Fast food: friendly?

Fast food is routinely blamed for the obesity epidemic and consequentially excluded from professional dietary recommendations. However, several sections of society including senior citizens, low-income adult and children, minority and homeless children, or those pressed for time appear to rely on fast food as an important source of meals. Considering the dependence of these nutritionally vulnerable population groups on fast food, we examined the possibility of imaginative selection of fast food, which would attenuate the potentially unfavorable nutrient composition. We present a sample menu to demonstrate that it is possible to design a fast food menu that provides reasonable level of essential nutrients without exceeding the caloric recommendations. We would like to alert health-care professionals that fast food need not be forbidden under all circumstances, and that a fresh look at the role of fast food may enable its inclusion in meal planning for those who depend on it out of necessity, while adding flexibility.

Bile carcinoembryonic antigen levels and occult hepatic metastases from colorectal cancer

PURPOSE

Up to 30 percent of patients will have occult hepatic metastases at the time of curative surgery for colorectal cancer. The ability to predict this group of patients would allow better targeting of appropriate therapy. It has been shown previously that patients with overt hepatic metastases have significantly high levels of carcinoembryonic antigen in gallbladder bile compared with serum levels. The aim of this study was to assess the accuracy of bile carcinoembryonic antigen levels taken at the time of operation in predicting patients with occult hepatic metastases.

METHODS

Bile and serum carcinoembryonic antigen samples were collected from 37 patients undergoing surgery for colorectal cancer, 26 of whose procedures were deemed curative and who were followed up for a median of 63.5 months.

RESULTS

Twelve patients were alive with no evidence of recurrent disease, and two had recurrent disease, whereas 12 died of disease. The median (interquartile range) serum carcinoembryonic antigen in the disease-free group was 2.8 (1.1-6.1) ng/ml, and in the recurrent group it was 6.35 (4.3-30) ng/ml (P = 0.006), whereas bile carcinoembryonic antigen in the disease-free group was 7 (5-39) ng/ml as compared with 31 (5-383.7) ng/ml in the recurrent group (P = 0.210). The accuracy of serum carcinoembryonic antigen in predicting occult hepatic metastases was 77 percent compared with 72 percent for bile carcinoembryonic antigen.

CONCLUSION

Intraoperative bile carcinoembryonic antigen levels are no more accurate than serum carcinoembryonic antigen levels in predicting occult hepatic metastases in patients undergoing potentially curative colorectal cancer surgery.

Rising levels of serum S100 protein precede other evidence of disease progression in patients with malignant melanoma

BACKGROUND

Several serum markers may be useful in the detection of metastatic melanoma, but none is in routine clinical use.

OBJECTIVE

To assess the validity of S100 protein as a serum marker of melanoma progression.

METHODS

Serum S100 protein levels were measured in 496 serum samples from 214 melanoma patients, using the Sangtec luminescence immunoassay. There were 75 patients with stage 1 melanoma, 66 initially with stage 2 melanoma, 49 initially with stage 3 melanoma and 24 with stage 4 melanoma.

RESULTS

Serum S100 protein levels were < 0.2 microg L-1 in 71 of 75 (95%) stage 1 patients. One patient who had a normal level developed local recurrence. Fifty-eight of 66 (88%) stage 2 patients also had normal serum S100 protein levels. One with elevated levels progressed to stage 3 melanoma and five with elevated levels progressed to stage 4 disease. The remaining two with elevated serum S100 protein remained well. Thirty-five of 49 (71%) stage 3 patients had normal levels and, of these, two have progressed to stage 4 disease. Three patients with stage 3 disease had an elevated serum S100 protein level on one occasion but remained well. Eleven of 13 patients who developed stage 4 melanoma during the study had rising levels of serum S100 protein > 0.2 microg L-1 5-23 weeks before detection of melanoma progression by conventional means. Twenty-two of 24 patients with stage 4 disease throughout the study had consistently elevated serum S100 protein levels, and the two patients with normal levels were clinically disease free after surgery and chemotherapy. None of 14 control subjects with atypical naevi had elevated S100 protein levels, and only one of 11 healthy normal controls had an elevated level.

CONCLUSIONS

Thus, rising levels of serum S100 protein are a specific and sensitive clinically relevant marker of tumour progression in melanoma patients, which precedes other evidence of melanoma recurrence.

Analysis of hCG: clinical applications and assay requirements

Study of the glycoprotein hormones, including hCG, is complex and evolving, and has benefited from recent major advances in analytical technology and molecular biology. It is important to be aware of the effect that these technological advances have, both on the analytical and the clinical requirements for provision of a diagnostic service for hCG. Some aspects of particular relevance are summarized in Table 10.

An independent evaluation of the potential clinical usefulness of proposed CA-125 indices previously shown to be of prognostic significance in epithelial ovarian cancer

CA-125 levels were assessed prior to each of the first three cycles of chemotherapy, in 81 patients with epithelial ovarian cancer receiving first-line chemotherapy. All patients have at least 1 year's follow-up. Thirty-nine patients (48%) have progressed clinically or have died within 1 year of treatment (treatment 'failures'). Three CA-125 indices previously shown to be of prognostic value are assessed for their ability to pick-out these 'failures'. When the indices examined are modified to obtain a specificity for picking out failures just exceeding 90%, the maximum sensitivity obtained was 46%. The use of CA-125 for clinical decision making in ovarian cancer requires further investigation to determine and validate a prognostic index with acceptable sensitivity and specificity, and to determine the clinical impact of treatment decisions made using such an index.

