Classification and localisation of carcinoembryonic antigen (CEA) related antigen expression in normal oesophageal squamous mucosa and squamous carcinoma.

Using a panel of carcinoembryonic antigen (CEA) related antibodies in normal oesophageal squamous mucosa CEA expression is present on suprabasal squames localised to the cell membrane. Immunoblotting shows that this positivity is predominantly due to a glycoprotein of around 180 kDa representing CEA itself. Positivity in squamous carcinomas is confined to cells in foci of squamous differentiation. A shift from membranous localisation to predominant cytoplasmic overexpression is shown between normal and malignant squames using confocal microscopy. The recognition of an adhesive role for CEA and a role in enhancing distant metastases in those tumours expressing CEA highlights the importance of recording CEA expression and changes in subcellular distribution between normal and malignant tissues; CEA expression in oesophageal squamous mucosa has not been well recognised previously and changes in expression may prove of great significance in the spread and dissemination of squamous carcinoma.

Classification of CEA-related positivity in primary and metastatic malignant melanoma.

Using a panel of antibodies to carcinoembryonic antigen (CEA), in paraffin-processed biopsy material patchy, predominantly membranous positivity was seen on tumour cells in 70 per cent of cases of superficial spreading melanoma, 60 per cent of nodular melanomas, and 75 per cent of secondary deposits studied with unabsorbed polyclonal anti-CEA only. No staining was seen using monoclonal anti-CEAs. Localization of CEA to the cell membrane was confirmed with confocal microscopy. Immunoblotting of fresh frozen material detected CEA of around 180 kD in both primary and metastatic melanomas migrating with an apparent molecular weight of between 150 and 200 kD, indicating variable glycosylation of the protein. Recognition of an adhesive role for CEA with roles in immunolocalization and immunotherapy emphasizes the importance of more precise classification of CEA-related positivity in human tumours.

Patterns of CEA-related antigen expression in invasive squamous carcinoma of the cervix.

The recognition of an adhesive role for the CEA-related antigens emphasizes the need for clear demonstration of the changes in CEA expression and subcellular localization between normal and neoplastic tissues. Using a panel of monoclonal and polyclonal antibodies, membranous and cytoplasmic CEA expression was seen in 50 invasive cervical squamous carcinomas in four distinct patterns dependent on tumour type and differentiation. Membranous CEA expression is a marker of differentiation in squamous carcinomas and may influence tumour behaviour and hence patient survival. Strong CEA positivity was seen on the endothelium of vessels containing tumour in ten cases where vascular metastases were prominent. Staining of these ten cases revealed concomitant sialated Lewis X positivity in tumour cells with weak endothelial positivity in three cases; cervical squamous tumour cells may localize to vascular endothelium, and hence disseminate, through specific binding of CEA and/or sialated Lewis X.

Treatment of hypercholesterolemia by a clinical nurse using a stepped-care protocol in a nonvolunteer population.

National trials have demonstrated that the incidence of myocardial infarction and coronary death can be decreased, and progression of atherosclerosis delayed or reversed, by administration of bile acid-binding resins. A cholesterol clinic was established to determine whether a simple protocol would be effective in a nonvolunteer population referred by practicing cardiologists. The clinic was operated by a nurse who followed a stepped-care protocol, similar in concept to that used for treatment of hypertension. In the treatment of 86 patients with type II hyperlipidemia (cholesterol level, greater than 6.85 mmol/L [greater than 265 mg/dL]; triglyceride levels, normal or mildly elevated), compliance with the protocol resulted in reductions in cholesterol level of 19% in patients treated with diet, 23% for those treated with diet plus a bile sequestrant (colestipol hydrochloride or cholestyramine resin), and 25% in those treated with diet plus other cholesterol-lowering drugs. This method of treatment was effective and may serve as a model for the management of large numbers of patients with this condition.