摘要:

A quantitative assessment of the long-term prognostic value and clinical usefulness of recall antigen reactions in patients with malignant melanoma is not available. The authors evaluated longitudinal observations of survival made in 846 patients over a 12-year period. Each patient was initially studied with Mantoux-type recall antigen skin tests. The patients were categorized with respect to the following: high (>5 mm) or low (≤5 mm) averaged skin test reaction diameters at 48 hr; Clark level; tumor stage (I=localized tumor, II=local extension and/or region lymph node metastasis, III=systemic metastasis); ulceration; site of primary; histologic type; age; and sex. The percentage of high reactors in Stages I, II, and III were 44.3%, 37.4%, and 25%, respectively. Survival was evaluated with the Cox-Mantell hazard function model and the Cox regression model. The significant (chi-squared; probability) risk factors detected were tumor stage (94.58; ≤0.0001), Clark level (19.37; ≤0.0001), sex (16.97; ≤0.0001), and skin test reactivity (7.48; ≤0.0062). A significant relationship also was detected between skin test reactor status and the tumor stage (p ≤ 0.0330). When evaluated within each stage of disease, skin test reactivity predicted survival only in Stage II patients (p ≤ 0.0080). Five-year survival estimates among Stage II patients were 58% among high reactors and 38% among low reactors. Despite this interesting difference, the amount of independent information about survival provided by recall skin tests was small in comparison to the other clinically available risk factors. This suggests that recall antigen skin tests are not likely to be helpful in the evaluation of the individual patient

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Recent evidence suggests a role for both immunotherapy and chemotherapy in the treatment of transitional cell carcinoma. Glucan, a derivative of the cell wall ofSaccharomyces cerevisiaeand a potent immunostimulant, was used in combination with cyclophosphamide for treatment of implanted murine transitional cell carcinoma (MBT 2). Cyclophosphamide prevented tumor appearance when tumor burden was low and decreased tumor growth rate in larger tumor volumes, but was unable to eradicate established tumors. Glucan did not reduce tumor incidence but decreased animal mortality. These experimental observations may correlate well with clinical evidence and suggest future clinical use of these agents.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The etiologic factors of major (≥200 ml/24 hr) and massive (≥1,000 ml/24 hr) hemoptysis may well affect the outcome and, therefore, the treatment of this often life-threatening problem. The decline in the incidence of tuberculosis (TB) and bronchiectasis, along with the increase in bronchitis and neoplasia, have led to a strong institutional bias against operating on patients with major and massive hemoptysis. A retrospective case study and an extensive literature review were under-taken to critically evaluate this policy. Fifty-nine consecutive patients with major hemoptysis, 26 of whom had massive hemoptysis, were identified from 887 patients seen in our institution over a 10-year period. Only four of these 59 patients underwent surgery, while 55 were managed conservatively. Etiologic factors, operability, and bleeding rate all appeared to play a major role in outcome. No patients with bronchitis, bronchiectasis, tuberculosis, or who were on anticoagulation therapy died compared to a mortality rate of 59% in patients with carcinoma (CA) of the lung and 71% in patients with leukemia. Eleven percent of operable patients treated conservatively died compared to a 46% mortality rate for nonoperable patients. And, 9% of patients with bleeding rates <1,000 ml/24 hr died compared to 58% of those with ≥1,000 ml/24 hr.Conservative management appears to have a low mortality in patients with non-tuberculosis-related major hemoptysis as well as in many patients with massive hemoptysis, especially those patients who are operable and those without neoplastic disease.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The effects of acute hemodilution on hepatic energy status were compared between carbon-tetrachloride-induced cirrhotic rats and normal rats, using arterial blood ketone body ratio and hepatic energy charge as indices. Arterial blood was withdrawn and replaced with rat plasma in hemodiluted rats and with whole blood in sham-diluted control rats. In normal rats, arterial blood ketone body ratio and energy charge level at 6 hours after hemodilution decreased when the hematocrit value was less than 15%. In contrast, the values decreased at an even higher hematocrit level in cirrhotic rats. It was suggested from these results that the hemodilution procedure exerts a more profound hypoxic effect at a milder hemodilution on a cirrhotic liver than on a normal liver.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Ethchlorvynol injection in humans leads to a clinical picture consistent with increased permeability pulmonary edema, ie, the adult respiratory distress syndrome. There has been only one such case reported in which the pulmonary wedge pressure was measured. In an attempt to mimic the human disease, the authors established the awake, unanesthetized chronic sheep lung lymph fistula model and injected 15 mg/kg of ethchlorvynol intravenously after a baseline period. There were transient increases in pulmonary artery and systemic blood pressure with decreases in cardiac output. Lymph flow increased five-fold and remained elevated for 24 hr, returning to normal by 48 hr. All animals survived. Pulmonary morphologic changes consisted of alveolar and interstitial edema and some disruption of endothelial and epithelial cells. These findings resolved by 48 hr postinjection. The authors conclude that this model mimics the findings in humans who have injected ethchlorvynol intravenously.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Serotonin is released by activated platelets and may promote platelet aggregation and epicardial coronary artery constriction in animal models. Serotonin may have similar effects in humans and, thus may be a mediator of certain ischemic syndromes. However, the role of serotonin in human ischemic heart disease has not been studied. Since evaluation of transcardiac serotonin metabolism requires that blood samples be obtained through long catheters, it is possible that artifactual changes in serotonin concentration could occur because of platelet activation in the catheters themselves. Accordingly, to determine if serotonin could be measured through long catheters without artifactual changes, the authors obtained paired blood samples by gentle aspiration through a large bore steel needle and a 100-cm polyurethane catheter placed in the femoral vein of 13 patients. All samples were processed to obtain platelet-poor plasma and then analyzed by a sensitive radioenzymatic assay. Blood sampling through long catheters did not cause a systematic alteration in plasma serotonin concentration. Mean serotonin concentration from the femoral vein through a needle was 22.3 ± 26.55 ng/ml (mean ± standard deviation), and that obtained through a long catheter was 20.0 ± 26.29 ng/ml (p=0.34). The authors conclude that carefully obtaining blood samples through long catheters does not significantly alter the plasma serotonin concentration and thus the accurate measurement of transcardiac serotonin concentrations is possible using these methods.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

