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The tissue polypeptide antigen, TPA, is a tumour-associated antigen which is synthesized during the S phase of cellular division and released later by the tissues when rapid growth takes place. For this reason, the TPA is considered to be a specific phase tumour-associated antigen [1].

Tissue polypeptide antigen (TPA) and carcino embryonic antigen (CEA) were measured in 55 patients with cancer in different locations (21 lung cancer, 133 breast cancer, 9 stomach cancer, 5 colorectal cancer, 7 cancer of unknown origin). TPA gives elevated values in all types of cancer. The statistical analysis shows that TPA is about equally sensitive for all cancer types, while CEA has a particularly high sensitivity for colorectal carcinoma. The TPA values in the group of cancer patients is significantly different from those in a group of healthy controls. TPA gives higher sensitivity than CEA in all tumour locations. By the use of combined determination of TPA and CEA the sensitivity can be further increased, to 64 for the whole patient population and 89 for the gastric tumour patients, even when the cut-off values are chosen so high that no false positives are obtained in either reference group (150 Ul-1for TPA, 10 ng ml-1for CEA). A limited correlation exists between the markers in tumour patients.

The aim of our study was to evaluate the cost of the tumor marker assays most widely used in pneumological practive and the effectiveness of the percentage of DRG-based reimbursements absorbed by these assays.For this purpose we assessed the cost of lung tumor marker assays in Emilia Romagna compared to the DRG-based reimbursement of inpatients affected by lung diseases in whom the use of tumor markers is indicated.As an example, we evaluated the cost/effectiveness of the CEA assay in the differential diagnosis of 68 pleural effusions from 46 patients (20 benign diseases, 26 malignant).Because the CEA assay was not a substitute for cytology when this was not diagnostic, 41.3% of the resources were not efficiently spent. If the marker assay had been performed only in cases with negative cytology, we could have spared 14 of 46 tests.Moreover, since the expense lies predominantly in the cost of reagents (81.23%), we suggest as a routine procedure to collect and store samples for tumor marker assay in all cases; the test should be performed in a selected population of patients with negative cytology and “suspect” clinical outcome.

Seventeen patients, screened from a neonatal programme for hypothyroidism were studied. As well as the scintigraphic investigations, serum TSH, T3, free T3, T4, free T4, and TBG were measured in all patients. Not more than 11.1 MBq (300 µCi) 99mTcO4-was administered IV. A gamma camera with a parallel-hole collimator on line with the computer was used. The method allowed good statistics to be obtained in 5–10 min in a wide field of exploration, thus reducing the problems of positioning and prolonged immobilization of the young patient. The data collected in the computer were elaborated to define better the characteristics of the thyroid image. This kind of in vivo study introduced into a screening programme, enables an ‘anatomic’ diagnosis of the defect to be obtained before starting the therapy. This is undoubtedly valuable from the epidemiological point of view, enables early determination of the degree of thyroid insufficiency, and contributes to the formulation of a prognosis based on the degree and on the moment in which prenatal harm occurred.

In 5 patients with partial gastric resection and esophagitis, in whom esophageal pH metry was unable to demonstrate significant gastroesophageal reflux (GER), we administered i.v. 5 mCi (185 MBq) of 99mTc-HIDA, the patient lying under a computer-assisted LFOV gamma camera. When gallbladder image was evident, caerulein was administered i.v. at a physiologic dose in order to induce gallbladder contraction, and in the subsequent 45 min the patient was asked to perform a standard series of manoeuvres that increase the intraabdominal pressure (Valsalva, etc.) and favour GER. Scintigraphic images and time/activity curves obtained from areas of interest corresponding to gastric remnant and distal esophagus showed that at least one of these manoeuvres in each case was followed by the appearance of the radiocompound in the distal esophagus, indicating a 99mTc-HIDA-tagged bile GER. Consequently, we believe that HIDA-GER dynamic scintigraphy may be more useful than esophageal pH metry in demonstrating the biliary origin of an esophagitis.