ELEVATION OF ACTIVITY OF CREATINE-PHOSPHOKINASE (CK) AND ITS ISOENZYMES IN THE NEWBORN IS ASSOCIATED WITH FETAL ASPHYXIA AND RISK AT BIRTH
CLINICAL BIOCHEMISTRY
Authors: FONSECA, E; GARCIAALONSO, A; ZARATE, A; OCHOA, R; GALVAN, RE; JIMENEZSOLIS, G
Abstract
Objective: To investigate the relationship of creatine phosphokinase and its isoenzymes with fetal asphyxia and risk at birth. Methods: Thirty-five pregnant women with high-risk pregnancy were studied. Results: In 21 patients, fetal distress was diagnosed by interpretation of the fetal heart rate tracing (FHR). The remaining 14 women, having normal fetal cardiotocography, were considered as the control group. Total CK and its isoenzymes activity was measured in cord sera and 24 h after birth in peripheral blood. Abnormal FHR patterns correlate well with elevated enzyme activities. Total CK and its isoenzymes (CK-MM, CK-MB, and CK-BB) exhibited higher values in asphyxiated infants as compared to normal neonates. Electrocardiographic ischemia occurred in seven newborns who had elevated CK-MB and CK-BB levels, both at birth and within 24 h postpartum. Chromatographic study showed in normal neonates that the predominant isoenzyme was CK-MM, whereas CK-BB activity was negligible. In the newborns with abnormal FHR, CK-MB and CK-BB were increased with predominance of CK-MB. Conclusions: Antepartum fetal distress is associated with release of CK-BB, and particularly CK-MB; therefore, these biochemical markers may indicate either brain or myocardial damage.
Morphological findings of 'cardiac concussion' due to experimental blunt impact to the precordial region
FORENSIC SCIENCE INTERNATIONAL
Authors: Guan, DW; Ohshima, T; Jia, JT; Kondo, T; Li, DX
Abstract
The dog's precordial region at the sternum was impacted with a mechanical elastic-cord propelled impactor at the velocity of 8.0 m/s. The left and right intraventricular pressures and electrocardiogram (ECG) were monitored continuously for 60 min after the impact. The micro- and ultra-structure of myocardium were examined. Localization of myocardial myoglobin (Mb), creatine kinase BE (CK-BB) and creatine kinase MM (CK-MM) as well as plasma membrane permeability were studied by immunohistochemical and lanthanum probe techniques. Upon the impact, abrupt over-pressures within both ventricles were recorded with transient depression of the left ventricular systolic pressure. In all the dogs, some rhythm- and conduction-disorders were noted, which lasted transiently and resumed to normal sinus rhythm. At autopsy, no gross injuries of the heart were detected, and microscopic examination showed no visible myocardial lesions. However, immunohistochemically, focal patchy loss of myocardial Mb, CK-BB and CK-MM was identified with scattered deposition of these substances between myocardial fibers elsewhere. Such changes as relaxed myofibrils with widened I band, contracted myofibrils and broken cristae of the mitochondria were observed in myocardial ultrastructure. Lanthanum particles deposited inside the mitochondria. These results indicate that increase in cardiac cell membrane permeability and ultrastructural damage in myocardium may be involved even in cardiac concussion. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.