Margaret C.K. Browning

Comparison of serum CA 72-4 and CA 19-9 levels in gastric cancer patients and correlation with recurrence

BACKGROUND This longitudinal prospective study evaluates the serum levels of the tumor markers CA 72-4 and CA 19-9, alone or in combination, in gastric cancer patients. PATIENTS AND METHODS Serum tumor markers CA 72-4 and CA 19-9 were measured in 52 patients who had gastric adenocarcinomas and 32 with benign gastric disorders. Serial measurements of these markers were carried out in 30 cancer patients at a median follow-up time of 38 months. RESULTS CA 72-4 and CA 19-9 had sensitivities of 42% and 46% for the preoperative detection of gastric cancer. Sensitivity for the two combined was 63%. CA 72-4 provided 100% specificity, compared to 72% for CA 19-9. Postoperatively, 17 cancer patients remained disease-free. Sixteen of these maintained normal levels of CA 72-4, and 10 of CA 19-9. Thirteen patients developed recurrent disease. In 9, serum CA 72-4 levels rose from near-normal after surgery and reached diagnostic values approximately 6 months before clinical diagnosis of recurrence. Only 3 patients exhibited such a pattern with CA 19-9. CONCLUSIONS CA 72-4 is a reliable marker in gastric cancer. Postoperative serial sampling of CA 72-4 may facilitate early identification of recurrences.

Biologic Variation of Urinary Albumin: Consequences for Analysis, Specimen Collection, Interpretation of Results, and Screening Programs

Studies on the analytic and biologic variability of albumin concentration, albumin/creatinine ratio, and albumin excretion rate in first morning, random, and 24-hour urine specimens from healthy subjects suggest that (1) first morning specimens are preferred, (2) results should be expressed as albumin concentration, (3) assay of creatinine confers little advantage, (4) an analytical precision of coefficient of variation (CV) less than 18% is satisfactory, and (5) semiquantitative or qualitative analyses are suitable for screening programs. The intraindividual variation of albumin concentration in first morning specimens from diabetics is such that no threshold value gives the desired 100% nosological sensitivity. However, a threshold value of 30 mg/L confers 100% specificity, and a single abnormal result therefore requires initiation of therapy. Patients with negative results should continue to be monitored regularly.

Re-evaluation of the captopril test for the diagnosis of primary hyperaldosteronism

OBJECTIVE We aimed to re‐evaluate the captopril test in the diagnosis of primary hyperaldosteronism.

Analytical Goals for Quantities Used to Assess Thyrometabolic Status

Analytical goals for imprecision derived from data on intra-individual variation for total T4, free T4, total T3, free T3 and thyrotropin (TSH) are coefficients of variation (CV) ⩽ 2·5, 4·7, 5·2, 3·9 and 8·1%, respectively. If total T4 is used to monitor replacement therapy with thyroxine, a more stringent goal of CV ⩽ 1·;4% is appropriate. For those analytes for which biological variation data are not available, analytical goals may be derived either from reference intervals or from the ‘state of the art’ as judged from the performance of a stated proportion of laboratories participating in an interlaboratory quality assessment scheme. Analytical goals for imprecision for reverse T3 and thyroxine-binding globulin derived from reference values are CV ⩽ 10·;7 and 7·;2%, respectively. The goal for inaccuracy is that there should be none. Statements regarding the detection limit of an assay should be replaced with information about the range of concentrations over which specified goals for imprecision are met. If goals are not achieved at concentrations which are used for clinical decision making the 95% confidence limits of the extreme values of the ‘working range’ should be calculated using the relevant imprecision. Improved analytical performance will result in better between-laboratory comparability and eventually allow the use of universally applicable reference values.

Intra- and Inter-Individual Variation of Serum Angiotensin Converting Enzyme: Clinical Implications

The potential usefulness of measurements of serum angiotensin converting enzyme activity (SAC E) was examined using data on the analytical and biological variation in IS ostensibly healthy subjects. Since there is evidence that biological variation in health and stable disease is of the same order, irrespective of whether the analyte is within or outside reference intervals, I the findings should be relevant to the use ofSACE assays in sarcoidosis.

Plasma 11-hydroxycorticosteroid concentrations and prognosis in accidental hypothermia

Abstract In 84 patients with accidental hypothermia plasma 11-hydroxycorticosteroid concentrations were found to be high (mean ± 1 SD=68.2 ± 44.9 μg/ 100 ml) at the time of their admission to hospital, although significant inverse correlations could still be demonstrated between the plasma 11-hydroxycorticosteroid concentrations and the severity ( P 0.0125) and estimated duration ( P

Cortisol utilization in accidental hypothermia

Abstract The rate of removal from the plasma of cortisol labelled with 14 C has been studied in 17 adults, 16 of whom were elderly, with accidental hypothermia. The half-life of the isotope in the plasma was abnormally prolonged (95 min or longer) in nine of these patients, and two of the nine had no effective utilization of cortisol. The prolonged half-life times of the isotope correlate with the total concentrations of plasma 11-hydroxycorticosteroids but not with the severity of the hypothermia. Many elderly hypothermic patients are therefore unlikely to benefit from the administration of parenteral steroids.

ALTERED ENDOCRINE RESPONSE TO PARTIAL THYROIDECTOMY IN PROPRANOLOL‐PREPARED HYPERTHYROID PATIENTS

The endocrine response to partial thyroidectomy in a group of twenty hyperthyroid patients prepared with propranolol alone was compared to that of a matched control group of ten euthyroid patients. In propranolol‐prepared patients the glucose response to surgery was reduced (P< 0·05) for up to 4 h post‐operatively and biochemical hypoglycaemia was noted in one patient. Both thyroxine and triiodothyronine (T3) fell significantly, associated with a marked rise in reverse T3. Growth hormone levels were higher (P<0·05) both pre‐and post‐operatively in propranolol‐prepared patients, whereas prolactin levels, although similar pre‐operatively, were lower (P<0·05) in these patients post‐operatively. Cortisol and ACTH levels were lower (P < 0·05) both before and following thyroidectomy in propranolol‐prepared patients. These results suggest that the endocrine response to surgical stress is markedly altered in propranolol‐prepared hyperthyroid patients.

Virilizing adrenal tumour in a 9–year‐old female

A 9–year‐old girl presented with acne as the first evidence of a virilizing adrenal tumour which proved to be a benign adenoma. The steroid excretion pattern showed a disproportionate increase in Dehydroepiandrosterone.