Ossification in intestinal neoplasms; a report of three cases.
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There is a relatively long delay in diagnosis of malignant tumors of the small bowel and operation is often carried out too late. These tumors cause symptoms in about 90% of the cases (according to our own experiences in 20 of 21 cases). In the discussion of the symptoms there is a description given that might be a help for "earlier thinking of it". Anamnesis and exploratory laparotomy are of paramount importance for the diagnosis in time. Operation carried out in time leeds to a relatively favourable prognosis. Out of 5 patients who did not have metastases at the time of operation there are 3 alive for longer than 8 years post operationem. From the German literature of the past 10 years (288 cases) the following data were subsumized in a table: radical resection, operation mortality, 5-year-survival, delay of diagnosis, ileus/perforation, diagnosis by barium studies of the small bowel.
CONTEXT: The monoclonal antibody M30 recognizes a neoepitope of cytokeratin 18 produced during apoptosis. It is reactive in formalin-fixed, paraffin-embedded tissue and has great potential in the study of apoptosis in clinical and experimental material. OBJECTIVES: To compare the results of M30 immunoexpression with a more established technique of demonstrating apoptosis in tissue sections, in situ end-labeling. A secondary objective was to compare the results with immunoexpression of the proliferation-associated antigen Ki-67. DESIGN: Retrospective analysis of adenomas and adenocarcinomas of the large intestine. INTERVENTIONS: Immunohistochemistry for M30 and Ki-67, and in situ end-labeling. Formalin-fixed, paraffin-embedded tissue was used. MAIN OUTCOME MEASURES: The number of cells positive for M30, Ki-67, and in situ end-labeling, expressed as a proportion of the total number of cells counted. RESULTS: A strong positive correlation was found between in situ end-labeling and expression of M30, although the counts were widely scattered around the regression line. Counts of Ki-67 were strongly correlated with both M30 expression and in situ end-labeling. Immunoexpression of M30 was generally easier to interpret than in situ end-labeling, and the procedures for M30 immunohistochemistry were technically less exacting. CONCLUSION: These findings support the application of M30 immunoreactivity in the study of apoptosis.
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Tumor-markers should only be used, if they could alter the management of the patient. Screening for hepatocellular cancer in patients with chronic liver disease and monitoring cancer therapy are established methods. In the future, benign and malignant diseases of the pancreas will become easier to differentiate by the determination of subgroups of Lewis A-antigens. During follow-up after curative surgery, markers are of limited value. Immunoscintigraphy is already in use, whereas therapy with monoclonal antibodies still remains investigational.
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