Valor de la cuantificación de la alfafetoproteína sérica en embarazos gemelares / Value of the quantization of the serumal alphafetoprotein in gemellary pregnancy

Con el objetivo de valorar si existe relación entre los resultados adversos en los embarazos gemelares, fundamentalmente parto pretérmino, recién nacido de bajo peso y muertes fetales, con los valores séricos de la alfafetoproteína durante el segundo trimestre del embarazo, se realizó una investigación en el Hospital Ginecobstétrico Ana Betancourt de Mora de la provincia de Camagüey, Cuba. Para la ejecución de la misma se llevó a cabo un estudio analítico transversal con 38 embarazos gemelares cuyos partos se produjeron durante el año 2003, a través de la revisión del libro de partos de ese año y el de documentación de entrada de muestras de sangre para cuantificación de la alfafetoproteína. El 47 por ciento de los embarazos cursaron con aumento de la alfafetoproteína. La mayoría de los partos se produjeron con 37 semanas ò más (N=26), sin embargo, la mayoría de este grupo tenían valores normales de la proteína, mientras que entre los casos de partos con menos de 37 semanas, el 75 por ciento cursó con elevación de la proteína. 40 recién nacidos bajo peso y 36 normopeso fueron los productos de los 38 embarazos. Entre los bajo peso predominaron aquellos cuyos embarazos cursaron con alfafetoproteína elevada y entre los normopeso y los de un feto con peso menor de 2500g y el otro con 2500g ó más, predominaron aquellos con alfafetoproteína normal. Se presentaron ocho muertes fetales, siete de ellas con alfafetoproteína elevada. Las elevaciones de la alfafetoproteína tanto para los partos pretérmino como para los recién nacidos bajo peso oscilaron entre 2 y 3.4 múltiplos de la mediana para determinada edad gestacional. La evaluación de la alfafetoproteína en los embarazos gemelares es de gran valor ya que permite identificar las gestaciones de mayor riesgo, y brindarle una mejor atención a las mismas para así evitar resultados no deseados(AU)

With the objective to value if there is relation among the adverse results in gemellary pregnancies, fundamentally preterm delivery, low birth weight and fetal deaths, with the serumal values of the alphafetoprotein during the second trimester of pregnancy, an investigation at Ana Betancourt de Mora Gynecobstetric Hospital of Camagüey province, Cuba was conducted. A cross-sectional analytic study with 38 gemellary pregnancies was carried out whose labors were produced during the year 2003, through the review of the labor book of that year and the one of blood samples entrance documentation for the quantization of the alphafetoprotein. The 47 percent of pregnancies progressed with an increase of the alphafetoprotein. The majority of labors were produced with 37 weeks or more (N=26), nevertheless, the majority of this group had protein normal values, while among the labor cases less than 37 weeks, the 75 percent progressed with protein elevation. Forty low birth weight and 36 normoweight were the products of 38 pregnancies. Among of the low weight dominated those whose pregnancies progressed with elevated alphafetoprotein and between the normoweight and of the one fetus with weight less than 2500g and the other with 2500g or more, dominated those with normal alphafetoprotein. Eight fetal deaths were presented, seven of them with high alphafetoprotein. The alphafetoprotein elevations so much for the preterm labors as for the low birth weight oscillated between 2 and 3,4 M.O.M. fundamentally. The alphafetoprotein evaluation in gemellary pregnancies is a great value which permits to identify the gestations of greater risk, and to offer a better care to avoid not desire results(AU)

Marcadores séricos en tumores digestivos: ¿más es mejor o sólo más caro? / Serum markers in digestive tumors: is more better or only more expansive?

