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1.
J BUON ; 13(2): 185-91, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18555463

RESUMO

Chest wall reconstructions can be a complex and challenging procedure and may require a multidisciplinary approach. The most common indications for chest wall reconstruction are repair of defects due to tumor resection, infection, radiation necrosis, congenital deformities or trauma. The repair of complex chest wall defects presents a challenging problem for the reconstructive surgeon. Although the majority of such defects can be repaired with the use of local and regional musculocutaneous flaps, more complicated cases require increasingly sophisticated reconstructive techniques. As defects increase in size, microsurgical techniques are necessary to augment blood flow to pedicled flaps or to provide free flap coverage from distant sites. A better understanding of the respiratory mechanics and local anatomy is crucial in managing these complex defects.


Assuntos
Procedimentos de Cirurgia Plástica/métodos , Parede Torácica/cirurgia , Ferimentos e Lesões/cirurgia , Humanos , Retalhos Cirúrgicos , Ferimentos e Lesões/etiologia
2.
Eur J Cancer Care (Engl) ; 11(2): 100-7, 2002 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12099945

RESUMO

The aim of this study was to evaluate the tolerability and the possible clinical benefit of intraoperative hyperthermia combined with multischedule chemotherapy and bypass surgery for the palliative treatment of inoperable pancreatic cancer. Ten patients with unresectable adenocarcinoma of the pancreas received preoperative chemotherapy [5-fluorouracil (5-FU)], bypass surgery and postoperative chemotherapy (5-FU, doxorubicin and cisplatin) plus sandostatin and radiotherapy (45 Gy, 25 fractions, 5 days a week). A single session of intraoperative hyperthermia was performed, by using a waveguide-type applicator (433 MHz). The tumour region was heated to 43-45 degrees C for up to 60 min, while 500 mg 5-FU was infused simultaneously through the gastroduodenal into the splenic artery. Postoperative recovery was uneventful for all patients. A brief instrument was developed for evaluating patients' quality of life. Chemotherapy-related toxicity included myelosuppression, vomiting, alopecia and increase in blood urea nitrogen (BUN), creatinine, SGOT and SGPT. Glucose and amylase determinations remained within normal limits throughout the whole treatment. There was a significant improvement before and 1 month after combined treatment in Eastern Cooperative Oncology Group (ECOG) status (1.8 +/- 0.4), Scott-Huskinsson pain scale (3.2 +/- 0.8) and quality of life score (30.5 +/- 6.7). No progressive disease was noticed and the median overall survival was 11 (SE = 2.4) months. There was also a significant (P = 0.002, Wilcoxon test) decrease in values of both serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA19-9), from 7.6 +/- 1.3 ng/mL and 875.7 +/- 104.8 U/mL to 3.5 +/- 0.7 ng/mL and 65.3 +/- 14.1 U/mL respectively. The first clinical results suggest a potential advantage of using combined intraoperative hyperthermia, chemotherapy and postoperative radiotherapy in the palliative treatment of the adenocarcinoma of the pancreas. The whole procedure seems to be free of perioperative morbidity, while the chemotherapy toxicity was rather moderate. However, the preliminary nature limits the general applicability of our results.


Assuntos
Adenocarcinoma/terapia , Hipertermia Induzida , Cuidados Intraoperatórios , Neoplasias Pancreáticas/terapia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/radioterapia , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Cisplatino/administração & dosagem , Terapia Combinada , Doxorrubicina/administração & dosagem , Feminino , Fluoruracila/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Octreotida/administração & dosagem , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/radioterapia , Neoplasias Pancreáticas/cirurgia
3.
Int J Hyperthermia ; 18(3): 233-52, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12028639

RESUMO

The aim of this study was to evaluate the potential role of intraoperative hyperthermia (IOHT) in the management of stage IV pancreatic adenocarcinoma. Twenty-seven patients (group A) received pre-operative chemotherapy (5-FU), by-pass surgery with intraoperative bolus infusion of 5-FU and post-operatively multi-agent chemotherapy plus sandostatin and external beam irradiation (45Gy, 25 fractions, 5 days a week). In a non-randomized way, 10 patients (group B) received an additional single session of IOHT (43-45 degrees C, 1h) performed directly on the tumour using a waveguide applicator (433MHz) with interstitial measurements of temperature measured. A brief instrument was developed for evaluating patients' quality of life. No progressive disease (PD) was noticed in group B vs 11% (3/27) of PD in group A. There was also a significant increase of overall survival (OS) in group B vs A patients (p = 0.029, log-rank test). Moreover, there was a significant improvement for group B vs A patients regarding Karnofsky performance status (p < 0.001, Mann-Whitney test), pain score (p < 0.001, Mann-Whitney test) and quality of life score (p = 0.031, Mann-Whitney test). A significant correlation was noticed between OS and thermal parameters such as average T(min) (p = 0.043), average T(max) (p = 0.027) and cumulative minutes T(90) >or= 44 degrees C (p < 0.001). Combined IOHT with chemotherapy (pre-, intra- and post-operative) and external beam post-operative radiotherapy seem to have a potential benefit in the management of unresectable adenocarcinoma of the pancreas, concerning local response, OS and quality of life. Further clinical studies to evaluate the benefit of IOHT suggested in this study are warranted.


