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[The CEA test and other immunological tests as disease course controls in gastrointestinal adenocarcinoma].

161 patients with adenocarcinoma of the gastrointestinal tract were studied to determine the value of the CEA test and a battery of non-specific immunological tests during the course of the disease. The ability of these tests to detect a tumor recurrence in radically operated patients was evaluated. A false negative preoperative CEA value was found in 40% of the patients with gastric carcinoma and 32% with colorectal carcinoma. Patients with a negative preoperative CEA value, and those with only slightly elevated values, had a distinctly better prognosis regarding initial operability and tendency to postoperative recurrence than patients with primarily markedly elevated values. With few exceptions, the development of distant metastases was detected earlier and more easily with the CEA test than by the usual routine follow-up methods. However, in the event of isolated local recurrence the CEA test was positive in only 1 of 5 patients. This reflects the direct correlation between tumor size and CEA elevation. The CEA test is a valuable supplement in the follow-up of patients with gastrointestinal carcinoma.

Adenocarcinoma

Month-related variability in immunological test results; implications for immunological follow-up studies.

This longitudinal study was originally designed to detect changes in the in vitro immune response of healthy subjects as a result of a psychological intervention. In this study a significant proportion, about 70%, of the immunological variability in the test results was accounted for by the differences in immunological response levels of the subjects. Apart from this between-subject-effect, a significant proportion of the variability in test results was related to the month of data sampling. The month-effect was computed in such a way that the between-subject variation was taken into account. This resulted in a more accurate estimation of the month-effect. Even after correction for the intervention, i.e. the defence of the PhD thesis, the effect of month of data sampling remains significant for mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, percentage of CD4 and CD8 cells, and for the response to the mitogens phytohaemagglutinin, pokeweed mitogen and concanavalin A as well as the results for the mixed lymphocyte culture for one pool out of three. In contrast, no significant month-effect was observed for the whole blood cell counts, for the differential white blood cell counts as determined by monoclonal antibody staining for cell surface markers CD3, CD16, TAC and OKM1, nor for the immunoglobulin IgM and IgG serum levels. Likewise the cell-mediated lympholysis activities measured against three pools of stimulator cells remained unaltered. We discuss the implications for future immunological follow-up studies of the observation that a significant proportion of the variability in immunological test results is related to differences between subjects and to the month of data sampling.

Adult

[Diagnostic performance of immunologic tests in amebic liver abscess using receiver operating characteristic curves].

Objectives. 1) To identify the tests of immunological diagnosis with a high diagnostic efficiency in amebic liver abscess. 2) To determine the ideal cutoff point for such tests. 3) To identify the influence degree of the antigen used over the test efficiency. Design. Comparative survey. Study units. Analysis of 24 articles identified in the medical literature about tests of immunological diagnosis in amebic liver abscess. Measurements. Starting from the articles, operating characteristics curves (ROC) were established derived from the test application to patients with amebic liver abscess. Results. A great variability in the diagnostic efficiency was identified between the various tests, even when the analysis was focused on the investigations of a specific test. It was not possible to conclude which test had a major degree of efficiency due to such variability. The cutoff level considered as relevant was higher than the one traditionally used for indirect hemagglutination and it had concordance with the one presently accepted for the fluorescence antibodies test. By maintaining steady the spectrum of the study patients and the type of test, variability among the tests persisted. This was due to the use of different antigens. Conclusions. A great variation in the diagnostic efficiency of the analyzed tests was identified. The variation source was the type of test, the antigen used and probably the illness spectrum.

Evaluation Studies as Topic

A simple visual surface immunology test.

A new general immunology test is described which is capable of detecting protein in the 1 microgram/ml range. First an antigen is adsorbed in a small area of a glass surface. The glass is exposed to an antibody solution and the antibody will attach specifically to the antigen. Next the slide is washed, dried and sprayed lightly with plastic particles that stick to the protein layers on the glass. Now when the glass slide is exposed to an acid the antigen--antibody bonds are broken, the antibodies will leave the surface removing some of the plastic particles and leaving an easily visible spot behind.

