home *** CD-ROM | disk | FTP | other *** search
| Unknown | 1992-06-06 | 144.4 KB |
open in: 
MacOS 8.1
|
Win98
|
DOS
view JSON data
|
view as text
This file was not able to be converted.
This format is not currently supported by dexvert.
| Confidence | Program | Detection | Match Type | Support
|
|---|
| 66%
| dexvert
| OS/2 Installation Package (archive/os2InstallPackage)
| ext
| Supported |
| 1%
| dexvert
| BeOS Installation Package (archive/beOSInstallPackage)
| ext
| Unsupported |
| 1%
| dexvert
| Newton Package (archive/newtonPackage)
| ext
| Unsupported |
| 1%
| dexvert
| Independence War 2 mod Package (other/independenceWar2ModPackage)
| ext
| Unsupported |
| 100%
| file
| data
| default
|
|
hex view+--------+-------------------------+-------------------------+--------+--------+
|00000000| 1a 44 50 31 2e 31 00 00 | 00 00 00 00 00 05 28 00 |.DP1.1..|......(.|
|00000010| 00 00 16 00 00 00 30 30 | 00 00 00 01 54 02 00 00 |......00|....T...|
|00000020| 5c 12 00 00 30 31 00 00 | 00 01 b0 14 00 00 45 10 |\...01..|......E.|
|00000030| 00 00 30 32 00 00 00 01 | f5 24 00 00 32 0e 00 00 |..02....|.$..2...|
|00000040| 30 33 00 00 00 01 27 33 | 00 00 68 0e 00 00 30 34 |03....'3|..h...04|
|00000050| 00 00 00 01 8f 41 00 00 | 91 10 00 00 30 35 00 00 |.....A..|....05..|
|00000060| 00 01 20 52 00 00 3f 14 | 00 00 30 36 00 00 00 01 |.. R..?.|..06....|
|00000070| 5f 66 00 00 5e 0e 00 00 | 30 37 00 00 00 01 bd 74 |_f..^...|07.....t|
|00000080| 00 00 f0 0c 00 00 30 38 | 00 00 00 01 ad 81 00 00 |......08|........|
|00000090| 9a 0f 00 00 30 39 00 00 | 00 01 47 91 00 00 bd 1e |....09..|..G.....|
|000000a0| 00 00 31 30 00 00 00 01 | 04 b0 00 00 75 11 00 00 |..10....|....u...|
|000000b0| 31 31 00 00 00 01 79 c1 | 00 00 79 0d 00 00 31 32 |11....y.|..y...12|
|000000c0| 00 00 00 01 f2 ce 00 00 | 2a 0c 00 00 31 33 00 00 |........|*...13..|
|000000d0| 00 01 1c db 00 00 90 14 | 00 00 31 34 00 00 00 01 |........|..14....|
|000000e0| ac ef 00 00 eb 0d 00 00 | 31 35 00 00 00 01 97 fd |........|15......|
|000000f0| 00 00 18 0f 00 00 31 36 | 00 00 00 01 af 0c 01 00 |......16|........|
|00000100| c3 09 00 00 31 37 00 00 | 00 01 72 16 01 00 f2 10 |....17..|..r.....|
|00000110| 00 00 31 38 00 00 00 01 | 64 27 01 00 fa 0f 00 00 |..18....|d'......|
|00000120| 31 39 00 00 00 01 5e 37 | 01 00 9c 0b 00 00 32 30 |19....^7|......20|
|00000130| 00 00 00 01 fa 42 01 00 | 31 0e 00 00 32 31 00 00 |.....B..|1...21..|
|00000140| 00 01 2b 51 01 00 fc 0f | 00 00 32 32 00 00 00 01 |..+Q....|..22....|
|00000150| 27 61 01 00 7b 0e 00 00 | 32 33 00 00 00 01 a2 6f |'a..{...|23.....o|
|00000160| 01 00 b0 0b 00 00 32 34 | 00 00 00 01 52 7b 01 00 |......24|....R{..|
|00000170| 0b 10 00 00 32 35 00 00 | 00 01 5d 8b 01 00 9a 0c |....25..|..].....|
|00000180| 00 00 32 36 00 00 00 01 | f7 97 01 00 b4 0a 00 00 |..26....|........|
|00000190| 32 37 00 00 00 01 ab a2 | 01 00 af 0c 00 00 35 30 |27......|......50|
|000001a0| 00 00 00 01 5a af 01 00 | e8 09 00 00 35 31 00 00 |....Z...|....51..|
|000001b0| 00 01 42 b9 01 00 22 0b | 00 00 35 32 00 00 00 01 |..B...".|..52....|
|000001c0| 64 c4 01 00 b7 0e 00 00 | 35 33 00 00 00 01 1b d3 |d.......|53......|
|000001d0| 01 00 2a 0a 00 00 35 34 | 00 00 00 01 45 dd 01 00 |..*...54|....E...|
|000001e0| e1 0b 00 00 35 35 00 00 | 00 01 26 e9 01 00 bc 0b |....55..|..&.....|
|000001f0| 00 00 35 36 00 00 00 01 | e2 f4 01 00 d0 10 00 00 |..56....|........|
|00000200| 35 37 00 00 00 01 b2 05 | 02 00 b6 0c 00 00 35 38 |57......|......58|
|00000210| 00 00 00 01 68 12 02 00 | eb 0b 00 00 35 39 00 00 |....h...|....59..|
|00000220| 00 01 53 1e 02 00 58 0c | 00 00 36 30 00 00 00 01 |..S...X.|..60....|
|00000230| ab 2a 02 00 8a 0c 00 00 | 36 31 00 00 00 01 35 37 |.*......|61....57|
|00000240| 02 00 69 0a 00 00 00 00 | 00 00 00 00 9e 41 02 00 |..i.....|.....A..|
|00000250| 00 00 00 00 24 55 6e 69 | 71 75 65 5f 49 44 7b 59 |....$Uni|que_ID{Y|
|00000260| 52 42 30 38 39 30 30 7d | 0d 0a 24 54 69 74 6c 65 |RB08900}|..$Title|
|00000270| 7b 52 65 64 2d 43 65 6c | 6c 2d 56 6f 6c 75 6d 65 |{Red-Cel|l-Volume|
|00000280| 20 44 69 73 74 72 69 62 | 75 74 69 6f 6e 20 43 75 | Distrib|ution Cu|
|00000290| 72 76 65 73 20 69 6e 20 | 44 69 61 67 6e 6f 73 69 |rves in |Diagnosi|
|000002a0| 73 20 6f 66 20 47 6c 6f | 6d 65 72 75 6c 61 72 20 |s of Glo|merular |
|000002b0| 61 6e 64 20 4e 6f 6e 2d | 47 6c 6f 6d 65 72 75 6c |and Non-|Glomerul|
|000002c0| 61 72 20 48 61 65 6d 61 | 74 75 72 69 61 7d 0d 0a |ar Haema|turia}..|
|000002d0| 24 41 75 74 68 6f 72 7b | 0d 0a 53 63 68 69 63 68 |$Author{|..Schich|
|000002e0| 69 72 69 2c 20 4d 0d 0a | 48 6f 73 6f 64 61 2c 20 |iri, M..|Hosoda, |
|000002f0| 4b 0d 0a 4e 69 73 68 69 | 6f 2c 20 59 0d 0a 4f 67 |K..Nishi|o, Y..Og|
|00000300| 75 72 61 2c 20 4d 0d 0a | 53 75 65 6e 61 67 61 2c |ura, M..|Suenaga,|
|00000310| 20 4d 0d 0a 53 61 69 74 | 6f 2c 20 48 0d 0a 54 6f | M..Sait|o, H..To|
|00000320| 6d 75 72 61 2c 20 53 0d | 0a 53 68 69 69 67 61 69 |mura, S.|.Shiigai|
|00000330| 2c 20 54 7d 0d 0a 24 41 | 66 66 69 6c 69 61 74 69 |, T}..$A|ffiliati|
|00000340| 6f 6e 7b 54 6f 6b 79 6f | 20 4d 65 74 72 6f 70 6f |on{Tokyo| Metropo|
|00000350| 6c 69 74 61 6e 20 4f 6f | 6b 75 62 6f 20 48 6f 73 |litan Oo|kubo Hos|
|00000360| 70 3b 20 48 6f 6b 75 73 | 68 69 6e 20 47 65 6e 20 |p; Hokus|hin Gen |
|00000370| 48 6f 73 70 2c 20 4e 61 | 67 61 6e 6f 2c 20 4a 61 |Hosp, Na|gano, Ja|
|00000380| 70 61 6e 3b 20 4e 61 6b | 61 6e 6f 20 47 65 6e 20 |pan; Nak|ano Gen |
|00000390| 48 6f 73 70 2c 20 54 6f | 6b 79 6f 3b 20 54 6f 72 |Hosp, To|kyo; Tor|
|000003a0| 69 64 65 20 4b 79 6f 64 | 6f 20 48 6f 73 70 2c 20 |ide Kyod|o Hosp, |
|000003b0| 49 62 61 72 61 6b 69 2c | 20 4a 61 70 61 6e 7d 0d |Ibaraki,| Japan}.|
|000003c0| 0a 24 53 75 62 6a 65 63 | 74 7b 52 65 64 20 63 65 |.$Subjec|t{Red ce|
|000003d0| 6c 6c 2c 20 76 6f 6c 75 | 6d 65 20 63 75 72 76 65 |ll, volu|me curve|
|000003e0| 73 20 69 6e 20 67 6c 6f | 6d 65 72 75 6c 61 72 20 |s in glo|merular |
|000003f0| 61 6e 64 20 6e 6f 6e 2d | 67 6c 6f 6d 65 72 75 6c |and non-|glomerul|
|00000400| 61 72 20 68 65 6d 61 74 | 75 72 69 61 3b 0d 0a 48 |ar hemat|uria;..H|
|00000410| 65 6d 61 74 75 72 69 61 | 2c 20 67 6c 6f 6d 65 72 |ematuria|, glomer|
|00000420| 75 6c 61 72 20 61 6e 64 | 20 6e 6f 6e 2d 67 6c 6f |ular and| non-glo|
|00000430| 6d 65 72 75 6c 61 72 2c | 20 72 65 64 20 63 65 6c |merular,| red cel|
|00000440| 6c 20 76 6f 6c 75 6d 65 | 20 63 75 72 76 65 73 20 |l volume| curves |
|00000450| 69 6e 3b 20 47 6c 6f 6d | 65 72 75 6c 61 72 2c 0d |in; Glom|erular,.|
|00000460| 0a 68 65 6d 61 74 75 72 | 69 61 2c 20 72 65 64 20 |.hematur|ia, red |
|00000470| 63 65 6c 6c 20 76 6f 6c | 75 6d 65 20 63 75 72 76 |cell vol|ume curv|
|00000480| 65 73 20 69 6e 7d 0d 0a | 24 4a 6f 75 72 6e 61 6c |es in}..|$Journal|
|00000490| 7b 4c 61 6e 63 65 74 7d | 0d 0a 24 56 6f 6c 75 6d |{Lancet}|..$Volum|
|000004a0| 65 7b 31 7d 0d 0a 24 50 | 61 67 65 7b 39 30 38 2d |e{1}..$P|age{908-|
|000004b0| 39 31 31 7d 0d 0a 24 44 | 61 74 65 7b 41 70 72 20 |911}..$D|ate{Apr |
|000004c0| 32 33 2c 20 31 39 38 38 | 7d 0d 0a 24 59 42 56 6f |23, 1988|}..$YBVo|
|000004d0| 6c 7b 31 39 38 39 20 59 | 65 61 72 20 42 6f 6f 6b |l{1989 Y|ear Book|
|000004e0| 20 6f 66 20 55 72 6f 6c | 6f 67 79 7d 0d 0a 24 43 | of Urol|ogy}..$C|
|000004f0| 68 61 70 74 65 72 7b 31 | 2d 32 7d 0d 0a 24 59 42 |hapter{1|-2}..$YB|
|00000500| 45 64 69 74 6f 72 7b 44 | 72 73 2e 20 47 69 6c 6c |Editor{D|rs. Gill|
|00000510| 65 6e 77 61 74 65 72 20 | 61 6e 64 20 48 6f 77 61 |enwater |and Howa|
|00000520| 72 64 73 7d 0d 0a 24 54 | 61 62 6c 65 7b 7d 0d 0a |rds}..$T|able{}..|
|00000530| 24 43 6f 6d 6d 65 6e 74 | 61 74 6f 72 7b 53 2e 53 |$Comment|ator{S.S|
|00000540| 2e 20 48 6f 77 61 72 64 | 73 2c 20 4d 2e 44 2e 7d |. Howard|s, M.D.}|
|00000550| 0d 0a 0d 0a 43 6f 70 79 | 72 69 67 68 74 20 28 63 |....Copy|right (c|
|00000560| 29 20 59 65 61 72 20 42 | 6f 6f 6b 20 4d 65 64 69 |) Year B|ook Medi|
|00000570| 63 61 6c 20 50 75 62 6c | 69 73 68 65 72 73 2c 20 |cal Publ|ishers, |
|00000580| 49 6e 63 2e 2c 20 31 39 | 38 39 0d 0a 0d 0a 31 39 |Inc., 19|89....19|
|00000590| 38 39 20 59 65 61 72 20 | 42 6f 6f 6b 20 6f 66 20 |89 Year |Book of |
|000005a0| 55 72 6f 6c 6f 67 79 20 | 28 52 29 0d 0a 0d 0a 50 |Urology |(R)....P|
|000005b0| 61 72 74 20 31 3a 20 20 | 41 64 75 6c 74 0d 0a 0d |art 1: |Adult...|
|000005c0| 0a 43 68 61 70 74 65 72 | 20 31 2d 2d 53 74 61 6e |.Chapter| 1--Stan|
|000005d0| 64 61 72 64 20 44 69 61 | 67 6e 6f 73 74 69 63 20 |dard Dia|gnostic |
|000005e0| 43 6f 6e 73 69 64 65 72 | 61 74 69 6f 6e 73 0d 0a |Consider|ations..|
|000005f0| 0d 0a 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |..------|--------|
|00000600| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000610| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000620| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000630| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000640| 2d 2d 0d 0a 52 65 64 2d | 43 65 6c 6c 2d 56 6f 6c |--..Red-|Cell-Vol|
|00000650| 75 6d 65 20 44 69 73 74 | 72 69 62 75 74 69 6f 6e |ume Dist|ribution|
|00000660| 20 43 75 72 76 65 73 20 | 69 6e 20 44 69 61 67 6e | Curves |in Diagn|
|00000670| 6f 73 69 73 20 6f 66 20 | 47 6c 6f 6d 65 72 75 6c |osis of |Glomerul|
|00000680| 61 72 20 61 6e 64 0d 0a | 4e 6f 6e 2d 47 6c 6f 6d |ar and..|Non-Glom|
|00000690| 65 72 75 6c 61 72 20 48 | 61 65 6d 61 74 75 72 69 |erular H|aematuri|
|000006a0| 61 0d 0a 0d 0a 53 63 68 | 69 63 68 69 72 69 20 4d |a....Sch|ichiri M|
|000006b0| 3b 20 48 6f 73 6f 64 61 | 20 4b 3b 20 4e 69 73 68 |; Hosoda| K; Nish|
|000006c0| 69 6f 20 59 3b 20 4f 67 | 75 72 61 20 4d 3b 20 53 |io Y; Og|ura M; S|
|000006d0| 75 65 6e 61 67 61 20 4d | 3b 20 53 61 69 74 6f 20 |uenaga M|; Saito |
|000006e0| 48 3b 20 54 6f 6d 75 72 | 61 20 53 3b 20 53 68 69 |H; Tomur|a S; Shi|
|000006f0| 69 67 61 69 0d 0a 54 0d | 0a 28 54 6f 6b 79 6f 20 |igai..T.|.(Tokyo |
|00000700| 4d 65 74 72 6f 70 6f 6c | 69 74 61 6e 20 4f 6f 6b |Metropol|itan Ook|
|00000710| 75 62 6f 20 48 6f 73 70 | 3b 20 48 6f 6b 75 73 68 |ubo Hosp|; Hokush|
|00000720| 69 6e 20 47 65 6e 20 48 | 6f 73 70 2c 20 4e 61 67 |in Gen H|osp, Nag|
|00000730| 61 6e 6f 2c 20 4a 61 70 | 61 6e 3b 20 4e 61 6b 61 |ano, Jap|an; Naka|
|00000740| 6e 6f 20 47 65 6e 0d 0a | 48 6f 73 70 2c 20 54 6f |no Gen..|Hosp, To|
|00000750| 6b 79 6f 3b 20 54 6f 72 | 69 64 65 20 4b 79 6f 64 |kyo; Tor|ide Kyod|
|00000760| 6f 20 48 6f 73 70 2c 20 | 49 62 61 72 61 6b 69 2c |o Hosp, |Ibaraki,|
|00000770| 20 4a 61 70 61 6e 29 0d | 0a 4c 61 6e 63 65 74 20 | Japan).|.Lancet |
|00000780| 31 3a 39 30 38 2d 39 31 | 31 2c 20 41 70 72 20 32 |1:908-91|1, Apr 2|
|00000790| 33 2c 20 31 39 38 38 0d | 0a 2d 2d 2d 2d 2d 2d 2d |3, 1988.|.-------|
|000007a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000007b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000007c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000007d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000007e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 0d 0a 0d 0a 41 62 73 |--------|-....Abs|
|000007f0| 74 72 61 63 74 0d 0a 0d | 0a 20 20 20 20 20 54 68 |tract...|. Th|
|00000800| 65 20 70 72 65 73 65 6e | 63 65 20 6f 66 20 62 6c |e presen|ce of bl|
|00000810| 6f 6f 64 20 69 6e 20 74 | 68 65 20 75 72 69 6e 65 |ood in t|he urine|
|00000820| 2c 20 65 73 70 65 63 69 | 61 6c 6c 79 20 69 66 20 |, especi|ally if |
|00000830| 74 68 65 72 65 20 69 73 | 20 6e 6f 20 6b 6e 6f 77 |there is| no know|
|00000840| 6e 20 72 65 6e 61 6c 0d | 0a 6f 72 20 73 79 73 74 |n renal.|.or syst|
|00000850| 65 6d 69 63 20 64 69 73 | 65 61 73 65 2c 20 70 6f |emic dis|ease, po|
|00000860| 73 65 73 20 64 69 61 67 | 6e 6f 73 74 69 63 20 70 |ses diag|nostic p|
|00000870| 72 6f 62 6c 65 6d 73 2e | 20 20 50 68 61 73 65 2d |roblems.| Phase-|
|00000880| 63 6f 6e 74 72 61 73 74 | 20 6d 69 63 72 6f 73 63 |contrast| microsc|
|00000890| 6f 70 79 20 69 73 0d 0a | 6e 6f 74 20 68 69 67 68 |opy is..|not high|
|000008a0| 6c 79 20 73 65 6e 73 69 | 74 69 76 65 20 6f 72 20 |ly sensi|tive or |
|000008b0| 73 70 65 63 69 66 69 63 | 2c 20 61 6e 64 20 62 69 |specific|, and bi|
|000008c0| 6f 70 73 79 20 6f 66 66 | 65 72 73 20 6e 6f 20 70 |opsy off|ers no p|
|000008d0| 6f 73 69 74 69 76 65 20 | 72 65 73 75 6c 74 73 20 |ositive |results |
|000008e0| 69 6e 20 61 0d 0a 73 69 | 7a 61 62 6c 65 20 6e 75 |in a..si|zable nu|
|000008f0| 6d 62 65 72 20 6f 66 20 | 70 61 74 69 65 6e 74 73 |mber of |patients|
|00000900| 2e 20 20 49 6e 20 61 20 | 6e 65 77 20 6d 65 74 68 |. In a |new meth|
|00000910| 6f 64 20 6f 66 20 61 6e | 61 6c 79 7a 69 6e 67 20 |od of an|alyzing |
|00000920| 72 65 64 20 62 6c 6f 6f | 64 20 63 65 6c 6c 20 28 |red bloo|d cell (|
|00000930| 52 42 43 29 0d 0a 6d 6f | 72 70 68 6f 6c 6f 67 79 |RBC)..mo|rphology|
|00000940| 20 61 75 74 6f 6d 61 74 | 65 64 20 62 6c 6f 6f 64 | automat|ed blood|
|00000950| 20 63 65 6c 6c 20 61 6e | 61 6c 79 7a 65 72 73 20 | cell an|alyzers |
|00000960| 61 72 65 20 75 73 65 64 | 20 74 6f 20 6f 62 74 61 |are used| to obta|
|00000970| 69 6e 20 52 42 43 20 73 | 69 7a 65 0d 0a 64 69 73 |in RBC s|ize..dis|
|00000980| 74 72 69 62 75 74 69 6f | 6e 20 63 75 72 76 65 73 |tributio|n curves|
|00000990| 2e 0d 0a 20 20 20 20 20 | 4f 66 20 31 34 36 20 70 |... |Of 146 p|
|000009a0| 61 74 69 65 6e 74 73 20 | 77 68 6f 20 6d 65 74 20 |atients |who met |
|000009b0| 74 68 65 20 73 74 75 64 | 79 20 63 72 69 74 65 72 |the stud|y criter|
|000009c0| 69 61 2c 20 36 37 20 68 | 61 64 20 67 6c 6f 6d 65 |ia, 67 h|ad glome|
|000009d0| 72 75 6c 6f 6e 65 70 68 | 72 69 74 69 73 20 61 6e |ruloneph|ritis an|
|000009e0| 64 0d 0a 37 39 20 68 61 | 64 20 6c 6f 77 65 72 20 |d..79 ha|d lower |
|000009f0| 75 72 69 6e 61 72 79 20 | 74 72 61 63 74 20 6c 65 |urinary |tract le|
|00000a00| 73 69 6f 6e 73 2e 20 20 | 41 6e 61 6c 79 73 69 73 |sions. |Analysis|
|00000a10| 20 6f 66 20 52 42 43 20 | 64 69 73 74 72 69 62 75 | of RBC |distribu|
|00000a20| 74 69 6f 6e 20 63 75 72 | 76 65 73 20 73 68 6f 77 |tion cur|ves show|
|00000a30| 65 64 0d 0a 61 20 67 6c | 6f 6d 65 72 75 6c 61 72 |ed..a gl|omerular|
|00000a40| 20 64 69 73 74 72 69 62 | 75 74 69 6f 6e 20 69 6e | distrib|ution in|
|00000a50| 20 38 31 20 70 61 74 69 | 65 6e 74 73 20 28 35 35 | 81 pati|ents (55|
|00000a60| 25 29 2e 20 20 53 69 78 | 74 65 65 6e 20 28 31 31 |%). Six|teen (11|
|00000a70| 25 29 20 77 65 72 65 0d | 0a 6e 6f 6e 67 6c 6f 6d |%) were.|.nonglom|
|00000a80| 65 72 75 6c 61 72 2c 20 | 61 6e 64 20 34 39 20 28 |erular, |and 49 (|
|00000a90| 33 33 2e 36 25 29 20 77 | 65 72 65 20 6d 69 78 65 |33.6%) w|ere mixe|
|00000aa0| 64 2e 20 20 41 6c 6c 20 | 70 61 74 69 65 6e 74 73 |d. All |patients|
|00000ab0| 20 77 69 74 68 20 61 20 | 6e 6f 6e 67 6c 6f 6d 65 | with a |nonglome|
|00000ac0| 72 75 6c 61 72 0d 0a 64 | 69 73 74 72 69 62 75 74 |rular..d|istribut|
|00000ad0| 69 6f 6e 20 77 65 72 65 | 20 64 69 61 67 6e 6f 73 |ion were| diagnos|
|00000ae0| 65 64 20 77 69 74 68 20 | 6c 6f 77 65 72 20 75 72 |ed with |lower ur|
|00000af0| 69 6e 61 72 79 20 74 72 | 61 63 74 20 6c 65 73 69 |inary tr|act lesi|
|00000b00| 6f 6e 73 20 6f 74 68 65 | 72 20 74 68 61 6e 0d 0a |ons othe|r than..|
|00000b10| 69 6e 66 65 63 74 69 6f | 6e 2e 0d 0a 20 20 20 20 |infectio|n... |
|00000b20| 20 53 69 78 74 79 2d 66 | 69 76 65 20 6f 66 20 74 | Sixty-f|ive of t|
|00000b30| 68 65 20 38 31 20 70 61 | 74 69 65 6e 74 73 20 77 |he 81 pa|tients w|
|00000b40| 69 74 68 20 67 6c 6f 6d | 65 72 75 6c 61 72 20 64 |ith glom|erular d|
|00000b50| 69 73 74 72 69 62 75 74 | 69 6f 6e 20 68 61 64 20 |istribut|ion had |
|00000b60| 70 72 6f 76 65 6e 0d 0a | 67 6c 6f 6d 65 72 75 6c |proven..|glomerul|
|00000b70| 6f 6e 65 70 68 72 69 74 | 69 73 2e 20 20 4e 69 6e |onephrit|is. Nin|
|00000b80| 65 74 79 2d 65 69 67 68 | 74 20 70 65 72 63 65 6e |ety-eigh|t percen|
|00000b90| 74 20 6f 66 20 70 61 74 | 69 65 6e 74 73 20 77 69 |t of pat|ients wi|
|00000ba0| 74 68 20 6c 6f 77 65 72 | 20 75 72 69 6e 61 72 79 |th lower| urinary|
|00000bb0| 20 74 72 61 63 74 0d 0a | 6c 65 73 69 6f 6e 73 20 | tract..|lesions |
|00000bc0| 6f 74 68 65 72 20 74 68 | 61 6e 20 69 6e 66 65 63 |other th|an infec|
|00000bd0| 74 69 6f 6e 20 68 61 64 | 20 65 69 74 68 65 72 20 |tion had| either |
|00000be0| 6e 6f 6e 67 6c 6f 6d 65 | 72 75 6c 61 72 20 6f 72 |nonglome|rular or|
|00000bf0| 20 6d 69 78 65 64 20 64 | 69 73 74 72 69 62 75 74 | mixed d|istribut|
