Spinal fluid

Up to 20 mL of spinal fluid can be safely removed from an adult, although this amount is not usually required. Antiglycolytic agents usuaEy are not added to the tube for glucose measurement rapid processing of specimens, a cEn-icai requirement for tests on spinal fluid, ensures that little metaboEsm of glucose occurs even in the presence of many bacteria. To allow proper interpretation of spinal fluid glucose values, a simultaneous blood specimen should be obtained. 

---

Transport. Transcobalamin II dehvers the absorbed vitamin 3 2 to cells and is the primary plasma vitamin B22-binding transport protein. It is found in plasma, spinal fluid, semen, and extracellular fluid. Many cells, including the bone marrow, reticulocytes, and the placenta, contain surface receptor sites for the transcobalamin II—cobalamin complex. 

Marken-artikel, m. standard article. -Si, n. branded oil. -schutz, m. trade-mark protection. -werkatoff, m. branded material. Markette, /. virgin wax in cake form. MarkflUssigkeit, /. spinal fluid. 

The drug is metabolized rapidly in the liver, kidney, intestinal mucosa, and even red blood cells. Therefore it has a plasma half-life of only 10 min after bolus intravenous application. The major metabolite, uracil arabinoside (ara-U), can be detected in the blood shortly after cytarabine administration. About 80% of the dose is excreted in the urine within 24 h, with less than 10% appearing as cytarabine the remainder is ara-U. After continuous infusion, cytarabine levels in the liquor (cerebro-spinal fluid) approach 40% of that in plasma. Continuous infusion schedules allow maximal efficiency, with uptake peaks of 5-7 pM. It can be administered intrathecally as an alternative to methotrexate. 

FIGURE 29-1. The blood-brain barrier selectively inhibits certain substances from entering the interstitial spaces of the brain and spinal fluid. It is thought that certain cells within the brain form tight junctions that prevent or slow the passage of certain substances. Levodopa passes the blood-brain barrier, whereas dopamine is unable to pass. 

A generalized systemic illness may accompany HIV seroconversion (Cooper et al. 1985). Guillain-Barre syndrome (GBS) (Piette et al. 1986), unilateral (Wiselka et al. 1987) or bilateral facial palsies (Wechsler and Ho 1989), bibra-chial palsy (Calabrese et al. 1987) and sensory neuropathy (Denning 1988) have been reported to occur during this process, usually within 1-2 weeks of the acute febrile illness. Spinal fluid analysis may show a mild to moderate mononuclear pleocytosis and a mild increase in protein levels. The precise relationship to HIV viral load in the cerebrospinal fluid (CSF) or plasma is unknown (Brew 2003). There is no proven therapy, but most patients recover spontaneously without any treatment. 

The identification of bacteria has traditionally required the establishment of a pure culture before any other steps are taken. Pure cultures of bacteria may sometimes be obtained from blood and spinal fluid, which are normally sterile, or from extreme environments like hot springs. However, because there are few such situations in nature, individual bacteria must generally be isolated from other cells and grown for one to five days to obtain pure cultures before identification. Some pathogenic bacteria are obligate intracellular parasites that are difficult or impossible to grow outside their mammalian host cells 37 for these, pure cultures are not feasible. 

Laterra, L. and Goldstein, G.W., Ventricular organization of cerebral spinal fluid blood-brain barrier, brain edema, and hydrocephalus, in Principles of Neuroscience, 4th ed., Kandel, E.R., Schwartz, J.H., and Jessell, T.M., Eds., McGraw-Hill, New York, 2000, appendix B. 

D.G. Georganopoulou, L. Chang, J.M. Nam, C.S. Thaxton, E.J. Mufson, W.L. Klein, and C.A. Mirkin, Nanoparticle-based detection in cerebral spinal fluid of a soluble pathogenic biomarker for Alzheimer s disease. Proc. Natl. Acad. Sci. U.S.A. 102, 2273-2276 (2005). 

