Aim: To examine the survival benefit of liver and lung resection for colorectal metastasis and the potential prognostic factors that affect patient survival. Methods: All patients who had resection of lung or liver metastasis for colorectal metastasis in Queen Elizabeth Hospital, Hong Kong from 1995 to 2004 were retrospectively reviewed. The overall and disease‐free survival was analysed, in particularly between liver and lung metastasis. All factors that may have affected the survival were entered into Cox's proportional hazards regression model to identify significant variables associated with survival. Results: At 5 years, the overall survival of patients who had resection of lung and liver metastasis was 44% and 38%, respectively; the disease‐free survival was 26% and 24%, respectively. Overall and disease‐free survival of patients with resection of lung metastasis was comparable to those with resection of liver metastasis. The differentiations of primary tumour and time to metastasis were shown to be significant prognostic factors influencing overall survival. Those patients with systemic chemotherapy after resection of colorectal metastasis demonstrated a significantly higher probability of overall survival. Conclusion: Resection of lung and liver metastases from colorectal origin was safe and both procedures improved survival. The use of chemotherapy after resection of metastasis significantly improved the overall survival. 相似文献
Background: The pathogenic mechanisms and the antigens
involved in the establishment and progress of IgA nephropathy are unknown.
As antibodies against C1q have been reported to correlate with SLE
nephritis, we analysed the occurrence of these antibodies in IgA
nephropathy in order to investigate the possibility of pathogenetic
similarities in these renal disorders. Methods: The
occurrence of IgA- and IgG anti-C1q antibodies (anti-C1q) were determined
by ELISA in patients with IgA nephropathy (n=36) and SLE nephritis (n=37),
diseases both known to be associated with circulating immune complexes.
Levels of these antibodies were also determined in two other glomerular
diseases, i.e. idiopathic membranous glomerulo-nephritis (n=7) and minimal
change disease (n=2), in which circulating immune complexes are usually not
present, and in 40 healthy controls. Results: IgA
anti-C1q was observed in increased titres in 11/36 of the patients with IgA
nephropathy, in 2/37 of the patients with SLE nephritis (both with
proliferative disease) and in 1/9 of the patients with membranous and
minimal change disease (P<0.001). Increased titres of IgG anti-C1q
were observed in 1/36 of the patients with IgA nephropathy, in 17/37 of the
patients with SLE nephritis and in 0/9 of the patients with membranous and
minimal change disease (P<0.001). There were no correlations between
the levels of anti-C1q antibodies and clinical parameters such as degree of
proteinuria, haematuria, or renal function. Nor was there any correlation
to the concentration of C3a and the terminal complement complex (TCC) in
patients with IgA nephropathy. Conclusions: The
occurrence of anti-C1q antibodies in both IgA nephropathy and SLE
nephritis, albeit of different predominating isotypes, indicates the
possibility of a similar pathogenic mechanism involved in these renal
disorders. The occurrence of IgA anti-C1q antibodies in patients with IgA
nephropathy has to our knowledge not previously been reported. 相似文献
1. The pharmacokinetics of Dalal-peptide T-NH2 (peptide T) was determined during phase I clinical trials in patients with acquired immunodeficiecy disease (AIDS) and AIDS related complex (ARC). Drug levels were determined by specific RIA, and in some cases with HPLC analysis, after intraveneous (i.v.) or intranasal (i.n.), via metered sprayer, administration.
2. The plasma kinetics appeared to be bi-phasic with a first compartment half-life of 30 to 60 minutes and a second plasma clearence rate of 4 to 6 hours, observed for both routes of administration. Peptide T, in one individual was confirmed to be present at 6 hrs in plasma, determined after HPLC isolation followed by specific RIA.
