Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound

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Query: EC:1.1.1.27 (lactate dehydrogenase)
29,211 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the differential diagnosis of intermittent claudication some rare myopathies have to be considered. The most frequent is phosphorylase deficiency (McArdle's disease). Exercise-induced muscular pain, weakness, contractures and occasionally myoglobinuria are the most prominent clinical signs. Serum creatine phosphokinase, aldolase and lactic dehydrogenase may be elevated after exertion. In the ischemic forearm test there is no rise of serum lactic acid. The enzyme deficiency can be demonstrated by histochemical and biochemical examination of a muscle specimen. Further, but more infrequent, enzymatic disturbances of glycolysis are phosphofructokinase deficiency and phosphohexoisomerase inhibitor, which also yield an abnormal ischemic forearm test and must be demonstrated histochemically and biochemically. Apart from muscular signs, myopathy with lactic acidosis is associated with palpitation, dyspnea and exhaustion, and a disproportionate rise in serum lactic acid level after exertion. Histochemically and electronmicroscopically demonstrable fat accumulation in the muscle can be a sign of a disturbance in lipid metabolism. This type of exercise-induced myopathy has been reported only in a few cases with carnitine-pylmityltransferase deficiency, which has to be demonstrated biochemically. Muscular contractures also exercise-induced but painless and reversible within seconds may be due to deficient uptake of sarcoplasmic calcium in the tubular system. Dyskalemic paralysis causes painless paresis within minutes of hours after exertion, which disappears within hours to a few days. Myopathy with tubular aggregates can be differentiated from other exercise-induced myopathies by morphology. Myotonia combined with painful contractures characterizes myopathia myotonica.
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PMID:[Exercise-induced muscular weakness, myalgia and contractures. I. A clinical review]. 13 80

The clinical and physiologic effects of bronchopulmonary lavage of both lungs at separate times in 14 patients with alveolar proteinosis proved by biopsy were followed for 2 to 96 months. Before lavage, all patients had moderate to severe dyspnea on exertion. Twelve had a nonproductive cough, and 2 had a productive cough; both were smokers. Nine had generalized fatigue, and 4 had weight loss. Twelve of 14 had fine inspiratory rales. All of the patients had abnormal chest roentgenograms, and 13 of 14 had an increased lactate dehydrogenase concentration. After lavage, all patients had loss of fatigue and improved exercise tolerance, with most returning to normal activity. Cough cleared in 12 of 14 and remained only in the cigarette smokers. Inspiratory rales cleared completely in most patients (11 of 12) and partially in one. The rales usually returned during exacerbations. Physiologic measurements that changed significantly after bilateral lavage included: vital capacity, total lung capacity, resting room air PO2, exercise PO2, PO2 while breathing 100 per cent O2, and DLCO. Because all measurements were made within 5 days of the second lavage, one must attribute the acute improvement to the removal of proteinaceous material from the alveoli. The long-term effects varied; some patients required annual or semiannual lavages, wherease others remained in remission after lavage for 36 to 96 months. Exacerbations were accompanied by increased dyspnea, reappearance of rales, and deterioration of the gas-exchange parameters noted previously. Repeat lavage reversed the clinical symptoms and physiologic abnormalities in patients who had recurrences.
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PMID:Physiologic effects of bronchopulmonary lavage in alveolar proteinosis. 69 76

It has been previously demonstrated that serum lactate dehydrogenase is elevated among HIV patients with pneumocystis carinii pneumonia (PCP). To evaluate the clinical utility of this test we analyzed the admission LDH levels of patients hospitalized for the first time due to the secondary complications of AIDS. Among 76 patients without a prior history of PCP, 41 (54%) had PCP diagnosed during their hospitalization while 35 (46%) did not have PCP. Serum LDH was significantly higher among PCP patients than in patients without PCP (mean = 423 IU/L vs 234 IU/L). Receiver operating characteristic curve analysis demonstrated that at an optimal cutoff point of LDH greater than or equal to 240 IU/L, the test sensitivity and specificity were 0.78 and 0.74 respectively among all hospitalized patients. However, when only patients with dyspnea were considered, the optimal test sensitivity and specificity improved to 0.94 and 0.78 at a cutoff point of LDH greater than or equal to 220 IU/L. Comparing the areas under fitted ROC curves, serum LDH was a significantly better discriminator among patients with dyspnea than among those who were not short of breath. We conclude that while serum LDH is strongly associated with the presence of PCP among AIDS patients, it is a poor screening test for PCP when applied to all hospitalized AIDS patients with and without respiratory complaints. Serum LDH is no substitute for appropriate microbiological studies. However, with further evaluation, it may prove to be a useful test in guiding the clinical management of dyspneic patients in whom sputum or bronchial examinations are negative or not immediately available.
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PMID:The clinical utility of serum lactate dehydrogenase in diagnosing pneumocystis carinii pneumonia among hospitalized AIDS patients. 151 88

