Correlation between stage and grade in prostatic adenocarcinoma: a morphometric study.

The independence of stage and grade as prognostic factors for prostatic carcinoma is unclear. Previous studies have been hampered by both the uncertain reproducibility of subjective grading systems and the lack of a scalar grading measure, and have reached opposing conclusions. To examine this question, we quantitated via point-counting the per cent of tumor cells showing glandular differentiation in 90 cases of primary prostatic adenocarcinoma. Patient records were examined retrospectively to verify both the stage at presentation and follow-up. Stage and morphometric grade were found to be inversely correlated, (p less than 0.001), with the mean per cent of tumor cells showing glandular differentiation at each stage as follows: A--71 per cent; B--59 per cent; C--33 per cent; D--28 per cent. Analysis of variance revealed these differences to be significant (p less than 0.001), and Newman-Keuls test showed significant differences between the following stage pairs: A-C, A-D, B-C, B-D (p less than 0.05). In spite of the marked correlation between stage and grade, multiple regression analysis showed them to be independent predictors of survival, although their combined effect was not much greater than that of morphometric grading alone. We conclude that, for prostatic carcinoma, the close correlation of stage and grade makes it difficult to combine them in determining the prognosis of the individual patient, although both together may be useful in studies of large populations.

Aztreonam compared with gentamicin for treatment of serious urinary tract infections.

52 patients with serious urinary tract infections were randomised to receive either aztreonam (35) or gentamicin (17). In the aztreonam group 23 patients had unqualified cures, 6 cures with relapse, and 6 cures with reinfection; the comparable numbers in the gentamicin group were 9, 1, and 4. There were no failures with aztreonam and 3 with gentamicin. The most important determinant of outcome was the presence or absence of urological abnormalities. 11 further patients, with renal failure or gentamicin-resistant isolates, treated with aztreonam were all cured. Toxic effects were limited to symptomless liver-function-test abnormalities with aztreonam , whereas deterioration in renal function occurred in 4 gentamicin-treated subjects. Urinary colonisation with group D streptococci occurred in 14 of 46 aztreonam -treated patients (1 required treatment) compared with only 1 of 17 gentamicin-treated patients. 97% of 309 consecutive gram-negative urinary isolates tested, including 50 Pseudomonas aeruginosa, were susceptible in vitro to aztreonam and 91% to gentamicin. Aztreonam may prove an effective and safe alternative to the aminoglycosides.