Detection of central nervous system metastasis with cerebrospinal fluid beta-2-microglobulin.

Beta-2-microglobulin determinations in cerebrospinal fluid (CSF) of patients with leukemia, lymphoma, and oat cell carcinoma were performed to evaluate the utility of this test in early detection of metastasis to the central nervous system (CNS). In the presence of CNS disease, significantly higher levels (P less than 0.001) were found than in normals or patients without CNS disease. Serial measurements were performed on two patients, and in all cases beta-2-microglobulin became elevated coincident with CNS relapse, and returned to normal as remission was achieved. Serial testing of CSF beta-2-microglobulin, in patients with cancers known to invade the CNS, should facilitate prompt treatment of CNS metastasis.

Platelet aggregation during and after general anesthesia and surgery.

Because of evidence suggesting that volatile anesthetics interfere with platelet aggregation in vitro, platelet function was investigated in patients exposed to combinations of nitrous oxide, halothane, and enflurane during brief surgical procedures. In 12 patients undergoing elective operations, blood was sampled before anesthesia, after induction but prior to surgery, during surgery, and postoperatively. Platelet aggregation by ADP, epinephrine, and collagen was similar during each sampling period in all but two subjects in whom only minor changes were noted. During brief exposure to these general anesthetics, there appears to be no clinically important inhibition of platelet function.

The effect of dexamethasone on platelet function.

To assess the effects of dexamethasone on platelet function, aggregation studies were performed on nine healthy adults before and after ingestion of a single dose of dexamethasone 10 mg, and on six patients receiving daily dexamethasone. Bleeding times were done on 14 volunteers before and after a similar drug dose. Platelet aggregation by ADP, epinephrine and collagen was unchanged after dexamethasone in the healthy subjects and aggregation curves in the patient group were comparable to the normals. Bleeding times were moderatley prolonged in women (from 284 +/- 58 seconds to 389 +/- 114 seconds) but not in men. This prolongation was much less pronounced than that which occurs with low doses of aspirin and no subject experienced delayed bleeding. Dexamethasone in single high doses probably does not cuase a clinically important effect on platelet function.

Systemic complications of MER immunotherapy of cancer: pulmonary granulomatosis and rash.

BCG immunotherapy often has severe complications in cancer patients despite lack of toxicity in the immunocompetent individual. MER, a cell wall fraction of BCG, has been reported to cause immunopotentiation similar to that of BCG without equivalent toxicity. Recently, animal models have been reported to develop MER complications, especially disseminated granuloma formation, like those of BCG. For the past several years, MER has been used as adjuvant immunotherapy for treatment of malignant tumors with minimal systemic toxicity reported. A patient with malignant melanoma was treated with intralesional MER at the site of local metastases. He developed military pulmonary granulomatosis and a severe cutaneous eruption in association with MER therapy. The toxicities of BCG and MER therapy were compared with the pathogenesis of granuloma formation reviewed. This patient's complications were consistent with a hypersensitivity reaction to MER. Pulmonary granulomatosis and rash must be added to the list of known MER toxicities.

A column chromatographic method for the determination of 5-hydroxytryptamine (serotonin) and 5-hydroxyindole acetic acid in cerebrospinal fluid.

A method is described for measurement of 5-hydroxytryptamine (5-HT) and 5-hydroxyindole acetic acid (5-HIAA) in cerebrospinal fluid. 5-HT and 5-HIAA are isolated from columns of Biorex BR-70 and Sephadex G-10 with recoveries of 85 and 89% respectively. The indoles are quantitated by fluorometric measurement of the ortho-phthaldialdehyde derivatives in acidic solution. Correction for interfering 5-methoxytryptamine and 5-methoxyindole acetic acid is accomplished by a second measurement at alkaline pH. Thin-layer chromatographic analysis of column eluates has revealed no other interfering indoles in the 5-HT and 5-HIAA fractions. Preliminary results in normal cerebrospinal fluid samples have been in the ranges 10--60 ng/ml 5-HIAA and 0--13 ng/ml 5-HT.