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carcinomas. CK-MM and CK-MB were not increased in any types of carcinoma. Serum CK-BB was increased in all types of lung carcinoma examined, while serum CK-MM and CK-MB were within normal limits in all patients. Serum CK-BB of healthy adults was estimated as 0.32 + or - 0.14 (mean + or - SD) ng/ml, rang- ing from 0.11-0.68 ng/ml. If CK-BB values above 1.0 ng/ml were considered abnormal, elevation occurred in 28/40 (70%) of patients with small cell carcinoma, 25/67 (37%) with adenocarcinoma, 21/51 (41%) with squamous cell carcinoma, 4/11 (36%) with other carcinoma of the lung and 10/42 (24%) with lung tuberculosis. Since serum CK-BB with lung cancer changed in parallel with the clinical course, this isozyme may be a marker for monitoring the clinical course, especially in small cell carcinoma of the lung.

Value of CEA and Ca 19-9 Assays in the Diagnosis and Staging of Lung Cancer. Rapellino, M., Pecchio, F., Baldi, S. et al. Ospedale S. Giovanni Battista, Servizio di Fisiopatologia Respiratoria, Torino, Italy. Minerva Med. 78: 373-375, 1987.

The value of CEA and Ca 19-9 assays in the diagnosis and staging of lung cancer is examined. The particular sen- sitivity of CEA, especially in exten- sive or metastasised tumours, is demonstrated. The minimal sensitivity of Ca 19-9 is pointed out but also its absolute specificity in high risk con- trol groups (smokers and BPCO). It is therefore concluded that Ca 19-9 might be used together with CEA in the diag- nosis and staging of lung cancer.

Myasthenic Syndrome (Eaton-Lambert Syndrome) Associated With Pulmonary Adenocarcinoma. Ramos Yeo, Y.L., Reyes, C.V. Laboratory Service, Hines Veterans Administration Hospital, Hines, IL 60141, U.S.A. J. Surg. Oncol. 34: 239-242, 1987.

A case of a 57-year-old man who presented with the clinical features of Eaton-Lambert syndrome preceding the diagnosis of lung adenocarcinoma at autopsy by 7 years, is reported. Al- though myasthenic syndrome is in- timately associated with pulmonary small cell carcinoma, which connotes a grave prognosis, a small percentage of the tumor can be squamous cell car- cinoma or adenocarcinoma, which may be resectable. Therefore, a continued search for evidence of intrathoracic neoplasm must be pursued following manifestations of myasthenic syndrome.

Three Synchronous Bilateral Lung Tumors: A Case Report. Paul, S.M., Bacharach, B. Department of

Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, U.S.A. J. Surg. Oncol. 34: 253-257, 1987.

Two synchronous primary lung car- cinomas presenting bilaterally are rare. Their presentation, predisposing factors, and treatment are similar to those of single lung carcinomas. The authors present the first reported case known to them of three synchronous primary lung carcinomas involving both lungs. These tumours fulfill accepted criteria for synchronous tumors - each is malignant, each is anatomically separate and distinct from the other, and each is histologically different and is not manifestation of metastatic disease.

Brain Metastasis in Patients With Supe- rior Sulcus Tumors. Komaki, R., Derus, S.B., Perez-Tamayo, C. et al. Department of Radiation Oncology, Columbia-Presbuterian Medical Center, New York, NY 10032, U.S.A. Can- cer 59: 1649-1653, 1987.

During a 20-year period, from 1963 to 1983, 68 patients were treated for carcinoma of teh lung presenting in the superior sulcus. Their ages ranged from 41 to 79 years (median, 56 years). Thirty-six patients had squamous cell carcinoma, 13 had adenocarcinoma, 14 had large cell carcinoma, two had small cell carcinoma, and three had clinical diagnosis only. All tumors were con- sidered to be inoperable or unresec- table and were treated with external irradiation alone. The 3-year disease- free survival was 25%. Brain metastasis developed in 23 patients (34%); the brain was the first site of metastasis in 16 patients (24%), five of whom eventually developed other sites of metastasis. The cumulative probability of brain metastasis was 53% at 3 years. Brain metastases were seen in ten patients (28%) with squamous cell carcinoma, five patients (38%) with adenocarcinoma, seven patients (50%) with large cell carcinoma, and one patient without a histocytologic diagnosis. The proportion of patients younger than 60 years (19/41, 46%) who developed brain metastasis was sig- nificantly greater than that for patients 60 years or older (4/27, 15%) (P < 0.01). Nine of ii patients with metastasis only to the brain died as a consequence of the intracranial disease 1 to 13 months (median, 6 months) after the diagnosis of brain metastases. The other two patients received therapeutic irradiation to the entire brain and survived longer than 5 days after the whole-brain irradiation: one died at 62 months of intercurrent disease, and the other is alive and well 129 months after diagnosis. The high probability of brain metastasis from superior sul-

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cus tumors, regardless of his- topathologic type and the frequency with which the brain in the only site of clinical failure, suggest that sys- tematic prophylactic cranial irradia- tion could reduce the morbidity and perhaps even contribute favorably to the survival of these patients.

