Clinical utility of determining tumor markers in patients with signs and symptoms of cancer.

BACKGROUND: Diagnosing patients with signs or symptoms suggestive of cancer is difficult. Serum tumor markers (TM) may be useful, but it is known that a range of pathologies other than cancer can increase their concentrations and so TM data must be interpreted with caution. The aim of this study is to determine the diagnostic accuracy of TMs in patients with signs or symptoms of cancer. METHODS: We prospectively studied 234 patients seen at rapid diagnostic units who presented signs or symptoms suggestive of cancer. Ninety patients had wasting syndrome, 74 had pulmonary symptoms and 70 other presentations. CYFRA21-1, CEA, CA19-9, total bilirubin and creatinine were determined. The final diagnosis was obtained after 6 months' follow-up. Patients were classified according to the absence (group A) or presence (group B) of abnormal bilirubin or creatinine. RESULTS: Of the 234 patients studied, 103 (44.0%) had tumors diagnosed. Cut-off points for each TM were calculated for a specificity of 100%. For the total group, the values were CYFRA21-1, 15 µg/L, CEA, 43.8 µg/L and CA19-9, 7428 KU/L, with an overall sensitivity of 46.6%. For group A (n=142), the following cut-off points were established: CYFRA21-1, 7.8 µg/L, CEA, 13.8 µg/L and CA19-9, 101 KU/L, obtaining a sensitivity of 68.6%. For group B (n=92), the values were the same as for the whole group, and a sensitivity of 42.4% was achieved. CONCLUSIONS: We conclude that TMs can aid diagnosis in these patients with signs or symptoms suggestive of cancer. Their sensitivity can be improved by using different cut-off points in the presence and absence of renal and hepatic dysfunction.

Raquitismo fetal mortal y celiaquía materna no diagnosticada / Fatal rickets in the fetus and undiagnosed maternal celiac disease

La enfermedad celíaca es una enteropatía frecuente que se asocia a manifestaciones clínicas muy variadas en parte debidas a la malabsorción. En la mujer se ha asociado a alteraciones obstétricas y ginecológicas como abortos de repetición, retraso intrauterino de crecimiento, parto prematuro y bajo peso al nacer. Presentamos el caso de una mujer con enfermedad celíaca no diagnosticada y con un parto eutócico de feto muerto de 34 semanas de gestación con alteraciones morfológicas graves de hipomineralización compatibles con raquitismo. En la literatura médica el raquitismo congénito secundario a malabsorción por enfermedad celíaca de la madre es excepcional. Se comentan los conocimientos actuales sobre el metabolismo fosfocálcico materno-fetal. Relacionamos la celiaquía activa con la hipocalcemia severa durante la gestación y con el raquitismo fetal mortal. Se sugiere la necesidad de un cribado de dicha enfermedad en las gestantes con signos de malabsorción o anomalías en el desarrollo del feto (AU)

Celiac disease is a relatively frequent enteropathy associated with a wide range of clinical manifestations, due in part to malabsorption. In women, it has been associated with obstetric and gynecological alterations such as repeated miscarriages, intrauterine growth delay, premature delivery, and low birth weight. We present the case of a woman with undiagnosed celiac disease who gave birth to a stillborn foetus via normal delivery after 34 weeks of gestation. The foetus presented severe morphological alterations due to hypomineralization which were compatible with rickets.In the medical literature congenital rickets secondary to maternal celiac disease due to malabsorption is rare. We discuss the current knowledge on maternofoetal phospho-calcium metabolism and relate active celiac disease with severe hypocalcaemia during pregnancy and fatal rickets in the foetus. We recommend screening for celiac disease in pregnant women with signs of malabsorption or impaired fetal development (AU)

[Fatal rickets in the fetus and undiagnosed maternal celiac disease]. / Raquitismo fetal mortal y celiaquía materna no diagnosticada.

Celiac disease is a relatively frequent enteropathy associated with a wide range of clinical manifestations, due in part to malabsorption. In women, it has been associated with obstetric and gynecological alterations such as repeated miscarriages, intrauterine growth delay, premature delivery, and low birth weight. We present the case of a woman with undiagnosed celiac disease who gave birth to a stillborn foetus via normal delivery after 34 weeks of gestation. The foetus presented severe morphological alterations due to hypomineralization which were compatible with rickets. In the medical literature congenital rickets secondary to maternal celiac disease due to malabsorption is rare. We discuss the current knowledge on maternofoetal phospho-calcium metabolism and relate active celiac disease with severe hypocalcaemia during pregnancy and fatal rickets in the foetus. We recommend screening for celiac disease in pregnant women with signs of malabsorption or impaired fetal development.

[Acute pulmonary histoplasmosis in a Spanish traveller to Nicaragua: an imported disease case]. / Histoplasmosis pulmonar aguda en un viajero español a Nicaragua: ejemplo de enfermedad importada.

Pulmonary histoplasmosis is a rare disease in Spain. Moreover, it is difficult to diagnose due to unspecific clinical and radiological symptoms. The isolation of the fungus is essential for a proper diagnosis. Nevertheless, it is very difficult to identify the fungus itself in respiratory stains and we usually need invasive techniques. For all these reasons and taking into account the increase in journeys and immigration, we believe that it is probably underdiagnosed in our country. We report a case of acute pulmonary histoplasmosis in a Spanish traveller and emphasize the importance of the anamnesis and the value of the microbiologist's experience to obtain the diagnosis.