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Levels of a new carbohydrate antigen CA 19-9, which is a monosialo-ganglioside identified by a monoclonal antibody raised against colorectal carcinoma cells, were compared to carcinoembryonic antigen and tissue polypeptide antigen assays in 250 sera from patients with different pancreatic diseases including acute pancreatitis, chronic pancreatitis, and pancreatic cancer. All three tumoral markers were elevated at the onset of an acute pancreatic attack in a few patients. All but five patients with chronic pancreatitis displayed normal levels with each of the three markers; in two of these five cases an extraintestinal cancer was later discovered. CA 19-9 displayed higher sensitivity and predictive value of a negative result than the other two markers. The best operational characteristic of CA 19-9 was its high predictive value for a positive test which suggests a "ruling in" usage of it for pancreatic cancer diagnosis. CA 19-9 assay was of extreme value in disclosing both localized and metastatic pancreatic cancer while the other two markers were more often positive in the latter case. Of 71 cancer patients with positive markers, only four would have escaped a right diagnosis by assaying CA 19-9 alone. [ABSTRACT FROM AUTHOR]

In view of the fact that pulmonary malignancies still represent an important cause of tumor death and that the high rate of unsuccessful treatment may be partly due to the late clinical presentation, efforts should be spent not only to develop new and effective treatments but also to improve early diagnosis and to identify prognostic factors and parameters useful for the monitoring of the treatment. Tumor markers, if used properly, can provide a useful support for the management of patients suffering from various malignancies, including lung cancer patients. The clinical significance of one of the most widely used tumor markers, Tissue Polypeptide Antigen (TPA), has been reviewed and showed this marker to be useful to the clinician for the management of patients with pulmonary malignancy, as a complementary tool for diagnosing and staging the tumor as well as for monitoring treatment response or relapse occurrence.

Bone metastases frequently occur in prostate carcinoma. Total body radionuclide scan with diphosphonate methylene labelled with 99Tc is commonly used to diagnose such metastases. However this technique is aspecific and frequently unreliable. In recent years several biological markers dealing with bone metabolism were studied. Serum determination of skeletal alkaline phosphatase (ALP) and moreover of its bone isoenzyme (BAP) could be considered a reliable index of osteoblastic activity. In this preliminary report we analyzed a group of 43 patients affected by prostate carcinoma with or without bone metastases. The American Urological Association (AUA) staging system was adopted. Sixteen patients were D2, bone metastases had been suspected by means of radionuclide bone scan and confirmed by Computerized Tomography and/or aimed X-rays. Tandem R-Ostase by Hybritech was used to measure BAP, normal value is set to 20 micrograms/L. All D2 tumours had pathological BAP values (mean value 87.50 micrograms/l); 1/3 stage A, 5/13 stage B, 5/9 stage C and 0/2 stage D1 patients had pathological findings. One of this patients, stage C, revealed a bone metastase at a later bone scan.

The effect of intramuscular calcitriol was evaluated in five children (aged 1-16 years) with severe chronic renal failure and hyperparathyroidism [range of intact parathyroid hormone (PTH) 400-1,200 pg/ml]. All five children had been on oral calcitriol or 1 alpha-hydroxyvitamin D3 treatment (5-20 ng/kg per day), but an adequate, efficacious dosage could not be achieved since any attempt of increasing the dosage resulted in severe hypercalcaemia (> 2.9 mmol/l). Intramuscular calcitriol was given three times weekly for 5 months at an initial dosage of 65-70 ng/kg to all but one patient who received 100 ng/kg. In the first three patients, treatment resulted in an 86%-98% fall in serum PTH compared with baseline levels and serum calcium never exceeded 2.65 mmol/l, except for one episode of hypercalcaemia in one patient. In the last two patients, serum calcium rose above normal limits, thus calcitriol had to be discontinued several times and then restarted at a lower dosage (40 ng/kg); PTH fell by 61% and 73%, respectively, compared with basal values. All patients had very low pre-treatment levels of serum 1,25-dihydroxyvitamin D3 (5-15 pg/ml) which were normalized (35-56 pg/ml) by the intramuscular calcitriol-treatment. Serum phosphorus and magnesium did not vary in any of the five patients. No side effects were observed at the injection site. Intramuscular calcitriol seems a useful therapeutic option for patients with severe hyperparathyroidism associated with a high serum calcium level when treated with conventional oral calcitriol.

