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Neuroendocrine prostate cancer (NEPC) mostly occurs as a treatment-emergent adaptive response under the pressure of intensive androgen deprivation treatment (t-NEPC). Approximately 30-40% of patients with metastatic castration-resistant prostate cancer (mCRPC) also have neuroendocrine involvement. In contrast primary small cell prostate cancer is very rare (<1%). A t‑NEPC should be clinically suspected in patients who have particularly aggressive mCRPC but a disproportionately low prostate-specific antigen (PSA) level and elevated neuroendocrine tumor markers, such as chromogranin A and neuron-specific enolase. The initial Gleason score was shown to be an independent factor correlated to the risk of development of t‑NEPC. Treatment is oriented to that of small cell lung cancer. In patients with negative PSA levels, chemotherapy with cisplatin and etoposide is the first line treatment, for which response rates in the range of 30-60% with a median survival time of usually less than 1 year can be achieved. In patients with much higher serum PSA levels, chemotherapy with carboplatin plus docetaxel should be considered.

Background: The mortality in patients with cardiogenic shock after out-of-hospital cardiac arrest (OHCA) remains high despite advances in resuscitation and early revascularization strategies. The use of mild therapeutic hypothermia (MTH) for improvement of survival and neurological outcome in patients with cardiogenic shock is currently subject to renewed discussion., Objective: The aim of this study was the detection of risk factors for mortality and morbidity in patients under MTH in cardiogenic shock following preclinical resuscitation for OHCA., Methods: A total of 80 consecutive patients in cardiogenic shock after successful resuscitation (mean age 60 ± 3.2 years) treated with MTH were retrospectively analyzed. Patients were cooled to 33 °C for 24 h using an endovascular cooling device. Neurological outcome was assessed after 2 months based on the Glasgow-Pittsburgh cerebral performance category (CPC) and correlated with various blood parameter values., Results: After 2 months 31 patients (39 %) showed a good neurological recovery with CPC scores of 1-2, 20 patients (25 %) had a poor neurological outcome with CPC scores of 3-4 and 29 (36 %) patients enrolled in the trial died (CPC 5). Patients with a poor outcome showed significantly higher mean serum levels for lactate, creatinine and urea. In addition, these patients showed a continuous increase of serum neuron-specific enolase (NSE) values in contrast to patients with a good outcome (∆ NSE from admission to day 1, CPC 1 and 2: - 10.6 ± 3 µg/l and CPC 3-5: 33 ± 12 µg/l, p = 0.02)., Conclusion: Changes in the course of serum creatinine, urea and NSE levels within the first 72 h after OHCA could provide valuable additional information for the early assessment of the neurological prognosis in patients treated with MTH.

We report on a 31-year-old woman requiring resuscitation because of ventricular fibrillation during a standard dental procedure with local anaesthesia. In cardiac ventriculography, reverse takotsubo cardiomyopathy was diagnosed. Because of protracted cardiogenic shock early treatment with calcium sensitizers, as well as the use of an intra-aortic ballon pump (IABP) were necessary to achieve stable hemodynamics. Despite a maximum neuron-specific enolase value of 37.8 ng/ml, the patient was released from the hospital 19 days after admission without a neurological deficit and with completely restored cardiac function.

The developments of cardiopulmonary resuscitation and intensive care medicine have made possible survival after cardiac arrest. However, only 10-30% of patients with initially successful resuscitation later reach a state without severe neurological impairment. Ethical and socioeconomic reasons therefore make early prognosis important for certain patients. There are no reliable parameters for predictions of good clinical outcome. If clinical information is consistent with severe hypoxic brain damage, cortical somatosensory evoked potentials are absent, and neuron-specific enolase values exceed 33-65 microg/l, recovery of consciousness can be excluded. The same result can be predicted if brain imaging shows severe hypoxemic changes or if a myoclonic status occurs on the first day. In summary, the prognosis in patients with cerebral anoxy and cardiopulmonary resuscitation remains poor. Treatment with hypothermia for 24 h is recommended.

