RESUMEN
A female patient aged 37 years who suffered from chronic myeloid leukemia received an allogeneic bone marrow transplantation (BMT) from an HLA-matched unrelated donor. No life-threatening complications ensued; 2.5 years after BMT she is still in complete remission. Survival after BMT from an unrelated donor for the time being is still lower than that after BMT from a related donor, but is improving due to better prevention and treatment of opportunistic infections and better selection of registered donors by meticulous HLA matching.
Asunto(s)
Trasplante de Médula Ósea/métodos , Leucemia Mielógena Crónica BCR-ABL Positiva/terapia , Adulto , Trasplante de Médula Ósea/efectos adversos , Trasplante de Médula Ósea/mortalidad , Femenino , Enfermedad Injerto contra Huésped/prevención & control , Prueba de Histocompatibilidad , Humanos , Infecciones Oportunistas/prevención & control , Pronóstico , Inducción de Remisión , Donantes de TejidosRESUMEN
To analyse the clinical significance of the presence of androgen receptors (AR) in breast carcinomas, clinical and histological parameters of 153 primary breast carcinomas (median follow-up 46 months) were examined. Oestrogen (ER) and progesterone receptor (PR) levels were determined in cytosol preparations using enzyme immunoassay assays and in cryostat sections by immunohistochemistry. AR and Ki-67 levels were only determined immunohistochemically. Data were analysed by uni- and multivariate models. 94/153 (61%) breast carcinomas were ER+ PR+ AR+, while 14 cases were only positive for AR. All grade III tumours (n = 17) were steroid receptor negative and 14 (76%) of these cases demonstrated high Ki-67 values suggestive of more aggressive behaviour. Strikingly, 14 ductal carcinomas negative for ER and PR were positive for AR. In univariate analysis, AR as well as ER, tumour size, lymph node status, grade and Ki-67 proved to be significant prognostic factors for disease-free survival (DFS). Multivariate analysis, however, showed lymph node status, tumour size and ER status to be the only independent prognostic factors for DFS within this model. We conclude that simple histological and cell biological parameters, including AR, can be used to select high- and low-risk patients at the time of primary surgery and can provide valuable information on treatment options.
Asunto(s)
Neoplasias de la Mama/metabolismo , Receptores Androgénicos/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/patología , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Técnicas para Inmunoenzimas , Inmunohistoquímica , Antígeno Ki-67/metabolismo , Metástasis Linfática , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Receptores de Estrógenos/metabolismo , Receptores de Progesterona/metabolismoRESUMEN
The systemic treatment of soft tissue sarcomas is difficult due to the limited availability of active cytotoxic drugs. Combinations of cytotoxic drugs at standard doses do increase toxicity but do not improve response rates or survival. All combinations are limited by myelosuppression, mainly leukocytopenia. For at least two of the four active drugs (doxorubicin and ifosfamide) studies have shown a clear dose-response relationship. Recent studies have focused on increasing dose-intensity by increasing dosages or shortening treatment intervals, which is only possible by the use of hematological growth factors. This review will focus on the latter concept.
Asunto(s)
Antineoplásicos/administración & dosificación , Enfermedades de la Médula Ósea/tratamiento farmacológico , Factores de Crecimiento de Célula Hematopoyética/uso terapéutico , Sarcoma/tratamiento farmacológico , Neoplasias de los Tejidos Blandos/tratamiento farmacológico , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Enfermedades de la Médula Ósea/inducido químicamente , Ensayos Clínicos como Asunto , Relación Dosis-Respuesta a Droga , Humanos , Estudios Multicéntricos como Asunto , Proteínas Recombinantes/uso terapéutico , Inducción de Remisión , Sarcoma/complicaciones , Neoplasias de los Tejidos Blandos/complicaciones , Resultado del TratamientoRESUMEN
Thirty-two patients suspected of deep venous thrombosis (DVT) of the leg were evaluated after simple plasma tests (latex D-dimer and Elisa D-dimer) against echography and phlebography as the gold standard of DVT. Seven patients showed negative results in the latter test. The classification conformity between the D-dimer methods amounted 84.4%. With regard to the diagnostic classification a high specificity of 100% was found for the latex D-dimer test at the cut-off level of 450 ng/ml, whereas for sensitivity, 96% was reached. The Elisa D-dimer test was striking by its high sensitivity of 100%, but its low specificity of 28.5%. In summary, these results demonstrate that when there is a suspicion of DVT according to the clinical symptoms, a negative latex test may reject the diagnosis, whereas the latex test is less useful to establish the diagnosis. On the contrary, the Elisa D-dimer test has a too high false-positive rate. The latex D-dimer test seems to be a reliable tool to exclude the diagnosis after which an ascending contrast venography can be omitted.