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therapeutic response (p = .0054) and in the length of survival (p = .001) among those who had extensive disease without abdominal metastases as compared with those who had abdominal metastases on their initial abdominal CT examination. The development of new or recurrent ab- dominal metastases in general or in specific organs on follow-up scans ob- tained in 35 patients did not sig- nificantly decrease their survival time as compared with that of patients without such metastases. Our findings suggest that CT of the abdomen is beneficial in the initial staging of patients with small-cell carcinoma of the lung and provides prognostic infor- mation concerning response to therapy and length of survival.

Small Cell Lung Cancer: A Problem of Tumor Heterogeneity. Sheehan, R.G. Veterans Administration Medical Center, Dallas, TX 75216, U.S.A. Am. J. Med. Sci. 292: 241-256, 1986.

Small cell undifferentiated car- cinoma represents a subtype of lung cancer that possesses biologic and clinical characteristics that make it significantly distinct from other forms. A major impact on the natural history of this disease has been ac- complished during the past 15 years, including the potential for cure by non-surgical treatment modalities. Fur- ther progress in the management of this disorder has been impaired by a number of factors that appear to be inherent to the biology of the tumor and its clinical features. Analysis of initial clinical trials and more detailed ex- amination of this tumor in vitro have permitted the elucidation of many bar- riers to curative outcome presently being evaluated at the laboratory and clinical levels. These include clear biologic and morphologic heterogeneity; problems with chemotherapy responsive- ness including drug resistance; the potential for combining chemotherapy and radiation modalities; the re- examination of the role of surgical in- tervention in selected patients; and the need to deal with central nervous system dissemination of tumor cells. Further advances in this disease will be dependent on the successful integra- tion of laboratory and clinical disciplines.

Neuronal Antinuclear Antibody (Anti-Hu) in Paraneoplastic Encephalomyelitis Simulating Acute Polyneuritis. Graus, F., Elkon, K.B., Lloberes, P. et al. Department of Neurology, Hospital Clinic i Provincial, Barcelona 08036, Spain. Acta Neurol. Scand. 75: 249-252, 1987.

A patient with paraneoplastic en-

cephalomyelitis (PEM) and small cell lung cancer had a clinical presentation of acute polyneuritis. The patient had an antibody (anti-Hu) restricted to nuclei of neurons identical to that reported in patients with subacute sen- soty neuronopathy and lung cancer. This finding further supports the hypothesis that PEM and subacute sensory neuronopathy are closely related disor- ders of autoimmune origin. PEM should be considered in patients with small cell lung cancer and clinical features limited to the peripheral nervous system.

Lymphocyte Subsets in Lung Cancer. Wesselius, L.J., Wheaton, D.L., Manahan Wahl, L.J. et al. Section of Pulmonary and Critical Care Medicine, Kansas City Veterans Administraiton Medical Center, Kansas City, MO, U.S.A. Chest 91: 725- 729, 1987.

Altered cellular immune function has been demonstrated in patients with lung cancer, including decreased num- bers of circulating lymphocytes and changes in the percentage of lym- phocytes in various functional subsets. We quantitated lymphocyte subsets in 54 patients with lung cancer including patients with limited (stages 1 and 2) nonsmall cell lung cancer (NSCLC, n = 23), advanced (stage 3) NSCLC (n = 16), and small cell cancer (SCLC, n = 15). Serum albumin was decreased in 15 lung cancer patients, and lymphocyte subsets were separately evaluated in these patients. Lymphocyte populations in cancer patients were compared to those of nonsmokers and a smoking patient population. No difference from smokers was noted in patients with limited NSCLC. Patients with SCLC and advanced NSCLC had significantly decreased num- bers of T-helper and T-suppressor cells (p < 0.05). Patients with lung cancer and hypoalbuminemia had the greatest decrease in number of circulating T- helper cells (p < 0.001). B-lymphocytes were also decreased in patients with advanced NSCLC and patients with hypoalbuminemia (p < 0.05). A decrease in population of T-lymphocytes subsets is frequent in patients with SCLC, ad- vanced NSCLC, and lung cancer patients with hypoalbuminemia.

Determination of Creatine Kinase Isozymes in Sera and Tissues of Patients With Various Lung Carcinomas. Usui, A., Fujita, K., Imaizumi, M. et al. Department of Thoracic Surgery, Nagoya University School of Medicine, Showa-ku, Nagoya 466, Japan. Clin. Chim. Acta. 164: 47-53, 1987.

Three creatine kinase isozymes (CK- BB, CK-MB and CK-MM) were estimated by immunoassay in tumor tissues and in sera of patients with various lung