H. G. Beger

The value of the tumor marker CA 15‐3 in diagnosing and monitoring breast cancer. A comparative study with carcinoembryonic antigen

To estimate the utility of the tumor‐associated antigen CA 15‐3 in the diagnosis of patients with breast cancer, this tumor marker was measured preoperatively in 1342 patients. This group included 509 patients with malignant disease (134 breast cancer patients and 375 patients with other malignancies not involving the breast) and 833 patients with benign surgical diseases (95 patients with fibroadenoma of the breast and 738 patients with other benign diseases). The results were compared with those obtained for carcinoembryonic antigen (CEA) in the diagnosis of breast cancer. The CA 15‐3 level was above normal (25 U/ml) in 31% of the patients with breast cancer, in 22% of patients with other malignancies, and in 9% of patients with benign diseases. The CEA level was elevated in 26% of patients with breast cancer (more than 3 ng/ml). There was a good correlation of CA 15‐3 levels with the tumor stage of breast cancer. Both CA 15‐3 and CEA also were determined in 671 patients who had received initial curative surgery of breast cancer and who regularly attended our follow‐up clinic. The CA 15‐3 was found to be more sensitive than CEA in detecting recurrences of breast cancer. In the postcare period, carcinoma recurred in 205 patients. Of these, 73% had CA 15‐3 concentrations above 25 U/ml; only 50% had CEA values above 3 ng/ml (P less than 0.0001). Although neither CA 15‐3 nor CEA were sensitive enough for the screening and diagnosis of early breast cancer, CA 15‐3 was significantly better than CEA in the detection of breast cancer metastases.

Comparison of CA 15-3 and CEA in diagnosis and monitoring of breast cancer.

In order to assess the utility of the tumor-associated antigen CA15-3 in the diagnosis of breast cancer, this new tumor marker was measured pre-operatively in 1342 patients. This group comprised 509 patients with malignant disease (134 with breast cancer and 375 with other malignancies not involving the breast) and 833 patients with benign surgical diseases (95 patients with fibroadenoma of the breast, 738 with other benign diseases). The results were compared with those for carcino-embryonic antigen (CEA) in the diagnosis of breast cancer. CA15-3 was above the normal limits of 25 U/ml in 31% of the patients with breast cancer, in 22% of patients with other malignancies, and in 9% of patients with benign diseases. CEA was elevated in 26% of patients with breast cancer (> 3ng/ml). CA15-3 levels were above 50 U/ml in 13% of the breast cancer patients, in 6%) of patients with other malignancies, and in 0.2% of the patients with benign diseases. There was a good correlation between CA 15-3 level and tumor stage in breast cancer. CA 15-3 serum levels were over 50 U/ml in respectively 0%, 2%, 13%, and 73% of the patients with stages I, II, III, and IV. CA 15-3 and CEA were also determined in 671 patients who had received initial curative surgery of breast cancer, and who regularly attended our follow-up clinic. CA15-3 was found to be more sensitive than CEA in detecting recurrences of breast cancer. In the post-care period, carcinoma recurred in 205 patients. Of these 73% had CA15-3 concentrations above 25 U/ml, whereas only 50% had CEA values above 3 ng/ml (p< 0.0001). Although neither CA15-3 nor CEA are sensitive enough for the screening and diagnosis of early breast cancer, CA 15-3 is superior to CEA in the detection of breast cancer metastases.

Comparison of CA 72-4, CA 19-9 and CEA in the diagnosis and monitoring of gastric cancer

