Serum melatonin levels: a new neurodiagnostic tool in pineal region tumors?

The pineal hormone melatonin (MLT) is secreted in a circadian rhythm with high serum levels during nighttime and low serum levels during daytime. Several authors have reported an altered secretion pattern of MLT in patients with pineal tumors and have proposed that MLT may be used as a tumor marker. In nine patients, a pineal region tumor was diagnosed by computer-assisted tomography. Before and after surgical removal of the tumor, several day- and nighttime serum samples were collected and MLT concentrations were estimated by radioimmunoassay. Before operation, five patients presented a normal circadian pattern of MLT secretion. In the remaining four subjects, MLT levels were undetectable or at the limit of detection, with no signs of a circadian secretion pattern. Eight patients were reexamined after tumor resection, when all but one had undetectable or very low MLT levels. The remaining subject, with a pineomesencephalic pilocytic astrocytoma, dislocating but not involving the pineal gland, presented a normal circadian secretion pattern of MLT after operation; in this case, tumor resection was possible without damaging the pineal gland. Thus, before operation, MLT deficiency rather than exaggerated serum levels may be used as a marker for pineal tumors that destroy the pineal gland. After tumor resection, serum MLT may serve to demonstrate complete pinealectomy.

Tissue polypeptide specific antigen and cancer associated serum antigen in the follow-up of ovarian cancer.

420 clinical and serological examinations prior to surgery and during follow-up were performed in 30 patients suffering from ovarian cancer. The population consisted of three FIGO stage Ia, nine stage Ic, four stage II and fourteen stage III cases. Serous carcinoma of the ovary, mucinous carcinoma and other kinds of ovarian cancer were found in 16, 9 and 5 cases, respectively. The serum levels of the tumor markers tissue polypeptide specific antigen (TPS), cancer associated serum antigen (CASA) and carbohydrate antigen 125 (CA 125) were determined. Cut-off values of 97 U/l, 4 U/ml and 35mU/ml for TPS, CASA and CA 125, respectively, were selected according to the 95% of serum concentrations measured in healthy controls. Sensitivity, specificity, PPV and NPV of CA 125 were 75%/96%/69%/92%, respectively. Sensitivity, specificity, PPV and NPV of TPS were 67%/84%/59%/90%, respectively. CASA showed a sensitivity of 58%, specificity of 96% and a PPV and NPV of 73%/94%, respectively. The combination of TPS and CA125 increased the sensitivity to 81%, reaching a specificity of 82% and a PPV and NPV of 58/96%, respectively. The combination of CASA and CA125 showed a sensitivity, specificity, PPV and NPV of 88/85/65/96%, respectively. Twelve patients developed recurrence of disease after response to primary treatment. TPS, CASA and CA 125 detected recurrent disease in six, two and four cases, respectively. For TPS mean lead time was 4.6 months (range 2-18 months), for CASA 1.7 months (range 1-6 months), and for CA 125 3.5 months (range 1-24 months. As a matter of fact TPS never showed lead time effects in patients without elevated pretherapeutic levels. A combination of all makers showed a mean lead time of 6.72 months. Detection of recurrent disease by CA 125 is improved when CA 125 is used in combination with TPS, especially in those patients with pretherapeutically elevated TPS serum levels.

[Leydig cell function in idiopathic oligozoospermia]. / Leydig-Zell-Funktion bei idiopathischer Oligozoospermie.

Repeated blood sampling at 10-minute intervals over a 4-hour period (15.00 until 19.00) for simultaneous determination of FSH, LH and testosterone was carried out in 7 normospermic men and 8 patients presenting with idiopathic oligozoospermia. Fluctuations of LH and testosterone were observed within the 4-hour sampling period. Only minor alterations of FSH were found. Planimetric assessment of the areas under the curves of FSH, LH and testosterone did not show any significant difference in FSH. Testosterone was found to be significantly decreased in the oligospermic group (p less than 0.025), while LH showed a tendency to be increased (p less than 0.1). These results point out that single determinations of LH and testosterone do not provide exact information, due to the wide range of hormone fluctuation. Serial sampling of the hormones demonstrates Leydig cell dysfunction in patients with moderate idiopathic oligozoospermia.

