Systematic Approach to the Patients with Elevated Liver Transaminase

Hepatic transaminase tests are the primary tests of standard laboratory panels in outpatients or emergent cases. In this retrospective study, epidemiological, clinical, and laboratory data of 223 patients who were hospitalized for elevated transaminase levels and acute liver damage between January 2004 and January 2009 were evaluated. The most frequently encountered viral cause of elevated transaminases was acute hepatitis B (HBV) (51%) infection. This was followed by acute hepatitis A (HAV) (30%), acute hepatitis C (HCV) (1%), delta co-infection (1%), and HAV plus HBV co-infections (0.5%). Other causes were alcoholic hepatitis (2%), acute cholecystitis and choledocholithiyasis (1.5%), and ischemic hepatitis due to congestive heart failure (1%). No causative factor was detected in 11% of the patients. Elevations in liver transaminas levels are common in routine practices, and should be evaluated accurately based on revised current knowledge in order to make correct diagnosis since they may reflect many underlying conditions. In the present study, the clinical conditions led to moderate and marked elevations in liver transaminase levels were indicated and the requirement of a systematic approach to these patients for the diagnosis was emphasized

Matrix Metalloproteinase Levels in Cervical and Intracranial Carotid Dolichoarteriopathies

Background: Matrix metalloproteinases (MMPs) are enzymes suggested as a possible candidate for pathogenesis of arterial dolichoarteriopathy (DA). We aimed to investigate the relationship between MMP levels and DA of intra-and extracranial carotid arteries. Methods: This study included 88 subjects admitted with headache, vertigo, or pulsatile tinnitus and those who underwent computed tomography angiography. The study group (n = 70) consisted of patients with kink-coiling (group I, n = 41) and patients with tortuosity (group II, n = 29). The control group (n = 18) had normal angiography results. The diameter, course, and geometry of the carotid artery were analyzed. Serum MMP-1, -2, -3, and -12 levels were measured in all subjects. Vascular risk factors for DA were also noted. Results: MMP-2 levels were significantly higher in the kink-coiling and tortuous groups than in the control group. In the study group (n = 70), MMP-12 levels were also significantly higher in patients with atheromatous plaques than in those without plaques. Diameters of arteries were meaningfully wider in the kink and tortuous groups than in the control group. Among vascular risk factors, hypertension and diabetes mellitus were more common in the kink group than in the control group, and there were significant differences between them. Conclusions: MMP-2 plays a role in the etiology of DA, and MMP-12 levels increase in carotid atherosclerotic lesions and may lead to plaque formation. We demonstrated that dilatation and tortuosity occur together