Cerebrospinal fluid biochemical markers of central nervous system metastases

beta-Glucuronidase and carcinoembryonic antigen (CEA) were measured in the cerebrospinal fluid of patients with cancer. Both substances were found to reliably detect the presence of leptomeningeal infiltration by carcinoma. Neither substance was reliable in the detection of leptomeningeal infiltration by lymphoma or of metastases to the brain parenchyma or spinal epidural space. beta-Glucuronidase was moderately elevated in chronic infectious meningitis, whereas CEA was not. Both markers approached control levels with favorable treatment of the leptomeningeal metastases, reflecting the effectiveness of treatment. Both beta-glucuronidase and CEA hold promise as indicators of early metastatic involvement of the leptomeninges by carcinoma.

Accumulation of hormones in breast cyst fluid

The concentration of some immunoreactive peptide hormones in breast cyst fluid and serum from a series of patients with cystic breast disease were compared. The concentrations of the two pituitary gonadotropins, LH and FSH, were consistently higher in serum than in cyst fluid, confirming earlier more limited observations. The mean PRL concentration, on the other hand, was elevated in cyst fluid though the variability was great. The cyst fluid serum ratio of hCG was elevated in the patient group as a whole. However, the results suggested the presence of two subpopulations; group I, in which the cyst fluid and serum hCG levels were essentially indistinguishable and in the range found in normal serum, and group II, in which the cyst fluid hCG concentration was consistently greater than the normal serum range. Analysis of hormone concentrations in multiple cysts aspirated at the same time showed a remarkable degree of agreement in the cyst hormone levels in most of the patients. The greatest variability in the levels was seen with hCG, were a small numer of subjects showed a very large spread in the values.

Carcinoembryonic antigen in colonic lavage

Colonoscopic lavage was performed for assay of carcinoembryonic antigen (CEA) concentration in patients with small and large colonic adenomas, in patients with adenocarcinoma of the colon, and in normal controls. CEA concentration was considerably higher in colonoscopic lavage as compared to plasma. CEA concentration in normal controls and in patients with colonic adenomas less than 1 cm in size were not significantly different. CEA concentrations in patients with colonic adenomas greater than 1 cm in size and in patients with adenocarcinoma of the colon were significantly higher than those observed in patients with small adenomas and in the normal controls. In all except 2 patients, plasma CEA concentrations were normal. Assay of CEA concentrations in colonic lavage may have potential application in the further assessment of the mucosa at risk for colon adenomas and for colon cancer. It does not appear to be accurate enough for diagnosis of colon cancer in individual patients.

The clinical utility of plasma and urinary carcinoembryonic antigen in patients with genitourinary disease

Carcinoembryonic antigen was measured in the urine and plasma of 108 patients with several types and various stages of genitourinary cancer. The value of the carcinoembryonic antigen assay as an early indicator of neoplastic disease was evaluated and a correlation was made between the extent of disease and the concentration of urinary and plasma carcinoembryonic antigen. Patients were classified according to stage of tumor involvement as follows: no evidence of disease, non-malignant disease, non-invasive disease, no known metastasis, regional metastasis and disseminated metastasis. The urinary carcinoembryonic antigen levels more closely paralleled the extent of disease than did the plasma carcinoembryonic antigen levels in patients with bladder cancer. Neither urinary nor plasma carcinoembryonic antigen levels were useful in assessing the extent of disease in patients with prostatic or testicular cancer. Studies related to microbiological interference in the carcinoembryonic antigen assay indicated that bacterial counts up to 10(5) organisms per ml. did not interfere. Cytological studies indicated that the presence of white blood cells, atypical cells and malignant cells could result in elevated urinary carcinoembryonic antigen levels.

Correlation between estrogen receptor protein and carcinoembryonic antigen in normal and carcinomatous human breast tissue

We determined estrogen receptor protein and carcinoembryonic antigen in cytosols prepared from 189 human breast carcinoma tissues, 85 benign or normal breast biopsies, and 101 tissue specimens metastatic from breast carcinoma. Carcinoembryonic antigen was observed in 70% of the primary carcinomatous tissues, 15% of the benign or normal specimens, and 51% of the metastases. Ninety-six of the 189 primary carcinomatous specimens with increased concentrations of carcinoembryonic antigen were also positive for estrogen receptor protein, whereas 67 of the 72 benign or normal biopsies with low concentrations of carcinoembryonic antigen were also negative for estrogen receptor protein. All five fenign specimens with positive estrogen receptor protein and normal carcinoembryonic antigen concentrations were from fibroadenomas. The concordance between estrogen receptor protein and carcinoembryonic antigen in the primary carcinomatous tissue was 66%, in metastatic carcinoma 51%, and in benign and normal tissue 85%.

Correlation between estrogen receptor protein and carcinoembryonic antigen in normal and carcinomatous human breast tissue

We determined estrogen receptor protein and carcinoembryonic antigen in cytosols prepared from 189 human breast carcinoma tissues, 85 benign or normal breast biopsies, and 101 tissue specimens metastatic from breast carcinoma. Carcinoembryonic antigen was observed in 70% of the primary carcinomatous tissues, 15% of the benign or normal specimens, and 51% of the metastases. Ninety-six of the 189 primary carcinomatous specimens with increased concentrations of carcinoembryonic antigen were also positive for estrogen receptor protein, whereas 67 of the 72 benign or normal biopsies with low concentrations of carcinoembryonic antigen were also negative for estrogen receptor protein. All five fenign specimens with positive estrogen receptor protein and normal carcinoembryonic antigen concentrations were from fibroadenomas. The concordance between estrogen receptor protein and carcinoembryonic antigen in the primary carcinomatous tissue was 66%, in metastatic carcinoma 51%, and in benign and normal tissue 85%.

