Values of alkaline phosphathase and their isoenzyme profiles in patients with cancer in respect to bone and liver metastasis

Background: Alkaline phosphatase is a glycoprotein that catalyzes two kinds of chemical reactions: hydrolysis of phosphorus ester breaking P-O bonds and phospho-transfer reactions in which phosphoric group is transferred to an acceptor molecule. In the human body, ALP exists in multiple molecular forms whose heterogeneity is partly due to genetic factors and partly to posttranslational modifications. The aim was to evaluate a total ALP activity and its isoforms in cancer patients with bone and liver metastasis in comparison to healthy controls. Methods: Human serum was collected from 20 healthy individuals, and 20 cancer patients with bone and liver metastases, with metastases confirmed by ultrasound, computerized tomography and a radiology scan. Determination of ALP was done by the endpoint spectrophotometric method. Isoenzymes were determined by heat inactivation method. Results: In cancer patients, the total ALP activity was significantly higher (p< 0.05) compared to healthy controls. In the sera of cancer patients with liver metastases, the remaining ALP activity was two-fold higher in comparison to bone metastases. Conclusion: Determination of ALP isoenzymes is important but a correct clinical interpretation in the context of other analyses is vital for a proper diagnosis of a disease.

Acute Poisoning with Methidathion: A Case

An acute poisoning in a 50-year-old man who ingested approximately 6.2 g of the phosphorus ester methidathion is described. The patient was treated with three haemoperfusions 23, 44 and 115 h after ingestion, with continuous gastric lavage, atropine and pralidoxime administration and with prolonged mechanical ventilation. Haemoperfusion was an ineffective epuration technique since it removed only 0.22% of the ingested methidathion. The clinical course wavered because of a probable redistribution of phosphorus ester from fat to blood. A plasma level higher than 100 μg l-1 was associated with the most serious phases. Methidathion was present in the plasma until the sixth day, in the urine until the seventh and in the gastric juice until the eighth. Its absence in the fat biopsy made on the tenth day was an aid to therapy. The phosphorus ester did not inhibit lymphocyte neuropathy target esterase (NTE), neither did it induce development of delayed polyneuropathy.