Objective of the Study: Carotid endarterectomy (CEA) remains the standard procedure for primary and secondary prevention of stroke. Somato-sensory evoked potentials (SEP) are frequently used in carotid endarterectomy under general anaesthesia and recommended for monitoring cerebral functions. The aim of the study was to compare changes in SEP and serum levels of S-100 beta protein and neuron-specific enolase (NSE) with perioperative clinical neurological deficits in patients undergoing regional anaesthesia (RA)., Patients and Methods: After approval of the ethics committee of the Otto-von-Guericke-University, Magdeburg fifty patients undergoing elective CEA under RA were prospectively investigated. RA was performed by combined deep and superficial cervical plexus blockade. SEP was monitored continuously during the surgical procedure. A more of 50 % decrease of potentials (N 20 / P 25 amplitude) compared to potentials before clamping was considered to be significant. Arterial blood samples were collected preoperatively, before declamping and on the first postoperative day to determine serum levels of S-100 beta and NSE., Results: 12 patients developed intraoperatively neurological deficits with carotid clamping. The symptoms were transient and regressed in one minute after shunting. One patient was discharged with persistent hemiparesis. In 8 of 12 patients (66 %) with neurological deficits a more of 50 % decrease of potentials was observed. In one patient with loss of consciousness and hemiparesis changes in SEP or decrease in N 20 / P 25 amplitude were absent. Decrease in amplitude was in patients with intraoperative neurological deficits with 78 % versus 34 % in patients without any deficits significantly reduced (p = 0.01). The sensitivity of monitoring was 67 % at a specificity of 74 %. Serum levels of S-100 beta increased before declamping between patients with and without any neurological deficits significantly (p = 0.02). On the first postoperative day, increased levels of S-100 beta correlated with decrease in amplitude (p = 0.001)., Conclusion: Compared to SEP, CEA under regional anaesthesia is a safer method to detect patients with cerebral ischaemia before irreversible cellular brain damage occurs. Measuring blood levels of S-100 beta could help to evaluate patients with risk to develop cerebral ischaemia during clamping.

Unlabelled: S-100 protein and neuron-specific enolase (NSE) serum concentrations serve as markers of cerebral damage in cardiac surgery, neurology, or after head injury. In these circumstances, S-100 and NSE levels correspond with the results of neuropsychological tests. The present study investigated the diagnostic value in orthopaedic patients after joint replacement., Methods: Forty patients scheduled for elective hip or knee arthroplasty were investigated. Serum values of NSE and S-100 were determined preoperatively and 30 min and 4, 18, and 36 h postoperatively. Neuropsychological tests (syndrome short test, SKT, delirium assessment according to DSM IV) were performed preoperatively and two, three, and four days following surgery. General anaesthesia was induced with fentanyl and etomidate and maintained with isoflurane in oxygen/air., Findings: The S-100 increased from a median of 0.04 ng/ml (range 0.004-0.19 ng/ml) preoperatively to 1.03 ng/ml (range 0.18-3.65 ng/ml) at 30 minutes postoperatively (P < 0.0001). These levels returned to normal in the course of the following 2 days. NSE values were 8.55 ng/ml (range 4.6-14.9 ng/ml) preoperatively and 7.07 ng/ml (range 4-16.4 ng/ml) postoperatively (P = 0.167). There were no differences in serum concentrations of S-100 and NSE between normal patients and those with postoperative cognitive deficit. Furthermore, no correlation was found between the serum marker and neuropsychological tests., Interpretation: Obviously, increased NSE levels seem to indicate cerebral damage only in more severe cases. S-100 does not seem to be brain-specific in patients undergoing orthopaedic surgery. Therefore, the value of S-100 in the assessment of brain disorders is limited.

Aim: The diagnostic value of 123I-mIBG-scintigraphy, bone scintigraphy and catecholamine metabolites in the follow up of neuroblastoma stage IV will be evaluated., Methods: Nineteen children suffering from neuroblastoma were analysed retrospectively by 123I-mIBG-scintigraphy, bone scintigraphy and measurement of homovanillic acid, vanillic acid, neuronspecific enclose, lactate dehydrogenase, and ferritine. Follow up was 7-132 (median 36) months., Results and Conclusion: The significance of the methods was dependent on the time of diagnostic use. In principal, 123I-mIBG-scintigraphy has the highest diagnostic impact. For initial staging and diagnosis of recurrence a combination of all three methods can be used. On the contrary, follow up during chemotherapy is best documented by 123I-mIBG-scintigraphy, whereas bone scintigraphy is of limited and measurement of catecholamine metabolites of less diagnostic value.

To assess the predictive value of the tumour marker NSE in respect of survival time prognosis in patients with small-cell bronchial carcinoma we performed serial measurements of the NSE concentration in 67 patients in whom the small-cell bronchial carcinoma had been newly diagnosed, before and during chemotherapy or radiotherapy. Pretherapeutic NSE determination proved an important predictive parameter with regard to survival time prognosis. In patients with an initial NSE concentration of over 60 ng/ml the survival time was significantly reduced (from 12.1 months to 8.4 months, p < 0.01). The pretherapeutic NSE concentrations are associated with the initial tumour stage. Serial NSE determinations reflect the course of the disease. A drop in NSE concentrations during the early phase of therapy may be important as a secondary prognosis indicator.