In recent years, evidence has accumulated suggesting that early dietary intervention in the form of protein restriction can dramatically alter the natural history of chronic renal insufficiency. This article reviews the literature in this area and summarizes the questions that remain for future investigators to answer.Interest in the role of protein intake in renal disease dates back to the early 1900s, when several investigators found that the progression of renal failure was accelerated in rats and rabbits fed high-protein diests. Subsequent work in animal models has demonstrated that nephron loss, resulting from a variety of disease states, is associated with elevated intraglomerular pressures and flows. Several investigators now have postulated that these abnormal hemodynamics, resulting from intrarenal vasodilation and hyperperfusion, damage the glomerulus and may produce further nephron loss independent of the initial renal insult. Dietary protein restriction appears to reduce these pressures and flows towards normal in animals, although the operative mechanism has yet to be identified. Limited studies of dietary protein restriction in human renal disease have suggested a beneficial effect, but carefully controlled prospective studies will be necessary to establish clear therapeutic efficacy.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The authors report the longest-lived patient with homozygous familial hypercholesterolemia, the seventh case of a defect in internalization of low-density lipoprotein (LDL). The patient is a 57-year-old man, whose plasma total cholesterol (TC) and LDL-cholesterol (LDL-C) concentrations were 465–660 mg/100 ml and 461 mg/100 ml, respectively, while his plasma high-density lipoprotein-cholesterol (HDL-C) was 13.6–16.9 mg/100 ml. He was the product of a consanguineous marriage, and his parents, brothers, and a sister had mild hypercholesterolemia. His coronary angiogram revealed diffuse coronary artery narrowing. Receptor studies revealed that his fibroblasts bound as much LDL as normal cells, but could not internalize or degrade LDL.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Endometriosis is a common disorder affecting women of all ages. Although urinary tract involvement is not uncommon, ureteral obstruction is an infrequent complication of endometriosis. A case is reported of acute renal failure caused by bilateral ureteral obstruction resulting from extensive pelvic endometriosis. All reported cases of ureteral endometriosis are reviewed with special emphasis on bilateral ureteral involvement. Physicians need to be aware of this reversible complication of endometriosis.

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The case of a previously healthy man with endocarditis due to the group C streptococcus,complicated by myocardial abscess and fatal cardiac tamponade, is presented. Group C streptococcus is an unusual cause of endocarditis which tends to produce extensive valve destruction. Early surgery should be considered in patients with endocarditis caused by this organism

ISSN:0002-9629    

出版商:OVID    

年代:1987

数据来源: OVID