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ment of Haematology, East Birmingham Hospi-
tal, Birmingham B9 5ST, U.K. Eur. J. Cancer
Clin. Oncol. 22: 831-835, 1986.
Serum ferritin levels were measured
before treatment, using an im~noradiometric
method, in 39 patients with small cell lung
cancer. In ii patients serial estimations
were also made. The medium serum ferritin
level for male patients was 666 mug/l (range
13-1329) and for females 306 (range 134-
5300), the normal range being 32-501. This
increase is significant (P < 0.001). Serum
ferritin levels were not related to metas-
tatic, haematological or iron status. Serial
ferritin levels did not reflect the clinical
course of the disease. Patients with a pre-
treatment serum ferritin of <600 mug/l had a
significant prolongation of median survival
compared to those with an initial serum fer-
ritin of > 600 mug/l (P < 0.02). Serum fer-
ritin levels are not of value in staging
small cell lung cancer nor in monitoring its
progress. However, the initial serum fer-
ritin is of prognostic significance.
Diagnostic Value of High Molecular Weight
Alkaline Phosphatase in Detection of Hepatic
Metastasis in Patients with Lung Cancer.
Nishio, H., Sakuma, T., Nakamura, S.-I. et
al. Department of Lung Cancer, The Center
for Adult Diseases, Osaka 537, Japan. Cancer
57: 1815-1819, 1986.
High molecular weight alkaline phos-
phatase (HMW-ALP) was measured in the sera
of 126 patients with lung cancer to deter-
mine its diagnostic value in the detection
of hepatic metastasis. This isoenzyme was
found in 21 of 24 patients with hepatic
metastasis and in 27 of 102 patients without
hepatic metastasis. When i0 U/L was used as
a cut-off value, the sensitivity,
specificity, and accuracy of this test were
71%, 89%, and 86%, respectively. From the
standpoint of histologic type, this test was
most useful in patients with small cell car-
cinoma. HMW-ALP was not detected in the sera
of 15 controls. It is concluded that HMW-ALP
is a useful marker for hepatic metastasis in
patients with lung cancer.
Plasma Angiotensin-Converting Enzyme Ac-
tivity in Patients with Bronchial Carcinoma.
Roulston, J.E., Galloway, P.J., Douglas,
J.G. University Department of Clinical
Chemistry, Royal Infirmary of Edinburgh,
Edinburgh, U.K. Br. J. Dis. Chest 80: 229-
234, 1986.
Plasma angiotensin-converting enzyme
(ACE) activities were measured in 58 con-
secutive patients presenting with bronchial
carcinoma. The mean ACE activity before
treatment was significantly lower than that
of a control population (P < 0.005). There
was a significant and direct relationship
between the initial plasma ACE activity and
survival time (P < 0.01) which could not be
explained by further analysis for age,
clinical staging, or respiratory function,
as judged by 9~EV. There was a significant
increase in plasma ACE activity (P < 0.03)
in nine patients with three or more plasma
samples after treatment with chemotherapy or
radiotherapy. These results suggest that low
plasma ACE activity is associated with poor
prognosis in bronchial carcinoma.
Bronchogenic Carcinoma Associated with Upper
Aerodigestive Cancers.
Yellin, A., Hill, L.R., Benfield, J.R.
Department of Thoracic Surgery, City of Hope
National Medical Center, Duarte, CA 91010,
U.S.A.J. Thorac. Cardiovasc. Surg. 91: 674-
683, 1986.
Of 1,450 patients with upper airway
cancers, 189 (13%) had additional cancers.
There were 60 cases in which lung cancer oc-
curred after upper airway cancer and a
single case in which it preceded upper air-
way cancer. The occurrence of upper airway
plus lung cancer in 61 patients was referred
to as multiple airway cancers. The overall
incidence of multiple airway cancers was
4.1% or 1:112 patient-years at risk. The
highest incidence of lung cancer was 1:70
patients-years, and this was associated with
laryngeal cancer. The mean diagnostic inter-
val between upper airway and lung cancers
was 6.1 (0 to 23) years, including nine
cases (14.8%) in which the two were
synchronous. Triple endoscopy revealed oc-
cult lung cancer only once. The use of
mediastinoscopy (n = 9) and other surgical
staging procedures (n = 9) was limited, be-
cause previous treatment of upper airway
cancers made such procedures impractical and
also because interpretation of findings
would have been difficult. Past reports have
indicated that lung cancer in association
with upper airway cancer is almost in-
variably squamous cell and almost always
develops in men. By contrast, among our 61
patients, the incidence of adenocarcinomas
was 24%, and 16 patients or 26% were women.
Among patients whose records could be