Doxorubicin-induced cardiac neurotoxicity: study with iodine 123-labeled metaiodobenzylguanidine scintigraphy.

BACKGROUND: Iodine 123-labeled metaiodobenzylguanidine (123I-MIBG) can be used to generate a scintigraphic image of the adrenergic nervous innervation of the heart. METHODS AND RESULTS: To test the hypothesis that doxorubicin may lead to damage of cardiac neurons, we examined 37 patients with various malignant neoplasms, 14 of whom were on therapy with doxorubicin. All patients were examined with 123I-MIBG scintigraphy and radionuclide ventriculography. Cardiac 123I-MIBG uptake was assessed by means of a heart to mediastinum activity ratio (H/M). Left ventricular ejection fraction was not different in patients with or without doxorubicin. In patients receiving doxorubicin, the H/M ratio was significantly lower (1.73 +/- 0.25 vs 2.13 +/- 0.25, p < 0.001) and correlated with doxorubicin cumulative dose (r = -0.51, p < 0.001). By using a H/M ratio of 1.73 as a cutoff point, 123I-MIBG uptake was abnormal in none of the 23 patients not receiving and 6 of 14 patients receiving doxorubicin therapy (p < 0.001). In 10 patients initially not receiving doxorubicin, 123I-MIBG scintigraphy was repeated after receiving 236 +/- 47 mg/m2 of doxorubicin. The H/M became abnormal in 3 of 10 patients, whereas the ejection fraction became abnormal in 2 of 10 patients. CONCLUSION: 123I-MIBG cardiac uptake decreases in a doxorubicin dose-dependent way, indicating a cardiac adrenergic neurotoxic effect of doxorubicin. This phenomenon appears early and generally before deterioration of the ejection fraction.

Doxorubicin cardiotoxicity detected by indium 111 myosin-specific imaging.

A patient with primary hepatoma, treated with doxorubicin and presenting with atypical electrocardiographic findings, was investigated with myosin-specific monoclonal antibody radiolabelled with indium-111. Despite a normal ejection fraction, myosin-specific scintigraphy was positive, indicating doxorubicin cardiotoxicity.

Detection of benign or malignant origin of ascites with combined indirect immunoperoxidase assays of carcinoembryonic antigen and lysozyme.

The indirect immunoperoxidase method was used to study the presence of the intracellular carcinoembryonic antigen (CEA) and lysozyme (LZ) in alcohol-fixed cytologic smears of peritoneal fluids from 2 patients with chronic active hepatitis, 31 patients with liver cirrhosis and 7 patients with malignant liver disease. In the two patients with hepatitis, LZ was positive in both CEA was positive in one and negative in the other. Of the 31 patients with liver cirrhosis, 21 (67.5%) were LZ positive, 27 (87%) were CEA negative and only 4 (13%) were CEA positive. Of the seven patients with malignant disease, six were CEA positive and six were LZ negative. It is of interest that 23 of 24 (96%) LZ-positive results and 28 of 29 (97%) CEA-negative results corresponded to negative cytologic diagnoses for malignancy. Cytologic diagnosis of "reactive mesothelial cells" seemed to correlate better (71%) with CEA-negative and LZ-positive results. The data suggest that the investigation of CEA and LZ in the cells of peritoneal fluids appears to have promise as an adjunct to cytology in differentiating benign from malignant origins of the fluid.

The cytologic application of carcinoembryonic antigen for the discrimination of malignant from benign serous effusions.

In an attempt to diminish false cytologic diagnosis in discriminating between benign and malignant effusions, the value of intracellular carcinoembryonic antigen (CEA) was estimated in cytologic smears of effusions using a modified immunoperoxidase technique. CEA serum level was estimated by radioimmunoassay technique. In this study we included a group of 42 patients, 23 with a malignant and 19 with a benign effusion. CEA in cells of effusions was positive and useful for confirming malignancy in 65% of malignant effusions. The percentage increased to 83% with the combination of the results of positive CEA in cells and serum. Cytology was positive for malignancy in 16 of the 23 (70%) malignant cases. CEA in cells of benign effusions was negative in 84% and cytology in 100%. It is concluded that intracellular CEA estimation, when combined with CEA estimation in serum, improves the discriminating range of cytology for differentiating malignant and benign effusions.

[Primary malignant melanoma of the cornea (author's transl)]. / Mélanome primitif malin de la cornée.

In this communication, we present a case of malignant melanoma of the cornea, in an 80-year old female. The tumor, covering 3/4 of the cornea, had a lobulated appearance, pinkish colour with vascularization and pigment granules, in a few places. The limbal area was free of tumor. Histologic examination indicated that the melanoma was primary, of the epithelioid type, with a few areas of spindle type cells.