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2.
Ann Oncol ; 27(3): 480-7, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26704052

RESUMEN

BACKGROUND: We investigate rates of pathologic complete response (pCR) and tumor expression of ER, PgR, HER2 discordance after neoadjuvant chemotherapy using Japanese breast cancer registry data. PATIENTS AND METHODS: Records of more than 300,000 breast cancer cases treated at 800 hospitals from 2004 to 2013 were retrieved from the breast cancer registry. After data cleanup, we included 21,755 patients who received neoadjuvant chemotherapy and had no distant metastases. pCR was defined as no invasive tumor in the breast detected during surgery after neoadjuvant chemotherapy. HER2 overexpression was determined immunohistochemically and/or using fluorescence in situ hybridization. RESULTS: pCR was achieved in 5.7% of luminal tumors (n = 8730), 24.6% of HER2-positive tumors (n = 4403), and 18.9% of triple-negative tumors (n = 3660). Among HER2-positive tumors, pCR was achieved in 31.6% of ER-negative tumors (n = 2252), 17.0% of ER-positive ones (n = 2132), 31.4% of patients who received trastuzumab as neoadjuvant chemotherapy (n = 2437), and 16.2% of patients who did not receive trastuzumab (n = 1966). Of the 2811 patients who were HER2-positive before treatment, 601 (21.4%) had HER2-negative tumors after neoadjuvant chemotherapy, whereas 340 (3.4%) of the 9947 patients with HER2-negative tumors before treatment had HER2-positive tumors afterward. Of the 10,973 patients with ER-positive tumors before treatment, 499 (4.6%) had ER-negative tumors after neoadjuvant chemotherapy, whereas 519 (9.3%) of the 5607 patients who were ER-negative before treatment had ER-positive tumors afterward. CONCLUSION: We confirmed that loss of HER2-positive status can occur after neoadjuvant treatment in patients with primary HER2-positive breast cancer. We also confirmed that in practice, differences in pCR rates between breast cancer subtypes are the same as in clinical trials. Our data strongly support the need for retest ER, PgR, HER2 of surgical sample after neoadjuvant therapy in order to accurately determine appropriate use of targeted therapy.


Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Terapia Neoadyuvante , Receptor ErbB-2/metabolismo , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismo , Trastuzumab/uso terapéutico , Biomarcadores de Tumor/metabolismo , Neoplasias de la Mama/genética , Femenino , Humanos , Hibridación Fluorescente in Situ , Japón , Persona de Mediana Edad , Receptor ErbB-2/biosíntesis , Receptor ErbB-2/genética , Sistema de Registros , Resultado del Tratamiento
3.
Clin Lab Haematol ; 27(5): 307-11, 2005 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-16178910

RESUMEN

The T cell-lineage marker CD2 is sometimes expressed in acute promyelocytic leukemia (APL), and CD2 expression is reported to correlate with some clinical characteristics. However, the significance of CD2 expression in APL has not been fully elucidated. We evaluated CD2 expression in APL treated by the same treatment strategy in a single institute, and whether it had any special characteristics. Among 29 APL, 6 were positive for CD2. Patients with CD2+ APL tended to have a higher leukocyte count than CD2- APL (34.5 +/- 13.1/l vs. 6.8 +/- 2.1/l), morphological characteristics as variant-APL (50 vs. 0%). They also showed poor clinical prognosis. The CR rate of CD2- APL was 87.0% while that of CD2+ APL was 50 %. The mortality was 13.0 and 66.7%, respectively, and the survival rate was significantly lower in CD2+ APL. CD2 expression was proven to be a risk factor associated with death in addition to the morphological characteristics of variant-APL and leukocytosis. These results indicated that CD2 expression might have a significant impact on the prognosis of APL. Whether CD2+ APL should be characterized as a special clinical entity should be discussed in a larger patient population.


Asunto(s)
Antígenos CD2/análisis , Leucemia Promielocítica Aguda/patología , Adulto , Antígenos de Neoplasias/análisis , Forma de la Célula , Humanos , Inmunofenotipificación , Leucemia Promielocítica Aguda/diagnóstico , Leucemia Promielocítica Aguda/mortalidad , Recuento de Leucocitos , Leucocitosis/etiología , Persona de Mediana Edad , Pronóstico , Inducción de Remisión , Factores de Riesgo , Análisis de Supervivencia , Linfocitos T
4.
Transplant Proc ; 37(1): 223-5, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-15808601