Assuntos
Adenocarcinoma/terapia , Hipertermia Induzida/métodos , Neoplasias Pancreáticas/terapia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/radioterapia , Adenocarcinoma/cirurgia , Adulto , Idoso , Terapia Combinada , Feminino , Fluoruracila/uso terapêutico , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/radioterapia , Neoplasias Pancreáticas/cirurgia , Qualidade de Vida , Taxa de Sobrevida
4.
J Surg Oncol ; 72(4): 225-9, 1999 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-10589038

RESUMO

BACKGROUND AND OBJECTIVES: Estrogen receptors (ER) and progesterone receptors (PR) have been detected in both normal and malignant colonic mucosa, but the prognostic value of this observation is unknown. We aimed to define the prognostic significance of the presence of ER and PR in malignant cells from colorectal adenocarcinoma specimens. METHODS: An immunohistochemical assay for ER and PR was performed on paraffinized sections from 65 colorectal adenocarcinoma specimens. Survival curves were analyzed to define the prognostic implications of ER and PR. RESULTS: Twenty nine (45%) tumors tested receptor positive (32% for ER and 23% for PR). Tumors of advanced stage were more likely to express receptors than early stage tumors (56% vs. 32%; P = 0.01). Median survival of patients with neoplasms expressing PR was 30 months. For patients whose tumors did not express any receptors, median survival had not been reached at the time of follow-up (P = 0.04). Similarly, patients with tumors expressing both receptors had significantly reduced survival (median survival = 20 months; P = 0.003). CONCLUSIONS: Expression of receptors for sex steroids correlates with advanced stage disease. Expression of PR by the tumor cells is associated with a shorter patient survival. The results suggest that sex steroids may play a role in carcinogenesis and tumor progression.


Assuntos
Adenocarcinoma/metabolismo , Neoplasias Colorretais/metabolismo , Mucosa Intestinal/química , Receptores de Estrogênio/biossíntese , Receptores de Progesterona/biossíntese , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida
5.
Dis Colon Rectum ; 42(1): 66-70, 1999 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-10211522

RESUMO

PURPOSE: Similar to findings obtained for most carcinomas, the pathogenesis of colorectal cancer is considered to be multifactorial. There is strong evidence for an inherited, genetic predisposition to disease in patients with familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer. There is still debate, however, about the contribution of genetic factors to the pathogenesis of sporadic colorectal cancer. The present study was undertaken to search for human leukocyte antigen associations in a group of patients with colorectal cancer and to correlate the findings with both the histology of the disease and family history. SUBJECTS AND METHODS: The allele frequencies of serologically defined human leukocyte antigen class I and II antigens were studied in 101 patients with a recent, histologically confirmed diagnosis of colorectal cancer. All individuals in this study were unrelated to each other. After surgical treatment, all patients were grouped according to the stage (Dukes Stages A, B, C, and D), differentiation (Grades 1, 2, and 3), and the site of the tumor. Patients were also classified with regard to family history for colorectal cancer. The results obtained for human leukocyte antigen frequencies were compared with those of 105 healthy control subjects (control group). RESULTS: An increased frequency of human leukocyte antigen-B18 (27.72 vs. 14.28 percent; P < 0.025; odds ratio = 2.3) and of human leukocyte antigen-DQ5 (43.56 vs. 22.5 percent; P < 0.01; odds ratio = 2.65) was observed for patients with colorectal cancer vs. control subjects, respectively. In addition, human leukocyte antigen-B18 was present with increased frequency (30.76 percent; P < 0.05; odds ratio = 2.66; and 26.67 percent; P < 0.05; odds ratio = 2.18) among patients with rectal and colon carcinoma, respectively. A higher frequency of human leukocyte antigen-DQ5 (45.33 percent; P < 0.01; odds ratio = 2.84) was observed among patients with colon carcinoma. Remarkably, human leukocyte antigen-DQ5 (50 vs. 22.5 percent; P < 0.05; odds ratio = 3.43) and human leukocyte antigen-A1 (41.66 vs. 12.38 percent; P < 0.01; odds ratio = 5.05) were found to be strongly associated with a family history of colorectal cancer. CONCLUSION: The observation of specific human leukocyte antigen associations with particular subsets of colorectal cancer strongly suggests that genetic susceptibility for the development of colorectal cancer exists. Although the multifactorial pathogenesis of colorectal cancer must be considered, human leukocyte antigens may have useful predictive and diagnostic value.


