Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0009676 (confusion)
 21,692 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The factors which affect the standardisation and quality control of serum alkaline phosphatase assays are discussed. A quality control project was designed to test the performance of seven Birmingham laboratories in the assay of sera with alkaline phosphatase activities outside the range normally tested by the National Quality Control and Wellcome schemes. The results showed that the precision of individual laboratories was satisfactory. Differences between the results of the laboratories were considerable and could be accounted for by differences in methodology. Auto-Analyzer methods employing phenyl phosphate as substrate would best be standardised by adopting the optimised reaction conditions of Buch and Buch (1939); but the borate buffer of these authors should be replaced by the carbonate-bicarbonate buffer of Moss et al. (1971). To avoid the confusion which may arise in future if alkaline phosphatases are reported in U/l irrespective of the substrate, it is suggested that some substrate--indicative nomenclature may be advisable.
 ...
PMID:Quality control of serum alkaline phosphatase assays: project report and discussion of some factors affecting the assay. 125 61

Immunoreactivities of 35 different monoclonal antibodies (MAbs) that detect intermediate filaments were studied systematically on serial cryostat sections of 14 well-defined human gliomas (five astrocytomas, three oligodendrogliomas, six glioblastomas) and on normal brain. Glial fibrillary acidic protein (GFAP), vimentin, desmin, neurofilaments, and broad-specificity keratin MAbs, as well as MAbs that recognize several or only single keratin polypeptides, were used. Unexpected reactivities were surprisingly frequent. As these may lead to diagnostic confusion and misinterpretation on this material, the authors investigated these phenomena more thoroughly. Four major sources of artifactual staining were found: 1) positive staining attributable to the rabbit gamma G immunoglobulins used in the alkaline phosphatase anti-alkaline phosphatase technique; 2) certain desmin and keratin MAbs cross-reacted with astrocytic glia and with other brain-specific epitopes; 3) technical difficulties; 4) some MAbs directed against neurofilaments and keratins showed unexpected reactivities only on individual anaplastic gliomas. The implications of these findings for intermediate filament typing of neuropathologic material are discussed.
 ...
PMID:Unexpected immunoreactivities of intermediate filament antibodies in human brain and brain tumors. 171 22

Physicians and surgeons have long recognized that septic illness may be accompanied by abnormal brain functions; however, no systematic, comprehensive study has been done to define the clinical and laboratory features of the syndrome of sepsis-associated encephalopathy. We undertook such a prospective study in a tertiary care hospital and found that of 69 patients with fever and microbial cultures, 32 had marked brain dysfunction, 17 showed mild encephalopathy, and 20 were clinically nonencephalopathic. Severe cases showed obtundation and paratonic rigidity while milder cases showed confusion, inappropriate behavior, inattention, disorientation, and writing errors. There were no focal neurological deficits. The following factors correlated with the severity of brain dysfunction: adult respiratory distress syndrome; fatal outcome; certain types of EEG abnormality; axonal peripheral neuropathy; elevated peripheral white blood cell count; elevated serum levels of alkaline phosphatase, bilirubin, creatinine, phosphate, potassium, and urea; reduced blood pressure and reduced serum albumin level. Our data suggest that brain functions fail with dysfunction of other organs in septic illness. Pathogenetic mechanisms are discussed. The brain dysfunction should be regarded as potentially reversible, even in severely encephalopathic cases. Prompt control of the infection is the most important measure in controlling the encephalopathy and in preventing the increased mortality found with severely encephalopathic patients.
 ...
PMID:The encephalopathy associated with septic illness. 207 9

Diseases do not always show the usual or "classic" signs and symptoms in the elderly. Physiologic changes over the years of a long life seem to be responsible for impairment of regulation or function of many organ systems. Since function often is measured in clinical medicine by laboratory testing, physicians frequently face difficult clinical decisions as to the need for further evaluation of a patient based upon a laboratory test result received. For the most part, the laboratory values obtained in elderly persons seem to fall into our traditional or so-called normal ranges, and little evidence supports the need for separate sets of reference ranges for the elderly. A few patients do show abnormalities on specific tests, and a few test values can be expected more frequently than others to be out of line in healthy elderly individuals, specifically: serum alkaline phosphatase (elevations to about 2.5 times the normal) fasting blood glucose (up to 135 to 150 mg/dl) postprandial blood glucose or oral glucose tolerance test (increased above normal to 10 mg/dl per decade of age) normal serum creatinine with the existence of markedly decreased creatinine clearance higher erythrocyte sedimentation rates (up to 40 mm/hr) hemoglobin (lowest acceptable level is 11.0 gm/dl in women; 11.5 gm/dl in men) BUN (up to 28 to 35 mg/dl) The presence of multiple diseases in elderly patients, as well as the many medications often taken, will no doubt be more of a source of confusion and consternation in the clinical correlation of laboratory test results than the lack of adequate reference ranges specifically compiled for the elderly. The question "What test result is significant and raises suspicion of disease?" will remain a part of that all-important integration and correlation of the information available to the physician for the diagnosis and treatment of the patient.
 ...
PMID:Laboratory values in the elderly. Are they different? 218 80

