R. Farini

CA 19-9 in the differential diagnosis between pancreatic cancer and chronic pancreatitis.

CA 19-9 serum concentration was determined by a immunoradiometric technique in 130 subjects to evaluate its role in differentiating pancreatic cancer from chronic pancreatitis. Two threshold values were chosen, 17 and 37 U/ml. With the former, sensitivity, specificity and diagnostic accuracy were 86.7, 62.3 and 49.0 respectively, with the latter 73.3, 87.0 and 60.3%. The receiver-operating characteristic curves demonstrated a satisfactory discriminating capacity of CA 19-9 as regards pancreatic cancer and chronic pancreatitis; in contrast, the discrimination was poor for other gastrointestinal diseases, mainly of a malignant nature.

Calcification of radiolucent gall stones during treatment with ursodeoxycholic acid.

calculated to explain the blood lead concentration by wine consumption, y-GT, MCV, and tobacco consumption; the regression coefficients were significant for wine consumption (p < 10-), enzyme activity (p < 10-3), and tobacco consumption (p < 10-2), but not for MCV. On the other hand, wine and alcohol consumptions were not associated with creatinine, and negatively with serum urea (r = 0084, p < 008; r =-0154, p < 10-2), a result already found by Chang-Yeung and others.3 According to Shaper, the excretion of lead, which occurs mainly through the kidneys and presumably through the liver, may be disturbed in drinkers. They note that the kidney function was not affected by alcohol, which seems to be confirmed here, since a positive correlation was not observed between wine consumption and serum urea or creatinine; on the other hand, as it is well known that even moderate alcohol intake may damage the liver, the increase of blood lead concentration in drinkers could be at least partly explained by hepatic dysfunction. In our population, the most common alcoholic beverage was wine, whose lead content is much higher than that of beer or spirits. Our results, however, show that the direct increase in lead intake from wine does not explain entirely the increase in blood lead concentration of drinkers, since liver damage, as assessed by y-GT is associated with increased blood lead concentration, independently of wine consumption. This agrees with the hypothesis of Shaper and others. On the contrary, it appears that the elevated blood lead of drinkers, smokers, or both cannot be explained by an increase of MCV. Moreover, the hypothesis of Awad and others, at least concerning alcohol consumption, seems untenable since, in our men, an increase of MCV in drinkers is accompanied by a decrease in red cell count so that the packed cell volume does not vary with alcohol intake. T MOREAU J LELLOUCH INSERM U169, Villejuif 94800

Copper, zinc and copper/zinc ratio in chronic pancreatitis and pancreatic cancer.

Serum copper and zinc levels and their ratio were evaluated in 48 control subjects, 29 patients with pancreatic cancer, 46 with chronic pancreatitis and 32 with extra-pancreatic diseases, with the purpose of ascertaining modifications in chronic pancreatic disease. Hepatic involvement and age were also investigated as possible factors influencing results. Cu/Zn ratio was found to be significantly increased in pancreatic cancer (2.66 +/- 0.16, mean +/- SE) as compared to controls (1.39 +/- 0.06, p less than 0.001), chronic pancreatitis (1.82 +/- 0.09. p less than 0.001) and extra-pancreatic diseases (1.81 +/- 0.18, p less than 0.001), but without practical clinical value. Serum zinc levels appear to decrease with age, while copper and Cu/Zn ratio increase. However, covariance analysis demonstrated that age does not play an important role in influencing copper and Cu/Zn ratio. A decreased liver synthetic function, at least in part age-related, seems to be an additional factor in decreasing serum zinc values.

Actual role of pepsinogen group I in the study of upper gastrointestinal diseases

The role of serum PG I in screening patients with chronic atrophic gastritis and gastric cancer, and in detecting peptic ulcer patients with high relapse risk, was ascertained in 276 subjects. Although not diagnostic per se, PG I was found to be under 20 micrograms/L in patients with chronic atrophic gastritis and in some gastric cancer or partially gastrectomized patients. In patients presenting with relapsing duodenal ulcer, PG I values were significantly higher than in the non-relapsing ones, but a satisfactory identification of all the duodenal ulcer patients with high relapse risk was not possible on this basis. Even the correlation between PG I and MAO was not accurate in every subject considered. These results suggest that the value of PG I is limited to assessing patients with upper gastrointestinal diseases in which a reduction of peptic secretion, and therefore of PG I in serum, is present.

