Significance of molecular diagnostics for therapeutic decision-making in recurrent glioma

Background

Targeted therapies have substantially improved survival in cancer patients with malignancies outside the brain. Whether in-depth analysis for molecular alterations may also offer therapeutic avenues in primary brain tumors remains unclear. We herein present our institutional experience for glioma patients discussed in our interdisciplinary molecular tumor board (MTB) implemented at the Comprehensive Cancer Center Munich (LMU).

Methods

We retrospectively searched the database of the MTB for all recurrent glioma patients after previous therapy. Recommendations were based on next-generation sequencing results of individual patient's tumor tissue. Clinical and molecular information, previous therapy regimens, and outcome parameters were collected.

Results

Overall, 73 consecutive recurrent glioma patients were identified. In the median, advanced molecular testing was initiated with the third tumor recurrence. The median turnaround time between initiation of molecular profiling and MTB case discussion was 48 ± 75 days (range: 32-536 days). Targetable mutations were found for 50 recurrent glioma patients (68.5%). IDH1 mutation (27/73; 37%), epidermal growth factor receptor amplification (19/73; 26%), and NF1 mutation (8/73; 11%) were the most detected alterations and a molecular-based treatment recommendation could be made for all of them. Therapeutic recommendations were implemented in 12 cases (24%) and one-third of these heavily pretreated patients experienced clinical benefit with at least disease stabilization.

Conclusions

In-depth molecular analysis of tumor tissue may guide targeted therapy also in brain tumor patients and considerable antitumor effects might be observed in selected cases. However, future studies to corroborate our results are needed.

CD4+ immune response as a potential biomarker of patient reported inflammatory bowel disease (IBD) activity

BACKGROUND

Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBDs) which are characterized by dysfunctional regulation of the immune system. A number of immune modifying drugs are used to treat CD and UC. Therapy is adjusted largely on the bases of subjective reports of disease activity and non-specific laboratory tests. Identification of a single or combination of immune markers of disease activity could be useful to select and monitor therapeutic responses. However, to date no reliable quantitative associations between IBD activity and laboratory measures of immune function have been identified. This study was designed to evaluate the usefulness of a commercially available laboratory measure of CD4(+) immune function, the Cylex® ImmuKnow®, as a surrogate marker of IBD activity.

METHODS

Adult IBD patients with either CD (N=55, 27 males, mean, SD age=38.5, 11.5 years) or UC (N=45, 24 males, mean, SD age=41.7, 15.4 years) were enrolled. Patients both in clinical remission and with active disease provided responses to structured, validated questionnaires (CDAI and HBI for CD patients and SCCAI for UC patients) used to monitor IBD activity. Whole blood and plasma samples were collected to quantify various markers of disease status including routine cell counts and differentials (CBCs), CRP, and albumin (Alb), as well as CD4(+) immune response (Cylex® ImmuKnow®, N=98). Results were compared between all IBD patients as well as between CD and UC subgroups.

RESULTS

There was a good correlation between the results of CDAI and HBI scores (r=0.811, p<0.01, Spearman-Rho) but HBI scores correlated slightly better (r=0.575, p<0.001) than the CDAI's (r=0.449, p=0.001) with CD patients' reported perception of their general condition. CDAI and HBI scores categorized 12/55 versus 36/55 of CD patients respectively as having active disease. SCCAI scores indicated that 25/45 of UC patients had active disease. Cylex® results (in ng/mL of ATP) were increased in 74/98 IBD subjects (≥525 ng/mL) but were influenced by the use of systemic corticosteroids (SCS) and infliximab. There were weak but statistically significant Spearman-Rho correlations between Alb concentrations and both CDAI (r=0.413, p=0.002) and HBI (r=0.325, p=0.017) scores as well as between CRP values and HBI scores (r=0.331, p=0.016). Correlations between CRP and both CDAI and SCCAI scores and between Alb and SCCAI scores were not significant and there were no significant positive associations between any of the three clinical scores and Cylex® results.