M-mode and two-dimensional echocardiographic images were obtained using the planimeter method in the short axis view and calculated by Doppler-derived pressure half-time in 24 patients with mitral stenosis before and after surgical commissurotomy and posterior annuloplasty. The diameter of the mitral valve annulus was measured in the standard long axis view and in the apical four-chamber view using two-dimensional echocardiography. Preoperatively, the mitral annulus was dilated in all patients as a consequence of left atrial dilation. This could be one of the factors causing residual regurgitation after surgical mitral commissurotomy. However, more data are needed to demonstrate that annuloplasty can prevent the development of mitral regurgitation after surgery.

Specific markers able to detect either the presence of tumours or to identify the histological type of tumour are not currently available. Previous work yields an inconsistent picture of actual effectiveness of oncological markers, we therefore carried out a study on the cancer patients in our clinic. The present paper considered five markers (CEA, SCC, ca 19-9, TPA and Ferritin) and tested their effectiveness in diagnosing and following patients with head and neck neoplasias. The study was carried out on 102 patients, divided into three groups: 59 had been histologically diagnosed cancer but had not received any treatment (first group), the remaining 43 who had been treated (second group). We have also monitored the first group of no treated patients six months after therapy (third group). Our results suggest that while no significant conclusions may be drawn from SCC and CA 19-9, we found interesting results concerning Ferritin. Indeed Ferritin values increased by 22% in the first group, by 26% in the second one and by 19% in the third one. CEA and TPA values increased in non treated patients only by 22% and 12% respectively while they did not alter in the treated ones and they altered by 10.5% and by 10% respectively six months after therapy. Although our data are still preliminary and speculative and further evidence is needed, we can infer that the stage of the cancer and the positive markers appear to be concluded. The correlation is even stronger when all the cases are considered, without introducing the statistical and epidemiological variables.

Atrial natriuretic peptide (ANP) has been reported to have protective effects against methacholine-induced bronchoconstriction in asthmatics. The aim of the study was to evaluate the relationship between plasma ANP levels and bronchial responsiveness to methacholine in patients with mitral stenosis. In 12 patients with moderate mitral stenosis, age 35-58 years, 9 female, 8 in NYHA class 2, 4 in NYHA class 3 for symptoms, plasma ANP and bronchial threshold to methacholine (PD20FEV1) were determined. The same measurements were performed in 10 asthmatic patients, hyperresponsive to methacholine, and in 10 normal subjects, nonresponsive to methacholine. Mean +/- SE plasma ANP levels were significantly higher in patients with mitral stenosis in comparison with asthmatics and normals (159 +/- 41.8, 7.3 +/- 0.98, 7.6 +/- 1.3, respectively, p < 0.01). In patients with mitral stenosis there was a significant relationship between plasma ANP and PD20FEV1 (r = 0.81, p < 0.01). No relationship was found between ANP and PD20FEV1 in asthmatics. In conclusion, in patients with mitral stenosis ANP seems to play a protective role against bronchial hyperresponsiveness to methacholine.

One-hundred-and-fifty-five consecutive symptom-free patients underwent maximal treadmill exercise testing, rest and stress radionuclide angiography at least two months after an uncomplicated acute myocardial infarction; of these, 90 underwent coronary angiography. All patients were followed-up for a mean of 32 +/- 13 months regarding the prediction of hard (death and reinfarction) and soft (angina and coronary surgery) coronary events. The specificity, sensitivity, positive and negative predictive value of exercise stress test were 47%, 76% and 41% for any coronary events; none of the patients who incurred a hard coronary event showed ischemia during electrocardiographic exercise tests. Sensitivity, specificity and positive predictive value for failure to increase the ejection fraction of at least 5% were 60%, 45% and 30% for any coronary event and 25%, 49% and 2% for any hard coronary event. The presence of multivessel disease at coronary angiography showed a sensitivity of 62% for any coronary event and of 67% for hard coronary events; specificities were 66% and 57%, and predictive values were 52% and 10%, respectively. It is concluded that electrocardiographic exercise testing, radionuclide angiography and coronary angiography are not helpful two months after an episode of uncomplicated myocardial infarction in order to identify patients who will suffer a new coronary event.

