Cholesterol in pleural effusions. A diagnostic aid.

In this prospective study of 70 patients with pleural effusion, the underlying disease could be identified in 62 cases. By predefined criteria, 31 of these effusions were classified as transudates and 31 as exudates. Pleural fluid protein content, LDH activity and cholesterol level were measured to investigate their utility in differentiating the exudates from the transudates. Protein and LDH levels, and their pleural fluid-to-serum ratios, resulted in erroneous classification of 11 to 15 percent of the effusions. Mean cholesterol level in malignant effusions was 94 mg/dl, 76 mg/dl in inflammatory effusions and 30 mg/dl in the transudates. Using a dividing line of 60 mg/dl to separate the exudates from the transudates, only 5 percent were incorrectly classified. Elevated cholesterol levels in exudates seem to be independent of the serum levels. Our findings indicate that the pleural fluid cholesterol level is a simple and cost-effective aid in differentiating exudative from transudative pleural effusions.

Incidence and origin of non-systemic microdeposits of amyloid.

In a general hospital, 391 consecutive necropsies in which at least seven organs were available, were examined retrospectively by polarizing microscopy of Congo-red-stained sections for the presence of local amyloid deposits.Non-systemic microdeposits of amyloid were encountered in 72 cases, an overall incidence of 18.4%. They were usually small and frequently detectable only by virtue of polarizing microscopy. There is no indication that these microdeposits of amyloid are of pathogenetic significance. Although they sometimes occur in more than one organ, such deposits can be readily distinguished from those of systemic amyloidosis by their histological features.

Tuberculin and dinitrochlorobenzene (DNCB) tests in cancer patients before and after cytostatic drug therapy.

In 137 patients with different kinds of cancer and different cancer stage, cell-mediated immunity was investigated by DNCB (dinitrochlorobenzene) and tuberculin test. These two skin tests were performed before and after cytostatic drug combination therapy. For a collective of cancer patients we found a positive correlation between skin reactions and prognosis and a negative correlation between skin reactions and cancer stage. After cytostatic drug therapy skin reactions could be significantly stronger. This could be observed in 50% when one test was positive before chemotherapy and in only 20% when both tests were negative before chemotherapy. There existed a significant correlation between an increased reaction after cytostatic drug therapy and objective tumor regression. When skin reactions decreased, tumor progression was seen in all cases. Due to these observations we use skin reactions as a good parameter for therapy results. When delayed cutaneous hypersensitivity impairs 2--3 weeks after chemotherapy, we then change the cytostatic drug combination immediately. We cannot say at this moment, whether an improvement of cytostatic drug therapy can be reached in this way.

Amyloid in intervertebral discs of surgery and autopsy material. A new class of amyloid?

Intervertebral discs from 82 consecutive operations on herniation and 59 autopsies (one case with generalized amyloidosis) were studied. Amyloid deposits observed in surgical and autopsy specimens increased with age in both series. Degenerative changes were related to age and to amyloid deposits in autopsy, but not in surgical cases. Calcium pyrophosphate dihydrate deposits (often in proximity to amyloid deposits) were found in autopsy discs of six patients and in surgical specimens of three patients with previous operations on herniated discs. Antisera against amyloid fibril proteins of different types including AA-, A lambda-, A kappa, AF- and AB-types showed no reaction with disc amyloid. In one case with generalized A lambda-amyloidosis the disc amyloid was not of the A lambda-type. Based on our results, we suppose that disc amyloid is a form of localized senile amyloidosis - possibly representing a new class of amyloid limited to cartilage tissue.

Amyloidosis as a complication of cystic fibrosis.

Amyloidosis appears to be a rare complication of cystic fibrosis. We discuss three patients with amyloidosis complicating cystic fibrosis to add to the six patients previously recorded. The presenting problem was proteinuria in five patients, thyromegaly in three patients, and hepatosplenomegaly in one patient. The progression of proteinuria to nephrotic syndrome and edema occurred in eight of nine patients and portended a very poor prognosis. The kidneys, adrenal glands, spleen, thyroid gland, liver, heart, and bowel were most frequently involved. Renal involvement is a frequent and devastating complication of amyloidosis in patients with cystic fibrosis.