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1.
Tech Coloproctol ; 26(6): 479-487, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35305182

RESUMO

BACKGROUND: The aim of this study was to evaluate the safety and efficacy of radiofrequency ablation (RFA) for treating third degree haemorrhoids, with a follow-up over 2 years. METHODS: We conducted a prospective, two-centre study to assess RFA of third-degree haemorrhoids in an outpatient setting. Treatment was performed under local anaesthesia, optionally in combination with sedation. The primary endpoint was analysis of a proctological symptom score ([PSS] bleeding, itching, pain, soiling) and proctological examination to detect recurrence at 1, 6, 12 and 24 months after surgery. The secondary endpoints were postoperative complications, incidence of postoperative pain, including administration of analgesics and time to return to daily routine. RESULTS: Ninety-eight patients were included in the study. The mean age of the patients was 49.1 ± 10.9 (mean ± SD). 83 patients (84.7%) were male and 15 patients (15.3%) were female. The follow-up involved 100% (1 month), 95% (6 months), 86% (12 months) and 74% after 24 months. The individual symptom scores and overall PSS score decreased significantly in comparison to the initial score at each time point assessed. Prolapsed haemorrhoids decreased in comparison to the initial situation (100%) to 7.2% (1 month), 3.5% (6 months), 13.1% (12 months) and 13.7% (after 24 months). Thirteen patients (12.7%) required repeat haemorrhoid therapy during the 2-year follow-up period. The mean maximum pain score after the procedure was 2.5 ± 2.7 (determined with the visual analogue scale), while 33 (33.7%) patients reported having no pain. 59 (60.2%) patients did not take analgesics after the procedure. Eleven patients (11.2%) experienced minor complications (bleeding, fever, cramps, diarrhoea, anal venous thrombosis) but did not require additional treatment. Eight cases (8.2%) of major complications (infection, bleeding, severe pain) required treatment with antibiotics, a second intervention, analgesics or hospitalization. CONCLUSIONS: RFA is safe and effective for treatment of third-degree haemorrhoids. The main advantages of this new method are its use on an outpatient basis under local anaesthesia, a very low level of postoperative pain and significant control of haemorrhoid symptoms over 2 years.


Assuntos
Ablação por Cateter , Hemorroidas , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Feminino , Hemorroidas/complicações , Hemorroidas/cirurgia , Humanos , Masculino , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Recidiva , Resultado do Tratamento
2.
ESMO Open ; 6(4): 100190, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34144271

RESUMO

BACKGROUND: After the advent of new treatment options for advanced hepatocellular carcinoma (HCC), the identification of prognostic factors is crucial for the selection of the most appropriate therapy for each patient. PATIENTS AND METHODS: With the aim to fill this gap, we applied recursive partitioning analysis (RPA) to a cohort of 404 patients treated with lenvatinib. RESULTS: The application of RPA resulted in a classification based on five variables that originated a new prognostic score, the lenvatinib prognostic index (LEP) index, identifying three groups: low risk [patients with prognostic nutritional index (PNI) >43.3 and previous trans-arterial chemoembolization (TACE)]; medium risk [patients with PNI >43.3 but without previous TACE and patients with PNI <43.3, albumin-bilirubin (ALBI) grade 1 and Barcelona Clinic Liver Cancer stage B (BCLC-B)]; high risk [patients with PNI <43.3 and ALBI grade 2 and patients with PNI <43.3, albumin-bilirubin (ALBI) grade 1 and Barcelona Clinic Liver Cancer stage C (BCLC-C)]. Median overall survival was 29.8 months [95% confidence interval (CI) 22.8-29.8 months] in low risk patients (n = 128), 17.0 months (95% CI 15.0-24.0 months) in medium risk (n = 162) and 8.9 months (95% CI 8.0-10.7 months) in high risk (n = 114); low risk hazard ratio (HR) 1 (reference group), medium risk HR 1.95 (95% CI 1.38-2.74), high risk HR 4.84 (95% CI 3.16-7.43); P < 0.0001. The LEP index was validated in a cohort of 127 Italian patients treated with lenvatinib. While the same classification did not show a prognostic value in a cohort of 311 patients treated with sorafenib, we also show a possible predictive role in favor of lenvatinib in the low risk group. CONCLUSIONS: LEP index is a promising, easy-to-use tool that may be used to stratify patients undergoing systemic treatment of advanced HCC.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Carcinoma Hepatocelular/tratamento farmacológico , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Compostos de Fenilureia , Prognóstico , Quinolinas
3.
HIV Med ; 22(5): 397-408, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33421299

