Usefulness and Limitation of Carcinoembryonic Proteins as Therapeutic and Prognostic Markers in Malignant Tumors

Patients with germ cell tumors, hepatomas and other malignant tumors were studied throughout their courses of surgical, radiological and medical treatments with serial determinations of AFP, CEA, HCG and basic fetoprotein (BFP), which was newly found by M. Ishii.
In general, these carcinoembryonic or trophoblastic markers were observed to be well correlated with the fate of the tumor in the body and to be useful in evaluating the effect of treatment or in predicting the prognosis of the patient. Except for a postoperative transient increase in serum BFP and CEA, the levels fell after surgery and rose again with recurrence of the tumor. Although we had some patients with teratocarcinoma, hepatoma or gastric carcinoma, whose serum AFP showed a transient parallelism with their clinical courses, an obvious dissociation in these markers occurred later in their course. Similar dissociations were also observed with these carcinofetal or trophoblastic markers in patients with chemotherapy or radiotherapy for their teratocarcinomas.
We conclude that each carcinoembryonic protein is a useful but limited marker for malignancy but should be used clinically in combination with other tumor markers.     

Impaired instrumental activities of daily living affect conversion from mild cognitive impairment to dementia: the Osaki‐Tajiri Project

Aim: To determine whether impaired instrumental activities of daily living affect conversion from mild cognitive impairment to dementia for subjects in a community. Methods: This is a 7‐year retrospective study that followed 226 randomly selected participants from the Prevalence Study 1998 in Tajiri in northern Japan who had Clinical Dementia Rating 0.5. Instrumental activities of daily living levels were assessed with a 21‐item questionnaire. We analyzed the scores at baseline between the converters to dementia and non‐converters. Results: The converters had lower baseline scores on the ‘bed making’ and ‘mode of transportation’ items compared with the non‐converters; the former item was significant after a stepwise logistic regression analysis that excluded age and Mini‐Mental State Examination effects. In gender analysis, female converters had lower baseline scores on the ‘bed making’ and ‘cleaning’ items. For male participants, no items were found to have such an effect. Conclusions: We suggest that when individuals with mild cognitive impairment are limited in their performance of instrumental activities of daily living, this is predictive of dementia onset.     

Characteristics of exploratory eye movements in elderly people: possibility of early diagnosis of dementia

Background: Visual cognitive dysfunction is one of the most important signs indicating the early stage of dementia. Thus, visual testing could be used as an aid to the clinical diagnosis of dementia. In the present study, exploratory eye movement was measured to evaluate visual cognitive function in elderly subjects, including those with dementia. Methods: We analyzed responsive search scores (RSS) from exploratory eye movements of 300 subjects who were examined with an eye mark recorder while viewing S shaped figures. Subjects were divided into three groups (dementia, intermediate, healthy) from the values of the Revised Hasegawa Dementia Scale (HDS‐R), the Mini‐Mental State Examination (MMSE) and the Clinical Dementia Rating. We further divided the intermediate groups into two subgroups, the high score and low score groups, based on RSS. In 202 subjects, Z‐scores of voxel‐based specific regional analysis system for Alzheimer's disease (VSRAD) were obtained from magnetic resonance imaging (MRI). Results: RSS of the dementia group were significantly lower than those in the intermediate and healthy groups, in order: dementia < intermediate < healthy groups. RSS of the low score intermediate group was significantly lower than that of the high score intermediate group. There was no significant difference between the low score intermediate and dementia groups, or between the high score intermediate and healthy groups. No significant differences of either HSD‐R or MMSE were observed between the low score and the high score intermediate groups. The Z‐score of VSRAD using MRI in the low score intermediate group was significantly higher than that in the high score intermediate group. Conclusions: These findings suggest that RSS using an eye mark recorder is a useful psychophysiological marker to evaluate the early stage of dementia as well as at‐risk elderly people.     

PROGRESSIVE SYSTEMIC SCLEROSIS ASSOCIATED WITH CUTANEOUS AMYLOIDOSIS

A 43-year-old woman presented with a 3-year history of Raynaud's phenomenon and a six-month history of numbness in both arms. Sclerosis was noted on the entire body surface. The skin of the face was smooth and the lips were constricted (Fig. 1). The fingers and hands were atrophic and sclerotic, and full extension of the fingers and metacarpal joints was impossible (Fig. 2). There was pigmentation on the dorsal aspect of the hands. From the nape to the upper back, pruritic wavy, rippled or reticular pigmented macules in addition to sclerosis were noted (Fig. 3). Other parts of her skin did not show such a wavy pigmentation. Physical examination revealed no specific findings in the lung, heart, and abdomen. Neurologic examination was unremarkable. Motor function including muscle tonus was normal.
Laboratory studies disclosed that the complete blood count and tests of hepatic and renal function were within normal limits. Antinuclear antibody was I:80 and showed a speckled pattern, antitopoisomerase 1 antibody, anticen-tromere antibody, anti-Sm antibody and anti-RNP antibody were all negative, and the CH50 was 31.5 units/ml; C3 was 59.4 mg/dL; and C4, 17 mg/dL. Radiologically the chest and esophagus were normal.
Pulmonary function and electro-cardiogram were also normal. Histologic examination of a skin biopsy obtained from the upper back revealed that the collagen bundles throughout the dermis were thickened, homogenous, and closely packed. In the upper dermis, a small number of inflammatory cells around blood vessels was observed. Eosinophilic homogeneous masses were seen in the papillary dermis and upper dermis (Fig. 4). These homogeneous masses were positive to Dylan' (Fig. 5), Congo red, and thioflavin T staining. Therefore, the diagnosis of cutaneous macular amyloidosis was made.