Pneumonia caused by common pyogenic bacteria occurs frequently in HIV-infected patients. Its clinical presentation has been described as being similar to that seen in non-immunosuppressed hosts but clearly different to that of opportunistic pneumonias. An atypical presentation has rarely been seen. In a 10-month period, we saw 12 HIV-infected patients who presented with Haemophilus influenzae pneumonia which was clinically and radiologically indistinguishable from Pneumocystis carinii pneumonia. Ten of the patients were intravenous drug users and were in different stages of HIV disease. The clinical picture was characterized by a prolonged course (median 4 weeks), non-productive cough, dyspnoea, and absence of findings usually present in bacterial pneumonia. Laboratory data frequently showed absence of leukocytosis, increased lactate dehydrogenase levels, hypoxaemia, and decreased CD4+ cell counts. All presented with interstitial or mixed bilateral infiltrates. Resistance to ampicillin and trimethoprim-sulphamethoxazole were each found in seven cases. Eleven patients were cured with antibiotic therapy, although five relapsed. H. influenzae pneumonia should be considered in HIV-infected patients who present with pulmonary symptoms and bilateral infiltrates of subacute or chronic onset. Clinical resolution of pneumonia is the usual outcome, but recurrences of infection are frequent.
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PMID:Latent Haemophilus influenzae pneumonia in patients infected with HIV. 177 77

The pharmacology, toxicity, and therapeutic effectiveness of etoposide (VP-16) given by the intrapleural route were examined in a phase I trial. Ten patients with malignant pleural effusion received 100, 150, or 225 mg/m2 VP-16 infused over 2 h into the pleural space after drainage of pleural fluid. The administration of VP-16 was tolerated well, with no local pain, increase in cough, dyspnea, or infection. Myelosuppression was mild at doses of 150 mg/m2 or less but severe at 225 mg/m2. Drug levels were followed in both plasma and pleural fluid for up to 12 h. Clearance of VP-16 from the pleural cavity was low at 2 ml/min m2. Peak pleural-fluid drug levels in patients receiving 225 mg/m2 exceeded 300 micrograms/ml, whereas peak drug concentrations in corresponding plasma samples obtained at the same time amounted to less than 10 micrograms/ml. Serial chest X-rays showed no disappearance of pleural effusion in nine evaluable patients. However, follow-up investigation of pleural fluid characteristics [carcinoembryonic antigen (CEA), lactic dehydrogenase (LDH), and cytologic examination] suggested some evidence of local therapeutic benefit.
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PMID:Intrapleural etoposide for malignant effusion. 218 91

The clinical presentation of 60 consecutive Pneumocystis carinii pneumonias in 58 HIV-infected patients (48 men, 10 women, mean age 34 [22-53] years) was prospectively evaluated from April to August 1989 and compared with 60 consecutive P. carinii pneumonias in 59 HIV-infected patients (55 men, 4 women, mean age 37.5 [22-60] years) between 1981-88. Mortality rates within 14 days after diagnosis of P. carinii pneumonia were 50% (8 of 16 patients) until 1985, 20.5% (9 of 44) between 1986 and August 1988, and 1.7% (one of 60) in 1989. The degree of severity of the pneumonias at time of diagnosis was markedly lower in 1989, as shown by following parameters (averages of 1989, compared with averages of 1981-88): lactate dehydrogenase 540 (250-1419) U/l versus 680 (235-1920) U/l (not significant); alveolo-arterial difference of partial oxygen tension (pA-aO2) 22.9 (0.5-73.5) mmHg versus 39.7 (19-70) mmHg (P less than 0.001); score of radiological findings 1.4 (0-3) versus 2.7 (0-4) (P less than 0.001). In 1989, mainly clinical symptoms (dry cough: 57 of 60 cases, dyspnea: 44 of 60 cases, fever: 43 of 60 cases) initiated the diagnostic procedure: chest radiographs, lactate dehydrogenase and pA-aO2 were normal in 13, 25 and 33 episodes, respectively. The lower mortality rate of P. carinii pneumonia could not primarily be explained by therapeutical progress since the treatment of choice did not change fundamentally since 1981. Above all, early diagnosis fundamentally determined the probability of survival.
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PMID:[Pneumocystis carinii pneumonia in HIV infection: better prognosis because of early diagnosis]. 222 63

Allergic alveolitis due to mold dust inhalation in farmers is a severe but rare disease in Scandinavia. In this report 38 cases of the disease are presented. There were 31 men and 7 women, with mean ages of 46 and 38 years respectively. Strict diagnostic criteria were used, resulting in 21 definite, 12 probable and 5 possible cases. None of the patients were current smokers, but 10 of the men were ex-smokers. The great majority of the patients fell ill between October and April. The symptoms were dyspnea, cough, fatigue, episodes of fever, and in some cases loss of weight. The average duration of the disease was 6 months. The moldy material most commonly associated with the disease was straw, followed by hay, grain, and wood chips. For those tested serum lactate dehydrogenase was raised in 80% and the mean value for PaO2 was 7.8 kPa. Precipitating antibodies to mold antigens were positive in 68%. In general, pulmonary function tests showed a restrictive pattern. Over half of the patients still had dyspnea on exercise after recovery. Three fourths of the patients were treated with antibiotics and thus clearly had been misjudged as having an infection.
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PMID:Allergic alveolitis in Swedish farmers. 260 70