RESUMO

OBJECTIVES: Despite its importance as an HIV anatomic sanctuary, little is known about the characteristics of the HIV reservoir in the terminal ileum (TI). In blood, the immune checkpoint inhibitor programmed-death-1 (PD-1) has been linked to the HIV reservoir and T-cell immune dysfunction. We thus evaluated PD-1 expression and cell-associated HIV DNA in memory CD4 T-cell subsets from TI, peripheral blood (PB) and rectum (RE) of untreated and treated HIV-positive patients to identify associations between PD-1 and HIV reservoir in other sites. METHODS: Using mononuclear cells from PB, TI and RE of untreated HIV-positive (N = 6), treated (n = 18) HIV-positive and uninfected individuals (n = 16), we identified and sorted distinct memory CD4 T-cell subsets by flow cytometry, quantified their cell-associated HIV DNA using quantitative PCR and assessed PD-1 expression levels using geometric mean fluorescence intensity. Combined HIV-1 RNA in situ hybridization and immunohistochemistry was performed on ileal biopsy sections. RESULTS: Combined antiretroviral therapy (cART)-treated patients with undetectable HIV RNA and significantly lower levels of HIV DNA in PB showed particularly high PD-1 expression in PB and TI, and high HIV DNA levels in TI, irrespective of clinical characteristics. By contrast, in treatment-naïve patients HIV DNA levels in memory CD4 T-cell subsets were high in PB and TI. CONCLUSION: Elevated PD-1 expression on memory CD4 T-cells in PB and TI despite treatment points to continuous immune dysfunction and underlines the importance of evaluating immunotherapy in reversing HIV latency and T-cell reconstitution. As HIV DNA particularly persists in TI despite cART, investigating samples from TI is crucial in understanding HIV immunopathogenesis.


Assuntos
Infecções por HIV , HIV-1 , Linfócitos T CD4-Positivos , DNA , HIV-1/genética , Humanos , Íleo/metabolismo , Receptor de Morte Celular Programada 1 , Subpopulações de Linfócitos T/metabolismo
4.
J Bone Oncol ; 12: 33-37, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30042924

RESUMO

•Natural history of biliary cancers metastatic to bone•The role of skeletal events in patients with biliary cancer•Biliary cancer and bone metastases: role of bisphosphonates.

7.
Br J Cancer ; 110(9): 2165-9, 2014 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-24714745

RESUMO

BACKGROUND: The role of second-line chemotherapy (CT) is not established in advanced biliary tract cancer (aBTC). We investigated the outcome of aBTC patients treated with second-line CT and devised a prognostic model. METHODS: Baseline clinical and laboratory data of 300 consecutive aBTC patients were collected and association with overall survival (OS) was investigated by multivariable Cox models. RESULTS: The following parameters resulted independently associated with longer OS: Eastern Cooperative Oncology Group performance status of 0 (P<0.001; hazard ratio (HR), 0.348; 95% confidence interval (CI) 0.215-0.562), CA19.9 lower than median (P=0.013; HR, 0.574; 95% CI 0.370-0.891), progression-free survival after first-line CT ≥ 6 months (P=0.027; HR, 0.633; 95% CI 0.422-0.949) and previous surgery on primary tumour (P=0.027; HR, 0.609; 95% CI 0.392-0.945). We grouped the 249 patients with complete data available into three categories according to the number of fulfilled risk factors: median OS times for good-risk (zero to one factors), intermediate-risk (two factors) and poor-risk (three to four factors) groups were 13.1, 6.6 and 3.7 months, respectively (P<0.001). CONCLUSIONS: Easily available clinical and laboratory factors predict prognosis of aBTC patients undergoing second-line CT. This model allows individual patient-risk stratification and may help in treatment decision and trial design.