The manifestations of inflammation with deep-seated infections such as meningitis, pneumonia, endocarditis, and urinary tract infection must be ascertained by examining tissues or fluids. For example, the presence of polymorphonuclear leukocytes (neutrophils) in spinal fluid, lung secretions (sputum), and urine is highly suggestive of bacterial infection. 

Blood cultures should be performed in the acutely ill, febrile patient. Less accessible fluids or tissues are obtained when needed to assess localized signs or symptoms (e.g., spinal fluid in meningitis, joint fluid in arthritis). Abscesses and cellulitic areas should also be aspirated. 

Recently, most of the methods which have been used for the analysis of valproic acid in plasma, serum, cerebral spinal fluid, saliva, breast milk, and urine involve acidification of the biological sample, extraction into an organic solvent, and direct injection onto a gas-liquid chromatographic column (28, 29, 16, 30, 31, 32,... 

While levels of endrin or endrin metabolites can be measured in tissue and excreta, thereby serving as biomarkers of exposure, the analytical techniques required are somewhat sophisticated and non-routine. Further, measurements of endrin in blood are best suited for detecting recent exposures because endrin is cleared rapidly from blood. The lack of persistence of endrin in human tissues and blood seen in the study of Coble et al. (1967) indicates a brief half-life for endrin on the order of 1-2 days. Sera levels of endrin (time to sample not specified) in Pakistani patients who were poisoned with endrin ranged from 0.3 to 254 ppb (0.3-254 pg/L) survivors had sera levels that ranged from 1.3 to 17.4 ppb (1.3-17.4 pg/L) (Rowley et al. 1987). An endrin concentration of 0.3 ppb was detected in the cerebro-spinal fluid. 

Prednisolone was observed to be effective in ameliorating the headache seen in 3 workers with elevated cerebral spinal fluid pressure and papilledema resulting from exposure to high levels of chlordecone (Sanborn et al. 1979). However, when prednisolone therapy was stopped, the headaches returned and did not dissipate until serum chlordecone levels were reduced. It is possible that the prednisolone blocked the headache by increasing vasoconstriction and decreasing intracranial cerebral spinal fluid volume. 

McNay EC, Sherwin RS. 2004. From artificial cerebro-spinal fluid (acsf) to artificial extracellular fluid (aecf) microdialysis perfusate composition effects on in vivo brain ecf glucose measurements. J Neurosci Methods 132(1) 35-43. 

Spinal anesthesia Spinal anesthesia is the introduction of local anesthetics directly into the spinal fluid, which causes a sympathetic blockage, or loss of feeling as well as muscle relaxation resulting from the interaction of anesthetic with every spinal nerve tract. This method is used during major surgical interventions. As a rule, lidocaine, mepivacaine, and bupivacaine are used for this purpose. 

Phenothiazines may increase serum cholesterol, spinal fluid protein, and urinary urobilinogen levels decrease protein bound iodine yield false-positive urine bilirubin tests interfere with urinary ketone and steroid determinations. 

Syphilis Primary, secondary, and /afenf with a negative spinal fluid (adults and children >12 years of age)... 

Late (tertiary, neurosyphilis, and latent syphilis with positive spinal fluid examination or no spinal fluid examination)... 

Carnosine is also associated with nervous tissues, including the brain, where it is concentrated especially in the olfactory lobe (Bonfanti et al., 1999 de Marchis et al., 2000). However, human cerebral spinal fluid contains homocamosine but no carnosine (Huang et al., 2005). 

Cystatin C (Formerly Post-y-globulin, y-Trace Protein). Cystatin C is a new parameter in a spinal fluid and serum (plasma), originating from glial elements and belonging to so-called trace proteins. Its increasein CSF is considered to be a marker of tissue destruction. Assessment of cystatin C in serum (plasma) is a marker of renal glomerular filtration. 

B3. Berner, J. J., Ciemins, V. A., and Schroeder, E. R, Radial immunodiffusion of spinal fluid Diagnostic value in multiple sclerosis. AJCP 58, 145-152 (1972). 

---