En la práctica clínica, tendemos a solicitar los marcadores tumorales séricos en forma arbitraria, sin contemplar las normas disponibles o la evidencia bibliográfica. Por esta razón nos planteamos analizar el valor de dichos marcadores en tumores disgestivos, en distintas situaciones clínicas. Cáncer colorrectal: CEA: no resulta de utilidad en el screening, ni para establecer diagnóstico diferencial; es de utilidad: como factor pronóstico independiente del estadío, para predecir recaída junto a otro hallazgo clínico y para monitoreo de respuesta al tratamiento. CA 19-9 sería sólo de utilidad en el monitoreo de respuesta a la quimioterapia, en caso de CEA normal. Adenocarcinoma de páncreas: CA 19-9: Es de utilidad complementaria en el diagnóstico y de dudosa utilidad como factor pronóstico y en el monitoreo de la respuesta. Cáncer del árbol biliar: CA 19-9: Es de utilidad en el diagnóstico (particularmente colangiocarcinoma), como factor pronóstico, en el monitoreo de respuesta al tratamiento y en la detección de recurrencias. El uso combinado de CEA + CA 19-9 resulta mayor especificidad para el diagnóstico de esta enfermedad. Hepatocarcinoma: Alfafetoproteína: Es de utilidad en el screening de población de riesgo y de variable utilidad para el diagnóstico (AU)

Marcadores séricos en tumores digestivos: ¿más es mejor o sólo más caro? / Serum markers in digestive tumors: is more better or only more expansive?

En la práctica clínica, tendemos a solicitar los marcadores tumorales séricos en forma arbitraria, sin contemplar las normas disponibles o la evidencia bibliográfica. Por esta razón nos planteamos analizar el valor de dichos marcadores en tumores disgestivos, en distintas situaciones clínicas. Cáncer colorrectal: CEA: no resulta de utilidad en el screening, ni para establecer diagnóstico diferencial; es de utilidad: como factor pronóstico independiente del estadío, para predecir recaída junto a otro hallazgo clínico y para monitoreo de respuesta al tratamiento. CA 19-9 sería sólo de utilidad en el monitoreo de respuesta a la quimioterapia, en caso de CEA normal. Adenocarcinoma de páncreas: CA 19-9: Es de utilidad complementaria en el diagnóstico y de dudosa utilidad como factor pronóstico y en el monitoreo de la respuesta. Cáncer del árbol biliar: CA 19-9: Es de utilidad en el diagnóstico (particularmente colangiocarcinoma), como factor pronóstico, en el monitoreo de respuesta al tratamiento y en la detección de recurrencias. El uso combinado de CEA + CA 19-9 resulta mayor especificidad para el diagnóstico de esta enfermedad. Hepatocarcinoma: Alfafetoproteína: Es de utilidad en el screening de población de riesgo y de variable utilidad para el diagnóstico

Second-look laparotomy in endodermal sinus tumor: a report of two patients with normal levels of alpha-fetoprotein and residual tumor at reexploration.

The role of second-look laparotomy in the management of patients with endodermal sinus tumor of the ovary is controversial. We report two women who converted to a normal alpha-fetoprotein (AFP) level during treatment with combination chemotherapy, yet were found to have residual endodermal sinus tumor at second-look laparotomy. In view of the limited experience with this rare disease, we continue to recommend second-look laparotomy for patients who have completed chemotherapy for endodermal sinus tumor of the ovary, regardless of the serum AFP level.

Repeat maternal serum alpha-fetoprotein testing in antenatal screening programmes for Down's syndrome.

The risk of having a Down's syndrome term pregnancy was estimated using maternal age and the results of two maternal serum alpha-fetoprotein (AFP) tests carried out between 14 and 20 weeks gestation. The estimates of risk were derived from published data and the AFP results from nine affected and 145 unaffected pregnancies in which repeat testing had been carried out. Repeat AFP testing is unjustified in antenatal screening programmes for Down's syndrome, but if a second test happens to have been done, the appropriate estimate of risk that would be applicable when counselling individual patients depends on both results. For example a woman aged 35 years and 6 months with a first AFP level of 0.50 multiples of the normal median (MoM) was estimated to have a risk of 1:172. If a second test were done on a fresh sample and the AFP level were 0.80 MoM then the estimated risk would be 1:216 which is higher than the estimated risk of 1:353 obtained if the second test were regarded as the only result. Estimates of risk are given for maternal serum AFP results in first and second tests ranging from 0.40 to 2.50 MoM.

Maternal zinc and selenium status in pregnancies with a neural tube defect or elevated plasma alpha-fetoprotein.