In order to assess the utility of the tumor-associated antigen CA 72-4 in the diagnosis and monitoring of gastric cancer, this tumor marker was measured preoperatively in 718 patients. This group comprised 282 patients with malignant disease (115 with gastric cancer and 167 with other malig-nancies not involving the stomach) and 476 patients with benign surgical diseases. The results were compared with those for carcinoembryonic antigen (CEA) and the tumor-associated antigen CA 19-9. CA 72-4 was above the normal limit of 2.5 U/ml in 61% of the patients with gastric cancer, in 35% of the patients with other malignancies, and in 7% of the patients with benign diseases. CEA and CA 19-9 were elevated in 37% of the patients with gastric cancer (>3 ng/mlfor CEA and >37 U/ml for CA 19-9). CA 72-4 levels were above 10 U/ml in 26% of the gastric cancer patients, in 15% of patients with other malignancies, and in 0.4% of the patients with benign diseases. There was a good correlation between CA 72-4 level and tumor stage in gastric cancer. CA 72-4 serum levels were over 2.5 U/ml in 31%, 48%, 68% and 88% of patients with stage I, II, III and IV disease, respectively. CA 72-4 was found to be more sensitive than CEA and CA 19-9 in detecting recurrences of gastric cancer. In the postoperative-care period, carcinoma recurred in 29 patients. Of these 93% had CA 72-4 concentrations above 2.5 U/ml, whereas only 59% and 35% had pathological CEA and CA 19-9 serum levels (p<0.002, p<0.0001). Although neither CA 72-4 nor CEA and CA 19-9 are sensitive enough for screening and diagnosis of early gastric cancer, CA 72-4 is superior to CEA and CA 19-9 in the detection of gastric cancer recurrences.

[Influence of the liver on the pre- and posthepatic concentrations of plasma histamine in human subjects (author's transl)].

SummaryFluorometric estimations of plasma histamine in the blood of the portal vein, hepatic vein, cubital vein and the femoral artery were performed in 8 patients.Concerning the difference of histamine in the portal and the hepatic vein blood, the histamine elimination of the liver comes to 63.1±12.8 per cent. The human liver seems to be important in the regulation of the plasma histamine concentration.ZusammenfassungPlasmahistaminkonzentrationen wurden bei 8 Patienten im Blut der Pfortader, der Lebervene, der Femoralarterie und systemvenös fluorimetrisch bestimmt. Der von der Leber eliminierte Histaminanteil, errechnet aus der Differenz des portal einströmenden und des über die Lebervene ausströmenden Plasmahistamins, beträgt bei arterieller Beimischung von 30% im Mittel 63,1±12,8%. Auf die Fähigkeit der Leber durch unterschiedlich große Eliminierung des Histamins den Plasmahistamingehalt zu regulieren wird hingewiesen.

Insulinkonzentrationen im Pfortaderblut des Menschen nac Glucose-Infusion

SummaryIn the early postoperative period the insulin concentration of the portal vein was measured by 9 patients, before, during and after intravenous glucose stimulation. The insulin concentrations of the portal vein show a biphasic curve. The inconstant difference of the insulin level in the portal and systemic blood fluctuates between 44–83%.ZusammenfassungIn der frühen postoperativen Phase wurde bei neun lebergesunden Patienten die Insulin-Konzentration in der Pfortader vor, während und nach i.v. Glucosestimulation gemeseen. Die in der Pfortader gemessenen Insulinkonzentrationen ergaben einen doppelgipfeligen Kurvenverlauf. Die Differenz der Insulin-Konzentration zwischen Pfortader und Cubitalvene ist unterschiedlich und schwankt zwischen 44 und 83%.

Regional Chemotherapy in Liver Metastases of Colorectal Carcinoma: Monitoring with Arterial Computed Tomography

Continuous chemotherapy was administered to 82 patients through the hepatic artery via Infusaid pumps. In order to obtain a primary status and to evaluate the success of therapy, the perfusion patterns of the liver and of the existing tumor masses in the liver were estimated by conducting arterial angiocomputed tomographies (AACTs) immediately after pump implantation of every 3 months thereafter. In 70% of the patients, findings showed both liver lobes to be homogeneously perfused, 24% demonstrated distinct inhomogeneities. The response of the latter cases should depend primarily on the efficacy of the administered cytostatic agent. Six percent of the patients showed selective perfusion of either the left or right hepatic lobe. In these cases, only the perfused liver regions exhibited stable disease or regression of the metastases, whereas the metastases of the nonperfused regions progressed. At 3-month follow-up, the majority of the patients (50-57%) showed homogeneous hepatic perfusion. Inhomogeneities were found in 26-36% of the patients, 12 patients demonstrated incomplete perfusion. There was no association between the perfusion patterns of the metastases or of the prechemotherapeutic liver involvement and the response of the metastases to regional chemotherapy. In regional chemotherapy, liver perfusion should be controlled both intraoperatively or directly postoperatively and during therapy.