The clinical value of alkaline phosphatase isoenzyme analysis is limited by the inability of most electrophoretic methods to resolve the liver and bone isoenzymes. The authors attacked this problem by treating serum samples with neuraminidase, then running treated and untreated samples side-by-side on specially prepared agarose gels. Each isoenzyme showed a characteristic mobility before and after neuraminidase treatment that allowed its identification. The mobility of the bone isoenzyme was most affected, whereas the intestinal isoenzyme was resistant to the action of neuraminidase. In samples with both liver and bone isoenzymes, pretreatment with neuraminidase clearly distinguished the bands, allowing quantitation by densitometry. Using this method, the authors discovered 22 liver isoenzymes in 54 samples that were interpreted as only bone isoenzyme before neuraminidase treatment. They also detected two bone isoenzymes in 35 samples that appeared to contain only liver +/- biliary isoenzymes. In addition, this procedure enabled them to characterize several unusual isoenzymes with respect to mobility, thus avoiding confusion with the other isoenzymes.
 ...
PMID:Agarose gel patterns of alkaline phosphatase isoenzymes before and after treatment with neuraminidase. 339 58

The clinical syndrome of "shock liver," also known as ischemic hepatitis, is characterized by sudden elevation (to more than 20 times the upper limit of normal) of SGOT and SGPT in response to cellular anoxia, followed by resolution to near normal levels within seven to ten days. In our experience with ten cases, systemic hypotension was documented in only four, but processes characterized by decreased cellular perfusion were identified in all and included cardiac failure or arrhythmia, sepsis, cerebrovascular accidents, renal failure, and chronic obstructive pulmonary disease. We were also able to document the transient rise in serum bilirubin and alkaline phosphatase levels and prolonged prothrombin time that followed the transaminase elevations by 24 to 48 hours in most cases, followed by rapid resolution. In neither of the two cases in which tissue was available by biopsy after resolution of the biochemical abnormalities did we find the classic histologic picture of necrosis in zone 3 ("centrilobular necrosis"). The clinical picture of shock liver is so characteristic and resolves so rapidly that there should be no confusion with other causes of marked elevations of transaminase levels.
 ...
PMID:Shock liver. 407 Nov 67

Within 1 year six elderly patients (aged 80-89 years) were admitted because of non-specific deterioration in mental or physical well-being. In no instance was hepatobiliary disease suspected at the time of hospital admission. One patient presented with intermittent confusion only. The other five were referred with "falls" or having "gone off legs", with malaise, confusion, or incontinence. All had raised alkaline phosphatase levels of 159-1230 IU/l, which led to investigation of the biliary tree. At endoscopic retrograde cholangiopancreatography all were shown to have biliary disease (three common duct stones, one gallbladder calculus, one an abscess, and one a widely dilated common bileduct ). With appropriate treatment (endoscopic sphincterotomy for two, surgery for two, and antibiotics alone for two), all showed a gratifying return of mobility and mental function. Biliary disease is a treatable cause of chronic ill health in the elderly and should be excluded, even in the absence of "classical" symptoms, when there is abnormal liver function.
 ...
PMID:Gallstones presenting as mental and physical debility in the elderly. 614 85

Twenty-five patients who underwent nephrectomy for chronic pyonephrosis were studied retrospectively. Such patients may present with a wide range of symptoms. Marked haematological and biochemical abnormalities are found, the most striking being a gross elevation of plasma viscosity (or ESR) and a raised alkaline phosphatase. The resulting picture often suggests extrarenal disease, and diagnostic confusion occurred in a number of patients.
 ...
PMID:Extraurinary manifestations of chronic pyonephrosis. 662 Feb 78

Fibrosis of chronic pancreatitis can cause obstructive jaundice by compressing the intrapancreatic portion of the common bile duct. The frequency and clinical manifestations of common bile duct stricture from symptomatic chronic pancreatitis have been evaluated in 26 patients undergoing lateral pancreaticojejunostomy for intractable pain between 1974 and 1980. Four patients (15%) had a stricture with partial obstruction of the common duct in addition to pancreatic duct obstruction. Three of the four strictures were identified prior to operation by ERCP. The fourth developed biliary obstruction six months after pancreaticojejunostomy. Slight elevation of alkaline phosphatase was common and occurred in 12 of 22 patients with chronic pancreatitis without biliary obstruction. Alkaline phosphatase was elevated greater than four times normal in three of the four patients with a biliary stricture. Elevation of total and direct serum bilirubin occurred only in patients with stricture of the distal common duct. A waxing and waning picture of jaundice was seen in these four patients. When a fixed smooth stricture of the common duct is demonstrated in a patient with symptomatic chronic pancreatitis, drainage of the biliary tree should be combined with pancreatic duct drainage in order to prevent cholangitis, biliary cirrhosis, diagnostic confusion with pancreatic carcinoma, and persistence of pain.
 ...
PMID:common duct obstruction in patients with intractable pain of chronic pancreatitis. 711 5

Thirteen patients with amebic liver abscess and 26 with pyogenic abscess were identified during a 10 year period. All but one patient with an amebic abscess had emigrated or traveled to areas where amebiasis was endemic. Half of the patients in whom pyogenic abscesses developed had debilitating disease and anemia. Factors predisposing to multiple rather than solitary hepatic abscess were biliary tract disease before surgery, cancer, chemotherapy, steroid administration and alcoholism. Elevated levels of alkaline phosphatase and hypoalbuminemia were present in most patients. Three patients with amebic abscess died, two of whom has massive gastrointestinal hemorrhage from associated amebic colitis. No patient with a solitary pyogenic liver abscess died. Fifteen of 16 patients with multiple liver abscesses died. Failure to consider the diagnosis of liver abscess, confusion over interpretation of the scan, failure to operate or provide a timely operation and failure to adequately explore the abdomen or identify all abscesses were factors responsible for eight unnecessary deaths.
 ...
PMID:Management of liver abscess. 739 87


1 2 3 Next >>