Volume 41, Issue 3

Zusammenfassung Ausgehend von der kasuistischen Beobachtung einer zweigipfligen Albuminbande in der Serumproteinelektrophorese wird die Bisalbuminämie als angeborene oder erworbene Proteinanomalie nach Durchsicht der Literatur in einer Kurzübersicht dargestellt. Nach einer Einführung zur Bisalbuminämie werden deren Nachweismethoden, funktionelle und klinische Bedeutung sowie Befundinterpretation behandelt. Bei der Bisalbuminämie handelt es sich um eine seltene neutrale Normvariante ohne Symptom- bzw. Krankheitswert, die keiner weiteren Abklärung bedarf.

Background: Endocan was shown to be a possible predictor of vascular endothelium related diseases. Due to this fact we aimed to investigate the role of maternal serum endocan levels in preeclampsia presence and severity. Methods: A total of 70 patients, including 25 normal pregnant women and 45 patients with preeclampsia (consists of 25 mild and 20 severe preeclamptic women), were included in this study. Maternal serum endocan concentrations were measured and compared among groups and subgroups. Results: Levels of endocan were detected statistically higher in the preeclamptic group than the control group. Endocan levels were lower in the severe preclampsia group than the mild preeclampsia group but this was not detected statistically significant. Conclusions: Maternal serum endocan levels can be used as a biomarker for preeclampsia presence.

Background: The primary aim of this study was to investigate the diagnostic values of serum S100 calcium-binding protein B (S100B) and proenkephalin (P-ENK) levels in brain damage caused by traumatic brain injury (TBI). Methods: We prospectively collected serum blood samples of 58 adult patients admitted to our emergency department due to TBI. Serum S100B and P-ENK levels were measured and compared according to clinical findings and outcomes of the patients. Results: When patients with brain injury were compared to controls, statistical significance was determined in both S100B and P-ENK levels. According to the receiver operating characteristic (ROC) analysis, cut-off values for serum S100B and P-ENK levels for the differential diagnosis of patients with and without brain damage were found to be 785.944 ng/mL and 2.445 ng/mL, respectively. There was a statistical significance in both S100B and P-ENK levels when patients who were discharged and those who died were compared. Conclusions: Serum S100B and P-ENK levels are found to be elevated in patients with TBI when compared to controls. Additionally, serum levels of both markers are found to be elevated in patients with multiple lesions when compared to patients with a single lesion. Serum S100B and P-ENK levels may also be used as predictors of mortality in patients with TBI.

Background: Leptin and adiponectin play an important role during normal gestation; they are implicated in energy metabolism, glucose utilization and inflammation. Osteocalcin is released into circulation during bone formation; it also affects glucose metabolism by regulating insulin secretion and sensitivity, possibly mediated by adiponectin. The aim of this study was to explore the longitudinal changes of leptin and adiponectin in pregnancy, and their associations with lipid profile, insulin and bone formation parameters in late pregnancy. Methods: Leptin, adiponectin, lipid status parameters, C-reactive protein (CRP), insulin, 25-hydroxyvitamin D, osteocalcin and procollagen type 1 aminoterminal propeptide (P1NP) were measured in the sera of 38 healthy pregnant women. The samples were obtained in the 1 st , 2 nd , early and late 3 rd trimester, and post-partum. Results: Leptin was significantly increased in the 3 rd trimester. The decrease of adiponectin was significant only in postpartum. Osteocalcin and P1NP increased in the late 3 rd trimester and postpartum. Leptin was significantly positively correlated with body mass index (BMI), uric acid, insulin, osteocalcin, P1NP and CRP in the 3 rd trimester; adiponectin was positively correlated with high-density lipoprotein (HDL) cholesterol, and negatively with BMI, glucose, osteocalcin, triglycerides and insulin. Multiple regression analysis showed that only HDL is independently associated with adiponectin. Conclusions: The results of our study suggest complex interactions of leptin and adiponectin with glucose, lipid and bone metabolism during pregnancy. Adiponectin might be part of the protective systems that counterbalance a transient proatherogenic state observed in pregnancy mainly by improving the HDL levels. The exact mechanisms and potential implications in pathological states of pregnancy remain unexplained and require further investigation.

