The road to reorganization. A system keeps its regional network all in the family.

One prominent strategy health-care institutions are pursuing today is the formation of regional networks providing comprehensive continuums of care. Regional activities can be organized according to several distinct geographical parameters: city, county, state, or multistate regions. Although the different types of regionalization may be beneficial, they will generate different types of activities and benefits.

Expression of laminin in benign and malignant sclerosing lesions of extrahepatic bile ducts.

The distribution of laminin, a basement membrane glycoprotein, was studied by an immunohistochemical technique in six samples of benign sclerosing lesions of extrahepatic bile ducts and in 11 sclerosing cholangiocarcinomas. The expression of laminin showed that benign glandular structures were surrounded by a mainly intact basement membrane. In sclerosing cholangiocarcinomas laminin was irregularly distributed, and in large areas totally absent.

Tumour markers in pancreatic cancer.

Patients with pancreatic cancer usually lack signs and symptoms in the early course of the disease. Even when malignancy is suspected, differential diagnosis between benign and malignant pancreatic disorders may be difficult with current methods. An increasing interest has been focused on the utility of immunological tumour markers.

Tumour markers in gastric cancer.

We still lack clinically useful tumour markers in gastric cancer. To be of clinical value markers should be elevated in the early stages of the disease, when surgery for cure is possible. However, tumour markers available today, like CEA, CA 19-9 and CA 50, mainly detect advanced gastric cancer, for which only palliative treatment is available.

Tumour-associated trypsin inhibitor (TATI) in human ovarian cyst fluid. Comparison with CA 125 and CEA.

The levels of tumour-associated trypsin inhibitor (TATI), CA 125 and CEA were measured in ovarian cyst fluids from 21 patients. TATI in cyst fluid was immunologically and physicochemically similar to the peptide originally isolated from the urine of a patient with ovarian cancer. Mucinous cysts contained significantly higher levels of TATI than did serous cysts.

Comparison of CA-50, a new tumour marker, with carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP) in patients with gastrointestinal diseases.

Serum levels were determined in 434 patients with benign and malignant gastrointestinal diseases and compared with the serum concentrations of carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP). The highest proportion of elevated CA-50 levels (greater than 17 U ml-1) was found in patients with pancreatic cancer (73%). High levels were mainly associated with advanced cancer, but also half of the patients with a resectable pancreatic tumour had an increased CA-50 concentration.

Serum CA 50 as a tumor marker in pancreatic cancer: a comparison with CA 19-9.

CA 50 is a new tumor marker based on a monoclonal antibody (MAb) against a human colorectal carcinoma cell line. The CA 50 antigen is similar, but not identical, to the tumor marker CA 19-9. The serum concentrations of CA 50 were measured by an immunoradiometric assay (CA 50 IRMA) in 95 patients with pancreatic cancer and in 94 patients with benign pancreatic, biliary and hepatocellular diseases.

Tissue expression of the tumor marker CA 50 in benign and malignant pancreatic lesions. A comparison with CA 19-9.

The expression of the tumor marker antigen CA 50, defined by the monoclonal antibody (MAb) C 50, was studied by the immunoperoxidase technique in formalin-fixed, paraffin-embedded tissue sections from normal pancreata, from pancreata with pancreatitis and from benign and malignant pancreatic neoplasms. The results were compared with those obtained with Mab 1116 NS 19-9. The C 50 antibody reacts, like the 1116 NS 19-9 antibody, with sialosylfucosyllactotetraose (corresponding to sialylated blood group antigen Lewisa), but also with another sugar moiety, sialosyllactotetraose.

Tumour marker antigen CA125 in pancreatic cancer: a comparison with CA19-9 and CEA.

CA125 is a tumour marker test based on a monoclonal antibody against an antigen from an ovarian carcinoma cell line. Serum concentrations of CA125 were determined in 95 patients with pancreatic cancer and in 106 patients with benign pancreatic, biliary and hepatocellular diseases. The CA125 concentrations were compared with the CA19-9 and CEA levels.

