Plasma thrombin-antithrombin III complexes in the diagnosis of primary hepatocellular carcinoma complicating liver cirrhosis
Article Abstract:
It is well over 100 years since it was first established that cancer patients are often hypercoagulable, that is, have an increased tendency to form blood clots. However, this tendency has not proved useful as a diagnostic tool since hypercoagulability is difficult to measure in a manner that is both sensitive and specific. One measure of coagulability that may prove to be useful in this regard is the level of thrombin-antithrombin III complexes. During the clot-forming process, thrombin is created from prothrombin; the enzymatic action of thrombin converts fibrinogen in the plasma into fibrin, the major protein constituent of the clot. Since the circulatory system can not tolerate an excess of activated thrombin molecules, the active thrombin is rapidly inactivated by the irreversible binding of antithrombin III. Therefore, it may be presumed that the level of thrombin-antithrombin III complexes found in the plasma is representative of the rate at which thrombin is being activated in the system. Measurement of thrombin-antithrombin III complexes may be especially useful in patients with liver cirrhosis, when abnormal liver function upsets much of the normal blood chemistry. To determine the value of thrombin-antithrombin III complexes in the diagnosis of liver cancer, the complexes were assayed in the blood plasma of 50 patients with cirrhosis of the liver. Twenty-five patients had liver cirrhosis only, and 25 had cirrhosis complicated by hepatocellular carcinoma (liver cancer). It was found that while there was some overlap between the patients with and without liver cancer, most cancer patients had complex levels that were at least an order of magnitude greater than the patients without cancer. Only 12 percent of the patients without cancer had levels higher than an arbitrary cutoff point of 2 nanograms per milliliter, in contrast with the cancer patients, 80 percent of whom exceeded this value. These levels decreased within eight days after treatment for the cancer. The results suggest that the measurement of levels of thrombin-antithrombin III complexes circulating in the blood may be a useful diagnostic tool, particularly for hepatocellular carcinoma complicating liver cirrhosis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1991
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Serum CA 19-9 and alpha-fetoprotein levels in primary hepatocellular carcinoma and liver cirrhosis
Article Abstract:
Some cancers may produce large amounts of specific proteins and blood levels of these proteins may be measured. Such proteins, called tumor markers, may prove useful in developing blood tests for the early detection of cancer. The development of successful tumor marker tests for hepatocellular carcinoma, a form of liver cancer, is hampered by the fact that many cases of hepatocellular carcinoma (HCC) develop in patients who already have liver cirrhosis. The blood chemistries of such patients are already abnormal, and detecting the biochemical changes that correlate with the cancerous transformation of a few liver cells may prove very difficult in such cases. A study was conducted to evaluate two tumor markers in the detection of HCC. These two markers, CA 19-9 and alpha-fetoprotein (AFP), were measured in 211 patients with liver cirrhosis and 27 patients with HCC. CA 19-9 proved unable to distinguish adequately between cirrhosis and HCC. Twelve of 27 cancer patients had high levels of CA 19-9, as did 50 of the 211 cirrhosis patients. AFP was also elevated in substantial numbers of patients with cirrhosis, 39 of 211. However, AFP proved to be more sensitive to the presence of HCC, and 23 of the 27 patients with known cancer had increased amounts of HCC. Furthermore, while 39 of the cirrhosis patients did have levels of AFP that were above the normal limits, the AFP levels in many cancer patients were much higher. Twelve cancer patients had AFP levels that were above the highest levels of the cirrhosis patients, and a few HCC patients had levels almost 10,000 times greater than the normal upper limit. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1991
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A comparison of five maintenance therapies for reflux esophagitis
Article Abstract:
Omeprazole alone or in combination with cisapride or ranitidine may be more effective than cisapride or rantidine alone in maintaining remission of reflux esophagitis. Reflux esophagitis is the irritation of the esophagus caused by a backward flow of stomach acid. Researchers initially treated 175 people with reflux esophagitis and then divided them into five groups for different maintenance therapies. For 12 months, each group received one of the following drugs or drug combinations: ranitidine, cisapride, omeprazole, ranitidine plus cisapride, cisapride plus omeprazole. After 12 months the percentages of patients who did not have lesions on their esophagus were 49% in the ranitidine group, 54% in the cisapride group, 80% in the omeprazole group, 66% in the ranitidine plus cisapride group, and 89% in the cisapride plus omeprazole group. Omeprazole was more effective than the other drugs in relieving symptoms of heartburn, pain, and regurgitation. Sixteen percent of the patients experienced side effects, including abdominal pain, diarrhea, flatulence, and headaches.
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1995
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