3. Bioavailabilty, determined for a 2 mg test dose in six individuals was 9.3 ± 6.9 nmol/L. Peak plasma levels of 41 ± 30 nmol/L after 10 mg i.n., 2.8 ± 5.9 nmol/L after 2mg i.n., and 0.13 ± 0.07 nmol/L after 0.4 mg i.n. were observed. In two individuals tested, peptide T was detected in CSF at levels 20% of the corresponding plasma level 90 and 145 minutes post i.v. administration. Peptide T was not detected in urine. I.N. administration was well tolerated for times up to 21 months. 相似文献
A vast number of potent neuropharmaceuticals, many of which are peptides, are excluded from entry into the brain because of the highly selective blood-brain barrier. The fact that a number of drugs have been shown to be transported directly to the central nervous system following application to the olfactory region of the nose is therefore of major interest. In the present study, the feasibility of delivering peptides to the brain via the olfactory route was assessed using insulin as a model peptide. Systemic hyperinsulinemia induced by subcutaneous injection did not significantly reduce the amount of 125I-insulin transported from the nose to the brain in vivo, which suggests that the impact of systemic absorption on drug transport is minimal. A linear relationship was seen between insulin accumulation in the brain and the dose applied, without any relevant saturation. Contrary to what was expected, both systemic and olfactory absorption of insulin was enhanced when the pH of the medium was near the isoelectric point. The amount absorbed to the brain was found to be linearly related to the net charge of the molecule (r = -0.61; n = 20). It was concluded that insulin gains access to the central nervous system from the olfactory region of the nose by a nonspecific pathway. The olfactory route may therefore become an important means to deliver peptides to the brain. 相似文献
Recent studies of mortality from motor neurone disease (MND) in Sweden have demonstrated rising levels of mortality from the disease, especially amongst older age groups. Case-control investigations have suggested that certain environmental factors are significantly related to variations in mortality from the disease, and are associated with a probable individual susceptibility to MND. This study applies an innovative epidemiological technique to longitudinal and cohort analysis of Swedish mortality from MND during the period 1961 to 1990. Survival modelling shows that a subpopulation susceptible to MND exists in Sweden, as has been demonstrated in other countries. The increased life expectancy of the Swedish population since 1961 has resulted in more of that susceptible population living to the ages at which MND is expressed, explaining the majority of the increase in mortality from the disease. However, environmental factors may play a role in accelerating the course of MND and may affect the timing of death within the susceptible sub-population. 相似文献
There is considerable variation in care provided to patients with diabetes related to metabolic control, preventive services, and degree of patient-centered support. This study evaluates the relation of self-determination theory (SDT) constructs of clinician autonomy support, and patient competence to glycemic control, depressive symptoms, and patient satisfaction from baseline surveys of 634 patients of 31 Colorado primary care physicians participating in a program to improve diabetes care. Spearman correlations of autonomy support from one's clinician with patient competence, HbA1c, depressive symptoms and satisfaction were significant (R = -0.11 to 0.55, P < 0.005). Structural equation modeling demonstrated that autonomy support was significantly related to perceived competence, depressive symptoms, patient satisfaction, and indirectly to glycemic control. Perceived competence was significantly related to depressive symptoms, patient satisfaction and glycemic control. Further, the motivation constructs from SDT accounted for 5% of the variance in glycemic control, 8% of the variance in depression, and 42% of the variance in patient satisfaction. Quality improvement efforts need to pay greater attention to patient competence, satisfaction, and depression, in addition to glycemic control. Clinician autonomy support was found to be reliably measured and moderately correlated with psychosocial and biologic outcomes related to diabetes self-management. These results suggest training clinicians to increase their support of patient autonomy may be one important avenue to improve diabetes outcomes. 相似文献
This study used a novel delayed nonmatching-to-position task to compare visuospatial learning and memory in young and aged beagle dogs (Canis familiaris). The task used 3, rather than 2, spatial locations, which markedly increased difficulty. There were striking age differences in acquisition. Most of the aged canines did not learn the task, and those that did showed impaired learning when compared with the young canines. The aged canines also showed reduced maximal working memory capacity compared with the young canines. Analysis of the response patterns of individual canines indicated that the deficits were related to the use of ineffective strategies and inflexibility in strategy modification. 相似文献
Pigmented nodular cortical hyperplasia, a rare cause of Cushing’s syndrome, is characterized by resistance to inhibition with
dexamethasone and normal sized adrenal glands with multiple, small pigmented nodules. The disorder may be a component of a
syndrome inherited as an autosomal dominant pattern that includes intra- and extracardiac myxomas, lentiginous lesions, blue
nevi, other functional endocrine tumors, and peripheral nerve tumors (Carney’s complex).
We report a patient in whom bilateral myelolipomas were found, in addition to the usual features of this complex. A 29-yr-old
man was admitted to the hospital for Cushing’s syndrome of probably more than 15 yr duration. Physical examination showed
diffuse facial hyperchromatic macules, 0.2–0.5 cm, predominantly around the lips and on the palmar surfaces of the fingers.
Results with dexamethasone suppression nocturnal testing (1 and 8 mg) were compatible with an adrenal adenoma. The computed
tomography (CT) of the sella turcica was normal. Adrenal CT showed a tumor in the left gland with a double component: one
solid and another suggestive of fat, consistent with an angiomyelolipoma. Following 5 wk treatment with ketoconazole, 800
mg per day po, serum cortisol decreased to 5.9 μg/dL, morning and evening, respectively.
Bilateral adrenalectomy was performed. Pathologic examination revealed pigmented nodular cortical hypersplasia and a dominant
myelolipoma in the left adrenal. A microscopic myelolipoma was identified in the right adrenal.
An echocardiogram showed a mass on the posterior wall of the left ventricle which was a myxoma. Study of the patient's family
disclosed two sisters with facial lentigines. Echocardiograms were performed on all available first degree relatives: all
were normal. Nocturnal inhibition with dexamethasone revealed that one of the patient’s sisters with lentigines also had hypercortisolism.
Myelolipoma has been reported in association to Cushing syndrome in humans and experimentally after pituitary extracts in
animals. The relationship between this finding and the Carney’s complex remain elusive. 相似文献