RESUMEN

Activation of Na(+)/H(+) exchanger (NHE) may have an important role in the ischemia/reperfusion injury by producing intracellular calcium overload. Recent studies have shown a beneficial effect of an NHE inhibitor on the ischemia/reperfusion injury in the heart. In this study, we examined the effect of FR183998, a potent NHE inhibitor, in porcine pancreas allotransplantation from non-heart-beating Landrace pig donors (NHBDs). The four experimental groups included: untreated with no preservation (group 1; n = 3), treated with no preservation (group 2; n = 5), untreated with preservation (group 3; n = 6), and treated with preservation (group 4; n = 4). The preservation was made in ice-cold University of Wisconsin (UW) solution for 24 hours. The groups treated received 1 mg/kg FR183998 before donor cardiac arrest and 10 mg in the UW solution flush in situ. Serum blood glucose, insulin, and amylase were measured daily. An intravenous glucose tolerance test (IVGTT) was performed on the postoperative day (POD) 7 when pigs were sacrificed for histological examination. Graft survival rates on that day in groups 1,2,3, and 4 were 3 of 3; 5 of 5; 3 of 6; and 4 of 4, respectively. The mean K values of IVGTT in groups 3 and 4 were 0.78 +/- 0.10 and 1.27 +/- 0.16, respectively, which were significantly different (P < .05). Upon histological examination, pancreatic tissue in group 3 showed more severe edema and necrosis than other groups. FR183998 may be considered beneficial for ischemia/reperfusion injury to pancreatic grafts from NHBDs.


Asunto(s)
Supervivencia de Injerto/fisiología , Guanidinas/farmacología , Trasplante de Páncreas/fisiología , Daño por Reperfusión/prevención & control , Intercambiadores de Sodio-Hidrógeno/antagonistas & inhibidores , Tiofenos/farmacología , Adenosina , Alopurinol , Animales , Glucemia/efectos de los fármacos , Muerte Encefálica , Prueba de Tolerancia a la Glucosa , Glutatión , Supervivencia de Injerto/efectos de los fármacos , Insulina , Soluciones Preservantes de Órganos , Trasplante de Páncreas/métodos , Rafinosa , Porcinos , Conservación de Tejido , Trasplante Homólogo
5.
Transplant Proc ; 37(1): 407-8, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-15808660

RESUMEN

We investigated the effects of portocaval shunt (PCS) on excessive portal flow in producing sinusoidal microcirculatory injury in small-for-size liver transplants in pigs. The posterior segment of a whole liver (25%) was transplanted orthotopically. The pigs were divided two groups: group A, graft with PCS (n = 11), and group B, graft without PCS (n = 11). The PCS was a side-to-side anastomosis of the portal vein and the inferior vena cava. In group A, eight pigs survived for more than 4 days; all pigs except for one died of graft nonfunction within 24 hours in group B. The portal flow after reperfusion decreased in group A, but increased about three times greater in group B than that before the operation (P < .01). In group B, destruction of the sinusoidal lining and bleeding in the periportal areas were observed after reperfusion, findings that were not recognized in group A. These results suggest that graft nonfunction after small-for-size liver transplantation may be attributable to excessive portal flow producing sinusoidal microcirculatory injury.


Asunto(s)
Trasplante de Hígado/fisiología , Hígado/anatomía & histología , Sistema Porta , Animales , Hepatectomía/métodos , Porcinos , Recolección de Tejidos y Órganos/métodos , Trasplante Homólogo
6.
Jpn Circ J ; 65(3): 165-70, 2001 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-11266189

RESUMEN

There are only a few studies of the relationship between hemostatic abnormalities and intraarterial pressure, so the present study investigated the association of various newer lipid and hemostatic variables with intraarterial pressure levels. Levels of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, triglyceride, lipoprotein-(a), remnant-like particle cholesterol, cholesteryl ester transfer protein, uric acid, blood glucose, fibrinogen, free form of tissue factor pathway inhibitor (TFPI), C-reactive protein, serum amyloid A protein, anti-Chlamydia pneumoniae immunoglobulin G and immunoglobulin A, and apolipoproteins (apo) A-I, B, and E were measured in 176 patients who underwent diagnostic coronary angiography. Intraarterial blood pressure was determined from central aortic pressure using a standard fluid-filled catheter-external transducer system. Multivariate regression analyses showed that TFPI level was the only independent factor associated with aortic diastolic pressure. The linear regression equation demonstrated a significant negative correlation of TFPI level with aortic diastolic pressure (r=-0.395, p=0.0011). With respect to the association with other parameters, the TFPI level showed significant correlations between the HDL-C level and the apo A-I level, both in the overall patients and in the patients with coronary artery stenosis. This is the first evidence that the level of the plasma free form of TFPI is inversely correlated to aortic diastolic pressure.