Assuntos
Neoplasias Colorretais/genética , Marcadores Genéticos , Antígenos HLA/análise , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Suscetibilidade a Doenças , Antígenos HLA-A/análise , Antígenos HLA-B/análise , Antígeno HLA-B18 , Antígenos HLA-C/análise , Antígenos HLA-DQ/análise , Antígenos HLA-DR/análise , Humanos , Masculino , Pessoa de Meia-Idade
6.
Gut ; 42(1): 88-91, 1998 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-9505891

RESUMO

BACKGROUND: Human chorionic gonadotropin (hCG) is normally produced and secreted by trophoblastic cells during pregnancy and from gestational trophoblastic neoplasms. It is also detected in ovarian, stomach, and colon adenocarcinomas, as well as in squamous cell carcinoma of the oesophagus. Recently, interest in its role in the pathogenesis of tumours has been enlivened after the presence of beta hCG in the cell membrane of several malignant cells was shown in vitro. AIMS: To investigate the circulating concentrations of beta hCG in patients with exocrine pancreatic adenocarcinoma and to examine its potential prognostic value. PATIENTS: Thirty six patients with exocrine pancreatic adenocarcinoma, 12 patients with chronic pancreatitis, and 21 healthy volunteers were studied. METHODS: beta hCG serum concentrations were detected by the application of a radioimmunoassay technique. RESULTS: Fifteen of 36 patients with pancreatic adenocarcinoma and only one patient with chronic pancreatitis had detectable plasma concentrations of beta hCG (p < 0.01). The patients with circulating serum titres of beta hCG had a worse outcome compared with the group of beta hCG negative patients: the difference was statistically significant (p = 0.01). CONCLUSION: More than 40% of pancreatic exocrine tumours produce beta hCG and its production is correlated with an adverse effect on outcome.


Assuntos
Adenocarcinoma/sangue , Biomarcadores Tumorais/sangue , Gonadotropina Coriônica Humana Subunidade beta/sangue , Neoplasias Pancreáticas/sangue , Adenocarcinoma/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/mortalidade , Pancreatite/sangue , Prognóstico , Taxa de Sobrevida
7.
Hybridoma ; 17(5): 431-5, 1998 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-9873988

RESUMO

To evaluate the presence in serum and the clinical relevance of several antinuclear autoantibodies, we investigated 31 patients with initially diagnosed gastric cancer and 40 age-matched healthy controls. Autoantibodies against ssDNA, dsDNA, cardiolipin, actin, myosin, tropomyosin, GM1, GD1b and GT3 gangliosides, were detected with an enzyme-linked immunoassay (ELISA). Anti-ssDNA, anti-actin, anti-GM1 and anti-GD1b antibodies were detected in the serum of 11 (p = 0.001), 8 (p = 0.02), 11 (p = 0.001), and 9 (p = 0.008) patients with gastric cancer, respectively. There was no significant difference between patients with cancer and the control group, as far as the other autoantibodies were concerned. Most of the patients (90%) had autoantibodies against at least one of the antigens examined. Patients with anti-ssDNA, anti-actin, anti-GM1 and anti-GD1b antibodies were less likely to survive than the patients being negative to the above autoantibodies: the figures are 1 of 11 (9%) compared with 4 of 20 (20%); 1 of 8 (13%) compared with 5 of 23 (22%); 1 of 11 (9%) compared with 4 of 20 (20%); and 1 of 9 (11%) compared with 4 of 22 (18%), respectively. Our findings suggest that 4 of the 9 autoantibodies that we assayed are significantly more likely to be found in serum of patients with gastric cancer, indicating that the immune system has a role in the process of the malignant disease. If our results are confirmed by forthcoming studies, some of the immunological variables that we examined could be used as markers of prognostic value in patients with gastric cancer.