The clinical relevance of tumor marker CEA, CA 19-9 in regional chemotherapy of hepatic metastases of colorectal carcinoma.

Up to December 1986, 50 patients with documented hepatic metastases from colorectal carcinoma were treated with 5-fluoro-2-deoxyuridine (FUDR) using Infusaid pumps. The response of liver metastases to regional chemotherapy was studied by computerized tomography (CT) and carcino-embryonal antigen (CEA), and/or CA 19-9 antigen serum assays. Preoperative CEA values were pathological in 94% of the patients but only 48% had a pathological concentration of the antigen CA 19-9 of over 37 U/ml. The course of CEA and CA 19-9 in combination with the arterial angio-CT reflected the response of liver metastases to regional chemotherapy. A decrease or normalisation of CEA and CA 19-9 after the beginning of therapy is an indication of partial or complete remission of metastases (68% of the patients showed lowered CEA serum values). If the marker continues to rise in serum this is a danger signal of progression of liver metastases or of extrahepatic tumor spread if the tumor stage in the liver remains unchanged.

84. Endotoxinschock: Erkennung und Behandlung

SummaryEndotoxin shock is the most frequent form of septic shock. Endotoxin, a macromolecular lipopolysaccharide, is released from the cellular wall of gram-negative spores. In patients with bacterial peritonitis these signs are typical: temperature above 38°C, thrombocytopenia, leukocytosis, lactazidosis, and increase of creatinine. Early laparotomy in bacterial peritonitis is the most important step to avoid endotoxin shock.ZusammenfassungDer Endotoxinschock ist die häufigste Form des septischen Schocks. Endotoxin, ein makromolekulares Lipopolysaccharid wird beim Zerfall aus der Zellwand der gramnegativen Keime freigesetzt. Bei Patienten mit bakterieller Peritonitis sind: Fieber über 38°C, Thrombocytopenie, Leukocytose, Lactacidose, Kreatininanstieg hinweisende Zeichen. Die Frühlaparotomie ist bei bakterieller Peritonitis der entscheidende Schritt zur Vermeidung eines Endotoxinschocks.

Profil der Glucosestimulierten Insulinsekretion im Pfortaderblut des Menschen

SummaryThe concentration of insulin in the portal venous blood shows in 8 patients in the early postoperative period under constant infusion of glucose a multiphasic course. The differences between the highest and lowest points are significant. Only the initial and the most prominent secondary peak can be followed up in the cubital venous blood. The role of the liver as buffer against the surplus of secreted insulin is discussed.ZusammenfassungDie Insulinkonzentration im Pfortaderblut bei 8 Patienten in der frühen postoperativen Phase zeigt unter konstanter Glucoseinfusion einen vielgipfligen Verlauf. Die Unterschiede zwischen Gipfel und Täler sind signifikant. Lediglich initialer und der am stärksten ausgeprägte sekundäre Gipfel sind auch im Cubitalvenenblut zu beobachten. Die Rolle der Leber als Puffer gegenüber überschüssig sezerniertem Insulin wird diskutiert.

Regional Chemotherapy in Hepatic Metastases of Colorectal Carcinoma: Continuous Intra-arterial Versus Continuous Intra-arterial/Intravenous Therapy

About 25% of patients have already liver metastases when the diagnosis of colorectal carcinoma is established. In another 30%–40% of the patients, metachronic metastases of a primary tumor settle in the liver, indicating that liver metastases are a significant factor for the prognosis of colorectal carcinoma [1]. The median survival time of the patients is approximately 6 months; only 7% live longer than 1 year [3]. Lymphogenous spread of metastases is not the decisive factor; rather, it is the invasion of the primary tumor into the vascular system [4].