The role of dietary protein in the treatment of renal disease remains a controversial one, in part because the influence of diets high or low in protein upon normal renal function is not completely understood. In the rat much evidence has accumulated that high-protein intakes lead to renal hypertrophy (1-3) and that low-protein diets may be associated with impairment of some renal functions (4). Pullman, Alving, Dern, and Landowne (5) (6), creatinine (7), urea (8), sodium and potassium (9) were also determined. The "t" test of "Student" was used in analyzing the data. Each subject was studied after three days on a LowProtein diet, containing approximately 20 grams of protein per day, and a High-Protein diet, containing 150 to 200 grams of protein per day. The latter was achieved by the use of 100 to 200 grams per day of a high-protein, low-sodium supplement.5 Both diets were approximately isocaloric; in some subjects the low-protein diet consisted chiefly of carbohydrate, in others fat predominated. Two subjects were studied on a Regular diet, containing about 90 gramns of protein per day. Other variations in dietary regimen will be described under Results.RESULTS (Table I) Effect of low-vs. high-protein diets on renal concentrating ability, inulin clearance and urea clearance (Figure 1) Maximum urinary solute concentration and maximum osmolal U/P ratio were invariably higher after three days of a high-protein intake than after a diet low or normal with respect to protein. The increases in maximum urinary osmolality with ingestion of large amounts of protein varied from 87 to 332 mOsm. per K. This occurred in association with an increased basal urinary flow containing from 1.2 to 5 times the quantity of solutes excreted on a low-protein diet. The maximum capacity of the kidneys to reabsorb water free of solute (TmOH2O) was likewise increased by 15 to 50 per cent in five subjects by feeding protein.Inulin clearance was slightly higher in each of five subjects on a high-protein regimen than on a diet low in protein. At the high urine flows obtained during mannitol diuresis, the clearance of 5 Melactin, supplied by E. R. Squibb and Co.635
A b s t r a c tAdenocarcinoma of the lung constituted 9% of all lung carcinomas in men 30 years ago.1 During the last several decades, its incidence has been increasing. [2][3][4][5][6][7][8] It is the most common cell type in females and in nonsmoking patients, and it is the most common tumor subtype in some regions of the world. 9-14 The incidence of bronchioloalveolar carcinoma (BAC) is also increasing. 15-17Many studies have evaluated pathologic prognostic features of adenocarcinomas, including cell types, architectural patterns, and stage. The majority these studies have not specifically examined Tl NO MO adenocarcinomas. Some studies used the previous definition of a stage I carcinoma and included patients with Nl metastases, other studies grouped adenocarcinomas with non-small cell carcinomas, and many have grouped Tl with T2 carcinomas.18~38 This has left a dearth of attention directed toward identifying prognostic factors for patients with Tl NO MO adenocarcinomas and BACs that undergo curative surgical excision. Prognostic features for this group of patients are important because the 5-year disease-free survival of patients with Tl NO MO adenocarcinoma is 66% to 85%. 39^6 Separation of adenocarcinomas from other pulmonary carcinomas and examining the subset of patients with Tl disease is essential to understand the metastatic potential and prognostic strength of pathologic factors of the different tumors included under the rubric of stage I adenocarcinoma and BAC. 43 In addition, the prognostic significance of distinguishing between BAC and conventional adenocarcinoma and the threshold for amount of central fibrosis allowable within the BAC category for prognostication has not been defined fully. Finally, the identification of prognostic variables within this group of patients is important for future adjuvant therapy studies to identify the subset of patients that are at higher risk of having an adverse carcinoma-related outcome.We retrospectively studied 218 cases of completely resected, surgically staged, Tl NO adenocarcinomas and
The T1, N0, M0 subset of stage I lung adenocarcinoma is a tumor that has a 5-year disease-free survival rate of 66% to 85%. To date, there has not been a rigorous immunohistochemically detected lymph node micrometastasis study composed of patients with identical stage and type of tumors, and in which standard histologic features were incorporated into multivariate analyses. We immunohistochemically examined the peribronchial and mediastinal lymph nodes from 80 consecutively accrued patients with T1, N0, M0 adenocarcinomas and bronchioloalveolar carcinomas unselected for distant metastasis, and an additional 39 patients with similar stage and type neoplasms who were selected for their development of metastases to evaluate the prevalence of micrometastases, their association with distant metastases, and their relationship with other pathologic prognostic features. All slides were stained with keratin AE1/3. Micrometastases were confirmed with Ber-Ep4. Three immunohistochemically detected lymph node micrometastases were identified in three of 80 consecutively accrued patients (4%). These three positive stains constituted 0.5% of the 573 stains required to immunohistochemically screen all of the lymph node blocks from these patients. Among the 39 patients who were selected because they developed distant metastases, three immunohistochemically detected lymph node micrometastases from three patients were identified, which constituted 8% of patients in this group and 1% of the 280 stains required to screen all of these patients' lymph nodes. Small vessel invasion, maximum tumor dimension, and immunohistochemically detected lymph node micrometastases were independently associated with metastases on multivariate analysis. Among patients who developed metastases, there was no significant difference in the disease-free survival rate between those with and those without immunohistochemically detected lymph node micrometastases. Given the low sensitivity in terms of the number of immunohistochemical stains performed, and the prognostic significance of standard histologic features, the use of immunohistochemical screening lymph nodes from all patients with T1, N0, M0 adenocarcinomas is questionable.
Background. The clinical, radiographic, and bronchoscopic records of patients treated with out‐patient high dose rate (HDR) endobronchial brachytherapy were reviewed to determine its effectiveness in patients with malignant airway obstruction (with or without prior external beam radiation). In addition, quality of life and acute and chronic morbidity were evaluated. Methods. From January 1, 1989 to June 30, 1993, 46 patients received 128 HDR endobronchial treatments employing a high activity Ir‐192 source with a remote afterloader. Patients treated had a total of 22 primary and 17 recurrent bronchogenic carcinomas, 7 of which were metastatic nonpulmonary tumors. Three separate fractions of 7.0 Gy were prescribed to a depth of 1.0 cm. and given 1 week apart. Twelve patients (30%) received prior external beam irradiation (median dose, 58 Gy). Results. Median follow‐up for the entire group was 5 months (17.5 for surviving patients). Of the eight asymptomatic patients, five (62%) remained asymptomatic for the remainder of their lives. Of the 38 symptomatic patients, 28 (74%) had significant clinical improvement, and 12 of them remained improved for the duration of their lives. Of thirty‐six (78%) patients examined for radio‐graphic response, 25 (69%) had a partial or complete response to this treatment. In patients without prior irradiation, there was a tendency for a higher percentage of clinical and radiographic response. Two patients (4%) experienced mild, transient dysphagia, four patients developed self‐limited radiation pneumonitis (9%), and three patients (7%) suffered fatal hemoptysis (all of these patients received prior or concurrent external beam radiotherapy). No factor (i.e., prior radiation therapy, number of catheters placed, surgery, or chemotherapy) predicted an increased risk of complications (P = NS). Conclusions. Outpatient HDR endobronchial brachytherapy is effective in both preventing and relieving endobronchial obstruction in patients with or without prior irradiation, recurrent lesions, or metastatic nonpulmonary disease. A significant proportion of patients can be rendered asymptomatic for the duration of their lives, hence were provided with improved quality of life. These treatments are well tolerated and safe, and result in minimal long term morbidity.
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