Serum Ferritin in Pancreatic Disease

Serum ferritin, described as increased in patients with pancreatic cancer, was studied in 109 subjects by an immunoradiometric technique in order to assess its reliability in detecting pancreatic malignancy. A significant increase of serum ferritin was found in pancreatic cancer as compared to controls (p

Epithelial dysplasia in endoscopic gastric mucosal biopsies

To define the frequency of gastric epithelial dysplasia (precancerous lesion), 1463 biopsies from 842 endoscopically studied patients were reassessed. Mild dysplasia was found in 19.9 % of the cases, moderate in 4.1 %, severe in 0.95 %. Since the clinical and biological significance of the lesion is still an open question, indications for follow-up are discussed in the light of personal views, together with a critical evaluation of the recently proposed classifications.

Role of Trypsin/Creatinine Clearance Ratio in the Differential Diagnosis of Chronic Pancreatic Disease

Trypsin/creatinine clearance ratio--a recently proposed screening test for pancreatic cancer--was assessed in 45 subjects (17 control subjects, 15 patients with pancreatic cancer, and 13 with chronic pancreatitis). A statistically significant increase of the ratio was detected not only in pancreatic cancer, but also in chronic calcifying pancreatitis. Thus, the previously reported clinical usefulness of the test in pancreatic cancer diagnosis was not substantiated by the present data. Although not fully investigated as yet, reasons for an abnormal ratio are probably independent of the neoplastic or inflammatory nature of the pancreatic disease. Science renal enzyme excretion (alpha-glucosidase, gamma-glutamyltranspeptidase, leucine aminopeptidase) was not found to be invariably elevated when trypsin/creatinine clearance ratio was increased, tubular damage cannot be assumed as constituting the only reason for an altered clearance ratio.

Pepsinogen group I radioimmunoassay and total serum pepsinogen colorimetric determination: a comparative study in normal subjects and in peptic ulcer patients

Pepsinogens, proteolytic enzymes produced by peptic cells of the stomach and discharged into the gastric lumen as well as into the blood have been divided into two groups: PG-I, originating from chief cells, and PG-II, mainly from antrum peptic cells. Both total serum pepsinogen (s-Pg) and PG-I have been separately reported as being significantly increased in gastric (GU) and duodenal ulcer (DU) patients and related to maximal acid output. In order to ascertain the relationship between s-Pg measured by means of the colorimetric Uete method, and PG-I determined by RIA method, these were assayed in 72 control subjects, 35 GU and 95 DU patients. s-Pg was found to be significantly increased both in GU and DU patients in comparison with control subjects. Likewise PG-I was significantly enhanced in GU and DU patients as compared with controls. A significant direct correlation between s-Pg and PG-I was found in all the subjects studied (r = 0.732).

Study of retinol-binding protein in pancreatic cancer

SummarySerum RBP, prealbumin, and zinc were evaluated in normal subjects and patients with pancreatic cancer and chronic pancreatitis. A significant decrease of RPB was found in pancreatic cancer patients compared with controls. A concomitant reduction of prealbumin and zinc was also observed. Multiple regression analysis suggested that the modification of RBP serum levels might be accounted for mainly by diminished prealbumin levels, while the direct role of zinc is negligible.

Ranitidine in Long-Term Duodenal Ulcer Treatment: A Multicentre Trial

An endoscopically controlled clinical trial on maintenance Ranitidine treatment of scarred duodenal ulcer was carried out in 78 patients, randomly allocated to either 150 mg Ranitidine at night or low-dose antacid when necessary in a 1 -year follow-up study. The maintenance Ranitidine regime prevented ulcer relapse in 23 of 31 cases (74.2%), without any significant adverse reaction. In the control group, the relapse was prevented in 12 of 30 cases (40%); the difference was found to be statistically significant.