Asunto(s)
Presión Sanguínea , Angiografía Coronaria , Lipoproteínas/sangre , Adulto , Anciano , Anticoagulantes/sangre , Enfermedad Coronaria/sangre , Femenino , Hemostáticos/sangre , Humanos , Lípidos/sangre , Masculino , Persona de Mediana Edad , Análisis de Regresión
8.
Intern Med ; 39(7): 540-6, 2000 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-10888209

RESUMEN

OBJECTIVE: We designed the present study to evaluate the association of various lipid and fibrinolytic components with coronary artery stenosis with respect to the triglyceride (TG) level. METHODS: Levels of TG, remnant-like particle cholesterol (RLP-C), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), lipoprotein-(a), uric acid, blood glucose, tissue plasminogen activator (t-PA), t-PA inhibitor type 1, antithrombin III, and protein C were measured in 208 patients who underwent diagnostic coronary angiograms. PATIENTS: Of these 208 patients, 59 were hypertriglyceridemic (150 mg/dl or higher) and 149 were normotriglyceridemic. RESULTS: Both LDL-C and HDL-C showed significant differences between patients with and those without coronary artery stenosis in both hypertriglyceridemic and normotriglyceridemic patient subgroups. However, RLP-C showed a significant difference in the normotriglyceridemic patient subgroup (p=0.012) but not in the hypertriglyceridemic patient subgroup (p=0.736). CONCLUSION: Our current retrospective study disclosed that RLP-C levels are closely associated with coronary artery stenosis in patients with normal TG levels.


Asunto(s)
Colesterol/sangre , Enfermedad Coronaria/sangre , Triglicéridos/sangre , Anciano , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Enfermedad Coronaria/etiología , Femenino , Humanos , Hiperlipidemias/sangre , Hiperlipidemias/complicaciones , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo
9.
Am Heart J ; 139(2 Pt 1): 305-10, 2000 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-10650304

RESUMEN

BACKGROUND: Limited information is available as to whether there is a difference in the association of lipid and fibrinolytic variables with coronary artery disease according to the presence or absence of elevated serum total cholesterol. We examined the levels of various lipid and fibrinolytic variables including remnant-like particle cholesterol (RLP-C). RLP-C is a recently established simple assay method for the estimation of triglyceride-rich lipoprotein remnants. METHODS AND RESULTS: Levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), triglyceride, lipoprotein(a), RLP-C, uric acid, blood glucose, tissue plasminogen activator, tissue plasminogen activator inhibitor type 1, antithrombin III, and protein C were measured in 208 patients who underwent diagnostic coronary angiograms. Of these 208 patients, 57 were hypercholesterolemic (> or =220 mg/dL) and 151 were normocholesterolemic. HDL-C showed significant differences between patients with and those without angiographically determined coronary artery stenosis in both hypercholesterolemic and normocholesterolemic patients (P =.0025 and P =.0003, respectively). Both RLP-C and uric acid showed significant differences only in the normocholesterolemic subgroup (P =.0006 and P =.0060, respectively). This difference in uric acid was not significant by multivariable analysis. The ratio of RLP-C/HDL-C was demonstrated to be highly significantly (P <.0001) associated with coronary artery stenosis in patients with normal total cholesterol, whereas there was no statistically significant association in the hypercholesterolemic patient subgroup. CONCLUSIONS: Our current study disclosed that RLP-C levels are strongly associated with coronary artery disease, especially in patients with normal total cholesterol levels. Moreover, RLP-C/HDL-C ratio may be even more significantly associated with the presence of coronary artery stenosis in normocholesterolemic patients.


Asunto(s)
Colesterol/sangre , Enfermedad Coronaria/sangre , Adulto , Anciano , Anciano de 80 o más Años , HDL-Colesterol , Fibrinólisis , Humanos , Hipercolesterolemia/sangre , Persona de Mediana Edad , Estudios Retrospectivos , Ácido Úrico/sangre
10.
Rinsho Ketsueki ; 41(11): 1226-30, 2000 Nov.
Artículo en Japonés | MEDLINE | ID: mdl-11193444