CONCLUSIONS

CD4(+) immune responses were significantly elevated in IBD patients whether or not they were in clinical remission but were influenced by treatment. There were some significant correlations between the clinical scores and CRP or Alb but not with the CD4(+) results. Both other clinical scoring systems, other measures of immune function, and CD4(+) immune response changes over time should be examined to see if this or other laboratory measures of immune response are predictive of actual disease activity or symptoms in CD or UC patients.

PD06-09: Early Predictors of Prolonged Unemployment after a Diagnosis of Breast Cancer

Introduction: Low-income women may be more vulnerable to job loss and prolonged work absence after a diagnosis of breast cancer than their higher-income counterparts. This can have important adverse financial consequences on breast cancer survivors. The identification of early risk factors for long-term unemployment could inform interventions to help patients avoid this outcome. Methods: A consecutive sample of 921 low-income, underinsured or uninsured, English and/or Spanish-speaking women treated for breast cancer through the California Breast and Cervical Cancer Treatment Program was recruited and surveyed 6 months after a diagnosis of breast cancer. Participants completed follow-up telephone surveys at 18, 36, and 60 months post-diagnosis; 539 remained in the cohort at 60 months. This analysis includes only the 315 (58%) women who were employed before diagnosis. Our primary study outcome was prolonged unemployment, defined as being unemployed at every survey. Baseline characteristics (measured in the 6-month survey) were compared between women with prolonged unemployment and those who were working 60 months after diagnosis. Results: The median age of the study sample was 50, and 98% had a baseline annual household income &lt; $40,000. Eighty-five of 315 (27%) women who were employed before diagnosis had prolonged unemployment after diagnosis. In contrast, 168 (53%) were working at 60 months. Baseline predictors of prolonged unemployment after diagnosis include lower household income (p=0.003), inadequacy of financial resources to cover needs (40% vs. 23%, for inadequate vs. adequate, p=0.006), lower education (43%, 30%, and 23% among those who did not complete high school, had a high school diploma, and had a college diploma, respectively, p=0.04), higher comorbidity burden (p=0.006), higher cancer stage at diagnosis (p=0.001), and receipt of chemotherapy (p=0.008). Variables found not to be associated with prolonged unemployment include age, ethnicity, acculturation, marital status, children in the home, social support, job type, type of breast surgery, type of axillary surgery, endocrine therapy, and radiation therapy. In a multivariable analysis that included ethnicity, education, income, chemotherapy, and comorbidity, the latter three variables remained statistically significant predictors of prolonged unemployment, but education and ethnicity were not significantly associated with the outcome. Discussion: More than a quarter of women treated for breast cancer never returned to work during the five years after their diagnosis. In this low-income sample, those with the lowest income appeared to be especially vulnerable to prolonged unemployment, even when controlling for education. It is possible that the income provided by a low-paying job provides a marginal benefit, if any, over disability income, and additional research is needed to better understand this relationship and its financial and psychosocial consequences. Clinical variables also were important predictors of prolonged unemployment. Women with a higher comorbidity burden and those treated with chemotherapy appear to be most vulnerable to prolonged unemployment. This may have clinical implications for informed decision-making between oncologists and their patients.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr PD06-09.

Persistent effects of cognitive-behavioral stress management on cortisol responses to acute stress in healthy subjects--a randomized controlled trial

Psychosocial stress leads to a release of cortisol. While this psychoneuroendocrine response helps to maintain physiological as well as psychological equilibrium under stress, exaggerated secretion of cortisol has been shown to have negative effects on somatic health and cognitive functioning. The study set out to examine the long-term effects of cognitive-behavioral stress management training on cortisol stress responses in healthy men and women. Eighty-three healthy subjects were randomly assigned to cognitive-behavioral stress management (CBSM) training or a control condition. Four months after the CBSM, 76 subjects underwent a standardized psychosocial stress test. Salivary cortisol responses were assessed repeatedly before and after the stress test. Subjects in the CBSM group showed significantly reduced cortisol stress responses. With regard to gender, this effect was observed in both men and women. However, the magnitude of the CBSM effect on cortisol responses was smaller in women than in men. Use of oral contraceptives in women influenced the cortisol response, but did not have an impact on the CBSM effect on cortisol. The results show that the previously reported attenuation of cortisol stress responses through CBSM persists and are observable in both men and women. Since stress-induced alterations of hypothalamus pituitary adrenal axis functioning are discussed to be involved in the onset and maintenance of both somatic and psychiatric conditions, similar interventions could be used for prevention and therapy of these detrimental stress effects.

