ABSTRACT
Trastuzumab has substantially changed the prognosis of breast carcinomas. As HER2 over-expression/amplification is a prerequisite for treatment with trastuzumab, an accurate assessment of HER-2 status is the first step for successful treatment. In metastatic breast cancer, we routinely assess HER2 expression in the primary tumour, assuming that HER2 status remains stable through cancer progression. However, it is frequent to find reports that describe discordance between HER2 expression in primary and metastatic tumours. The aim of this paper was to verify whether HER2 status of breast carcinomas is maintained in the corresponding axillary metastasis. Immunohistochemistry was performed on 52 breast carcinomas and their matched axillary metastasis. HercepTest results were concordant in 46 out of 52 cases (88.5%). FISH proved that the differences observed were clinically relevant in only one of the 52 cases studied (98% concordance). We concluded that HER2 status was stable during axillary metastatic progression. Evaluation of gene HER2 status in axillary metastasis rather than in the primary can be useful in certain situations, e.g., small invasive component intimately mixed with in situ component and difficult to recognize in dark field, no tumor after biopsy, or axillary relapse (in this case we can find occasional de novo amplifications susceptible to trastuzumab treatment).
Subject(s)
Breast Neoplasms/metabolism , Breast Neoplasms/pathology , Lymphatic Metastasis/pathology , Receptor, ErbB-2/biosynthesis , Adult , Aged , Aged, 80 and over , Female , Gene Amplification , Humans , Immunohistochemistry , In Situ Hybridization, Fluorescence , Middle AgedSubject(s)
Brain Abscess/diagnosis , Jugular Veins , Solitary Pulmonary Nodule/diagnosis , Thrombosis/diagnosis , Acute Disease , Adolescent , Brain Abscess/therapy , Combined Modality Therapy , Female , Headache/diagnosis , Headache/therapy , Humans , Sepsis/diagnosis , Sepsis/therapy , Solitary Pulmonary Nodule/therapy , Syndrome , Thrombosis/therapyABSTRACT
Provided here are the descriptions of 18 patients with focal infections caused by Salmonella spp no-typhi occurring in a period of seven years at the Puerta de Hierro Clinic. In all cases, there was at least one local factor, treatment, or underlying illness associated with decreased resistance to infection. Antecedents of severe gastroenteritis were found in seven cases (38 percent). Eighty-three percent had previous or concomitant bacteremia caused by the same serotype of Salmonella isolated in the focal infection. S. enteritidis was the most prevalent serotype (66 percent). The most common localizations were plueropulmonary (5), osteoarticular (5), and intravascular (3). Relapsing infection was demonstrated in five cases. There was 28 percent mortality. Statistically, age greater than 65 years and the absence of surgical intervention were associated with a worse prognosis.
Subject(s)
Salmonella Infections , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Salmonella/isolation & purification , Salmonella Infections/classification , Salmonella Infections/drug therapy , Salmonella Infections/mortalityABSTRACT
The syndrome of inappropriate secretion of antidiuretic hormone is a common consequence of neurologic and pulmonary infections as well as drug intake and many other clinical situations. Its association with herpes varicella-zoster virus infections is scarcely reported in the literature. It generally appears in immunosuppressed patients suffering from serious underlying diseases. There are also a few cases of syndrome of inappropriate secretion of antidiuretic hormone related to vidarabine use. We report the case of a man infected by human immunodeficiency virus who developed a disseminated herpes varicella-zoster virus infection and symptoms due to hyponatremia caused by antidiuretic hormone excess. The patient was cured with saline hypertonic infusion, water restriction, and intravenous administration of acyclovir. To the best of our knowledge, this is the first case of this association in a human immunodeficiency virus infected patient. We propose the use of acyclovir instead of vidarabine in the management of these situations.
Subject(s)
AIDS-Related Opportunistic Infections/complications , Acquired Immunodeficiency Syndrome/complications , HIV-1 , Herpes Zoster/complications , Inappropriate ADH Syndrome/complications , AIDS-Related Opportunistic Infections/drug therapy , Acyclovir/therapeutic use , Adult , Herpes Zoster/drug therapy , Humans , Hyponatremia/complications , Male , SyndromeABSTRACT
BACKGROUND: Tuberculous meningitis accounts for 5% to 12% of all extrapulmonary tuberculosis cases in western-hemisphere population non infected by HIV virus, and carries a high mortality rate. METHODS: We analyze retrospectively 21 patients with tuberculous meningitis in HIV negative patients seen from 1975 to 1989, with emphasis on clinical, laboratory and therapeutic features. RESULTS: In 48% of cases there were not typical meningeal signs, and 61% of patients showed neurological focal signs and/or seizures. CSF examination revealed a clear fluid with high cell counts (mostly lymphocytes), high protein and low sugar levels in 67% of cases. However, the microbiologic examination had a low yield of diagnosis (33%). The clinical course is prolonged, and treatment is usually delayed. Morbidity and mortality were high (34% and 10% of cases). In this study, the use of steroids did not show a significant reduction in mortality nor in neurological sequelae. CONCLUSION: Tuberculous meningitis in HIV negative patients is a chronic infection, without meningeal signs in most cases and linked to a high rate of neurological defects. The microbiologic tests have low yield of diagnosis. Steroid drugs seem to be indicated only if there are additional complications.
Subject(s)
Tuberculosis, Meningeal/epidemiology , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Aged, 80 and over , Antitubercular Agents/therapeutic use , Biomarkers , Child , Child, Preschool , Disease Susceptibility/immunology , Female , Humans , Incidence , Male , Middle Aged , Nervous System Diseases/etiology , Retrospective Studies , Spain/epidemiology , Tuberculosis, Meningeal/cerebrospinal fluid , Tuberculosis, Meningeal/complications , Tuberculosis, Meningeal/diagnosis , Tuberculosis, Meningeal/drug therapyABSTRACT
Due to the controversy on the need of performing temporal artery biopsies for the diagnosis of giant cell arteritis (GCA), we have reviewed 204 biopsies of temporal arteries as well as the clinical histories of the 190 patients. Patients without local manifestations were excluded from this study. From the 173 remaining patients, 54 presented a diagnostic biopsy of GCA. The 119 patients with a negative biopsy were divided into different groups according to the final diagnosis. From our data we could not find a clinical pattern which could permit the prediction of biopsy positiveness. We could not find either any clinical entity in the nondiagnostic group which would permit to exclude a diagnosis before performing the biopsy. We consider that the biopsy of the temporal artery can not be avoided nowadays and that it represents the only decisive diagnostic method of GCA.
Subject(s)
Biopsy , Giant Cell Arteritis/pathology , Temporal Arteries/pathology , Aged , Diagnosis, Differential , Evaluation Studies as Topic , Female , Giant Cell Arteritis/diagnosis , Humans , Male , Polymyalgia Rheumatica/diagnosisABSTRACT
The case is described of a 34 year old female who suffered quinidine induced lupus, which appeared 14 months after the administration of the drug, and it was necessary to substitute it. This secondary effect o quinidine, which is rarely described, can go unnoticed if it is no kept in mind. The diagnostic criteria for drug induced lupus ar discussed and the clinical and analytical manifestations of 27 cases o quinidine induced lupus described in the literature are reviewed.
