138
15-KETO-13, 14-DIHYDROPROSTAGLANDIN E2 CONCENTRATIONS IN SERUM OF PATIENTS WITH BREAST CANCER
SIR,-Prostaglandins, including prostaglandin E2, can be synthesised in vitro by human breast-cancer tissue.1.2 Although these substances are biologically active they are metabolised rapidly in plasma to inactive and stable 15-keto derivatives. We have measured the concentration of 15-keto-13, 14-dihydroprostaglandin E2 (KH2-p.G.E2) in the plasma of 71 patients with breast cancer, 13 patients with benign breast disease, and 20 healthy controls. Blood-samples were taken in heparin, spun immediately, and stored in liquid nitrogen. None of the patients had taken non-steroidal anti-inflammatory drugs for at least seven days before venepuncture. Plasma KH2-p.G.E2 was estimated by a radioimmunoassay3 developed by one of us (L. L.) (unpublished). The patients with breast cancer were divided into those with disease confined clinically to the breast (37) and those with overt metastases (34). The mean KH2-p.G.E2 in the healthy controls was 0-028 ± 0.010 jjg/1 and in patients with benign breast disease it was 0-062 ± 0.018 g/1. These higher concen1.
Dowsett, M., Gazet, J. C., Powles, T. J., Easty, G. C., Neville, A. M. Prostaglandins, 1976, 11, 447. 2. Bennett, A., Macdonald, A. M., Simpson, J. A., Stanford, I. F. Lancet, 1976, i, 1218. 3. Dowsett, M., Gazet, J. C., Powles, T. J., Easty, G. C., Neville, A. M. ibid. p. 970.
trations in benign breast disease may be related to prostaglandin synthesis by benign breast tumours’ or may be the result of stress which patients with benign breast disease undergo before operation. 11 of 37 patients with non-metastatic and 15 of 34 patients with overt metastatic disease had values in excess of 2 s.D. above the mean of the benign group (see figure). The concentrations in patients with bone metastases were the same as in patients with metastases at other sites, suggesting that excessive P.G. synthesis is not a special feature of overt
osteolytic metastases. are required to evaluate the clinical and bio-
Further studies
logical significance
of these
findings
and the value of estimat-
ing other metabolites. This work
was
done in
conjunction with the Royal
Marsden
Hospi-
tal, Sutton, and the combined breast clinic of St George’s Hospital,
Tooting, and the Royal Marsden Hospital, Sutton. TREVOR J. POWLES R. C. COOMBES A. MUNRO NEVILLE H. T. FORD J. C. GAZET
Institute of Cancer Research, and Unit of Human Cancer Biology, Ludwig Institute of Cancer Research, London SW3
Department of Biochemistry, Brandeis University,
LAWRENCE LEVINE
Waltham, Massachusetts U.S.A.
PROSTAGLANDINS AND ACUTE INTESTINAL PSEUDO-OBSTRUCTION
SIR,-Intestinal pseudo-obstruction’ is characterised by a clinical picture simulating mechanical obstruction of the intestine without organic occlusion of the lumen. It can be transient or chronic; and associated with various diseases or idiopathic. In a case of chronic idiopathic intestinal pseudo-obstruction increased concentrations of peripheral prostaglandin E have been reported and the beneficial effect of indomethacin therapy has been emphasised.2 We have also observed hyperprostaglandinoemia of the E and F series in a case of acute intestinal
pseudo-obstruction. A 40-year-old White woman was admitted to our hospital on Nov.
20, 1976, because of alcoholic liver disease and transient
mild
hepatic encephalopathy.
On Dec. 2
an
occlusive
period
PERIPHERAL PROSTAGLANDINS IN PSEUDO-OBSTRUCTIVE PATIENT AND CONTROLS
(pg/ml)
*Mean+s.E.M. no gas, no stool, vomiting, and painful abdominal distension. The serum-electrolytes were normal. Plain films of the abdomen revealed small-bowel distension with fluid levels. Barium enema showed neither distension nor obstruction. She was treated with intravenous fluids and nasogastric suction 3 days later diarrhoea developed with the passage of four to five watery stools daily. The serum-potassium fell to 2.7 mmol/1. Since Dec. 12 she has had normal bowel habits. On Dec. 10 upper-gastrointestinal series showed slight dilatation of the jejunum with normal mucosal pattern. Barium
developed with
Plasma-KHz-P.G.Ez concentrations. C controls; B benign disease; L (local) and =
breast cancer.
=
M
(metastatic)
=
1. Moss, A. A., Goldberg, H. I. C. R. C. crit. Rev. radiol. Sci. 1972, 3, 363. 2. Luderer, J. R., Demers, L. M., Bonnem, E. M., Saleem, A., Jeffries, G. H. New Eng Med. 1977, 295, 1179.