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The increasing long-term use of intravenous chemotherapy has resulted in problems of venous access for a number of reasons, one being the sclerosing action of the drugs used. Silastic catheters were introduced to ameliorate this problem, initially with some caution because of potential complications and the lack of necessary equipment. The purpose of this paper was to show that the procedure is simple, effective and associated with few complications. Ninety-six patients (32 men, 64 women) with lymphoma (25), leukemia (28), metastatic breast cancer (28) or other malignant lesions (15) were referred for insertion of a Silastic permanent indwelling catheter into the superior vena cava. The catheter was inserted through a subclavian vein using a Cordis Vein Dilator Kit, itself introduced over a guide wire inserted initially under fluoroscopic control. Local sepsis at the insertion site occurred in 6 of the first 43 patients treated but in none of the remainder. Six catheters became thrombosed and required revision. There were no instances of bleeding, air embolism or pulmonary complications. Patient acceptance of this method of venous access was high compared with that for peripheral, repeated venepuncture.

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We have studied the electrophoretic characteristics of a creatine kinase (CK, EC 2.7.3.2) isoenzyme, macro creatine kinase type 2 (MCK-2), in the serum of 42 patients with carcinoma of the colon. The patients could be divided into three subgroups by the intensity of the MCK-2 band (nine high, nine medium, and 24 low intensity), but we detected no correlation between the isoenzyme activity and the stage of the cancer. Inhibition of the activity of the CK-M subunit by antibody to CK-M allowed more sensitive detection of MCK-2 in serum and revealed that MCK-2 may be obscured by CK-MM. Moreover, there may be major discrepancies between the amount of MCK-2 seen on electrophoresis and the apparent total CK.

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Macro creatine kinase type 2 (MCK-2) is a promising new tumour marker for carcinoma of the colon. We have purified it from tumour tissue, from serum and, for the first time, from normal colonic epithelium and identified it in a tissue culture line of colon cancer cells. The molecular weight of each preparation, regardless of the source, was similar. Its consistent presence in tumours and in normal colon, contrasted to its variable appearance in serum, implies that there are other factors affecting its release into, or removal from, the circulation.

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The macrocreatine kinase type 2 isoenzyme (MCK-2) was investigated as a marker for colonic cancer. It was sought in 252 serum samples from 231 patients: 69 with active colonic cancer, 49 in whom colonic cancer had been successfully resected, 58 with nonmalignant diseases of the colon, and 76 patients immediately following colonic surgery. MCK-2 was detected in the serum of 39 of the patients with cancer (57%) and in one patient with diverticulitis. MCK-2 and carcinoembryonic antigen (CEA) were both measured in 47 colonic cancer patients. Both markers were detected in 19 cases, MCK-2 alone in eight and CEA alone in eight. We conclude that MCK-2 is a promising tumor marker for carcinoma of the colon and that its value might be complementary to that of CEA.

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It is now possible to store large amounts of data, which can be rapidly retrieved and cross-referenced, on relatively inexpensive computers. This study was done to determine if a small computer could be used to store detailed data on patients attending an oncology clinic in such a manner that personnel inexperienced in the use of computers would be able to enter or access information without training or the need for reference literature. Ninety items can be entered on each patient under 11 options (demography, diagnosis, laboratory, tumour markers, investigations, surgery, chemotherapy, radiotherapy and immunotherapy, complications, clinic visits and palliative care). The data can be retrieved rapidly on any individual or group of patients and cross-referenced to two or more variables and can be updated, corrected or transmitted by an automated print-out in letter form. The study illustrates basic principles in program design that will function on any "home" computer.

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Creatine kinase (CK) is an enzyme found in many body organs. It is used clinically in the diagnosis of myocardial infarction. Recently an atypical isoenzyme, macro-CK2, not found in the sera of healthy individuals, has been reported in patients with gastrointestinal malignancies. This study is a report of our findings in serum samples obtained from 200 patients from November 1981 until December 1982. Twenty-eight patients had gastrointestinal complaints but did not have malignant disease. One hundred seventy-two patients had malignancy. Samples of serum were studied for macro-CK2 with a standard laboratory agarose gel electrophoresis technique. The tests were done without knowledge of the patients' diagnoses. The results show no detectable macro-CK2 in sera from patients without malignancy. It was present before operation in nine of 13 patients with colorectal cancer and 16 of 21 patients with metastases from colorectal cancer or gastric cancer. This preliminary study suggests that the presence of macro-CK2 in serum may be an indicator of malignancy of the gastrointestinal tract and in particular of colorectal cancer.

