How can treatment response be measured in breast cancer patients?

Serum TPS, CA 15-3 and CEA levels were measured in 31 women when progressive metastatic disease was established according to UICC criteria. A method was developed to apply these serum tumor markers in order to measure the short-term effect of the treatment. Using strict criteria, whereby an increase of the markers of more than 25% indicated progressive disease and a decrease of more than 50% indicated a positive effect of the treatment, TPS (which measures tumoral activity) was shown to be a more sensitive and earlier marker for measuring treatment response than CA 15-3 and CEA (which measure tumor mass).

Gallstone size and the risk of gallbladder cancer

The relation between gallstone size and gallbladder cancer was investigated in a matched hospital-based case-control study of surgical patients in a predominantly white population. Stone size was considered to be an indicator of the damaging effects of gallstones on gallbladder mucosa, which may enhance carcinogenesis. A radiologist determined the size of the largest gallstone within the gallbladder by reviewing hard copies of the ultrasonographic examinations of cases and controls. Between 1983 and 1989, 83 surgical patients with gallbladder cancer were identified in 18 participating hospitals. Hard copies were available for 72 patients and 208 matched controls. For 43 cancer patients and 98 matched controls stone size could be determined. In contrast to two other studies, no relation was found between stone size and gallbladder cancer. The reasons for this discrepancy are discussed.

TPS in breast cancer--a comparative study with carcinoembryonic antigen and CA 15-3

The serum levels of tissue polypeptide antigen were determined using the M3 monoclonal antibody (TPS) and compared with the serum levels of carcinoembryonic antigen (CEA) and breast carcinoma antigen 15-3 (CA 15-3) in 96 patients with benign breast tumors, in 25 breast cancer patients with no evidence of disease, in 139 preoperative breast cancer patients and in 298 samples of 25 breast cancer patients during therapy monitoring (4-22 samples per patient). The 95th percentile of TPS in 89 apparently healthy females was 51 U/l. The 95th percentile of TPS in patients with benign breast tumors was 55 U/l. The maximum TPS level in breast cancer patients with no evidence of disease was 56 U/l. In preoperative breast cancer the number of patients with TPS levels above the 95th percentile of TPS in benign breast tumors was significantly higher in stage III breast cancer as compared with stage I+II. This was not established for CEA and CA 15-3. During therapy monitoring TPS followed the course of the disease faster than CEA and CA 15-3 in patients with bone metastases, liver metastases, lung metastases and pleural effusion, with one exception. TPS levels could be correlated with progression of disease in patients with normal and steady levels of CEA and/or CA 15-3.

Herniography in 79 patients with unexplained pain in the groin: a retrospective study

To assess the safety and accuracy of herniography for the diagnosis of inguinal hernia in young military men with unexplained pain in the groin, a retrospective study in 79 patients with unexplained pain in the groin who underwent a herniography is presented. Nineteen patients (24%) showed a positive herniogram which was confirmed in 15 out of 16 patients who subsequently underwent surgery. All 60 (76%) patients with a negative herniography were followed-up. An inguinal hernia was subsequently found at surgery in two patients out of eight who were operated on later. In our series no serious complications occurred. Herniography has been shown to be a safe and reliable method to demonstrate or exclude an inguinal hernia in young military men with unexplained pain in the groin. The differential diagnosis in this specific patient group is discussed.

Pre-operative tumour marker levels in patients with breast cancer and their prognosis

The serum levels of carcino-embryonic antigen, tissue polypeptide antigen (TPA), breast carcinoma antigen 15-3 and mucin-like carcinoma-associated antigen were measured pre-operatively in 99 patients with breast cancer receiving no adjuvant hormonal or chemotherapy and in 64 patients with benign breast tumours. Using the 95th percentile of the marker levels in patients with benign breast tumours as the cut-off level, marker levels in patients with breast cancer were related to prognosis. In the follow-up period of 6-36 months (mean = 17.9 months), 20 out of the 99 patients developed metastases. Only 4 out of these 20 patients had elevated pre-operative levels of one or more of the markers. One out of these 4 patients was misclassified having metastatic disease at the time of the operation. On the other hand, in a total of 28 patients the pre-operative levels of one or more markers were noted to be elevated; 26 of the patients remained disease-free at the time of follow-up.

Antibiotic sclerotherapy for renal cysts

Seven patients with a large symptomatic renal cyst were treated by aspiration under US guidance and injection of a tetracycline solution (5-8 ml; 1%). All patients were relieved of complaints directly after treatment and US follow-up revealed complete remission or only small residual cysts after one week to twenty-one months. The combination of a strong sclerosing action with a long-acting local antibiotic prophylaxis gives tetracycline an advantage over other sclerosing agents, especially in patients with impaired renal function.

Real time (US) scanning of palpable lesions in the soft tissues (muscles and tendons) of the extremities

The results of real time ultrasound (US) examination of palpable lesions located in the muscle and tendon area of the extremities are reported in a series of 67 patients. The US appearance of various lesions is described. The contribution of real time US (B mode) during muscular contraction to the diagnosis and the results of diagnostic fine needle punctures (FNP) and their value are discussed.

Interlaboratory investigation on the CEA assay (Roche) with column filtration, dialysis and ultrafiltration techniques

An interlaboratory study on the reproducibility of the CEA (Roche) RIA Test was carried out. Four different plasma pools of approximately 2, 3, 6, and 12 micrograms/l CEA were tested over a period of 4 weeks with 4 different lots of reagents in order to determine the interassay variances. At the same time we compared the lately introduced column technique with the dialysis and ultrafiltration method. Best results were obtained with the column technique which also showed best reproducibility. Only 1.4% of samples showed deviations greater than 5% between the mean of CEA duplicates and single CEA values, and these were omitted from the evaluation. On the other hand about 15% of the corresponding dialysis results showed deviations greater than 5% and were excluded from the evaluation. The methods compared showed a good correlation with a coefficient of 0.96, but the average values for the CEA determination, using the columns technique were lower than those obtained from dialysis. Interassay variances were greater for the dialysis procedures, i.e. 1.88 +/- 0.81, 3.25 +/- 0.83, 5.81 +/- 1.09, and 11-91 +/- 1.23 compared with 1.77 +/- 0.54, 2.63 +/- 0.68, 4.89 +/- 0.79, and 11.16 +/- 1.23 for the column technique. There were no systematic changes of the CEA values over the period of 4 weeks, thus giving optimal conditions for a follow up of patients.