Granulocyte function in patients with L-ferritin iron-responsive element (IRE) 39C-->T-positive hereditary hyperferritinaemia-cataract syndrome

BACKGROUND

Hereditary hyperferritinaemia-cataract syndrome (HHCS) is an autosomal dominant trait associated with mutations in the iron responsive element (IRE) of the ferritin light-chain (L-ferritin) gene. Patients typically show elevated serum ferritin concentrations without iron overload and a bilateral cataract. Hyperferritinaemia can be associated with granulocyte dysfunction in patients with thalassemia beta and in haemodialysis patients. The effect of increased L-ferritin levels on granulocyte function in patients with HHCS is unknown.

MATERIAL AND METHODS

We examined glucose uptake, oxidative burst, chemotaxis, phagocytosis, apoptosis and intracellular calcium concentrations in polymorphonuclear leucocytes (PMNLs) of five affected members of a family with HHCS and in five healthy individuals matched for age and gender.

RESULTS

Mutation testing revealed a 39C-->T transition in IRE in all five patients with HHCS. Serum ferritin levels of patients ranged between 907 and 2030 microg L(-1), respectively. In comparison with healthy individuals, PMNLs of patients with HHCS showed a significant increase in PMA-mediated stimulation of the oxidative burst, as well as a significantly higher stimulation of glucose uptake but no difference with respect to chemotaxis, phagocytosis, apoptosis and intracellular calcium concentrations.

CONCLUSION

In summary, our study suggests that hyperferritinaemia in patients with IRE 39C-->T-positive HHCS is associated with activation of PMNLs but not with disturbance of fundamental PMNL function.

[Quality control after hernia operation]

QUESTION

An important feature in surgery is the absence of wound infection after elective sterile operation. That's why the VQG (Verein zur Qualitätssicherung im Gesundheitswesen) from Berne recommends as a standard control the surveillance of wound healing, where hernia repair is suited for a tracer operation [1].

METHOD

In our hospital retrospectively all 106 patients of the year 1999 were asked by a questionnaire, 3 month after operation, if their wound healed primarily or if they noticed any signs of infection or even had to be re-operated again.

RESULTS

Most hernias were indirect (71) or direct (11), followed by umbilical hernias (11), epigastric or incisional hernias (4), femoral hernias (2). The majority of procedures were a Shouldice repair (43), followed by mesh implantation according to Lichtenstein (33) or Bassini repair (15). 14 times an umbilical or epigastric hernia was operated by Mayo's method. One Stoppa operation was performed. 7 Hernias were incarcerated at the time of operation. 51 hernias were on the right, 41 on the left side, 5 on both sides. Mean age of patients was 52.9 years; mean duration of hospital stay was 4.42 days. After Shouldice repair hospital stay was 3.9 days with an average patients age of 48.3 years, after Bassini 5.41 days (mean age 46.4 years), after Lichtenstein repair 5.23 days (mean age 66.0 years). 82 (77.4%) from 106 patients returned the questionnaire. 67 (81.7%) were completely satisfied, 11 (13.6%) mentioned minor problems. So 95.1% had a normal primary wound healing without infection. There was no correlation between wound healing, type of hernia, age, hospital stay, surgeon or method of operation. In the same study other complications occurred (e.g. 5% recurrences of hernias, nerve lesions), that could not be integrated into the evaluation because they were excluded by definition.

CONCLUSION

Studying the tracer "wound healing after groin hernia repair" allows an approximate follow-up for quality control with little expense. Because of the narrow point of view and the neglect of other complications in the same investigation we estimate the power of the result as limited.

