Insulin antibodies: methodology and clinical implications

Anti-insulin antibodies detection is based on the demonstration of a specific and saturable binding to insulin either radiolabelled with 125 I (Radiobinding assay or RBA) or coated on a solid phase (Enzyme linked immunosorbent assay or EIA). The 2 assays are remarkably different by their sensitivity to the affinity of the antigen antibody reaction. In addition, RBA may be biased by the presence of the iodine atom on the radioiodinated insulin whereas, at least on theoretical grounds. EIA could be biased because of denaturation or non availability of some epitopes when insulin is coated. Anti-insulin antibodies may be induced by insulin therapy. When they "spontaneously" appear, they are called autoantibodies. Insulin autoantibodies may be detected in the normal population, in type 1 diabetic patients before any administration of exogenous insulin and in patients suffering from the autoimmune hypoglycemic syndrome. In some patients, this syndrome may be associated with administration of a thiol containing drug. In some cases, insulin antibodies may appear several years after a transient insulin therapy, possibly as a consequence of a disturbance of the immunologic memory. The properties of antibodies and autoantibodies (concentration, affinity, number and nature of epitopes, heavy and light chain composition and ability to form aggregates) are relatively characteristic of the disease with which they are associated and determine their potential effects on insulin bioavailability and plasma glucose homeostasis.     

Predictive value of plasma CEA in patients with colorectal carcinoma

Two years follow-up of 46 patients with colorectal carcinoma resected "for cure" shows that of the nine patients with an elevated (less than 5 ng/ml) CEA plasma titer one to six months after surgery, only one, or 11%, had remained disease free. Of the 38 patients with normal (less than 5 ng/ml) plasma CEA, 27, or 71%, were free of disease two years after surgery. In another 85 patients presenting six months to ten years after resection "for cure" of their colorectal carcinoma, normal CEA levels were found in 73, and only five, or 6.4%, of these presented with disease progression when followed for two years; of the 12 patients that presented with CEA values less than 5 ng/ml, disease progression was evident in eight or 67%; in eight patients with CEA levels of greater than 10 ng/ml, the proportion of patients with disease progression increased to 87.5% (7/8). When a patient with a history of colorectal cancer, but seemingly free of disease, presents with levels not only repeatedly above normal (greater than 5 ng/ml) but above the levels found in some nonmalignant conditions (greater than 10 ng/ml), thorough re-examination of the patient to locate the site of possible disease progression is indicated. In 14 such patients further diagnostic methods showed local recurrences in four, metastasis limited to the liver in six, and other metastasis in four. In conclusion, in patients with colorectal carcinoma postoperative elevated CEA plasma levels are a sign of poor prognosis. Consistently elevated CEA levels (greater than 10 ng/ml) are a strong indication of disease progression.     

Wertigkeit der CT und MRT in der Diagnostik von Lebermalignomen

Prim?re und sekund?re Lebermalignome z?hlen weltweit zu den h?ufigsten Tumoren. Metastasen kommen hierbei etwa 30-mal h?ufiger vor als hepatozellul?re Karzinome [4]. Die H?ufigkeit metastatischer Tumorabsiedlungen erkl?rt sich aus der topographisch-funktionellen Lage der Leber als Bindeglied zwischen dem portalen und kavalen Kreislaufsystem. Abh?ngig von der Art des Prim?rtumors liegen die Angaben über das Auftreten einer Lebermetastasierung zwischen 30 und 80%[4, 16]. Die Therapie von Lebertumoren hat sich entscheidend weiterentwickelt. In den letzten 20 Jahren etablierte sich mit der Verbesserung der Operationstechniken – verbunden mit einer Senkung der Operationsletalit?t – eine zunehmend aggressive chirurgische Therapie mit potenziell kurativer Zielsetzung in der Behandlung von Lebertumoren.Auch die chemotherapeutischen Verfahren und in den letzten Jahren insbesondere die interventionellen Therapiem?glichkeiten der Lebertumoren wurden weiterentwickelt. Insofern ist eine genaue Bild gebende Diagnostik zur ad?quaten Therapieplanung von gro?er Bedeutung. Priv.-Doz.Dr. G.Jung Institut für Diagnostische Radiologie, Heinrich-Heine-Universit?t Düsseldorf, Moorenstra?e 5, 40225 Düsseldorf, E-Mail: Jung@med.uni-duesseldorf.de     

Katzenkratzkrankheit Eine wichtige Differentialdiagnose der Lymphadenopathie

Zusammenfassung Wir berichten über 2 F?lle von Katzenkratzkrankheit. Diese Erkrankung z?hlt zu den seltenen Ursachen einer Lymphadenopathie. Die Verdachtsdiagnose stützt sich auf Katzenkratzer in der Anamnese und die typischen Befunde mit Lymphknotenschwellung im Bereich der Prim?rl?sion.