate ; Heart* ; Hemodynamics ; L-Lactate Dehydrogenase ; Lactic Acid ; Mitochondria, Heart ; Myoglobin ; Rats* ; Troponin I

A 29-year-old man was admitted to hospital with fever, myalgia, and sore throat. Initial laboratory findings were compatible with acute hepatitis; he was positive for the serologic marker for acute hepatitis A. On the 3rd day of admission, in spite of normalization of body temperature and a reduction in serum liver enzyme levels, serum levels of creatinine phosphokinase had increased up to 16,949 U/L. The patient recovered with supportive therapy and was discharged on the 12th day. We report a case of acute hepatitis A complicated by rhabdomyolysis during hospitalization.
Acute Disease ; Adult ; Alanine Transaminase/blood ; Aspartate Aminotransferases/blood ; Creatine Kinase/blood ; Hepatitis A/complications/*diagnosis ; Hospitalization ; Humans ; Male ; Rhabdomyolysis/*diagnosis/etiology

PURPOSE: Reperfusion after acute ischemia is associated with high rates of morbidity and mortality due to the ischemic injury itself and the following myonephropathic metabolic syndrome, in spite of complete revascularization. Therefore, we attempted to verify the difference in reperfusion injury with or without pre-reperfusion intravascular rinsing in a canine acute limb ischemia model. METHOD: We used five female mongrel dogs. Complete acute hind limb ischemia was induced by infrarenal aortic and bilateral femoral artery clamping for 8 hours. We divided the dogs into two groups. In the rinse group (RG): three dogs were declamped with intravascular rinsing, and in the non-rinse group (non-RG): two dogs were declamped without any additional procedures. The perfusate solution was infused through both femoral arteries and was drained via both femoral veins. Serial blood samples were obtained four times. The gastrocnemius muscles were biopsied 3 days after reperfusion. RESULT: The results at preischemia, just before, 30 min, and 3 days after reperfusion were as follows: Creatine phosphokinase (CK) was 204, 1031, 1373, and 443 (IU/L) in the RG and 159, 3855, 6345, and 5455 (IU/L) in the non-RG. Lactate dehydrogenase (LDH) was 177, 248, 173, and 232 (IU/L) in the RG and 95, 508, 638, and 878 (IU/L) in the non-RG. Aspartate transaminase (AST) was 23, 50, 43, and 42 (IU/L) in the RG and 19, 118, 154, and 399 (IU/L) in the non-RG. Potassium (K) was 5.7, 5.8, 5.4, and 4.0 (mEq/L) in the RG and 5.4, 5.5, 5.7, and 5.3 (mEq/L) in the non-RG. Muscle injury in the non-RG was more severe than in the RG. CONCLUSION: There was a considerable difference between the groups in the CK, LDH and AST levels and the muscle biopsy findings. The results showed that the intravascular rinsing provided beneficial effects in reperfusion injury acute limb ischemia.
Animals ; Aspartate Aminotransferases ; Biopsy ; Constriction ; Creatine Kinase ; Dogs ; Extremities* ; Female ; Femoral Artery ; Femoral Vein ; Humans ; Ischemia* ; L-Lactate Dehydrogenase ; Mortality ; Muscles ; Potassium ; Reperfusion ; Reperfusion Injury

The mechanism of long-term potentiation (LTP) in basolateral amygdala (BLA) was explored using field potential recording in rat brain slice preparation. Field potentials (field excitatory post-synaptic potentials, fEPSPs) in BLA were evoked with sharpened steel bipolar stimulating electrodes placed in the external capsule (EC). Two theta burst stimulations (TBS, interval=10 min) induced LTP in BLA. TBS-induced synaptic potentiation lasted for more than 30 min after the second TBS. LTP in BLA was input-specific and was blocked by N-methyl-D-aspartate receptor (NMDAR) antagonist 2-amino-5-phosphonovaleric acid (APV). The effect of protein kinase C (PKC) on LTP was then determined using PKC inhibitor chelerythrine chloride. Bath application of chelerythringe chloride had no effect on basic field potentials and paired-pulse ratio (PPR). However, in the presence of chelerythrine chloride, two TBS failed to induce LTP. In contrast, bath application of chelerythrine chloride 10 min after the second TBS did not affect the maintenance of LTP in BLA. These results indicate that LTP is NMDAR-dependent and PKC is involved in the induction and early maintenance of LTP in BLA.
2-Amino-5-phosphonovalerate ; pharmacology ; Amygdala ; enzymology ; Animals ; Electric Stimulation ; In Vitro Techniques ; Long-Term Potentiation ; Protein Kinase C ; metabolism ; Rats ; Receptors, N-Methyl-D-Aspartate ; metabolism ; Synaptic Potentials

OBJECTIVETo study the relationship between insulin resistance and myocardial injury in children with critical diseases in light of the fact that such children usually suffer from noticeable insulin resistance and myocardial injury.

