D. P. Derman

The effects of fruit juices and fruits on the absorption of iron from a rice meal

The effects of the chemical composition of fruit juices and fruit on the absorption of iron from a rice (Oryza sativa) meal were measured in 234 parous Indian women, using the erythrocyte utilization of radioactive Fe method. The corrected geometric mean Fe absorptions with different juices varied between 0.040 and 0.129, with the variation correlating closely with the ascorbic acid contents of the juices (rs 0.838, P less than 0.01). Ascorbic acid was not the only organic acid responsible for the promoting effects of citrus fruit juices on Fe absorption. Fe absorption from laboratory orange juice (100 ml water, 33 mg ascorbic acid and 750 mg citric acid) was significantly better than that from 100 ml water and 33 mg ascorbic acid alone (0.097 and 0.059 respectively), while Fe absorption from 100 ml orange juice (28 mg ascorbic acid) was better than that from 100 ml water containing the same amount of ascorbic acid (0.139 and 0.098 respectively). Finally, Fe absorption from laboratory lemon juice (100 ml orange juice and 4 g citric acid) was significantly better than that from 100 ml orange juice (0.226 and 0.166 respectively). The corrected geometric mean Fe absorption from the rice meal was 0.025. Several fruits had little or no effect on Fe absorption from the meal (0.013-0.024). These included grape (Vitis vinifera), peach (Prunus persica), apple (Malus sylvestris) and avocado pear (Persea americana). Fruit with a mild to moderate enhancing effect on Fe absorption (0.031-0.088) included strawberry (Fragaria sp.) (uncorrected values), plum (Prunus domestica), rhubarb (Rheum rhaponticum), banana (Musa cavendishii), mango (Mangifera indica), pear (Pyrus communis), cantaloup (Cucumis melo) and pineapple (Ananas comosus) (uncorrected values). Guava (Psidium guajava) and pawpaw (Carica papaya) markedly increased Fe absorption (0.126-0.293). There was a close correlation between Fe absorption and the ascorbic acid content of the fruits tested (rs 0.738, P less than 0.0001). There was also a weaker but significant correlation with the citric acid content (rs 0.55, P less than 0.03). Although this may have reflected a direct effect of citric acid on Fe absorption, it should be noted that fruits containing citric acid also contained ascorbic acid (rs 0.70, P less than 0.002).(ABSTRACT TRUNCATED AT 400 WORDS)

Significance of serum concentrations of carcinoembryonic antigen, ferritin, and calcitonin in breast cancer

Serum concentrations of carcinoembryonic antigen (CEA), ferritin, and calcitonin were measured in 107 patients with breast cancer, 80 of whom had overt or occult metastatic disease. CEA and ferritin values were statistically higher in those patients with metastases. In contrast, there was no correlation between calcitonin concentrations and the stage of the disease. All 27 subjects with CEA concentrations greater than 80 μg/liter and 32 of 40 with values between 41–80 μg/liter had metastatic disease. Ferritin was a definite but less sensitive discriminator, with metastatic disease present in all nine patients having concentrations greater than 400 μg/liter. Such metastases were invariably hepatic. When the two measurements were used as a combined discriminant, the diagnostic accuracy increased somewhat. All 32 patients with a CEA concentration greater than μg/liter and/or a ferritin concentration greater than 400 μg/liter had metastatic disease; the same was true for 32 of the 42 subjects with CEA concentration between 41–80 μg/liter and/or a ferritin concentration between 200–400 μg/liter. The measurements had prognostic value, both when assessed alone and together, with a median survival from the time of study significantly shorter in those with the highest values.

Relationship between Absorption of Inorganic and Food Iron in Field Studies

Food iron absorption data on 853 Indian women were compared to the haemoglobin concentrations, other iron-related measurements and the absorption of a reference dose of 3 mg iron given as ferrous ascorbate. The serum ferritin concentration was identified as the best predictor of the absorption of the reference dose (r = -0.54, p less than 0.0001). These two measurements were then compared in terms of their relative ability to predict the absorption of iron from 10 individual meals. Results were comparable, with correlations for the pooled data of -0.50 (p less than 0.0001) for the serum ferritin and 0.47 (p less than 0.0001) for the reference dose. Since serum ferritin is a simple and non-invasive test, it may represent the more satisfactory way of standardising food iron absorption results to a common iron status in field studies. However, the value of such an approach is limited by the wide confidence limits of the relationship between food iron absorption and both the other measurements.

A Systematic Evaluation of Bathophenanthroline, Ferrozine and Ferene in an ICSH-Based Method for the Measurement of Serum Iron

The chromogenic substrates ferrozine and ferene were compared to bathophenanthroline disulphonic acid for the measurement of iron concentrations in aqueous and serum samples in an assay based on that of the Iron Panel of the International Committee for Standardisation in Haematology. Ferrozine and ferene were more sensitive than bathophenanthroline. Copper at physiological concentrations in plasma caused only minimal positive interference with all three chromogenic substrates when thioglycollic acid was used as the reducing agent, but when ascorbic acid was used significant positive interference occurred with ferrozine and ferene. Interference due to contaminating haem was comparable with all agents. Bilirubin and carotene produced no interference. Profound reductions in colour development were noted with EDTA plasma.