Animals

[Evaluation of immunological tests in thyroid diseases].

We evaluated immunological tests for autoimmune thyroid diseases. Although both humoral and cellular immunity are correlated to the onset and pathophysiological progression of these diseases, the major tests employed in daily clinic belong to the former. We measured the anti-TSH receptor antibody (TRAb, TBII), circulating immune complex (CIC), thyroid growth stimulating immunoglobulin (TGSI) and interleukin-2 (IL2) levels in patients with Graves' disease (GD) and chronic thyroiditis (CT). The normal range of TRAb in 190 healthy controls was from -10.9 to +10.3% calculated from the mean +/- 2SD. Sixty eight out of 78 untreated cases of GD (87.2%) showed a higher TRAb than the upper normal level (positive), 92 out of 131 cases of GD under treatment (70.2%) were positive and only 5 out of 57 cases of treated GD (8.8%) were positive. Three neonates out of 12 GD mothers had a positive TRAb and one of them developed neonatal GD. Nine out of the 45 CT (20%) had positive TRAb, but about half were euthyroid and goitrous. In untreated GD, CIC was distributed widely from the normal range to high levels. CIC showed a significantly negative correlation with TRAb. TGSI correlated with goiter size and CIC in GD revealed autologous inhibition on TGSI. Three cases showed markedly decreased levels of TRAb which was found to be due to anti-TSH antibodies. Production of IL2 in GD was impaired, but it was improved by treatment of GD.(ABSTRACT TRUNCATED AT 250 WORDS)

Autoantibodies

[Extrauterine pregnancy--the clinical experience of using a new differential-diagnostic immunological test].

The authors report results of immunologic test, that has been used to help the decision in some difficult for differential diagnosis cases. Two immunologic parameters were investigated--the amount of circulating immune complexes (CIC) and the lymphocytic nuclear coefficient (LNC). The results are put on a specially designed nomogram. The combined test used in the Department of "Obstetrics and Gynaecology"--Pleven, gives excellent results. The advantages of the test are discussed and a clinical case is presented as an illustration.

Adult

Identification of squamous cell carcinoma of the head and neck by tissue culture and immunological testing.

We outline the techniques used to successfully grow squamous cell carcinoma in tissue culture, and to test the cellular immunity of the patient by lymphocyte cytotoxicity studies. Lymphocytes cultured with malignant squamous cells killed from 40 to 60 percent of the tumor cells during 48 hours of incubation. These same lymphocytes did not show any killing potential against cultured melanoma cells or against cultured fibroblasts. This demonstrates an immune response that is tumor-antigen specific. There was no evidence of any serum-blocking factor, because the killing potential of these lymphocytes was not significantly altered by the addition of the patients' sera. The implications and potential for early diagnosis made possible by these techniques are discussed.

Adult

[Glomerulonephritis: critical evaluation of immunological tests performed routinely (author's transl)].

The clinical value of the immunological tests performed routinely has been evaluated in 91 patients with various histological types of glomerulonephritis. An antigen possibly involved in the pathogeny of renal disease was found in 24% cases. However, in most instances no direct link between the presence of this given antigen and the disease could be observed. Therefore systematic investigations for antigens should be restricted to dosages of antistreptolysin and antinuclear antibodies and to determination of Hbs antigen. Immune complexes, which were observed in many cases, were of no discriminant value for the clinician. Dosages of the complement fractions and the determination of cryoglobulins can be helpful for diagnostic, follow-up and treatment. Our results justify a restricted selection of the routine immunological tests used in patients with glomerulonephritis. More specific investigations remain useful when they are clinically oriented.

Antibodies, Antinuclear

Predictors for live birth after unexplained spontaneous abortions: correlations between immunologic test results, obstetric histories, and outcome of next pregnancy without treatment.