Glucagon-producing neuroendocrine tumour associated with hypoaminoacidaemia and skin lesions

A nine-year-old neutered female crossbred Bernese mountain dog was diagnosed with superficial necrolytic dermatitis and a glucagon-producing islet cell tumour. Laboratory findings included hyperglucagonaemia and hypoaminoacidaemia. The dog was euthanased because of progression of the disease, and necropsy revealed liver metastases of a neuroendocrine carcinoma with immunohistochemical expression of glucagon and somatostatin. This report represents a case of canine glucagonoma syndrome; the previously reported cases in dogs are also briefly described.

The phytoestrogens Genistein and Daidzein, and 17 beta-estradiol inhibit development of neointima in aortas from male and female rabbits in vitro after injury

BACKGROUND

17 beta-Estradiol and phytoestrogens are known to have beneficial effects on the cardiovascular systems of women. The exact mechanisms for how estrogens and phytoestrogens influence the cardiovascular system are not yet understood in detail.

OBJECTIVE

The objective of this study was to investigate whether 17 beta-estradiol and the phytoestrogens Genistein and Daidzein have an effect on post-injury processes in vessel walls.

METHODS

In this in-vitro experiment, the sex-specific effects of 50 micrograms/ml 17 beta-estradiol (equivalent to 180 mumol/l), and of the isoflavones Genistein (5 and 50 micrograms/ml, equivalent to 18.5 and 185 mumol/l), and Daidzein (5 and 50 micrograms/ml, equivalent to 19.7 and 197 mumol/l) on endothelium-denuded aortas from female and male rabbits after vascular injury were studied. Morphometry and immunohistochemistry were performed for quantitative and qualitative analysis.

RESULTS

Neointimal cells were in part positive for alpha-actin staining of smooth muscle cells. Staining with 5'-bromo-2'deoxyuridine plus 2'-deoxycytidine showed that proliferative activity in the neointima had significantly decreased after 28 days for groups that had been treated with 50 micrograms/ml Genistein. Immunofluorescence staining for the expression of nuclear estrogen receptor protein in the arterial wall for aortic rings from female and male rabbits was positive. 17 beta-Estradiol, Genistein, and its analog Daidzein (with no protein tyrosine kinase activity) inhibited formation of neointima sex-independently at equivalent concentrations of 50 micrograms/ml. However, a concentration of 5 micrograms/ml Genistein decreased formation of neointima significantly for aortic rings from male rabbits only, whereas 5 micrograms/ml Genistein increased formation of neointima in rings from female rabbits, which corresponded to the increase in proliferative activity detected after 28 days.

CONCLUSION

Genistein and Daidzein both inhibited proliferation at certain concentrations, so this effect is supposed to be independent from Genistein's protein tyrosine kinase activity. The antiproliferative properties of all three estrogens were observed in the absence of endothelium and therefore are independent from endothelium-mediated effects.

Effect of omeprazole treatment on plasma concentrations of the gastric peptides, xenin, gastrin and somatostatin, and of pepsinogen

The peptide xenin 25 is a gastric mucosal constituent like gastrin, somatostatin and pepsinogen. Gastrin and pepsinogen plasma concentrations increase when the secretion of gastric acid is reduced by proton pump inhibitors. In the present investigation, treatment with omeprazole led to an increase in fasting and postprandial plasma concentrations of xenin, gastrin and pepsinogens A and C (P < 0.05, in each instance), whereas somatostatin plasma levels remained unchanged. Because subcutaneous injection of pentagastrin did not raise xenin plasma concentrations, a direct effect of gastrin on xenin production seems unlikely. This study indicates that xenin plasma concentrations are regulated by intragastric pH, as are those of gastrin and pepsinogen.

