ON THE CALCIUM CONTENT OF THE BLOOD WITH

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1 ON THE CALCIU CONTENT O THE BLOOD WITH SPECIAL REERENCE TO CANCER OTTO KREHBIEL rom e Pathological Laboratory, Lenox Hill Hospital, New York Received for publication, December 12, 1919 In his studies on the chemistry of malignant growths, Beebe (1) found that old degenerated carcinomata and sarcomata contained much more calcium than did young, rapidly growing tumors. Likewise, Clowes and risbie (2) observed a low calcium and high potassium content in rapidly growing mouse tumors, and the reverse in tumors of slow growth. These observations suggested the possibility of a disturbance of calcium metabolism in neoplastic disease; and, with a view to demonstrating such a disturbance, the determination of the blood calcium was undertaken in a series of cancer cases. As a basis for comparison with the values obtained in cancer, the calcium content of the blood of a number of patients presenting no evidence of malignant disease, was ascertained. The method employed was that of Halverson and Bergeim (3). The technique of these authors was closely followed, except that the protein precipitation was done in a 50 cc. centrifuge tube and centrifugalization resorted to in order to facilitate removal of the protein precipitate. Duplicates were done in all cases. The data of thirty-four patients with malignant disease are presented in table 1. The calcium content of the blood plasma varied from 5.87 to mgm. per 100 cc., the average being 9.41 mgm. If the type and location of the tumor are disregarded, the calcium concentration of the plasma of the male is slightly lower than that of the female, the mean figure for the former being 9.42 mgm., for the latter mgm. These average values may be considered to be within normal limits, Howland and arriott (4) having found from 10 to 11 mgm. per 100 cc., and 199 TEE JOURNAL O CANCER REBEARCH, VOL. V, NO. 2

2 200 OTTO KREHBIEL Halverson, ohler, and Bergeim (5) from 9 to 11 mgm. in a series of normal individuals. In 4 per cent of the inoperable abdom- TABLE 1 BIX DIAQNOBIB ' Epithelioma of face Epithelioma of face Epithelioma of back ' Carcinoma of stomach Carcinoma of stomach Carcinoma of esophagus Carcinoma of rectum Carcinoma of bladder Carcinoma of bladder Carcinoma of uterua Carcinoma of vocal cord Sarcoma of thymus Sarcoma of uterus mqn Q * indicates generalized peritoneal metastases, primary tumor not located. All diagnoses confirmed by histological examination. inal cases, the calcium content exceeded 10 mgm., but a truly eharacteristic calcium value for any definite type or location of

3 CALCIU CONTENT O THE BLOOD 201 I -- REX $ TABLE 2 DI AONOBIS Thromboangiitis obli terans Thromboangiitis obliterane Thromboangiitia obliteraas ultiple exostoses Cystic goiter Congenital cystic kidney Cystadenoma of ovary Cystadenoma of ovary Papilloma of bladder Pulmonary tuberculosis Healed pulmonary tuberculosis Cholecy stitis Cholecystitis Pneumonia (ante mortem) Abscess of lung Chronic appendicitis Syphilis Eclampsia Acromegaly Acromegaly Exophthalmic goiter Diabetes, Diabetes Pernicious anemia? Cerebral degeneration, arteriosclerosis Gastroptosis Neurosis Neurosis Bronchial asthma Obscure abdominal condition Tumor of lung? Tetany ~1 CALCIUU Pas 100 cc. wm ,.11

4 202 OTTO KREHBIEL neoplasm is not in evidence. In six benign tumors (table 2) the results were similar to those obtained in malignant disease; they varied from 7.5 to mgm,, and averaged mgm. Table 2 also records the calcium figures of eleven cases of thromboangiitis obliterans, as well as the clinical diagnoses and blood calcium values of twenty-six miscellaneous cases, in which no sign of malignant disease was manifest. In the miscellaneous material, no one disease is represented by a number of cases sufficiently large to permit of definite conclusions regarding changes in the calcium concentration that may occur; the figures are presented, however, because additions to the blood calcium data available at present, seem indicated. or thromboangiitis obliterans, the average calcium concentration in the blood is again within normal limits (10.11 mgm. per 100 cc.), while the variations in individual cases (5.41 to mgm.) would tend to show that a relationship between this disease and calcium metabolism does not exist. Regarding individual cases, it may be of interest to note that only 4.29 mgm. of calcium were found in a case of eclampsia, and that.11 mgm. occurred in a typical case of tetany, the latter figure in accord with those observed by Howland and arriott (). In chronic nephritis our results agree with those of Halverson, ohler, and Bergeim (7), a low figure of 7.8 mgm. occurring in a case with retention, while two of a milder type presented concentrations within normal limits. On the other hand, mgm. occurring in one of our tuberculous patients, is rather high as compared to the figures obtained by Halverson, ohler, and Bergeim in their study of thirty cases of tuberculosis. SUARY AND CONCLUSIONS The blood plasma calcium content was determined in thirtyfour cases of malignant disease, in six of benign tumors, in eleven of thromboangiitis obliterans, and in twenty-six miscellaneous cases. In cancer the average calcium values were within the figures generally sccepted as normal, and no characteristic cpncentra-

5 CALCIU CONTENT O THE BLOOD 203 tion accompanied any given type or location of neoplasm. In benign tumors the results were similar. The average calcium figure for thromboangiitis was within normal limits, while the variations in individual cases would indicate that calcium metabolism has no connection with this disease. In accordance with the results of other authors, low calcium values were obtained in severe nephritis, in eclampsia, and in tetany. REERENCES (1) BEEBE: Am. Jour. Physiol., 1904, xii, lj7. (2) CLOWEB AND RIBBIE: Am. Jour. Physiol., 1905, xiv, 173. (3) HALVERBON AND BERGEI: Jour. Biol. Chem., 1917, xxxii, 159. (4) HOWLAND AND ARRIOTT: Arch. Int. ed., 191, xviii, 709. (5) HALVERBON, OHLER, AND BERGEI: Jour. Biol. Chem., 1917, xxxii, 171. () HOWLAND AND ARRIOTT: Quart. Jour. ed., 1918, xi, 289. (7) HALVERBON, OHLER, AND BERGEI: Jour. Am. ed. Aasn., 1917, lxviii, 1309.