Assuntos
Neoplasias do Sistema Biliar/tratamento farmacológico , Neoplasias do Sistema Biliar/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Intervalo Livre de Doença , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Recidiva Local de Neoplasia/epidemiologia , Prognóstico , Estudos Retrospectivos
9.
Ann Oncol ; 24(8): 2062-7, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23666916

RESUMO

BACKGROUND: The FOLFOXIRI regimen developed by the Gruppo Oncologico Nord Ovest (GONO) demonstrated higher activity and efficacy compared with FOLFIRI in metastatic colorectal cancer (mCRC). Panitumumab is effective in some patients with KRAS codon 12-13 wild-type mCRC. KRAS codon 61, HRAS, NRAS, and BRAF V600E mutations might predict resistance to anti-epidermal growth factor receptor antibodies. PATIENTS AND METHODS: We conducted a phase II study evaluating the combination of panitumumab (6 mg/kg on day 1) with a slightly modified GONO-FOLFOXIRI (irinotecan 150 mg/m², oxaliplatin 85 mg/m², and folinate 200 mg/m² on day 1, followed by fluorouracil 3000 mg/m² as a 48-h continuous infusion starting on day 1) repeated every 2 weeks as first-line treatment of wild-type KRAS, HRAS, NRAS (codon 12-13-61), and BRAF unresectable mCRC patients. Fluorouracil dose was reduced to 2400 mg/m² after two of the first three patients reported grade 3-4 diarrhoea (in one case with febrile neutropenia). Induction treatment was scheduled for a maximum of 12 cycles, followed by panitumumab ± fluorouracil/folinate maintenance until progression. Primary end point was overall response rate (ORR). RESULTS: Eighty-seven patients were screened and 37 were enrolled. Thirty-three patients achieved an objective response (ORR: 89%; 95% CI 75% to 96%). Sixteen patients (43%) underwent secondary surgery of metastases, and R0 resection was achieved in 13 cases (35%). At a median follow-up of 17.7 months, median progression-free survival was 11.3 months (95% CI 9.7-12.9 months). After amendment, most common grade 3-4 adverse events reported during induction treatment were neutropenia (48%; febrile neutropenia: 5%), diarrhoea (35%), asthenia (27%), stomatitis (14%), and skin toxic effect (14%). One treatment-related death was registered. CONCLUSIONS: Adding panitumumab to FOLFOXIRI is feasible decreasing the dose of fluorouracil and irinotecan to reduce the risk of diarrhoea. Activity and secondary resectability of metastases among Ras-BRAF wild-type patients are promising.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Camptotecina/análogos & derivados , Neoplasias Colorretais/tratamento farmacológico , Metástase Neoplásica/tratamento farmacológico , Adulto , Idoso , Anticorpos Monoclonais/efeitos adversos , Camptotecina/efeitos adversos , Camptotecina/uso terapêutico , Neoplasias Colorretais/cirurgia , Intervalo Livre de Doença , Receptores ErbB/imunologia , Feminino , Fluoruracila/efeitos adversos , Fluoruracila/uso terapêutico , GTP Fosfo-Hidrolases/genética , Humanos , Leucovorina/efeitos adversos , Leucovorina/uso terapêutico , Masculino , Proteínas de Membrana/genética , Pessoa de Meia-Idade , Compostos Organoplatínicos/efeitos adversos , Compostos Organoplatínicos/uso terapêutico , Panitumumabe , Proteínas Proto-Oncogênicas/genética , Proteínas Proto-Oncogênicas B-raf/genética , Proteínas Proto-Oncogênicas p21(ras)/genética , Resultado do Tratamento , Proteínas ras/genética
10.
Zentralbl Chir ; 133(1): 82-5, 2008 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-18278709

RESUMO

Accidentally swallowed dentures can lead to severe complications in the gastrointestinal tract. Therefore, early detection and effective therapeutic management are important. We report on two cases of accidentally swallowed dentures with exceptional clinical courses. In the first case, the patient initially did not notice the swallowed denture for several days. After diagnosis of the impacted foreign body, endoscopy revealed that an interventional removal was not feasible, and thus surgical removal was performed. In the second case, endoscopic retrieval of the ingested denture was also impossible, however, unsuccessful endoscopic extraction induced a large esophageal perforation, leading to an urgent esophagectomy. After a complicated course on the intensive care unit, a reconstruction with a colon interposition was carried out. The two cases highlight the importance of early detection and effective management in cases of swallowed dentures. A controlled surgical removal should be considered early as a safe procedure compared to endoscopic extraction.