Our objective was to determine whether results from tests for maternal serum antinuclear antibodies, cytotoxic antibodies to paternal lymphocytes, parental histocompatibility types, and blocking factors for maternal-paternal mixed lymphocyte reactions were predictive of pregnancy outcome without immunologic treatment. Pregnancy outcome data from 95 women with a history of unexplained recurrent spontaneous abortions who underwent immunologic tests at Jefferson Medical College were evaluated with multiple logistic regression analyses. The number of prior spontaneous abortions, history of another relevant diagnosis, parental sharing of one histocompatibility antigen, and maternal age were related to the outcome of the next pregnancy in women given no immunologic treatment (p = 0.05). No significant correlation was found between results from the immunologic tests or other history characteristics evaluated and outcome of the next pregnancy. The immunologic tests evaluated were not clinically useful predictors of pregnancy outcome.

Abortion, Habitual

Immunologic tests of specific antibodies to organic acid anhydrides.

The outcome of immunologic tests of antibodies directed against hapten conjugates of organic acid anhydrides and human serum albumin (HSA) has been studied in workers exposed to phthalic anhydride (PA), methyltetrahydrophthalic anhydride (MTHPA), hexahydrophthalic anhydride (HHPA), and methylhexahydrophthalic anhydride (MHHPA). HSA conjugates of PA, MTHPA, HHPA, MHHPA, and maleic anhydride (MA) have been prepared and used in the tests. The hapten densities (HD) of the conjugates were varied by different molar ratios of hapten and macromolecule in the preparative procedure. Skin prick reactions to MTHPA-HSA increased with rising HD over the range 6-13 mol/mol. The achieved HD was tested by spectrometric and gas chromatographic methods. In RAST of IgE antibodies MTHPA-HSA with HD six and 25 showed significantly lower bindings than conjugates with intermediate HD. There was a good correlation between skin prick tests and RAST. Of 234 workers tested [MTHPA (n = 145), and HHPA (n = 89)], 45 had a skin prick reaction greater than or equal to 50% of the histamine reaction (1 mg/ml). All but two of these were RAST positive (RAST value greater than 0.3%; 0.3% upper range in 147 controls; MTHPA, n = 63; HHPA, n = 84). Nine RAST positive workers had no obvious skin prick reaction. However, their RAST values were low (less than 0.8%). In exposed workers, the ELISA value of specific IgG antibodies to MTHPA-HSA showed optimal values when tested with the HD 13 conjugate.(ABSTRACT TRUNCATED AT 250 WORDS)

Enzyme-Linked Immunosorbent Assay

[Prognostic significance of immunologic tests in cancer of the oral cavity].

An analysis of delayed action cell immunology tests involved 300 patients suffering from stomatological cancers. The tests used, tuberculine, candidine, varidase and DNCB have no particular value as far as discovering the size of the tumour, the quality of eradicating treatment or its progress. On the other hand, bias in the same direction and, even more, variations in the direction of immunity in the course of evolution seem to be a reflection of the patient's immune defence potential. This immune defence potential which can be roughly assessed in this way dose not seem to be reduced by chemotherapy or increased by immunotherapy, at least judging by the criteria used.

Antigen-Antibody Complex

Chemical and immunological testing for faecel occult blood: a comparison of two tests in symptomatic patients.

An established chemical faecal occult blood test (Haemoccult prepared without rehydration) has been compared with a new immunological test (Hemeselect) in patients referred for investigation of lower gastro-intestinal symptoms. Hemeselect was shown to have a higher sensitivity for colorectal carcinoma (94.0% compared with 58.0%), the greatest difference in sensitivity between the two tests being for rectal cancers. Similarly Hemeselect was more sensitive than Haemoccult for colorectal adenomas (66.6% vs 33.3%), and for inflammatory bowel disease (88.9% vs 33.3%). However the enhanced sensitivity of Hemeselect for colorectal neoplasia and inflammatory bowel disease was accompanied by a significant increase in the overall rate of positive reactions (32.8% of patients had a positive Hemeselect reaction compared with 14.8% who had a positive Haemoccult test), and a reduction in specificity (84.1% for Hemeselect vs 96.0% for Haemoccult). Hemeselect is a more sensitive indicator of colorectal neoplasia in symptomatic subjects, trials of its use as a screening test for asymptomatic neoplasia appear justified.

Adenoma