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GASTROINTESTINAL CANCER AND ALBUMIN TURNOVER
1144
persistent tenderness and pain operating-list. If anyone suffering from this
for many hours after
an
or similar troubles would like to write to me I will try to correlate replies and get in touch with one of the glove manufacturers.
97, London Road,
J. F. BOURDILLON.
Gloucester.
MASSIVE ALBUMINURIA FOLLOWING AORTOGRAPHY
SiR,—It has been known for some time that after the intravenous injection of radio-opaque, substances the urine "
apparently " false-positive result for protein with the salicylsulphonic-acid test. Recently it has been reported that urine containing various radio-opaque substances does not give false positive results with the ’Albustix’ test (Ames Co. Ltd.) which is claimed to be more specific for protein.23 During the clinical trial of a new paper-strip test (’ Uristix ’, Ames) (not available in this country) designed to detect both proteinuria and glucosuria, I found a strongly positive result for protein in the urine of a patient after an aortogram with diodine, the diethanolamine salt of 3,5 diiodo-4-pyridone-N-acetic acid. This result was at first thought to be a false positive due to the excretion products of diodone, but as the protein-testing portion of uristix is similar to albustic, and therefore presumably not likely to give a false positive, I decided to investigate this apparent anomaly. Samples of urine were tested from each of 24 patients before and after injection in the following groups:
gives
an
A.
2
are
summarised in the accompanying table.
RESULTS OF URINE TESTS BEFORE AND AFTER
I am grateful to Sister C. A. MacPherson, of the radiology department, for her cooperation and help with the collection of urine samples and to Miss M. R. Haslock, B.sc., of the department of pathology, for technical assistance. Department of Pathology,
Queen’s College, University of St. Andrews.
JAMES A. KIRKLAND.
2
Aortogram (4 patients: samples before, samples Group after). Group B. Intravenous pyelogram (18 patients: 1 sample before, 1 sample after). Group C. Angiocardiogram (2 patients: 2 samples before, 2 samples after). The results
(a) Day before aortogram, no proteinuria. (b) Day of aortogram : before aortogram, no proteinuria. (c) Day of aortogram : after aortogram, gross proteinuria (1300 mg. per 100 ml.). (d) Day after aortogram: gross proteinuria (500 mg. per 100 ml.).
INJECTION
To confirm the presence of protein, 11 of the urines from group A (aortogram) were further examined by dialysis and subsequent electrophoresis; those taken after aortography all showed the presence of abundant material at the site corresponding to the albumin fraction (see figure). Quantitative values of 730 mg. and 1300 mg. per 100 ml. (i.e., a massive proteinuria) were obtained by the biuret test which is thought to be specific for the -CO-NH-grouping of proteins; the biuret tests against the opaque media in vitro gave values of only 16 mg. forHypaque’ (sodium diacetamido triiodobenzoate) (Bayer) and 115 mg. per 100 ml. for diodone.
These results suggest that the intravascular injection of radio-opaque material, particularly into the aorta, may be followed by gross proteinuria. The implication of temporary renal damage is of course obvious, and this is being investigated further. 1. Harrison, G. A. Chemical Methods in Clinical Medicine. 2. Baron, D. N., Newman, F. Brit. med. J. 1958, i, 980. 3. Frazer, S. C. ibid. p. 981.
London, 1957.
GASTROINTESTINAL CANCER AND ALBUMIN TURNOVER
SIR,-We read with interest Dr. Madden’s observations (Nov. 28) on total exchangeable albumin pool and turnover studies using 1311-albumin on 3 patients with malignant disease and hypoalbuminxmia. 2 of his 3 patients-both with high gastrointestinal cancer-showed high rates of protein (albumin) synthesis despite severe hypoproteinxmia, and as neither of his 2 patients had external protein loss he thinks it would be interesting to speculate on the possibility of internal protein shunts in patients with malignant disease. Dr. Madden cites a paper by usand states that we believe that if external loss can be ruled out, this indicates internal loss. In this paper, however, we clearly showed in 3 patients with high gastrointestinal cancer (in the stomach) an abnormal permeability of the gastrointestinal tract by means of the 131I-p.v.p. test introduced by Gordon.2 The 3 patients had hypoproteinaemia and it was also mentioned that one of these patients had free albumin in the gastric juice. We finally expressed our belief that the hypoalbuminxmia often seen in gastric cancer could be caused by a loss in the gastrointestinal tract.
These observations have been extended and confirmed several patients with cancer of the stomach3 and we think it is extremely probable that the very low serumalbumin values in Dr. Madden’s 2 patients are due to gastrointestinal protein loss. A 1311-p.v.p. test would surely show a gastrointestinal protein leakage in Dr. Madden’s 2 patients as it did in ours. Medical Department B, M. SCHWARTZ Bispebjerg Hospital, S. JARNUM. Copenhagen. on
1.
Schwartz, M., Jarnum, S. Lancet, 1959, i, 327. p. 325. Schwartz, M. (in the press).
