BACKGROUND. The antibody Ki-67 binds to nuclei in all cell cycle phases except GO and can be used to measure growth fraction. Because proliferative activity has been linked to prognosis in neoplasia, the authors analyzed 100 cases of colorectal carcinoma, each with 3 or more years of follow-up, using Ki-67 immunostaining. METHODS. The Ki-67-positive nuclear area and total nuclear area of carcinoma cells in 20 microscopic fields were measured by computed morphometry. A Ki-67 score (percent positive nuclear area x 100) was calculated. The following characteristics also were recorded for each case: patient age and sex, tumor site and size, modified Dukes' stage, spread beyond bowel wall, lymph node status, tumor grade, histologic type, extramural venous spread, tumor growth pattern, fibrosis, lymphocytic infiltration, and mitotic rate. RESULTS. Ki-67 scores ranged from 1 to 90 (mean, 34.6). Ki-67 scores were higher in Stage A disease (versus Stage B, C, and D disease) but were not associated with survival. Survival curves differed by stage, lymph node metastases, infiltrative growth pattern, lymphocytic infiltration, fibrosis, extramural venous spread, and tumor grade in a univariate analysis. The infiltrative growth pattern (P = 0.04) and lymphocytic infiltration (P = 0.003) were features associated independently with survival after adjusting for modified Dukes' stage. Furthermore, the lack of a significant lymphocytic infiltrate was associated with a death rate 3.4 times greater than that occurring in patients with Stage B disease with a significant infiltrate. CONCLUSIONS. The authors conclude that proliferative activity in colorectal carcinoma as measured by Ki-67 immunostaining was not associated with prognosis. 相似文献
Summary Symphysial osteomyelitis has been distinguished from osteitis pubis because of the more serious nature of the disease. We report a case in which there was a pelvic separation similar to that seen after trauma or pregnancy. The previously undescribed complications of bladder perforation and pelvic instability are also noted. There was no predisposing cause in this case, in contrast to the 40 previously reported. The causative organism was staphylococcus aureus, but pseudomonas aeruginosa and escherichia coli have also been found in other cases.
Résume L'ostéomyélite de la symphyse pubienne a pu être distinguée de l'ostéite pubienne en raison de sa plus grande gravité. Nous en rapportons un cas dans lequel existait une disjonction symphysaire semblable à celles que l'on observe après traumatisme ou grossesse. On a également noté des complications jamais décrites, à savoir une perforation vésicale et une instabilité pelvienne. Il n'y avait pas de cause prédisposante dans ce cas, contrairement aux 40 observations précédemment rapportées dans la littérature. La bactérie causale était un staphylocoque doré, mais le pyocyanique et le colibacille ont également été retrouvés dans d'autres cas.
Background: Only few data exist on pharmacokinetics of
tacrolimus in children. Patients: In 1995 and 1996, 14
children (mean age 13 years, range 5-23 years) received tacrolimus after
renal transplantation; 10 of these after biopsy-proven steroid-resistant
rejection (2 with vascular rejection), two for cyclosporin A (CsA)-induced
severe nephrotoxicity, one for untreatable gingival hyperplasia on CsA, and
one child was treated primarily after transplantation because of severe
liver involvement in nephronophthisis. Pharmacokinetic investigations were
performed after establishing a stable maintenance dose with trough levels
in the desired window of 5-12 ng/ml. Results: Mean
follow-up time was 6 months (range 3-25 months). Eleven patients were still
on tacrolimus. Two were discontinued because of severe aggravation of
chronic persistent hepatitis C (one of them also developed diabetes
mellitus),and one patient was subsequently switched to conventional
immunosuppression because of tacrolimus-associated nephrotoxicity. All
tacrolimus levels were measured by a modified assay (MEIA, Tacrolimus,
Abbott) with improved sensitivity. At the time of switch, median serum
creatinine was 234±82 7mgr;mol;l and 6 months after switch
201±99 &mgr;mol/l. All grafts are still functioning. Mean
FK-506 dose was 0.16 mg/kg body weight/day (range 0.036-0.30 mg/kg). Mean
trough level was 7.1±2.6 ng/ml in the morning and
6.5±2.0 ng/ml in the evening. Median time of maximum
concentration (tmax) was 120 min after application, and the mean maximum
concentration (Cmax) was 15.2±6.7 ng/ml. Mean area under the
curve (AUC) was 104±33 ng * h/ml, with a range from 65 to 169 ng
* h/ml. No patient had unsatisfactorily low trough levels during the study.
There was only a weak but significant (P<0.05) correlation between
dose per kg body weight and AUC and, as expected, an excellent correlation
(r2=0.73, P<0.001) between AUC and trough
level. Conclusion: Because of interindividual
variation between patients, therapeutic drug monitoring of tacrolimus is
mandatory. In this study, a daily dose of 0.15 mg/kg was sufficient in most
patients. We recommend the performance of at least one pharmacokinetic
study after establishing stable FK 506 trough levels to ascertain a safe
profile. 相似文献
Background: Liver dysfunction as a result of impaired oxygen availability frequently occurs following hemorrhage and contributes to delayed mortality. Artificial oxygen carriers may improve oxygen supply to vital organs while avoiding the need for allogeneic transfusion.
Methods: Rats were subjected to hemorrhagic hypotension (mean arterial pressure = 35-40 mmHg for 120 min) and were subsequently resuscitated with (1) stored whole rat blood, (2) pentastarch, or (3) pentastarch combined with perflubron emulsion (PFE; 2.7 or 5.4 g/kg body weight), a second-generation artificial oxygen carrier. Recovery of liver adenosine triphosphate, hepatocellular injury, and expression of glutamine synthetase 1, a gene that is induced by exposure of hepatocytes to low partial pressure of oxygen, were studied at 4 h of resuscitation.
Results: Stored whole blood or pentastarch failed to restore liver adenosine triphosphate concentrations after prolonged shock as compared to sham controls and resulted in increased gene expression of glutamine synthetase 1. Addition of 2.7 g PFE/kg restored liver adenosine triphosphate to control, whereas 5.4 g PFE/kg resulted in adenosine triphosphate concentrations significantly above control. Improved hepatocellular oxygen supply was also confirmed by restoration of the physiologic expression pattern of glutamine synthetase 1. Serum enzyme concentrations were highest after resuscitation with stored blood, whereas addition of PFE failed to further decrease enzyme concentrations as compared to pentastarch alone. 相似文献