RESUMEN

A 45-year-old woman was referred to our hospital because of hyperthyroidism complicated by atrial fibrillation and heart failure. Laboratory data revealed pancytopenia, with a white blood cell count of 2,600/microliter, red blood cell count of 330 x 10(4)/microliter, and platelet count of 6.2 x 10(4)/microliter. The patient had normal transaminase levels, but tests for hepaplastin and cholinesterase showed values of 34% and 1.4 U/ml, respectively, indicating liver dysfunction. There was also decreased excretion of indocyanine green. After initiation of treatment with 30 mg thiamazole and 20 mg propranolol daily, the patient's thyroid function normalized and the other abnormal laboratory findings such as pancytopenia and liver dysfunction also disappeared. Pancytopenia is a rare complication of hyperthyroidism. In this case, various laboratory abnormalities were normalized by antithyroid therapy alone, indicating that the hyperthyroidism itself was closely related to the pathogenesis of pancytopenia and liver dysfunction.


Asunto(s)
Antitiroideos/uso terapéutico , Hipertiroidismo/tratamiento farmacológico , Hepatopatías/fisiopatología , Metimazol/uso terapéutico , Pancitopenia/fisiopatología , Femenino , Humanos , Hepatopatías/complicaciones , Persona de Mediana Edad , Pancitopenia/complicaciones
11.
Rinsho Ketsueki ; 40(8): 646-51, 1999 Aug.
Artículo en Japonés | MEDLINE | ID: mdl-10496039

RESUMEN

A 60-year-old woman was admitted to our hospital in February 1993 due to dizziness, dyspnea, abdominal pain, and high susceptibility to bleeding. Physical examination revealed livedo reticularis of the foot, but did not detect hepatosplenomegaly. Examination of the peripheral blood detected pancytopenia, leukoerythroblastosis, and tear-drop erythrocytes. Primary myelofibrosis (PMF) was diagnosed on the basis of bone marrow biopsy findings. Antiphospholipid syndrome (APS) was confirmed by positive response to anti-cardiolipin antibody and recurrent splenic infarction. Because of factor XIII deficiency, the patient experienced severe gingival bleeding after tooth extraction. Her condition was complicated by mesenteric arterial thromboembolism and she died of sepsis 5 years after onset. Although the incidence of immunopathy in PMF patients is high, few studies to date have focused on APS patients presenting with a variety of severe embolic symptoms. Our patient required careful monitoring due to bleeding tendency and thromboemboli.


Asunto(s)
Síndrome Antifosfolípido/complicaciones , Arterias Mesentéricas , Mielofibrosis Primaria/complicaciones , Tromboembolia/etiología , Resultado Fatal , Femenino , Humanos , Persona de Mediana Edad
12.
Br J Haematol ; 103(2): 297-303, 1998 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-9827895

RESUMEN

There is an increasing incidence of the evolution of myelodysplastic syndrome (MDS) from aplastic anaemia (AA) with immunosuppressive treatment. In paediatric patients G-CSF is also reported to increase MDS evolution, but this process is not precisely understood in children or in adults. Therefore risk factors of MDS evolution in adults are evaluated here. Of 72 patients, five developed MDS. In 47 patients without cyclosporine (CyA) or antithymocyte globulin (ATG) therapy, only one developed MDS with trisomy 8, 242 months after diagnosis. But of 25 patients treated with either CyA or ATG, four developed monosomy 7 MDS within 3 years. Of these 25 patients, 18 were treated with G-CSF and the four patients (22.2%) who developed MDS were found in this group. The cumulative dose and the duration of G-CSF administration were significantly elevated in patients who developed MDS when compared with those who did not, 822.3 +/- 185.0 v 205.4 +/- 25.5 microg/kg (P<0.05) and 187.5 +/- 52.5 v 72.0 +/- 24.6 d (P<0.002), respectively. However these two values for CyA did not differ significantly. Statistically, treatment with CyA, G-CSF and combined G-CSF and CyA were significantly related to MDS evolution. The administration of G-CSF for more than a year was the most important factor (P=0.00). These results suggested that a close relationship exists between G-CSF and subsequent monosomy 7 MDS from AA in adults who receive immunosuppressive therapy. Long-term administration of G-CSF should be prohibited in order to prevent MDS evolution.


