RESUMO
BACKGROUND: The development of high-resolution anoscopy (HRA) has advanced our ability to detect anal dysplasia. Historically, HRA is performed in a clinical setting and subsequent ablation is performed in the clinical setting or operating room. The aim of this study was to determine the most effective venue for the performance of HRA. METHODS: Following institutional review board (IRB) approval, the correlation between anal cytology and HRA performed in the clinic versus in the operating room was evaluated. Data were extracted from our IRB-approved prospective HRA database over the time period of 2013-2017. RESULTS: One hundred twenty-eight HRAs were compared (101 in the clinical setting, 27 in the operating room). There was a statistically significant difference in the correlation between anal cytology and HRA pathology for procedures performed in the clinical setting (55% [56/101]) versus those performed in the operating room (82% [22/27]) (p = 0.014). More biopsies were obtained in the operating room than in the clinic setting (3 vs. 1, p < 0.0001). The majority of patients who had HRA in a clinical setting with subsequent HRA in the operating room stated that they preferred to have their HRAs performed in the operating room due to discomfort from the HRA procedure. CONCLUSIONS: Detection rates for anal dysplasia on HRA, are significantly higher when performed in the operating room. To prevent discomfort in the clinical setting, patients with high-grade dysplasia on anal pap testing may benefit from proceeding directly to the operating room for concurrent HRA and ablation.
Assuntos
Neoplasias do Ânus , Salas Cirúrgicas , Canal Anal/cirurgia , Neoplasias do Ânus/cirurgia , Humanos , Proctoscopia , Estudos ProspectivosRESUMO
AIM: The objective was to assess the effect of three different surgical treatments for T1 rectal tumours, radical resection (RR), open local excision (open LE) and laparoscopic local excision (laparoscopic LE), on overall survival (OS). METHODS: Adults from the National Cancer Database (2008-2016) with a diagnosis of T1 rectal cancer were stratified by treatment type (LE vs RR). We assumed that laparoscopic LE equates to transanal minimally invasive surgery (TAMIS) or transanal endoscopic microsurgery. The primary outcome was 5-year OS. Subgroup analyses of the LE group stratified by time period [2008-2010 (before TAMIS) vs 2011-2016 (after TAMIS)] and approach (laparoscopic vs open) were performed. RESULTS: Among 10 053 patients, 6623 (65.88%) underwent LE (74.33% laparoscopic LE vs 25.67% open LE) and 3430 (34.12%) RR. The use of LE increased from 52.69% in 2008 to 69.47% in 2016, whereas RR decreased (P < 0.001). In unadjusted analysis, there was no significant difference in 5-year OS between the LE and RR groups (P = 0.639) and between the two LE time periods (P = 0.509), which was consistent with the adjusted analysis (LE vs RR, hazard ratio 1.05, 95% CI 0.92-1.20, P = 0.468; 2008-2010 LE vs 2011-2016 LE, hazard ratio 1.09, 95% CI 0.92-1.29, P = 0.321). Laparoscopic LE was associated with improved OS in the unadjusted analysis only (P = 0.006), compared to the open LE group (hazard ratio 0.94, 95% CI 0.78-1.12, P = 0.495). CONCLUSIONS: This study supports the use of a LE approach for T1 rectal tumours as a strategy to reduce surgical morbidity without compromising survival.
Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Laparoscopia , Neoplasias Retais , Microcirurgia Endoscópica Transanal , Cirurgia Endoscópica Transanal , Adulto , Humanos , Neoplasias Retais/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: The predictors of intra-operative PTH (IOPTH) decline during minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism have been but poorly studied. MATERIALS AND METHODS: This retrospective study included 108 patients who underwent MIP for a single adenoma. Serum calcium and phosphorus were measured before surgery and 1 day post-operatively. IOPTH was measured before (intra-operative preincision or PTHt0) and 10 min after removal of the adenoma (PTHt10). The Modification of Diet in Renal Disease (MDRD) equation was used to estimate the glomerular filtration rate. The weight of the adenoma was assessed in all the subjects. RESULTS: The sex ratio female/male was 5.37 with a mean age of 57.3 yr. The mean pre- and postoperative values were for calcium 2.80 and 2.19 mmol/l, respectively (p<0.0001) and for phosphorus 0.90 and 1.16 mmol/l, respectively (p<0.0001). The PTH dropped from a mean value of 184.8 to 50.8 pg/ml 10 min after adenoma resection with a mean drop of 69.7%. Thirteen patients (12%) did not achieve a PTH fall of more than 50%. In a bivariate analysis, age, an MDRD<60 ml/min and weight of adenoma were inversely associated with IOPTH fall (p=0.009, p=0.004, and p<0.001, respectively) while gender, body mass index, hypertension, diabetes, pre-operative phosphorus and calcium had no significant effects. In the multivariate analysis, age, weight of adenoma, and MDRD were still independent negative predictors of the IOPTH fall (p=0.01, p=0.018, and p<0.001, respectively). CONCLUSION: Our results suggest that during MIP the presence of a parathyroid adenoma with a high weight, in an elderly subject or in a subject with altered renal function, will result in a lesser degree of IOPTH fall.
