Development of immunohistochemistry services for cancer care in western Kenya: Implications for low- and middle-income countries.

Background: Cancer is becoming a major cause of mortality in low- and middle-income countries. Unlike infectious disease, malignancy and other chronic conditions require significant supportive infrastructure for diagnostics, staging and treatment. In addition to morphologic diagnosis, diagnostic pathways in oncology frequently require immunohistochemistry (IHC) for confirmation.

Myocardial abscess and fatal cardiac arrhythmia in a hemodialysis patient with an arterio-venous fistula infection.

Myocardial abscess formation is a life-threatening complication that is frequently but not exclusively associated with infective endocarditis. To our knowledge there are only two case reports of myocardial abscess formation in hemodialysis patients. Only one of these reports describes a myocardial abscess of bacterial etiology secondary to an infected intravascular hemodialysis catheter.

Molecular evidence for the same clonal origin of multifocal papillary thyroid carcinomas.

Purpose: Patients with papillary thyroid carcinoma often have two or more distinct papillary tumors at thyroidectomy. Whether these multifocal papillary lesions are clonally related or whether they arise independently is unknown as previous studies have shown conflicting results. Molecular analysis of microsatellite alterations and X-chromosome inactivation status in separate tumors from the same patient can be used to define the genetic relationships among the multiple coexisting tumors.

Calcified thoracic disc herniation with paraparesis. A case report.

We present a case with partially calcified thoracic discs, one of which extruded into the spinal canal with paraparesis. The paste-like consistency complicated excision.

Changes in serum catecholamine levels in patients who are brain dead.

Prospective blood samplings from 15 patients admitted with a Glasgow Coma Score of less than 7 were obtained to observe and compare epinephrine, norepinephrine, and dopamine serum levels in patients with brain injury before, after, and in the absence of brain death. Nine of the patients developed or were admitted after brain death. Wide variations in catecholamine blood levels over time were documented, and subgroup analysis precluded useful statistical comparison or inference of the data.

Individualizing amikacin regimens: accurate method to achieve therapeutic concentrations.

Amikacin's pharmacokinetics and dosage requirements were studied in 98 patients receiving treatment for gram-negative infections. A wide interpatient variation in the kinetic parameters of the drug occurred in all patients and in patients who had normal serum creatinine levels or normal creatinine clearance. The half-life ranged from 0.

Death occurring within one week of cardiac transplantation: findings in eight patients.

Between October 1982 and July 1988, 85 patients underwent orthotopic heart transplantation at Methodist Hospital of Indiana. Excluding perioperative deaths, survival rates at six months, one year, two years and three years were 94%, 80%, 74% and 61%, respectively. However, eight patients (9.

Amikacin pharmacokinetics: wide interpatient variation in 98 patients.

The disposition of amikacin was studied in 98 patients receiving treatment for severe gram-negative sepsis. Several factors were identified which were significantly related to the drug's elimination rate. These included renal function (r = .

Initial dosage regimens of gentamicin in patients with burns.

For 95 patients with burns the gentamicin dosage regimen necessary to achieve optimal serum concentrations was determined. Individual elimination rates and distribution volumes for gentamicin were determined and correlated with renal function parameters and age. In patients with burns who had normal serum creatinine levels (less than 1.

Blunt trauma in adults and children: a comparative analysis.

Trauma remains the major cause of death in children and young adults. Adult and pediatric patients differ significantly in both mechanism of and physiologic response to injury. We reviewed the records of all consecutive adult and pediatric blunt trauma patients admitted to a major metropolitan trauma center for a 10-year period.

Thermal injury effects on drug disposition: a prospective study with piperacillin.

The disposition of piperacillin was prospectively evaluated in nine severely burned patients who had normal renal and hepatic function. Wide interpatient variations were demonstrated in the drug's distribution volume, half-life, and clearance, with mean (+/- SD) values of 55.0 (+/- 44.

Effects of treatment and the metabolic response to injury on drug clearance: a prospective study with piperacillin.

The disposition of piperacillin was prospectively evaluated in 11 critically ill surgical patients who had no evidence of pre-existing renal and hepatic disease. Interpatient variations were demonstrated in the drug's half-life, distribution volume, and clearance, with values of 1.50 +/- 2.

An unusual cause of massive non-surgical pneumoperitoneum: case report.

A case of pneumoperitoneum due to cocaine abuse is presented. Although most commonly associated with surgical disease, pneumoperitoneum may actually be a manifestation of non-surgical intrathoracic pathology. In this patient percutaneous diagnostic peritoneal lavage resulted in return of a large quantity of air and was negative for bleeding or contamination.