Zinc and selenium status was assessed in 30 non-pregnant women, 69 women during normal pregnancy, six with a fetus with a neural tube defect (NTD) and 16 who had a raised plasma alpha-fetoprotein (AFP) but no detectable fetal abnormality. Plasma zinc and selenium concentrations were significantly reduced in the second trimester of normal pregnancy compared with non-pregnant levels. A significant decrease in concentrations of zinc in plasma and selenium in plasma and leucocytes was observed in women in the third trimester compared with women in the second trimester. Women with a fetal NTD and women with an unexplained elevation of plasma AFP had significantly lower leucocyte concentrations of zinc and of selenium. Mean values for plasma zinc, plasma and erythrocyte selenium, and for the activity of glutathione peroxidase in whole blood did not differ from those for normal pregnancy.

The role of membranous obstruction of the inferior vena cava in the etiology of hepatocellular carcinoma in Southern African blacks.

Membranous obstruction of the inferior vena cava has been incriminated as a risk factor for hepatocellular carcinoma in South African Blacks and in Japanese. However, the frequency with which this anomaly is found in patients with hepatocellular carcinoma, and hence its numerical importance as an etiological association of the tumor, has not been ascertained. Using radionuclide and contrast venography as well as necropsy and laparotomy examination, we investigated 162 unselected southern African Blacks with hepatocellular carcinoma together with appropriate controls for the presence of membranous obstruction of the inferior vena cava. Membranous obstruction of the inferior vena cava was detected in six of 162 (3.7%) hepatocellular carcinoma patients, compared with one of 279 subjects (0.36% p = 0.011) dying a violent death, none of 55 patients (p = 0.169) with malignant disease other than hepatocellular carcinoma and eight of 150 patients (5.3%; p = 0.336) being investigated for conditions which might have been associated with membranous obstruction of the inferior vena cava. Six of the 15 individuals (40%) found to have membranous obstruction of the inferior vena cava had concomitant hepatocellular carcinoma, confirming that membranous obstruction of the inferior vena cava constitutes a risk factor for the development of the tumor. However, only a very small proportion of hepatocellular carcinoma patients have this abnormality, so that it is a minor causal association of the tumor only.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of AFP and HCG in metastatic testicular cancer after treatment with chemotherapy or radiation therapy.

We used an indirect immunoperoxidase technique to detect alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) in tissue sections of nine metastatic germ cell tumors excised after treatment with chemotherapy or radiation therapy, and correlated the results with the serum levels of AFP and HCG. In all but 1 case yolk sac tumor (YST) was the only histologic type that reacted for AFP (AFP+) and syncytiotrophoblasts (STB) were the only histologic type that reacted for HCG (HCG+). Among 5 cases with normalization of the serum AFP before surgery, 3 were associated with YST-/AFP-, 1 with YST+/AFP+, and 1 with YST+/AFP- metastases; and among 4 cases with normalization of the serum HCG all were associated with STB-/HCG- metastases. Among 3 cases with persistent elevation of the serum AFP, 1 was associated with YST+/AFP+, 1 with YST+/AFP-, and 1 with YST-/AFP- metastases; and of 2 cases with persistent elevation of the serum HCG, 1 was associated with STB-/HCG- and 1 with STB+/HCG+ metastases. These data suggest that marker normalization in the face of persistent tumor results primarily from eradication of YST and STB, but also from treatment-induced inhibition of AFP and HCG synthesis or secretion.

Alpha-fetoprotein and its concanavalin A affinity in acute exacerbation of chronic hepatitis B.

Serum samples from 20 patients with acute exacerbation of chronic hepatitis due to hepatitis B virus and 20 patients with hepatocellular carcinoma arising from B viral cirrhosis with elevated levels of alpha-fetoprotein (AFP) were analyzed by affinity column chromatography for concanavalin A binding. Serum AFP was tested at regular intervals in all of these patients. Acute exacerbation was defined as elevation of serum transaminase greater than 300 IU/L in patients with chronic hepatitis B. In hepatocellular carcinoma, serum AFP levels fluctuated but remained higher than 92 ng/ml, whereas, in acute exacerbation of chronic hepatitis B, serum AFP levels returned to normal within 3-12 months of follow-up. The results of concanavalin A-binding assay revealed that AFP from both these groups had a high affinity for concanavalin A, and this assay could not be used to discriminate between the two conditions.

