G. J. Duffy

Carcino-embryonic antigen assay as a guide to tumour bulk, response to therapy and prognosis in human breast cancer

SummarySerum carcinoembryonic antigen (CEA) levels were studied in 128 patients with histologically proven breast cancer. When measured at diagnosis in patients with non-metastatic disease (all stages except Stage IV) 27% of patients had levels greater than 10 ng/ ml. Measurement of the CEA at initial diagnosis gave little guide to which patients subsequently relapsed. Patients with Stage IV disease at diagnosis had levels in excess of 10 ng/ml in 75% of cases. Furthermore, changes in serum CEA levels were found to reflect changes in tumour bulk, in individual patients, in 75.8% of cases. It is concluded that while serial measurements of serum CEA levels can be of value, particularly in the management of advanced breast cancer patients, it is of less value in the earlier stages as a predicator of recurrence.

Radiography and scintigraphy in the diagnosis of carpal scaphoid fractures.

SummaryTHIRTY patients with clinically fractured carpel scaphoid bones, but with negative antero posterior (AP), lateral and oblique radiographs, had both modified Stetcher radiographs and bone scintiscans of the wrist performed. A final diagnosis in these patients was made by repeating AP, lateral and oblique x-rays at 2 weekly intervals for 6 weeks. The Stetcher x-ray correctly identified 4 fractures amongst these 30 patients but failed to detect 2 other scaphoid fractures. The results indicate that the specialized radiographs increased the sensitivity of scaphoid fracture detection but still failed to detect some true fractures. Bone scintiscanning on the other hand identified all “true” fractures and accurately identified 19 of the 30 patients as not having a scaphoid fracture. Since bone scintiscanning missed no true fractures, these 19 patients with negative bone scintiscans could have safely been treated without plaster immobilization.

A comparison of diuretic induced potassium losses in normal and abnormal subjects

SummaryThe effect of administration of a single dose of 100 mg. of chlorthalidone has been studied in normal and oedematous subjects while on a controlled metabolic balance régime. The natriuretic effect was similar in both groups but the urinary loss of both sodium and potassium was smaller in oedematous subjects with the possible exception of patients with hepatic cirrhosis. The smaller kaliuresis in abnormal states did not appear to be related to previously existing depletion of body potassium, as judged by the preliminary balance data, muscle biopsy analysis and measurement of total exchangeable potassium. A possible explanation was the relationship between reduction in kaliuretic response and decrease in glomerular filtration rate.It is concluded that potassium depletion occurs less commonly in oedematous patients given chlorthalidone than studies in “control” normal subjects might suggest. The routine prescription of potassium salts may thus be unnecessary in many oedematous conditions during short-term chlorthalidone administration.

The value of isotope angiography in the diagnosis and management of vascular disease

SummaryWe performed 182 isotope angiograms on 173 patients over a three year period. We have reviewed our results and evaluated the role of isotope angiography in vascular surgery by comparing it with contrast angiography, ultrasound imaging, clinical and operative findings and subsequent course of the patient. Isotope angiography was particularly useful in the investigation of abdominal aortic aneurysms; 58 aneurysms being found following 92 investigations. There were no false positive results but four false negative results were obtained. Following vascular reconstruction 40 isotope angiograms were carried out; the correct diagnosis was made in 98%. This is now our investigation of choice in these patients. Isotope angiography was also useful in the investigation of peripheral vascular disease especially in those patients where a more invasive technique might be contraindicated.