Assuntos
Adenocarcinoma/imunologia , Autoanticorpos/análise , Neoplasias Gástricas/imunologia , Actinas/imunologia , Adenocarcinoma/sangue , Adenocarcinoma/mortalidade , Adulto , Idoso , Cardiolipinas/imunologia , DNA/imunologia , DNA de Cadeia Simples/imunologia , Ensaio de Imunoadsorção Enzimática , Feminino , Gangliosídeos/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Miosinas/imunologia , Prognóstico , Neoplasias Gástricas/sangue , Neoplasias Gástricas/mortalidade , Tropomiosina/imunologia
8.
J Surg Oncol ; 65(4): 242-8, 1997 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-9274788

RESUMO

BACKGROUND AND OBJECTIVES: Cathepsin D (CD), an estrogen-regulated lysosomal protease, has been detected in a variety of tissues. CD expression has been correlated with the invasive potential of breast cancer, acting as an autocrine mitogen or as a protease that degrades the extracellular matrix. The role of CD expression in predicting prognosis or invasive potential in colorectal carcinomas is mostly unknown. METHODS: CD immunohistochemical expression was studied in 60 surgical specimens of colon adenocarcinomas. A three-step avidin biotinylated, horseradish immuno-peroxidase (ABC-HRP) staining technique was performed on 4 microm paraffin-embedded tissue sections with a polyclonal antibody to CD. RESULTS: Carcinoma cells showed positive CD immunostaining in 41.6% of adenocarcinomas (50%, 43.7%, 37.5%, and 25% of Dukes' Stage A, B, C, and D, respectively). Nonneoplastic stromal cells demonstrated positive staining in 68.3% of the adenocarcinoma specimens (37.5%, 62.5%, 91.6%, and 75% of Stage A, B, C, and D, respectively). Patients with colorectal carcinomas exhibiting simultaneously negative and positive CD expression in malignant and stromal cells, respectively, had a worse 5-year overall survival (P < 0.05). The mean 5-year survival of the 16 patients overexpressing CD in nonneoplastic stromal cells (>15% of stromal cells positive for CD) was significantly worse in comparison with the rest of the adenocarcinomas (n = 44) (27.6 +/- 4.6 vs. 46 +/- 2.7 months, respectively, P < 0.01). CONCLUSIONS: Expression of CD immunoreactivity by the stromal cells may be associated with a more invasive phenotype. Therefore, CD expression in tumor and stromal cells may serve as an important indicator of progression and guide postoperative treatment.


Assuntos
Adenocarcinoma/enzimologia , Catepsina D/metabolismo , Neoplasias do Colo/enzimologia , Neoplasias Retais/enzimologia , Adenocarcinoma/mortalidade , Adenocarcinoma/secundário , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Avidina , Neoplasias do Colo/mortalidade , Neoplasias do Colo/patologia , Feminino , Peroxidase do Rábano Silvestre , Humanos , Imuno-Histoquímica , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Neoplasias do Colo Sigmoide/enzimologia , Neoplasias do Colo Sigmoide/mortalidade , Neoplasias do Colo Sigmoide/patologia , Células Estromais/enzimologia , Taxa de Sobrevida
10.
Horm Metab Res ; 29(3): 115-8, 1997 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-9137981

RESUMO

The objective of this study was to evaluate the levels of several pituitary and gonadal hormones in pancreatic adenocarcinoma. We examined circulating levels of LH, FSH, Testosterone, Oestradiol, Progesterone and delta 4-Androstenedione in 36 patients with pancreatic adenocarcinoma, 12 patients with chronic pancreatitis and 87 age matched controls. According to our findings males with pancreatic cancer were found to have higher levels of FSH (p < 0.01). LH and oestradiol (p < 0.001) and lower levels of progesterone (p < 0.01) and testosterone (p < 0.05) than the controls. Female patients with pancreatic cancer were found to have higher levels of oestradiol (p < 0.001) and lower levels of LH, FSH and progesterone (p < 0.001), compared with group of healthy volunteers. Our data provide evidence of a generalised dysfunction of the hypothalamic-hypophysial-gonadal axis in pancreatic cancer patients.