The intracytoplasmatic glycolytic enzyme neuron-specific enolase (NSE) can be found in cells of endocrine tissue and their derived tumours. The enzyme is not secreted but released if cells are destroyed, i.e. continuously in malignant tumours. The serum level of neuron-specific enolase (NSE) has been used as a marker for small cell carcinomas of the lung, glioblastomas and malignant phaeochromocytomas. In this investigation blood samples were taken prior to and following surgical manipulation of the tumour in 21 patients with paragangliomas of the head and neck region and 6 controls. 22 serum samples were obtained before angiography and two hours after angiography, 41 before surgery, during surgery and after surgery. The serum level of NSE was measured by NSE-RIA test (Diagnostics, Uppsala). In all tumour specimens NSE could be demonstrated by the immunohistological PAP method (Abb. 1). Only two patients had preoperatively elevated serum-NSE levels. An arterial venous shunt had been detected by angiography in one of these patients. No significant effect on NSE serum level could be produced in the majority of patients by an angiography with embolisation or surgical manipulation of the tumour (Fig. 1, 2). A reduction in serum NSE level was observed postoperatively in both cases mentioned before. None of the 6 controls showed any significant change in serum NSE level (Fig. 3). It can be concluded from this study that embolisation does not lead to direct or indirect cell destruction through ischaemia. Manipulation of the tumour does not destroy a significant number of cells.(ABSTRACT TRUNCATED AT 250 WORDS)

In a prospective study 199 risk newborn infants were examined by means of cerebral ultrasound scanning and after this the influence of diagnosed intracerebral events on the concentration of neuron-specific enolase (NSE) was determined. The NSE may be valid as an indicator of intracerebral damage. A significant relationship between increased concentration of NSE and intracerebral haemorrhage of type II could be found only for the NSE-1 (determination from cordblood or from blood of the first or second day of life). The same relationship results for intracranial cystic rebuildings, destructions and enlargements of ventricles. The diagnostic tests of NSE-1 for intracerebral haemorrhages don't prove with a validity of 57.4% high prognostic value. Not until a NSE-1-level of 16.0 micrograms/l a predictive value of the positive test of 100% was calculated.

The neuron-specific enolase (NSE) level is elevated in neurons and in numerous cells of the APUD system; melanocytes are also considered to belong to this system. In order to test the relevance of NSE as a tumour marker for malignant melanoma, its concentration in serum was radioimmunologically determined in 89 patients with melanomas: 24 in stage I (primary tumours), 44 in stage II (regional metastases), and 21 in stage III (distant metastases). The average (+/- coefficient of variation) concentrations recorded were 7.4 micrograms/l (+/- 46%) in patients in stage I, 5.8 micrograms/l (+/- 32%) in those in stage II, and 11.0 micrograms/l (+/- 72%) in those in stage III. A threshold value of 11.5 micrograms/l was exceeded in 9 cases, including 8 patients in stage III. Since definitely increased values arose almost exclusively in distant metastases, determination of NSE levels in serum is hardly a suitable tool for early detection of latent metastases.

In a prospective study the psychomotor development of an unselected collective of risk newborn infants up to the end of the second year of life was examined. 199 children have developed normal, 21 showed developmental abnormalities, 84 light to moderate disturbances, and 30 severe disabilities. Already in the newborn period the concentration of neuron-specific enolase in the serum was evaluated. The NSE could be an indicator of brain damage. The determined values of NSE showed a log-normal-distribution at the three times (cord-blood, first or second day of life, third or fourth day of life, and ninth to eleventh day of life). Significant relationship between the psychomotor development during the first two years of life and of NSE-concentration was not found. Nevertheless the diagnostic value of the NSE is better with a specificity of 47.7% and a sensitivity of 80.0% than those of the results of intracranial ultrasound examination or of the erythrocytic-density-test. In contrast to these results the use of the neuron-specific enolase alone for the prediction of individual prognosis of children is not be recommended.

In 54 patients with untreated, histologically proven lung cancers (18 squamous cell, 15 small cell, 12 large cell carcinomas and 9 adenocarcinomas), the serum antigens NSE and SCC were measured. 43 (71) patients with benign lung diseases served as controls for serum levels of SCC (NSE). With a cut-off level of 2.5 (15.0) ng/ml elevated serum values were observed in 4.6% (4.2%) of the control collectives. We determined the sensitivity of both antigens in the diagnosis of the different histological cancer types. The highest sensitivity of 80% was observed for NSE in patients with small cell cancer, whereas non-small cell cancers were associated with only 11-27% elevated serum concentrations. The sensitivity for SCC was highest in patients with adenocarcinoma (44%) and attained only 33% in squamous cell cancer patients. We could not confirm a selectivity of serum-SCC for squamous cell differentiation in lung cancers. Combined serum determination of SCC and NSE increased the sensitivity in the diagnosis of non-small cell lung cancer but not of small cell cancer compared to the NSE determination alone. The data suggest a correlation of serum SCC levels to the tumour stage in squamous cell carcinoma patients.