Tumour-associated trypsin inhibitor, TATI, in patients with pancreatic cancer, pancreatitis and benign biliary diseases.

The serum and urine concentrations of a tumour-associated trypsin inhibitor, TATI, were determined by radioimmunoassay in patients with pancreatic cancer and with benign pancreatic and biliary diseases. Elevated serum levels (greater than 20 micrograms l-1) were found in 85% of the patients with pancreatic cancer, and elevated urine levels (greater than 50 micrograms g-1 creatinine) in 96% of the patients. Thus low TATI level, especially in urine, makes the possibility of pancreatic cancer less likely.

Gastrointestinal cancer-associated antigen CA 19-9 in histological specimens of pancreatic tumours and pancreatitis.

The expression of the gastrointestinal cancer associated antigen CA 19-9, defined by the monoclonal antibody 1116 NS 19-9, was studied by immunoperoxidase staining in routine formalin-fixed, paraffin-embedded tissue sections from normal pancreata, pancreata with pancreatitis and from benign and malignant pancreatic neoplasms. The formalin-fixed specimens were treated with pepsin, which enhanced the staining intensity. Eighty-five per cent of well to moderately differentiated adenocarcinomas were positive.

Evaluation of CA 19-9 as a serum tumour marker in pancreatic cancer.

Serum concentrations of the CA 19-9 antigen were determined in 91 patients with pancreatic cancer and in 111 patients with benign pancreatic, biliary and hepatocellular diseases. The CA 19-9 concentration was above the cut-off limit (37 U ml-1) in 78% of the patients with pancreatic cancer and high levels (greater than 500 U ml-1) were seen in 56% of these patients. Elevated levels were also seen in benign diseases (22%), especially in patients with extrahepatic cholestasis (up to 440 U ml-1).

Tumour markers in pancreatic cancer.

The serum levels of three new tumour markers defined by monoclonal antibodies, CA 19-9, CA 50 and CA 125, were analysed and compared with carcinoembryonic antigen (CEA) in samples from 91 patients with pancreatic cancer and from 111 patients with benign pancreatic, biliary tract and hepatocellular diseases. High serum concentrations of CA 19-9 and CA 50 were found in most patients with pancreatic cancer, 78% and 72%, respectively. The serum levels of these two markers showed a positive correlation, while no other correlation was found between the markers.

Out-of-plan use by Medicare enrollees in a risk-sharing health maintenance organization.

In this study, we analyzed the cost and volume effects of a waiver that eliminated lock-in restrictions on out-of-plan use in a health maintenance organization (HMO) with a Medicare risk-sharing contract. We compared out-of-plan cost and number of claims during a 15-month base line period when the lock-in was in effect, with a 24-month waiver period when the lock-in was removed. The results demonstrate that average per capita cost and claims increased significantly for both Medicare Part A (hospital insurance) and Part B (supplementary medical insurance) out-of-plan services during the waiver.

Expression of laminin in pancreatic neoplasms and in chronic pancreatitis.

The distribution of laminin, a basement membrane glycoprotein, was studied by immunohistological techniques in 10 samples of normal pancreatic tissue, in 15 samples of chronic pancreatitis, and in 33 pancreatic neoplasms. Sections of formalin-fixed, paraffin-embedded specimens were pretreated with pepsin and immunostained for laminin. As judged by the expression of laminin, normal pancreatic glands were surrounded by a continuous, intact basement membrane.

Comparison of a new tumour marker, CA 19-9, with alpha-fetoprotein and carcinoembryonic antigen in patients with upper gastrointestinal diseases.

Serum CA 19-9 antigen concentrations were measured in 246 patients with benign and histologically confirmed malignant gastrointestinal diseases. The CA 19-9 concentration was above the upper limit of the normal range (0-37 U/ml) in 76% of patients with pancreatic carcinoma, 73% of patients with cholangiocarcinoma, 42% of patients with gastric carcinoma, and 22% of patients with hepatoma. High CA 19-9 concentrations were found mainly in patients with a metastasised cancer, whereas 71% of patients with a localised carcinoma had normal CA 19-9 concentrations.