2. ibid.
3. Jarnum, S.,
persistent tenderness and pain operating-list. If anyone suffering from this
for many hours after
an
or similar troubles would like to write to me I will try to correlate replies and get in touch with one of the glove manufacturers.
97, London Road,
J. F. BOURDILLON.
Gloucester.
MASSIVE ALBUMINURIA FOLLOWING AORTOGRAPHY
SiR,—It has been known for some time that after the intravenous injection of radio-opaque, substances the urine "
apparently " false-positive result for protein with the salicylsulphonic-acid test. Recently it has been reported that urine containing various radio-opaque substances does not give false positive results with the ’Albustix’ test (Ames Co. Ltd.) which is claimed to be more specific for protein.23 During the clinical trial of a new paper-strip test (’ Uristix ’, Ames) (not available in this country) designed to detect both proteinuria and glucosuria, I found a strongly positive result for protein in the urine of a patient after an aortogram with diodine, the diethanolamine salt of 3,5 diiodo-4-pyridone-N-acetic acid. This result was at first thought to be a false positive due to the excretion products of diodone, but as the protein-testing portion of uristix is similar to albustic, and therefore presumably not likely to give a false positive, I decided to investigate this apparent anomaly. Samples of urine were tested from each of 24 patients before and after injection in the following groups:
gives
an
A.
2
are
summarised in the accompanying table.
RESULTS OF URINE TESTS BEFORE AND AFTER
I am grateful to Sister C. A. MacPherson, of the radiology department, for her cooperation and help with the collection of urine samples and to Miss M. R. Haslock, B.sc., of the department of pathology, for technical assistance. Department of Pathology,
Queen’s College, University of St. Andrews.
JAMES A. KIRKLAND.
2
Aortogram (4 patients: samples before, samples Group after). Group B. Intravenous pyelogram (18 patients: 1 sample before, 1 sample after). Group C. Angiocardiogram (2 patients: 2 samples before, 2 samples after). The results
(a) Day before aortogram, no proteinuria. (b) Day of aortogram : before aortogram, no proteinuria. (c) Day of aortogram : after aortogram, gross proteinuria (1300 mg. per 100 ml.). (d) Day after aortogram: gross proteinuria (500 mg. per 100 ml.).
INJECTION
To confirm the presence of protein, 11 of the urines from group A (aortogram) were further examined by dialysis and subsequent electrophoresis; those taken after aortography all showed the presence of abundant material at the site corresponding to the albumin fraction (see figure). Quantitative values of 730 mg. and 1300 mg. per 100 ml. (i.e., a massive proteinuria) were obtained by the biuret test which is thought to be specific for the -CO-NH-grouping of proteins; the biuret tests against the opaque media in vitro gave values of only 16 mg. forHypaque’ (sodium diacetamido triiodobenzoate) (Bayer) and 115 mg. per 100 ml. for diodone.
These results suggest that the intravascular injection of radio-opaque material, particularly into the aorta, may be followed by gross proteinuria. The implication of temporary renal damage is of course obvious, and this is being investigated further. 1. Harrison, G. A. Chemical Methods in Clinical Medicine. 2. Baron, D. N., Newman, F. Brit. med. J. 1958, i, 980. 3. Frazer, S. C. ibid. p. 981.
London, 1957.
GASTROINTESTINAL CANCER AND ALBUMIN TURNOVER
SIR,-We read with interest Dr. Madden’s observations (Nov. 28) on total exchangeable albumin pool and turnover studies using 1311-albumin on 3 patients with malignant disease and hypoalbuminxmia. 2 of his 3 patients-both with high gastrointestinal cancer-showed high rates of protein (albumin) synthesis despite severe hypoproteinxmia, and as neither of his 2 patients had external protein loss he thinks it would be interesting to speculate on the possibility of internal protein shunts in patients with malignant disease. Dr. Madden cites a paper by usand states that we believe that if external loss can be ruled out, this indicates internal loss. In this paper, however, we clearly showed in 3 patients with high gastrointestinal cancer (in the stomach) an abnormal permeability of the gastrointestinal tract by means of the 131I-p.v.p. test introduced by Gordon.2 The 3 patients had hypoproteinaemia and it was also mentioned that one of these patients had free albumin in the gastric juice. We finally expressed our belief that the hypoalbuminxmia often seen in gastric cancer could be caused by a loss in the gastrointestinal tract.
These observations have been extended and confirmed several patients with cancer of the stomach3 and we think it is extremely probable that the very low serumalbumin values in Dr. Madden’s 2 patients are due to gastrointestinal protein loss. A 1311-p.v.p. test would surely show a gastrointestinal protein leakage in Dr. Madden’s 2 patients as it did in ours. Medical Department B, M. SCHWARTZ Bispebjerg Hospital, S. JARNUM. Copenhagen. on
1.
Schwartz, M., Jarnum, S. Lancet, 1959, i, 327. p. 325. Schwartz, M. (in the press).
2. ibid.
3. Jarnum, S.,