Different hematochemical parameters using a histological sample (hepatic needle biopsy) were compared in patients affected by alcoholic liver diseases. In conclusion, the importance of hepatic needle biopsy is confirmed in the definitive diagnosis of this pathology.

Many authors have shown that osteoporosis is an important complication in male hypogonadism, due to the chronic lack of androgens; but in hypogonadal males the pathogenesis of osteopenia isn't completely explained. In this work we examined in 10 hypogonadal males (4 with Klinefelter's Syndrome and 6 with Hypogonadotropic Hypogonadism) lumbar bone mineral content (BMC) and the effects of testosterone (Sustanon) administration on BMC and other phosphocalcium parameters. We evidenced lower BMC levels in hypogonadal subjects if compared to those observed in the control age-matched group; moreover after 3 months of treatment a statistically significant increment of plasma bone gla protein, calcitonin and lumbar BMC was observed. On the contrary no significant variation was observed in osteoclastic indexes (PTH-MM, OHPU/CrU, CaU/CrU) after treatment. In addition both calcitonin basal levels and secretory reserve, measured with calcium infusion, were significantly increased after treatment. Our data confirm the hypothesis that androgen acts on bone principally directly at osteoblastic level, in a stimulatory manner, and indirectly, with calcitonin mediation, with inhibition of osteoclasts.

The Authors have evaluated the possibilities of use of the PFD in the regular dialysis treatment. At first they have studied in 8 patients the advantages offered by this technique in terms of depuration of small molecules and of tolerance in comparison with HD and HDF. Subsequently, they have compared the performances obtained in HF in a second group of 7 patients with the results observed in PFD executed by using 2 dialyzers on line and, in a second phase, in parallel, extending the comparison parameters to a higher molecular weight solute such as the beta 2-M. The results obtained indicate the PFD as a technique which can offer (compared to HD) a better tolerance and higher depurative performances, which on their turn can eventually allow a reduction of the length of the treatment. Moreover the possibility of executing the PFD with 2 polysulfone dialyzers on line and in parallel, increasing the UF to 13.5 and 15 L, renders this technique competitive with the HF also for its capacity of removing the beta 2-M.

Levels of alkaline phosphatase isoenzymes in patients with hepatic diseases, liver tumours and in normal control groups were analysed. Attention was focused on the ALP 1 isoenzyme and its validity in the diagnosis of hepatic metastases was confirmed.

The authors have evaluated general immunocompetence after cryosurgical treatment of 33 patients affected by oral squamous carcinoma. Patients have been divided into two groups: 17 of them were classifiable in 1st and 2nd stage and 16 of them in 3rd and 4th stages. Serum immunoglobulin levels, C3 - C4, peripheral lymphocytes, E-rosette forming cells, lymphocyte response to PHA were analyzed before a single cryotreatment 7 and 14 days after. The results indicate that immunological parameters vary in a significant way and can be constantly observed in 1st and 2nd stages, while the 3rd and 4th stages undergo no variations. Cryosurgery in the 1st and 2nd stages is able to modify, in particular, the parameters concerning cell - mediate immunity, although the phenomenon seems transitory, showing itself most on the seventh day.

Serum IgA, IgG and IgM values in 238 normal aged subjects were compared with those in 100 normal adults. Both male and female aged subjects displayed a significant rise in IgA and a significant fall in IgM, whereas IgG values were not markedly different. It was found that IgA increased and IgM decrease by an average of 12 mg % and 10 mg % (17 mg % in the aged) per decade respectively. Values were also determines in 597 aged hospital patients and related to the disease for which they were admitted. Increases in all three Igs were noted in sclerotic cardiopathy, chronic cerebrovascular insufficiency, acute broncopneumopathy (IgA increase only in chronic forms), and gastroduodenal ulcer. Diverticulosis of the colon and acute pancreatitis, however, were accompanied by elevated IgA values only. Increases were particularly marked in chronic liver disease, less so in diseases of the gallbladder. Neoplasia was usually accompanied by higher Ig levels.