To develop reference ranges for creatine kinase (CK) appropriate for the patient population served by this hospital, levels of serum CK were measured in 1,537 individuals in our employee population. There was substantial heterogeneity in mean, median, and range of CK levels among the several race/gender subgroups in the population studied. The race/gender subgroups could be placed into three broad groups: a high CK group, composed solely of black men; an intermediate CK group, consisting of nonblack men plus black women; and a low CK group, comprised of nonblack women. Mean CK level of the high CK group was twice that of the intermediate CK group, which, in turn, was twice that of the low CK group. Differences in mean CK values among the subgroups placed into either the intermediate CK group or the low CK group were not significant when tested with analysis of variance. Therefore, practical reference ranges for these groups are as follows: 52-520 U/L for the high CK group; 35-345 U/L for the intermediate CK group; and 25-145 U/L for the low CK group.

In a study of the effects of heart failure on the responses of cardiac receptors, ten dogs were subjected to tricuspid avulsion and pulmonary artery stenosis. One case of spontaneous heart failure was included in the series, and the electrical spike responses of atrial receptors to progressive changes in atrial stretch induced by infusion and hemorrhage were contrasted with those in normal control dogs. In the control dogs, the number of spikes per cycle increased very sharply with moderate, i.e., 5-10 cm H 2 O, venous pressure increments before reaching a maximum at 20 cm H 2 O. In the experimental dogs, the firing rate failed to increase to the same extent despite large increases in pressure. The resulting sets of curves exhibited a sharp dichotomy. This evidence for the impaired response of elements of the subendocardial receptor network is compatible with a decrease in the sensitivity of feedback mechanisms responsible for the regulation of sodium and water metabolism.

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