Fourteen patients with sexually transmitted human immunodeficiency virus (HIV)-related immune thrombocytopenia were treated with intravenous gammaglobulin (IVIG). The patients were treated with a ...uniform program consisting of 1 g/kg of IVIG on day 1 and day 2, followed by 1 g/kg on day 15. Most patients had pretreatment bleeding symptoms, which included petechiae, spontaneous and traumatic ecchymoses, gum bleeding, and epistaxis. Median baseline platelet count was 17,000/mm3 (range 3-61,000/mm3). After the infusion of the IGIV, all patients had a resolution of their bleeding by day 8. The median maximum platelet count achieved with the IGIV was 220,000/mm3 (range 76-426,000/mm3). No patient achieved either a sustained complete or partial remission after the conclusion of the IVIG therapy. Toxicities were minimal with the majority being headache and nausea. In conclusion, patients with sexually transmitted HIV infection and immune thrombocytopenia respond favorably to IVIG. This treatment should be considered as first-line therapy for patients with HIV-related immune thrombocytopenia who require immediate but temporary increase in their platelet count, attributable to symptoms or signs of clinical bleeding or because of the need for an invasive procedure.
Ornithine decarboxylase (ODC) activity in biopsy specimens of normal-appearing rectal mucosa was measured in 15 control patients, 5 patients with colon adenomas, and 11 patients with colon cancer. ...While women had significantly higher ODC activity than men, ODC activity was increased regardless of gender in the rectal mucosal biopsies of patients with benign or malignant colonic neoplasia compared with those of controls. The positive predictive value of ODC activity for remote colonic neoplasia was 61% for women and 91% for men. The results provide a rationale for long-term studies of ODC activity in rectal mucosa as a biological marker of high risk for large bowel neoplasia.
Invited Comment Hunter, J. Stuart; Stigler, Stephen M.; Fienberg, Stephen E. ...
The American statistician,
05/1994, Volume:
48, Issue:
2
Journal Article
The ABH blood group isoantigen status of a retrospective series of 233 invasive breast carcinomas was examined, employing monoclonal antibodies (MCAB) against A, B, and H antigens with the ...avidin-biotin-peroxidase complex method. In addition, the H antigen was localized with Ulex Europeus Agglutinin I (UEAI) binding. The MCABs provided consistent and specific staining of erythrocytes and endothelium, as well as normal and neoplastic breast epithelium. The anti-H MCAB yielded cleaner background and less intense staining, but otherwise the staining distribution was comparable to the UEA I technique. Contrary to previous reports, deletion of isoantigen expression was not universal in all invasive carcinomas. Whereas 64%, 77%, and 73% of carcinomas from groups A, B, and AB patients, respectively, demonstrated total isoantigen loss, the remaining tumors exhibited variable degrees of isoantigen expression. Moreover, those carcinomas with complete loss of A and B determinants still displayed variable degrees of H immunoreactivity. Carcinomas from group O patients had different degrees of H antigen deletion, with only 12% showing total loss. Statistical analysis revealed that the isoantigen status bore no significant relationship to various epidemiologic, clinical, and pathologic parameters and did not serve as a useful prognostic determinant.
Inter-observer and intra-observer reliability for classifying radial head fractures by the system of Mason was analyzed. Twenty-three cases of isolated radial head fractures and twenty-five sets of ...corresponding AP and lateral radiographs representing these fractures were assembled. The cases were reviewed and assessed independently according to the system of Mason by twenty practicing orthopedic surgeons. On two occasions, the inter-observer and intra-observer variation was analyzed by standard unweighted Kappa statistics. In both observations, complete agreement was seen in only 16% of the cases. Kappa statistic values indicated that 69% of the cases at first observation and 45% of the cases at second observation suggest moderate to poor agreement. Intra-observer agreement between the first and second observation was graded fair to poor in 60% of the cases. Individual observer consistency was, on average, only 78% (range 60% to 92%). The demonstrated wide degree of variation suggests that the Mason classification is unreliable.
Clinical Trials: A Pratical Approach Groshen, Susan
Journal of the American Statistical Association,
03/1987, Volume:
82, Issue:
397
Book Review, Journal Article
Background. There are few biologic determinants that are prognostic for patients with localized prostate cancer. We examined whether cellular levels of the cyclin-kinase inhibitor p27Kipl (also known ...as p27) in prostate tumors could be used to predict progression of this disease. Methods: Levels of p27 in tumor cell nuclei were assessed by immunohistochemical analysis of tissue sections from the primary tumors of 96 patients with stage C prostate carcinoma who had been treated by radical prostatectomy. Tumors were classified into one of the following three groups on the basis of the percentage of tumor cells showing nuclear p27 reactivity: low (0%–10%), moderate (11%–50%), and high (>50%). The Mantel-Haenszel test, Kaplan-Meier analysis, and the logrank test were used to calculate the probability that nuclear p27 levels were associated with tumor grade and substage, with a serum prostate-specific antigen (PSA) recurrence (defined as the finding of a detectable level 0.4 ng/ mL or greater of serum PSA following radical prostatectomy), with the recurrence of clinically evident disease, and with survival. All reported P values are two-sided. Results: Luminal cells and basal cells of normal prostate glands showed high levels of nuclear p27 immunoreactivity in all tissue sections examined. Fifty-three tumors showed high p27 reactivity, 31 showed moderate reactivity, and 12 showed low or no detectable reactivity. Decreased levels of p27 were associated with tumor grade (P = .004). Tumor levels of p27 were not associated with preoperative prostate-specific antigen levels (P = .360) or with tumor substage (P =.320). However, decreased p27 reactivity was significantly associated with an increased probability of recurrence (P -.004) and decreased survival (P =.010). The median recurrence-free interval for patients with tumors showing high, moderate, or low p27 reactivity was 13.7 years, 8.4 years, and 4.7 years, respectively. Median survival times were more than 14 years, more than 13.5 years, and 8.1 years for patients in the high, moderate, and low p27 reactivity groups, respectively. Conclusion: Levels of nuclear p27 immunoreactivity in the primary tumor can be used to predict recurrence and survival among patients with localized prostate cancer. J Nall Cancer Inst 1998;90:916-20
Enteral solutions must flow freely through nasoenteric tubes selected for gravity drip administration particularly in outpatients receiving nutritional support. This study determined in vitro flow ...rates of solutions with intact protein and hydrolyzed protein sources with various caloric densities. Each solution was infused through silicone rubber and polyurethane tubes of various lengths and bore sizes. Flow rates were measured five times at 25 degrees C using formula bags and drip sets hung at a uniform height and tubes uniformly positioned in a collecting vessel. Data are presented for tubes and formulas tested. Recommendations for selection of tubes for gravity drip administration are made based on flow rate data, patient comfort, administration convenience, and patient tolerance to osmolality.
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