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Alpha2-HS glycoprotein (AHSG), also known as fetuin-A, is a plasma protein displaying high-affinity interaction with calcium phosphate, by which ectopic vascular calcification is prevented. This investigation has attempted to evaluate the relationship between AHSG polymorphism and serum levels of AHSG and calcium-related parameters. AHSG levels in unrelated individuals were measured by quantitative rocket immunoelectrophoresis and were 581+/-38, 542+/-31, and 494+/-23 mg/l for three major genotypes of AHSG1 homozygotes (n=99), heterozygotes (n=55), and AHSG2 homozygotes (n=22), respectively (differences were significant: P0.001). The circulating AHSG level was therefore influenced by the genetic polymorphism with the additive reduction in the AHSG2 allele. Statistical analysis of simple and multiple regression models revealed no associations between AHSG levels and serum values of total calcium, albumin-corrected total calcium, and ionized calcium. However, the AHSG levels demonstrated a significant negative correlation with free phosphate levels (P0.001), indicating that AHSG is a novel determinant of serum phosphate. The AHSG polymorphism is attributable to the hereditary variation of AHSG and phosphate serum levels, which may affect skeletal development and chronic disorders such as vascular calcification.

Intracerebral Hemorrhage (ICH) can be seen in patients with acute leukemia, however, it is extremely rare to present ICH as the initial presentation in previously undiagnosed acute leukemia. Only four cases were reported in the English literature. This 17-year-old male was admitted with sudden onset of headache, nausea and vomiting. Three days before this admission, he visited an ophthalmological department for bilateral blurred vision. Bilateral retinal hemorrhages were detected by the funduscopic examination; however, further examinations were not performed at that time. On arrival at our hospital, his Glasgow Coma Scale was 8 (E2, V3, M3) and urgent head CT scan showed multiple Computed Tomography (CT) head demonstrated multiple ICHs. On admission, his White Blood Cell (WBC) count was 584,000/μl with evidence of blast crisis, and platelet count was 18,000/μl. Despite urgent platelet and plasma transfusions, his conscious level deteriorated, and the patient died 12 hours after the admission due to respiratory failure. The importance of correct diagnosis and early management of leukemia is emphasized, which may prevent blast crisis and disseminated intravascular coagulation leading to fatal ICH.

This report documented three autopsy cases involving fatal shock during intravenous injection of therapeutic and diagnostic agents in a hospital setting. For postmortem diagnosis, clinical laboratory parameters for anaphylaxis, specificity of antibodies for allergens and mast cell numbers in tissue sections were examined. Elevated plasma tryptase levels were evident in the three adult males; two of the three victims displayed elevated IgE levels. However, immunoassay failed to detect antibodies specific to the relevant agent. Double immuno-staining was performed employing anti-tryptase and anti-chymase monoclonal antibodies in order to count mast cells in lung sections. Increased numbers of mast cells were observed in anaphylactic tissues, which was particularly true for chymase-positive cells, in comparison with tissues associated with acute traumatic deaths. In addition to findings at autopsy, positive data obtained by laboratory examinations and immunohistochemical analyses indicated that fatal systemic anaphylaxis occurred during intravenous injection of clinical agents.

Chymase, a serine protease, is stored mainly in secretory granules of human mast cells. Serum chymase concentration was examined in 8 autopsy cases with anaphylaxis as well as in 104 control cases without anaphylaxis. It was detected in all 8 cases with anaphylaxis (range 3-380 ng/ml, mean 89.8 ng/ml), while it was detected in only 2 of the 104 controls and was below a detectable level (

Prolactin-inducible protein (PIP), also known as gross cystic disease fluid protein 15, is a predominant secretory protein in various body fluids, including saliva, milk and seminal plasma. Immunohistochemistry of this protein has been exploited as a clinical marker for breast cancer and Paget's disease. This study comparatively examined PIP expression in normal prostate tissues and in adenocarcinomas of the prostate. Quantitative real-time RT-PCR revealed low-level presence (6%) of PIP mRNA in normal prostate tissue in comparison with the seminal vesicle. Indirect immunostaining with monoclonal antibody 3E7 displayed a positive sign for benign epithelium in 8 cases (29.6%) among 27 normal specimens; however, the incidence significantly increased to 56.1% (37/66) in instances involving primary prostate carcinoma tissues of different types. Quantitative RT-PCR also demonstrated that PIP transcript levels in carcinoma regions were significantly higher than corresponding levels in benign regions. These findings conclusively showed that benign prostate epithelium expresses PIP at low levels; in contrast, PIP is over-expressed in carcinomas of the prostate.