Serum lactate dehydrogenase isoenzyme 1 and tumour volume are indicators of response to treatment and predictors of prognosis in metastatic testicular germ cell tumours.

44 patients with metastatic testicular germ cell tumours treated with cisplatin-based chemotherapy were evaluated for prognostic implications of clinical characteristics. 22 obtained complete remission by the initial chemotherapy, and 30 are disease-free. S-LDH-1 had an overall predictive value regarding the response of 80%, S-LDH of 64%, S-AFP of 62%, and S-hCG of 62%. In multivariate analysis regarding response, only tumour volume classified according to the Royal Marsden system (P = 0.0036) and S-LDH-1 (P = 0.0069) yielded information. Regarding survival, S-LDH-1 (P = 0.0141) and an estimate of total tumour mass (P = 0.0171) had most impact with additional information from S-hCG only (P = 0.0536). We conclude that S-LDH-1 may be used as a tumour marker in addition to S-hCG and S-AFP in patients with metastatic testicular germ cell tumour.

Vincristine, Adriamycin, cyclophosphamide, and etoposide (VP16-213) in small-cell anaplastic carcinoma of the lung.

Twelve patients with small-cell anaplastic carcinoma of the lung were treated with vincristine 1 mg/m2 i.v. day 1, adriamycin 50 mg/M2 i.v. day 1, cyclophosphamide 1,000 mg/m2 i.v. day 1, and etoposide 80 mg/m2 i.v. day 2, 4, 6 given on an outpatient basis and repeated at 3-week intervals. As consolidation therapy seven patients received two courses of BCNU median 29 mg/m2 (range 24-73 mg/m2) short term intraarterial infusion in the bronchial artery with 2 to 3-weeks intervals. One patient with limited disease had no evidence of disease for 13+ months and one patient complete remission for 3+ months. Four of ten patients with extensive disease had complete remission for median 5 months (range 2+ to 5+ months) and four patients had partial remission for median 5 months (range 4 to 5+ months). Despite side effects the chemotherapy was well tolerated by the patients. The results correspond to those obtained with other effective regimens in small-cell anaplastic carcinoma of the lung.

A systematic review of lactate dehydrogenase isoenzyme 1 and germ cell tumors.

OBJECTIVES: To evaluate lactate dehydrogenase isoenzyme 1 (LD-1) as a tumor marker of germ cell tumors. METHODS: A literature search included a CancerLit and Medline computer search of articles regarding germ cell tumors and LD-1 published between 1963 to 99 and a manual search of reference lists, theses, and textbooks. Forty articles, letters to the editor, and abstracts on testicular germ cell tumors and 10 articles on ovarian germ cell tumors fulfilled inclusion criteria. RESULTS: Of 696 patients with testicular germ cell tumors, 423 (61%) had a raised serum LD-1 catalytic concentration (S-LD-1). Patients with seminoma have a raised S-LD-1 more often (63%) than those with nonseminoma (60%). S-LD-1 was raised less often in patients with stage I (48%) than in those with stage II (50%) and stage III (67%). S-LD-1, serum alpha fetoprotein concentration (S-AFP), and serum human chorionic gonadotropin concentration (S-hCG) were discordant. S-LD-1 predicted outcome in four studies: one study regarding relapse in patients with nonseminomatous testicular germ cell tumors stage I, and three studies regarding survival of patients with metastatic testicular germ cell tumors. In two of three studies, S-LD-1 was a better prognostic predictor for patients with metastatic testicular germ cell tumors than S-LD. Of 40 patients with ovarian germ cell tumors, thirty-five (88%) had a raised S-LD-1. CONCLUSIONS: S-LD-1 is a useful serum tumor marker of testicular germ cell tumors. For patients with ovarian germ cell tumors, S-LD-1 was raised more often than for patients with testicular germ cell tumors. Further studies are required for a general recommendation regarding the use of S-LD-1 for germ cell tumors.

Analytical bias by contamination from hemolysis in determination of serum lactate dehydrogenase isoenzyme 1 in patients with testis germ cell tumors.

We investigated the impact of correction for contamination from hemolysis on serum lactate dehydrogenase isoenzyme 1 (S-LD-1) determinations. A study of hemolysates from 7 control patients showed a mean correction factor for the contamination of 0.1 U/L S-LD-1 for each 1 mg/L serum hemoglobin (S-Hb). S-LD-1 in a series of blood samples from 44 patients (EJC 1992;28:410-5) would decrease median 24 U/L (range 8-70 U/L) if the measurements were corrected with this factor. So we advice to correct S-LD-1 determinations for the contamination with a common correction based on the S-Hb concentrations in the samples.

[Computer tomography in Greenland--a basis for establishment of the service]. / Computertomografi i Grønland--basis for hjemtagelse.

The purpose of this study is to evaluate the consequences of referral of patients for medical reasons from Greenland to Denmark for computed tomography (CT) scans. Twenty-eight of 35 evaluable patients could have been treated following the information from the CT scans without the use of the resources of a university hospital (for instance rehabilitation of patients with cerebral infarction). The establishment of a CT scanning service in Greenland may reduce costs without a deterioration in medical care. Accordingly, the alternative seems attractive.