|00000c00| 69 6f 6e 73 2e 0d 0a 20 | 20 20 20 20 54 68 65 20 |ions... | The |
|00000c10| 73 6f 75 72 63 65 20 6f | 66 20 62 6c 65 65 64 69 |source o|f bleedi|
|00000c20| 6e 67 20 69 6e 20 74 68 | 65 73 65 20 70 61 74 69 |ng in th|ese pati|
|00000c30| 65 6e 74 73 20 77 61 73 | 20 6f 62 74 61 69 6e 65 |ents was| obtaine|
|00000c40| 64 20 77 69 74 68 20 61 | 20 64 65 67 72 65 65 20 |d with a| degree |
|00000c50| 6f 66 0d 0a 73 65 6e 73 | 69 74 69 76 69 74 79 20 |of..sens|itivity |
|00000c60| 61 6e 64 20 73 70 65 63 | 69 66 69 63 69 74 79 20 |and spec|ificity |
|00000c70| 6e 6f 74 20 70 6f 73 73 | 69 62 6c 65 20 77 69 74 |not poss|ible wit|
|00000c80| 68 20 70 68 61 73 65 20 | 63 6f 6e 74 72 61 73 74 |h phase |contrast|
|00000c90| 20 6d 69 63 72 6f 73 63 | 6f 70 79 2e 20 20 49 6e | microsc|opy. In|
|00000ca0| 0d 0a 74 68 69 73 20 73 | 74 75 64 79 20 61 6c 6c |..this s|tudy all|
|00000cb0| 20 70 61 74 69 65 6e 74 | 73 20 77 69 74 68 20 75 | patient|s with u|
|00000cc0| 72 69 6e 61 72 79 20 74 | 72 61 63 74 20 69 6e 66 |rinary t|ract inf|
|00000cd0| 65 63 74 69 6f 6e 20 65 | 78 63 72 65 74 65 64 20 |ection e|xcreted |
|00000ce0| 67 6c 6f 6d 65 72 75 6c | 61 72 20 52 42 43 73 0d |glomerul|ar RBCs.|
|00000cf0| 0a 61 6e 64 20 6e 6f 6e | 65 20 73 68 6f 77 65 64 |.and non|e showed|
|00000d00| 20 6f 6e 6c 79 20 6e 6f | 6e 67 6c 6f 6d 65 72 75 | only no|nglomeru|
|00000d10| 6c 61 72 20 64 69 73 74 | 72 69 62 75 74 69 6f 6e |lar dist|ribution|
|00000d20| 2e 20 20 45 76 65 6e 20 | 77 68 65 6e 20 75 72 69 |. Even |when uri|
|00000d30| 6e 65 20 73 61 6d 70 6c | 65 73 20 61 72 65 0d 0a |ne sampl|es are..|
|00000d40| 73 65 76 65 72 61 6c 20 | 68 6f 75 72 73 20 6f 6c |several |hours ol|
|00000d50| 64 2c 20 72 65 73 75 6c | 74 73 20 61 72 65 20 61 |d, resul|ts are a|
|00000d60| 6c 6d 6f 73 74 20 61 6c | 77 61 79 73 20 61 63 63 |lmost al|ways acc|
|00000d70| 75 72 61 74 65 2e 20 20 | 44 69 61 67 6e 6f 73 69 |urate. |Diagnosi|
|00000d80| 73 20 63 61 6e 20 62 65 | 20 72 65 61 63 68 65 64 |s can be| reached|
|00000d90| 0d 0a 71 75 69 63 6b 6c | 79 2c 20 72 65 73 75 6c |..quickl|y, resul|
|00000da0| 74 73 20 61 72 65 20 72 | 65 70 72 6f 64 75 63 69 |ts are r|eproduci|
|00000db0| 62 6c 65 2c 20 61 6e 64 | 20 69 6e 76 61 73 69 76 |ble, and| invasiv|
|00000dc0| 65 20 74 65 73 74 73 20 | 61 72 65 20 61 76 6f 69 |e tests |are avoi|
|00000dd0| 64 65 64 2e 0d 0a 0d 0a | 50 6f 73 74 2d 43 6f 6d |ded.....|Post-Com|
|00000de0| 6d 65 6e 74 0d 0a 0d 0a | 20 20 20 20 20 54 65 6e |ment....| Ten|
|00000df0| 20 79 65 61 72 73 20 61 | 67 6f 2c 20 42 69 72 63 | years a|go, Birc|
|00000e00| 68 20 61 6e 64 20 46 61 | 69 72 6c 65 79 20 28 4c |h and Fa|irley (L|
|00000e10| 61 6e 63 65 74 20 32 3a | 38 34 35 2c 20 31 39 37 |ancet 2:|845, 197|
|00000e20| 39 29 20 64 65 73 63 72 | 69 62 65 64 20 74 68 65 |9) descr|ibed the|
|00000e30| 20 75 73 65 20 6f 66 0d | 0a 70 68 61 73 65 20 63 | use of.|.phase c|
|00000e40| 6f 6e 74 72 61 73 74 20 | 6d 69 63 72 6f 73 63 6f |ontrast |microsco|
|00000e50| 70 79 20 74 6f 20 64 65 | 74 65 63 74 20 64 79 73 |py to de|tect dys|
|00000e60| 6d 6f 72 70 68 69 63 20 | 72 65 64 20 62 6c 6f 6f |morphic |red bloo|
|00000e70| 64 20 63 65 6c 6c 73 20 | 28 52 42 43 73 29 2c 20 |d cells |(RBCs), |
|00000e80| 77 68 69 63 68 0d 0a 74 | 68 65 79 20 73 74 61 74 |which..t|hey stat|
|00000e90| 65 64 20 77 65 72 65 20 | 64 69 61 67 6e 6f 73 74 |ed were |diagnost|
|00000ea0| 69 63 20 6f 66 20 67 6c | 6f 6d 65 72 75 6c 61 72 |ic of gl|omerular|
|00000eb0| 20 62 6c 65 65 64 69 6e | 67 2e 20 20 53 69 6e 63 | bleedin|g. Sinc|
|00000ec0| 65 20 74 68 65 6e 20 6d | 61 6e 79 20 61 75 74 68 |e then m|any auth|
|00000ed0| 6f 72 73 0d 0a 68 61 76 | 65 20 63 6f 6e 66 69 72 |ors..hav|e confir|
|00000ee0| 6d 65 64 20 74 68 65 20 | 6f 72 69 67 69 6e 61 6c |med the |original|
|00000ef0| 20 6f 62 73 65 72 76 61 | 74 69 6f 6e 2c 20 62 75 | observa|tion, bu|
|00000f00| 74 20 62 65 63 61 75 73 | 65 20 6f 66 20 74 65 63 |t becaus|e of tec|
|00000f10| 68 6e 69 63 61 6c 20 64 | 69 66 66 69 63 75 6c 74 |hnical d|ifficult|
|00000f20| 69 65 73 0d 0a 61 6e 64 | 20 69 6d 70 72 65 63 69 |ies..and| impreci|
|00000f30| 73 69 6f 6e 20 74 68 65 | 20 74 65 63 68 6e 69 71 |sion the| techniq|
|00000f40| 75 65 20 68 61 73 20 6e | 6f 74 20 72 65 70 6c 61 |ue has n|ot repla|
|00000f50| 63 65 64 20 73 74 61 6e | 64 61 72 64 20 64 69 61 |ced stan|dard dia|
|00000f60| 67 6e 6f 73 74 69 63 20 | 6d 65 74 68 6f 64 73 2e |gnostic |methods.|
|00000f70| 0d 0a 53 63 68 69 63 68 | 69 72 69 20 61 6e 64 20 |..Schich|iri and |
|00000f80| 61 73 73 6f 63 69 61 74 | 65 73 20 68 61 76 65 20 |associat|es have |
|00000f90| 70 75 72 73 75 65 64 20 | 74 68 65 20 70 72 69 6e |pursued |the prin|
|00000fa0| 63 69 70 6c 65 20 74 68 | 61 74 20 67 6c 6f 6d 65 |ciple th|at glome|
|00000fb0| 72 75 6c 61 72 20 52 42 | 43 73 20 61 72 65 0d 0a |rular RB|Cs are..|
|00000fc0| 64 69 66 66 65 72 65 6e | 74 20 66 72 6f 6d 20 6e |differen|t from n|
|00000fd0| 6f 6e 67 6c 6f 6d 65 72 | 75 6c 61 72 20 52 42 43 |onglomer|ular RBC|
|00000fe0| 73 20 75 73 69 6e 67 20 | 61 6e 20 61 75 74 6f 61 |s using |an autoa|
|00000ff0| 6e 61 6c 79 7a 65 72 2e | 20 20 54 68 65 72 65 20 |nalyzer.| There |
|00001000| 69 73 20 6e 6f 20 64 6f | 75 62 74 20 74 68 61 74 |is no do|ubt that|
|00001010| 0d 0a 74 68 65 69 72 20 | 6d 65 74 68 6f 64 20 67 |..their |method g|
|00001020| 65 6e 65 72 61 6c 6c 79 | 20 64 69 76 69 64 65 73 |enerally| divides|
|00001030| 20 70 61 74 69 65 6e 74 | 73 20 69 6e 74 6f 20 67 | patient|s into g|
|00001040| 6c 6f 6d 65 72 75 6c 61 | 72 20 61 6e 64 20 6e 6f |lomerula|r and no|
|00001050| 6e 67 6c 6f 6d 65 72 75 | 6c 61 72 0d 0a 67 72 6f |nglomeru|lar..gro|
|00001060| 75 70 73 2e 20 20 48 6f | 77 65 76 65 72 2c 20 74 |ups. Ho|wever, t|
|00001070| 68 65 79 20 64 69 64 20 | 6e 6f 74 20 6f 62 74 61 |hey did |not obta|
|00001080| 69 6e 20 63 6f 6d 70 6c | 65 74 65 20 73 65 70 61 |in compl|ete sepa|
|00001090| 72 61 74 69 6f 6e 20 6f | 66 20 74 68 65 20 70 6f |ration o|f the po|
|000010a0| 70 75 6c 61 74 69 6f 6e | 73 2c 0d 0a 61 6e 64 20 |pulation|s,..and |
|000010b0| 74 68 65 20 6d 65 74 68 | 6f 64 20 69 73 20 6e 6f |the meth|od is no|
|000010c0| 74 20 73 69 6d 70 6c 65 | 20 6f 72 20 69 6e 65 78 |t simple| or inex|
|000010d0| 70 65 6e 73 69 76 65 20 | 65 6e 6f 75 67 68 20 74 |pensive |enough t|
|000010e0| 6f 20 75 73 65 20 69 6e | 20 61 20 70 68 79 73 69 |o use in| a physi|
|000010f0| 63 69 61 6e 27 73 0d 0a | 6f 66 66 69 63 65 2e 20 |cian's..|office. |
|00001100| 54 68 65 72 65 20 77 65 | 72 65 20 6d 61 6e 79 20 |There we|re many |
|00001110| 70 61 74 69 65 6e 74 73 | 20 77 69 74 68 20 61 20 |patients| with a |
|00001120| 22 6d 69 78 65 64 22 20 | 70 61 74 74 65 72 6e 2c |"mixed" |pattern,|
|00001130| 20 61 6e 64 20 31 31 25 | 20 6f 66 20 74 68 6f 73 | and 11%| of thos|
|00001140| 65 20 77 69 74 68 20 61 | 0d 0a 67 6c 6f 6d 65 72 |e with a|..glomer|
|00001150| 75 6c 61 72 20 70 61 74 | 74 65 72 6e 20 68 61 64 |ular pat|tern had|
|00001160| 20 6e 6f 6e 67 6c 6f 6d | 65 72 75 6c 61 72 20 64 | nonglom|erular d|
|00001170| 69 73 65 61 73 65 2e 0d | 0a 20 20 20 20 20 44 6f |isease..|. Do|
|00001180| 63 63 69 20 61 6e 64 20 | 61 73 73 6f 63 69 61 74 |cci and |associat|
|00001190| 65 73 20 72 65 70 65 61 | 74 65 64 20 74 68 65 20 |es repea|ted the |
|000011a0| 73 74 75 64 79 20 77 69 | 74 68 20 73 69 6d 69 6c |study wi|th simil|
|000011b0| 61 72 20 72 65 73 75 6c | 74 73 2e 20 20 4e 65 69 |ar resul|ts. Nei|
|000011c0| 74 68 65 72 0d 0a 67 72 | 6f 75 70 20 70 72 65 73 |ther..gr|oup pres|
|000011d0| 65 6e 74 65 64 20 74 68 | 65 69 72 20 61 63 74 75 |ented th|eir actu|
|000011e0| 61 6c 20 64 61 74 61 20 | 66 6f 72 20 69 6e 73 70 |al data |for insp|
|000011f0| 65 63 74 69 6f 6e 2e 20 | 20 42 6f 74 68 20 67 72 |ection. | Both gr|
|00001200| 6f 75 70 73 20 63 6c 61 | 69 6d 20 74 68 65 20 6d |oups cla|im the m|
|00001210| 65 74 68 6f 64 0d 0a 63 | 61 6e 20 72 65 70 6c 61 |ethod..c|an repla|
|00001220| 63 65 20 22 75 6e 6e 65 | 63 65 73 73 61 72 79 20 |ce "unne|cessary |
|00001230| 75 72 6f 6c 6f 67 69 63 | 20 69 6e 76 65 73 74 69 |urologic| investi|
|00001240| 67 61 74 69 6f 6e 2e 22 | 20 20 41 74 20 74 68 69 |gation."| At thi|
|00001250| 73 20 70 6f 69 6e 74 20 | 77 65 20 64 6f 20 6e 6f |s point |we do no|
|00001260| 74 0d 0a 63 6f 6e 63 75 | 72 2e 20 20 54 68 65 20 |t..concu|r. The |
|00001270| 75 72 6f 6c 6f 67 69 73 | 74 20 6d 75 73 74 20 72 |urologis|t must r|
|00001280| 75 6c 65 20 6f 75 74 20 | 6d 61 6c 69 67 6e 61 6e |ule out |malignan|
|00001290| 63 79 20 61 6e 64 20 73 | 69 67 6e 69 66 69 63 61 |cy and s|ignifica|
|000012a0| 6e 74 20 6f 62 73 74 72 | 75 63 74 69 6f 6e 20 69 |nt obstr|uction i|
|000012b0| 6e 0d 0a 70 61 74 69 65 | 6e 74 73 20 77 69 74 68 |n..patie|nts with|
|000012c0| 20 68 65 6d 61 74 75 72 | 69 61 2e 20 20 45 69 67 | hematur|ia. Eig|
|000012d0| 68 74 79 20 74 6f 20 6e | 69 6e 65 74 79 20 70 65 |hty to n|inety pe|
|000012e0| 72 63 65 6e 74 20 61 63 | 63 75 72 61 63 79 20 77 |rcent ac|curacy w|
|000012f0| 69 6c 6c 20 6e 6f 74 20 | 64 6f 2e 0d 0a 46 75 72 |ill not |do...Fur|
|00001300| 74 68 65 72 6d 6f 72 65 | 2c 20 74 68 65 72 65 20 |thermore|, there |
|00001310| 77 65 72 65 20 76 65 72 | 79 20 66 65 77 20 70 61 |were ver|y few pa|
|00001320| 74 69 65 6e 74 73 20 69 | 6e 20 74 68 65 73 65 20 |tients i|n these |
|00001330| 73 74 75 64 69 65 73 20 | 77 69 74 68 20 67 65 6e |studies |with gen|
|00001340| 69 74 6f 75 72 69 6e 61 | 72 79 0d 0a 6d 61 6c 69 |itourina|ry..mali|
|00001350| 67 6e 61 6e 63 69 65 73 | 2e 20 20 55 6e 74 69 6c |gnancies|. Until|
|00001360| 20 6d 6f 72 65 20 73 74 | 75 64 69 65 73 20 61 72 | more st|udies ar|
|00001370| 65 20 64 6f 6e 65 20 77 | 69 74 68 20 6c 61 72 67 |e done w|ith larg|
|00001380| 65 72 20 6e 75 6d 62 65 | 72 73 20 6f 66 20 70 61 |er numbe|rs of pa|
|00001390| 74 69 65 6e 74 73 20 77 | 68 6f 0d 0a 68 61 76 65 |tients w|ho..have|
|000013a0| 20 67 65 6e 69 74 6f 75 | 72 69 6e 61 72 79 20 63 | genitou|rinary c|
|000013b0| 61 6e 63 65 72 73 20 6f | 72 20 6f 62 73 74 72 75 |ancers o|r obstru|
|000013c0| 63 74 69 6f 6e 73 2c 20 | 61 6e 64 20 69 74 20 69 |ctions, |and it i|
|000013d0| 73 20 64 6f 63 75 6d 65 | 6e 74 65 64 20 74 68 61 |s docume|nted tha|
|000013e0| 74 20 74 68 65 73 65 0d | 0a 69 6e 64 69 76 69 64 |t these.|.individ|
|000013f0| 75 61 6c 73 20 61 72 65 | 20 70 6c 61 63 65 64 20 |uals are| placed |
|00001400| 69 6e 20 74 68 65 20 6e | 6f 6e 67 6c 6f 6d 65 72 |in the n|onglomer|
|00001410| 75 6c 61 72 20 67 72 6f | 75 70 2c 20 74 68 69 73 |ular gro|up, this|
|00001420| 20 6d 65 74 68 6f 64 20 | 77 69 6c 6c 20 72 65 6d | method |will rem|
|00001430| 61 69 6e 20 61 6e 0d 0a | 69 6e 74 65 72 65 73 74 |ain an..|interest|
|00001440| 69 6e 67 20 72 65 73 65 | 61 72 63 68 20 74 6f 6f |ing rese|arch too|
|00001450| 6c 20 62 75 74 20 6e 6f | 74 20 61 20 70 72 61 63 |l but no|t a prac|
|00001460| 74 69 63 61 6c 20 61 64 | 64 69 74 69 6f 6e 20 74 |tical ad|dition t|
|00001470| 6f 20 74 68 65 20 63 6c | 69 6e 69 63 61 6c 0d 0a |o the cl|inical..|
|00001480| 75 72 6f 6c 6f 67 69 73 | 74 73 27 20 61 72 6d 61 |urologis|ts' arma|
|00001490| 6d 65 6e 74 61 72 69 75 | 6d 2e 2d 2d 53 2e 53 2e |mentariu|m.--S.S.|
|000014a0| 20 48 6f 77 61 72 64 73 | 2c 20 4d 2e 44 2e 0d 0a | Howards|, M.D...|
|000014b0| 24 55 6e 69 71 75 65 5f | 49 44 7b 59 52 42 30 38 |$Unique_|ID{YRB08|
|000014c0| 39 30 31 7d 0d 0a 24 54 | 69 74 6c 65 7b 41 62 6e |901}..$T|itle{Abn|
|000014d0| 6f 72 6d 61 6c 20 52 65 | 64 2d 43 65 6c 6c 20 43 |ormal Re|d-Cell C|
|000014e0| 61 6c 63 69 75 6d 20 50 | 75 6d 70 20 69 6e 20 50 |alcium P|ump in P|
|000014f0| 61 74 69 65 6e 74 73 20 | 57 69 74 68 20 49 64 69 |atients |With Idi|
|00001500| 6f 70 61 74 68 69 63 20 | 48 79 70 65 72 63 61 6c |opathic |Hypercal|
|00001510| 63 69 75 72 69 61 7d 0d | 0a 24 41 75 74 68 6f 72 |ciuria}.|.$Author|
|00001520| 7b 0d 0a 42 69 61 6e 63 | 68 69 2c 20 47 0d 0a 56 |{..Bianc|hi, G..V|
|00001530| 65 7a 7a 6f 6c 69 2c 20 | 47 0d 0a 43 75 73 69 2c |ezzoli, |G..Cusi,|
|00001540| 20 44 0d 0a 43 6f 76 61 | 2c 20 54 0d 0a 45 6c 6c | D..Cova|, T..Ell|
|00001550| 69 2c 20 41 0d 0a 53 6f | 6c 64 61 74 69 2c 20 4c |i, A..So|ldati, L|
|00001560| 0d 0a 54 72 69 70 6f 64 | 69 2c 20 47 0d 0a 53 75 |..Tripod|i, G..Su|
|00001570| 72 69 61 6e 2c 20 4d 0d | 0a 4f 74 74 61 76 69 61 |rian, M.|.Ottavia|
|00001580| 6e 6f 2c 20 45 0d 0a 52 | 69 67 61 74 74 69 2c 20 |no, E..R|igatti, |
|00001590| 50 0d 0a 4f 72 74 6f 6c | 61 6e 69 2c 20 53 7d 0d |P..Ortol|ani, S}.|
|000015a0| 0a 24 41 66 66 69 6c 69 | 61 74 69 6f 6e 7b 55 6e |.$Affili|ation{Un|
|000015b0| 69 76 20 6f 66 20 4d 69 | 6c 61 6e 3b 20 55 6e 69 |iv of Mi|lan; Uni|
|000015c0| 76 20 6f 66 20 53 61 73 | 73 61 72 69 3b 20 42 61 |v of Sas|sari; Ba|
|000015d0| 73 73 69 6e 69 20 48 6f | 73 70 20 43 69 6e 69 73 |ssini Ho|sp Cinis|
|000015e0| 65 6c 6c 6f 2c 20 4d 69 | 6c 61 6e 3b 20 4f 73 70 |ello, Mi|lan; Osp|
|000015f0| 65 64 61 6c 65 20 64 69 | 20 4c 6f 64 69 3b 20 4f |edale di| Lodi; O|
|00001600| 73 70 65 64 61 6c 65 20 | 53 20 52 61 66 66 61 65 |spedale |S Raffae|
|00001610| 6c 65 2c 20 4d 69 6c 61 | 6e 2c 20 49 74 61 6c 79 |le, Mila|n, Italy|
|00001620| 7d 0d 0a 24 53 75 62 6a | 65 63 74 7b 52 65 64 20 |}..$Subj|ect{Red |
|00001630| 63 65 6c 6c 2c 20 63 61 | 6c 63 69 75 6d 20 70 75 |cell, ca|lcium pu|
|00001640| 6d 70 20 69 6e 20 69 64 | 69 6f 70 61 74 68 69 63 |mp in id|iopathic|
|00001650| 20 68 79 70 65 72 63 61 | 6c 63 69 75 72 69 61 3b | hyperca|lciuria;|
|00001660| 20 50 75 6d 70 2c 20 72 | 65 64 20 63 65 6c 6c 0d | Pump, r|ed cell.|
|00001670| 0a 63 61 6c 63 69 75 6d | 2c 20 69 6e 20 69 64 69 |.calcium|, in idi|
|00001680| 6f 70 61 74 68 69 63 20 | 68 79 70 65 72 63 61 6c |opathic |hypercal|
|00001690| 63 69 75 72 69 61 3b 20 | 48 79 70 65 72 63 61 6c |ciuria; |Hypercal|
|000016a0| 63 69 75 72 69 61 2c 20 | 69 64 69 6f 70 61 74 68 |ciuria, |idiopath|
|000016b0| 69 63 2c 20 72 65 64 20 | 63 65 6c 6c 0d 0a 63 61 |ic, red |cell..ca|
|000016c0| 6c 63 69 75 6d 20 70 75 | 6d 70 20 69 6e 3b 20 43 |lcium pu|mp in; C|
|000016d0| 61 6c 63 69 75 6d 2c 20 | 72 65 64 20 63 65 6c 6c |alcium, |red cell|
|000016e0| 20 63 61 6c 63 69 75 6d | 20 70 75 6d 70 20 69 6e | calcium| pump in|
|000016f0| 20 69 64 69 6f 70 61 74 | 68 69 63 20 68 79 70 65 | idiopat|hic hype|
|00001700| 72 63 61 6c 63 69 75 72 | 69 61 7d 0d 0a 24 4a 6f |rcalciur|ia}..$Jo|
|00001710| 75 72 6e 61 6c 7b 4e 20 | 45 6e 67 6c 20 4a 20 4d |urnal{N |Engl J M|
|00001720| 65 64 7d 0d 0a 24 56 6f | 6c 75 6d 65 7b 33 31 39 |ed}..$Vo|lume{319|
|00001730| 7d 0d 0a 24 50 61 67 65 | 7b 38 39 37 2d 39 30 31 |}..$Page|{897-901|
|00001740| 7d 0d 0a 24 44 61 74 65 | 7b 4f 63 74 20 36 2c 20 |}..$Date|{Oct 6, |
|00001750| 31 39 38 38 7d 0d 0a 24 | 59 42 56 6f 6c 7b 31 39 |1988}..$|YBVol{19|
|00001760| 38 39 20 59 65 61 72 20 | 42 6f 6f 6b 20 6f 66 20 |89 Year |Book of |
|00001770| 55 72 6f 6c 6f 67 79 7d | 0d 0a 24 43 68 61 70 74 |Urology}|..$Chapt|
|00001780| 65 72 7b 34 2d 34 7d 0d | 0a 24 59 42 45 64 69 74 |er{4-4}.|.$YBEdit|
|00001790| 6f 72 7b 44 72 73 2e 20 | 47 69 6c 6c 65 6e 77 61 |or{Drs. |Gillenwa|
|000017a0| 74 65 72 20 61 6e 64 20 | 48 6f 77 61 72 64 73 7d |ter and |Howards}|
|000017b0| 0d 0a 24 54 61 62 6c 65 | 7b 7d 0d 0a 24 43 6f 6d |..$Table|{}..$Com|
|000017c0| 6d 65 6e 74 61 74 6f 72 | 7b 41 2e 44 2e 20 4a 65 |mentator|{A.D. Je|
|000017d0| 6e 6b 69 6e 73 2c 20 4d | 2e 44 2e 7d 0d 0a 0d 0a |nkins, M|.D.}....|
|000017e0| 43 6f 70 79 72 69 67 68 | 74 20 28 63 29 20 59 65 |Copyrigh|t (c) Ye|
|000017f0| 61 72 20 42 6f 6f 6b 20 | 4d 65 64 69 63 61 6c 20 |ar Book |Medical |
|00001800| 50 75 62 6c 69 73 68 65 | 72 73 2c 20 49 6e 63 2e |Publishe|rs, Inc.|
|00001810| 2c 20 31 39 38 39 0d 0a | 0d 0a 31 39 38 39 20 59 |, 1989..|..1989 Y|
|00001820| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 55 72 6f 6c |ear Book| of Urol|
|00001830| 6f 67 79 20 28 52 29 0d | 0a 0d 0a 50 61 72 74 20 |ogy (R).|...Part |
|00001840| 31 3a 20 20 41 64 75 6c | 74 0d 0a 0d 0a 43 68 61 |1: Adul|t....Cha|
|00001850| 70 74 65 72 20 34 2d 2d | 43 61 6c 63 75 6c 75 73 |pter 4--|Calculus|
|00001860| 0d 0a 0d 0a 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |....----|--------|
