BACKGROUND:Automated laboratory analyzers that mass produce data have been linked to information systems for more than two decades, but little progress has been made in developing more comprehensible report forms. Results are still reported in computer-generated printouts containing hundreds of numbers crowded into columns on each printed page.METHODS:We developed three software applications focusing on the graphic presentation of laboratory results.RESULTS:The first application summarizes data for a patient with a monoclonal gammopathy. The report provides a cumulative graphic presentation of immunofixation/electrophoresis data without any additional interpretation, focuses on a color-coded electrophoresis scan, and records up to 5 years on a single page. The second application deals with cerebrospinal fluid analysis. The report calculates relevant data and graphs the complex relationship between albumin and immunoglobulin results from paired serum and cerebrospinal fluid samples. Manually added interpretive text assures an output comprehensible to clinicians in all specialties. The third application produces a report summarizing quantitatively measured urinary marker protein profiles. The report form is generated by a flexible, completely user-definable knowledge-based system. It calculates numerous ratios and formulae, supports reflex testing, supplies an automated interpretation, and generates a specific graphic signature pattern of the results (MDI LabLink proteinuria differentiation).CONCLUSIONS:Increased clinical demand for graphically oriented report forms 5 years after their introduction has provided evidence that these reports transfer complex laboratory data and results to the clinician more effectively. The highest (more than threefold) increase in demand has been for reports for urinary marker protein profiles that feature a largely self-explanatory graphic signature pattern.

A 79-year-old male patient presented with a subacute cauda syndrome caused by an intradural metastasis of the lumbosacral caudate fibres from an adenocarcinoma of the prostate, which had been treated 5 years earlier with external beam radiation therapy. Diagnosis could not be established by repeated magnetic resonance images (MRIs) during a 2-year period of increasingly severe radicular pain. Eventually, a small tumour mass could be visualized on the fourth MRI. Repeated normal serum prostate-specific antigen (PSA) did not hint at a prostate cancer metastasis (range 2.4-5.1 ng ml(-1)); however, PSA in the cerebrospinal fluid was found to be elevated (29.1 ng ml(-1)). Empirical radiation therapy of the caudate region did not improve radicular pain. Therefore, an exploratory surgical procedure was conducted, which confirmed the suspicion of an intradural prostate cancer metastasis. In conclusion, PSA in the cerebrospinal fluid provides a useful diagnostic tool for detecting intradural prostate cancer metastasis.

Epidermal growth factor receptor (EGF-R) was estimated in Hypernephroma by saturation analysis using 125-I EGF as ligand. Tissue levels of this oncogene related protein were increased five-fold (24 to 99 fmol/mg protein) in comparison with the surrounding tumor free tissue (3 to 18 fmoles/mg protein). There was no apparent correlation to the stage of tumor growth or tumor differentiation and there was no correlation of EGF serum levels with tumor growth. EGF serum levels in the tumor patients did not exceed levels in control patients.

A commercially available radioimmunoassay (RIA) for prostate specific antigen (PSA) was investigated in respect to its analytical specificity and its clinical applicability for the diagnosis of prostate cancer. PSA detected in serum by RIA was immunochemically identical to PSA found in seminal plasma. PSA is not a single protein but rather a group of isoproteins with different isoelectric points (pI) in the pH range 6-8. Furthermore PSA could be split in subunits by means of denaturing electrophoresis under reducing conditions. Unlike prostatic acid phosphatase (PAP) serum PSA was stable at room temperature. In sera of patients with benign hyperplasia of the prostate (BPH) two significantly different populations were found. The lower group (0.5-5.8 ng/ml PSA) had PSA values comparable to the control group of apparently healthy males (0.5-6.3 ng/ml). The higher group between 7.7 and 12.2 ng/ml was also characteristic for early stages of prostate cancer (T0 and T1). PSA seemed to be correlated to the tumor volume and allowed to differentiate between early carcinomas of the prostate and BPH or possibly T0/1 staged prostate carcinoma. PSA may be a screening method for early cancer of the prostate.

