Early transoesophageal echocardiography in cryptogenic and lacunar stroke and transient ischaemic attack.

OBJECTIVES: To test the hypothesis that transoesophageal echocardiography (TOE) carried out within three days of a first stroke or transient ischaemic attack of cryptogenic or lacunar type may disclose more thrombi or spontaneous echo contrast (SEC) than previously reported. This finding may help early treatment decisions. METHODS: Patients aged between 40 and 80 years, admitted for transient ischaemic attack or ischaemic stroke during a 40 month period, were prospectively considered. TOE was carried out within 72 hours of symptom onset with a 5 MHz biplanar transducer. Subjects with recurring events, very severe strokes, large artery obstructions, or obvious cardiac sources of embolism were excluded. RESULTS: Sixty five patients were studied, 43 with a cryptogenic stroke or transient ischaemic attack (66.2%), and 22 with a lacunar stroke (33.8%). The mean (SD) interval between symptom onset and TOE was 43.4 (17.2) hours for cryptogenic, and 48.5 (19.5) hours for lacunar patients. Atrial thrombi were found in one patient with a cryptogenic stroke (2.32% of cryptogenic events; 95% confidence interval 0.06-12.29), whereas SEC was found in five patients (7.7% overall), two with a lacunar and three with a cryptogenic stroke. CONCLUSIONS: An early TOE does not seem to increase substantially the detection of atrial thrombi or SEC in patients with a first stroke or transient ischaemic attack of cryptogenic or lacunar nature. Therefore, this examination can be carried out when the patients' conditions are stable, and without overloading the cardiovascular laboratory daily schedule.

Radioimmunoassay of epidermal growth factor in human saliva and gastric juice.

A sensitive radioimmunoassay was developed for human epidermal growth factor (hEGF) in saliva and gastric juice. This method was sufficiently sensitive for an accurate measurement of hEGF in these biological fluids. The minimal detectable concentration of EGF was 30 ng/L. The imprecision profile of EGF standard curve had a CV less than 10% in the range of 0.1-3.0 micrograms/L. Serial dilution curves of saliva and gastric juice paralleled that of standard EGF. The antibody to hEGF showed no cross-reactivity with a large excess of growth factors, such as human transforming growth factor alpha, human insulin-like growth factor I, and platelet-derived growth factor (c-sis). No detectable cross-reactivity was observed with some biological gut peptides: somatostatin, gastrin, secretin or pancreatic polypeptide. The intra-assay CV for saliva and gastric juice was less than 10%, and the recoveries were 93.9 +/- 8.7% and 93.7 +/- 11.3%, respectively for saliva and gastric juice. Gel exclusion chromatography revealed hEGF-like substances, heterogeneous in size in saliva and gastric juice, the origins and physiological functions of which are unknown.

Serum tissue polypeptide antigen (TPA): a marker of acute injury of salivary glands during radiation therapy.

The modifications of serum concentrations of TPA were monitored in patients undergoing curative radiation therapy. Patients with tumors localized in the head and neck were treated with one of four different schedules based on conventional fractionation or multiple daily fractionation where the dose per fraction and total daily dose varied. Serum TPA increased immediately on the first day of irradiation: the higher the dose, the greater the increase. These increases disappeared rapidly after the first few days of treatment. A more limited rise was observed in some cases when treatment was renewed after the first week-end split or after more prolonged interruptions. Results demonstrated that TPA is a valid biochemical marker of acute radiation injury to the salivary tissue.

Limitations of CEA monitoring as a guide to second-look surgery in colorectal cancer follow-up.

Forty-two patients with localized colorectal cancer (Dukes' A, B, C stages) were treated with potentially curative surgery and controlled with a follow-up program, which included CEA monitoring, for a period ranging from 12 to 48 months (median 33 months). During this period, we observed recurrent neoplastic disease in 14 patients. A retrospective analysis of the results showed that: 1. patients with a preoperative CEA value greater than 20 ng/ml have a significantly higher risk of recurrence than the patients with CEA less than 20 ng/ml; 2. sensitivity of the CEA test was good for metastatic recurrent disease, fairly good for residual neoplastic disease, but insufficient for local recurrence; 3. test-specificity was poor, as demonstrated by the negative results of four exploratory laparotomies performed exclusively on the basis of increased CEA levels. Since the principal aim of a second-look operation is the cure of local recurrence, this type of surgery cannot be proposed only on the basis of increased CEA levels.