Biomedical subjects
Publications and source records attributed to W Reiter.
The length of the oculomotory nerve in the midbrain, in the cisterns, and the orbit to the muscles Mm. rectus superior, rectur inferior, obliquus inferior, and rectus medialis are measured on 91 objects. Also the distances between the margins of the orbit and the most anterior nerve fibers to the muscles are estimated.
The intraorbital, intracanalicular, and intracranial length of the optic nerve was measured. Also the length of the optic tract between chiasm and lateral geniculate body was estimated. Included are the ampulla of the optic sheaths, the course of the ophthalmic artery, and the distance of the ciliary ganglion to the lateral margin of the orbit.
Adriamycin (ADR) (NSC-123127) uptake and retention in ADR-sensitive P388 leukemia (P388/S) and ADR-resistant P388 leukemia (p388/R) cells were compared by fluorometry and laser flow cytometry (FCM) and were correlated with cytotoxic effects. Drug levels in P388/R cells treated in vitro with ADR (1-10 micrograms/ml) were twofold to fourfold lower than were levels in similarly treated P388/S cells FCM analysis of P388/S and P388/R cells exposed in vitro to ADR showed qualitative and quantitative differences in ADR fluorescence profiles of drug-treated cells (1-5 micrograms/ml) but not of the isolated nuclei (0.5- 10 micrograms/ml). Drug-induced perturbations in cell cycle traverse and chromosome aberrations were seen in P388/S but not in P388/R cells treated with 0.5-5 micrograms ADR/ml in vitro or 4-8 mg ADR/kg in vivo. The role of FCM in rapidly comparing and quantitating cellular ADR fluorescence profiles of ADR-sensitive and ADR-resistant tumors was demonstrated.
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In a prospective study (N = 566) we investigated the tumour associated carbohydrate-protein CA 242, focusing on the question whether CA 242 (CaNAG, Sweden) expression in carcinoma patients is distinctly higher than in benign disorders, especially when compared to CA 19-9 (EIA Roche Germany). A second point of interest was if CA 242 is expressed to a higher extent in early stages of colorectal cancer than CEA (MEIA Abbott, USA) and CA 19-9 are, and third its behavior in pancreatic and lung cancer. We found CA 242 values comparable in healthy individuals and benign gastrointestinal disorders, thus CA 19-9 remains the marker of first choice for pancreatic cancer and CEA for colorectal cancer. CA 242 shows no advantage in lung cancer as compared to the established markers (CEA, CYFRA 21-1 (EIA Roche Germany) and NSE (EIA Hoffmann LaRoche, Switzerland) and no clearly higher expression in early colorectal cancer. Overall, the combination of CEA and CA 242 shows the best sensitivity in colorectal cancer.
During recent years the BTA-TRAK-assay (Bard Diagnostics, Redmont, USA) has been described in several investigations to be of clinical utility for patients suffering from bladder cancer. In a prospective study we investigated over four months the voided urine samples of all consecutive patients undergoing cystoscopy independent of their clinical background (n = 244) with the BTA-TRAK-assay. With a specificity of 95% for benign urological diseases (cut off: 1300 U/mL) we found a sensitivity of 13% for active bladder tumours. Using healthy individuals as a reference group (cut off: 40 U/mL) we found a sensitivity of 56% (specificity 67%). Using the cut off value recommended by the manufacturer (14 U/mL) a specificity of 54% and a sensitivity of 62% was found. For patients without relapse (NED) versus patients with active bladder tumours we got a specificity of 55% and a sensitivity of 62%. Due to an insufficient specificity and sensitivity the BTA-TRAK-test is not able to replace cystoscopy nor to improve existing diagnostic strategies in bladder cancer.