|00001870| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001880| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001890| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000018a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000018b0| 2d 2d 2d 2d 0d 0a 41 62 | 6e 6f 72 6d 61 6c 20 52 |----..Ab|normal R|
|000018c0| 65 64 2d 43 65 6c 6c 20 | 43 61 6c 63 69 75 6d 20 |ed-Cell |Calcium |
|000018d0| 50 75 6d 70 20 69 6e 20 | 50 61 74 69 65 6e 74 73 |Pump in |Patients|
|000018e0| 20 57 69 74 68 20 49 64 | 69 6f 70 61 74 68 69 63 | With Id|iopathic|
|000018f0| 20 48 79 70 65 72 63 61 | 6c 63 69 75 72 69 61 0d | Hyperca|lciuria.|
|00001900| 0a 0d 0a 42 69 61 6e 63 | 68 69 20 47 3b 20 56 65 |...Bianc|hi G; Ve|
|00001910| 7a 7a 6f 6c 69 20 47 3b | 20 43 75 73 69 20 44 3b |zzoli G;| Cusi D;|
|00001920| 20 43 6f 76 61 20 54 3b | 20 45 6c 6c 69 20 41 3b | Cova T;| Elli A;|
|00001930| 20 53 6f 6c 64 61 74 69 | 20 4c 3b 20 54 72 69 70 | Soldati| L; Trip|
|00001940| 6f 64 69 20 47 3b 20 53 | 75 72 69 61 6e 20 4d 3b |odi G; S|urian M;|
|00001950| 0d 0a 4f 74 74 61 76 69 | 61 6e 6f 20 45 3b 20 52 |..Ottavi|ano E; R|
|00001960| 69 67 61 74 74 69 20 50 | 3b 20 4f 72 74 6f 6c 61 |igatti P|; Ortola|
|00001970| 6e 69 20 53 0d 0a 28 55 | 6e 69 76 20 6f 66 20 4d |ni S..(U|niv of M|
|00001980| 69 6c 61 6e 3b 20 55 6e | 69 76 20 6f 66 20 53 61 |ilan; Un|iv of Sa|
|00001990| 73 73 61 72 69 3b 20 42 | 61 73 73 69 6e 69 20 48 |ssari; B|assini H|
|000019a0| 6f 73 70 20 43 69 6e 69 | 73 65 6c 6c 6f 2c 20 4d |osp Cini|sello, M|
|000019b0| 69 6c 61 6e 3b 20 4f 73 | 70 65 64 61 6c 65 20 64 |ilan; Os|pedale d|
|000019c0| 69 0d 0a 4c 6f 64 69 3b | 20 4f 73 70 65 64 61 6c |i..Lodi;| Ospedal|
|000019d0| 65 20 53 20 52 61 66 66 | 61 65 6c 65 2c 20 4d 69 |e S Raff|aele, Mi|
|000019e0| 6c 61 6e 2c 20 49 74 61 | 6c 79 29 0d 0a 4e 20 45 |lan, Ita|ly)..N E|
|000019f0| 6e 67 6c 20 4a 20 4d 65 | 64 20 33 31 39 3a 38 39 |ngl J Me|d 319:89|
|00001a00| 37 2d 39 30 31 2c 20 4f | 63 74 20 36 2c 20 31 39 |7-901, O|ct 6, 19|
|00001a10| 38 38 0d 0a 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |88..----|--------|
|00001a20| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001a30| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001a40| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001a50| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00001a60| 2d 2d 2d 2d 0d 0a 0d 0a | 41 62 73 74 72 61 63 74 |----....|Abstract|
|00001a70| 0d 0a 0d 0a 20 20 20 20 | 20 49 64 69 6f 70 61 74 |.... | Idiopat|
|00001a80| 68 69 63 20 68 79 70 65 | 72 63 61 6c 63 69 75 72 |hic hype|rcalciur|
|00001a90| 69 61 20 69 73 20 61 20 | 6d 61 6a 6f 72 20 63 61 |ia is a |major ca|
|00001aa0| 75 73 65 20 6f 66 20 63 | 61 6c 63 69 75 6d 20 6e |use of c|alcium n|
|00001ab0| 65 70 68 72 6f 6c 69 74 | 68 69 61 73 69 73 2e 0d |ephrolit|hiasis..|
|00001ac0| 0a 41 6c 74 68 6f 75 67 | 68 20 69 74 73 20 65 74 |.Althoug|h its et|
|00001ad0| 69 6f 6c 6f 67 79 20 69 | 73 20 61 73 20 79 65 74 |iology i|s as yet|
|00001ae0| 20 75 6e 6b 6e 6f 77 6e | 2c 20 69 74 20 69 73 20 | unknown|, it is |
|00001af0| 6c 69 6b 65 6c 79 20 74 | 68 61 74 20 73 6f 6d 65 |likely t|hat some|
|00001b00| 20 65 6e 7a 79 6d 61 74 | 69 63 0d 0a 61 63 74 69 | enzymat|ic..acti|
|00001b10| 76 69 74 79 20 69 6e 76 | 6f 6c 76 65 64 20 69 6e |vity inv|olved in|
|00001b20| 20 63 61 6c 63 69 75 6d | 20 74 72 61 6e 73 70 6f | calcium| transpo|
|00001b30| 72 74 20 61 63 72 6f 73 | 73 20 63 65 6c 6c 20 6d |rt acros|s cell m|
|00001b40| 65 6d 62 72 61 6e 65 73 | 20 6d 61 79 20 62 65 20 |embranes| may be |
|00001b50| 67 65 6e 65 74 69 63 61 | 6c 6c 79 0d 0a 61 6c 74 |genetica|lly..alt|
|00001b60| 65 72 65 64 20 69 6e 20 | 70 61 74 69 65 6e 74 73 |ered in |patients|
|00001b70| 20 77 69 74 68 20 74 68 | 69 73 20 64 69 73 6f 72 | with th|is disor|
|00001b80| 64 65 72 2e 20 20 42 65 | 63 61 75 73 65 20 70 6c |der. Be|cause pl|
|00001b90| 61 73 6d 61 2d 6d 65 6d | 62 72 61 6e 65 20 63 61 |asma-mem|brane ca|
|00001ba0| 6c 63 69 75 6d 2d 70 75 | 6d 70 69 6e 67 0d 0a 61 |lcium-pu|mping..a|
|00001bb0| 64 65 6e 6f 73 69 6e 65 | 20 74 72 69 70 68 6f 73 |denosine| triphos|
|00001bc0| 70 68 61 74 61 73 65 20 | 28 41 54 50 61 73 65 29 |phatase |(ATPase)|
|00001bd0| 20 69 73 20 6f 6e 65 20 | 6f 66 20 74 68 65 20 6d | is one |of the m|
|00001be0| 61 6a 6f 72 20 63 61 6c | 63 69 75 6d 2d 74 72 61 |ajor cal|cium-tra|
|00001bf0| 6e 73 70 6f 72 74 69 6e | 67 0d 0a 65 6e 7a 79 6d |nsportin|g..enzym|
|00001c00| 65 73 2c 20 74 68 65 20 | 63 61 6c 63 69 75 6d 2d |es, the |calcium-|
|00001c10| 6d 61 67 6e 65 73 69 75 | 6d 20 41 54 50 61 73 65 |magnesiu|m ATPase|
|00001c20| 20 61 63 74 69 76 69 74 | 79 20 69 6e 20 72 65 64 | activit|y in red|
|00001c30| 20 63 65 6c 6c 20 6d 65 | 6d 62 72 61 6e 65 73 20 | cell me|mbranes |
|00001c40| 66 72 6f 6d 0d 0a 70 61 | 74 69 65 6e 74 73 20 77 |from..pa|tients w|
|00001c50| 69 74 68 20 69 64 69 6f | 70 61 74 68 69 63 20 68 |ith idio|pathic h|
|00001c60| 79 70 65 72 63 61 6c 63 | 69 75 72 69 61 20 77 61 |ypercalc|iuria wa|
|00001c70| 73 20 73 74 75 64 69 65 | 64 20 74 6f 20 64 65 74 |s studie|d to det|
|00001c80| 65 72 6d 69 6e 65 20 77 | 68 65 74 68 65 72 20 74 |ermine w|hether t|
|00001c90| 68 65 79 0d 0a 68 61 64 | 20 61 20 70 72 69 6d 61 |hey..had| a prima|
|00001ca0| 72 79 20 61 62 6e 6f 72 | 6d 61 6c 69 74 79 20 6f |ry abnor|mality o|
|00001cb0| 66 20 74 68 69 73 20 63 | 61 6c 63 69 75 6d 20 74 |f this c|alcium t|
|00001cc0| 72 61 6e 73 70 6f 72 74 | 20 73 79 73 74 65 6d 2e |ransport| system.|
|00001cd0| 0d 0a 20 20 20 20 20 54 | 68 65 20 73 74 75 64 79 |.. T|he study|
|00001ce0| 20 69 6e 63 6c 75 64 65 | 64 20 36 36 20 70 61 74 | include|d 66 pat|
|00001cf0| 69 65 6e 74 73 20 77 69 | 74 68 20 61 20 68 69 73 |ients wi|th a his|
|00001d00| 74 6f 72 79 20 6f 66 20 | 69 64 69 6f 70 61 74 68 |tory of |idiopath|
|00001d10| 69 63 20 66 6f 72 6d 61 | 74 69 6f 6e 20 6f 66 0d |ic forma|tion of.|
|00001d20| 0a 63 61 6c 63 69 75 6d | 20 6f 78 61 6c 61 74 65 |.calcium| oxalate|
|00001d30| 20 6b 69 64 6e 65 79 20 | 73 74 6f 6e 65 73 20 61 | kidney |stones a|
|00001d40| 6e 64 20 34 34 20 68 65 | 61 6c 74 68 79 20 63 6f |nd 44 he|althy co|
|00001d50| 6e 74 72 6f 6c 73 2e 20 | 20 54 68 69 72 74 79 2d |ntrols. | Thirty-|
|00001d60| 65 69 67 68 74 20 6f 66 | 20 74 68 65 20 36 36 0d |eight of| the 66.|
|00001d70| 0a 70 61 74 69 65 6e 74 | 73 20 68 61 64 20 69 64 |.patient|s had id|
|00001d80| 69 6f 70 61 74 68 69 63 | 20 68 79 70 65 72 63 61 |iopathic| hyperca|
|00001d90| 6c 63 69 75 72 69 61 2c | 20 61 6e 64 20 32 38 20 |lciuria,| and 28 |
|00001da0| 68 61 64 20 6e 6f 72 6d | 61 6c 20 75 72 69 6e 61 |had norm|al urina|
|00001db0| 72 79 20 65 78 63 72 65 | 74 69 6f 6e 20 6f 66 0d |ry excre|tion of.|
|00001dc0| 0a 63 61 6c 63 69 75 6d | 2e 20 20 41 6c 73 6f 20 |.calcium|. Also |
|00001dd0| 73 74 75 64 69 65 64 20 | 77 65 72 65 20 31 30 20 |studied |were 10 |
|00001de0| 66 61 6d 69 6c 69 65 73 | 20 77 69 74 68 20 6b 6e |families| with kn|
|00001df0| 6f 77 6e 20 65 6c 65 76 | 61 74 65 64 20 75 72 69 |own elev|ated uri|
|00001e00| 6e 61 72 79 20 65 78 63 | 72 65 74 69 6f 6e 20 6f |nary exc|retion o|
|00001e10| 66 0d 0a 63 61 6c 63 69 | 75 6d 20 62 75 74 20 6e |f..calci|um but n|
|00001e20| 6f 20 68 69 73 74 6f 72 | 79 20 6f 66 20 6b 69 64 |o histor|y of kid|
|00001e30| 6e 65 79 20 73 74 6f 6e | 65 73 2e 0d 0a 20 20 20 |ney ston|es... |
|00001e40| 20 20 50 61 74 69 65 6e | 74 73 20 77 69 74 68 20 | Patien|ts with |
|00001e50| 68 79 70 65 72 63 61 6c | 63 69 75 72 69 61 2c 20 |hypercal|ciuria, |
|00001e60| 77 69 74 68 20 6f 72 20 | 77 69 74 68 6f 75 74 20 |with or |without |
|00001e70| 61 20 68 69 73 74 6f 72 | 79 20 6f 66 20 6b 69 64 |a histor|y of kid|
|00001e80| 6e 65 79 20 73 74 6f 6e | 65 0d 0a 66 6f 72 6d 61 |ney ston|e..forma|
|00001e90| 74 69 6f 6e 2c 20 68 61 | 64 20 68 69 67 68 65 72 |tion, ha|d higher|
|00001ea0| 20 65 72 79 74 68 72 6f | 63 79 74 65 20 63 61 6c | erythro|cyte cal|
|00001eb0| 63 69 75 6d 2d 6d 61 67 | 6e 65 73 69 75 6d 20 41 |cium-mag|nesium A|
|00001ec0| 54 50 61 73 65 20 61 63 | 74 69 76 69 74 79 20 61 |TPase ac|tivity a|
|00001ed0| 6e 64 20 68 69 67 68 65 | 72 0d 0a 73 6f 64 69 75 |nd highe|r..sodiu|
|00001ee0| 6d 2d 70 6f 74 61 73 73 | 69 75 6d 20 70 75 6d 70 |m-potass|ium pump|
|00001ef0| 20 61 63 74 69 76 69 74 | 79 20 77 69 74 68 20 6c | activit|y with l|
|00001f00| 6f 77 65 72 20 73 6f 64 | 69 75 6d 20 63 6f 6e 74 |ower sod|ium cont|
|00001f10| 65 6e 74 20 74 68 61 6e | 20 64 69 64 20 6e 6f 72 |ent than| did nor|
|00001f20| 6d 61 6c 0d 0a 63 6f 6e | 74 72 6f 6c 73 20 6f 72 |mal..con|trols or|
|00001f30| 20 70 61 74 69 65 6e 74 | 73 20 77 69 74 68 20 6b | patient|s with k|
|00001f40| 69 64 6e 65 79 20 73 74 | 6f 6e 65 20 66 6f 72 6d |idney st|one form|
|00001f50| 61 74 69 6f 6e 20 62 75 | 74 20 6e 6f 72 6d 61 6c |ation bu|t normal|
|00001f60| 20 75 72 69 6e 61 72 79 | 20 65 78 63 72 65 74 69 | urinary| excreti|
|00001f70| 6f 6e 20 6f 66 0d 0a 63 | 61 6c 63 69 75 6d 2e 20 |on of..c|alcium. |
|00001f80| 20 54 68 65 72 65 20 77 | 61 73 20 6e 6f 20 73 69 | There w|as no si|
|00001f90| 67 6e 69 66 69 63 61 6e | 74 20 64 69 66 66 65 72 |gnifican|t differ|
|00001fa0| 65 6e 63 65 20 62 65 74 | 77 65 65 6e 20 74 68 65 |ence bet|ween the|
|00001fb0| 20 67 72 6f 75 70 73 20 | 69 6e 0d 0a 73 6f 64 69 | groups |in..sodi|
|00001fc0| 75 6d 2d 70 6f 74 61 73 | 73 69 75 6d 20 63 6f 74 |um-potas|sium cot|
|00001fd0| 72 61 6e 73 70 6f 72 74 | 20 6f 72 20 73 6f 64 69 |ransport| or sodi|
|00001fe0| 75 6d 2d 6c 69 74 68 69 | 75 6d 20 63 6f 75 6e 74 |um-lithi|um count|
|00001ff0| 65 72 74 72 61 6e 73 70 | 6f 72 74 2e 20 20 48 6f |ertransp|ort. Ho|
|00002000| 77 65 76 65 72 2c 0d 0a | 70 61 74 69 65 6e 74 73 |wever,..|patients|
|00002010| 20 77 69 74 68 20 68 79 | 70 65 72 63 61 6c 63 69 | with hy|percalci|
|00002020| 75 72 69 61 20 68 61 64 | 20 69 6e 63 72 65 61 73 |uria had| increas|
|00002030| 65 64 20 75 72 69 6e 61 | 72 79 20 6c 65 76 65 6c |ed urina|ry level|
|00002040| 73 20 6f 66 20 75 72 69 | 63 20 61 63 69 64 20 61 |s of uri|c acid a|
|00002050| 6e 64 0d 0a 65 78 63 72 | 65 74 69 6f 6e 20 6f 66 |nd..excr|etion of|
|00002060| 20 70 68 6f 73 70 68 61 | 74 65 20 77 68 65 6e 20 | phospha|te when |
|00002070| 63 6f 6d 70 61 72 65 64 | 20 77 69 74 68 20 63 6f |compared| with co|
|00002080| 6e 74 72 6f 6c 73 20 77 | 68 6f 20 68 61 64 20 6e |ntrols w|ho had n|
|00002090| 6f 20 68 79 70 65 72 63 | 61 6c 63 69 75 72 69 61 |o hyperc|alciuria|
|000020a0| 2e 0d 0a 45 69 67 68 74 | 20 70 61 74 69 65 6e 74 |...Eight| patient|
|000020b0| 73 20 77 68 6f 20 77 65 | 72 65 20 72 65 73 74 75 |s who we|re restu|
|000020c0| 64 69 65 64 20 61 66 74 | 65 72 20 6d 61 69 6e 74 |died aft|er maint|
|000020d0| 61 69 6e 69 6e 67 20 61 | 20 6c 6f 77 2d 63 61 6c |aining a| low-cal|
|000020e0| 63 69 75 6d 20 64 69 65 | 74 20 66 6f 72 20 31 32 |cium die|t for 12|
|000020f0| 30 0d 0a 64 61 79 73 20 | 73 68 6f 77 65 64 20 6e |0..days |showed n|
|00002100| 6f 20 63 68 61 6e 67 65 | 20 69 6e 20 72 65 64 20 |o change| in red |
|00002110| 63 65 6c 6c 20 63 61 6c | 63 69 75 6d 2d 6d 61 67 |cell cal|cium-mag|
|00002120| 6e 65 73 69 75 6d 20 41 | 54 50 61 73 65 20 61 63 |nesium A|TPase ac|
|00002130| 74 69 76 69 74 79 2e 0d | 0a 20 20 20 20 20 54 68 |tivity..|. Th|
|00002140| 61 74 20 63 61 6c 63 69 | 75 6d 20 70 75 6d 70 20 |at calci|um pump |
|00002150| 61 63 74 69 76 69 74 79 | 20 77 61 73 20 69 6e 63 |activity| was inc|
|00002160| 72 65 61 73 65 64 20 69 | 6e 20 61 6c 6c 20 70 61 |reased i|n all pa|
|00002170| 74 69 65 6e 74 73 20 77 | 69 74 68 0d 0a 68 79 70 |tients w|ith..hyp|
|00002180| 65 72 63 61 6c 63 69 75 | 72 69 61 20 72 65 67 61 |ercalciu|ria rega|
|00002190| 72 64 6c 65 73 73 20 6f | 66 20 77 68 65 74 68 65 |rdless o|f whethe|
|000021a0| 72 20 6f 72 20 6e 6f 74 | 20 74 68 65 79 20 68 61 |r or not| they ha|
|000021b0| 64 20 6b 69 64 6e 65 79 | 20 73 74 6f 6e 65 20 64 |d kidney| stone d|
|000021c0| 69 73 65 61 73 65 0d 0a | 63 6f 6e 66 69 72 6d 73 |isease..|confirms|
|000021d0| 20 74 68 65 20 70 72 65 | 73 65 6e 63 65 20 6f 66 | the pre|sence of|
|000021e0| 20 61 6e 20 69 6e 68 65 | 72 69 74 65 64 20 65 6e | an inhe|rited en|
|000021f0| 7a 79 6d 65 20 61 62 6e | 6f 72 6d 61 6c 69 74 79 |zyme abn|ormality|
|00002200| 2e 20 20 48 6f 77 65 76 | 65 72 2c 20 74 68 65 20 |. Howev|er, the |
|00002210| 67 65 6e 65 74 69 63 0d | 0a 6d 65 63 68 61 6e 69 |genetic.|.mechani|
|00002220| 73 6d 20 74 68 61 74 20 | 63 6f 6e 74 72 6f 6c 73 |sm that |controls|
|00002230| 20 63 61 6c 63 69 75 6d | 2d 74 72 61 6e 73 70 6f | calcium|-transpo|
|00002240| 72 74 20 73 79 73 74 65 | 6d 73 20 69 6e 20 72 65 |rt syste|ms in re|
|00002250| 64 20 63 65 6c 6c 20 70 | 6c 61 73 6d 61 20 6d 65 |d cell p|lasma me|
|00002260| 6d 62 72 61 6e 65 73 0d | 0a 69 73 20 61 73 20 79 |mbranes.|.is as y|
|00002270| 65 74 20 75 6e 6b 6e 6f | 77 6e 2e 0d 0a 0d 0a 50 |et unkno|wn.....P|
|00002280| 6f 73 74 2d 43 6f 6d 6d | 65 6e 74 0d 0a 0d 0a 20 |ost-Comm|ent.... |
|00002290| 20 20 20 20 43 61 6c 63 | 69 75 6d 2d 6d 61 67 6e | Calc|ium-magn|
|000022a0| 65 73 69 75 6d 2d 41 54 | 50 61 73 65 20 69 73 20 |esium-AT|Pase is |
|000022b0| 61 6e 20 65 6e 7a 79 6d | 65 20 74 68 61 74 20 74 |an enzym|e that t|
|000022c0| 72 61 6e 73 70 6f 72 74 | 73 20 63 61 6c 63 69 75 |ransport|s calciu|
|000022d0| 6d 20 61 63 72 6f 73 73 | 20 74 68 65 0d 0a 70 6c |m across| the..pl|
|000022e0| 61 73 6d 61 20 6d 65 6d | 62 72 61 6e 65 2e 20 20 |asma mem|brane. |
|000022f0| 54 68 65 73 65 20 69 6e | 76 65 73 74 69 67 61 74 |These in|vestigat|
|00002300| 6f 72 73 20 66 6f 75 6e | 64 20 74 68 61 74 20 74 |ors foun|d that t|
|00002310| 68 65 20 61 63 74 69 76 | 69 74 79 20 6f 66 20 74 |he activ|ity of t|
|00002320| 68 69 73 20 65 6e 7a 79 | 6d 65 20 69 6e 0d 0a 72 |his enzy|me in..r|
|00002330| 65 64 20 62 6c 6f 6f 64 | 20 63 65 6c 6c 73 20 77 |ed blood| cells w|
|00002340| 61 73 20 69 6e 63 72 65 | 61 73 65 64 20 69 6e 20 |as incre|ased in |
|00002350| 70 61 74 69 65 6e 74 73 | 20 77 69 74 68 20 68 79 |patients| with hy|
|00002360| 70 65 72 63 61 6c 63 69 | 75 72 69 61 2e 20 20 54 |percalci|uria. T|
|00002370| 68 65 20 61 75 74 68 6f | 72 73 0d 0a 68 79 70 6f |he autho|rs..hypo|
|00002380| 74 68 65 73 69 7a 65 20 | 74 68 61 74 20 61 20 73 |thesize |that a s|
|00002390| 69 6d 69 6c 61 72 20 61 | 62 6e 6f 72 6d 61 6c 69 |imilar a|bnormali|
|000023a0| 74 79 20 6d 61 79 20 65 | 78 69 73 74 20 69 6e 20 |ty may e|xist in |
|000023b0| 69 6e 74 65 73 74 69 6e | 61 6c 20 65 70 69 74 68 |intestin|al epith|
|000023c0| 65 6c 69 61 6c 20 61 6e | 64 0d 0a 72 65 6e 61 6c |elial an|d..renal|
|000023d0| 20 74 75 62 75 6c 61 72 | 20 63 65 6c 6c 73 20 66 | tubular| cells f|
|000023e0| 72 6f 6d 20 74 68 65 73 | 65 20 70 61 74 69 65 6e |rom thes|e patien|
|000023f0| 74 73 2e 0d 0a 20 20 20 | 20 20 41 6e 20 65 61 72 |ts... | An ear|
|00002400| 6c 69 65 72 20 73 74 75 | 64 79 20 28 31 29 20 66 |lier stu|dy (1) f|
|00002410| 6f 75 6e 64 20 61 6e 20 | 61 62 6e 6f 72 6d 61 6c |ound an |abnormal|
|00002420| 69 74 79 20 6f 66 20 6f | 78 61 6c 61 74 65 20 74 |ity of o|xalate t|
|00002430| 72 61 6e 73 70 6f 72 74 | 20 69 6e 20 72 65 64 20 |ransport| in red |
|00002440| 62 6c 6f 6f 64 0d 0a 63 | 65 6c 6c 73 20 66 72 6f |blood..c|ells fro|
|00002450| 6d 20 70 61 74 69 65 6e | 74 73 20 77 69 74 68 20 |m patien|ts with |
|00002460| 69 64 69 6f 70 61 74 68 | 69 63 20 63 61 6c 63 69 |idiopath|ic calci|
|00002470| 75 6d 20 6f 78 61 6c 61 | 74 65 20 6e 65 70 68 72 |um oxala|te nephr|
|00002480| 6f 6c 69 74 68 69 61 73 | 69 73 2e 0d 0a 55 6e 66 |olithias|is...Unf|
|00002490| 6f 72 74 75 6e 61 74 65 | 6c 79 2c 20 6f 74 68 65 |ortunate|ly, othe|
|000024a0| 72 20 69 6e 76 65 73 74 | 69 67 61 74 6f 72 73 20 |r invest|igators |
|000024b0| 68 61 76 65 20 68 61 64 | 20 64 69 66 66 69 63 75 |have had| difficu|
|000024c0| 6c 74 79 20 72 65 70 72 | 6f 64 75 63 69 6e 67 20 |lty repr|oducing |
|000024d0| 74 68 65 73 65 0d 0a 72 | 65 73 75 6c 74 73 2e 2d |these..r|esults.-|
|000024e0| 2d 41 2e 44 2e 20 4a 65 | 6e 6b 69 6e 73 2c 20 4d |-A.D. Je|nkins, M|
|000024f0| 2e 44 2e 0d 0a 24 55 6e | 69 71 75 65 5f 49 44 7b |.D...$Un|ique_ID{|
|00002500| 59 52 42 30 38 39 30 32 | 7d 0d 0a 24 54 69 74 6c |YRB08902|}..$Titl|
|00002510| 65 7b 4d 65 61 73 75 72 | 65 6d 65 6e 74 20 6f 66 |e{Measur|ement of|