Small Bowel Metastases From Primary Carcinoma of The Lung. McNeill, P.M., Wagman, L.D., Neifeld, J.P. Division of Surgical Oncology, Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, U.S.A. Cancer 59: 1486-1489, 1987.

Although about half of all patients with carcinoma of the lung have metas- tases at initial presentation, only nine with metastases to the small bowel have been previously reported. This study was performed to determine the incidence of occult and clinically ap- parent metastases of lung cancer to the small intestine. Small bowel metastases were present in 46 of 431 patients with primary lung cancer who underwent autopsy during an ll-year period. These patients had an average of 4.8 metas- tatic sites. Small bowel metastases were present in 12 of 31 (39.0%) patients with large cell carcinoma, 13 of 108 (12.3%) with adenocarcinoma, six of 73 (8.0%) with small cell carcinoma, 15 of 199 (7.5%) with squamous cell carcinoma, and none of 20 with undif- ferentiated carcinoma. During the same interval, six of 78 patients undergoing small bowel resection for metastatic tumor had lung cancer primaries. Among the nine previously reported clinical cases of small bowel metastases and the six in this series, 14 were operated upon for small bowel perforation and one for obstruction. Nine patients died perioperatively, and no patient sur- vived longer than 16 weeks. These data demonstrate that the incidence of lung cancer metastases to the small bowel is higher than is clinically apparent. Lung cancer metastases to the small bowel often present as intestinal per- foration and indicate a poor prognosis; surgery is indicated for palliation.

Skeletal Muscle Metastases From Lung Cancer. Sridhar, K.S., Rao, R.K., Kunhardt, B. Section of Medical Oncology, Medical Service, V.A. Hospital, Miami FL, U.S.A. Cancer 59: 1530-1534, 1987.

Hematogenous metastases to the limb skeletal muscles are extremely rare. Better understanding of the mechanisms resulting in the relative resistance of skeletal muscle to metastases could have bearing on therapeutic interven- tions for prevention of metastases. Three patients with non-small cell lung

cancer and metastases in the proximal limb muscles are presented. Skeletal muscle metastases may present as pain- ful masses in the proximal skeletal muscles. Subcutaneous and osseous metastases which are more frequent must be excluded by careful physical examination, bone scan and x-rays. Com- puted tomography (CT) can confirm the location of the tumor within the fas- cial planes of skeletal muscles and may help in the accurate delineation of the radiation portal. The tumor can be diagnosed and more common causes, such as hematoma or abscess, can be excluded by thin needle aspiration with cytologic examination. Clinical recog- nition of metastases in this unusual site is important based on our report that total tumor dose of 3600 to 4200 cGy of radiation in fractions of 300 cGy, 5 days a week, is effective in palliation of swelling and pain.

Doubling Time of Neuron-Specific Enolase and Survival in Small Cell Lung Cancer Patients. Results of a Prelimi- nary Analysis. Splinter, T.A.W., Cooper, E.H., Oosterom, R. et al. Department of Oncology, University Hospital Dijkzigt, 3015 GD Rotterdam, The Netherlands. Eur. J. Respir. Dis. 70: 37-44, 1987.

During a retrospective analysis of the value of neuron specific enolase (NSE) in patients with small cell lung cancer (SCLC) it became apparent that at progressive disease (PD) NSE rose exponentially with a doubling time (NSE-Td) varying from 10-94 days. In this study the influence of the NSE-Td on the survival of 29 SCLC-patients had been investigated. A significant cor- relation between survival from the start of rise of NSE at PD and NSE-Td was observed. By extrapolating the ex- ponential rise of NSE to the start of treatment a theoretical logarithmic value of NSE, called Yr, could be calculated. When the patients were grouped according to the Yr value >-i, between -i and -4 and < or = -4 a highly significant correlation between the survival from the stau[ of treat- ment and NSE-Td was found in all 3 groups. These preliminary data suggest that by means of NSE-Td and Yr value the survival of an SCLC-patient from the time of rise of NSE and from the start of treatment may be predicted within certain limits.

Bilateral Cavitary Bronchiolo-Alveolar Carcinoma of the Diffuse Type. Seibel, M.J., Von Witzleben, E., Lesch, R. Krankenanstalten Konstanz, Pathologie, D-7750 Konstanz, Germany. Prax. Klin. Pneumol. 41: 49-52, 1987.

We report on the case of a 79-year old female patient who died of