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Editor-in-chief
Maria Stella Graziani
Deputy Director
Martina Zaninotto
Associate Editors
Ferruccio Ceriotti
Davide Giavarina
Bruna Lo Sasso
Giampaolo Merlini
Martina Montagnana
Andrea Mosca
Paola Pezzati
Rossella Tomaiuolo
Matteo Vidali
EIC Assistant
Francesco Busardò
International Advisory Board
Khosrow Adeli Canada
Sergio Bernardini Italy
Marcello Ciaccio Italy
Eleftherios Diamandis Canada
Philippe Gillery France
Kjell Grankvist Sweden
Hans Jacobs The Netherlands
Eric Kilpatrick UK
Magdalena Krintus Poland
Giuseppe Lippi Italy
Mario Plebani Italy
Sverre Sandberg Norway
Ana-Maria Simundic Croatia
Tommaso Trenti Italy
Cas Weykamp The Netherlands
Maria Willrich USA
Paul Yip Canada
Publisher
Biomedia srl
Via L. Temolo 4, 20126 Milano
Responsible Editor
Giuseppe Agosta
Editorial Secretary
Chiara Riva
Biomedia srl
Via L. Temolo 4, 20126 Milano
Tel. 0245498282
email: biochimica.clinica@sibioc.it
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ISSN print: 0393 – 0564
ISSN digital: 0392- 7091
BC: Articoli scritti da G. Passerini
La diagnosi di liquorrea nasale e post-chirurgica
Diagnosis of cerebrospinal fluid (CSF) rhinorrhoea and of post-surgical CSF leakage
<p>Pathological CSF leakage outside central nervous system is a very dangerous situation with high risk of meningitis and cerebral abscess. Rhinorrhoea and post-surgical CSF leakage are the most frequent conditions. Diagnosis is made by combination of imaging procedures, radionucleide cisternography via lumbar puncture (fluorescein) and biochemical tests, which utilize markers suggesting the presence of CSF in suspected fluid. Low CSF glucose concentrations suggest rhinorrhoea, as glucose is absent in nose secretion, but cannot be used in post-surgical leakage, as blood is nearly almost present. CSF proteins are the best biomarkers and intrathecal synthesized <span style="font-family:symbol">b</span>-trace protein and transferrin are the best choice. For quantitative analysis, nephelometric <span style="font-family:symbol">b</span>-trace protein measurement has the best performance, as it can be easily automatically performed, also for stat analysis, but relatively high volume of sample is needed. Isoelectricfocusing or high resolution electrophoresis followed by immunodetection are the most sensitive and specific methods for detecting asialotransferrin, but they are time consuming, unsuitable for stat analysis, even if they need low amounts of sample. Other quantitative tests include prealbumin/albumin ratio, having insufficient sensitivity in blood contaminated samples, and zone electrophoresis of protein pattern that, however, has too low sensitivity. New methods like capillary electrophoresis have been recently proposed.</p>
<p>The laboratory investigation of CSF has been developed over the years as a diagnostic tool for many neurological diseases. Although minimally invasive, CSF is obtained with a traumatic procedure; therefore, the whole laboratory process should be established to maximize the analytical performance. Based on the review of international guidelines and on the experience developed by members of the SIBioC Working Group, the present document provides practical information for laboratory professionals to better address the CSF analysis in different diagnostic situations. The report faces the pathophysiologic meaning of the determination of biochemical parameters, such as glucose, lactate, albumin, immunoglobulins, <span style="font-family:symbol">b</span>-amyloid, tau protein, and the cellular content, providing also evidence on the proper methodological approach. Quantitative and qualitative CSF parameters useful to diagnose an inflammatory process of the central nervous system are discussed, particularly with reference to multiple sclerosis. Indications on how laboratory data should be presented to meet international recommendations are also included.</p>
Biochimica Clinica ; 38(1) 74 Lettere all'Editore - Letters to the Editor
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