Outpatient paediatric fibreoptic proctosigmoidoscopy: possible and useful.

Interestingly, serum creatine kinase BB measured by radioimmunoassay, was abnormal in this patient (figure). Brain-type creatine kinase BB is present in astrocytes and, at a lower concentration, in other tissues. In cases of proved macroscopic brain injury very high enzyme levels may be detected within hours.3 Here, highest levels were observed after 48 hours, possibly when hypoxic cells developed structural changes due to continuing ischaemia. Previously we found transient abnormalities of creatine kinase BB and MB in marathon runners without neurological deficits.4 In this instance creatine kinase MB was normal while the BB isoenzyme remained high and then fell, correlating with clinical improvement.