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SUMMARY Serial measurements of 11 serum proteins have been made throughout 39 admissions of 36 patients to hospital for the treatment of acute attacks of ulcerative colitis. There was a striking correlation between rapid changes in C-reactive protein and pre-albumin concentrations and the clinical response to medical treatment. Measurements of the a,-acid glycoprotein, albumin, and total serum protein concentrations at the time of admission were found to correlate with the outcome of the attack. Measurement of these proteins provides a useful guide to the management of patients with attacks of ulcerative colitis.

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SUMMARY.Fasting blood samples were collected from 83 patients with histologically proven breast cancer and analysed for plasma glucagon, serum immunoreactive tumour necrosis factor (TNFa), insulin, glucose, growth hormone, cortisol and TSH. Samples from patients with known diabetes mellitus or thyroid disease, and those on parenteral nutrition or with evidence of infection were excluded as were patients who had a history of weight loss through dieting or who were anorexic.Fasting plasma glucagon, serum cortisol and immunoreactive TNFa concentrations in patients with stage IV breast cancer who had developed weight loss were significantly higher than those in patients with stage IV disease who had not developed weight loss. There were no significant differences in the fasting serum concentrations of insulin, glucose, growth hormone and TSH between the two patient groups.The association between weight loss in stage IV breast cancer and increased concentrations of plasma glucagon, serum cortisol and TNFa suggests a possible role for these hormonal factors in the development of cancer cachexia. Additional key phrases: cancer cachexia; cachectin; glucagon; cortisol; tumour necrosis factorSevere weight loss and debilitative wasting of lean body mass, termed cachexia, frequently complicate the treatment of patients suffering from malignancy. Some data indicate that as many as 30% of cancer patients die from cachexia rather than tumour burden.'" While it is likely that a variety of mechanisms participate in the pathogenesis of cachexia, and that cachexia adversely affects prognosis, the aetiology of this syndrome is not known.4Although a significant number of patients with malignant disease are anorexic5 and have a reduced food intake possibly related to abnormalities in the sensation of tasteS or in the central control of appetite,6 most studies have shown that caloric intake is not significantly reduced in cancer patients with Abnormalities of intermediary metabolism in cancer patients are well described. They include increased Cori cycle activity,* impaired glucose tolerance and insulin re~istance,~J~ a tendency to Correspondence: Dr M L Knapp. mobilize and metabolize fat,lL increased gluconeogenesis from alanineI2 and depletion of intramuscular energy substrates.I3 All these metabolic processes could contribute to the development of cancer cachexia. However, the hormonal mechanisms behind these metabolic changes have yet to be elucidated. The present study was therefore undertaken to ascertain whether there was an association between weight loss and blood levels of immunoreactive tumour necrosis factor a (TNFa), insulin, glucagon, growth hormone, cortisol and thyroid-stimulating hormone (TSH) in breast cancer. PATIENTS AND METHODS PatientsBlood samples were collected from 83 patients with histologically proven breast cancer who were attending the oncology clinic at the Westminster Hospital, London, or the breast clinic at St Peter's Hospital, Chertsey. Prior to the study, ethical committee approval for the collection...