Assuntos
Adenoma/cirurgia , Monitorização Intraoperatória , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/cirurgia , Paratireoidectomia/métodos , Adenoma/sangue , Adenoma/patologia , Idoso , Cálcio/sangue , Feminino , Humanos , Hiperparatireoidismo Primário/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Neoplasias das Paratireoides/sangue , Neoplasias das Paratireoides/patologia , Fósforo/sangue , Estudos RetrospectivosAssuntos
Terapia de Reposição de Estrogênios/efeitos adversos , Hipertensão/induzido quimicamente , Congêneres da Progesterona/efeitos adversos , Ensaios Clínicos como Assunto , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/fisiopatologia , Feminino , Humanos , Hipertensão/fisiopatologia , Pós-Menopausa/efeitos dos fármacos , Pós-Menopausa/fisiologia , Congêneres da Progesterona/administração & dosagem , Fatores de RiscoRESUMO
The association between pregnancy and Cushing syndrome is extremely rare. The diagnosis of Cushing syndrome during pregnancy is rendered difficult by hyperoestrogenic state that alters many of the classical tests. An early and precise diagnosis with adequate management will allow us to reduce maternal and fetal risks.
Assuntos
Síndrome de Cushing/complicações , Complicações na Gravidez , Adulto , Feminino , Humanos , GravidezAssuntos
Gravidez em Diabéticas/complicações , Gravidez em Diabéticas/prevenção & controle , Anormalidades Congênitas/etiologia , Parto Obstétrico/métodos , Feminino , Morte Fetal/etiologia , Retardo do Crescimento Fetal/etiologia , Macrossomia Fetal/etiologia , Monitorização Fetal , Aconselhamento Genético , Humanos , Trabalho de Parto Prematuro/etiologia , Obstetrícia/métodos , GravidezAssuntos
Diabetes Mellitus Tipo 1/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Gestacional/metabolismo , Gravidez em Diabéticas/metabolismo , Adulto , Peso ao Nascer , Anormalidades Congênitas/etiologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Diabetes Gestacional/diagnóstico , Nefropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/diagnóstico , Retinopatia Diabética/diagnóstico , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/etiologia , Gravidez , Gravidez em Diabéticas/diagnóstico , Fatores de RiscoAssuntos
Abscesso/microbiologia , Doenças Mamárias/microbiologia , Brucella melitensis/virologia , Brucelose/complicações , Tipagem de Bacteriófagos , Brucella melitensis/classificação , Brucella melitensis/isolamento & purificação , Feminino , Humanos , Pessoa de Meia-Idade , Emirados Árabes UnidosRESUMO
TSH receptor antibodies (TRAb) was performed by binding assay in seventy-seven patients (47 with Graves disease, 32 with other thyroid abnormalities). The sensitivity and specificity of our assay were respectively 81% and 96.5%. These results were similar to the results found in medical literature. The association of ophthalmopathy with Graves disease does not increase the sensitivity of the test. In this study we conclude that TRAb assay is of great interest in confirming the diagnosis and in the following of Graves disease.
Assuntos
Autoanticorpos/análise , Doença de Graves/diagnóstico , Receptores da Tireotropina/imunologia , Adolescente , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Doença de Graves/imunologia , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Kit de Reagentes para Diagnóstico , Sensibilidade e EspecificidadeAssuntos
Aneurisma Roto/diagnóstico por imagem , Artéria Femoral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/patologia , Aneurisma Roto/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Arteriosclerose/patologia , Calcinose/patologia , Artéria Femoral/patologia , Artéria Femoral/cirurgia , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Masculino , Ultrassonografia Doppler DuplaRESUMO
Primary hyperparathyroidism is a more frequently recognized entity. The clinical picture historically severe, has changed overtime. We present herein our experience relating 28 cases with emphasis of our results compared to the medical literature.