Asunto(s)
Anemia Aplásica/terapia , Cromosomas Humanos Par 7 , Factor Estimulante de Colonias de Granulocitos/efectos adversos , Monosomía , Síndromes Mielodisplásicos/etiología , Adolescente , Adulto , Anciano , Ciclosporina/efectos adversos , Esquema de Medicación , Femenino , Estudios de Seguimiento , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Humanos , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia
13.
Am Heart J ; 136(2): 226-30, 1998 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-9704682

RESUMEN

BACKGROUND: There is as yet no definite consensus on the predictive value of the various lipid profiles and fibrinolytic parameters that became available in clinical use recently for coronary artery disease. METHODS: Levels of lipoprotein(a), high-density lipoprotein cholesterol (HDL-C), remnant-like particles cholesterol (RLP-C), tissue plasminogen activator (TPA), TPA inhibitor, antithrombin III, and protein C were measured in 124 patients who underwent diagnostic coronary angiograms. RESULTS: Of these patients, 37 had no significant stenoses (group N) and 87 had significant stenoses (group S). There were no significant differences in patient characteristics between the two groups. HDL-C was significantly lower (p = 0.0071 ) and RLP-C was significantly higher (p = 0.0022) in group S. When a product and a ratio of each of two factors were calculated, RLP-C/HDL-C was demonstrated to be a highly significant predictor for coronary artery stenoses (p < 0.0001). There were also significant increases in RLP-C/HDL-C levels with increasing number of vessels involved (r = 0.359, p < 0.0001 ). CONCLUSION: Our present study disclosed the predictive value of RLP-C/HDL-C ratio as a new indicator of coronary artery disease.


Asunto(s)
HDL-Colesterol/sangre , Colesterol/sangre , Enfermedad Coronaria/diagnóstico , Fibrinólisis/fisiología , Lipoproteína(a)/sangre , Adulto , Anciano , Anciano de 80 o más Años , Antitrombina III/metabolismo , Angiografía Coronaria , Enfermedad Coronaria/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Proteína C/metabolismo , Factores de Riesgo , Activador de Tejido Plasminógeno/sangre
14.
Acta Haematol ; 100(1): 57-60, 1998.
Artículo en Inglés | MEDLINE | ID: mdl-9691149

RESUMEN

A 55-year-old Jehova's Witness was treated for acute myelogenous leukemia (AML) by intensive chemotherapy with enocitabine, 6-mercaptopurine and daunorubicin. G-CSF, M-CSF and EPO were subsequently administered. Even though no blood transfusion was given for religious reasons, complete remission was achieved without serious infection and hemorrhage. The total cost for induction chemotherapy was less expensive than is the case for elderly AML patients. This case indicates that the administration of cytokines might reduce the incidence of infection and the necessity for blood products, which would result in favorable cost effectiveness for the treatment of elderly patients with AML.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Eritropoyetina/uso terapéutico , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Leucemia Mieloide Aguda/tratamiento farmacológico , Factor Estimulante de Colonias de Macrófagos/uso terapéutico , Transfusión Sanguínea , Costos y Análisis de Costo , Humanos , Leucemia Mieloide Aguda/economía , Masculino , Persona de Mediana Edad , Inducción de Remisión
15.
Rinsho Ketsueki ; 39(6): 463-5, 1998 Jun.
Artículo en Japonés | MEDLINE | ID: mdl-9695677

RESUMEN

An 80-year-old woman was referred to our hospital because of irregular genital bleeding. An abnormal mass was found in the uterine cervix, and diagnosed as non-Hodgkin's lymphoma, diffuse large B cell type. Soon after admission, the patient became anuric and was given a diagnosis of acute renal failure due to obstruction of the ureter. She was immediately placed on dose-reduced CHOP and radiotherapy of 15 Gy. As a result, not only did the malignant lymphoma go into remission, but diminished renal function was alleviated. Because malignant lymphoma of the uterus is extremely rare, it exact biocharacteristics are not well understood. We are unaware of any previous report concerning uterine lymphoma complicated by renal failure.


Asunto(s)
Lesión Renal Aguda/etiología , Linfoma de Células B/complicaciones , Linfoma de Células B Grandes Difuso/complicaciones , Obstrucción Ureteral/etiología , Neoplasias del Cuello Uterino/complicaciones , Anciano , Anciano de 80 o más Años , Femenino , Humanos
16.
Intern Med ; 37(3): 330-3, 1998 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-9617874

RESUMEN

A 55-year-old man had rhabdomyolysis and myocardial damage induced by palytoxin. Weakness and myalgia of four extremities occurred five hours after eating a fish. Rhabdomyolysis developed and the serum creatine phosphokinase (CK) was elevated to 40,000 IU/l on the 3rd day. Gastric lavage with activated charcoal and forced mannitol-alkaline diuresis therapy were performed. The patient recovered with no complication such as renal failure. In this case, palytoxin was suggested to induce myocardial damage which was demonstrated by an elevation of the myosin light chain level and a change in electrocardiogram.


