RESUMEN
BACKGROUND: Unfractionated and low-molecular-weight heparin are commonly used in the prevention and therapy of a variety of cardiovascular diseases. Because the major side effects of these drugs are hemorrhagic events, very little attention is paid to another important side effect (ie, heparin-induced thrombocytopenia [HIT]). HIT is an immune-mediated transient prothrombotic state with very severe implications determined by thromboembolic phenomena in both the venous and arterial circulation. DATA SOURCES: A PubMed search from 1995 to 2008 was performed. Pertinent literature was identified and other references retrieved from bibliographic citations of the articles identified on PubMed. Articles related to the pathogenesis, clinical picture, diagnosis and treatment of HIT were reviewed. CONCLUSIONS: HIT is a potentially fatal but treatable and largely preventable disease. An increased awareness of the signs and symptoms of the disorder is necessary to prevent its potentially devastating complications.
Asunto(s)
Anticoagulantes/efectos adversos , Heparina/efectos adversos , Trombocitopenia/inducido químicamente , Trombocitopenia/epidemiología , Tromboembolia/prevención & control , Anticoagulantes/uso terapéutico , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Estudios de Seguimiento , Heparina/uso terapéutico , Heparina de Bajo-Peso-Molecular/efectos adversos , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Incidencia , Masculino , Complicaciones Posoperatorias/prevención & control , Medición de Riesgo , Procedimientos Quirúrgicos Operativos/efectos adversos , Procedimientos Quirúrgicos Operativos/métodos , Análisis de Supervivencia , Trombocitopenia/diagnóstico , Tromboembolia/etiologíaRESUMEN
The observation of a number of cases of intestinal carcinoid tumours prompted the authors to review the literature in order to define the principal biological and anatomopathological aspects and the current therapeutic choices. The diagnosis is often obtained on the basis of anatomopathological examination. The kind of surgical treatment is still a matter of controversy: minimal or extended resection? A number of criteria may orient the surgeon towards major surgery, such as tumour size, node involvement, infiltration of the serous membrane, and liver metastases.
Asunto(s)
Tumor Carcinoide , Neoplasias Intestinales , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/terapia , Femenino , Humanos , Neoplasias Intestinales/diagnóstico , Neoplasias Intestinales/terapia , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
AIM: To analyze the prevalence of the two commonest thrombophilic mutations, factor V Leiden and prothrombin G20210A, in patients with gastric cancer. METHODS: One hundred and twenty-one patients with primary gastric carcinoma and 130 healthy subjects, comparable for age and sex, were investigated. Factor V Leiden was detected by using polymerase chain reaction and restriction enzyme digestion, and prothrombin G20210A gene mutation by allele-specific PCR. RESULTS: Among the 121 cancer patients, factor V Leiden was found in 4 cases (GA genotype: 3.3%) and prothrombin G20210A in 10 cases (GA genotype: 8.3%). Of the 130 control subjects, factor V Leiden was detected in 6 cases (GA genotype: 4.6%) and prothrombin G20210A in 8 cases (GA genotype: 6.1%). No double heterozygous carriers of both mutations were found in either group. The prevalence of both factor V Leiden and prothrombin G20210A variant was not statistically different between the cancer patients and the healthy subjects. CONCLUSION: Our study suggests that, in gastric cancer, the risk factors of thrombophilic cancer state are on acquired rather than on a genetic basis and that prothrombin G20210A does not seem to be a cofactor in gastric cancer pathogenesis.
Asunto(s)
Factor V/genética , Protrombina/genética , Neoplasias Gástricas/genética , Anciano , Estudios de Casos y Controles , Análisis Mutacional de ADN , Femenino , Regulación Neoplásica de la Expresión Génica/genética , Frecuencia de los Genes , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Neoplasias Gástricas/complicaciones , Trombofilia/etiología , Trombofilia/genéticaRESUMEN
Gastrointestinal stromal tumours account for fewer than 1% of malignant tumours of the digestive system. Analysing a case referred to us for observation, we review the literature with regard to diagnostic and therapeutic difficulties. A 68-year-old patient was referred to our institute with a diagnosis of "retroperitoneal haematoma". Computerised tomography showed a solid mass with a liquid component, occupying almost the whole of the abdominal cavity. An ultrasonography-guided biopsy examination suggested the presence of a sarcoma. Exploratory laparotomy and the histological examination, which was positive for CD117, CD34 and the smooth muscle marker caldesmon, allowed a diagnosis of gastrointestinal stromal tumour to be made. Thus, no thoroughly reliable and accurate diagnosis of gastrointestinal tumour can be made without surgical exploration and consequent histological and immunohistochemical examinations that still represent the only method capable of confirming or ruling out a diagnosis of gastrointestinal stromal tumour. Such tumours are rare and aggressive and their prognosis is closely related to tumour size and the mitotic index per high power field. Radical resection affords the only possibility of long-term survival.
