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Edward M Messing Judith Manola George Wilding Kathleen Propert Jonathan Fleischmann E David Crawford J Edson Pontes Richard Hahn Donald Trump 《Journal of clinical oncology》2003,21(7):1214-1222
PURPOSE: To evaluate the role of adjuvant interferon alfa after complete resection of locally extensive renal cell carcinoma. PATIENTS AND METHODS: A total of 283 eligible patients with pT3-4a and/or node-positive disease were randomly assigned after radical nephrectomy and lymphadenectomy to observation or to interferon alfa-NL (Wellferon, Burroughs-Wellcome, Research Park, NC) given daily for 5 days every 3 weeks for up to 12 cycles. Patients were stratified on the basis of pathologic stage. Patients remained on treatment until documented recurrence, excessive toxicity, or patient/physician preference deemed removal appropriate. RESULTS: At median follow-up of 10.4 years, median survival was 7.4 years in the observation arm and 5.1 year in the treatment arm (log-rank P =.09). Median recurrence-free survival was 3.0 years in the observation arm and 2.2 years in the interferon arm (P =.33). Performance status (P =.003), nodal status (N2 v N0, P <.0001), and tumor stage (P =.0002) were significant prognostic factors in multivariate analysis. A proportional hazards model examining the effects of treatment arm and time to recurrence on survival after recurrence among patients who recurred found that random assignment to interferon treatment (P =.009) and shorter time to recurrence (P <.0001) were independent predictors of shorter survival after recurrence. Although no lethal toxicities were observed, severe (grade 4) toxicities including neutropenia, myalgia, fatigue, depression, and other neurologic toxicities occurred in 11.4% of those randomly assigned to interferon treatment. CONCLUSION: Adjuvant treatment with interferon did not contribute to survival or relapse-free survival in this group of patients. 相似文献
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Paracoccidioidomycosis of the central nervous system presents either as meningeal or pseudotumoral lesions. Although occurring more frequently in the brain and meninges, they can occasionally involve the spinal cord. A case of paracoccidioidomycosis in the cervical spinal cord is reported in this paper. Difficulties in establishing the etiologic diagnosis, the importance of radiologic examination of the thorax, and the treatment of the patient are commented. In an extensive review of the literature on the subject, only three other cases have been found, which are also discussed. 相似文献
5.
P Pellizzari C Pozzan S Marchiori T Zen M Gangemi 《Ultrasound in obstetrics & gynecology》2002,19(4):366-370
OBJECTIVE: To compare uterine artery blood flow in normal first-trimester pregnancies with those complicated by uterine bleeding. METHODS: Uterine artery blood flow was investigated by transvaginal color Doppler in 46 pregnant women affected by uterine bleeding and in a control group of 35 women with normal intrauterine pregnancy. Gestational age ranged from the 6th to the 12th week. Three blood flow values were calculated, the pulsatility index, the resistance index and the peak systolic velocity. Results were compared between the two groups. RESULTS: Of the 46 patients affected by uterine bleeding, 18 had an incomplete miscarriage, eight had a blighted ovum, five had a missed miscarriage and 15 continued their pregnancy until term and delivered liveborn infants. No significant differences were found in any of the three vascular indices between the normal and the pathological groups of patients. Uterine artery pulsatility and resistance indices decreased with gestational age in both normal and abnormal pregnancies but this change was not statistically significant. The peak systolic velocity significantly increased with gestational age in the control group but not in the pathological group. In patients with a retroplacental hematoma, uterine vascular resistance appeared higher than in those without a hematoma, while the peak systolic velocity showed no difference between the two groups. CONCLUSION: Doppler analysis of the uterine artery blood flow is unlikely to have a clinical role in the management of early pregnancies complicated by uterine bleeding. 相似文献
6.
P E Marchiori A J Duarte M I Birolli C A Figueiredo M Scaff J L De Assis 《Arquivos de neuro-psiquiatria》1988,46(3):248-253
A significant decline of CD3 cell detected by rosettes and a significant increased of B cell populations were observed. The total CD3+, helper CD4+ and suppressor CD8+ T-cell subsets showed no significant variation em relation to sex, age thymectomy and corticotherapy by monoclonal antibodies. 相似文献
7.