|00002520| 20 4e 6f 72 65 70 69 6e | 65 70 68 72 69 6e 65 20 | Norepin|ephrine |
|00002530| 61 6e 64 20 33 2c 34 2d | 44 69 68 79 64 72 6f 78 |and 3,4-|Dihydrox|
|00002540| 79 70 68 65 6e 79 6c 67 | 6c 79 63 6f 6c 20 69 6e |yphenylg|lycol in|
|00002550| 20 55 72 69 6e 65 20 61 | 6e 64 20 50 6c 61 73 6d | Urine a|nd Plasm|
|00002560| 61 20 66 6f 72 20 74 68 | 65 20 44 69 61 67 6e 6f |a for th|e Diagno|
|00002570| 73 69 73 20 6f 66 20 50 | 68 65 6f 63 68 72 6f 6d |sis of P|heochrom|
|00002580| 6f 63 79 74 6f 6d 61 7d | 0d 0a 24 41 75 74 68 6f |ocytoma}|..$Autho|
|00002590| 72 7b 0d 0a 44 75 6e 63 | 61 6e 2c 20 4d 57 0d 0a |r{..Dunc|an, MW..|
|000025a0| 43 6f 6d 70 74 6f 6e 2c | 20 50 0d 0a 4c 61 7a 61 |Compton,| P..Laza|
|000025b0| 72 75 73 2c 20 4c 0d 0a | 53 6d 79 74 68 65 2c 20 |rus, L..|Smythe, |
|000025c0| 47 41 7d 0d 0a 24 41 66 | 66 69 6c 69 61 74 69 6f |GA}..$Af|filiatio|
|000025d0| 6e 7b 53 74 20 56 69 6e | 63 65 6e 74 27 73 20 48 |n{St Vin|cent's H|
|000025e0| 6f 73 70 2c 20 53 79 64 | 6e 65 79 2c 20 41 75 73 |osp, Syd|ney, Aus|
|000025f0| 74 72 61 6c 69 61 7d 0d | 0a 24 53 75 62 6a 65 63 |tralia}.|.$Subjec|
|00002600| 74 7b 50 68 65 6f 63 68 | 72 6f 6d 6f 63 79 74 6f |t{Pheoch|romocyto|
|00002610| 6d 61 2c 20 33 2c 34 2d | 64 69 68 79 64 72 6f 78 |ma, 3,4-|dihydrox|
|00002620| 79 70 68 65 6e 79 6c 67 | 6c 79 63 6f 6c 20 6d 65 |yphenylg|lycol me|
|00002630| 61 73 75 72 65 6d 65 6e | 74 20 69 6e 7d 0d 0a 24 |asuremen|t in}..$|
|00002640| 4a 6f 75 72 6e 61 6c 7b | 4e 20 45 6e 67 6c 20 4a |Journal{|N Engl J|
|00002650| 20 4d 65 64 7d 0d 0a 24 | 56 6f 6c 75 6d 65 7b 33 | Med}..$|Volume{3|
|00002660| 31 39 7d 0d 0a 24 50 61 | 67 65 7b 31 33 36 2d 31 |19}..$Pa|ge{136-1|
|00002670| 34 32 7d 0d 0a 24 44 61 | 74 65 7b 4a 75 6c 79 20 |42}..$Da|te{July |
|00002680| 32 31 2c 20 31 39 38 38 | 7d 0d 0a 24 59 42 56 6f |21, 1988|}..$YBVo|
|00002690| 6c 7b 31 39 38 39 20 59 | 65 61 72 20 42 6f 6f 6b |l{1989 Y|ear Book|
|000026a0| 20 6f 66 20 55 72 6f 6c | 6f 67 79 7d 0d 0a 24 43 | of Urol|ogy}..$C|
|000026b0| 68 61 70 74 65 72 7b 36 | 2d 31 7d 0d 0a 24 59 42 |hapter{6|-1}..$YB|
|000026c0| 45 64 69 74 6f 72 7b 44 | 72 73 2e 20 47 69 6c 6c |Editor{D|rs. Gill|
|000026d0| 65 6e 77 61 74 65 72 20 | 61 6e 64 20 48 6f 77 61 |enwater |and Howa|
|000026e0| 72 64 73 7d 0d 0a 24 54 | 61 62 6c 65 7b 7d 0d 0a |rds}..$T|able{}..|
|000026f0| 24 43 6f 6d 6d 65 6e 74 | 61 74 6f 72 7b 53 2e 53 |$Comment|ator{S.S|
|00002700| 2e 20 48 6f 77 61 72 64 | 73 2c 20 4d 2e 44 2e 7d |. Howard|s, M.D.}|
|00002710| 0d 0a 0d 0a 43 6f 70 79 | 72 69 67 68 74 20 28 63 |....Copy|right (c|
|00002720| 29 20 59 65 61 72 20 42 | 6f 6f 6b 20 4d 65 64 69 |) Year B|ook Medi|
|00002730| 63 61 6c 20 50 75 62 6c | 69 73 68 65 72 73 2c 20 |cal Publ|ishers, |
|00002740| 49 6e 63 2e 2c 20 31 39 | 38 39 0d 0a 0d 0a 31 39 |Inc., 19|89....19|
|00002750| 38 39 20 59 65 61 72 20 | 42 6f 6f 6b 20 6f 66 20 |89 Year |Book of |
|00002760| 55 72 6f 6c 6f 67 79 20 | 28 52 29 0d 0a 0d 0a 50 |Urology |(R)....P|
|00002770| 61 72 74 20 31 3a 20 20 | 41 64 75 6c 74 0d 0a 0d |art 1: |Adult...|
|00002780| 0a 43 68 61 70 74 65 72 | 20 36 2d 2d 41 64 72 65 |.Chapter| 6--Adre|
|00002790| 6e 61 6c 73 0d 0a 0d 0a | 2d 2d 2d 2d 2d 2d 2d 2d |nals....|--------|
|000027a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000027b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000027c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000027d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000027e0| 2d 2d 2d 2d 2d 2d 2d 2d | 0d 0a 4d 65 61 73 75 72 |--------|..Measur|
|000027f0| 65 6d 65 6e 74 20 6f 66 | 20 4e 6f 72 65 70 69 6e |ement of| Norepin|
|00002800| 65 70 68 72 69 6e 65 20 | 61 6e 64 20 33 2c 34 2d |ephrine |and 3,4-|
|00002810| 44 69 68 79 64 72 6f 78 | 79 70 68 65 6e 79 6c 67 |Dihydrox|yphenylg|
|00002820| 6c 79 63 6f 6c 20 69 6e | 20 55 72 69 6e 65 20 61 |lycol in| Urine a|
|00002830| 6e 64 20 50 6c 61 73 6d | 61 0d 0a 66 6f 72 20 74 |nd Plasm|a..for t|
|00002840| 68 65 20 44 69 61 67 6e | 6f 73 69 73 20 6f 66 20 |he Diagn|osis of |
|00002850| 50 68 65 6f 63 68 72 6f | 6d 6f 63 79 74 6f 6d 61 |Pheochro|mocytoma|
|00002860| 0d 0a 0d 0a 44 75 6e 63 | 61 6e 20 4d 57 3b 20 43 |....Dunc|an MW; C|
|00002870| 6f 6d 70 74 6f 6e 20 50 | 3b 20 4c 61 7a 61 72 75 |ompton P|; Lazaru|
|00002880| 73 20 4c 3b 20 53 6d 79 | 74 68 65 20 47 41 0d 0a |s L; Smy|the GA..|
|00002890| 28 53 74 20 56 69 6e 63 | 65 6e 74 27 73 20 48 6f |(St Vinc|ent's Ho|
|000028a0| 73 70 2c 20 53 79 64 6e | 65 79 2c 20 41 75 73 74 |sp, Sydn|ey, Aust|
|000028b0| 72 61 6c 69 61 29 0d 0a | 4e 20 45 6e 67 6c 20 4a |ralia)..|N Engl J|
|000028c0| 20 4d 65 64 20 33 31 39 | 3a 31 33 36 2d 31 34 32 | Med 319|:136-142|
|000028d0| 2c 20 4a 75 6c 79 20 32 | 31 2c 20 31 39 38 38 0d |, July 2|1, 1988.|
|000028e0| 0a 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |.-------|--------|
|000028f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002900| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002910| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002920| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00002930| 2d 0d 0a 0d 0a 41 62 73 | 74 72 61 63 74 0d 0a 0d |-....Abs|tract...|
|00002940| 0a 20 20 20 20 20 50 68 | 65 6f 63 68 72 6f 6d 6f |. Ph|eochromo|
|00002950| 63 79 74 6f 6d 61 20 69 | 73 20 61 6e 20 75 6e 63 |cytoma i|s an unc|
|00002960| 6f 6d 6d 6f 6e 20 62 75 | 74 20 63 6f 72 72 65 63 |ommon bu|t correc|
|00002970| 74 61 62 6c 65 20 63 61 | 75 73 65 20 6f 66 20 68 |table ca|use of h|
|00002980| 79 70 65 72 74 65 6e 73 | 69 6f 6e 20 74 68 61 74 |ypertens|ion that|
|00002990| 0d 0a 68 61 73 20 70 72 | 6f 76 65 64 20 74 6f 20 |..has pr|oved to |
|000029a0| 62 65 20 61 20 64 69 61 | 67 6e 6f 73 74 69 63 20 |be a dia|gnostic |
|000029b0| 63 68 61 6c 6c 65 6e 67 | 65 2e 20 20 41 20 63 6f |challeng|e. A co|
|000029c0| 6d 70 61 72 69 73 6f 6e | 20 6f 66 20 70 6c 61 73 |mparison| of plas|
|000029d0| 6d 61 20 6f 72 20 75 72 | 69 6e 65 20 6c 65 76 65 |ma or ur|ine leve|
|000029e0| 6c 73 0d 0a 6f 66 20 6e | 6f 72 65 70 69 6e 65 70 |ls..of n|orepinep|
|000029f0| 68 72 69 6e 65 20 28 4e | 45 29 20 61 6e 64 20 33 |hrine (N|E) and 3|
|00002a00| 2c 34 2d 64 69 68 79 64 | 72 6f 78 79 70 68 65 6e |,4-dihyd|roxyphen|
|00002a10| 79 6c 67 6c 79 63 6f 6c | 20 28 44 48 50 47 29 20 |ylglycol| (DHPG) |
|00002a20| 6d 61 79 20 70 65 72 6d | 69 74 20 4e 45 20 6f 66 |may perm|it NE of|
|00002a30| 0d 0a 74 75 6d 6f 72 20 | 6f 72 69 67 69 6e 20 74 |..tumor |origin t|
|00002a40| 6f 20 62 65 20 64 69 73 | 74 69 6e 67 75 69 73 68 |o be dis|tinguish|
|00002a50| 65 64 20 66 72 6f 6d 20 | 4e 45 20 6f 66 20 6e 65 |ed from |NE of ne|
|00002a60| 75 72 6f 6e 61 6c 20 6f | 72 69 67 69 6e 2e 20 20 |uronal o|rigin. |
|00002a70| 54 68 65 20 64 69 61 67 | 6e 6f 73 74 69 63 0d 0a |The diag|nostic..|
|00002a80| 75 74 69 6c 69 74 79 20 | 6f 66 20 73 69 6d 75 6c |utility |of simul|
|00002a90| 74 61 6e 65 6f 75 73 20 | 64 65 74 65 72 6d 69 6e |taneous |determin|
|00002aa0| 61 74 69 6f 6e 20 6f 66 | 20 4e 45 20 61 6e 64 20 |ation of| NE and |
|00002ab0| 44 48 50 47 20 6c 65 76 | 65 6c 73 20 69 6e 20 74 |DHPG lev|els in t|
|00002ac0| 68 65 20 64 69 66 66 65 | 72 65 6e 74 69 61 6c 0d |he diffe|rential.|
|00002ad0| 0a 64 69 61 67 6e 6f 73 | 69 73 20 6f 66 20 70 68 |.diagnos|is of ph|
|00002ae0| 65 6f 63 68 72 6f 6d 6f | 63 79 74 6f 6d 61 20 77 |eochromo|cytoma w|
|00002af0| 61 73 20 73 74 75 64 69 | 65 64 2e 0d 0a 20 20 20 |as studi|ed... |
|00002b00| 20 20 53 70 65 63 69 66 | 69 63 20 67 61 73 20 63 | Specif|ic gas c|
|00002b10| 68 72 6f 6d 61 74 6f 67 | 72 61 70 68 69 63 2d 6d |hromatog|raphic-m|
|00002b20| 61 73 73 20 73 70 65 63 | 74 72 6f 6d 65 74 72 69 |ass spec|trometri|
|00002b30| 63 20 61 6e 61 6c 79 73 | 69 73 20 6f 66 20 62 6f |c analys|is of bo|
|00002b40| 74 68 20 75 72 69 6e 65 | 20 61 6e 64 0d 0a 70 6c |th urine| and..pl|
|00002b50| 61 73 6d 61 20 77 61 73 | 20 75 73 65 64 2e 20 20 |asma was| used. |
|00002b60| 4f 66 20 31 2c 30 38 36 | 20 68 79 70 65 72 74 65 |Of 1,086| hyperte|
|00002b70| 6e 73 69 76 65 20 70 61 | 74 69 65 6e 74 73 20 73 |nsive pa|tients s|
|00002b80| 74 75 64 69 65 64 2c 20 | 32 35 20 68 61 64 20 70 |tudied, |25 had p|
|00002b90| 72 6f 76 65 64 0d 0a 70 | 68 65 6f 63 68 72 6f 6d |roved..p|heochrom|
|00002ba0| 6f 63 79 74 6f 6d 61 2e | 20 20 4d 65 61 73 75 72 |ocytoma.| Measur|
|00002bb0| 65 6d 65 6e 74 20 6f 66 | 20 66 72 65 65 20 6e 6f |ement of| free no|
|00002bc0| 72 65 70 69 6e 65 70 68 | 72 69 6e 65 20 69 6e 20 |repineph|rine in |
|00002bd0| 32 34 2d 68 6f 75 72 20 | 75 72 69 6e 65 20 73 61 |24-hour |urine sa|
|00002be0| 6d 70 6c 65 73 0d 0a 67 | 61 76 65 20 74 68 65 20 |mples..g|ave the |
|00002bf0| 62 65 73 74 20 69 6e 64 | 65 78 20 6f 66 20 61 20 |best ind|ex of a |
|00002c00| 70 68 65 6f 63 68 72 6f | 6d 6f 63 79 74 6f 6d 61 |pheochro|mocytoma|
|00002c10| 2e 20 20 54 68 69 73 20 | 6d 65 74 68 6f 64 20 68 |. This |method h|
|00002c20| 61 64 20 61 20 31 30 30 | 25 20 73 65 6e 73 69 74 |ad a 100|% sensit|
|00002c30| 69 76 69 74 79 0d 0a 61 | 6e 64 20 61 20 39 38 25 |ivity..a|nd a 98%|
|00002c40| 20 73 70 65 63 69 66 69 | 63 69 74 79 20 61 6d 6f | specifi|city amo|
|00002c50| 6e 67 20 31 2c 31 39 32 | 20 75 72 69 6e 65 20 73 |ng 1,192| urine s|
|00002c60| 61 6d 70 6c 65 73 2c 20 | 63 6f 6d 70 61 72 65 64 |amples, |compared|
|00002c70| 20 77 69 74 68 20 61 6e | 20 38 32 25 0d 0a 73 65 | with an| 82%..se|
|00002c80| 6e 73 69 74 69 76 69 74 | 79 20 61 6e 64 20 39 35 |nsitivit|y and 95|
|00002c90| 25 20 73 70 65 63 69 66 | 69 63 69 74 79 20 61 6d |% specif|icity am|
|00002ca0| 6f 6e 67 20 33 35 38 20 | 70 6c 61 73 6d 61 20 73 |ong 358 |plasma s|
|00002cb0| 61 6d 70 6c 65 73 2e 20 | 20 53 69 6d 75 6c 74 61 |amples. | Simulta|
|00002cc0| 6e 65 6f 75 73 0d 0a 6d | 65 61 73 75 72 65 6d 65 |neous..m|easureme|
|00002cd0| 6e 74 20 6f 66 20 4e 45 | 20 61 6e 64 20 44 48 50 |nt of NE| and DHP|
|00002ce0| 47 20 69 6e 20 75 72 69 | 6e 65 20 66 75 72 74 68 |G in uri|ne furth|
|00002cf0| 65 72 20 69 6d 70 72 6f | 76 65 64 20 73 70 65 63 |er impro|ved spec|
|00002d00| 69 66 69 63 69 74 79 20 | 74 6f 20 39 39 25 2c 20 |ificity |to 99%, |
|00002d10| 62 75 74 20 74 68 65 0d | 0a 75 73 65 20 6f 66 20 |but the.|.use of |
|00002d20| 74 68 65 20 72 61 74 69 | 6f 20 6f 66 20 4e 45 20 |the rati|o of NE |
|00002d30| 74 6f 20 44 48 50 47 20 | 72 65 64 75 63 65 64 20 |to DHPG |reduced |
|00002d40| 73 65 6e 73 69 74 69 76 | 69 74 79 20 74 6f 20 39 |sensitiv|ity to 9|
|00002d50| 35 25 2c 20 73 69 6e 63 | 65 20 73 6f 6d 65 20 70 |5%, sinc|e some p|
|00002d60| 61 74 69 65 6e 74 73 0d | 0a 77 69 74 68 20 70 68 |atients.|.with ph|
|00002d70| 65 6f 63 68 72 6f 6d 6f | 63 79 74 6f 6d 61 20 73 |eochromo|cytoma s|
|00002d80| 65 63 72 65 74 65 20 6c | 61 72 67 65 20 61 6d 6f |ecrete l|arge amo|
|00002d90| 75 6e 74 73 20 6f 66 20 | 44 48 50 47 2e 0d 0a 20 |unts of |DHPG... |
|00002da0| 20 20 20 20 4f 6e 20 74 | 68 65 20 62 61 73 69 73 | On t|he basis|
|00002db0| 20 6f 66 20 74 68 65 73 | 65 20 66 69 6e 64 69 6e | of thes|e findin|
|00002dc0| 67 73 2c 20 69 74 20 77 | 61 73 20 72 65 63 6f 6d |gs, it w|as recom|
|00002dd0| 6d 65 6e 64 65 64 20 74 | 68 61 74 20 6d 65 61 73 |mended t|hat meas|
|00002de0| 75 72 65 6d 65 6e 74 20 | 6f 66 0d 0a 32 34 2d 68 |urement |of..24-h|
|00002df0| 6f 75 72 20 75 72 69 6e | 61 72 79 20 6c 65 76 65 |our urin|ary leve|
|00002e00| 6c 73 20 6f 66 20 66 72 | 65 65 20 4e 45 20 62 65 |ls of fr|ee NE be|
|00002e10| 20 64 6f 6e 65 20 66 6f | 72 20 74 68 65 20 64 69 | done fo|r the di|
|00002e20| 61 67 6e 6f 73 69 73 20 | 6f 66 20 70 68 65 6f 63 |agnosis |of pheoc|
|00002e30| 68 72 6f 6d 6f 63 79 74 | 6f 6d 61 2e 0d 0a 53 69 |hromocyt|oma...Si|
|00002e40| 6d 75 6c 74 61 6e 65 6f | 75 73 20 61 6e 61 6c 79 |multaneo|us analy|
|00002e50| 73 69 73 20 66 6f 72 20 | 44 48 50 47 20 6d 61 79 |sis for |DHPG may|
|00002e60| 20 73 6f 6d 65 74 69 6d | 65 73 20 70 72 6f 76 65 | sometim|es prove|
|00002e70| 20 75 73 65 66 75 6c 20 | 69 6e 20 64 65 63 72 65 | useful |in decre|
|00002e80| 61 73 69 6e 67 20 74 68 | 65 20 72 61 74 65 0d 0a |asing th|e rate..|
|00002e90| 6f 66 20 66 61 6c 73 65 | 20 70 6f 73 69 74 69 76 |of false| positiv|
|00002ea0| 65 20 72 65 73 75 6c 74 | 73 2e 0d 0a 0d 0a 50 6f |e result|s.....Po|
|00002eb0| 73 74 2d 43 6f 6d 6d 65 | 6e 74 0d 0a 0d 0a 20 20 |st-Comme|nt.... |
|00002ec0| 20 20 20 54 68 65 20 6d | 61 6a 6f 72 20 63 6c 69 | The m|ajor cli|
|00002ed0| 6e 69 63 61 6c 20 70 6f | 69 6e 74 20 64 6f 63 75 |nical po|int docu|
|00002ee0| 6d 65 6e 74 65 64 20 62 | 79 20 74 68 69 73 20 73 |mented b|y this s|
|00002ef0| 74 75 64 79 20 69 73 20 | 74 68 61 74 20 61 20 32 |tudy is |that a 2|
|00002f00| 34 2d 68 6f 75 72 20 75 | 72 69 6e 65 0d 0a 66 6f |4-hour u|rine..fo|
|00002f10| 72 20 6e 6f 72 65 70 69 | 6e 65 70 68 72 69 6e 65 |r norepi|nephrine|
|00002f20| 20 28 4e 45 29 20 69 73 | 20 61 20 6d 6f 72 65 20 | (NE) is| a more |
|00002f30| 61 63 63 75 72 61 74 65 | 20 74 65 73 74 20 66 6f |accurate| test fo|
|00002f40| 72 20 70 68 65 6f 63 68 | 72 6f 6d 6f 63 79 74 6f |r pheoch|romocyto|
|00002f50| 6d 61 20 74 68 61 6e 20 | 61 0d 0a 70 6c 61 73 6d |ma than |a..plasm|
|00002f60| 61 20 6c 65 76 65 6c 2e | 20 20 54 68 65 20 61 75 |a level.| The au|
|00002f70| 74 68 6f 72 73 20 66 6f | 75 6e 64 20 35 25 20 66 |thors fo|und 5% f|
|00002f80| 61 6c 73 65 20 70 6f 73 | 69 74 69 76 65 73 20 61 |alse pos|itives a|
|00002f90| 6e 64 20 32 35 25 20 66 | 61 6c 73 65 20 6e 65 67 |nd 25% f|alse neg|
|00002fa0| 61 74 69 76 65 73 20 69 | 6e 0d 0a 70 6c 61 73 6d |atives i|n..plasm|
|00002fb0| 61 20 4e 45 20 74 65 73 | 74 73 2e 20 20 57 65 20 |a NE tes|ts. We |
|00002fc0| 68 61 76 65 20 61 6c 77 | 61 79 73 20 66 65 6c 74 |have alw|ays felt|
|00002fd0| 20 74 68 61 74 20 74 68 | 65 20 75 72 69 6e 61 72 | that th|e urinar|
|00002fe0| 79 20 74 65 73 74 20 66 | 6f 72 20 4e 45 20 61 6e |y test f|or NE an|
|00002ff0| 64 0d 0a 63 61 74 65 63 | 68 6f 6c 61 6d 69 6e 65 |d..catec|holamine|
|00003000| 20 6d 65 74 61 62 6f 6c | 69 74 65 73 20 69 73 20 | metabol|ites is |
|00003010| 74 68 65 20 62 65 73 74 | 20 6d 65 74 68 6f 64 20 |the best| method |
|00003020| 74 6f 20 64 69 61 67 6e | 6f 73 65 20 70 68 65 6f |to diagn|ose pheo|
|00003030| 63 68 72 6f 6d 6f 63 79 | 74 6f 6d 61 20 28 73 65 |chromocy|toma (se|
|00003040| 65 0d 0a 41 64 75 6c 74 | 20 61 6e 64 20 50 65 64 |e..Adult| and Ped|
|00003050| 69 61 74 72 69 63 20 55 | 72 6f 6c 6f 67 79 2c 20 |iatric U|rology, |
|00003060| 63 68 61 70 74 65 72 20 | 31 34 29 2e 0d 0a 20 20 |chapter |14)... |
|00003070| 20 20 20 41 6e 6f 74 68 | 65 72 20 69 6e 74 65 72 | Anoth|er inter|
|00003080| 65 73 74 69 6e 67 20 61 | 73 70 65 63 74 20 6f 66 |esting a|spect of|
|00003090| 20 74 68 65 20 73 74 75 | 64 79 20 77 61 73 20 74 | the stu|dy was t|
|000030a0| 68 65 20 65 76 61 6c 75 | 61 74 69 6f 6e 20 6f 66 |he evalu|ation of|
|000030b0| 20 74 68 65 20 73 65 72 | 75 6d 20 61 6e 64 0d 0a | the ser|um and..|
|000030c0| 75 72 69 6e 65 20 44 48 | 50 47 20 6c 65 76 65 6c |urine DH|PG level|
|000030d0| 73 20 61 73 20 61 20 64 | 69 61 67 6e 6f 73 74 69 |s as a d|iagnosti|
|000030e0| 63 20 74 65 73 74 20 66 | 6f 72 20 70 68 65 6f 63 |c test f|or pheoc|
|000030f0| 68 72 6f 6d 6f 63 79 74 | 6f 6d 61 2e 0d 0a 33 2c |hromocyt|oma...3,|
|00003100| 34 2d 44 69 68 79 64 72 | 6f 78 79 70 68 65 6e 79 |4-Dihydr|oxypheny|
|00003110| 6c 67 6c 79 63 6f 6c 20 | 69 73 20 61 20 6d 65 74 |lglycol |is a met|
|00003120| 61 62 6f 6c 69 74 65 20 | 6f 66 20 4e 45 2e 20 20 |abolite |of NE. |
|00003130| 4c 65 73 73 20 6f 66 20 | 74 68 65 20 4e 45 20 66 |Less of |the NE f|
|00003140| 72 6f 6d 20 74 75 6d 6f | 72 73 0d 0a 74 68 61 6e |rom tumo|rs..than|
|00003150| 20 6f 66 20 74 68 61 74 | 20 66 72 6f 6d 20 6e 65 | of that| from ne|
|00003160| 72 76 65 73 20 69 73 20 | 63 6f 6e 76 65 72 74 65 |rves is |converte|
|00003170| 64 20 74 6f 20 44 48 50 | 47 20 62 65 63 61 75 73 |d to DHP|G becaus|
|00003180| 65 20 74 68 65 20 4e 45 | 20 72 65 6c 65 61 73 65 |e the NE| release|
|00003190| 64 20 66 72 6f 6d 0d 0a | 6e 65 75 72 6f 6e 73 20 |d from..|neurons |
|000031a0| 69 73 20 73 75 62 6a 65 | 63 74 20 74 6f 20 72 65 |is subje|ct to re|
|000031b0| 75 70 74 61 6b 65 20 61 | 6e 64 20 6d 65 74 61 62 |uptake a|nd metab|