METHODSSixty-three children with critical diseases who were admitted between March 2010 and June 2011 were enrolled to comprise a case group. Fasting blood glucose, serum insulin, myocardial enzyme, and troponin I (CTnI) levels were measured. The insulin resistance index (HOMA-IR) was calculated. The children were classified into two groups: insulin resistance (HOMA-IR>1.0; n=30) and non-insulin resistance (HOMA-IR≤1.0; n=33). Thirty healthy children served as the control group.

RESULTSHOMA-IR, lactate dehydrogenase (LDH), aspartate aminotransferaseaspartate transaminase (AST), creatine kinase (CK), isoenzymes of creating kinase (CK-MB), α-hydroxybuty rate dehydrogenase (α-HBDH) and CTnI in the insulin resistance group were higher than those in the non-insulin resistance and the control groups (all P<0.05). The non-insulin resistance group also showed obviously higher levels in terms of LDH, AST, CK, CK-MB, α-HBDH, and CTnI than the control group (P<0.05). In the insulin resistance group, there exists a positive correlation between HOMA-IR and such indicators as LDH, CK, CK-MB, AST, α-HBDH and CTnI (r=0.697, 0.739, 0.781, 0.642, 0.381, 0.792 respectively; all P<0.05).

CONCLUSIONSInsulin resistance makes myocardial injury more serious; HOMA-IR can serve as a forecast indicator for the degree of myocardial injury.

Aspartate Aminotransferases ; blood ; Cardiomyopathies ; etiology ; Child ; Child, Preschool ; Creatine Kinase, MB Form ; blood ; Critical Illness ; Female ; Humans ; Insulin Resistance ; L-Lactate Dehydrogenase ; blood ; Male ; Troponin I ; blood

OBJECTIVETo explore the etiology and clinical characteristics of hypoxic hepatitis (HH) in children.

METHODClinical data of 7 patients with HH in Shenzhen Children's Hospital from January 2011 to March 2014 were retrospectively reviewed.

RESULTSeven cases diagnosed as HH, age from 4 months to 11 years, were admitted to pediatric intensive care unit (PICU), and accounted for 0.32% of patients in PICU during the same period. The primary causes of HH were respiratory failure and cardiac shock caused by severe hand-foot-and-mouth disease, fulminant myocarditis, infant muggy syndrome . Serologic tests for hepatitis B virus, hepatitis C virus, as well as serum antibody and DNA for Epstein-Barr virus and cytomegalovirus were all negative. There was an increase of alanine aminotransferase (ALT) (≥20 time supper limit of normal (ULN), the highest ALT was more than 130 times ULN in all the patients, which was decreased to 2 times ULN from peak within 10 days. There was a significant relationship between ALT and aspartate aminotransferase(AST)in 3 cases(r=1.000, 1.000, and 0.833, respectively, P<0.05), ALT and lactate dehydrogenase (LDH)in 2 cases(r=1.000 and 0.886, respectively, P<0.05), ALT and blood urea nitrogen(BUN)in 1 case(r=1.000, P<0.05), and ALT and creatine kinase(CK)in 1 case(r=0.964, P<0.05). The ALT, AST and LDH returned to normal soon after the primary diseases were controlled.

CONCLUSIONSevere heart failure, hypoxemia, shock, etc. are the leading primary diseases causing HH. The sharp increase in ALT, AST and LDH is the typical laboratory manifestion in HH after the onset, which may decline to normal shortly after the treatment, sometimes complicated with reversible change in BUN or CK.

Alanine Transaminase ; Animals ; Aspartate Aminotransferases ; Child ; Child, Preschool ; Creatine Kinase ; Heart Failure ; Hepatitis ; Herpesvirus 4, Human ; Humans ; Hypoxia ; Infant ; L-Lactate Dehydrogenase ; Respiratory Insufficiency ; Retrospective Studies