Postprandial GLP-1, norepinephrine, and reactive hypoglycemia in dumping syndrome.

Rapid gastric emptying and exaggerated plasma concentrations of the insulinotropic hormone GLP-1 precede reactive hypoglycemia after oral glucose in gastrectomy patients. We suspected that the plasma volume drop associated with rapid gastric emptying (early dumping) would be accompanied by elevated plasma concentrations of norepinephrine. In order to study any relationship between postprandial norepinephrine, the enteroinsular axis, and plasma glucose, twelve patients with dumping syndrome and nine controls were studied. The plasma concentrations of norepinephrine, GLP-1, GIP, glucagon, insulin, and glucose were measured following a 1.5 g/kg lean body mass glucose meal. The early (0-30 min) integrated norepinephrine concentration was significantly higher in dumpers (22.1 +/- 3.8 nmol/ml/min) compared to controls (14.7 +/- 3.1 nmol/ml/min; P < 0.001) and correlated closely with the postprandial hematocrit increment (r = 0.71; P < 0.05). Early immunoreactivities of GLP-1, GIP, and glucagon peaked 30 min after glucose ingestion and were significantly higher in dumpers. Insulin peaked after 60 min and correlated with early GLP-1. In 11 of the patients glucose fell below baseline after a median interval of 120 min. Glucose at 120 min, when most of the nadirs occurred was lowest in patients with high early GLP-1 concentrations (r = 0.78; P < 0.001). Gel filtration chromatography of the dumpers' plasma revealed that pancreatic glucagon was detectable at time 0 and after 20 min, but not after 120 min. It is concluded that in dumpers pancreatic glucagon is augmented in the early postprandial period, probably through stimulation by catecholamines. At 120 min, when most of the hypoglycemias are encountered, pancreatic glucagon is no longer detectable, probably through inhibition by GLP-1.

Effects of epidural analgesia on plasma catecholamines and cortisol in parturition.

To assess the effect of epidural block on plasma catecholamines and cortisol during labour and delivery, plasma epinephrine, norepinephrine and cortisol levels were determined in 26 healthy parturients, all of whom delivered vaginally (18 received an epidural block, eight had meperidine 50 mg intramuscularly). We found a significant drop of plasma epinephrine and cortisol and no significant reduction of plasma norepinephrine 1 h after administration of epidural block compared to preblock values. Observing the data during the whole course of labour in correlation with cervical dilatation, in the control group, where the parturients received meperidine, all hormones rose progressively up to the moment of delivery. One hour after delivery the catecholamines returned to normal levels; cortisol returned more slowly. In the epidural group the increase of plasma epinephrine and cortisol was significantly inhibited but not that of norepinephrine.

Effect of vitamin C on neutrophil function after high-intensity exercise.

High-intensity exercise leads to an increased risk of upper respiratory tract infections in athletes, which had been related to an exercise-induced impairment of neutrophil function. In this study, several indices of neutrophil function were analysed before and after a biathlon and the effect of oral vitamin C on neutrophil function was determined. Six athletes took 2 g vitamin C daily for 1 week prior to a biathlon and four athletes did not take any supplementation. Neutrophil phagocytosis was analysed by fluorescence microscopy and flow cytometry. Cytosolic calcium kinetics were assessed fluorometrically and neutrophil bactericidal ability was assessed by fluorescence microscopy. Reactive oxygen production was analysed by flow cytometry. Catecholamines were analysed by high-performance liquid chromatography. After high-intensity exercise there were significant reductions in the number of phagocytosed Escherichia coli per neutrophil and in neutrophil bactericidal ability. There was a significant exercise-dependent increase of catecholamines. There was no difference between the two groups of athletes. These results do not support the concept that vitamin C supplementation corrects neutrophil dysfunction after strenuous exercise.