|000031c0| 6f 6c 69 73 6d 20 74 6f | 20 44 48 50 47 2c 20 77 |olism to| DHPG, w|
|000031d0| 68 65 72 65 61 73 20 74 | 68 65 72 65 20 69 73 20 |hereas t|here is |
|000031e0| 6d 75 63 68 0d 0a 6c 65 | 73 73 20 63 6f 6e 76 65 |much..le|ss conve|
|000031f0| 72 73 69 6f 6e 20 69 6e | 20 74 68 65 20 62 6c 6f |rsion in| the blo|
|00003200| 6f 64 2e 20 20 54 68 65 | 72 65 66 6f 72 65 20 69 |od. The|refore i|
|00003210| 6e 20 70 61 74 69 65 6e | 74 73 20 77 69 74 68 20 |n patien|ts with |
|00003220| 74 75 6d 6f 72 73 2c 20 | 74 68 65 20 72 61 74 69 |tumors, |the rati|
|00003230| 6f 20 6f 66 0d 0a 4e 45 | 20 74 6f 20 44 48 50 47 |o of..NE| to DHPG|
|00003240| 20 73 68 6f 75 6c 64 20 | 62 65 20 68 69 67 68 65 | should |be highe|
|00003250| 72 20 74 68 61 6e 20 69 | 6e 20 63 6f 6e 74 72 6f |r than i|n contro|
|00003260| 6c 73 2e 20 20 48 6f 77 | 65 76 65 72 2c 20 74 68 |ls. How|ever, th|
|00003270| 65 20 61 75 74 68 6f 72 | 73 20 66 6f 75 6e 64 0d |e author|s found.|
|00003280| 0a 73 65 76 65 72 61 6c | 20 74 75 6d 6f 72 20 70 |.several| tumor p|
|00003290| 61 74 69 65 6e 74 73 20 | 77 69 74 68 20 6c 6f 77 |atients |with low|
|000032a0| 20 72 61 74 69 6f 73 2c | 20 73 75 67 67 65 73 74 | ratios,| suggest|
|000032b0| 69 6e 67 20 63 6f 6e 76 | 65 72 73 69 6f 6e 20 6f |ing conv|ersion o|
|000032c0| 66 20 4e 45 20 74 6f 20 | 44 48 50 47 20 69 6e 0d |f NE to |DHPG in.|
|000032d0| 0a 74 68 65 69 72 20 74 | 75 6d 6f 72 73 20 61 6e |.their t|umors an|
|000032e0| 64 20 74 68 75 73 20 64 | 65 63 72 65 61 73 69 6e |d thus d|ecreasin|
|000032f0| 67 20 74 68 65 20 65 66 | 66 69 63 61 63 79 20 6f |g the ef|ficacy o|
|00003300| 66 20 74 68 65 20 44 48 | 50 47 20 74 65 73 74 2e |f the DH|PG test.|
|00003310| 2d 2d 53 2e 53 2e 20 48 | 6f 77 61 72 64 73 2c 0d |--S.S. H|owards,.|
|00003320| 0a 4d 2e 44 2e 0d 0a 24 | 55 6e 69 71 75 65 5f 49 |.M.D...$|Unique_I|
|00003330| 44 7b 59 52 42 30 38 39 | 30 33 7d 0d 0a 24 54 69 |D{YRB089|03}..$Ti|
|00003340| 74 6c 65 7b 4d 61 6c 69 | 67 6e 61 6e 74 20 50 68 |tle{Mali|gnant Ph|
|00003350| 65 6f 63 68 72 6f 6d 6f | 63 79 74 6f 6d 61 3a 20 |eochromo|cytoma: |
|00003360| 20 45 66 66 65 63 74 69 | 76 65 20 54 72 65 61 74 | Effecti|ve Treat|
|00003370| 6d 65 6e 74 20 57 69 74 | 68 20 61 20 43 6f 6d 62 |ment Wit|h a Comb|
|00003380| 69 6e 61 74 69 6f 6e 20 | 6f 66 20 43 79 63 6c 6f |ination |of Cyclo|
|00003390| 70 68 6f 73 70 68 61 6d | 69 64 65 2c 20 56 69 6e |phospham|ide, Vin|
|000033a0| 63 72 69 73 74 69 6e 65 | 2c 20 61 6e 64 20 44 61 |cristine|, and Da|
|000033b0| 63 61 72 62 61 7a 69 6e | 65 7d 0d 0a 24 41 75 74 |carbazin|e}..$Aut|
|000033c0| 68 6f 72 7b 0d 0a 41 76 | 65 72 62 75 63 68 2c 20 |hor{..Av|erbuch, |
|000033d0| 53 44 0d 0a 53 74 65 61 | 6b 6c 65 79 2c 20 43 53 |SD..Stea|kley, CS|
|000033e0| 0d 0a 59 6f 75 6e 67 2c | 20 52 43 0d 0a 47 65 6c |..Young,| RC..Gel|
|000033f0| 6d 61 6e 6e 2c 20 45 50 | 0d 0a 47 6f 6c 64 73 74 |mann, EP|..Goldst|
|00003400| 65 69 6e 2c 20 44 53 0d | 0a 53 74 75 6c 6c 2c 20 |ein, DS.|.Stull, |
|00003410| 52 0d 0a 4b 65 69 73 65 | 72 2c 20 48 52 7d 0d 0a |R..Keise|r, HR}..|
|00003420| 24 41 66 66 69 6c 69 61 | 74 69 6f 6e 7b 4e 61 74 |$Affilia|tion{Nat|
|00003430| 6c 20 43 61 6e 63 65 72 | 20 49 6e 73 74 3b 20 55 |l Cancer| Inst; U|
|00003440| 6e 69 66 6f 72 6d 65 64 | 20 53 65 72 76 69 63 65 |niformed| Service|
|00003450| 73 20 55 6e 69 76 20 6f | 66 20 74 68 65 20 48 65 |s Univ o|f the He|
|00003460| 61 6c 74 68 20 53 63 69 | 65 6e 63 65 73 3b 20 4e |alth Sci|ences; N|
|00003470| 61 74 6c 20 48 65 61 72 | 74 2c 20 4c 75 6e 67 2c |atl Hear|t, Lung,|
|00003480| 20 61 6e 64 20 42 6c 6f | 6f 64 20 49 6e 73 74 2c | and Blo|od Inst,|
|00003490| 20 42 65 74 68 65 73 64 | 61 2c 20 4d 64 7d 0d 0a | Bethesd|a, Md}..|
|000034a0| 24 53 75 62 6a 65 63 74 | 7b 56 69 6e 63 72 69 73 |$Subject|{Vincris|
|000034b0| 74 69 6e 65 2c 20 69 6e | 20 70 68 65 6f 63 68 72 |tine, in| pheochr|
|000034c0| 6f 6d 6f 63 79 74 6f 6d | 61 2c 20 6d 61 6c 69 67 |omocytom|a, malig|
|000034d0| 6e 61 6e 74 3b 20 50 68 | 65 6f 63 68 72 6f 6d 6f |nant; Ph|eochromo|
|000034e0| 63 79 74 6f 6d 61 2c 0d | 0a 6d 61 6c 69 67 6e 61 |cytoma,.|.maligna|
|000034f0| 6e 74 2c 20 63 79 63 6c | 6f 70 68 6f 73 70 68 61 |nt, cycl|ophospha|
|00003500| 6d 69 64 65 2c 20 76 69 | 6e 63 72 69 73 74 69 6e |mide, vi|ncristin|
|00003510| 65 20 61 6e 64 20 64 65 | 63 61 72 62 61 7a 69 6e |e and de|carbazin|
|00003520| 65 20 69 6e 3b 20 44 61 | 63 61 72 62 61 7a 69 6e |e in; Da|carbazin|
|00003530| 65 20 69 6e 0d 0a 70 68 | 65 6f 63 68 72 6f 6d 6f |e in..ph|eochromo|
|00003540| 63 79 74 6f 6d 61 2c 20 | 6d 61 6c 69 67 6e 61 6e |cytoma, |malignan|
|00003550| 74 3b 20 43 79 63 6c 6f | 70 68 6f 73 70 68 61 6d |t; Cyclo|phospham|
|00003560| 69 64 65 2c 20 69 6e 20 | 70 68 65 6f 63 68 72 6f |ide, in |pheochro|
|00003570| 6d 6f 63 79 74 6f 6d 61 | 2c 20 6d 61 6c 69 67 6e |mocytoma|, malign|
|00003580| 61 6e 74 7d 0d 0a 24 4a | 6f 75 72 6e 61 6c 7b 41 |ant}..$J|ournal{A|
|00003590| 6e 6e 20 49 6e 74 65 72 | 6e 20 4d 65 64 7d 0d 0a |nn Inter|n Med}..|
|000035a0| 24 56 6f 6c 75 6d 65 7b | 31 35 7d 0d 0a 24 50 61 |$Volume{|15}..$Pa|
|000035b0| 67 65 7b 32 36 37 2d 32 | 37 33 7d 0d 0a 24 44 61 |ge{267-2|73}..$Da|
|000035c0| 74 65 7b 41 75 67 75 73 | 74 20 31 39 38 38 7d 0d |te{Augus|t 1988}.|
|000035d0| 0a 24 59 42 56 6f 6c 7b | 31 39 38 39 20 59 65 61 |.$YBVol{|1989 Yea|
|000035e0| 72 20 42 6f 6f 6b 20 6f | 66 20 55 72 6f 6c 6f 67 |r Book o|f Urolog|
|000035f0| 79 7d 0d 0a 24 43 68 61 | 70 74 65 72 7b 36 2d 32 |y}..$Cha|pter{6-2|
|00003600| 7d 0d 0a 24 59 42 45 64 | 69 74 6f 72 7b 44 72 73 |}..$YBEd|itor{Drs|
|00003610| 2e 20 47 69 6c 6c 65 6e | 77 61 74 65 72 20 61 6e |. Gillen|water an|
|00003620| 64 20 48 6f 77 61 72 64 | 73 7d 0d 0a 24 54 61 62 |d Howard|s}..$Tab|
|00003630| 6c 65 7b 7d 0d 0a 24 43 | 6f 6d 6d 65 6e 74 61 74 |le{}..$C|ommentat|
|00003640| 6f 72 7b 53 2e 53 2e 20 | 48 6f 77 61 72 64 73 2c |or{S.S. |Howards,|
|00003650| 20 4d 2e 44 2e 7d 0d 0a | 0d 0a 43 6f 70 79 72 69 | M.D.}..|..Copyri|
|00003660| 67 68 74 20 28 63 29 20 | 59 65 61 72 20 42 6f 6f |ght (c) |Year Boo|
|00003670| 6b 20 4d 65 64 69 63 61 | 6c 20 50 75 62 6c 69 73 |k Medica|l Publis|
|00003680| 68 65 72 73 2c 20 49 6e | 63 2e 2c 20 31 39 38 39 |hers, In|c., 1989|
|00003690| 0d 0a 0d 0a 31 39 38 39 | 20 59 65 61 72 20 42 6f |....1989| Year Bo|
|000036a0| 6f 6b 20 6f 66 20 55 72 | 6f 6c 6f 67 79 20 28 52 |ok of Ur|ology (R|
|000036b0| 29 0d 0a 0d 0a 50 61 72 | 74 20 31 3a 20 20 41 64 |)....Par|t 1: Ad|
|000036c0| 75 6c 74 0d 0a 0d 0a 43 | 68 61 70 74 65 72 20 36 |ult....C|hapter 6|
|000036d0| 2d 2d 41 64 72 65 6e 61 | 6c 73 0d 0a 0d 0a 2d 2d |--Adrena|ls....--|
|000036e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000036f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003700| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003710| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003720| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 0d 0a |--------|------..|
|00003730| 4d 61 6c 69 67 6e 61 6e | 74 20 50 68 65 6f 63 68 |Malignan|t Pheoch|
|00003740| 72 6f 6d 6f 63 79 74 6f | 6d 61 3a 20 20 45 66 66 |romocyto|ma: Eff|
|00003750| 65 63 74 69 76 65 20 54 | 72 65 61 74 6d 65 6e 74 |ective T|reatment|
|00003760| 20 57 69 74 68 20 61 20 | 43 6f 6d 62 69 6e 61 74 | With a |Combinat|
|00003770| 69 6f 6e 20 6f 66 0d 0a | 43 79 63 6c 6f 70 68 6f |ion of..|Cyclopho|
|00003780| 73 70 68 61 6d 69 64 65 | 2c 20 56 69 6e 63 72 69 |sphamide|, Vincri|
|00003790| 73 74 69 6e 65 2c 20 61 | 6e 64 20 44 61 63 61 72 |stine, a|nd Dacar|
|000037a0| 62 61 7a 69 6e 65 0d 0a | 0d 0a 41 76 65 72 62 75 |bazine..|..Averbu|
|000037b0| 63 68 20 53 44 3b 20 53 | 74 65 61 6b 6c 65 79 20 |ch SD; S|teakley |
|000037c0| 43 53 3b 20 59 6f 75 6e | 67 20 52 43 3b 20 47 65 |CS; Youn|g RC; Ge|
|000037d0| 6c 6d 61 6e 6e 20 45 50 | 3b 20 47 6f 6c 64 73 74 |lmann EP|; Goldst|
|000037e0| 65 69 6e 20 44 53 3b 20 | 53 74 75 6c 6c 20 52 3b |ein DS; |Stull R;|
|000037f0| 20 4b 65 69 73 65 72 0d | 0a 48 52 0d 0a 28 4e 61 | Keiser.|.HR..(Na|
|00003800| 74 6c 20 43 61 6e 63 65 | 72 20 49 6e 73 74 3b 20 |tl Cance|r Inst; |
|00003810| 55 6e 69 66 6f 72 6d 65 | 64 20 53 65 72 76 69 63 |Uniforme|d Servic|
|00003820| 65 73 20 55 6e 69 76 20 | 6f 66 20 74 68 65 20 48 |es Univ |of the H|
|00003830| 65 61 6c 74 68 20 53 63 | 69 65 6e 63 65 73 3b 20 |ealth Sc|iences; |
|00003840| 4e 61 74 6c 20 48 65 61 | 72 74 2c 0d 0a 4c 75 6e |Natl Hea|rt,..Lun|
|00003850| 67 2c 20 61 6e 64 20 42 | 6c 6f 6f 64 20 49 6e 73 |g, and B|lood Ins|
|00003860| 74 2c 20 42 65 74 68 65 | 73 64 61 2c 20 4d 64 29 |t, Bethe|sda, Md)|
|00003870| 0d 0a 41 6e 6e 20 49 6e | 74 65 72 6e 20 4d 65 64 |..Ann In|tern Med|
|00003880| 20 31 35 3a 32 36 37 2d | 32 37 33 2c 20 41 75 67 | 15:267-|273, Aug|
|00003890| 75 73 74 20 31 39 38 38 | 0d 0a 2d 2d 2d 2d 2d 2d |ust 1988|..------|
|000038a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000038b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000038c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000038d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000038e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 0d 0a 0d 0a 41 62 |--------|--....Ab|
|000038f0| 73 74 72 61 63 74 0d 0a | 0d 0a 20 20 20 20 20 4d |stract..|.. M|
|00003900| 61 6c 69 67 6e 61 6e 74 | 20 70 68 65 6f 63 68 72 |alignant| pheochr|
|00003910| 6f 6d 6f 63 79 74 6f 6d | 61 20 69 73 20 61 20 72 |omocytom|a is a r|
|00003920| 61 72 65 20 6e 65 6f 70 | 6c 61 73 6d 20 6f 66 20 |are neop|lasm of |
|00003930| 63 68 72 6f 6d 61 66 66 | 69 6e 20 74 69 73 73 75 |chromaff|in tissu|
|00003940| 65 20 69 6e 20 74 68 65 | 0d 0a 61 64 72 65 6e 61 |e in the|..adrena|
|00003950| 6c 20 6d 65 64 75 6c 6c | 61 20 6f 72 20 65 78 74 |l medull|a or ext|
|00003960| 72 61 2d 61 64 72 65 6e | 61 6c 20 70 61 72 61 67 |ra-adren|al parag|
|00003970| 61 6e 67 6c 69 6f 6e 69 | 63 20 73 69 74 65 73 2e |anglioni|c sites.|
|00003980| 20 20 41 62 6f 75 74 20 | 31 33 25 20 6f 66 20 70 | About |13% of p|
|00003990| 61 74 69 65 6e 74 73 0d | 0a 77 69 74 68 20 70 68 |atients.|.with ph|
|000039a0| 65 6f 63 68 72 6f 6d 6f | 63 79 74 6f 6d 61 20 68 |eochromo|cytoma h|
|000039b0| 61 76 65 20 6d 61 6c 69 | 67 6e 61 6e 74 20 64 69 |ave mali|gnant di|
|000039c0| 73 65 61 73 65 2e 20 20 | 54 68 65 20 70 72 69 6d |sease. |The prim|
|000039d0| 61 72 79 20 74 72 65 61 | 74 6d 65 6e 74 20 66 6f |ary trea|tment fo|
|000039e0| 72 0d 0a 6d 61 6c 69 67 | 6e 61 6e 74 20 70 68 65 |r..malig|nant phe|
|000039f0| 6f 63 68 72 6f 6d 6f 63 | 79 74 6f 6d 61 20 68 61 |ochromoc|ytoma ha|
|00003a00| 73 20 62 65 65 6e 20 61 | 6e 74 69 68 79 70 65 72 |s been a|ntihyper|
|00003a10| 74 65 6e 73 69 76 65 20 | 74 68 65 72 61 70 79 20 |tensive |therapy |
|00003a20| 77 69 74 68 20 61 6c 70 | 68 61 2d 20 61 6e 64 0d |with alp|ha- and.|
|00003a30| 0a 62 65 74 61 2d 61 64 | 72 65 6e 65 72 67 69 63 |.beta-ad|renergic|
|00003a40| 20 62 6c 6f 63 6b 61 64 | 65 2e 0d 0a 20 20 20 20 | blockad|e... |
|00003a50| 20 54 6f 20 64 65 74 65 | 72 6d 69 6e 65 20 74 68 | To dete|rmine th|
|00003a60| 65 20 65 66 66 69 63 61 | 63 79 20 61 6e 64 20 74 |e effica|cy and t|
|00003a70| 6f 78 69 63 69 74 79 20 | 6f 66 20 63 6f 6d 62 69 |oxicity |of combi|
|00003a80| 6e 61 74 69 6f 6e 20 63 | 68 65 6d 6f 74 68 65 72 |nation c|hemother|
|00003a90| 61 70 79 20 69 6e 0d 0a | 61 64 76 61 6e 63 65 64 |apy in..|advanced|
|00003aa0| 2c 20 6d 61 6c 69 67 6e | 61 6e 74 20 70 68 65 6f |, malign|ant pheo|
|00003ab0| 63 68 72 6f 6d 6f 63 79 | 74 6f 6d 61 2c 20 31 34 |chromocy|toma, 14|
|00003ac0| 20 70 61 74 69 65 6e 74 | 73 20 77 69 74 68 20 6d | patient|s with m|
|00003ad0| 61 6c 69 67 6e 61 6e 74 | 20 64 69 73 65 61 73 65 |alignant| disease|
|00003ae0| 0d 0a 63 6f 6e 66 69 72 | 6d 65 64 20 62 79 20 68 |..confir|med by h|
|00003af0| 69 73 74 6f 6c 6f 67 69 | 63 20 74 65 73 74 73 20 |istologi|c tests |
|00003b00| 77 65 72 65 20 65 6e 74 | 65 72 65 64 20 69 6e 74 |were ent|ered int|
|00003b10| 6f 20 61 20 6e 6f 6e 72 | 61 6e 64 6f 6d 69 7a 65 |o a nonr|andomize|
|00003b20| 64 2c 20 73 69 6e 67 6c | 65 2d 61 72 6d 0d 0a 74 |d, singl|e-arm..t|
|00003b30| 72 69 61 6c 2e 20 20 41 | 6c 6c 20 70 61 74 69 65 |rial. A|ll patie|
|00003b40| 6e 74 73 20 68 61 64 20 | 6d 65 74 61 73 74 61 74 |nts had |metastat|
|00003b50| 69 63 20 64 69 73 65 61 | 73 65 20 61 6e 64 20 69 |ic disea|se and i|
|00003b60| 6e 63 72 65 61 73 65 64 | 20 75 72 69 6e 61 72 79 |ncreased| urinary|
|00003b70| 20 63 61 74 65 63 68 6f | 6c 61 6d 69 6e 65 0d 0a | catecho|lamine..|
|00003b80| 73 65 63 72 65 74 69 6f | 6e 2e 20 20 41 66 74 65 |secretio|n. Afte|
|00003b90| 72 20 6f 70 74 69 6d 69 | 7a 61 74 69 6f 6e 20 6f |r optimi|zation o|
|00003ba0| 66 20 61 6e 74 69 68 79 | 70 65 72 74 65 6e 73 69 |f antihy|pertensi|
|00003bb0| 76 65 20 74 68 65 72 61 | 70 79 2c 20 70 61 74 69 |ve thera|py, pati|
|00003bc0| 65 6e 74 73 20 77 65 72 | 65 20 67 69 76 65 6e 0d |ents wer|e given.|
|00003bd0| 0a 63 79 63 6c 6f 70 68 | 6f 73 70 68 61 6d 69 64 |.cycloph|osphamid|
|00003be0| 65 2c 20 37 35 30 20 6d | 67 2f 6d 5e 32 20 62 6f |e, 750 m|g/m^2 bo|
|00003bf0| 64 79 20 73 75 72 66 61 | 63 65 20 61 72 65 61 20 |dy surfa|ce area |
|00003c00| 6f 6e 20 64 61 79 20 31 | 3b 20 76 69 6e 63 72 69 |on day 1|; vincri|
|00003c10| 73 74 69 6e 65 2c 20 31 | 2e 34 20 6d 67 2f 6d 5e |stine, 1|.4 mg/m^|
|00003c20| 32 0d 0a 6f 6e 20 64 61 | 79 20 31 3b 20 61 6e 64 |2..on da|y 1; and|
|00003c30| 20 64 61 63 61 72 62 61 | 7a 69 6e 65 2c 20 36 30 | dacarba|zine, 60|
|00003c40| 30 20 6d 67 2f 6d 5e 32 | 20 6f 6e 20 64 61 79 73 |0 mg/m^2| on days|
|00003c50| 20 31 20 61 6e 64 20 32 | 2e 20 20 54 72 65 61 74 | 1 and 2|. Treat|
|00003c60| 6d 65 6e 74 20 77 61 73 | 20 67 69 76 65 6e 20 69 |ment was| given i|
|00003c70| 6e 0d 0a 32 31 2d 64 61 | 79 20 63 79 63 6c 65 73 |n..21-da|y cycles|
|00003c80| 2e 0d 0a 20 20 20 20 20 | 41 20 63 6f 6d 70 6c 65 |... |A comple|
|00003c90| 74 65 20 6f 72 20 70 61 | 72 74 69 61 6c 20 72 65 |te or pa|rtial re|
|00003ca0| 73 70 6f 6e 73 65 20 77 | 61 73 20 6e 6f 74 65 64 |sponse w|as noted|
|00003cb0| 20 69 6e 20 35 37 25 20 | 6f 66 20 70 61 74 69 65 | in 57% |of patie|
|00003cc0| 6e 74 73 2e 20 20 43 6f | 6d 70 6c 65 74 65 20 6f |nts. Co|mplete o|
|00003cd0| 72 0d 0a 70 61 72 74 69 | 61 6c 20 62 69 6f 63 68 |r..parti|al bioch|
|00003ce0| 65 6d 69 63 61 6c 20 72 | 65 73 70 6f 6e 73 65 73 |emical r|esponses|
|00003cf0| 20 77 65 72 65 20 70 72 | 6f 64 75 63 65 64 20 69 | were pr|oduced i|
|00003d00| 6e 20 37 39 25 20 6f 66 | 20 74 68 65 20 70 61 74 |n 79% of| the pat|
|00003d10| 69 65 6e 74 73 20 6f 76 | 65 72 61 6c 6c 2e 20 20 |ients ov|erall. |
|00003d20| 41 6c 6c 0d 0a 70 61 74 | 69 65 6e 74 73 20 77 68 |All..pat|ients wh|
|00003d30| 6f 20 72 65 73 70 6f 6e | 64 65 64 20 68 61 64 20 |o respon|ded had |
|00003d40| 6f 62 6a 65 63 74 69 76 | 65 20 69 6d 70 72 6f 76 |objectiv|e improv|
|00003d50| 65 6d 65 6e 74 20 69 6e | 20 70 65 72 66 6f 72 6d |ement in| perform|
|00003d60| 61 6e 63 65 20 73 74 61 | 74 75 73 20 61 6e 64 20 |ance sta|tus and |
|00003d70| 62 6c 6f 6f 64 0d 0a 70 | 72 65 73 73 75 72 65 2e |blood..p|ressure.|
|00003d80| 20 20 54 6f 78 69 63 69 | 74 79 20 69 6e 63 6c 75 | Toxici|ty inclu|
|00003d90| 64 65 64 20 65 78 70 65 | 63 74 65 64 20 68 65 6d |ded expe|cted hem|
|00003da0| 61 74 6f 6c 6f 67 69 63 | 2c 20 6e 65 75 72 6f 6c |atologic|, neurol|
|00003db0| 6f 67 69 63 2c 20 61 6e | 64 0d 0a 67 61 73 74 72 |ogic, an|d..gastr|
|00003dc0| 6f 69 6e 74 65 73 74 69 | 6e 61 6c 20 65 66 66 65 |ointesti|nal effe|
|00003dd0| 63 74 73 20 77 69 74 68 | 6f 75 74 20 73 65 72 69 |cts with|out seri|
|00003de0| 6f 75 73 20 63 6f 6d 70 | 6c 69 63 61 74 69 6f 6e |ous comp|lication|
|00003df0| 73 2e 20 20 46 6f 75 72 | 20 6d 69 6e 6f 72 20 68 |s. Four| minor h|
|00003e00| 79 70 6f 74 65 6e 73 69 | 76 65 0d 0a 65 70 69 73 |ypotensi|ve..epis|
|00003e10| 6f 64 65 73 20 61 6e 64 | 20 31 20 6d 69 6e 6f 72 |odes and| 1 minor|
|00003e20| 20 68 79 70 65 72 74 65 | 6e 73 69 76 65 20 65 70 | hyperte|nsive ep|
|00003e30| 69 73 6f 64 65 20 6f 63 | 63 75 72 72 65 64 2e 0d |isode oc|curred..|
|00003e40| 0a 20 20 20 20 20 43 6f | 6d 62 69 6e 61 74 69 6f |. Co|mbinatio|