Asunto(s)
Acrilamidas/envenenamiento , Cardiomiopatías/inducido químicamente , Venenos de Cnidarios/envenenamiento , Peces , Rabdomiólisis/inducido químicamente , Animales , Cardiomiopatías/sangre , Cardiomiopatías/terapia , Creatina Quinasa/sangre , Diuréticos Osmóticos/uso terapéutico , Electrocardiografía , Estudios de Seguimiento , Enfermedades Transmitidas por los Alimentos/etiología , Lavado Gástrico , Humanos , Masculino , Persona de Mediana Edad , Cadenas Ligeras de Miosina/sangre , Rabdomiólisis/sangre , Rabdomiólisis/terapia
17.
Surg Today ; 28(4): 412-5, 1998.
Artículo en Inglés | MEDLINE | ID: mdl-9590708

RESUMEN

An extremely unusual case of gastric outlet syndrome, otherwise known as Bouveret's syndrome, caused by a large gallstone impacted in the duodenum due to a cholecystoduodenal fistula (CDF), is described herein. Another large gallstone impacted in the CDF itself was also detected. As endoscopic extraction of the gallstone from the duodenum proved unsuccessful, and a laparotomy was required. Our patient, being 88 years old, is probably the oldest patient recorded in the literature of this syndrome. The methods of establishing a correct diagnosis by endoscopy and recent therapeutic strategies are discussed following the case report.


Asunto(s)
Colelitiasis/complicaciones , Obstrucción de la Salida Gástrica/etiología , Anciano , Anciano de 80 o más Años , Fístula Biliar/complicaciones , Fístula Biliar/diagnóstico , Colelitiasis/cirugía , Enfermedades Duodenales/complicaciones , Enfermedades Duodenales/diagnóstico , Femenino , Gastroscopía , Humanos , Fístula Intestinal/complicaciones , Fístula Intestinal/diagnóstico
19.
Eur J Haematol ; 59(4): 247-53, 1997 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-9338623

RESUMEN

Hemophagocytic syndrome (HPS) presents with fever, pancytopenia, liver dysfunction and increase in hemophagocytic histiocytes in various organs. Although there are two major classifications of HPS in adults, malignant and reactive histiocytosis, it is often very difficult to distinguish between these disorders. We analyzed the laboratory data of patients with HPS to evaluate prognostic factors. Of 34 patients, 14 survived, and 20 died. The median age of survivors was 29.6+/-11.5 yr significantly younger than those who died (54.7+/-17.8 yr). Twenty patients had no obvious underlying disease, the other 13 had hematological malignancies or viral infections. Comparison of laboratory data revealed that nonsurvivors had significantly lower Hb and platelet values on admission. During treatment, worsening of anemia and thrombocytopenia, increase of transaminase and biliary enzymes were similarly more prominent. Risk factors associated with death were: age over 30 yr, presence of disseminated intravascular coagulation, increased ferritin and beta2-microglobulin, anemia accompanied by thrombocytopenia and jaundice. Our data suggests that patients with HPS and any of these risk factors should be treated aggressively with sufficient chemotherapy and supportive care.


Asunto(s)
Trastornos Histiocíticos Malignos/fisiopatología , Histiocitosis de Células no Langerhans/fisiopatología , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Trastornos Histiocíticos Malignos/mortalidad , Histiocitosis de Células no Langerhans/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo
20.
Surg Today ; 27(6): 559-62, 1997.
Artículo en Inglés | MEDLINE | ID: mdl-9306552

RESUMEN

The direct causal relationship between dermatomyositis-polymyositis (PM) and malignancy remains controversial. We describe herein the case of a patient who underwent surgical treatment for colon cancer, which had preceded the onset of PM with tumor relapse. The PM markedly improved following the initiation of steroid therapy, and has remained under control, probably as a result of chemotherapy. The current concepts of variable clinical courses and the possible mechanism for the association of PM with malignancy are discussed following this case report.


Asunto(s)
Adenocarcinoma/complicaciones , Neoplasias del Colon/cirugía , Recurrencia Local de Neoplasia/complicaciones , Polimiositis/complicaciones , Adenocarcinoma/inmunología , Adenocarcinoma/patología , Antígeno Carcinoembrionario/sangre , Neoplasias del Colon/inmunología , Neoplasias del Colon/patología , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/inmunología , Recurrencia Local de Neoplasia/patología , Polimiositis/inmunología , Polimiositis/patología
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