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Abstract
The aim of this study was to monitor serum and perfusate levels of myoglobin (MB)
and creatine kinase (CK) during isolated limb perfusion (ILP) in order to identify
those at risk of renal failure. We investigated the release of MB and CK in 40 patients
who underwent ILP for melanoma (n = 15) or sarcoma (n = 25) using rhTNFα/melphalan (n = 28) or a triple-drug regimen (n = 12). Serial determinations of CK and MB were performed in both perfusate and systemic
circulation during and after ILP and renal function was assessed. A significant increase
of MB could be detected in the perfusate during ILP. After ILP, an up to 100-fold
increase with a double peak of MB at 4 h and 24 h postoperatively was observed. The
maximum elevation of serum activity of CK was at 30 h. The increase for both proteins
was highly significant (P < 0.001). ILP with rhTNFα/melphalan yielded significantly (P < 0.001) higher serum values of MB and CK and also the impairment of the renal function
was more pronounced. The peak values of MB after ILP occur early and allow the patients
most at risk of developing renal failure to be identified. Rhabdomyolysis can be detected
early by determination of MB from the perfusate. Further measurements twice daily
for 2–3 days post ILP from serum samples as well as daily assessment of MB in the
urine is helpful for detecting myoglobinuria and imminent renal failure.
Keywords
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Article info
Publication history
Accepted:
December 10,
1996
Received in revised form:
November 1,
1996
Received:
August 20,
1996
Footnotes
☆Part of this work was presented at the Annual Meeting of the American Society of Clinical Oncology (ASCO), Dallas, May 14–17, 1994; and published in abstract form (A1652).
Identification
Copyright
© 1997 Published by Elsevier Inc.