|00003e50| 6e 20 63 68 65 6d 6f 74 | 68 65 72 61 70 79 20 77 |n chemot|herapy w|
|00003e60| 69 74 68 20 63 79 63 6c | 6f 70 68 6f 73 70 68 61 |ith cycl|ophospha|
|00003e70| 6d 69 64 65 2c 20 76 69 | 6e 63 72 69 73 74 69 6e |mide, vi|ncristin|
|00003e80| 65 2c 20 61 6e 64 0d 0a | 64 61 63 61 72 62 61 7a |e, and..|dacarbaz|
|00003e90| 69 6e 65 20 61 70 70 65 | 61 72 73 20 65 66 66 65 |ine appe|ars effe|
|00003ea0| 63 74 69 76 65 20 69 6e | 20 74 68 65 20 74 72 65 |ctive in| the tre|
|00003eb0| 61 74 6d 65 6e 74 20 6f | 66 20 61 64 76 61 6e 63 |atment o|f advanc|
|00003ec0| 65 64 20 6d 61 6c 69 67 | 6e 61 6e 74 0d 0a 70 68 |ed malig|nant..ph|
|00003ed0| 65 6f 63 68 72 6f 6d 6f | 63 79 74 6f 6d 61 2e 20 |eochromo|cytoma. |
|00003ee0| 20 55 72 69 6e 61 72 79 | 20 63 61 74 65 63 68 6f | Urinary| catecho|
|00003ef0| 6c 61 6d 69 6e 65 73 20 | 61 72 65 20 75 73 65 66 |lamines |are usef|
|00003f00| 75 6c 20 69 6e 20 61 73 | 63 65 72 74 61 69 6e 69 |ul in as|certaini|
|00003f10| 6e 67 20 74 68 65 0d 0a | 62 69 6f 63 68 65 6d 69 |ng the..|biochemi|
|00003f20| 63 61 6c 20 72 65 73 70 | 6f 6e 73 65 20 74 6f 20 |cal resp|onse to |
|00003f30| 74 72 65 61 74 6d 65 6e | 74 2e 0d 0a 0d 0a 50 6f |treatmen|t.....Po|
|00003f40| 73 74 2d 43 6f 6d 6d 65 | 6e 74 0d 0a 0d 0a 20 20 |st-Comme|nt.... |
|00003f50| 20 20 20 54 68 65 20 72 | 65 73 75 6c 74 73 20 6f | The r|esults o|
|00003f60| 66 20 74 68 69 73 20 73 | 74 75 64 79 20 61 72 65 |f this s|tudy are|
|00003f70| 20 65 6e 63 6f 75 72 61 | 67 69 6e 67 20 62 65 63 | encoura|ging bec|
|00003f80| 61 75 73 65 20 74 68 65 | 72 65 20 69 73 20 6e 6f |ause the|re is no|
|00003f90| 20 65 73 74 61 62 6c 69 | 73 68 65 64 0d 0a 63 68 | establi|shed..ch|
|00003fa0| 65 6d 6f 74 68 65 72 61 | 70 79 20 66 6f 72 20 6d |emothera|py for m|
|00003fb0| 61 6c 69 67 6e 61 6e 74 | 20 70 68 65 6f 63 68 72 |alignant| pheochr|
|00003fc0| 6f 6d 6f 63 79 74 6f 6d | 61 2e 20 20 4e 65 76 65 |omocytom|a. Neve|
|00003fd0| 72 74 68 65 6c 65 73 73 | 20 69 74 20 69 73 20 64 |rtheless| it is d|
|00003fe0| 69 66 66 69 63 75 6c 74 | 20 74 6f 0d 0a 6b 6e 6f |ifficult| to..kno|
|00003ff0| 77 20 68 6f 77 20 65 66 | 66 65 63 74 69 76 65 20 |w how ef|fective |
|00004000| 74 72 65 61 74 6d 65 6e | 74 20 77 69 74 68 20 63 |treatmen|t with c|
|00004010| 79 63 6c 6f 70 68 6f 73 | 70 68 61 6d 69 64 65 2c |yclophos|phamide,|
|00004020| 20 76 69 6e 63 72 69 73 | 74 69 6e 65 2c 20 61 6e | vincris|tine, an|
|00004030| 64 20 64 61 63 61 72 62 | 61 7a 69 6e 65 0d 0a 28 |d dacarb|azine..(|
|00004040| 43 56 44 29 20 77 69 6c | 6c 20 62 65 20 62 65 63 |CVD) wil|l be bec|
|00004050| 61 75 73 65 20 6f 6e 6c | 79 20 32 20 70 61 74 69 |ause onl|y 2 pati|
|00004060| 65 6e 74 73 20 68 61 64 | 20 61 20 63 6f 6d 70 6c |ents had| a compl|
|00004070| 65 74 65 20 74 75 6d 6f | 72 20 72 65 73 70 6f 6e |ete tumo|r respon|
|00004080| 73 65 2c 20 74 68 65 0d | 0a 64 75 72 61 74 69 6f |se, the.|.duratio|
|00004090| 6e 20 6f 66 20 72 65 73 | 70 6f 6e 73 65 20 77 61 |n of res|ponse wa|
|000040a0| 73 20 6f 6e 6c 79 20 32 | 31 20 6d 6f 6e 74 68 73 |s only 2|1 months|
|000040b0| 2c 20 61 6e 64 20 74 68 | 65 20 35 2d 79 65 61 72 |, and th|e 5-year|
|000040c0| 20 73 75 72 76 69 76 61 | 6c 20 6f 66 20 68 69 73 | surviva|l of his|
|000040d0| 74 6f 72 69 63 61 6c 0d | 0a 63 6f 6e 74 72 6f 6c |torical.|.control|
|000040e0| 73 20 69 73 20 34 34 25 | 2e 20 20 54 68 65 20 61 |s is 44%|. The a|
|000040f0| 75 74 68 6f 72 73 20 77 | 65 72 65 20 71 75 69 74 |uthors w|ere quit|
|00004100| 65 20 63 6c 65 76 65 72 | 20 74 6f 20 70 69 63 6b |e clever| to pick|
|00004110| 20 43 56 44 20 74 68 65 | 72 61 70 79 20 62 61 73 | CVD the|rapy bas|
|00004120| 65 64 20 6f 6e 20 74 68 | 65 0d 0a 6b 6e 6f 77 6c |ed on th|e..knowl|
|00004130| 65 64 67 65 20 74 68 61 | 74 20 74 68 69 73 20 63 |edge tha|t this c|
|00004140| 6f 6d 62 69 6e 61 74 69 | 6f 6e 20 69 73 20 65 66 |ombinati|on is ef|
|00004150| 66 65 63 74 69 76 65 20 | 69 6e 20 63 68 69 6c 64 |fective |in child|
|00004160| 72 65 6e 20 77 69 74 68 | 20 6e 65 75 72 6f 62 6c |ren with| neurobl|
|00004170| 61 73 74 6f 6d 61 2e 0d | 0a 2d 2d 53 2e 53 2e 20 |astoma..|.--S.S. |
|00004180| 48 6f 77 61 72 64 73 2c | 20 4d 2e 44 2e 0d 0a 24 |Howards,| M.D...$|
|00004190| 55 6e 69 71 75 65 5f 49 | 44 7b 59 52 42 30 38 39 |Unique_I|D{YRB089|
|000041a0| 30 34 7d 0d 0a 24 54 69 | 74 6c 65 7b 44 69 73 74 |04}..$Ti|tle{Dist|
|000041b0| 69 6e 67 75 69 73 68 69 | 6e 67 20 42 65 6e 69 67 |inguishi|ng Benig|
|000041c0| 6e 20 46 72 6f 6d 20 4d | 61 6c 69 67 6e 61 6e 74 |n From M|alignant|
|000041d0| 20 45 75 61 64 72 65 6e | 61 6c 20 4d 61 73 73 65 | Euadren|al Masse|
|000041e0| 73 7d 0d 0a 24 41 75 74 | 68 6f 72 7b 0d 0a 47 72 |s}..$Aut|hor{..Gr|
|000041f0| 6f 73 73 2c 20 4d 44 0d | 0a 53 68 61 70 69 72 6f |oss, MD.|.Shapiro|
|00004200| 2c 20 42 0d 0a 42 6f 75 | 66 66 61 72 64 2c 20 4a |, B..Bou|ffard, J|
|00004210| 41 0d 0a 47 6c 61 7a 65 | 72 2c 20 47 4d 0d 0a 46 |A..Glaze|r, GM..F|
|00004220| 72 61 6e 63 69 73 2c 20 | 49 52 0d 0a 57 69 6c 74 |rancis, |IR..Wilt|
|00004230| 6f 6e 2c 20 47 50 0d 0a | 4b 68 61 66 61 67 69 2c |on, GP..|Khafagi,|
|00004240| 20 46 0d 0a 53 6f 6e 64 | 61 2c 20 4c 50 7d 0d 0a | F..Sond|a, LP}..|
|00004250| 24 41 66 66 69 6c 69 61 | 74 69 6f 6e 7b 55 6e 69 |$Affilia|tion{Uni|
|00004260| 76 20 6f 66 20 4d 69 63 | 68 69 67 61 6e 3b 20 56 |v of Mic|higan; V|
|00004270| 41 20 4d 65 64 20 43 74 | 72 73 2c 20 41 6e 6e 20 |A Med Ct|rs, Ann |
|00004280| 41 72 62 6f 72 2c 20 4d | 69 63 68 7d 0d 0a 24 53 |Arbor, M|ich}..$S|
|00004290| 75 62 6a 65 63 74 7b 45 | 75 61 64 72 65 6e 61 6c |ubject{E|uadrenal|
|000042a0| 20 6d 61 73 73 65 73 2c | 20 64 69 73 74 69 6e 67 | masses,| disting|
|000042b0| 75 69 73 68 69 6e 67 20 | 62 65 6e 69 67 6e 20 66 |uishing |benign f|
|000042c0| 72 6f 6d 20 6d 61 6c 69 | 67 6e 61 6e 74 3b 20 41 |rom mali|gnant; A|
|000042d0| 64 72 65 6e 61 6c 2c 0d | 0a 65 75 61 64 72 65 6e |drenal,.|.euadren|
|000042e0| 61 6c 20 6d 61 73 73 65 | 73 2c 20 64 69 73 74 69 |al masse|s, disti|
|000042f0| 6e 67 75 69 73 68 69 6e | 67 20 62 65 6e 69 67 6e |nguishin|g benign|
|00004300| 20 66 72 6f 6d 20 6d 61 | 6c 69 67 6e 61 6e 74 7d | from ma|lignant}|
|00004310| 0d 0a 24 4a 6f 75 72 6e | 61 6c 7b 41 6e 6e 20 49 |..$Journ|al{Ann I|
|00004320| 6e 74 65 72 6e 20 4d 65 | 64 7d 0d 0a 24 56 6f 6c |ntern Me|d}..$Vol|
|00004330| 75 6d 65 7b 31 30 39 7d | 0d 0a 24 50 61 67 65 7b |ume{109}|..$Page{|
|00004340| 36 31 33 2d 36 31 38 7d | 0d 0a 24 44 61 74 65 7b |613-618}|..$Date{|
|00004350| 4f 63 74 20 31 35 2c 20 | 31 39 38 38 7d 0d 0a 24 |Oct 15, |1988}..$|
|00004360| 59 42 56 6f 6c 7b 31 39 | 38 39 20 59 65 61 72 20 |YBVol{19|89 Year |
|00004370| 42 6f 6f 6b 20 6f 66 20 | 55 72 6f 6c 6f 67 79 7d |Book of |Urology}|
|00004380| 0d 0a 24 43 68 61 70 74 | 65 72 7b 36 2d 33 7d 0d |..$Chapt|er{6-3}.|
|00004390| 0a 24 59 42 45 64 69 74 | 6f 72 7b 44 72 73 2e 20 |.$YBEdit|or{Drs. |
|000043a0| 47 69 6c 6c 65 6e 77 61 | 74 65 72 20 61 6e 64 20 |Gillenwa|ter and |
|000043b0| 48 6f 77 61 72 64 73 7d | 0d 0a 24 54 61 62 6c 65 |Howards}|..$Table|
|000043c0| 7b 7d 0d 0a 24 43 6f 6d | 6d 65 6e 74 61 74 6f 72 |{}..$Com|mentator|
|000043d0| 7b 53 2e 53 2e 20 48 6f | 77 61 72 64 73 2c 20 4d |{S.S. Ho|wards, M|
|000043e0| 2e 44 2e 7d 0d 0a 0d 0a | 43 6f 70 79 72 69 67 68 |.D.}....|Copyrigh|
|000043f0| 74 20 28 63 29 20 59 65 | 61 72 20 42 6f 6f 6b 20 |t (c) Ye|ar Book |
|00004400| 4d 65 64 69 63 61 6c 20 | 50 75 62 6c 69 73 68 65 |Medical |Publishe|
|00004410| 72 73 2c 20 49 6e 63 2e | 2c 20 31 39 38 39 0d 0a |rs, Inc.|, 1989..|
|00004420| 0d 0a 31 39 38 39 20 59 | 65 61 72 20 42 6f 6f 6b |..1989 Y|ear Book|
|00004430| 20 6f 66 20 55 72 6f 6c | 6f 67 79 20 28 52 29 0d | of Urol|ogy (R).|
|00004440| 0a 0d 0a 50 61 72 74 20 | 31 3a 20 20 41 64 75 6c |...Part |1: Adul|
|00004450| 74 0d 0a 0d 0a 43 68 61 | 70 74 65 72 20 36 2d 2d |t....Cha|pter 6--|
|00004460| 41 64 72 65 6e 61 6c 73 | 0d 0a 0d 0a 2d 2d 2d 2d |Adrenals|....----|
|00004470| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004480| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004490| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000044a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000044b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 44 69 |--------|----..Di|
|000044c0| 73 74 69 6e 67 75 69 73 | 68 69 6e 67 20 42 65 6e |stinguis|hing Ben|
|000044d0| 69 67 6e 20 46 72 6f 6d | 20 4d 61 6c 69 67 6e 61 |ign From| Maligna|
|000044e0| 6e 74 20 45 75 61 64 72 | 65 6e 61 6c 20 4d 61 73 |nt Euadr|enal Mas|
|000044f0| 73 65 73 0d 0a 0d 0a 47 | 72 6f 73 73 20 4d 44 3b |ses....G|ross MD;|
|00004500| 20 53 68 61 70 69 72 6f | 20 42 3b 20 42 6f 75 66 | Shapiro| B; Bouf|
|00004510| 66 61 72 64 20 4a 41 3b | 20 47 6c 61 7a 65 72 20 |fard JA;| Glazer |
|00004520| 47 4d 3b 20 46 72 61 6e | 63 69 73 20 49 52 3b 20 |GM; Fran|cis IR; |
|00004530| 57 69 6c 74 6f 6e 20 47 | 50 3b 20 4b 68 61 66 61 |Wilton G|P; Khafa|
|00004540| 67 69 20 46 3b 0d 0a 53 | 6f 6e 64 61 20 4c 50 0d |gi F;..S|onda LP.|
|00004550| 0a 28 55 6e 69 76 20 6f | 66 20 4d 69 63 68 69 67 |.(Univ o|f Michig|
|00004560| 61 6e 3b 20 56 41 20 4d | 65 64 20 43 74 72 73 2c |an; VA M|ed Ctrs,|
|00004570| 20 41 6e 6e 20 41 72 62 | 6f 72 2c 20 4d 69 63 68 | Ann Arb|or, Mich|
|00004580| 29 0d 0a 41 6e 6e 20 49 | 6e 74 65 72 6e 20 4d 65 |)..Ann I|ntern Me|
|00004590| 64 20 31 30 39 3a 36 31 | 33 2d 36 31 38 2c 20 4f |d 109:61|3-618, O|
|000045a0| 63 74 20 31 35 2c 20 31 | 39 38 38 0d 0a 2d 2d 2d |ct 15, 1|988..---|
|000045b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000045c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000045d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000045e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000045f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 0d |--------|-----...|
|00004600| 0a 41 62 73 74 72 61 63 | 74 0d 0a 0d 0a 20 20 20 |.Abstrac|t.... |
|00004610| 20 20 49 74 20 69 73 20 | 6e 6f 74 20 75 6e 63 6f | It is |not unco|
|00004620| 6d 6d 6f 6e 20 66 6f 72 | 20 63 6f 6d 70 75 74 65 |mmon for| compute|
|00004630| 64 20 74 6f 6d 6f 67 72 | 61 70 68 79 20 28 43 54 |d tomogr|aphy (CT|
|00004640| 29 20 74 6f 20 69 64 65 | 6e 74 69 66 79 20 61 64 |) to ide|ntify ad|
|00004650| 72 65 6e 61 6c 20 6d 61 | 73 73 0d 0a 6c 65 73 69 |renal ma|ss..lesi|
|00004660| 6f 6e 73 20 69 6e 20 70 | 61 74 69 65 6e 74 73 20 |ons in p|atients |
|00004670| 77 68 6f 20 68 61 76 65 | 20 6e 6f 20 64 65 6d 6f |who have| no demo|
|00004680| 6e 73 74 72 61 62 6c 65 | 20 73 69 67 6e 73 20 6f |nstrable| signs o|
|00004690| 72 20 73 79 6d 70 74 6f | 6d 73 20 6f 66 20 61 64 |r sympto|ms of ad|
|000046a0| 72 65 6e 61 6c 0d 0a 64 | 69 73 65 61 73 65 2e 20 |renal..d|isease. |
|000046b0| 20 4d 6f 73 74 20 6f 66 | 20 74 68 65 73 65 20 70 | Most of| these p|
|000046c0| 61 74 69 65 6e 74 73 20 | 64 6f 20 6e 6f 74 20 68 |atients |do not h|
|000046d0| 61 76 65 20 61 62 6e 6f | 72 6d 61 6c 20 70 65 72 |ave abno|rmal per|
|000046e0| 69 70 68 65 72 61 6c 20 | 62 6c 6f 6f 64 20 6c 65 |ipheral |blood le|
|000046f0| 76 65 6c 73 20 6f 66 0d | 0a 61 64 72 65 6e 6f 63 |vels of.|.adrenoc|
|00004700| 6f 72 74 69 63 61 6c 20 | 6f 72 20 6d 65 64 75 6c |ortical |or medul|
|00004710| 6c 61 72 79 20 68 6f 72 | 6d 6f 6e 65 73 20 61 6e |lary hor|mones an|
|00004720| 64 20 68 61 76 65 20 6e | 6f 72 6d 61 6c 20 72 65 |d have n|ormal re|
|00004730| 73 70 6f 6e 73 65 73 20 | 74 6f 20 68 79 70 6f 74 |sponses |to hypot|
|00004740| 68 61 6c 61 6d 69 63 0d | 0a 6f 72 20 70 69 74 75 |halamic.|.or pitu|
|00004750| 69 74 61 72 79 20 73 74 | 69 6d 75 6c 61 74 69 6f |itary st|imulatio|
|00004760| 6e 20 61 6e 64 20 73 75 | 70 70 72 65 73 73 69 6f |n and su|ppressio|
|00004770| 6e 20 74 65 73 74 73 2e | 0d 0a 20 20 20 20 20 57 |n tests.|.. W|
|00004780| 68 65 6e 20 61 20 63 6c | 69 6e 69 63 61 6c 6c 79 |hen a cl|inically|
|00004790| 20 73 69 6c 65 6e 74 2c | 20 65 75 61 64 72 65 6e | silent,| euadren|
|000047a0| 61 6c 20 6d 61 73 73 20 | 69 73 20 66 6f 75 6e 64 |al mass |is found|
|000047b0| 20 6f 6e 20 43 54 2c 20 | 74 68 65 20 70 61 74 69 | on CT, |the pati|
|000047c0| 65 6e 74 20 77 69 6c 6c | 0d 0a 75 73 75 61 6c 6c |ent will|..usuall|
|000047d0| 79 20 68 61 76 65 20 74 | 6f 20 75 6e 64 65 72 67 |y have t|o underg|
|000047e0| 6f 20 69 6e 76 61 73 69 | 76 65 20 65 76 61 6c 75 |o invasi|ve evalu|
|000047f0| 61 74 69 6f 6e 20 73 75 | 63 68 20 61 73 20 6e 65 |ation su|ch as ne|
|00004800| 65 64 6c 65 2d 61 73 70 | 69 72 61 74 69 6f 6e 20 |edle-asp|iration |
|00004810| 62 69 6f 70 73 79 20 74 | 6f 0d 0a 73 65 70 61 72 |biopsy t|o..separ|
|00004820| 61 74 65 20 62 65 6e 69 | 67 6e 20 66 72 6f 6d 20 |ate beni|gn from |
|00004830| 6d 61 6c 69 67 6e 61 6e | 74 20 61 64 72 65 6e 61 |malignan|t adrena|
|00004840| 6c 20 6d 61 73 73 65 73 | 2e 20 20 54 68 65 20 70 |l masses|. The p|
|00004850| 72 65 73 65 6e 74 20 73 | 74 75 64 79 20 77 61 73 |resent s|tudy was|
|00004860| 20 64 6f 6e 65 20 74 6f | 0d 0a 64 65 74 65 72 6d | done to|..determ|
|00004870| 69 6e 65 20 77 68 65 74 | 68 65 72 20 61 64 72 65 |ine whet|her adre|
|00004880| 6e 61 6c 20 73 63 69 6e | 74 69 67 72 61 70 68 79 |nal scin|tigraphy|
|00004890| 20 77 69 74 68 0d 0a 31 | 33 31 2d 49 2d 36 2d 62 | with..1|31-I-6-b|
|000048a0| 65 74 61 2d 69 6f 64 6f | 6d 65 74 68 79 6c 2d 31 |eta-iodo|methyl-1|
|000048b0| 39 2d 6e 6f 72 63 68 6f | 6c 65 73 74 65 72 6f 6c |9-norcho|lesterol|
|000048c0| 20 28 4e 50 2d 35 39 29 | 20 63 61 6e 20 61 63 63 | (NP-59)| can acc|
|000048d0| 75 72 61 74 65 6c 79 20 | 61 6e 64 0d 0a 6e 6f 6e |urately |and..non|
|000048e0| 69 6e 76 61 73 69 76 65 | 6c 79 20 63 68 61 72 61 |invasive|ly chara|
|000048f0| 63 74 65 72 69 7a 65 20 | 6d 6f 73 74 20 61 73 79 |cterize |most asy|
|00004900| 6d 70 74 6f 6d 61 74 69 | 63 2c 20 61 63 63 69 64 |mptomati|c, accid|
|00004910| 65 6e 74 61 6c 6c 79 20 | 64 69 73 63 6f 76 65 72 |entally |discover|
|00004920| 65 64 20 65 75 61 64 72 | 65 6e 61 6c 0d 0a 6d 61 |ed euadr|enal..ma|
|00004930| 73 73 65 73 2e 0d 0a 20 | 20 20 20 20 42 65 74 77 |sses... | Betw|
|00004940| 65 65 6e 20 31 39 37 36 | 20 61 6e 64 20 31 39 38 |een 1976| and 198|
|00004950| 37 2c 20 31 31 39 20 70 | 61 74 69 65 6e 74 73 20 |7, 119 p|atients |
|00004960| 77 68 6f 20 75 6e 64 65 | 72 77 65 6e 74 20 61 62 |who unde|rwent ab|
|00004970| 64 6f 6d 69 6e 61 6c 20 | 43 54 20 73 63 61 6e 6e |dominal |CT scann|
|00004980| 69 6e 67 20 66 6f 72 0d | 0a 72 65 61 73 6f 6e 73 |ing for.|.reasons|
|00004990| 20 6f 74 68 65 72 20 74 | 68 61 6e 20 73 75 73 70 | other t|han susp|
|000049a0| 65 63 74 65 64 20 61 64 | 72 65 6e 61 6c 20 64 69 |ected ad|renal di|
|000049b0| 73 65 61 73 65 20 77 65 | 72 65 20 66 6f 75 6e 64 |sease we|re found|
|000049c0| 20 74 6f 20 68 61 76 65 | 20 75 6e 69 6c 61 74 65 | to have| unilate|
|000049d0| 72 61 6c 0d 0a 65 75 61 | 64 72 65 6e 61 6c 20 6d |ral..eua|drenal m|
|000049e0| 61 73 73 65 73 2e 20 20 | 4f 6e 20 74 68 65 20 62 |asses. |On the b|
|000049f0| 61 73 69 73 20 6f 66 20 | 66 69 6e 64 69 6e 67 73 |asis of |findings|
|00004a00| 20 66 72 6f 6d 20 43 54 | 2d 67 75 69 64 65 64 20 | from CT|-guided |
|00004a10| 62 69 6f 70 73 79 2c 0d | 0a 61 64 72 65 6e 61 6c |biopsy,.|.adrenal|
|00004a20| 65 63 74 6f 6d 79 2c 20 | 6f 72 20 66 6f 6c 6c 6f |ectomy, |or follo|
|00004a30| 77 2d 75 70 20 43 54 20 | 65 78 61 6d 69 6e 61 74 |w-up CT |examinat|
|00004a40| 69 6f 6e 73 2c 20 38 32 | 20 70 61 74 69 65 6e 74 |ions, 82| patient|
|00004a50| 73 20 77 65 72 65 20 64 | 69 61 67 6e 6f 73 65 64 |s were d|iagnosed|
|00004a60| 20 61 73 0d 0a 68 61 76 | 69 6e 67 20 61 20 62 65 | as..hav|ing a be|
|00004a70| 6e 69 67 6e 20 61 64 72 | 65 6e 61 6c 20 6d 61 73 |nign adr|enal mas|
|00004a80| 73 2c 20 32 35 20 61 73 | 20 68 61 76 69 6e 67 20 |s, 25 as| having |
|00004a90| 69 6e 74 72 61 2d 61 64 | 72 65 6e 61 6c 20 6e 65 |intra-ad|renal ne|
|00004aa0| 6f 70 6c 61 73 6d 73 2c | 20 33 20 61 73 20 68 61 |oplasms,| 3 as ha|
|00004ab0| 76 69 6e 67 0d 0a 61 64 | 72 65 6e 61 6c 20 63 79 |ving..ad|renal cy|
|00004ac0| 73 74 73 2c 20 34 20 61 | 73 20 68 61 76 69 6e 67 |sts, 4 a|s having|
|00004ad0| 20 70 65 72 69 61 64 72 | 65 6e 61 6c 20 6d 65 74 | periadr|enal met|
|00004ae0| 61 73 74 61 73 65 73 2c | 20 61 6e 64 20 35 20 61 |astases,| and 5 a|