Background: About 2/3 of the hemoglobin (Hb) variants do not show a charge difference to the wildtype entity but most of them differ in hydrophobicity. In addition to cation exchange chromatography, globin differentiation by liquid chromatography-tandem mass spectrometry (MS) was introduced. Hb Ullevaal was chosen as one example to demonstrate the performance of the approach. Methods: Screening for Hb variants was performed using cation exchange HPLC. For globin separation reversed phase-LC/MS was performed. Tryptic digests of variants were separated on RP-HPLC with or without CID-fragmentation and database search for identification of mutation bearing fragments. Sequencing of the β-globin gene has been performed. Results: HbS, HbC, HbE, Hb South Florida and Hb Ullevaal show typical and distinct patterns in the globin LC/MS according to the theoretical protein data. The tryptic digest of Hb Ullevaal resulted in the identification of the respective mutated peptide βT9, which was confirmed by genetic sequencing. Conclusions: By the application of globin-LC/MS two more dimensions for the Hb identification are added, hydropathicity and protein mass. With this workflow as screening procedure for Hb variants it is expected to be able to detect and identify the majority of variants with the exception of highly unstable variants, which cannot be determined in the peripheral blood at all. A negative result makes the presence of a significant Hb variant in the peripheral blood improbable.

Background: We aim to determine the relationships among vitamin B 12 , folic acid, homocysteine (Hcy), and methylenetetrahydrofolatereductase (MTHFR) C677T polymorphism, as well as the clinical importance of these relationships, in patients using valproic acid (VPA), carbamazepine (CBZ), and levetiracetam (LEV) as monotherapy and polytherapy. Methods: We enrolled 37 patients on VPA, 30 on CBZ, 31 on LEV, 30 on multidrug therapy, and 60 control subjects. We compared the levels of vitamin B 12 , folic acid, Hcy and polymorphism. Results: Vitamin B 12 was low in patients on CBZ (p=0.02) and in combined CBZ and VPA (p=0.02). B 12 was low in combined CBZ and VPA (p=0.05). In patients without polymorphism, Hcy was high on VPA (p=0.02), and folic acid was the low on CBZ (0.005). In patients with polymorphism, vitamin B 12 was low on CBZ (p=0.02), and folic acid was low on VPA (p=0.04). Vitamin B 12 was low in combined CBZ and VPA (p=0.05). Conclusions: Vitamin B 12 therapy is necessary on CBZ and on combined CBZ and VPA. VPA should not be used in the presence of other thrombophilic risk factors because of hyperhomocysteinemia. Polytherapy does not increase hyperhomocysteinemia risk in comparison to monotherapy. Vitamin B 12 , folic acid, Hcy do not effect on seizure frequency.

Background: Behçet’s disease (BD) is a systemic vasculitis of all types of vessels of both the venous and arterial sites. Mean platelet volume (MPV) is the most commonly used measure of platelet (Plt) size and is also a potential marker of Plt activity. In this study, we wanted to evaluate the MPV value and the MPV/Plt ratio in patients with deep venous thrombosis (DVT) in BD. Methods: Overall, 228 patients – 49 BD patients with a thrombotic complication and 179 BD patients without a thrombotic complication (as the control group) – were included the study. Results: Of the 49 patients with thrombosis, there was a very significant difference between the genders: 41 (83.6%) were males while only eight (16.4%) were females (p<0.0001). There was a statistically significant difference among the patients with and without thrombosis according to the median MPV value and the MPV/Plt ratio (p<0.0001). Conclusions: Increased MPV can predict the risk of DVT development as well as the male sex among BD patients. The MPV/Plt ratio may also be used for predicting DVT.