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Raised serum alpha-fetoprotein levels measured by radioimmunoassay were found in 19 out of 24 (79%) patients with primary liver cancer and in 32 out of 311 (10%) patients with other liver diseases. The rise was transient in cases of hepatitis and a transient rise was also seen after alcohol intake ceased in two patients with cirrhosis. alpha-Fetoprotein levels exceeding 500 ng/ml were 30-50 times more common in primary liver cancer than in other liver diseases. A rise in level seems to reflect the extent of liver regeneration in liver diseases other than primary cancer.

Circulating carcinoembryonic antigen (CEA) and alpha fetoprotein (AFP) levels were measured by radioimmunoassay in 53 patients with carcinoma of the ovary, 16 patients with other malignant genital tumors, and 31 women with nonmalignant diseases of the genital tract. The serum CEA concentration was elevated (greater than 5 ng/ml) in 11 patients with ovarian cancer, 2 patients with endometrial cancer, 1 patient with carcinoma of the cervix, and 1 patient with a benign embryonal cystic teratoma. Elevated CEA levels were found only in patients with advanced malignant disease, while early stages were associated with normal CEA concentrations. AFP levels were normal in all but 1 patient. Both CEA and AFP levels were markedly raised in a case of advanced genital carcinoma arising probably from the ovary. Ascitic fluid of another patient with ovarian cancer contained a high concentration of CEA, giving an identical reaction in immunodiffusion with CEA from colon cancer. The present results indicate that while the increased expression of carcinofetal components takes place in some malignant tumors of the female genital tract, it is usually a late phenomenon.

Nine families in which a previous child had had congenital nephrotic syndrome (C.N.) sought genetic counselling and possible antenatal diagnosis of fetal disease. Maternal serum and amniotic-fluid alpha-fetoprotein (A.F.P.) assays were carried out between the 15th and 20th weeks of subsequent pregnancies. Seven women in whom A.F.P. concentrations were normal chose to continue pregnancy, and they were all delivered of a healthy child. Markedly raised amniotic A.F.P. concentrations were found in two cases; in one of these cases maternal serum-A.F.P. was also raised. These pregnancies were terminated, and electron microscopy of the fetal kidneys showed evidence of C.N. in the fetus--i.e., loss of foot processes and an increase in the mesangial matrix of the glomeruli. The outcomes of these at-risk pregnancies indicate that prenatal diagnosis and genetic counselling are possible in families with a history of C.N. The results also stress the importance of carefully examining fetal kidneys whenever amniotic-fluid A.F.P. concentration is raised in the absence of apparent malformations.

Abnormally low human placental lactogen (HPL) or high alpha fetoprotein (AFP) levels in maternal serum are unfavorable prognostic signs in women with threatened abortion but normal levels cannot be used to discriminate between viable and nonviable pregnancies. Out of 112 women with threatened abortion, 69 aborted; of these, 36 had a low HPL level and they all aborted. Five women had an increased AFP concentration. Four of these aborted and the remaining case was a twin pregnancy in which one fetus died and the other survived. HPL and AFP levels provide complementary information as to the fetal outcome in threatened abortion. This was indicated by a normal HPL level in all of the five cases with raised maternal AFP, and by a normal AFP level in 35 of the 36 women with low maternal HPL.

The clinical value of maternal serum alpha-fetoprotein (AFP) as a guide to the outcome of threatened abortion was assessed. After the thirteenth week of gestation, abortion occurred more frequently (10/12) in women with abnormal serum AFP levels than in those (2/12) whose AFP concentrations were within the normal range. Low levels were present in women with blighted ovum and high concentrations were associated with intrauterine fetal death. In legal first and second trimester abortions, the circulating maternal AFP levels in postabortion samples were often higher than before abortion, irrespective of whether abortion was performed instrumentally or induced with prostaglandins. Maternal serum AFP levels provide a new means for prediction of the outcome of threatened abortion.