Tissue polypeptide antigen (TPA) and prostatic acid phosphatase were both detected by radioimmunoassay in the sera of a male population (age>45 years) consulting the clinic for urological problems or check-up on treatment. Increased concentrations of TPA were associated mostly with advanced stages of prostatic carcinomas, parallel to PAP. Some enhanced TPA concentrations were detected with haematuria and adenomas of the prostate.

Creatine kinase isoenzyme (CK-BB) measured by mass was used to determine its value in the early diagnosis of prostatic cancer. Sera of patients with prostatic carcinoma of various stages (treated and untreated) were compared to normal male sera and sera of patients with benign hyperplasia of the prostate (BPH) with respect to CK-BB. The sera were simultaneously tested for PAP content. The sensitivity of the CK-BB-RIA was 1.63+/-0.08 μg/l and reproducibility in the higher and lower concentration range 7.6% and 10.5%, respectively. CK-BB alone or in combination with PAP is no marker for early detection of prostatic cancer. In individual cases changes occurred similar to those found with a malignant growth of the prostate.

We quantitated the concentrations of prostatic acid phosphatases (EC 3.1.3.2) in serum and bone-marrow aspirates with three commercial radioimmunoassay kits, and the catalytic activities with a thymolphthalein monophosphate-based enzyme test. The enzyme's immunological activity in serum was compared with its catalytic activity for its potential as a detector of early prostatic cancer and its performance as an early marker of metastatic activity in bone. Neither measurement is useful for detecting early stages of prostatic cancer. The spread of carcinoma to lymph nodes or to bone is detected with greater frequency by radioimmunoassay than by the enzymic test. Radioimmunoassay also detected metastasis to the bone more frequently than did physical methods. Analytical and clinical performance of the four methods is described.

Sera of patients without any tumors of the prostate and sera of patients with benign and malignant tumors of the prostate were tested with the enzyme assay using thymolphthalein monophosphate as substrate. The results were compared with the RIA of Clinical Assay (Travenol) and found to yield an approximately 50% better recognition of malignant growth. However, false-positive rates were rather high (approximately 20%), which lowers the overall success rate to approximately 30%.

Unsere Basler Gruppe hat die Radioimmunoassays verschiedener Firmen untereinander und gegen die im Zentrallabor der Universitätskliniken übliche enzymatische Methode mit Tymolphtalein verglichen, wobei Befunde im Serum, aber auch in der Knochenmarkspunktionsflüssigkeit berücksichtigt wurden.

A technique for reproduction and quantitative determination of human cellular retinoic acid-binding protein (CRABP) activity in breast tissue specimens is described. A multiphasic polyacrylamide disc gel electrophoresis system (operative at pH 10.2) was adapted for this purpose. This technique allows, after incubation with tritiated retinoic acid (RA) overnight, the separation of the specific CRABP activity from the nonspecific serum-originated binding activity and from the free RA. Previous purification of the tissue cytosols is therefore not necessary. The same assay method was also used for the determination of the molecular weight (Ferguson plot, m.w. 13,000) and the dissociation constant Kd (2.5 x 10(-7) M) of mammary CRABP. The activity in tissue cytosol, stored at -70 degrees, was found to be stable for at least 3 months. Results from 88 breast tissue specimens of different pathological degree are presented. CRABP activity was found in all tissue categories with progressively increasing amounts from normal tissue to breast cancer. The activity in the cancer tissues (14.85 +/- 12.05 pmol RA bound per mg soluble protein: N = 27) was significantly different (p less than 0.001) from the activity determined in tissue with simple dysplasia without epithelial proliferation [4.3 +/- 2.2 (S.D.) pmol RA bound per mg protein; N = 30]. It is possible that in the cases where high amounts of CRABP activity are found in dysplastic and preneoplastic tissue, a high risk for breast cancer development exists. Therefore, CRABP is tentatively proposed as a dedifferentiation and/or proliferation marker.