Renal failure and mortality after nephrectomy for severe trauma in multiply-injured patient: no inordinate risk.

It was recently reported that renal loss by partial or total nephrectomy for renal trauma increases the rates of acute renal failure and death in the multiply-injured patient. Because our preference has been for immediate surgical intervention in such patients, a retrospective review was performed to ascertain the effect of partial or total nephrectomy. Eighty-eight patients met the criteria of multiple injuries including severe renal injuries (laceration, rupture, or pedicle injury) and availability of renal function data.

Laser Doppler flowmetry and cardiac output in critically ill surgical patients.

Laser Doppler flowmetry (LDF) accurately measures cutaneous microcirculatory blood flow. We compared change in LDF flow to change in thermodilution cardiac output in ten critically ill surgical patients. A subset analysis of three patients with low cardiac output (cardiac index less than 2 L/min X m2) showed no correlation.

Squamous carcinoma of the lung in a nonirradiated, nonsmoking patient with juvenile laryngotracheal papillomatosis.

Juvenile laryngotracheal papillomatosis (JLTP)--a disease characterized by the growth of multiple, recurrent, koilocytolic papillomas of the upper respiratory tree--occurs in 1,500 to 2,000 infants and children in the United States every year. In rare instances, the papillomas, which are thought to be caused by a human papillomavirus (HPV), may extend into the distal bronchi and lungs. They are often excised surgically or by laser resection, but may regress spontaneously.

Pharmacy practice in the United States Air Force.

The current status of pharmaceutical services in the United States Air Force Medical Service is described. The mission of the USAF Medical Service is to provide medical support to combat forces and to deliver health care to active duty and retired military members and their dependents. The USAF operates 121 medical treatment facilities (MTFs) worldwide.

Eosinophilic enteritis associated with chronic eosinophilic pneumonia.

A case of eosinophilic pneumonia and eosinophilic infiltration of the small bowel and colon is reported. The patient presented with nonspecific chest and abdominal symptoms, and lack of response to therapy for presumed pneumonia. Further investigation including lung, muscle, and gastrointestinal tract biopsies revealed eosinophilic infiltration of the lung and gastrointestinal tract, an association that does not appear to have been previously documented.

Comparison of radioimmunoassay and fluorescent polarization immunoassay for quantitative determination of vancomycin concentrations in serum.

A new fluorescent polarization immunoassay (Abbott Laboratories, Diagnostics Division, North Chicago, Ill.) was compared with a standard radioimmunoassay (American Diagnostics Corp., Newport Beach, Calif.

The effect of barium enemas and barium sulfate on healing of colorectal biopsy sites.

Twelve mongrel dogs had superficial and deep colon biopsies above and below the peritoneal reflection. Six of the animals were given a barium enema; two had a barium enema immediately, two in three days, and two in six days. The animals were sacrificed 48 hours after the barium enema; the sigmoid was removed and tissue was examined macroscopically and microscopically.

Blunt injury to the colon and rectum.

One hundred nine patients suffering blunt injury to the colon or rectum were treated between 1 January 1970 and 31 December 1980. Vehicular accidents accounted for 90% of the injuries and 91% of the fatalities. Multiple system injury predominated, with survivors averaging 1.

Clinical use of a one-compartment model for determining netilmicin pharmacokinetic parameters and dosage recommendations.

To determine netilmicin pharmacokinetic parameters and to evaluate the use of a one-compartment pharmacokinetic model, 32 patients receiving netilmicin for suspected gram-negative sepsis were enrolled in our study protocol. Dose and dosage interval for each patient were determined by one-compartment pharmacokinetic analysis of six postinfusion netilmicin serum samples (0.16, 0.

Wide interpatient variations in gentamicin dose requirements for geriatric patients.

Substantial interpatient variations were demonstrated in the daily doses required to obtain therapeutic gentamicin sulfate serum concentrations in 417 elderly patients. Dosages ranged from 0.3 to 22.

Barium enema after colorectal biopsies: experimental data.

The appropriate interval between a colorectal biopsy and a barium enema is controversial. Superficial and deep biopsies, above and below the peritoneal reflection, were performed on 12 dogs. Six control dogs did not have a barium enema.

Gentamicin pharmacokinetics in 1,640 patients: method for control of serum concentrations.

The pharmacokinetics and dosage requirements of gentamicin were studied in 1,640 patients receiving treatment for gram-negative infections. A wide interpatient variation in the kinetic parameters of the drug occurred in all patients and in patients who had normal serum creatinine or normal creatinine clearance. The half-life ranged from 0.