Fibrinogen and albumin deficiencies associated with packed red blood cell transfusions

Fibrinogen content was determined for each of 50 units of citrate-dextrose-phosphate (CPD)-preserved whole blood, packed red blood cells reconstituted with 250 ml. of saline, and packed red cells reconstituted with 250 ml. of purified plasma protein fraction (PPF). The total protein and albumin were measured, by electrophoresis, on each of 10 units of the three varieties of blood. The fibrinogen content of the two types of reconstituted cells was significantly lower than that of whole blood. Although the total protein/albumin content of whole blood and PPF-reconstituted red cells was similar, saline-reconstituted cells were markedly deficient in both total protein and albumin. Low fibrinogen and platelet levels subsequent to transfusion with reconstituted packed red cells can lead to an erroneous diagnosis of disseminated intravascular coagulation. Administration of large quantities of saline-reconstituted packed cells could be an etiologic factor in postoperative interstitial pulmonary edema.

Chemical and Clinical Evaluation of the Continuous-flow Analyzer "SMAC"

"SMAC" (Sequential Multiple Analyzer plus Computer) is a high-speed computer-controlled multitest analyzer. A 20-channel prototype SMAC (glucose, urea nitrogen, creatinine, carbon dioxide content, total bilirubin, calcium, phosphorus, cholesterol, iron, uric acid, chloride, sodium, potassium, total protein, albumin, creatine kinase, alkaline phosphatase, lactate dehydrogenase, and aspartate and alanine aminotransferases) has been evaluated for: (a) method precision during within-day runs and on a day-to-day basis over a period of time; (b) method linearity over a range established on a chemical basis and related to clinical requirements, with use of both aqueous standards and protein matrix reference material; and (c) correlation of SMAC values with those obtained by the methods routinely in use in our department.

CEA-Like Material in Fluid from Benign Cysts of the Breast

A preliminary survey of carcinoembryonic antigen (CEA) concentrations in 23 breast-cyst fluids (BCF) and blood plasma has revealed markedly increased concentrations of CEA-like material in BCF as compared to its concentrations in plasma. Chromatography on Sephadex G-200 indicated the immunoreactive CEA component extracted from BCF corresponds to a glycoprotein with a molecular weight of at least 200 000.

Automated Method for Determination of Serum 5'-Nucleotidase Activity

An automated method has been devised for determining 5'-nucleotidase activity in serum. A modified creatine phosphokinase cartridge (Technicon Instrument Corp., Tarrytown, N. Y.) is used to prepare a reaction mixture containing, per liter: barbital buffer (pH 7.5), 16.1 mmol; adenosine-5'-phosphate, 5.4 mmol; Mg2+, 20.2 mmol; phenyl phosphate, 7.8 mmol; adenosine deaminase, 0.78 mg; and sample, 0.21 ml/ml of reaction mixture. After incubation, the liberated ammonium ion is determined by use of the alkaline hypochlorite-phenol reaction. Nucleotidase activity as determined by the automated method correlated well with activities as determined manually by a Ni2+ inhibition—phosphate analysis procedure. Respective values obtained by the manual and by this procedure were: for sera with activities within the normal range, 7.9 ± 3.2 and 8.2 ± 3.3 U/liter; for activities between 16 and 50 U/liter, 26.3 ± 9.3 and 26.5 ± 8.8 U/liter; and for serum with activities greater than 50 U/liter, 79.1 ± 42.5 and 78.7 ± 41.3 U/liter.

Urinary Cystathionine, Catecholamine, and Metabolites in Patients with Neuroblastoma

Urinary excretions of cystathionine, catecholamines, and vanillymandelic acid were compared in 27 patients with neuroblastoma and in nine other patients with non-neurogenic tumors. Eleven of the 27 patients were without clinical evidence of active neuroblastoma at the time of the study and excreted no or relatively small amounts of urinary cystathionine. Thirteen of the remaining 16 patients with progressive neuroblastoma had elevated cystathionine values. Elevated values were also detected in three of nine patients with other tumors. There was no correlation between the excretion of cystathionine and either catecholamines or vanillymandelic acid. The assay of cystathionine in addition to catecholamines and vanillymandelic acid is recommended for the complete biochemical evaluation of patients with neuroblastoma.

Use of Evacuated Collection Tubes for Routine Determination of Arterial Blood Gases and pH

There is a well-recognized need for a reliable, convenient, and simple method for determining whole blood pH, PaCOaCO2, and PaOaO2. We have designed a specimen collection set that facilitates collection of the specimen and permits convenient and reliable analysis by the laboratory. Specimens are collected in newly designed "Vacutainer" tubes containing heparin and nitrogen gas. Without removing the Vacutainer stopper, the specimen may be anaerobically introduced into the analytical equipment through a unique aspirating needle. Atmospheric contamination of the specimen is eliminated.

An Automated, Fluorometric Procedure for Determining Serum Lipase

Currently available routine assays for lipase (glycerol ester hydrolase EC 3.1.1.3) are lengthy and laborious, and may utilize nonspecific substrates. An automated continuous-flow procedure has been developed for the fluorometric determination of serum lipase activity. This involves the use of a fluorescein fatty acid ester, monodecanoyl fluorescein (MDF), as substrate. This compound is not fluorescent, but one of its hydrolytic products, fluorescein, is intensely fluorochromatic. Under the conditions of the assay, in which 0.5 mmol of MDF is used per liter, the hydrolysis is linear with time and follows zero-order kinetics through the hydrolysis of at least 35% of the substrate. Determinations are carried out on 0.1 ml serum at the rate of 60 assays/hour. By this assay, mean activity in the serum of normal persons is 751 units (SD, 38 units).