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Twenty-seven patients underwent percutaneous antegrade biliary drainage for obstructive jaundice. The serum bilirubin levels was elevated in all patients. Generalized pruritus was a major complaint. Twenty of the patients had had a laparotomy for malignant disease. Of the 24 patients in whom this method of drainage was successful, the obstructing lesion was found at the porta hepatis in 12 and in the extrahepatic bile ducts in 12. Metastatic disease was the commonest cause of obstruction. Following drainage the serum bilirubin level fell from a mean of 21.4 mg/dl (366 mumol/l) to a mean of 4.1 mg/dl (70.1 mumol/l) within a week. Pruritus was relieved. The major complications were transient cholangitis in five patients and inadvertent dislodgement of the catheter in four. In three of these patients another catheter was reinserted with ease. There was no peritonitis or uncontrolled bleeding. Twenty-one patients were able to leave hospital. Their mean survival time was 7.3 months. A multiperforated catheter manipulated through the obstruction has the advantage of permitting bile flow into the duodenum (antegrade) in contrast to external drainage (retrograde) by T- or U-tubes. Although the mean survival time with this method is similar to that with insertion of drainage tubes at the time of laparotomy, morbidity and mortality are reduced; this is important in view of the poor prognosis of bile duct obstruction due to malignant disease.

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The authors conducted a study using radioactive endogenous bile to detect gastric bile reflux in healthy volunteers and patients suspected of having bile gastritis. When 7 muCi of pyridoxylideneglutamate of hydroxyiminodiacetic acid labelled with technetium-99m is injected intravenously it is excreted by hepatocytes, and sequential gamma camera images visualize the bile ducts and show subsequent activity in the gut. Following such an injection, the authors determined the presence of isotope-labelled bile in the stomach in fasting subjects by assaying count rates in serial gastric aspirates obtained by means of a nasogastric tube positioned in the antrum. The results were related to the clinical history and gastroscopic findings. In normal persons only extremely low counts were detected, possibly due to free activity; high counts (in excess of 50 000/min) indicated abnormal reflux. It is suggested that this test is a useful adjunct, and is more physiologic than endoscopy, in the assessment of bile reflux.

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The clinical and pathological features of a tumor of the temporamandibular joint occurring in a 55 year old man, and subsequently identified as a calcium pyrophosphate dihydrate (CPPD) arthropathy, are reported. Crystalline deposits were identified by compensated light microscopy and confirmed with X-ray diffraction, transmission, and scanning electron microscopy. The relationship of this unique case to other clinical presentations of CPPD deposition disease and the implications of the histological features to the pathogenesis of pseudogout are discussed. This case demonstrates that CPPD arthropathy should be included in the differential diagnosis of an arthrosis or of a tumor involving the temporomandibular joint.

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This study was done to determine why the plasma insulin remained elevated during shock. Mongrel Female dogs (12-15 kg) were depancreatized and maintained on a constant intraportal infusion of porcine insulin while they were bled to reduce and maintain the mean arterial blood pressure at 50 mm Hg for 165 min. Blood samples were taken for glucose and plasma insulin at 15 min intervals. The data show that there was a progressive rise of plasma insulin during the course of hemorrhagic shock. This occurred despite a constant infusion of insulin, the sole source of insulin available to these depancreatized dogs. Since removal of plasma insulin is largely due to insulin utilization, our findings imply that the rise of plasma insulin in hemorrhagic shock is caused by decreased utilization.

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We have demonstrated a defect in tissue perfusion during hemorrhagic shock in dogs that is due in part to poor capillary flow, and in part to a defect in interstitial tissue diffusion. Treatment with whole blood alone improves capillary flow but diffusion remains defective. The use of hyaluronidase appears to correct the interstitial diffusion defect observed during shock.

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