A longitudinal study of one hundred consecutive admissions to the Royal Adelaide Hospital for carbon monoxide poisoning was conducted from 1986 to 1989. Twenty-five patients left hospital with persistent symptoms and signs of this poisoning. Five subsequently recovered. Twenty-four other patients, who were well when they left hospital, did not attend for a review one month after discharge. Extensive neuropsychiatric testing at this time showed 32% (24 of 76) had obvious sequelae of their exposure. Overall, the frequency of neuropsychiatric sequelae in the patients who only received oxygen at atmospheric pressure was 63% (N = 8) on discharge and 6 7% (N = 6) on one month follow-up. The frequency of sequelae among those who were given one hyperbaric oxygen treatment only was 46% (N = 24) on discharge and 50% (N = 20) on one month follow-up. In contrast, the frequency of sequelae in patients who had two or more hyperbaric oxygen treatments was only 13% (N = 68) on discharge (P< 0.005) and 18% (N = 50) on follow-up (P < 0.005). The frequency of sequelae was also significantly greater if hyperbaric oxygen was delayed (P < 0.05). No markers of severe poisoning could be identified.
Well-defined basement membrane laminin was seen in 98/158 (62%) rectal adenocarcinomas stained by an immunoperoxidase method. Only 27 (28%) patients with laminin-positive tumours developed distant metastases, compared with 39 (65%) patients with laminin-negative carcinomas. The corrected 5-year survival rates for patients with laminin-positive and laminin-negative tumours were 65% and 23%, respectively. Twenty-five out of 30 (83%) well-differentiated adenocarcinomas and only 3/15 (17%) poorly differentiated tumours contained basement membrane laminin, with moderately differentiated carcinomas showing intermediate laminin status (70/110, 64%, laminin positive). Forty-three of 60 (72%) of laminin-negative tumours had metastasized to regional lymph nodes. These data suggest that laminin may be a marker for differentiation. However, laminin status yields information about tumour behaviour which is not confined to stage and grade, and multivariate analysis shows that it is a better indicator of prognosis than tumour grade as assessed by conventional histology. Although laminin status alone is a less useful predictor of prognosis than Dukes' stage, a patient with a laminin-positive adenocarcinoma of rectum is 2.7 times as likely to survive 5 years than a patient with a laminin-negative tumour. Assessment of laminin status, together with Dukes' stage is, therefore, commended as a more precise and objective indicator of prognosis than histological degree of differentiation in colorectal carcinoma.
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