Incidence and Prognosis of Biliary Tract and Gallbladder Cancers in a Belgian Academic Hospital.

BACKGROUND: Biliary tract and gallbladder cancers are rare tumors with a poor prognosis (except the ampulla type). The evolution of hepatobiliary cancer incidence varies widely around the world. According to the Belgian Cancer Registry, the number of hepatobiliary cancers has increased every year since 2004. MATERIALS AND METHODS: This retrospective study included patients diagnosed with cholangiocarcinoma, ampulla cancer, or gallbladder cancer at the university hospital, CHU UCL, Godinne site, in Namur, Belgium, between 1997 and 2017. The evolution of cancer incidence was evaluated with the Mann-Kendall method, by analyzing 7 consecutive 3-year periods. We calculated survival with the Kaplan-Meier method, and we determined prognostic factors with the log-rank test and Cox models. RESULTS: Between 1997 and 2017, we included 128 patients that were newly diagnosed in our center. According to the Mann-Kendall test, the evolution of the incidence of these cancers in our hospital increased significantly over the study period (Sen's slope = 7; p = 0.003). The 1-year overall survival was 53.0 ± 4.7%. Poor prognostic factors included age, cancer stage, local cancer extension, and metastatic disease. The independent prognostic factors of survival were age (p = 0.002), ampulla cancer (p < 0.001), and metastatic disease (p < 0.001). CONCLUSIONS: We found that the incidence of biliary tract and gallbladder cancers increased over a period of 20 years in our center. Further investigations are needed to determine the reasons for this increase. Although new therapies are emerging, the prognosis remains poor for these cancers. Determining risk factors might promote the development of preventive approaches.

Circulating nucleosomes as new blood-based biomarkers for detection of colorectal cancer.

BACKGROUND: Colonoscopy is currently widely accepted as the gold standard for detection of colorectal cancer (CRC) providing detection of up to 95% of pre-cancerous lesions during the procedure. However, certain limitations exist in most countries including cost and access to the procedure. Moreover, colonoscopy is an invasive technique with risk inherent to the endoscopic procedure. For this reason, alternative screening tests, in particular, fecal occult blood-based tests, have been widely adopted for frontline screening. Limited compliance to colonoscopy and fecal screening approaches has prompted research on blood-based tests as an alternative approach to identifying individuals at risk who could then be referred for colonoscopy. Increased total levels of nucleosomes in the blood have been associated with tumor burden and malignancy progression. Here, we report for the first time, CRC-associated epigenetic profiles of circulating cell-free nucleosomes (cf-nucleosomes). METHODS: Levels of 12 epigenetic cf-nucleosome epitopes were measured in the sera of 58 individuals referred for endoscopic screening for CRC. RESULTS: Multivariate analysis defined an age-adjusted panel of four cf-nucleosomes that provided an AUC of 0.97 for the discrimination of CRC from healthy controls with high sensitivity at early stages (sensitivity of 75 and 86 at 90% specificity for stages I and II, respectively). A second combination of four cf-nucleosome biomarkers provided an AUC of 0.72 for the discrimination of polyps from the healthy group. CONCLUSIONS: This study suggests that a combination of different cf-nucleosome structures analyzed in serum samples by a simple ELISA is a promising approach to identify patients at risk of CRC.

Esophageal abscess complicating endoscopic treatment of refractory gastroesophageal reflux disease by Enteryx injection: a first case report.

Enteryx (Boston Scientific) is an injectable solution containing 8% ethylene vinyl alcohol copolymer dissolved in dimethyl sulfoxide that has been approved for the treatment of gastroesophageal reflux disease (GERD). The technique consists of injecting Enteryx into the lower esophageal sphincter where it solidifies into a sponge-like permanent implant and prevents or reduces gastric acid reflux into the esophagus. The procedure appears to be generally safe, even if minor or moderate adverse events have been observed. We present the case of a 52-yr-old female treated by Enteryx injection for GERD who developed subsequently an esophageal parietal abscess.

Implante palatino orthosystem como ancoragem ortodôntica máxima / Maximum anchorage using orthodontic implant orthosystem

O presente trabalho tem objetivo demosntrar a utilizaçäo de um implante no palato (orthosystem, Institut Straumann, Waldenburg, Suíça), como ancoragem máxima no arco dentário superior, utilizado no tratamento de uma maloclusäo de Classe II Divisäo 1ª de Angle. O paciente está sendo tratado em pesquisa desenvolvida na FOUSP. Nesta oportunidade, descreve-se a primeira etapa clínica do sistema pertinente aos procedimentos cirúrgicos de colocaçäo do implante. O planejamento cirúrgico realiza-se com o auxílio de um modelo de estudo, radiografias e uma moldeira plástica individualizada para cada paciente. O ato cirúrgico, muito simples, consiste na remoçäo de tecido da mucosa do palato, numa extensäo correspondente ao diâmetro do próprio implante (4,2mm). Colocado o implante, aguarda-se aproximadamente três meses para ocorrer a osseointegraçäo; a partir daí, a barra de ancoragem que une os dentes de apoio ao implante poderá ser instalada. A remoçäo do implante é procedida ao término do tratamento utilizando-se de uma broca de explantaçäo

Aspectos biológicos e teciduais dos implantes transmucosos - sistema ITI / Biological and tissular aspects of transgingival implants

A utilizaçäo de implantes de um estágio cirúrgico apresenta inúmeras vantagens. A cicatrizaçäo da mucosa se efetua ao mesmo tempo que a cicatrizaçäo óssea, evitando-se a cirurgia de reabertura. A ausência de interface de uniäo dos "abutments" aprofundada nos tecidos marginais é favorável à saúde periodontal. O acesso a essa uniäo implante-supra-estrutura facilita as etapas clínicas de reabilitaçäo protética e permite acesso à higiene nessa regiäo crítica. Os diferentes estudos clínicos e experimentais demonstram que, com essa técnica transmucosa, obtêm-se resultados a longo prazo muito favoráveis e semelhantes aos obtidos com as técnicas submergidas