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The value of MCA, CA 15-3, CEA and CA-125 for discrimination between metastatic breast cancer and adenocarcinoma of other primary sites 总被引:1,自引:0,他引:1
MCA, CA 15-3, CEA and CA 125 were determined in the serum of 49 patients with metastatic breast cancer and 38 patients with metastatic adenocarcinoma of other primary sites. By using the 99th percentile of the normal value distribution as the cut-off point, the positive predictive value (PV+) was found to be 85% (95% CI 76-94) for MCA, and 71% (95% CI 61-81) for CA 15-3. When receiver-operating-characteristic (ROC) curves were constructed, the PV+ for CA 15-3 was increased to 82% (95% CI 72-92), using 60 U ml-1 as the cut-off point. With the exception of two patients who had a slightly elevated MCA, MCA and CA 15-3 identified the same patients with breast cancer. By combining a positive MCA or CA 15-3 with a negative CEA and CA 125, further improvement of the PV+ could be achieved; 100% (95% CI 91-100). We conclude that MCA and CA 15-3 may play a useful role in discrimination between patients with metastatic breast cancer and those with adenocarcinoma of other primary sites. 相似文献
4.
Endosonography was carried out in a patient with an extensive juxtapapillary tumour. Radiology and endoscopy were unable to distinguish a villous adenoma from an invasive carcinoma. Endosonography revealed a mucosal hypoechoic tumour without penetration into the submucosa and muscularis propria. The common bile duct, pancreatic duct, and pancreas were normal. Lymph node abnormalities were not found. Based on the endosonography findings, local surgical tumour resection was undertaken instead of a Whipple procedure. The histology of the resected specimen confirmed the endosonography diagnosis. 相似文献
5.
Pneumocystis carinii pneumonia (PCP) is the most common opportunistic human immunodeficiency virus (HIV)-related infection, occurring in 85 % of HIV infected patients without prophylaxis. Preventive treatment is required when CD4 cell count falls below 200 cells per cubic millimeter. Cotrimoxazole has been shown to be highly effective but alternative drug regimens are often necessary because of the frequent drug hypersensitivity exhibited by HIV infected patients. The aim of this prospective, open, randomized, one-site study, involving HIV-infected patients with a CD4 cell count below 200/mm3, or a percentage under 20%, randomly assigned to receive either dapsone 50 mg daily or Fansidar® one tablet weekly, was to compare the efficacy and safety of these drugs in the primary prophylaxis of PCP. Both dapsone and Fansidar® appear to be safe and effective alternative agents for the prevention of PCP. Their role in Toxoplasma gondii prophylaxis requires further evaluation. 相似文献
6.
R. de Wit G. Stoter D. T. Sleijfer S. B. Kaye P. H. de Mulder W. W. ten Bokkel Huinink P. J. Spaander M. de Pauw R. Sylvester 《British journal of cancer》1995,71(6):1311-1314
We have investigated whether an alternating induction chemotherapy regimen of PVB/BEP is superior to BEP in patients with poor-prognosis testicular non-seminoma. A total of 234 eligible patients were randomised to receive an alternating schedule of PVB/BEP for a total of four cycles or four cycles of BEP. Poor prognosis was defined as any of the following: lymph node metastases larger than 5 cm, lung metastases more than four in number or larger than 2 cm, haematogenic spread outside the lungs, such as in liver and bone, human chorionic gonadotrophin > 10,000 IU l-1 or alphafetoprotein > 1000 IU l-1. The complete response (CR) rates to PVB/BEP and BEP were similar, 76% and 72% respectively (P = 0.58). In addition, there was no significant difference in relapse rate, disease-free and overall survival at an average follow-up of 6 years. The 5-year progression-free and survival rates in both treatment groups were approximately 80%. The PVB/BEP regime was more toxic with regard to bone marrow function; the frequencies of leucocytes below 1000 microliters-1, leucocytopenic fever and platelets below 25,000 microliters-1, throughout four cycles were 28% vs 5% (P < 0.001), 16% vs 5% (P = 0.006), and 10% vs 1% (P = 0.001) respectively. Neuropathy also occurred more often in the PVB/BEP arm: 47% vs 25% (P = 0.001). This study shows that an alternating regimen of PVB/BEP is not superior to BEP and that it is more myelo- and neurotoxic. 相似文献
7.
H. David Banta Inger Schou Hindrik Vondeling Ardine De Wit 《Lasers in medical science》1992,7(1-4):9-21
This article reports on the results of a project evaluating effectiveness and cost-effectiveness of laser applications in
health care. The literature was collected, emphasizing well-designed clinical trials and cost-effectiveness analyses. Few
randomized clinical trials (RCTs) have been done outside the specialty of ophthalmology. Even fewer cost-effectiveness studies
have been done, despite the frequent claims of cost-effectiveness in the medical literature. Review papers were commissioned,
and a group of laser experts, economists, and policy-analysts met for 2 days to discuss the policy implications of lasers.
The main conclusion from the conference is that inappropriate and unskilled use of lasers is presently the greatest problem
with their application in health care. 相似文献
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D. W. Meijer B. P. M. Rademaker S. Schlooz W. A. Bemelman L. T. de Wit J. J. G. Bannenberg T. Stijnen D. F. Gouma 《Surgical endoscopy》1997,11(6):645-649
Background: Disadvantages related to CO2 pneumoperitoneum have led to development of the abdominal wall retractor (AWR), a device designed to facilitate laparoscopic surgery without conventional pneumoperitoneum (15 mmHg CO2). We investigated the effects of the AWR on hemodynamics and gas exchange in humans. We also investigated whether the use of an AWR imposed extra technical difficulties for the surgeon. A pilot study revealed that cholecystectomy without low-pressure pneumoperitoneum was technically impossible. Methods: A prospective randomized controlled trial: Twenty patients undergoing laparoscopic cholecystectomy were randomly allocated into group 1: AWR with low-pressure pneumoperitoneum (5 mmHg), or group 2: conventional pneumoperitoneum (15 mmHg). Results: Surgery using the AWR lasted longer, 72 ± 16 min (mean ± SD) vs 50 ± 18 min compared with standard laparoscopic cholecystectomy. There were no differences between the groups with respect to hemodynamic parameters, although a small reduction of the cardiac output was observed using conventional pneumoperitoneum (from 3.9 ± 0.7 to 3.2 ± 1.1 l/min) and an increase during AWR (from 4.2 ± 0.9 to 5.2 ± 1.5 l/min). Peak inspiratory pressures were significantly higher during conventional pneumoperitoneum compared to AWR. A slight decrease in pH accompanied by an increase in CO2 developed during pneumoperitoneum and during the use of the AWR. In both groups arterial PO2 decreased. Conclusions: The results indicate that the view was impaired during use of the AWR and therefore its use was difficult and time-consuming. Possible advantages of this devices' effects on hemodynamics and ventilatory parameters could not be confirmed in this study. 相似文献
10.
GP SCHWAB AL BLUM E BODNER B DALLEMAGNE K GLASER H KOOP F PACE W RÖSCH JR SIEWERT G WETSCHER 《Journal of gastroenterology and hepatology》1997,12(12):785-789
Gastroesophageal reflux disease (GERD) is the most common disease of the upper gastrointestinal tract. With the introduction of proton pump inhibitors medical treatment of GERD has been significantly improved. However, the development of laparoscopic antireflux surgery resulted in an increasing interest of surgeons in this disease. An interactive meeting was organized in order to develop an agreement between gastoenterologists and surgeons regarding therapeutic decisions and this is the main topic of this paper. 相似文献