SUMMARY C-reactive protein and four other acute phase reactant proteins of non-cardiac origin (orosomucoid, alphal-antitrypsin, haptoglobin, and alpha2-macroglobulin) were studied serially by laser immunonephelometric assay in sera from 17 patients with myocardial infarction. A similar comparison was made in 57 patients undergoing surgery and 72 patients with acute infection. C-reactive protein was consistently the most sensitive acute phase reactant in all three conditions. After myocardial infarction, a raised serum C-reactive protein level was found on admission in four patients before a rise in creatine kinase MB isoenzyme (CK MB). The peak C-reactive protein level was reached on the third post-infarct day and it then declined over seven days with a half-life similar to myocardial tropomyosin. Serial monitoring of serum C-reactive protein, in parallel with cardiac proteins of short half-life (CK MB) and long half-life (tropomyosin), provides maximal information for diagnosis and for detecting post-infarct complications.Acute phase reactant proteins are synthesised by the liver in response to acute tissue damage. Serial estimation of these proteins, C-reactive protein in particular,' has been used to monitor the progress of a variety of clinical disorders and the recent introduction of rapid assays, using laser ixmunonephelometric,2 rate immunonephelometric,3 and immunoradiometric4 techniques, will increase their clinical application.The original observation5 that C-reactive protein could be detected in serum after myocardial infarction was followed by a number of studies using semiquantitative immunoprecipitation techniques6-9 and, later, electroimmunoprecipitation'0 and radial immunodiffusion"I assays. These studies, and a more recent immunoradiometric assay,4 indicate the potential clinical value of measuring acute phase reactants in serum after myocardial infarction. There is, however, a need to determine whether C-reactive protein estimation has advantages over other acute phase proteins for cardiac studies and to investigate the time course of its rise and fall in serum after myocardial infarction in comparison with proteins of cardiac origin. Laser immunonephelometric assays ofC-reactive protein and

The development of a malignant soft tissue tumour (malignant fibrous histiocytoma) in a surgical wound is reported. Although rare, this occurrence has important diagnostic implications and the management is discussed. Wide excision of these tumours is necessary as the lesion is covered with a dense pseudocapsule outside © The Fellowship of Postgraduate Medicine, 1987

We present the first case of a posttraumatic pseudoaneurysm of the axillary artery successfully treated with a stentgraft.A 89-year-old woman with a conservatively treated subcapital humeral fracture developed a pseudoaneurysm of the left axillary artery which was percutaneously successfully treated with a stentgraft. Endovascular repair of a traumatic axillary artery pseudoaneurysm should be considered especially in unfit patients.

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