A simple mathematical model applied to describing tumour marker data.

The blood levels of tumour markers (alpha-foetoprotein and human chorionic gonadotropin) were determined and serial chest X-rays were obtained from 11 patients with germ cell tumours to study the growth of the tumours. Assuming an exponential growth pattern, the tumour marker levels and diameters of lung metastases were analysed. The use of a simple model made it possible to describe the time course of the change of tumour marker levels in blood before and during treatment. The analysis provided estimates of doubling times for marker-positive subpopulations, which were generally in accordance with the doubling times for lung metastases. The estimated doubling times had a log-normal mean value of 21.3 days, in agreement with the 19.5 days for embryonic tumours obtained in other studies.

Serum alphafetoprotein levels in subjects infected with hepatitis B virus.

Serum alphafetoprotein (AFP) levels were measured using a sensitive radioimmunoassay in 108 hepatitis B surface antigen (HBsAg)-positive subjects and 695 controls. The concentrations were significantly higher in the HBsAg-positives. Within this group, the highest levels were found in those with active HBV infection. In those without evidence of acute infection, the levels were higher in the high-risk than in the low-risk subjects. It is concluded: 1) that measurement of serum AFP might be a useful additional index of infectivity and prognosis in HBsAg-positive subjects; and 2) that in the light of the association between chronic HBV infection, hepatocellular carcinoma, and raised AFP in non-European populations, consideration should be given to regular monitoring of AFP levels in HBsAg-positive subjects in the United Kingdom.

Determinants of altered anxiety after abnormal maternal serum alpha-fetoprotein screening.

With maternal serum alpha-fetoprotein testing, large numbers of previously "low-risk" patients are now considered high risk and are offered genetic testing. Anecdotally, these patients have been perceived as more highly anxious than other second-trimester patients referred for genetic testing because of advanced maternal age. Thus we have studied patient demographics, true genetic risks, the perceptions of risk, and state (situational) and trait (constitutional) anxiety for these patients and their partners. Significantly increased state anxiety was noted for mothers as compared with fathers both in the group of women referred for testing because of maternal serum alpha-fetoprotein levels and in those referred due to advanced maternal age. State anxiety was increased in the women referred for maternal serum alpha-fetoprotein levels as compared with women referred for advanced maternal age. True genetic risks were comparable between the groups. Some critics have argued that maternal serum alpha-fetoprotein screening engenders unnecessary anxiety. Our data show that patients undergoing genetic testing due to maternal serum alpha-fetoprotein levels have higher state anxiety than women undergoing testing because of advanced maternal age, but that indication is much less a factor than are partner differences. Therefore, increased anxiety after abnormal maternal serum alpha-fetoprotein testing results cannot be reasonably used as an argument against such testing.

Hepatocellular carcinoma in corticosteroid-treated severe autoimmune chronic active hepatitis.

To determine the frequency of hepatocellular cancer in corticosteroid-treated severe autoimmune chronic active hepatitis and to identify risk factors for its development, 124 patients who were selected by uniform criteria, treated comparably and followed systematically for 111 +/- 6 months were evaluated. Hepatocellular cancer was diagnosed in three patients (2%) after 66, 99 and 174 months of observation, respectively. The incidence of hepatocellular cancer was 1 per 350 patient-years of follow-up. All three patients with hepatocellular cancer had cirrhosis for at least 5 years. The frequency of neoplasm in patients with cirrhosis of at least 5 years' duration was 7%. The incidence of hepatocellular cancer in these patients with cirrhosis was 1 per 182 patient-years of follow-up, and the probability of tumor was 29% after 13 years. Late elevation of the serum alpha-fetoprotein level was associated with the presence of neoplasm but normal levels did not exclude the diagnosis. We conclude that patients with corticosteroid-treated severe autoimmune chronic active hepatitis are at risk for hepatocellular cancer. This risk is greatest in patients with cirrhosis for at least 5 years. Such patients are candidates for cancer surveillance.

Selective and persistent deposition and gradual drainage of iodized oil, Lipiodol in the hepatocellular carcinoma after injection into the feeding hepatic artery.