P. E. Marchiori M. dos Reis M. E. Quevedo M. Scaff W. Cossermelli J. L. Assis R. M. de Oliveira 《Acta neurologica Scandinavica》1989,80(5):387-389
Radioimmunoassay techniques were used to detect antibodies to the acetylcholine receptor (AAChR) in 164 patients with adult-onset myasthenia gravis. AAChR levels above 0.6 nM/l were considered pathological and were found in 67% of the patients with an average value of 58.99 +/- 125.02 nM/l (0.6-900.0). Correlation, with clinical functional status, the histopathological thymus alterations and the different therapeutics used did not disclose any statistically significant differences. 相似文献
8.
S A Harvey P Ayabaca M Bucagu S Djibrina W N Edson S Gbangbade A McCaw-Binns B R Burkhalter 《International journal of gynaecology and obstetrics》2004,87(2):203-210
OBJECTIVES: Percentage of deliveries assisted by a skilled birth attendant (SBA) has become a proxy indicator for reducing maternal mortality in developing countries, but there is little data on SBA competence. Our objective was to evaluate the competence of health professionals who typically attend hospital and clinic-based births in Benin, Ecuador, Jamaica, and Rwanda. Methods: We measured competence against World Health Organization's (WHO) Integrated Management of Pregnancy and Childbirth guidelines. To evaluate knowledge, we used a 49-question multiple-choice test covering seven clinical areas. To evaluate skill, we had participants perform five different procedures on anatomical models. The 166 participants came from facilities at all levels of care in their respective countries. Results: On average, providers answered 55.8% of the knowledge questions correctly and performed 48.2% of the skills steps correctly. Scores differed somewhat by country, provider type, and subtopic. Conclusion: A wide gap exists between current evidence-based standards and current levels of provider competence. 相似文献
9.
Comparison of Du Pont Isolator and Roche Septi-Chek for detection of fungemia. 总被引:4,自引:6,他引:4
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L Guerra-Romero R S Edson F R Cockerill rd C D Horstmeier G D Roberts 《Journal of clinical microbiology》1987,25(9):1623-1625
The rapid detection of fungemia in hospitalized patients is imperative, particularly for those who are immunocompromised. Our laboratory compared the Roche Septi-Chek with the Du Pont Isolator for the recovery of fungi from blood. Of 23,586 matched pairs of blood cultures, 199 were positive. The Isolator detected 178 (89.4%) and the Septi-Chek detected 119 (59.7%) of all positive isolates. The mean recovery time for the Isolator and Septi-Chek was 2.2 and 4.9 days, respectively. The Isolator detected fungemia earlier than the Septi-Chek did and was the only culture system positive in 83% of 53 patients, whereas the Septi-Chek system yielded the same results in only 13% of the patients. The Isolator provides a more rapid and sensitive method for the recovery of fungi from blood. 相似文献
10.
The authors investigated assays for free protein S (ProS) antigen, total ProS antigen, and ProS crossed immunoelectrophoresis (CIEP) in the diagnosis of type 1 inherited ProS deficiency. Accurate measurement of the hemostatically important free ProS required showing that, on each specimen, precipitation of the C4b-binding protein (C4b-BP)/protein S complex (C4b-BP/ProS) by polyethylene glycol-8,000 (PEG) was complete. The authors showed this by doing a ProS CIEP on the same PEG supernate that was used for quantitative measurement of free ProS. The +/- 2 standard deviation (+/- 2 SD) ranges for free ProS were 81-133% for males and 50-130% for females. This striking male-female difference has been reported only twice before. With the use of a graph of values for free ProS versus prothrombin time (PT), patients with inherited ProS deficiency segregated cleanly from normals and from patients on warfarin therapy without ProS deficiency until the PT was greater than 20 seconds. There is overlap of total ProS antigen values between normals and patients with inherited ProS deficiency. 相似文献