UNLABELLED: This study examined the clinical relevance of the determination of free PSA (f-PSA) in addition to total PSA (t-PSA) in 6 study groups. PATIENTS AND METHODS: Both total PSA- and free PSA-values of sera samples obtained pretherapeutically from 455 patients with carcinoma (PCA) and 680 patients with benign hyperplasia of the prostate (BPH) were analyzed by means of Enzymun-Test PSA and Enzymun-Test Free PSA (Boehringer Mannheim GmbH, Germany). RESULTS: At 95% specificity (true negative test results), a cutoff value of 13.6 [micrograms/L] was obtained for total PSA (34 patients with BPH [5%] were above this value). For this cutoff value we calculated a sensitivity (true positive test results) of 44%. Using the same criteria for the ratio Q = f-PSA:t-PSA a cutoff of 0.13 was found again at a specificity of 95%. In a second step only patients with total PSA values below the cutoff level of 13.6 [micrograms/L]) were considered. Out of these patients 26 of 646 with BPH and 108 of 257 with PCA were below the above mentioned ratio (Q = 0.13). Considering both steps (total PSA and Q) 306 patients with PCA were detected correctly and 60 patients with BPH would have been biopsied unnecessarily. CONCLUSION: High total PSA levels are a very good indicator for the presence of prostate cancer. There is still concern to improve the differentiation of the diagnosis between BPH and PCA, when an intermediate or low value (< or = 95% specificity) is observed. The determination of the ratio is only useful in this range. It is more powerful at discriminating between PCA and BPH than t-PSA alone and may contribute to a reduction in unnecessary invasive techniques.
UNLABELLED: Carcinoembrionic Antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) are the most commonly used tumor-associated antigens in the management of patients with colorectal cancer. The aim of this study was to evaluate the prognostic value of preoperative serum levels of CEA and/or CA 19-9 and the classical prognostic factors (age, sex, tumor infiltration and staging) in 495 patients. PATIENTS AND METHODS: The retrospective study was performed on frozen sera (stored at -70 degrees C) of patients with histologically proven colorectal cancer. Survival function estimates were calculated (Kaplan-Meier). The patients were separated into two groups according to the preoperative marker levels. Cut-off levels calculated at a specificity of 100% versus healthy individuals were used: < 4 ng/mL versus > or = 4 ng/mL for CEA and < 60 U/mL versus > or = 60 U/mL for CA 19-9. Survival curve differences were assessed using the log-rank-test. Mulivariate Cox's proportional hazard regression analysis was performed to examine the association between tumor marker levels and survival time. Classical prognostic factors such as age, sex, tumor infiltration, tumor stage (Dukes' classification) were included as covariants. The mantel-Haenszel method was used to assess the survival rate of patients with colorectal carcinoma and high versus low levels of tumor-associated antigens according to tumor stages. RESULTS: The Dukes' stages (log-rank chi-square = 231.9; p < 0.0001) represent the best prognostic factor besides the preoperative values of CA 19-9 (log-rank chi-square = 162.5). CEA shows a log-rank chi-square of 71.4. Thus, CEA and CA 19-9 can be used to discriminate two groups of patients with significantly different survival times (p < 0.0001). The importance of different parameters in providing additional prognostic information was evaluated by multivariate analysis. Only items of statistically significant prognostic relevance (univariate analysis) were used for this analysis. Estimated relative risks of death adjusted for tumor stage were 5.5 considering Dukes' stage A versus Dukes' stage B/C and Dukes' stage B/C versus Dukes' stage D, respectively, and an increasing relative risk of 27.5 for Dukes' stage A versus Dukes' stage D (p < 0.001). The relative risk for preoperative CA 19-9 serum concentrations (> or = 60 U/mL versus < 60 U/mL) was 2.3 (p < 0.001) and for preoperative CEA concentrations (> or = 4 ng/mL versus < 4 ng/mL) 1.4 (p < 0.07). For CEA the 2-year survival rates in the group of patients with preoperative serum concentrations > 4 ng/mL versus < 4 ng/mL and Dukes' stage D were 16% versus 38%, in Dukes' stage B/C 73% versus 91% and in Dukes' stage A 100% versus 98%. For CA 19-9 the 2-year survival rates in the group of patients with preoperative serum concentrations > or = 60 U/mL versus < 60 U/mL and Dukes' stage D were 10% versus 39%, whilst in Dukes' stage B/C 58% versus 87%. In the group of patients with Dukes' stage A with serum levels > or = 60 U/mL a 2-years survival rate of 100% was found. CONCLUSION: The postoperative Dukes' classification represents the best prognostic information besides the preoperative values of CA 19-9. The predictive information provided by preoperative CA 19-9 serum levels is independent from that obtained by the other factors investigated. Only Dukes' classification and CA 19-9 levels showed statistical significance (p < 0.001).