This prospective study was designed to obtain information on the fate of patients with severe pulmonary embolism who received anticoagulants as first-line treatment, in order to identify those in whom other treatments available might be expected to reduce mortality or sequelae. Thirty-seven patients selected as they showed evidence of acute cor pulmonale entered the study. Seven of them (18.9 p. 100) died in hospital, and these were patients whose age (p = 0.004), degree of pulmonary obstruction (p = 0.008) and serum lactate dehydrogenase level (p = 0.001) were significantly higher than those of the other patients. The mean values of these parameters (64 years, 72 p. 100 and 450 IU/l respectively) made it possible to select patients with a high risk of death. At the end of the follow-up period (25 +/- 12 months) only 2 patients complained of moderate dyspnoea, in contrast with the high incidence (17/18 patients) of paraclinical abnormalities observed 3 months after the initial accident. We conclude that clinical trials comparing other treatments with the one we used would be useful if their objective was to reduce mortality in high risk patients. On the other hand, it seems impossible to demonstrate a functional improvement: we found our treatment satisfactory and its results independent of the abnormalities observed on the 3rd month.
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PMID:[Anticoagulants in the treatment of severe pulmonary embolism. A prospective study]. 314 32

Male patients with effort angina were studied before (n = 7), 1 week, and 1 and 6 months (n = 6) after coronary artery bypass grafting (CABG) with 2 to 7 grafts. The test battery included graded exercise, which was performed until unbearable leg exertion or chest pain, or both, was present. Onsets of blood lactate accumulation, anginal pain, leg exertion and dyspnea were interpolated for either the lactate concentration 2 mmol X 1-1 or the ratings 2 on the Borg subjective intensity scale. Onsets of blood lactate accumulation and symptom-limited exercise capacity before surgery amounted to 58 and 100 W, respectively. The corresponding figures 6 months later were the same for onset of blood lactate accumulation, whereas symptom-limited exercise capacity had increased by 58%. Blood lactate was the same at rest and mild exercise (congruent to onset of blood lactate accumulation) but more than doubled at symptom-limited exercise capacity (peak blood lactate concentration). Muscle fiber typing showed a low figure for the slow twitch fiber proportion (35%), which was unchanged after 6 months. Fast twitch subtype C was elevated before (7%) but disappeared after surgery, and fast twitch subtype A percent increased correspondingly. The major muscle biochemical changes were in the glycogenolytic pathway and the lactate dehydrogenase enzyme system, which appeared to increase in a quantitative manner, but with an unchanged relative lactate dehydrogenase isozyme pattern. The increased symptom-limited exercise capacity was related to the increased glycogenolytic activity and peak blood lactate (i.e., increased "anaerobic power"). Whether the causative explanation was the relief from chest pain, i.e., a psychophysiologic feature or the biochemical changes that took place in the muscle could only be speculated on.
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PMID:Onset of blood lactate accumulation exercise capacity, skeletal muscle fibers and metabolism before and after coronary artery bypass grafting. 326 32

The toxicity of gossypol was studied in 20, 8-week-old feeder lambs that weighed approximately 16 kg. The lambs were allotted to 4 groups (A, B, C, D) and given (orally for 30 days) a daily dosage of gossypol (0, 45, 136, or 409 mg, respectively). Lambs were observed twice daily until they died or were euthanatized on the day the last dose was given. Clinical, electrocardiographic, clinicopathologic, pathologic, and toxicologic findings were recorded. All lambs given 409 mg of gossypol (group D) died before the end of the 30-day study. In this group, clinical signs included sudden death and/or chronic dyspnea syndromes. One group-B lamb had chronic dyspnea, but did not die. Electrocardiographic abnormalities observed in gossypol-treated lambs included increased amplitude of the T wave and decreased duration of the ST segment. Clinicopathologic alterations in group-D lambs included high serum total lactate dehydrogenase and lactate dehydrogenase liver-specific isoenzyme activities. Serum total creatine kinase activity decreased markedly in lambs of all groups treated with gossypol. Hemoglobinuria was detected in 2 group-D lambs. The average daily weight gain was remarkably consistent in lambs of all groups, except in 1 lamb each of groups D and B. Lambs were necropsied when they died or on day 30 of the study. The heart of gossypol-treated lambs weighted more than did that of untreated (control group A) lambs.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical, clinicopathologic, pathologic, and toxicologic alterations associated with gossypol toxicosis in feeder lambs. 337 8


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