C. R. K. Hind

Measurement of serum C-reactive protein concentration in myocardial ischaemia and infarction.

Serum C-reactive protein (CRP) and creatine kinase (CK) MB levels were measured prospectively in patients with definite myocardial infarction, patients with spontaneous or exercise-induced angina, subjects undergoing coronary arteriography, and patients with non-cardiac chest pain. All individuals with infarction developed raised CRP levels and there was a significant correlation between the peak CRP and CK MB values. The CRP, however, peaked around 50 hours after the onset of pain at a time when the CK MB, which peaked after about 15 hours, had already returned to normal. In 20 patients who recovered uneventfully, CRP levels fell, returning to normal about seven days after infarction in four cases who were followed to this point. In eight complicated cases, including four who died within the first 10 days, the CRP level remained high. Angina alone or coronary arteriography did not cause a rise in the CRP or CK MB concentrations. Increased CRP production is a non-specific response to tissue injury and raised CRP levels in cases of chest pain with a normal CK MB indicated a pathological process other than myocardial infarction. Regular monitoring of CRP levels may also assist in early recognition of intercurrent complications occurring after myocardial infarction.

Specific Chemical Dissociation of Fibrillar and Non-Fibrillar Components of Amyloid Deposits

In systemic amyloidosis, a fatal disorder for which there is no effective treatment, the extracellular protein deposits are composed of amyloid fibrils together with a non-fibrillar glycoprotein, amyloid P component (AP). Methyl 4,6-O-(1-carboxyethylidene)-beta-D-galactopyranoside (MO beta DG), a recently identified ligand for AP, was tested for its ability to produce in-vitro elution of AP which had been laid down with amyloid fibrils in vivo. Millimolar concentrations of MO beta DG completely dissociated AP from human and murine splenic amyloid deposits. Availability of this material thus provides for the first time the opportunity for specific molecular dissection of amyloid deposits. If MO beta DG or a related substance were effective in vivo it might be of therapeutic importance.

Serum C-reactive protein measurement in the detection of intercurrent infection in Oriental patients with systemic lupus erythematosus.

In a prospective study serum C-reactive protein (CRP) concentrations were measured during 28 febrile episodes in 27 Oriental patients with systemic lupus erythematosus (SLE). Although active SLE was associated with only a modest rise in serum CRP level, intercurrent infection provoked substantially higher levels. Serum CRP thus provides a sensitive objective test for this complication in SLE patients of all ethnic groups.

Plasma leucocyte elastase concentrations in smokers

The associations between cigarette smoking, plasma leucocyte elastase concentration, peripheral leucocyte count and FEV1 were examined in 148 men, 72 of whom were current cigarette smokers, 40 of whom were ex-smokers, and 36 who had never smoked. All men were part of a long-term survey. Smokers had significantly higher plasma leucocyte elastase concentrations than ex-smokers or those who had never smoked. Mean current FEV1 was lower, and the annual decline in FEV1 in the preceding 10 years was faster in smokers than the other two groups. A few smokers had slight increases in serum C-reactive protein concentrations. Although peripheral blood leucocyte counts were higher in smokers than in non-smokers or ex-smokers, no association was found in any of the three groups of men between plasma elastase concentration and peripheral leucocyte count, nor between either of these two variables and annual decline in FEV1 or current level of FEV1. There was also no relation between plasma elastase concentration and reported daily cigarette consumption or mixed expired carbon monoxide in smokers. The results indicate that some male smokers have increased in vivo release of elastase from peripheral blood neutrophils at a time when there is no evidence of acute infection. Because leucocyte elastase is a strong candidate for pulmonary tissue damage, further studies of the mechanisms that increase plasma concentrations are indicated.

Objective monitoring of disease activity in polyarteritis by measurement of serum C reactive protein concentration.

Serial measurements of the serum concentration of C reactive protein were made in 27 patients with polyarteritis over six years. The concentration was invariably raised when the disease was active, even in patients receiving immunosuppressive treatment, and fell rapidly in association with clinical remission induced by immunosuppression. During periods of complete remission, in the absence of any intercurrent condition, the value remained within the normal range. The correlation between C reactive protein concentration and disease activity was much closer than that between erythrocyte sedimentation rate and disease activity. These results indicate that serial measurement of the serum C reactive protein concentration fills the urgent need for an objective index of the activity of polyarteritis and its response to treatment.

Serum C-reactive protein concentration in the management of infection in patients treated by continuous ambulatory peritoneal dialysis.

In a prospective study over 21 months, serum C-reactive protein (CRP) concentration was measured serially in 39 consecutive patients undergoing continuous ambulatory peritoneal dialysis. All patients with peritonitis mounted a CRP response, and the height of the response correlated well with the severity and extent of the peritoneal damage. Patients who recovered uneventfully after antimicrobial treatment showed a prompt fall in CRP from its peak value towards normal. In contrast, each patient in whom the serum CRP value remained raised after antimicrobial treatment had a complicated course. During routine outpatient follow up the serum CRP value remained within the normal range in the absence of intercurrent complications. These results, together with the commercial availability of rapid and precise assays for CRP, indicate that serial CRP measurements may be useful in monitoring the efficacy of antimicrobial treatment during episodes of peritonitis and in the recognition of intercurrent complications in patients undergoing continuous ambulatory peritoneal dialysis.

Serum C-reactive protein response to therapeutic embolisation: Possible role in management

In a prospective study over 12 months, serum C-reactive protein concentration was measured serially in 20 consecutive patients who underwent therapeutic embolisation for various forms of malignancy and in 13 patients who had diagnostic coeliac or hepatic angiography without embolisation. All the patients who underwent successful embolisation showed a C-reactive protein response and in all cases the height of the response correlated well with the estimated size of the embolised tumour. Patients who recovered uneventfully showed a prompt fall in C-reactive protein from its peak values towards normal. In contrast, patients undergoing angiography alone showed only a minor increase in C-reactive protein concentration unless there were intercurrent complications. These results, together with the commercial availability of rapid and precise assays for C-reactive protein, indicate that serial measurement may be useful in the confirmation of tissue necrosis and assessment of its extent; also in the recognition of intercurrent complications following therapeutic embolisation.

TREATMENT OF WEGENER'S GRANULOMATOSIS

cholestyramine group and 187 in the controls-a reduction of 19%, significant at the 5% level on a one-tailed t test (a two-tailed test is usually considered essential in a trial of treatment). 7% of the treated men and 8 6% of the controls had heart attacks, an advantage of 1 per 400 treated men per year-a figure that applies to a high-risk group (0 8% of those screened). In England and Wales, ifthe results apply to women, 192 000 people would qualify for treatment, reducing the annual number of CHD events by 480. Compare that with the 152 000 CHD deaths recorded in England and Wales each