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A long term study was carried out to determine the possible toxic effects of therapeutic doses of a suspension of benorilate on bone marrow, liver and kidneys in 33 patients with rheumatoid arthritis. 14 were male and 19 femal patients. 11 of the male and 14 of the female patients presented a positive rheumatoid factor. The duration of the treatment was first limited to 6 months. In 20 of the 33 patients duration of treatment was extended to 7 and 91/2 months. Three patients interrupted treatment after respectively 2, 3 and 5 months. Benorilate was given in a daily dosage varying from 6-8-12 g (as a suspension containing 40% benorilate). The following parameters were used to determine the effect of the drug on bone marrow: Hemoglobin, erythrocyte count, leucocyte count, thrombocyte count. Tests were done at regular intervals to determine a possible toxic effect on the kidney: urea nitrogen, uric acid, creatinine and urineanalysis were performed at regular intervals. To determine any possible hepatic toxicity, SGOT, SGPT, alkaline phosphatase and prothrombin time were done at regular intervals. On the basis of the laboratory results, no toxicity could be demonstrated in bone marrow, liver and kidneys when benorilate was given in therapeutic doses for the treatment of rheumatoid arthritis. Rare temporary abnormal laboratory values are not statistically significant and can be considered part of systemic involvement secondary to rheumatoid arthritis. The combination of the two active substances of benorilate decreases to a minimum on the one hand the above mentioned side effects and on the other potentiates the therapeutic and especially the analgetic effect. After resorption, the preparation is hydrolized in the plasma to acetylic salicylic acid and paracetamol. The hydrolysis takes place in the gastrointestinal tract which probably explains why the drug is so well tolerated.
In two multicenter double-blind cross-over studies efficacy and safety of flurbiprofen and indomethacin were compared. Nineteen patients with rheumatoid arthritis and twenty with osteoarthrosis of the knee were treated. Both drugs were effective and almost equal. Also safety was good, however three patients on indomethacin and one on flurbiprofen had to be withdrawn from the trial because of side-effects.
The sera of 154 cancer patients were analyzed at primary diagnosis before any therapy to find out the clinical importance of CYFRA 21-1 (detecting cytokeratin 19-fragments) compared with the polyclonal TPA-IRMA and the monoclonal TPA-LIA-mat-assay (both measuring fragments of cytokeratin 8, 18 and 19). The reference group consisted of 100 healthy persons as well as 78 patients with exclusively benign urological diseases. We defined the cut-off values based on 95% specificity versus benign urological disorders. For CYFRA 21-1 the cut-off value was found to be 2.5 ng/ml, for TPA-IRMA 165 U/L, and for TPA-LIA-mat 136 U/L. Taking into account all stages CYFRA 21-1 showed a sensitivity of 31% versus 20% and 16% for TPA-IRMA and TPA-LIA-mat, respectively. Considering only the muscle invasive carcinomas 52% sensitivity for CYFRA 21-1 vs. 39% and 33% for TPA-IRMA and TPA-LIA-mat could be found. All three markers correlate with the stage of disease, CYFRA 21-1 to the highest degree (stage O: 16%, stage IV: 71%). CYFRA 21-1 shows the best sensitivity-specificity-profile and seems to be a recommendable marker for the follow-up of urinary bladder cancers except for the Ta-tumors which only rarely develop into muscle invasive cancers.