Gastroenteropancreatic effects of xenin in the dog

Xenin is a 25 amino acid peptide detected in the gastric mucosa of various mammals. It has since been found in low concentrations in other tissues. Xenin plasma concentrations increase after meals. The present study reports some gastroenteropancreatic effects of this peptide in the dog. Intravenous infusion of 64 pmol/kg min synthetic xenin significantly inhibited pentagastrin-stimulated gastric acid secretion and stimulated exocrine pancreatic secretion of volume and protein. Further, intravenous infusion of xenin in a dose of 1.0 pmol/kg min stimulated jejunal motility in the anaesthetized dog. An intravenous infusion of 32 pmol/kg min xenin raised plasma concentrations of pancreatic polypeptide, vasoactive intestinal polypeptide, insulin and glucagon. The present experiments therefore indicate manifold bioactive properties of intravenously infused xenin in the dog, with jejunal motility the most sensitive target. Conclusions as to the physiological role of xenin cannot be drawn from the present experiments. The release of other hormonal peptides indicates a complex action of xenin.

[Abnormal increase in pancreatic polypeptide in the secretin-provocation test: hypoglycemia-induced?]

Pancreatic polypeptide (PP) can be used as a marker for endocrine active tumors originating from the pancreas. After intravenous administration of secretin, individually divergent increases in plasma PP concentration can be observed hampering interpretation of the stimulation test. Under certain circumstances elevated basal PP concentrations can be observed. Besides age, renal insufficiency and diabetes, hypoglycemia can cause high PP levels. We therefore inquired whether in patients with atypically high increase of PP after secretin this increase could be caused by hypoglycemia during the secretin stimulation test. In order to test this hypothesis we prospectively determined the plasma glucose and insulin concentrations in addition to the routinely measured gastro-intestinal hormones in 19 patients referred for secretin provocation test. In the 16 patients in whom the increase of PP was not due to an endocrine active tumor or renal insufficiency, PP rose to 170 +/- 57 pmol/l (+/- SEM) 2 minutes after secretin administration. In parallel, plasma insulin concentration increased to 365 +/- 51 pmol/l 2 minutes after secretin. The maximal insulin concentrations correlated significantly with the PP concentrations observed at the same time (R = 0.73, p < 0.01). The mean glucose concentration, however, remained constantly between 4.8 +/- 0.3 and 5.2 +/- 0.3 mmol/l and there was no correlation between the peak plasma PP concentrations after secretin and the plasma glucose concentrations (R = 0.07). The minimal glucose concentrations observed were 3.3 mmol/l in three patients (30 minutes after secretin in 2 patients and 45 minutes after secretin in one). The mean plasma glucagon concentration rose to 22.5 +/- 4.1 pmol/l 10 minutes after secretin.(ABSTRACT TRUNCATED AT 250 WORDS)

[Gastrointestinal hormone profile in medullary thyroid carcinoma]

Medullary thyroid carcinoma (MTC) can be important for gastroenterologists because 20-30% of patients with MTC suffer from chronic diarrhea and the tumor is capable of producing--besides other bioactive substances--a multitude of gastroenteropancreatic hormones. Gastrointestinal hormone profiles of 5 patients with MTC were determined both basally and after intravenous stimulation with secretin and calcium respectively. Diagnosis of MTC was confirmed histologically or cytologically and by demonstration of elevated serum concentration of calcitonin both basally and after calcium stimulation. 4/5 patients had chronic diarrhea. Normal values or only borderline increases were found for the following hormones: vasoactive intestinal polypeptide (VIP), neurotensin, substance P, growth hormone releasing hormone (GRH), glucagon, neurokinin A, peptide YY, and pancreatic polypeptide. Somatostatin was elevated after calcium stimulation in 1/5 patients only. The main findings were increased basal concentrations for GAWK in 5/5 patients and elevated concentrations for gastrin-releasing peptide (GRP, human bombesin) after calcium stimulation in 4/5. Probably as a consequence of the GRP increase, an increase in gastrin occurred in parallel, indicating bioactivity of the GRP released from the tumor. Besides calcitonin as the main tumor marker for MTC, determination of GAWK and GRP seems to provide helpful additional markers in laboratory diagnosis of MTC. GRP determination after i.v. calcium infusion allowed identification of patients with normal basal plasma GRP concentration.