In a review of the literature the current knowledge of the diagnostic significance of sialic acid (NANA), neuron-specific enolase (NSE) and carcinoembryonic antigen (CEA) in the detection and differentiation of brain tumors is demonstrated. The efficiency of some additional biochemical tumor markers is briefly described. In a total of 101 patients of our own 63 patients operated on intracranial expansive lesions and 38 patients with non-tumoral diseases of the central nervous system were examined for their serum concentrations of NANA, NSE and CEA with additional determination of total serum protein (TSP) and C-reactive protein (CRP) concentrations. 24 benign, 15 semibenign, 12 semimalign and 12 malign expansions were compared with each other and with the controls for their tumor marker concentrations. The criteria of the diagnostic reliability (sensitivity, specificity, positive and negative predictive value) were calculated for each single marker and the reliability of information for the combined used markers was evaluated. In summary the following results were found: The concentration of C-reactive protein corresponded significantly with the NANA-concentrations on the one hand and with the CEA-concentrations on the other hand (p less than 0.05). NANA: 1. The average concentration increased with increasing malignancy (no significance). 2. Patients who suffered from non-tumorous diseases of the central nervous system which coincided with brain tissue lesions had often extremely high values. 3. 4 of 10 healthy controls had NANA-levels above the reference value. 4. The sensitivity was 44%, the specificity 73%, the positive predictive value 17%, the negative predictive value 88% (patients with pathological CRP- or TSP-values excluded).(ABSTRACT TRUNCATED AT 250 WORDS)

Both neuron-specific enolase (NSE) and beta 2-microglobulin were detected immunohistologically in malignant melanomas. In addition, serum NSE and beta 2-microglobulin were reported to be elevated in patients with malignant melanoma. The radioimmunoassay results presented did neither reveal any elevation of serum neuron-specific enolase nor of serum beta 2-microglobulin in more than 30 serum samples of patients with malignant melanoma in different tumour stages.

Serum neuron-specific enolase (NSE) and carcinoembryonic antigen (CEA) are two very good tumor markers for diagnosis and for monitoring response to therapy in patients with lung carcinoma. Especially, NSE has a high sensitivity and specificity for early detection of small-cell lung cancer and for management of these patients.

Neurone specific enolase (NSE) was measured in serum from 54 patients with untreated bronchial carcinoma. Serum NSE was elevated (greater than 12.5 micrograms/l) in 24 of 31 patients (77.4%) with small cell bronchial carcinoma, but in only 4 of 23 (17.4%) with non-small cell bronchial carcinoma. The median serum NSE level was significantly higher for small cell bronchial carcinoma than for the other forms (23.6 micrograms/l vs. 8.0 micrograms/l; P less than 0.001). NSE levels had a positive correlation to the tumour stage for the small cell tumour: median of 16.5 micrograms/l in "limited disease" (16 cases) and 43.2 micrograms/l in "extensive disease" (15 cases). Serum NSE levels seem to be suitable markers for documenting the course of small cell bronchial carcinoma: 15 patients with tumour regression or remission had normal NSE values while elevated levels were found in 7 of 8 patients with progression. NSE was demonstrated immunohistologically both in small cell and non-small cell bronchial carcinoma tissue, but high NSE levels were predominantly present in small cell carcinomas.

The diagnostic significance of neuron-specific enolase in serum was examined in 54 patients with bronchial carcinoma and in 28 with neuroendocrine tumors. Control groups were 42 patients with epithelial and 39 with nonepithelial malignant neoplasms as well as 40 patients with benign pulmonary diseases. The sensitivity of neuron-specific enolase in small-cell bronchial carcinoma was 60% and increased to 87.5% in advanced stages ("extensive disease"). On the other hand, non-specific enolase showed an increase in only 13.8% of patients with other than small-cell bronchial carcinoma. The proportion of false-positive enolase values in non-malignant pulmonary diseases was 5%. Some endocrinal tumors (e.g. tumors of the APUD cell system) showed pathological serum concentrations in 7.1% of the cases only. 37.5% of epithelial malignant neoplasms had enhanced levels, but only 5.1% in nonepithelial neoplasms. Small-cell bronchial carcinoma is most probably present in patients with bronchial carcinoma and neuron-specific enolase serum concentrations above 25 micrograms/l.