|00004af0| 73 20 68 61 76 69 6e 67 | 20 70 73 65 75 64 6f 61 |s having| pseudoa|
|00004b00| 64 72 65 6e 61 6c 0d 0a | 6d 61 73 73 65 73 2e 20 |drenal..|masses. |
|00004b10| 20 53 65 76 65 6e 20 70 | 61 74 69 65 6e 74 73 20 | Seven p|atients |
|00004b20| 77 65 72 65 20 69 6e 63 | 69 64 65 6e 74 61 6c 6c |were inc|identall|
|00004b30| 79 20 64 69 61 67 6e 6f | 73 65 64 20 77 69 74 68 |y diagno|sed with|
|00004b40| 20 61 6e 20 75 6e 61 6e | 74 69 63 69 70 61 74 65 | an unan|ticipate|
|00004b50| 64 0d 0a 6d 61 6c 69 67 | 6e 61 6e 63 79 2e 0d 0a |d..malig|nancy...|
|00004b60| 20 20 20 20 20 52 65 73 | 75 6c 74 73 20 6f 66 20 | Res|ults of |
|00004b70| 73 63 61 6e 73 20 77 69 | 74 68 20 4e 50 2d 35 39 |scans wi|th NP-59|
|00004b80| 20 77 65 72 65 20 63 6f | 6e 63 6f 72 64 61 6e 74 | were co|ncordant|
|00004b90| 20 77 69 74 68 20 66 69 | 6e 64 69 6e 67 73 20 6f | with fi|ndings o|
|00004ba0| 6e 20 43 54 20 73 63 61 | 6e 73 20 69 6e 20 37 36 |n CT sca|ns in 76|
|00004bb0| 0d 0a 6f 66 20 74 68 65 | 20 38 32 20 70 61 74 69 |..of the| 82 pati|
|00004bc0| 65 6e 74 73 20 77 69 74 | 68 20 62 65 6e 69 67 6e |ents wit|h benign|
|00004bd0| 20 61 64 72 65 6e 61 6c | 20 6d 61 73 73 65 73 2e | adrenal| masses.|
|00004be0| 20 20 54 68 65 72 65 20 | 77 65 72 65 20 6e 6f 20 | There |were no |
|00004bf0| 66 61 6c 73 65 20 70 6f | 73 69 74 69 76 65 0d 0a |false po|sitive..|
|00004c00| 66 69 6e 64 69 6e 67 73 | 2c 20 62 75 74 20 74 68 |findings|, but th|
|00004c10| 65 72 65 20 77 65 72 65 | 20 36 20 66 61 6c 73 65 |ere were| 6 false|
|00004c20| 20 6e 65 67 61 74 69 76 | 65 20 66 69 6e 64 69 6e | negativ|e findin|
|00004c30| 67 73 20 69 6e 20 69 64 | 65 6e 74 69 66 79 69 6e |gs in id|entifyin|
|00004c40| 67 20 62 65 6e 69 67 6e | 20 61 64 72 65 6e 61 6c |g benign| adrenal|
|00004c50| 0d 0a 6d 61 73 73 65 73 | 20 6f 6e 20 73 63 61 6e |..masses| on scan|
|00004c60| 73 20 77 69 74 68 20 4e | 50 2d 35 39 2e 20 48 6f |s with N|P-59. Ho|
|00004c70| 77 65 76 65 72 2c 20 74 | 68 65 72 65 20 77 61 73 |wever, t|here was|
|00004c80| 20 61 20 68 69 67 68 20 | 64 65 67 72 65 65 20 6f | a high |degree o|
|00004c90| 66 20 64 69 73 63 6f 72 | 64 61 6e 63 65 0d 0a 62 |f discor|dance..b|
|00004ca0| 65 74 77 65 65 6e 20 43 | 54 20 61 6e 64 20 4e 50 |etween C|T and NP|
|00004cb0| 2d 35 39 20 73 63 61 6e | 73 20 66 6f 72 20 6d 61 |-59 scan|s for ma|
|00004cc0| 6c 69 67 6e 61 6e 74 20 | 61 6e 64 20 73 70 61 63 |lignant |and spac|
|00004cd0| 65 2d 6f 63 63 75 70 79 | 69 6e 67 20 6d 61 73 73 |e-occupy|ing mass|
|00004ce0| 65 73 2e 20 20 54 68 75 | 73 2c 20 61 0d 0a 63 6f |es. Thu|s, a..co|
|00004cf0| 6e 63 6f 72 64 61 6e 74 | 20 43 54 20 61 6e 64 20 |ncordant| CT and |
|00004d00| 4e 50 2d 35 39 20 73 74 | 75 64 79 20 61 63 63 75 |NP-59 st|udy accu|
|00004d10| 72 61 74 65 6c 79 20 70 | 72 65 64 69 63 74 65 64 |rately p|redicted|
|00004d20| 20 61 20 62 65 6e 69 67 | 6e 20 70 72 6f 63 65 73 | a benig|n proces|
|00004d30| 73 2c 20 77 68 65 72 65 | 61 73 20 61 0d 0a 64 69 |s, where|as a..di|
|00004d40| 73 63 6f 72 64 61 6e 74 | 20 43 54 20 61 6e 64 20 |scordant| CT and |
|00004d50| 4e 50 2d 35 39 20 73 74 | 75 64 79 20 70 72 65 64 |NP-59 st|udy pred|
|00004d60| 69 63 74 65 64 20 61 20 | 73 70 61 63 65 2d 6f 63 |icted a |space-oc|
|00004d70| 63 75 70 79 69 6e 67 20 | 6f 72 20 70 6f 74 65 6e |cupying |or poten|
|00004d80| 74 69 61 6c 6c 79 0d 0a | 6d 61 6c 69 67 6e 61 6e |tially..|malignan|
|00004d90| 74 20 61 64 72 65 6e 61 | 6c 20 6d 61 73 73 2e 0d |t adrena|l mass..|
|00004da0| 0a 20 20 20 20 20 54 68 | 65 20 62 65 68 61 76 69 |. Th|e behavi|
|00004db0| 6f 72 20 6f 66 20 65 75 | 61 64 72 65 6e 61 6c 20 |or of eu|adrenal |
|00004dc0| 6d 61 73 73 65 73 20 61 | 73 20 64 65 70 69 63 74 |masses a|s depict|
|00004dd0| 65 64 20 62 79 20 4e 50 | 2d 35 39 20 73 63 69 6e |ed by NP|-59 scin|
|00004de0| 74 69 67 72 61 70 68 79 | 20 69 73 0d 0a 75 73 65 |tigraphy| is..use|
|00004df0| 66 75 6c 20 66 6f 72 20 | 64 69 66 66 65 72 65 6e |ful for |differen|
|00004e00| 74 69 61 74 69 6e 67 20 | 62 65 74 77 65 65 6e 20 |tiating |between |
|00004e10| 62 65 6e 69 67 6e 20 61 | 6e 64 20 6d 61 6c 69 67 |benign a|nd malig|
|00004e20| 6e 61 6e 74 20 6f 72 20 | 73 70 61 63 65 2d 6f 63 |nant or |space-oc|
|00004e30| 63 75 70 79 69 6e 67 0d | 0a 6d 61 73 73 65 73 2e |cupying.|.masses.|
|00004e40| 0d 0a 0d 0a 50 6f 73 74 | 2d 43 6f 6d 6d 65 6e 74 |....Post|-Comment|
|00004e50| 0d 0a 0d 0a 20 20 20 20 | 20 54 68 65 20 61 73 79 |.... | The asy|
|00004e60| 6d 70 74 6f 6d 61 74 69 | 63 2c 20 69 6e 63 69 64 |mptomati|c, incid|
|00004e70| 65 6e 74 61 6c 6c 79 2d | 64 69 73 63 6f 76 65 72 |entally-|discover|
|00004e80| 65 64 20 61 64 72 65 6e | 61 6c 20 6d 61 73 73 20 |ed adren|al mass |
|00004e90| 63 72 65 61 74 65 73 20 | 61 20 63 6c 69 6e 69 63 |creates |a clinic|
|00004ea0| 61 6c 0d 0a 70 72 6f 62 | 6c 65 6d 2e 20 20 54 68 |al..prob|lem. Th|
|00004eb0| 65 20 61 75 74 68 6f 72 | 73 20 70 72 65 73 65 6e |e author|s presen|
|00004ec0| 74 20 61 20 76 65 72 79 | 20 6c 61 72 67 65 20 73 |t a very| large s|
|00004ed0| 65 72 69 65 73 20 6f 66 | 20 6e 6f 6e 66 75 6e 63 |eries of| nonfunc|
|00004ee0| 74 69 6f 6e 69 6e 67 20 | 69 6e 63 69 64 65 6e 74 |tioning |incident|
|00004ef0| 61 6c 6c 79 0d 0a 64 65 | 74 65 63 74 65 64 20 6d |ally..de|tected m|
|00004f00| 61 73 73 65 73 2e 20 20 | 49 74 20 69 73 20 6e 6f |asses. |It is no|
|00004f10| 74 65 77 6f 72 74 68 79 | 20 74 68 61 74 20 37 20 |teworthy| that 7 |
|00004f20| 6f 66 20 31 31 39 20 77 | 65 72 65 20 75 6e 73 75 |of 119 w|ere unsu|
|00004f30| 73 70 65 63 74 65 64 20 | 6d 61 6c 69 67 6e 61 6e |spected |malignan|
|00004f40| 63 69 65 73 2e 0d 0a 54 | 68 65 72 65 20 77 65 72 |cies...T|here wer|
|00004f50| 65 20 31 36 20 69 6e 74 | 72 61 2d 61 64 72 65 6e |e 16 int|ra-adren|
|00004f60| 61 6c 20 61 6e 64 20 34 | 20 70 65 72 69 61 64 72 |al and 4| periadr|
|00004f70| 65 6e 61 6c 20 6d 61 6c | 69 67 6e 61 6e 74 20 6d |enal mal|ignant m|
|00004f80| 61 73 73 65 73 2c 20 62 | 75 74 20 6f 6e 6c 79 20 |asses, b|ut only |
|00004f90| 32 20 6f 66 0d 0a 74 68 | 65 73 65 20 77 65 72 65 |2 of..th|ese were|
|00004fa0| 20 70 72 69 6d 61 72 79 | 20 61 64 72 65 6e 61 6c | primary| adrenal|
|00004fb0| 20 63 61 6e 63 65 72 73 | 2e 20 20 54 68 65 20 61 | cancers|. The a|
|00004fc0| 75 74 68 6f 72 73 20 73 | 74 61 74 65 20 74 68 61 |uthors s|tate tha|
|00004fd0| 74 20 74 68 65 20 4e 50 | 2d 35 39 20 73 63 61 6e |t the NP|-59 scan|
|00004fe0| 20 69 73 0d 0a 75 73 65 | 66 75 6c 20 69 6e 20 74 | is..use|ful in t|
|00004ff0| 68 65 20 64 69 66 66 65 | 72 65 6e 74 69 61 6c 20 |he diffe|rential |
|00005000| 64 69 61 67 6e 6f 73 69 | 73 20 6f 66 20 74 68 65 |diagnosi|s of the|
|00005010| 73 65 20 61 64 72 65 6e | 61 6c 20 6d 61 73 73 65 |se adren|al masse|
|00005020| 73 2e 20 20 54 68 65 69 | 72 20 61 72 67 75 6d 65 |s. Thei|r argume|
|00005030| 6e 74 20 69 73 0d 0a 6e | 6f 74 20 63 6f 6e 76 69 |nt is..n|ot convi|
|00005040| 6e 63 69 6e 67 2e 20 20 | 4e 6f 74 20 6f 6e 6c 79 |ncing. |Not only|
|00005050| 20 77 61 73 20 74 68 65 | 20 70 72 65 63 69 73 69 | was the| precisi|
|00005060| 6f 6e 20 6f 66 20 74 68 | 65 20 74 65 73 74 20 6f |on of th|e test o|
|00005070| 6e 6c 79 20 66 61 69 72 | 20 74 6f 20 67 6f 6f 64 |nly fair| to good|
|00005080| 2c 20 62 75 74 0d 0a 74 | 68 65 79 20 64 65 66 69 |, but..t|hey defi|
|00005090| 6e 65 64 20 61 20 74 72 | 75 65 20 70 6f 73 69 74 |ned a tr|ue posit|
|000050a0| 69 76 65 20 61 73 20 61 | 20 73 70 61 63 65 2d 6f |ive as a| space-o|
|000050b0| 63 63 75 70 79 69 6e 67 | 20 6c 65 73 69 6f 6e 20 |ccupying| lesion |
|000050c0| 6f 72 20 64 65 73 74 72 | 75 63 74 69 76 65 20 6c |or destr|uctive l|
|000050d0| 65 73 69 6f 6e 0d 0a 69 | 6e 63 6c 75 64 69 6e 67 |esion..i|ncluding|
|000050e0| 20 63 79 73 74 73 2c 20 | 72 61 74 68 65 72 20 74 | cysts, |rather t|
|000050f0| 68 61 6e 20 61 73 20 61 | 20 6d 61 6c 69 67 6e 61 |han as a| maligna|
|00005100| 6e 74 20 6d 61 73 73 2e | 20 20 46 75 72 74 68 65 |nt mass.| Furthe|
|00005110| 72 6d 6f 72 65 2c 20 69 | 6e 0d 0a 63 6f 6e 74 72 |rmore, i|n..contr|
|00005120| 61 64 69 73 74 69 6e 63 | 74 69 6f 6e 20 74 6f 20 |adistinc|tion to |
|00005130| 74 68 65 20 73 74 61 74 | 65 6d 65 6e 74 20 69 6e |the stat|ement in|
|00005140| 20 74 68 65 20 61 62 73 | 74 72 61 63 74 2c 20 69 | the abs|tract, i|
|00005150| 74 20 69 73 20 6e 6f 74 | 20 6e 65 63 65 73 73 61 |t is not| necessa|
|00005160| 72 79 20 74 6f 20 64 6f | 20 61 0d 0a 62 69 6f 70 |ry to do| a..biop|
|00005170| 73 79 20 69 6e 20 6d 6f | 73 74 20 6f 66 20 74 68 |sy in mo|st of th|
|00005180| 65 73 65 20 70 61 74 69 | 65 6e 74 73 2e 20 20 4f |ese pati|ents. O|
|00005190| 6e 6c 79 20 74 68 6f 73 | 65 20 77 69 74 68 20 6c |nly thos|e with l|
|000051a0| 65 73 69 6f 6e 73 20 67 | 72 65 61 74 65 72 20 74 |esions g|reater t|
|000051b0| 68 61 6e 20 34 2d 35 20 | 63 6d 0d 0a 6f 72 20 65 |han 4-5 |cm..or e|
|000051c0| 6e 6c 61 72 67 69 6e 67 | 20 6d 61 73 73 65 73 20 |nlarging| masses |
|000051d0| 72 65 71 75 69 72 65 20 | 62 69 6f 70 73 79 20 28 |require |biopsy (|
|000051e0| 41 64 75 6c 74 20 61 6e | 64 20 50 65 64 69 61 74 |Adult an|d Pediat|
|000051f0| 72 69 63 20 55 72 6f 6c | 6f 67 79 2c 20 63 68 61 |ric Urol|ogy, cha|
|00005200| 70 74 65 72 0d 0a 31 34 | 29 2e 2d 2d 53 2e 53 2e |pter..14|).--S.S.|
|00005210| 20 48 6f 77 61 72 64 73 | 2c 20 4d 2e 44 2e 0d 0a | Howards|, M.D...|
|00005220| 24 55 6e 69 71 75 65 5f | 49 44 7b 59 52 42 30 38 |$Unique_|ID{YRB08|
|00005230| 39 30 35 7d 0d 0a 24 54 | 69 74 6c 65 7b 4d 65 74 |905}..$T|itle{Met|
|00005240| 61 73 74 61 74 69 63 20 | 52 65 6e 61 6c 20 43 61 |astatic |Renal Ca|
|00005250| 6e 63 65 72 20 54 72 65 | 61 74 65 64 20 57 69 74 |ncer Tre|ated Wit|
|00005260| 68 20 49 6e 74 65 72 6c | 65 75 6b 69 6e 2d 32 20 |h Interl|eukin-2 |
|00005270| 61 6e 64 20 4c 79 6d 70 | 68 6f 6b 69 6e 65 2d 20 |and Lymp|hokine- |
|00005280| 41 63 74 69 76 61 74 65 | 64 20 4b 69 6c 6c 65 72 |Activate|d Killer|
|00005290| 20 43 65 6c 6c 73 3a 20 | 20 41 20 50 68 61 73 65 | Cells: | A Phase|
|000052a0| 20 49 49 20 43 6c 69 6e | 69 63 61 6c 20 54 72 69 | II Clin|ical Tri|
|000052b0| 61 6c 7d 0d 0a 24 41 75 | 74 68 6f 72 7b 0d 0a 46 |al}..$Au|thor{..F|
|000052c0| 69 73 68 65 72 2c 20 52 | 49 0d 0a 43 6f 6c 74 6d |isher, R|I..Coltm|
|000052d0| 61 6e 2c 20 43 41 2c 20 | 4a 72 0d 0a 44 6f 72 6f |an, CA, |Jr..Doro|
|000052e0| 73 68 6f 77 2c 20 4a 48 | 0d 0a 52 61 79 6e 65 72 |show, JH|..Rayner|
|000052f0| 2c 20 41 41 0d 0a 48 61 | 77 6b 69 6e 73 2c 20 4d |, AA..Ha|wkins, M|
|00005300| 4a 0d 0a 4d 69 65 72 2c | 20 4a 57 0d 0a 57 69 65 |J..Mier,| JW..Wie|
|00005310| 72 6e 69 6b 2c 20 50 0d | 0a 4d 63 4d 61 6e 6e 69 |rnik, P.|.McManni|
|00005320| 73 2c 20 4a 44 0d 0a 57 | 65 69 73 73 2c 20 47 52 |s, JD..W|eiss, GR|
|00005330| 0d 0a 4d 61 72 67 6f 6c | 69 6e 2c 20 4b 41 0d 0a |..Margol|in, KA..|
|00005340| 47 65 6d 6c 6f 2c 20 42 | 54 0d 0a 48 6f 74 68 2c |Gemlo, B|T..Hoth,|
|00005350| 20 44 46 0d 0a 50 61 72 | 6b 69 6e 73 6f 6e 2c 20 | DF..Par|kinson, |
|00005360| 44 52 0d 0a 50 61 69 65 | 74 74 61 2c 20 45 7d 0d |DR..Paie|tta, E}.|
|00005370| 0a 24 41 66 66 69 6c 69 | 61 74 69 6f 6e 7b 4c 6f |.$Affili|ation{Lo|
|00005380| 79 6f 6c 61 20 55 6e 69 | 76 2c 20 4d 61 79 77 6f |yola Uni|v, Maywo|
|00005390| 6f 64 20 49 6c 6c 3b 20 | 55 6e 69 76 20 6f 66 20 |od Ill; |Univ of |
|000053a0| 54 65 78 61 73 2c 20 53 | 61 6e 20 41 6e 74 6f 6e |Texas, S|an Anton|
|000053b0| 69 6f 3b 20 43 69 74 79 | 20 6f 66 20 48 6f 70 65 |io; City| of Hope|
|000053c0| 20 43 61 6e 63 65 72 20 | 52 65 73 65 61 72 63 68 | Cancer |Research|
|000053d0| 20 43 74 72 2c 20 44 75 | 61 72 74 65 2c 20 43 61 | Ctr, Du|arte, Ca|
|000053e0| 6c 69 66 3b 20 55 6e 69 | 76 20 6f 66 20 43 61 6c |lif; Uni|v of Cal|
|000053f0| 69 66 6f 72 6e 69 61 2c | 20 53 61 6e 20 46 72 61 |ifornia,| San Fra|
|00005400| 6e 63 69 73 63 6f 3b 20 | 4e 61 74 6c 20 43 61 6e |ncisco; |Natl Can|
|00005410| 63 65 72 20 49 6e 73 74 | 2c 20 42 65 74 68 65 73 |cer Inst|, Bethes|
|00005420| 64 61 2c 20 4d 64 3b 20 | 65 74 20 61 6c 7d 0d 0a |da, Md; |et al}..|
|00005430| 24 53 75 62 6a 65 63 74 | 7b 4d 65 74 61 73 74 61 |$Subject|{Metasta|
|00005440| 73 65 73 2c 20 72 65 6e | 61 6c 20 63 61 6e 63 65 |ses, ren|al cance|
|00005450| 72 2c 20 69 6e 74 65 72 | 6c 65 75 6b 69 6e 2d 32 |r, inter|leukin-2|
|00005460| 20 61 6e 64 20 6c 79 6d | 70 68 6f 6b 69 6e 65 2d | and lym|phokine-|
|00005470| 61 63 74 69 76 61 74 65 | 64 20 6b 69 6c 6c 65 72 |activate|d killer|
|00005480| 0d 0a 63 65 6c 6c 73 20 | 69 6e 3b 20 4c 79 6d 70 |..cells |in; Lymp|
|00005490| 68 6f 6b 69 6e 65 2c 20 | 2d 61 63 74 69 76 61 74 |hokine, |-activat|
|000054a0| 65 64 20 6b 69 6c 6c 65 | 72 20 63 65 6c 6c 73 20 |ed kille|r cells |
|000054b0| 69 6e 20 6d 65 74 61 73 | 74 61 74 69 63 20 6b 69 |in metas|tatic ki|
|000054c0| 64 6e 65 79 20 63 61 6e | 63 65 72 3b 20 4b 69 6c |dney can|cer; Kil|
|000054d0| 6c 65 72 0d 0a 63 65 6c | 6c 73 2c 20 6c 79 6d 70 |ler..cel|ls, lymp|
|000054e0| 68 6f 6b 69 6e 65 2d 61 | 63 74 69 76 61 74 65 64 |hokine-a|ctivated|
|000054f0| 2c 20 69 6e 20 6d 65 74 | 61 73 74 61 74 69 63 20 |, in met|astatic |
|00005500| 6b 69 64 6e 65 79 20 63 | 61 6e 63 65 72 3b 20 49 |kidney c|ancer; I|
|00005510| 6e 74 65 72 6c 65 75 6b | 69 6e 2d 32 2c 20 69 6e |nterleuk|in-2, in|
|00005520| 0d 0a 6b 69 64 6e 65 79 | 20 63 61 6e 63 65 72 2c |..kidney| cancer,|
|00005530| 20 6d 65 74 61 73 74 61 | 74 69 63 3b 20 43 65 6c | metasta|tic; Cel|
|00005540| 6c 2c 20 43 65 6c 6c 73 | 2c 20 6b 69 6c 6c 65 72 |l, Cells|, killer|
|00005550| 2c 20 6c 79 6d 70 68 6f | 6b 69 6e 65 2d 61 63 74 |, lympho|kine-act|
|00005560| 69 76 61 74 65 64 2c 20 | 69 6e 0d 0a 6d 65 74 61 |ivated, |in..meta|
|00005570| 73 74 61 74 69 63 20 6b | 69 64 6e 65 79 20 63 61 |static k|idney ca|
|00005580| 6e 63 65 72 3b 20 43 61 | 6e 63 65 72 2c 20 6b 69 |ncer; Ca|ncer, ki|
|00005590| 64 6e 65 79 2c 20 6d 65 | 74 61 73 74 61 74 69 63 |dney, me|tastatic|
|000055a0| 2c 20 69 6e 74 65 72 6c | 65 75 6b 69 6e 2d 32 20 |, interl|eukin-2 |
|000055b0| 61 6e 64 0d 0a 6c 79 6d | 70 68 6f 6b 69 6e 65 2d |and..lym|phokine-|
|000055c0| 61 63 74 69 76 61 74 65 | 64 20 6b 69 6c 6c 65 72 |activate|d killer|
|000055d0| 20 63 65 6c 6c 73 20 69 | 6e 7d 0d 0a 24 4a 6f 75 | cells i|n}..$Jou|
|000055e0| 72 6e 61 6c 7b 41 6e 6e | 20 49 6e 74 65 72 6e 20 |rnal{Ann| Intern |
|000055f0| 4d 65 64 7d 0d 0a 24 56 | 6f 6c 75 6d 65 7b 31 30 |Med}..$V|olume{10|
|00005600| 38 7d 0d 0a 24 50 61 67 | 65 7b 35 31 38 2d 35 32 |8}..$Pag|e{518-52|
|00005610| 33 7d 0d 0a 24 44 61 74 | 65 7b 41 70 72 69 6c 20 |3}..$Dat|e{April |
|00005620| 31 39 38 38 7d 0d 0a 24 | 59 42 56 6f 6c 7b 31 39 |1988}..$|YBVol{19|
|00005630| 38 39 20 59 65 61 72 20 | 42 6f 6f 6b 20 6f 66 20 |89 Year |Book of |
|00005640| 55 72 6f 6c 6f 67 79 7d | 0d 0a 24 43 68 61 70 74 |Urology}|..$Chapt|
|00005650| 65 72 7b 37 2d 35 7d 0d | 0a 24 59 42 45 64 69 74 |er{7-5}.|.$YBEdit|
|00005660| 6f 72 7b 44 72 73 2e 20 | 47 69 6c 6c 65 6e 77 61 |or{Drs. |Gillenwa|
|00005670| 74 65 72 20 61 6e 64 20 | 48 6f 77 61 72 64 73 7d |ter and |Howards}|
|00005680| 0d 0a 24 54 61 62 6c 65 | 7b 7d 0d 0a 24 43 6f 6d |..$Table|{}..$Com|
|00005690| 6d 65 6e 74 61 74 6f 72 | 7b 53 2e 53 2e 20 48 6f |mentator|{S.S. Ho|
|000056a0| 77 61 72 64 73 2c 20 4d | 2e 44 2e 7d 0d 0a 0d 0a |wards, M|.D.}....|
|000056b0| 43 6f 70 79 72 69 67 68 | 74 20 28 63 29 20 59 65 |Copyrigh|t (c) Ye|
|000056c0| 61 72 20 42 6f 6f 6b 20 | 4d 65 64 69 63 61 6c 20 |ar Book |Medical |
|000056d0| 50 75 62 6c 69 73 68 65 | 72 73 2c 20 49 6e 63 2e |Publishe|rs, Inc.|
|000056e0| 2c 20 31 39 38 39 0d 0a | 0d 0a 31 39 38 39 20 59 |, 1989..|..1989 Y|
|000056f0| 65 61 72 20 42 6f 6f 6b | 20 6f 66 20 55 72 6f 6c |ear Book| of Urol|
|00005700| 6f 67 79 20 28 52 29 0d | 0a 0d 0a 50 61 72 74 20 |ogy (R).|...Part |
|00005710| 31 3a 20 20 41 64 75 6c | 74 0d 0a 0d 0a 43 68 61 |1: Adul|t....Cha|
|00005720| 70 74 65 72 20 37 2d 2d | 52 65 6e 61 6c 20 4e 65 |pter 7--|Renal Ne|
|00005730| 6f 70 6c 61 73 6d 73 0d | 0a 0d 0a 2d 2d 2d 2d 2d |oplasms.|...-----|
|00005740| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005750| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005760| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005770| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005780| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 0d 0a 4d 65 74 |--------|---..Met|