[Long-term follow-up of surgically treated intra-articular calcaneus fractures]

Between 1980 and 1991 we treated 150 joint fractures of the os calcis with open reduction and internal fixation with a special AO-plate. In this report we show the results of 36 fractures in 33 patients after an average follow-up of 89 months (43-132). Patients got back their working ability between 4.6 and 5.6 months. At the time of the clinical control two third of the patients had a working ability of 100%. 4 patients changed their profession due to the poor result of the fracture. 12% of the cases ended in spontaneous or secondary arthrodesis of the lower ankle joint. One third of the patients need orthopedic supports or special shoes. 73% of the patients are satisfied with the result.

[The gamma nail--an ideal implant for treatment of unstable fractures in elderly patients]

Altogether we used the Gamma-Nail in 150 cases. We show here a series of 50 instable pertrochanteric femur fractures in very old patients which we treated with a Gamma-Nail. All cases started with full weight bearing at the 4th day after operation. A clinical and radiological control 12 weeks later shows good mobilisation of the hip in 70% of the cases. Shortening of the operated leg is rare in comparison of cases treated with a DHS. Two thirds of the patients returned after dismission of the hospital to the old social situation. The advantages in treating instable pertrochanteric femur fractures with the Gamma-Nail are immediate full weight bearing without risks of shortening of the operated leg and the closed reduction of the fracture.

[Stable interlocking intramedullary nailing of humeral fractures with the Seidel nail]

22 fractures of the humerus (15 traumatological, 7 pathological) were treated with the Seidel-Nail. The results after a follow-up between 4 and 20 months showed good mobility of the shoulder. As major complications two paresis of the radial nerve occurred. One disappeared spontaneously. The Seidel-Nail is a good implant for all kind of shaft fractures with an intact distal fragment of 5 cm and also for fractures of an intact humerus head.

[The gamma-nail as a resilient alternative to the dynamic hip screw in unstable proximal femoral fractures in the elderly]

In a prospective randomised trial between September 1989 and June 1990 one hundred patients with per- and subtrochanteric fractures were consecutively treated by gamma-nail or DHS. The average age of both groups was about 80 years. The operation time for gamma-nailing was longer than for DHS implantation and also the postoperative blood loss was higher in the gamma-nail group. We found no difference of intraoperative blood loss, of perioperative lethality and in duration of hospital care. 90% of gamma-nail patients and 80% of DHS patients were successfully able to walk four days after operation with full weight bearing on the operated limb. Three patients in the DHS group with unstable fractures got cranial perforation of the cephalic screw mobilisation. Five patients of the gamma-nail group were reoperated, one case because of missed distal locking, one because of cranial perforation of the cephalic screw after varus dislocation of the proximal fragment. One patient suffered intraoperatively a proximal femur shaft fracture which was corrected during operation. In one case a wound hematoma was evacuated, an other patient needed secondary wound closure. Despite technical imperfection of implant and instruments, we conclude that the gamma-nail allows a very high percentage early and full weight bearing immediately after operation. So we consider that in the treatment of unstable pertrochanteric fractures of geriatric patients, the gamma-nail has proven to be more efficient than the DHS.

[The Gamma Nail in per- and intertrochanteric femoral fractures--alternative or supplement to the dynamic hip screw? A prospective randomized study of 100 patients with per- and intertrochanteric femoral fractures in the surgical clinic of the City Hospital of Triemli, Zurich, September 1989 - June 1990]

In a prospective randomised trial between September 89 and June 90 one hundred patients with per- and subtrochanteric fractures were consecutively treated by Gamma-nail or DHS. The average age of both groups was about 80 years. The operation time for Gamma-nailing was longer than for DHS-implantation and also the postoperative blood loss was higher in the Gamma-nail-group. We found no difference of intraoperative blood loss, of perioperative letality and in duration of hospital care. 90% of Gamma-nail-patients and 80% of DHS-patients were successfully able to walk four days after operation with full weight bearing on the operated limb. Six patients (12%) with DHS had to be reoperated within 6 weeks. Three patients with unstable fractures got cranial perforation of the cephalic screw after mobilisation. The other three patients had soft tissue complications. Five patients (10%) of the Gamma-nail-group were reoperated, one case because of missed distal locking, one because of cranial perforation of the cephalic screw after varus dislocation of the proximal fragment. One patient suffered intraoperatively a proximal femur shaft fracture which was corrected during operation. In one case a wound hematoma was evacuated, an other patient needed secondary wound closure. Despite technical imperfection of implant and instruments, we conclude that the Gamma-nail allows a very high percentage early and full weight bearing immediately after operation. So we consider that in the treatment of unstable pertrochanteric fractures of geriatric patients, the Gamma-nail has proven to be more efficient than the DHS.

