Blood Clotting Enzymology

Dr. Nelson is an endoscopist, and his technique involves introducing a small Geiger counter through an esophagoscope (or sigmoidoscope) and recording counting rates over the surface of the organ being examined in a patient who has received 500 uc. Of p32 the day before the exam. A positive result is obtained when a clear increase in counting rate is observed at some area as the counter is moved along the wall of the organ. A positive result can be obtained only if the counter is applied directly to a lesion, and this fact limits the application of the method to stomach lesions. (The author modified a gastroscope to include a counter in the tip but encountered difficulty in applying the tip to an area incriminated by X-ray or recognized as abnormal at gastroscopy.) In an experience with 47 cases of esophageal carcinoma, 45 tests were positive and in 23 patients with gastric carcinoma involving the esophagus, 21 tests were positive. Case reports make up a major portion of the monograph; in only a few of the 25 cases of esophageal lesions described separately at length could the p32 test have influenced management of the patient. Brief mention is made of the 2 false positive results in 22 patients with esophagitis, one false positive in 8 patients with achalasia, and one false positive in 46 normal patients. Similar but less accurate results were recorded in stomach and rectal lesions with a false positive incidence of 4 in 14 cases of benign gastric ulcer and in 2 of 6 adenomatous polyps of the rectum. This experience should give pause to anyone who wants to make clinical decisions on the basis of the present technique, but should encourage further experimentation. Given the wide experience with esophageal cytology, I am sorry the author did not systematically compare his technique with cytologic procedures and cannot agree with his recommendation that his test should be routinely employed in all questionable esophageal lesions. The presentation of multiple case histories which run on for pages is not a very convincing method for presentation of evidence to support his conclusion.