Clinical aspects of early increase in serum gamma-glutamyl transferase in cerebral infarction

Granulocyte-colony-stimulating Factor for Acute Ischemic Stroke: A Randomized Controlled Trial (STEMTHER)

Granulocyte-colony-stimulating factor (G-CSF) functions both as a neuroprotectant and a stimulator of autologous bone marrow stem cell release. Therefore, administration of G-CSF should improve the outcome of stroke. Here, we examine the safety of using G-CSF to treat acute ischemic stroke using a randomized controlled trial involving 20 adult patients presenting with ischemia in the carotid region within 48 h of onset. The experimental group (n = 10) received subcutaneous G-CSF injections (10 mg kg(-1) day(-1)) in addition to conventional therapy for 5 days. The primary outcome was motor function as measured by the modified Rankin Scale 180 days post-stroke. Safety was evaluated according to the frequency of hemorrhagic transformation of infarctions and serious adverse events. Only six patients in the experimental group completed full course of treatment, while four patients (three in the control and one in the experimental group) were lost to follow-up. We found the experimental and control groups did not differ significantly in either neurological impairment or degree of disability/dependence at 180 days post-stroke. We conclude that while adding G-CSF (10 mg kg(-1) day(-1)) to acute ischemic stroke therapy for 5 days is safe, its efficacy remains unproven.

Association Between Serum Gamma-Glutamyltransferase Activity and Carotid Intima-Media Thickness

Serum gamma-glutamyltransferase (GGT) activity is a marker of oxidative stress and activity is associated with cardiovascular disease. Carotid intima-media thickness (IMT) is a noninvasive predictor of atherosclerosis. We investigated the association between serum GGT activity and carotid IMT. Fifty-five persons who had normal liver function tests were consecutively enrolled. Carotid IMT was evaluated in the right and left common carotid arteries. The averaged values of carotid IMT and serum GGT activity were compared. Serum GGT activity correlated with carotid IMT (r = .396, P = .003). Serum GGT activities were increased in patients with carotid intimal hyperplasia compared with those without intimal hyperplasia (20.3 ± 11.2 vs 34.3 ± 16.1 U/L; P = .001). Serum GGT activity is associated with carotid IMT. This finding supports the concept that elevated serum GGT activity is a marker of atherosclerosis.

Cholestasis in acute stroke: an investigation on its prevalence and etiology

OBJECTIVE

Liver cholestatic enzymes and/or bilirubin occasionally occur in acute stroke and are usually, but not always, ascribed to comorbid conditions. We investigated the frequency and possible etiology of this phenomenon.

MATERIAL AND METHODS

Prospective evaluation of post-admission biochemical cholestasis of all patients hospitalized with acute stroke was conducted during a 21-month period.

RESULTS

Of 169 consecutive patients, 18 (10.7%) developed cholestasis. In 7 of the patients (4.1%; 4 M, 3 F, median age 70 years, range 57-82 years) no apparent cause of cholestasis could be found, and they were further evaluated (Group A). These patients were compared with 21 randomly selected stroke patients without cholestasis, matched for age and gender, and who acted as controls (Group B). Group A patients were in a deeper coma than the controls (Glasgow Coma Scale 3.4 +/- 0.8 versus 1.9 +/- 0.7, p < 0.001), associated with severe autonomic and hypothalamic involvement, while no such manifestations were present in Group B (p < 0.001). Cholestasis started on the 3rd-6th day and lasted up to the 11th-25th day, with maximum median levels of gamma-GT and serum alkaline phosphatase (SAP) of up to 4.38 (range 2.33-8.25) and 1.49 (range 0.63-2.56) times the upper limit of normal, respectively. Serum alanine aminotransferase (ALAT), total and direct bilirubin increased in Group A but not in Group B. The common bile duct was significantly wider in Group A than in Group B (7.7 +/- 0.5 versus 4.7 +/- 0.6 mm, p < 0.001) and within Group A during and after cholestasis (7.7 +/- 0.5 versus 4.7 +/- 0.5 mm, p < 0.001).

CONCLUSIONS

Transient cholestasis may occur in 4.1% of patients following acute stroke. Cholestasis is associated with deeper coma, autonomic and hypothalamic involvement and common bile duct dilatation without obstruction, possibly related to inordinate hypertonia of the sphincter of Oddi.