High prevalence of smoking in young patients with acute myocardial infarction.

Of 35 patients with acute myocardial infarction (AMI) at the age of 40 years or less, 32 (91%) smoked and only three patients were non-smokers. The age at AMI related significantly to the extent of smoking (p < 0.001, Kruskall-Wallis test). Five patients with AMI at the age < 30 years smoked more heavily than the 30 with AMI at the age of 30-40 years (p = 0.04, Mann Whitney U test). Heavy smoking men > 30 years at the AMI had a Q-wave infarction as often (11 of 13 (85%)) as those with multivessel disease or a coronary artery occlusion (8 of 9 (89%) and 14 of 16 (88%) respectively) on coronary arteriography after the infarction. Smoking may be the most important modifiable risk factor in young patients with AMI.

Biochemical markers in advanced testicular tumors: serum lactate dehydrogenase, urinary chorionic gonadotropin and total urinary estrogens.

Twenty-seven patients with advanced testicular tumors were screened for serum lactate dehydrogenase (LDH) concentration, and 24-hour urinary excretion of human chorionic gonadotropin (hCG) and total estrogens. The investigation indicates an overall correlation between serum LDH concentration and cancer burden and an overall correlation between the maximum serum LDH and prognosis. It indicates an overall ocrrelation between the hCG determined within 2.5 months after the orchiectomy and prognosis. The relation between total estrogens and cancer burden or prognosis does not support the hypothesis that total urinary estrogens are a biochemical marker in testicular tumors.

Lactate dehydrogenase and its isoenzymes in testicular germ cell tumors: an overview.

Serum lactate dehydrogenase (S-LDH) was raised in 41 of 82 patients with testicular germ cell tumors, none of three with subclinical testicular tumors, and 10 of 341 without testicular germ cell tumors, 215 of whom had a previous history of tumor. 13 of 38 with testicular germ cell tumors, none of three with subclinical testicular germ cell tumors, and seven of 341 without tumor lesions had raised levels of isoenzyme S-LDH-1. 46 of 52 had concordant changes in S-LDH and total tumor volume whereas in six this relationship was not noted. Concordant changes in S-LDH-1 and total tumor volume were found in most cases. Higher S-LDH and S-LDH-1 levels were noted in the blood from the testicular vein on the side of the tumor at orchiectomy than in peripheral blood. The S-LDH activity predicted survival in a multivariate analysis of risk factors in 39 patients with stage 3 metastases from testicular germ cell tumors. 70-75% of 37 with tumor lesions had concordantly raised or normal S-LDH and serum concentrations of alphafetoprotein (S-AFP) and human chorionic gonadotropin (S-hCG); 25-30% had discordant levels. The diagnostic specificity of S-LDH and S-LDH-1 with regard to tumors in 252 with a history of testicular germ cell tumors was 68%, the diagnostic sensitivity 90%, the nosographic specificity 97%, the nosographic sensitivity 41% for S-LDH and 35% for S-LDH-1, and the effectiveness of the tests 88% for S-LDH and 90% for S-LDH-1. Tumor tissue from a testicular germ cell tumor transplanted into athymic mice had a high activity of LDH-1. There was a good correlation between S-LDH-1 and tumor volume. S-LDH may be used as a tumor marker in patients with testicular germ cell tumors in addition to other diagnostic tests. In patients with a history of testicular germ cell tumors and an unexplained elevation of S-LDH, raised S-LDH-1 may indicate the presence, and normal S-LDH-1 the absence, of testicular germ cell tumors.

Bilateral optic neuritis evolved during tamoxifen treatment.

A 57-year-old woman developed bilateral optic neuritis after being treated for 6 months with tamoxifen in the dosage of 30 to 40 mg orally a day. As the neuritis progressed during continued treatment and no other causal explanation could be found, tamoxifen was stopped and the optic neuritis regressed. Since tamoxifen might cause optic neuritis the authors recommend the monitoring of ocular symptoms in treated patients.

Suppression of the mitogen response of normal lymphocytes by serum from patients with testicular germ cell tumors.

Serum from seven of 15 patients with nonseminomatous testicular germ cell tumors impaired the transformation of lymphocytes from normal donors by phytohemagglutinin to less than 50% of that with addition to the cultures of normal AB serum. Similarly, serum from eight patients impaired the transformation by Staphylococcus aureus Cowan I. The impairment of the lymphocyte transformation did not correlate with the serum concentrations of alpha-fetoprotein (S-AFP) and human chorionic gonadotropin (S-HCG). The patients with metastases and serum that impaired lymphocyte transformation to less than 50% of that with addition of serum from the controls and the other patients survived in the same way (0.50 less than p less than 0.75, log-rank test). The prognosis of patients with testicular germ cell tumors seems not be influenced by S-AFP and S-HCG through an impact on lymphocyte functions determined as the response to the two mitogens.