Rapid one step urine test for human chorionic gonadotrophin in evaluating suspected complications of early pregnancy

OBJECTIVE

To determine the ability of a sensitive one step urine test to detect human chorionic gonadotrophin in women with suspected complications of early pregnancy.

DESIGN

Test on women presenting to accident and emergency department with gynaecological problems over six months. Results were validated using a quantitative assay for human chorionic gonadotrophin in serum and urine.

SETTING

Accident and emergency department and gynaecology wards of a university teaching hospital.

SUBJECTS

130 unselected women.

MAIN OUTCOME MEASURES

Detection of human chorionic gonadotrophin by one step test, presence of ectopic pregnancy, and results of quantitative analysis of chorionic gonadotrophin in serum and urine.

RESULTS

79 women had a positive urine test result and 51 a negative result. All 12 women with ectopic pregnancy had a positive test result, although urinary concentration varied from 191 IU/l to 47,800 IU/l. Only one woman, who had a faintly positive result, was found not to be pregnant on subsequent examination. The sensitivity and negative predictive values of the urine test were 100% respectively. 33 women were sent home from the accident and emergency department with normal clinical findings after a negative urine test result. All these women had undetectable concentrations of chorionic gonadotrophin in matched samples of urine and serum.

CONCLUSIONS

A simple, rapid one step test for chorionic gonadotrophin should be available for the initial evaluation of emergency gynaecological problems. The additional cost of the test is offset by not admitting those patients whose clinical findings are normal and who have a negative urine test result and by reducing the number of women requiring quantitative assays of chorionic gonadotrophin.

Plasma alpha fetoprotein reference ranges in infancy: effect of prematurity

The dearth of plasma alpha fetoprotein reference ranges for preterm infants often impairs the clinical interpretation of plasma alpha fetoprotein data collected from ill babies. This study tested our hypothesis that meaningful plasma reference ranges could be established for preterm infants by a simple correction of patient age at sampling date for gestational age deficit at birth. Using a modified radioimmunoassay kit method, determinations of alpha fetoprotein were performed on capillary and venous blood samples collected from 56 babies aged from birth to 5 months with gestational ages ranging from 26 weeks to 43 weeks. Unmodified plasma alpha fetoprotein values were grouped according to patient age and examined statistically using established normal theory methods, but these yielded excessively wide reference intervals and non-Gaussian distribution parameters. Acceptable reference ranges were derived using logarithmic transformation of plasma alpha fetoprotein values and rearrangement against patient age corrected for gestational age deficit. These provisional reference ranges for plasma alpha fetoprotein in preterm (and term) infants are applied to groups of previously meaningless alpha fetoprotein results and used to test the potential usefulness of plasma alpha fetoprotein determination as a diagnostic marker in biliary atresia, hepatitis, and yolk sac derived tumours.

Effects of magnesium supplementation in testicular cancer patients receiving cis-platin: a randomised trial

The concentration of magnesium in serum has been shown to fall to potentially dangerously low levels after several courses of treatment with cis-diamminedichloroplatinum II (cis-platin). The aims of this study were to examine the effects of magnesium supplementation on predicted outcome of treatment, rate of response to treatment and toxicity of treatment. Sixteen patients with testicular cancer were studied in detail over a 14 month period. One patient with an ovarian dysgerminoma was also included in the study. Eight patients were randomised to receive magnesium supplements both intravenous and oral; nine did not. The non-supplemented group showed significantly greater renal tubular damage as assessed by urine N-acetyl-B-D-glucosaminidase (NAG). There was a trend towards a reduction in treatment delays due to neutropenic episodes in the supplemented group, and serum magnesium concentrations remained significantly higher. Neither group showed differences in tumour growth rates or outcome. These results show that magnesium supplements are of considerable benefit and show no harmful effects in patients receiving cis-platin treatment. It is is suggested that magnesium supplements should be a routine part of the treatment regime, and that these should comprise both i.v. supplements during treatment and oral supplements between courses.

An evaluation of the Jeol Clinalyzer

The Jeol Clinalyzer was evaluated over a period of 15 weeks. The operating principles are briefly described. The functions of the mechanical components were tested and assessments made of the instrument's safety and reliability. The mechanical and electrical reliability of the instrument was excellent and the pumps and spectrophotometer gave good accuracy and precision. Between-batch precision of the analytical methods was good for urea, protein and bilirubin and acceptable for alkaline phosphatase and aspartate transaminase. There was a poor relative accuracy for alkaline phosphatase and aspartate transaminase and some proportional inaccuracy for urea and bilirubin.

The quality control of alkaline phosphatase determinations with placental phosphatase

Human placenta has been recommended as the source of the alkaline phosphatase used for the preparation of control or reference materials. The effect of certain inhibitors, which may be present in the reagents, on control materials containing the placental isoenzyme, is shown to differ significantly from their effect on the isoenzymes in patient's sera. This finding indicates that if control materials are used which contain only human placental alkaline phosphatase, changes in accuracy resulting from differences in reagent quality may be missed, or alternatively a change in accuracy may be indicated by the quality control results which does not apply to the patient's sera.