Alterations in Serum Creatine Kinase and Lactate Dehydrogenase: RESULTS

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Patient groups consisted of 15 patients admitted to the coronary care unit who were diagnosed as having an acute transmural myocardial infarction confirmed by serial ECGs. There were 13 patients identified with bowel necrosis. The patients with AMI and those undergoing major aortic reconstructions all had serum samples drawn as noted. Those patients who had bowel necrosis had fewer samples drawn because patients were taken to the operating room or died early in their hospital course as a result of the bowel infarction. Six patients with bowel necrosis had iso­enzyme determinations of LD and С К subsequent to their bowel infarctions. Two other patients had ad­vanced so far into their clinical courses of severe bowel infarction that their enzymes were deemed unreliable for isoenzyme analysis. These two patients had pro­found hypoperfusion syndromes which promoted gen­eralized decrease in perfusion of the entire body with resulting enzyme release from many organs. Only one patient subsequently survived a bowel infarction (Ta­ble 1).

Table 1—Summary of Clinical Patients with Necrotic Bowel

Patient No.	Age/Sex	Anatomic Area of Necrotic Bowel	Etiology	Confirmation and Outcome
1	67/M	Left colon (perforation)	Surgery: aortic reconstruction	Surgery (Resection)
				Survived
2	60/M	Left colon —mucosal slough	Surgery: aortic reconstruction	Autopsy
3	65/M	Right colon	Embolization during angiography	Surgery (Resection)
				Autopsy
4	80/F	Jejunum, ileum and right half	Embolus; mitral stenosis	Autopsy
		of colon
5	74/M	Jejunum, ileum and right half	Thrombosis of superior	Autopsy
		of colon	mesenteric artery
6	67/M	Jejunum and ileum	Emboli after cardiac	Surgery
			catheterization	Autopsy
7	56/M	1) Distal ileum and colon	Thrombosis and low flow due to	Surgery
		2) Small bowel and all of colon	atherosclerosis	Died
8	60/M	Six feet of ileum	Strangulated internal hernia	Autopsy

FIGURE 1. Serum total CK values for all three groups of patients in this study. Bars represent standard errors of the mean. The horizontal line at 100 IU/L represents the upper limit of normal for our laboratory. Note that all three groups started out with initial CK values which were comparable. Patients having either necrotic bowel or AMI had elevation of serum total CK within eight hours of admission. Their maximum values were reached between 16 and 24 hours after their clinical events. They then had a subsequent gradual decline in this measurement.

All three groups of patients had elevations in serum total CK (Fig 1). The patients who had AMI had the most rapid rise in serum total CK. Each of the groups, however, started out at comparable initial levels and had comparable values within the first 24 hours after their clinical events. The patients who underwent repair of abdominal aortic aneurysms did not show elevations above the upper limits of normal until the second sample taken on the evening of their operative day. These patients had elevated levels of serum total CK throughout the rest of the study course. The patients who had necrotic bowel had initial values on hospitalization which were within normal limits, but their subsequent values rose within 8 hours after admission and reached a maximum on the first hospital day. The values for these patients have been plotted only through the second day since they proceeded into a terminal hypoperfusion syndrome (sepsis) and/ or went to surgery for correction. Hence, there were few samples to measure from these patients more than 48 hours after the onset of the bowel infarction. Pa­tients who were admitted with AMI had elevations on their 8 hour samples (sample 1), and reached maxi­mum levels on the samples taken between 18 and 22 hours after their myocardial infarctions. Day 2 actually represented their first full hospital day and should be viewed as a period of time from 24 to 48 hours after the clinical event. The differences between the groups were not statistically significant in the first three days as determined by the Wilcoxon rank-sum test. erectalis 20

Table 2—Changes in Serum CK and its Isoenzymes (All Values Are Mean Maximal Values)

	Total CK	CK-MB	CK-MB	CPK-BB
	(IU/L±SEM)	(IU/L± SEM)	(%± SEM)	(%±SEM)
Acute MI (N-15)	689 ±159	166 ±59	19.5 ±2.3*	0
Bowel necrosis	786 ±284	192 ±20	12.8± 1.5	4.3±0.8
Major aortic reconstruction (N = 13)	367 ±51	12 ±7	3.1±1.3	0
Upper limits of normal	100	<50	<5	0

Electrophoretic isoenzyme determinations allowed the serum CK-MB levels to be expressed as a per­centage of the total CK. Two groups had elevations above the upper limits of normal (5 percent), the patients who experienced AMI and those having necrotic bowel (Fig 2). Maximum values from CK-MB percent were reached by 16 hours after the clinical event in both groups. The patients who had AAS had elevated levels within 12 hours after surgery that were within the upper range of normal (less than 5 percent) and these elevations did not exceed the upper limit of normal at any time throughout the study. In the first three days of the study, there was no difference in the CK-MB percent between the patients having AMI and those having MES INF. Both groups, however, were different from those patients who had major reconstructions of the abdominal aorta (p<0.001). viagra plus

FIGURE 2. Serum CK-MB expressed as a percentage of the serum total CK for each of the three groups studied. Bars represent standard error of the mean. All three groups started with mean values below 5 percent. The AAS group had minimal elevations which were not significantly different from preoperative determination. The AMI and MED INF groups rose to higher levels than the AAS group in the first day (p<0.01). The AMI group was significantly higher than the other two groups only during the first day. The AMI and MES INF groups were not statistically different from one another by the day 2 samples.