Assuntos
Prótese Parcial , Esôfago/cirurgia , Migração de Corpo Estranho/cirurgia , Adulto , Idoso , Perfuração Esofágica/cirurgia , Esofagectomia , Esofagoscopia , Esofagostomia , Esôfago/diagnóstico por imagem , Migração de Corpo Estranho/diagnóstico por imagem , Humanos , Masculino , Radiografia , Reoperação
11.
Z Gastroenterol ; 44(8): 647-50, 2006 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-16902894

RESUMO

The transanal endoscopic microsurgery (TEM) is an adequate method for the local full-thickness excision of large rectum polyps and pT1 "low-risk" rectal carcinomas. We studied prospectively the relevance of this surgical technique concerning complete tumour excision after R1/R2-polypectomy of malignant rectal polyps. 16 patients with pT1 "low-risk" rectal carcinoma and macroscopic (R2) or microscopic (R1) incomplete endoscopic polypectomy were locally resected by TEM. In 12 patients (75 %) no residual tumour was found. In the remaining four cases (25 %), one adenoma with high-grade atypia, two pT1 "low-risk" carcinomas and one tumour infiltration in the mesorectal fat were diagnosed. The patient with the mesorectal infiltration was immediately operated on with radical resection. No further tumour cells were found in this specimen. The median follow-up was 21 months. One patient with a pT1 "low-risk" carcinoma developed a local recurrence and a single hepatic metastasis in the left liver lobe after TEM. Both were completely resected. Currently, all patients are living without evidence of tumour recurrence. Transanal endoscopic microsurgery is a suitable method for the treatment of pT1 "low-risk" rectal carcinomas after incomplete endoscopic polypectomy. In cases of a "high-risk" tumour or deeper tumour infiltration (pT> 1) after TEM radical resection must be carried out.


Assuntos
Pólipos Intestinais/cirurgia , Microcirurgia/métodos , Recidiva Local de Neoplasia/prevenção & controle , Proctoscopia/métodos , Neoplasias Retais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Canal Anal/cirurgia , Feminino , Humanos , Pólipos Intestinais/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Neoplasias Retais/patologia , Medição de Risco/métodos , Fatores de Risco , Resultado do Tratamento
12.
Chirurg ; 75(12): 1210-4, 2004 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-15205747

RESUMO

INTRODUCTION: The standard treatment of esophageal carcinoma is esophagectomy and reconstruction with gastric interposition. In many centers, preoperative colonoscopy is routinely performed in order to exclude any significant colonic pathology. This is important in case of the intraoperative necessity to use a colon interposition due to gastric pathology, anatomical variation, or injury of gastric vascularization. PATIENTS AND METHODS: Two hundred twenty-eight consecutive patients with esophageal carcinoma (adenocarcinoma 102, squamous cell carcinoma 126) who underwent esophagectomy were included in this study. Of them, 171 (75%) had preoperative colonoscopy. Reconstruction was done by gastric tube in 219 and colon interposition in nine. RESULTS: Intraoperative conversion to colon interposition was necessary in none of the 219 patients with intended reconstruction by a gastric conduit. In two of 171 patients (1.2%), preoperative colonoscopy revealed pT1 adenocarcinomas of the colon which were completely removed by endoscopy, and a total of 62 adenomas were histopathologically diagnosed. Fifty-three patients (31%) had endoscopic evidence of asymptomatic diverticulosis. No complications were observed after colonoscopy. CONCLUSION: Preoperative colonoscopy prior to esophagectomy and intended gastric tube formation appears unnecessary from the surgical point of view, as intraoperative conversion to a colon interposition is rare. The rate of colon adenomas or carcinomas was not increased in patients with adeno- or squamous cell carcinoma of the esophagus than in an age-matched, normal population.


Assuntos
Adenocarcinoma/cirurgia , Carcinoma de Células Escamosas/cirurgia , Colo/transplante , Colonoscopia , Neoplasias Esofágicas/cirurgia , Esofagectomia , Estômago/cirurgia , Estruturas Criadas Cirurgicamente , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Adenoma/diagnóstico , Adenoma/patologia , Adenoma/cirurgia , Adulto , Idoso , Anastomose Cirúrgica , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Diverticulose Cólica/diagnóstico , Diverticulose Cólica/patologia , Diverticulose Cólica/cirurgia , Feminino , Seguimentos , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/patologia , Complicações Intraoperatórias/cirurgia , Masculino , Pessoa de Meia-Idade , Reoperação
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