The selective and long-term deposition of iodized oil in the hepatocellular carcinoma (HCC) and its gradual drainage were clinicopathologically analyzed in 13 cases. All patients were Japanese and had an intrahepatic arterial injection of Lipiodol (LIP) mixed with Mitomycin C. The comparison among the follow-up computerized tomography (CT) findings, the observation of the soft x-ray radiogram, and histopathologic studies of the surgical or autopsy materials revealed that the selective deposition of LIP in HCC lasted for a long term, particularly in cases treated by LIP combined with transcatheter arterial embolization (TAE). Also revealed was an extremely gradual decrease of LIP from the HCC. It was thus postulated that, mainly, the accumulated macrophages surrounding LIP around the necrotic cancer tissue and, partially, the intrahepatic lymphatic system itself contributed to this drainage. Further, in histologic sections with lipid staining, x-ray microanalysis proved that the lipid droplets in the cancer tissue included highly concentrated iodine, as a deposition of LIP.

First-trimester maternal serum alpha-fetoprotein screening for chromosome defects.

Low maternal serum alpha-fetoprotein values during the second trimester of pregnancy are associated with an increased risk of Down syndrome in the fetus. In this study a sensitive, monoclonal-based radioimmunoassay for alpha-fetoprotein was used to determine whether such an association also applies to the first trimester and if maternal serum alpha-fetoprotein screening could successfully detect a significant number of pregnancies in which the fetus had a trisomy or other chromosome disorder. Sera were obtained prospectively from 540 women just before chorionic villus sampling for prenatal diagnosis of chromosome defects (largely because of advanced maternal age) at 8 to 12 weeks' fetal age and assayed for alpha-fetoprotein under code without knowledge of the cytogenetic results. Eight of 27 (29.6%) of all serious chromosome defects were associated with low maternal serum alpha-fetoprotein values (less than or equal to 0.6 multiples of the median). Overall, 59 of 540 patients (10.9%) had maternal serum alpha-fetoprotein values less than or equal to 0.6 multiples of the median, eight of whom had a fetus with a serious chromosome defect. Women whose maternal serum alpha-fetoprotein value was less than or equal to 0.6 multiples of the median had one in eight odds of carrying a fetus with a trisomy and one in seven odds of the fetus having any serious chromosome defect. From this study of a group of women at higher risk, we conclude that first-trimester maternal serum alpha-fetoprotein screening for chromosome defects is feasible. A prospective study to determine detection efficiency is now required of a consecutive routine pregnancy population in whom gestational age is determined by menstrual dates as is usually the case in clinical practice.

Hepatocellular carcinoma presenting as intracranial metastasis.

The authors describe two cases of hepatocellular carcinoma presenting with the initial manifestations of an intracranial mass lesion without any symptoms or signs suggestive of the primary hepatic site of the tumor. The only clue of hepatic dysfunction was mild elevation of the SGOT and SGPT. The diagnosis could not be made until operation. It is unusual for the initial clinical presentation to be related to intracranial metastasis without evidence of hepatic involvement. Measurement of the serum alpha-fetoprotein and liver ultrasound examination are the most helpful screening tools for diagnosing hepatocellular carcinoma. The literature of hepatoma with cranial metastasis is reviewed.

Analysis of alpha-fetoprotein gene expression in hepatocellular carcinoma and liver cirrhosis by in situ hybridization.

The expression of the alpha-fetoprotein (AFP) gene in hepatocellular carcinoma (HCC) and liver cirrhosis by in situ hybridization analysis of AFP mRNA in cryostat and paraffin-embedded tissue sections was studied. In HCC sections the majority of tumor cells showed positive hybridization with a 3H-labeled AFP complementary DNA probe. The number of radioactive hybrid grains detected in HCC sections generally paralleled the level of serum AFP in the patient. In liver cirrhosis sections a small number of cells showed positive hybridization. These cells were dispersed in the tissue and morphologically indistinguishable from surrounding hepatocytes. Each of these cells contained a high level of hybridization signals to permit easy identification. In situ hybridization analysis of AFP mRNA may be of use in detecting preneoplastic cells in liver cirrhosis that cannot be defined on the morphologic and immunohistochemical basis.