Relative trochanteric overgrowth after ischemic necrosis in congenital dislocation of the hip

To determine the relative trochanteric overgrowth after ischemic necrosis of the femoral head during treatment of congenital dislocation of the hip (CDH), we reviewed radiographs of patients with ischemic necrosis and no femoral side surgery. The articulotrochanteric distance (ATD) was recorded after physeal closure. Ischemic necrosis was classified with the systems proposed by Salter et al. and Kalamchi and MacEwen. The resultant overgrowth was correlated with these systems. The articulotrochanteric distance in 29 patients with a Trendelenburg gait was also measured. The Kalamchi classification is more useful for predicting relative trochanteric overgrowth. Children with an ATD of less than or equal to 0 mm are likely to have a Trendelenburg gait.

[Campylobacter pylori colonization of the antrum: effect of gastrin, somatostatin, pancreatic polypeptide and neurotensin]

Campylobacter pylori (C.p.) infection is often found in patients with antral gastritis and peptic ulcer disease. Pathophysiological links are still unclear, and we therefore tested the hypothesis whether C.p. affects the gastrointestinal peptides and thus influences gastric acid secretion and protective factors. 94 patients were examined by upper GI endoscopy and blood analyzed for gastrin, somatostatin, pancreatic polypeptide and neurotensin. Biopsies of antral mucosa were investigated for C.p. in urease testing, culture and microscopy. C.p. was found in 42 patients (45%). In microscopy all of these patients had chronic gastritis (100%). A significant increase in gastrin uninfluenced by C.p. was found in patients with antral gastritis (normal: 6.4 +/- 0.7, [n = 27]; gastritis without C.p.: 18.4 +/- 5.9 [p less than 0.02], [n = 7]; gastritis with C.p.: 10.7 +/- 2.2, [n = 22]). Somatostatin, pancreatic polypeptide and neurotensin showed no difference.

[Computed tomography of intra-articular calcaneal fractures]

The increasing number of operations on intraarticular calcaneal fractures created the need for a fast, reproducible method to examine the weight-bearing posterior talo-calcaneal joint. High resolution CT scanning in an almost coronal plane without reformating was done in 25 calcaneal fractures. Joint alignment and fragment dislocation were demonstrated more precisely than would have been possible with conventional studies. Three typical fractures were found: The lambda type, the y type and the comminution type. Follow-up studies showed osteo-arthritis, intraarticular degenerative changes of the articular surface and impingement of personeal tendons as possible causes of pain.

Production, characterization and clinical application of antisera to cortisol

In the present paper the production of highly specific and sensitive antisera to cortisol is described. The antisera were generated in rabbits using both cortisol-3-monooxime and cortisol-3,20-dioxime derivatives. Bovine thyroglobulin was used as a carrier protein. Antibody characteristics were determined by radioimmunoassay procedure. Antibody titers observed after immunization with the monooxime conjugate were significantly higher (p less than 0.001) than those obtained with the dioxime conjugate. In addition, cross reactivity for various naturally occurring steroids was markedly lower and sensitivity was increased as compared to dioxime antisera (15 vs. 40-60 pg/tube). Accuracy and precision were calculated for the monooxime antiserum used in a RIA system for clinical application. A close correlation (r = 0,9802) was found between plasma cortisol values measured by radioimmunoassay and the competitive protein binding method. The concentrations obtained by the protein binding method were slightly but significantly higher than those measured by radioimmunoassay indicating higher specificity of the antibody used (p less than 0.005).