Background: Urinary neopterin is an index of systemic immune activation, reflecting the activity of interferon-gamma. An increase in urinary neopterin excretion has been described in a variety of conditions, including malignant diseases, autoimmune diseases, or viral infections. Material and Methods: We measured urinary neopterin in 34 patients with colorectal cancer. In all patients the Dukes stage was determined. Neopterin was measured by high-performance liquid chromatography. Simultaneously, creatinine was determined by the Jaffé reaction and concentration of neopterin was expressed as neo-pterin/creatinine ratio (μmol/mol creatinine). The statistical analysis was performed by the Mann-Whitney U-test. Results: Neopterin excretion was significantly higher in the patients than in the reference group (325 ± 267 vs. 166 ± 67 μmol/mol creatinine, p < 0.005). Neopterin concentrations were considerably higher in stage Dukes D disease than in stages Dukes B and C disease (561 ± 372 vs. 188 ± 47 and 250 ± 142 μmol/mol creatinine, p < 0.001 and p < 0.002, respectively). An increased neopterin level detected the presence of metastatic disease with a sensitivity of 90 % and a specificity of 87.5 %. Conclusion: We conclude that increased urinary neopterin in colorectal cancer is mainly due to elevated levels in patients with metastatic disease.
In the foreground of the clinical picture of chronic pancreatitis and carcinoma of the pancreas is pain which frequently is difficult to control by drugs. The authors evaluate in a group of 18 patients with severe epigastric pain associated with carcinoma and in chronic pancreatitis the analgesic effect of splanchnicectomy. In 29.4% of operated patients after surgery pain disappeared completely, 47% of the patients reported substantial relief after surgery. Only in 17.7% of the patients the operation produced no effect. With regard to their own experience the authors can recommend splanchnicectomy in pain associated with diseases of the pancreas which cannot be influenced by other means.
Proliferative response of lymphocytes to mitogens is known to be decreased in cancer patients. Depressed proliferation of lymphocytes in other disorders has been linked to systemic inflammatory response.Lymphocyte proliferation in response to phytohemagglutinin (PHA) and concanavalin A, as well as urinary neopterin, plasma interferon-gamma and interleukin-4, were investigated in 41 patients with solid tumors.The proliferative response to PHA was significantly depressed in cancer patients at most of the concentrations examined. Urinary neopterin and plasma interferon-gamma were significantly elevated in cancer patients, whereas interleukin-4 was undetectable in all the subjects. A negative correlation was observed between urine neopterin and lymphocyte proliferative response to mitogens.Lymphocyte proliferative response to PHA is significantly diminished in cancer patients, and this depression appears to be partly linked to systemic inflammatory response. Plasma interferon-gamma was significantly increased in cancer patients, whereas interleukin-4 was undetectable.