|00005790| 61 73 74 61 74 69 63 20 | 52 65 6e 61 6c 20 43 61 |astatic |Renal Ca|
|000057a0| 6e 63 65 72 20 54 72 65 | 61 74 65 64 20 57 69 74 |ncer Tre|ated Wit|
|000057b0| 68 20 49 6e 74 65 72 6c | 65 75 6b 69 6e 2d 32 20 |h Interl|eukin-2 |
|000057c0| 61 6e 64 20 4c 79 6d 70 | 68 6f 6b 69 6e 65 2d 41 |and Lymp|hokine-A|
|000057d0| 63 74 69 76 61 74 65 64 | 0d 0a 4b 69 6c 6c 65 72 |ctivated|..Killer|
|000057e0| 20 43 65 6c 6c 73 3a 20 | 20 41 20 50 68 61 73 65 | Cells: | A Phase|
|000057f0| 20 49 49 20 43 6c 69 6e | 69 63 61 6c 20 54 72 69 | II Clin|ical Tri|
|00005800| 61 6c 0d 0a 0d 0a 46 69 | 73 68 65 72 20 52 49 3b |al....Fi|sher RI;|
|00005810| 20 43 6f 6c 74 6d 61 6e | 20 43 41 20 4a 72 3b 20 | Coltman| CA Jr; |
|00005820| 44 6f 72 6f 73 68 6f 77 | 20 4a 48 3b 20 52 61 79 |Doroshow| JH; Ray|
|00005830| 6e 65 72 20 41 41 3b 20 | 48 61 77 6b 69 6e 73 20 |ner AA; |Hawkins |
|00005840| 4d 4a 3b 20 4d 69 65 72 | 20 4a 57 3b 20 57 69 65 |MJ; Mier| JW; Wie|
|00005850| 72 6e 69 6b 0d 0a 50 3b | 20 4d 63 4d 61 6e 6e 69 |rnik..P;| McManni|
|00005860| 73 20 4a 44 3b 20 57 65 | 69 73 73 20 47 52 3b 20 |s JD; We|iss GR; |
|00005870| 4d 61 72 67 6f 6c 69 6e | 20 4b 41 3b 20 47 65 6d |Margolin| KA; Gem|
|00005880| 6c 6f 20 42 54 3b 20 48 | 6f 74 68 20 44 46 3b 20 |lo BT; H|oth DF; |
|00005890| 50 61 72 6b 69 6e 73 6f | 6e 20 44 52 3b 20 50 61 |Parkinso|n DR; Pa|
|000058a0| 69 65 74 74 61 0d 0a 45 | 0d 0a 28 4c 6f 79 6f 6c |ietta..E|..(Loyol|
|000058b0| 61 20 55 6e 69 76 2c 20 | 4d 61 79 77 6f 6f 64 20 |a Univ, |Maywood |
|000058c0| 49 6c 6c 3b 20 55 6e 69 | 76 20 6f 66 20 54 65 78 |Ill; Uni|v of Tex|
|000058d0| 61 73 2c 20 53 61 6e 20 | 41 6e 74 6f 6e 69 6f 3b |as, San |Antonio;|
|000058e0| 20 43 69 74 79 20 6f 66 | 20 48 6f 70 65 20 43 61 | City of| Hope Ca|
|000058f0| 6e 63 65 72 0d 0a 52 65 | 73 65 61 72 63 68 20 43 |ncer..Re|search C|
|00005900| 74 72 2c 20 44 75 61 72 | 74 65 2c 20 43 61 6c 69 |tr, Duar|te, Cali|
|00005910| 66 3b 20 55 6e 69 76 20 | 6f 66 20 43 61 6c 69 66 |f; Univ |of Calif|
|00005920| 6f 72 6e 69 61 2c 20 53 | 61 6e 20 46 72 61 6e 63 |ornia, S|an Franc|
|00005930| 69 73 63 6f 3b 20 4e 61 | 74 6c 20 43 61 6e 63 65 |isco; Na|tl Cance|
|00005940| 72 0d 0a 49 6e 73 74 2c | 20 42 65 74 68 65 73 64 |r..Inst,| Bethesd|
|00005950| 61 2c 20 4d 64 3b 20 65 | 74 20 61 6c 29 0d 0a 41 |a, Md; e|t al)..A|
|00005960| 6e 6e 20 49 6e 74 65 72 | 6e 20 4d 65 64 20 31 30 |nn Inter|n Med 10|
|00005970| 38 3a 35 31 38 2d 35 32 | 33 2c 20 41 70 72 69 6c |8:518-52|3, April|
|00005980| 20 31 39 38 38 0d 0a 2d | 2d 2d 2d 2d 2d 2d 2d 2d | 1988..-|--------|
|00005990| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000059a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000059b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000059c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000059d0| 2d 2d 2d 2d 2d 2d 2d 0d | 0a 0d 0a 41 62 73 74 72 |-------.|...Abstr|
|000059e0| 61 63 74 0d 0a 0d 0a 20 | 20 20 20 20 41 20 70 68 |act.... | A ph|
|000059f0| 61 73 65 20 49 49 20 63 | 6c 69 6e 69 63 61 6c 20 |ase II c|linical |
|00005a00| 73 74 75 64 79 20 77 61 | 73 20 63 6f 6e 64 75 63 |study wa|s conduc|
|00005a10| 74 65 64 20 74 6f 20 63 | 6f 6e 66 69 72 6d 20 74 |ted to c|onfirm t|
|00005a20| 68 65 20 61 6e 74 69 74 | 75 6d 6f 72 20 65 66 66 |he antit|umor eff|
|00005a30| 69 63 61 63 79 0d 0a 6f | 66 20 69 6e 74 65 72 6c |icacy..o|f interl|
|00005a40| 65 75 6b 69 6e 2d 32 20 | 61 6e 64 20 6c 79 6d 70 |eukin-2 |and lymp|
|00005a50| 68 6f 6b 69 6e 65 2d 61 | 63 74 69 76 61 74 65 64 |hokine-a|ctivated|
|00005a60| 20 6b 69 6c 6c 65 72 20 | 63 65 6c 6c 73 20 69 6e | killer |cells in|
|00005a70| 20 74 68 65 20 74 72 65 | 61 74 6d 65 6e 74 20 6f | the tre|atment o|
|00005a80| 66 0d 0a 6d 65 74 61 73 | 74 61 74 69 63 20 72 65 |f..metas|tatic re|
|00005a90| 6e 61 6c 20 63 61 6e 63 | 65 72 2e 20 20 54 68 69 |nal canc|er. Thi|
|00005aa0| 72 74 79 2d 66 69 76 65 | 20 70 61 74 69 65 6e 74 |rty-five| patient|
|00005ab0| 73 20 77 69 74 68 20 6d | 65 74 61 73 74 61 74 69 |s with m|etastati|
|00005ac0| 63 20 6f 72 20 75 6e 72 | 65 73 65 63 74 61 62 6c |c or unr|esectabl|
|00005ad0| 65 0d 0a 72 65 6e 61 6c | 20 63 65 6c 6c 20 63 61 |e..renal| cell ca|
|00005ae0| 6e 63 65 72 20 77 69 74 | 68 20 62 69 64 69 6d 65 |ncer wit|h bidime|
|00005af0| 6e 73 69 6f 6e 61 6c 6c | 79 20 6d 65 61 73 75 72 |nsionall|y measur|
|00005b00| 61 62 6c 65 20 64 69 73 | 65 61 73 65 2c 20 70 65 |able dis|ease, pe|
|00005b10| 72 66 6f 72 6d 61 6e 63 | 65 20 73 74 61 74 75 73 |rformanc|e status|
|00005b20| 20 6f 66 0d 0a 30 20 6f | 72 20 31 2c 20 61 6e 64 | of..0 o|r 1, and|
|00005b30| 20 61 64 65 71 75 61 74 | 65 20 66 75 6e 63 74 69 | adequat|e functi|
|00005b40| 6f 6e 20 6f 66 20 76 69 | 74 61 6c 20 6f 72 67 61 |on of vi|tal orga|
|00005b50| 6e 73 20 77 65 72 65 20 | 74 72 65 61 74 65 64 2e |ns were |treated.|
|00005b60| 0d 0a 20 20 20 20 20 49 | 6e 69 74 69 61 6c 6c 79 |.. I|nitially|
|00005b70| 20 74 68 65 20 70 61 74 | 69 65 6e 74 73 20 72 65 | the pat|ients re|
|00005b80| 63 65 69 76 65 64 20 35 | 20 64 61 79 73 20 6f 66 |ceived 5| days of|
|00005b90| 20 70 72 69 6d 69 6e 67 | 20 77 69 74 68 20 72 65 | priming| with re|
|00005ba0| 63 6f 6d 62 69 6e 61 6e | 74 0d 0a 69 6e 74 65 72 |combinan|t..inter|
|00005bb0| 6c 65 75 6b 69 6e 2d 32 | 2c 20 31 30 30 2c 30 30 |leukin-2|, 100,00|
|00005bc0| 30 20 75 6e 69 74 73 2f | 6b 67 20 65 76 65 72 79 |0 units/|kg every|
|00005bd0| 20 38 20 68 6f 75 72 73 | 2c 20 74 6f 20 73 74 69 | 8 hours|, to sti|
|00005be0| 6d 75 6c 61 74 65 20 6c | 79 6d 70 68 6f 6b 69 6e |mulate l|ymphokin|
|00005bf0| 65 2d 61 63 74 69 76 61 | 74 65 64 0d 0a 6b 69 6c |e-activa|ted..kil|
|00005c00| 6c 65 72 20 63 65 6c 6c | 20 70 72 65 63 75 72 73 |ler cell| precurs|
|00005c10| 6f 72 73 20 61 6e 64 20 | 65 66 66 65 63 74 6f 72 |ors and |effector|
|00005c20| 20 61 63 74 69 76 69 74 | 79 2e 20 20 4f 6e 20 64 | activit|y. On d|
|00005c30| 61 79 73 20 38 2d 31 32 | 20 74 68 65 20 70 61 74 |ays 8-12| the pat|
|00005c40| 69 65 6e 74 73 0d 0a 75 | 6e 64 65 72 77 65 6e 74 |ients..u|nderwent|
|00005c50| 20 64 61 69 6c 79 20 6c | 65 75 6b 61 70 68 65 72 | daily l|eukapher|
|00005c60| 65 73 69 73 20 61 6e 64 | 20 74 68 65 20 6c 79 6d |esis and| the lym|
|00005c70| 70 68 6f 63 79 74 65 73 | 20 77 65 72 65 20 63 75 |phocytes| were cu|
|00005c80| 6c 74 75 72 65 64 20 69 | 6e 20 76 69 74 72 6f 20 |ltured i|n vitro |
|00005c90| 77 69 74 68 0d 0a 69 6e | 74 65 72 6c 65 75 6b 69 |with..in|terleuki|
|00005ca0| 6e 2d 32 20 66 6f 72 20 | 33 2d 34 20 64 61 79 73 |n-2 for |3-4 days|
|00005cb0| 20 74 6f 20 61 6d 70 6c | 69 66 79 20 74 68 65 20 | to ampl|ify the |
|00005cc0| 6c 79 6d 70 68 6f 6b 69 | 6e 65 2d 61 63 74 69 76 |lymphoki|ne-activ|
|00005cd0| 61 74 65 64 20 6b 69 6c | 6c 65 72 20 63 65 6c 6c |ated kil|ler cell|
|00005ce0| 0d 0a 61 63 74 69 76 69 | 74 79 2e 20 20 4f 6e 20 |..activi|ty. On |
|00005cf0| 64 61 79 73 20 31 32 2d | 31 36 20 74 68 65 20 70 |days 12-|16 the p|
|00005d00| 61 74 69 65 6e 74 20 63 | 65 6c 6c 73 20 77 65 72 |atient c|ells wer|
|00005d10| 65 20 72 65 69 6e 66 75 | 73 65 64 20 74 6f 67 65 |e reinfu|sed toge|
|00005d20| 74 68 65 72 20 77 69 74 | 68 0d 0a 61 64 64 69 74 |ther wit|h..addit|
|00005d30| 69 6f 6e 61 6c 20 64 6f | 73 65 73 20 6f 66 20 69 |ional do|ses of i|
|00005d40| 6e 74 65 72 6c 65 75 6b | 69 6e 2d 32 2e 20 41 20 |nterleuk|in-2. A |
|00005d50| 6d 61 78 69 6d 75 6d 20 | 6f 66 20 33 20 74 72 65 |maximum |of 3 tre|
|00005d60| 61 74 6d 65 6e 74 73 20 | 77 61 73 20 70 65 72 6d |atments |was perm|
|00005d70| 69 74 74 65 64 2e 20 20 | 41 6c 6c 0d 0a 74 72 65 |itted. |All..tre|
|00005d80| 61 74 6d 65 6e 74 73 20 | 77 69 74 68 20 69 6e 74 |atments |with int|
|00005d90| 65 72 6c 65 75 6b 69 6e | 2d 32 20 61 6e 64 20 6c |erleukin|-2 and l|
|00005da0| 79 6d 70 68 6f 6b 69 6e | 65 2d 61 63 74 69 76 61 |ymphokin|e-activa|
|00005db0| 74 65 64 20 6b 69 6c 6c | 65 72 20 63 65 6c 6c 73 |ted kill|er cells|
|00005dc0| 20 77 65 72 65 20 64 6f | 6e 65 20 69 6e 0d 0a 74 | were do|ne in..t|
|00005dd0| 68 65 20 69 6e 74 65 6e | 73 69 76 65 20 63 61 72 |he inten|sive car|
|00005de0| 65 20 75 6e 69 74 2e 0d | 0a 20 20 20 20 20 54 68 |e unit..|. Th|
|00005df0| 65 20 70 61 74 69 65 6e | 74 73 20 72 65 63 65 69 |e patien|ts recei|
|00005e00| 76 65 64 20 61 20 6d 65 | 61 6e 20 6f 66 20 31 32 |ved a me|an of 12|
|00005e10| 2e 39 20 64 6f 73 65 73 | 20 6f 66 20 69 6e 74 65 |.9 doses| of inte|
|00005e20| 72 6c 65 75 6b 69 6e 2d | 32 20 64 75 72 69 6e 67 |rleukin-|2 during|
|00005e30| 20 74 68 65 0d 0a 70 72 | 69 6d 69 6e 67 20 70 68 | the..pr|iming ph|
|00005e40| 61 73 65 2e 20 20 4d 65 | 61 6e 20 6e 75 6d 62 65 |ase. Me|an numbe|
|00005e50| 72 20 6f 66 20 6c 79 6d | 70 68 6f 6b 69 6e 65 2d |r of lym|phokine-|
|00005e60| 61 63 74 69 76 61 74 65 | 64 20 6b 69 6c 6c 65 72 |activate|d killer|
|00005e70| 20 63 65 6c 6c 73 20 72 | 65 69 6e 66 75 73 65 64 | cells r|einfused|
|00005e80| 20 77 61 73 0d 0a 37 2e | 30 20 58 20 31 30 5e 31 | was..7.|0 X 10^1|
|00005e90| 30 2c 20 61 6e 64 20 6d | 65 61 6e 20 6e 75 6d 62 |0, and m|ean numb|
|00005ea0| 65 72 20 6f 66 20 64 6f | 73 65 73 20 6f 66 20 69 |er of do|ses of i|
|00005eb0| 6e 74 65 72 6c 65 75 6b | 69 6e 2d 32 20 61 64 6d |nterleuk|in-2 adm|
|00005ec0| 69 6e 69 73 74 65 72 65 | 64 20 64 75 72 69 6e 67 |inistere|d during|
|00005ed0| 20 74 68 65 0d 0a 66 69 | 6e 61 6c 20 70 68 61 73 | the..fi|nal phas|
|00005ee0| 65 20 77 61 73 20 31 30 | 2e 32 2e 20 20 54 77 6f |e was 10|.2. Two|
|00005ef0| 20 6f 66 20 74 68 65 20 | 33 32 20 65 76 61 6c 75 | of the |32 evalu|
|00005f00| 61 62 6c 65 20 70 61 74 | 69 65 6e 74 73 20 68 61 |able pat|ients ha|
|00005f10| 64 20 63 6f 6d 70 6c 65 | 74 65 20 72 65 73 70 6f |d comple|te respo|
|00005f20| 6e 73 65 73 0d 0a 61 6e | 64 20 33 20 68 61 64 20 |nses..an|d 3 had |
|00005f30| 61 20 67 72 65 61 74 65 | 72 20 74 68 61 6e 20 35 |a greate|r than 5|
|00005f40| 30 25 20 72 65 64 75 63 | 74 69 6f 6e 20 6f 66 20 |0% reduc|tion of |
|00005f50| 61 6c 6c 20 6d 65 61 73 | 75 72 61 62 6c 65 20 74 |all meas|urable t|
|00005f60| 75 6d 6f 72 2c 20 66 6f | 72 20 61 6e 20 6f 76 65 |umor, fo|r an ove|
|00005f70| 72 61 6c 6c 0d 0a 6f 62 | 6a 65 63 74 69 76 65 20 |rall..ob|jective |
|00005f80| 72 65 73 70 6f 6e 73 65 | 20 72 61 74 65 20 6f 66 |response| rate of|
|00005f90| 20 31 36 25 2e 20 20 54 | 68 65 20 63 6f 6d 70 6c | 16%. T|he compl|
|00005fa0| 65 74 65 20 72 65 73 70 | 6f 6e 64 65 72 73 20 72 |ete resp|onders r|
|00005fb0| 65 6d 61 69 6e 65 64 20 | 64 69 73 65 61 73 65 2d |emained |disease-|
|00005fc0| 66 72 65 65 0d 0a 61 74 | 20 31 32 20 61 6e 64 20 |free..at| 12 and |
|00005fd0| 39 20 6d 6f 6e 74 68 73 | 2e 20 20 54 77 6f 20 70 |9 months|. Two p|
|00005fe0| 61 72 74 69 61 6c 20 72 | 65 73 70 6f 6e 64 65 72 |artial r|esponder|
|00005ff0| 73 20 68 61 64 20 6e 6f | 20 74 75 6d 6f 72 20 72 |s had no| tumor r|
|00006000| 65 67 72 6f 77 74 68 20 | 61 74 20 31 36 20 61 6e |egrowth |at 16 an|
|00006010| 64 20 31 35 0d 0a 6d 6f | 6e 74 68 73 2c 20 62 75 |d 15..mo|nths, bu|
|00006020| 74 20 69 6e 20 74 68 65 | 20 74 68 69 72 64 20 70 |t in the| third p|
|00006030| 72 6f 67 72 65 73 73 69 | 76 65 20 64 69 73 65 61 |rogressi|ve disea|
|00006040| 73 65 20 64 65 76 65 6c | 6f 70 65 64 20 61 74 20 |se devel|oped at |
|00006050| 34 20 6d 6f 6e 74 68 73 | 2e 20 54 6f 78 69 63 69 |4 months|. Toxici|
|00006060| 74 79 20 77 61 73 0d 0a | 73 65 76 65 72 65 20 62 |ty was..|severe b|
|00006070| 75 74 20 67 65 6e 65 72 | 61 6c 6c 79 20 77 61 73 |ut gener|ally was|
|00006080| 20 73 65 6c 66 2d 6c 69 | 6d 69 74 65 64 20 61 6e | self-li|mited an|
|00006090| 64 20 6d 61 6e 61 67 65 | 61 62 6c 65 2e 20 20 48 |d manage|able. H|
|000060a0| 79 70 6f 74 65 6e 73 69 | 6f 6e 2c 20 77 65 69 67 |ypotensi|on, weig|
|000060b0| 68 74 20 67 61 69 6e 2c | 0d 0a 61 6e 65 6d 69 61 |ht gain,|..anemia|
|000060c0| 2c 20 65 6c 65 76 61 74 | 69 6f 6e 73 20 6f 66 20 |, elevat|ions of |
|000060d0| 6c 65 76 65 6c 73 20 6f | 66 20 73 65 72 75 6d 20 |levels o|f serum |
|000060e0| 63 72 65 61 74 69 6e 69 | 6e 65 20 61 6e 64 20 6c |creatini|ne and l|
|000060f0| 69 76 65 72 20 65 6e 7a | 79 6d 65 73 20 77 65 72 |iver enz|ymes wer|
|00006100| 65 20 63 6f 6d 6d 6f 6e | 2e 0d 0a 54 77 6f 20 70 |e common|...Two p|
|00006110| 61 74 69 65 6e 74 73 20 | 72 65 71 75 69 72 65 64 |atients |required|
|00006120| 20 69 6e 74 75 62 61 74 | 69 6f 6e 20 61 6e 64 20 | intubat|ion and |
|00006130| 31 20 68 61 64 20 6d 79 | 6f 63 61 72 64 69 61 6c |1 had my|ocardial|
|00006140| 20 69 6e 66 61 72 63 74 | 69 6f 6e 20 64 75 72 69 | infarct|ion duri|
|00006150| 6e 67 0d 0a 74 72 65 61 | 74 6d 65 6e 74 2e 20 20 |ng..trea|tment. |
|00006160| 4e 6f 6e 65 20 6f 66 20 | 74 68 65 20 70 61 74 69 |None of |the pati|
|00006170| 65 6e 74 73 2c 20 68 6f | 77 65 76 65 72 2c 20 64 |ents, ho|wever, d|
|00006180| 69 65 64 20 66 72 6f 6d | 20 74 6f 78 69 63 69 74 |ied from| toxicit|
|00006190| 79 2e 0d 0a 20 20 20 20 | 20 54 68 69 73 20 70 68 |y... | This ph|
|000061a0| 61 73 65 20 49 49 20 74 | 72 69 61 6c 20 63 6f 6e |ase II t|rial con|
|000061b0| 66 69 72 6d 73 20 74 68 | 65 20 61 6e 74 69 74 75 |firms th|e antitu|
|000061c0| 6d 6f 72 20 61 63 74 69 | 76 69 74 79 20 6f 66 20 |mor acti|vity of |
|000061d0| 69 6e 74 65 72 6c 65 75 | 6b 69 6e 2d 32 20 61 6e |interleu|kin-2 an|
|000061e0| 64 0d 0a 6c 79 6d 70 68 | 6f 6b 69 6e 65 2d 61 63 |d..lymph|okine-ac|
|000061f0| 74 69 76 61 74 65 64 20 | 6b 69 6c 6c 65 72 20 63 |tivated |killer c|
|00006200| 65 6c 6c 73 20 69 6e 20 | 74 68 65 20 74 72 65 61 |ells in |the trea|
|00006210| 74 6d 65 6e 74 20 6f 66 | 20 70 61 74 69 65 6e 74 |tment of| patient|
|00006220| 73 20 77 69 74 68 20 6d | 65 74 61 73 74 61 74 69 |s with m|etastati|
|00006230| 63 0d 0a 6f 72 20 75 6e | 72 65 73 65 63 74 61 62 |c..or un|resectab|
|00006240| 6c 65 20 72 65 6e 61 6c | 20 63 65 6c 6c 20 63 61 |le renal| cell ca|
|00006250| 6e 63 65 72 2e 20 20 54 | 68 65 20 6f 62 6a 65 63 |ncer. T|he objec|
|00006260| 74 69 76 65 20 72 65 73 | 70 6f 6e 73 65 20 72 61 |tive res|ponse ra|
|00006270| 74 65 73 20 61 72 65 20 | 63 6f 6d 70 61 72 61 62 |tes are |comparab|
|00006280| 6c 65 0d 0a 6f 72 20 62 | 65 74 74 65 72 20 74 68 |le..or b|etter th|
|00006290| 61 6e 20 74 68 65 20 72 | 61 74 65 73 20 61 63 68 |an the r|ates ach|
|000062a0| 69 65 76 65 64 20 77 69 | 74 68 20 6f 74 68 65 72 |ieved wi|th other|
|000062b0| 20 74 72 65 61 74 6d 65 | 6e 74 2e 0d 0a 0d 0a 50 | treatme|nt.....P|
|000062c0| 6f 73 74 2d 43 6f 6d 6d | 65 6e 74 0d 0a 0d 0a 20 |ost-Comm|ent.... |
|000062d0| 20 20 20 20 54 68 65 20 | 72 65 73 75 6c 74 73 20 | The |results |
|000062e0| 6f 66 20 74 68 69 73 20 | 63 6f 6f 70 65 72 61 74 |of this |cooperat|
|000062f0| 69 76 65 20 73 74 75 64 | 79 20 63 6f 6e 66 69 72 |ive stud|y confir|
|00006300| 6d 20 70 72 65 76 69 6f | 75 73 6c 79 20 72 65 70 |m previo|usly rep|
|00006310| 6f 72 74 65 64 20 72 65 | 73 75 6c 74 73 0d 0a 69 |orted re|sults..i|
|00006320| 6e 20 61 20 6c 61 72 67 | 65 72 20 67 72 6f 75 70 |n a larg|er group|
|00006330| 20 62 79 20 52 6f 73 65 | 6e 62 65 72 67 20 61 6e | by Rose|nberg an|
|00006340| 64 20 61 73 73 6f 63 69 | 61 74 65 73 20 28 31 39 |d associ|ates (19|
|00006350| 38 38 20 59 45 41 52 20 | 42 4f 4f 4b 20 4f 46 20 |88 YEAR |BOOK OF |
|00006360| 55 52 4f 4c 4f 47 59 2c | 20 70 20 34 33 3b 0d 0a |UROLOGY,| p 43;..|
|00006370| 4e 20 45 6e 67 6c 20 4a | 20 4d 65 64 20 33 31 36 |N Engl J| Med 316|
|00006380| 3a 38 38 39 2c 20 31 39 | 38 37 29 2e 20 20 54 68 |:889, 19|87). Th|
|00006390| 65 72 65 20 69 73 20 6e | 6f 20 64 6f 75 62 74 20 |ere is n|o doubt |
|000063a0| 74 68 61 74 20 74 68 69 | 73 20 74 68 65 72 61 70 |that thi|s therap|
|000063b0| 79 20 68 61 73 20 73 6f | 6d 65 0d 0a 61 6e 74 69 |y has so|me..anti|
|000063c0| 74 75 6d 6f 72 20 61 63 | 74 69 76 69 74 79 20 61 |tumor ac|tivity a|
|000063d0| 6c 74 68 6f 75 67 68 20 | 74 68 65 20 73 74 75 64 |lthough |the stud|
|000063e0| 79 20 77 61 73 20 6e 6f | 74 20 63 6f 6e 74 72 6f |y was no|t contro|
|000063f0| 6c 6c 65 64 2e 20 20 50 | 61 74 69 65 6e 74 73 20 |lled. P|atients |
+--------+-------------------------+-------------------------+--------+--------+
Only 25.0 KB of data is shown above.
