Huggins' test for cancer: report of 250 procedures

American Federation for Clinical Research ported monocytosis and increased immaturity of polymorphonuclears. Occurrence of relative polymorphonuclear leukocytosis has frequently been stated to occur but without supporting data. In one group of patients erythrocyte sedimentation rate (ESR) was used as the criterion of arthritic activity. Eosinopenia and lymphopenia did not occur as ESR increased. Instead, the total white count increased due to proportionate increases in each of its constituents. Absolute monocyte counts were somewhat above normal both during interval gout and attacks. The reported increased immaturity of polymorphonuclears was confirmed. In a second series total leukocyte counts and direct eosinophil counts (modified Randolph technic) were studied in the same patients during both interval and attack phases. During the interval total leukocytes averaged 7,567 with 156 eosinophils. During attacks total leukocytes averaged 9,545 with 210 eosinophils. Qualitative normality of the eosinophils present during attacks was shown by normal eosinopenic responses to administered ACTH. These findings permit the following deductions. First, the adrenal cortex remains responsive to ACTH during acute gouty arthritis and eosinopenia in response to glycocorticoid output (lymphopenia, eosinopenia, relative polymorphonuclear leukocytosis) during the attack indicates that the stress of an acute gouty attack does not adequately excite the hypothalamicpituitary mechanism to increase the rate of ACTH release. Second, the proportionate increase in all leukocyte types noted during acute gouty arthritis must arise from a general increase in the rate of leukocyte production, a general decrease in the rate of leukocyte destruction or from hemoconcentration. The increased immaturity of the polymorphonuclear leukocytes perhaps favors the first of these possibilities. HUGGINS’ TEST FOR CANCER: REPORT OF 250 PROCEDURES. J. L. Eisaman, M.D., L. E. Schneider, M.D. (by invitation) and R. E. Berger, M.Sc. (b,y invitation) Blufton, Ind. A series of 250 Huggins’ tests (least coagulable protein concentration) was performed on 239 patients. Seventy-seven of these patients had a pathologic diagnosis of cancer at some time. Of this number the Huggins’ test gave negative results in 110 patients in whom no evidence of cancer could be found. The positive test in JUNE,

1950

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known cases of cancer included carcinomas of almost every organ and one lymphosarcoma; results ran the gamut of general negative hospital diagnoses. These included chronic diseases often encountered in the cancer age. Of the thirty-seven patients with known cancer and negative Huggins’ results eight had gastrointestinal malignancies. Three tests on two different patients were definite failures, negative before operation and in both cases becoming positive during the week following surgery. The other negative cases were from four months to two years postoperative without clinical evidence of recurrence. False negatives were encountered in breast cancer (l), prostatic cancer (l), Hodgkin’s retinoblastoma (l), malignant disease (l), melanoma (l), sarcoma (l), hemangioblastoma (1) and metastatic carcinoma of lyrnph nodes (1). There were no proven false negatives in ten cancers involving the bladder (2), skin and orifices (5) and ovary (3). Negative tests in cancer cases occurred from two months to eighty-two months postoperatively. The longest negative test case was a twenty-two year post-irradiation skin cancer. Apparent false positive results were obtained in a variety of conditions, prominent among which were arthritides, thyroid diseases, rnazoplasia, duodenal ulcers and gastritides. CLINICAL STUDY OF SUPERIOR VENA CAVAI. OBSTRUCTION. Malcolm McCord, M.D.

invitation), Philip Edlin, M.D. tion) and Malcolm Block, M.D.

(by (by invitaDayton, 0.

Ten cases of obstruction of the superior vena caval system observed in a general hospital during the course of one year are presented. It is believed that the incidence of this syndrome is considerably higher than is stated in the literature. In addition to clinical studies four of these patients had postmortem examinations and six had venographic studies. The diagnosis was suspected in cases showing a mediastinal mass, edema of the upper body or visible venous distention of the upper body with or without collateral formation. In those cases in which caval obstruction was suspected, venous pressure determinations were done to demonstrate elevation in the arms with normal levels in the legs and a significant elevation of the venous pressure in the arm on hand exercise. Visualization by venograms was then obtained. A block was identified by a constant defect on serial