Relative Value of Oestrogen Receptor Assay, Lactoferrin Content, and Glucose-6-Phosphate Dehydrogenase Activity as Prognostic Indicators in Primary Breast Cancer

Oestrogen receptor content, lactoferrin, hexokinase, and glucose-6-phosphate dehydrogenase levels were measured in cytosol from 25 primary breast cancers and 3 fibroadenomas. Both hexokinase and glucose-6-phosphate dehydrogenase activity were higher in malignant tissue as compared to benign breast lesions. Oestrogen receptor concentration and lactoferrin content failed to predict the development of metastatic disease, while glucose-6-phosphate dehydrogenase activity was significantly higher in cytosol from those tumours which subsequently metastasized compared to those which remained localized.

Acute promyelocytic transformation of chronic myeloid leukaemia with an isochromosome 17q.

Summary. Transformation to an acute promyelocytic leukaemia occurred in a patient approximately 2 years after having been diagnosed as suffering from chronic myeloid leukaemia (CML). At this time, in addition to the Ph1 chromosomal aberration, an isochromosome 17q [i(17q)] was noted. The t(15;17) was absent. The implications of this are discussed.

Combination Chemotherapy of Hepatocellular Cancer

Forty-seven patients with hepatocellular cancer were treated in a randomised trial comparing adriamycin + VM 26 + 5-Fluorouracil (5-FU) to mAMSA + VM 26 + 5-FU. Thirteen patients had a partial response to treatment (28%) and another 6 (13%) showed disease stabilisation. There were no significant differences in the response rates between the two treatment regimens. Patients who responded to treatment showed significant prolongation of survival (48 weeks) when compared to non-responders (5 weeks).

Failure of transferrin to enhance iron absorption in achlorhydric human subjects

There is evidence in experimental animals that transferrin, produced either by gastrointestinal cells or derived from bile, mediates the luminal absorption of iron. The applicability of these findings to human subjects was tested by administering diferric transferrin labelled with 3 mg 59Fe to seven patients with pernicious anaemia. Achlorhydric subjects were chosen to ensure that the iron transferrin complex did not dissociate in the stomach. The geometric mean absorption of 1.4% was similar to that of 3 mg iron given as ferric chloride (1.9%) and much less than that of ferrous ascorbate (18.9%). These findings suggest that transferrin does not play a physiological role in the absorption of iron in human subjects.

Can Iron Fortification of Flour Cause Damage to Genetic Susceptibles (Idiopathic Haemochromatosis and β-Thalassaemia Major)?

Currently under consideration in the U.S.A. is a proposal to increase the level of iron fortification of flour from its current figure of 13.0-16.5 mg per pound to 40 mg per pound (Waddell et al. , 1972). The debate engendered by these proposals has been concerned with two aspects. On the one hand there is the question of efficacy and on the other the question of safety (Crosby, 1973). The purpose of the present paper is to attempt to predict the answer to the second question. At particular risk are those individuals who suffer from ‘iron-loading’ states. In the genetic disorder, idiopathic haemochromatosis, excessive amounts of iron are absorbed from a normal diet, while in the other group of conditions, which includes refractory anaemias such as β thalassaemia major, the iron is derived both from donor blood and from excessive absorption from the gut (Bothwell and Finch, 1962). While the number of subjects at risk is not accurately known, it has been estimated that there are currently about 20,000 individuals with idiopathic haemochromatosis and 5000 with β thalassaemia major in the United States.

Sequential Hormonal Therapy and Sequential Hormonal and Chemotherapy for Advanced Prostatic Cancer

Ninety-two patients with D2 prostatic cancer were studied. Initial treatment was with either diethylstilboestrol (DES) or orchidectomy. Response to DES (5/63, 81%) was significantly higher than for orchidectomy (18/29, 62%; p less than 0.01). However, duration of response and duration of survival were not significantly different for the 2 forms of hormonal therapy. Fifty-seven patients were randomised to receive second-line treatment with either medroxyprogesterone acetate (MPA), oral chlorambucil or combination chemotherapy (adriamycin + cyclophosphamide + 5-fluoro-uracil). Response to second-line treatment was similar for all 3 regimens (46% overall response). Most of the responses were disease stabilisation and, although there was symptomatic benefit, response to second-line therapy did not significantly improve survival compared to the survival experience of the group as a whole. It is concluded that palliative second-line treatment for advanced prostatic cancer should consist of the least toxic form of treatment which in this study was second-line hormone administration (MPA).