Assuntos
Adenocarcinoma/sangue , Hormônios Esteroides Gonadais/sangue , Neoplasias Pancreáticas/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Androstenodiona/sangue , Estradiol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Hormônio Luteinizante/sangue , Masculino , Pessoa de Meia-Idade , Progesterona/sangue , Testosterona/sangue
11.
Acta Oncol ; 36(1): 65-8, 1997.
Artigo em Inglês | MEDLINE | ID: mdl-9090969

RESUMO

Pancreatic adenocarcinoma (PA) patients often present high serum titres of several autoantibodies including autoantibodies against beta-islet cells and insulin. In the present study we examined with an hemagglutination method the sera of 33 patients with PA for the presence of both anti-mitochondrial and anti-thyroglobulin antithyroid autoantibodies (ATA). Twenty-six surgical patients with other non-malignant gastrointestinal tract (GI) disease (chronic pancreatitis or hernia) and 40 healthy volunteers were used as controls. Eight of the 33 PA patients were found to have ATA autoantibodies, whereas only one patient with chronic pancreatitis and 2 normal individuals had high serum ATA titres. The difference between the PA patients and either of the control groups was statistically significant (p < 0.05). The production of autoantibodies could be attributed to impaired immunoregulation caused by the malignant cells.


Assuntos
Adenocarcinoma/fisiopatologia , Autoanticorpos/sangue , Neoplasias Pancreáticas/fisiopatologia , Glândula Tireoide/fisiopatologia , Adenocarcinoma/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Microssomos/imunologia , Pessoa de Meia-Idade , Neoplasias Pancreáticas/imunologia , Valor Preditivo dos Testes , Prognóstico , Tireoglobulina/imunologia , Testes de Função Tireóidea , Glândula Tireoide/imunologia
12.
J Surg Oncol ; 63(3): 166-71, 1996 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-8944060

RESUMO

BACKGROUND: Evidence exists that estrogens influence the action of epidermal growth factor (EGF) and its receptor (EGF-R) at multiple levels. Estrogen and antiestrogen action on gastric and other gastrointestinal malignancies has been evaluated by several groups with conflicting results, and EGF-R has been implicated in the current growth factor-mediated models for gastric cancer progression. METHODS: ERs and EGF-Rs were detected immunohistochemically in a total of 53 advanced gastric carcinomas using monoclonal antibodies (mAbs) to human ERs and EGF-Rs. RESULTS: ERs were expressed in 30 (56%) and EGF-Rs in 20 (38%) of the gastric tumors. ER(+) gastric tumors were closely associated with the intestinal type (P < 0.01), whereas EGF-R(+) tumors were significantly correlated with poor differentiation status and ER(+) expression (P < 0.01). Of EGF-R(+) tumors, 85% were also ER(+). EGF-R and ER co-expression was demonstrated in 17 tumors (32% of the group). These cases were significantly corelated with poor differentiation and large tumor size upon resection (P < 0.05). CONCLUSIONS: ER and EGF-R co-expression indicates that a functional interaction between estrogens and EGF may exist in gastric cancer and that when such an interaction becomes operative, it may lead to dedifferentiation and increased tumor growth.


Assuntos
Adenocarcinoma/química , Receptores ErbB/análise , Regulação Neoplásica da Expressão Gênica , Receptores de Estrogênio/análise , Neoplasias Gástricas/química , Adenocarcinoma/cirurgia , Adulto , Idoso , Anticorpos Monoclonais , Receptores ErbB/imunologia , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Receptores de Estrogênio/imunologia , Neoplasias Gástricas/cirurgia , Regulação para Cima
13.
Int J Cancer ; 66(5): 624-6, 1996 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-8647623

RESUMO

To evaluate the prevalence of autoantibodies against the b-islet cells (ICA) and the molecule of insulin (IAA) in the serum of patients with pancreatic adenocarcinoma (PA), we examined the sera of 36 newly diagnosed pancreatic adenocarcinoma patients for the presence of these antibodies, using an enzyme-linked immuno-assay method. These results were correlated with survival. Ten patients with insulin-dependent diabetes mellitus (IDDM) and 21 healthy volunteers were evaluated as age-matched controls. Twenty out of 36 (57%) PA patients were found to have detectable ICA autoantibodies and 17 (48%) PA patients had detectable IAA antibodies. Five out of 10 (50%) and 3 out of 10 (30%) IDDM patients had ICA and IAA antibodies, respectively. None of the healthy volunteers was positive for either of the autoantibodies examined. The difference was statistically very significant and the presence of high serum titers of both autoantibodies was associated with a worse outcome for these patients than for those without such autoantibodies. Our data suggest that the high incidence of diabetes mellitus in patients with PA may be attributed to the presence of these autoantibodies. Further clinical studies are needed to establish the above autoantibodies as prognostic markers of pancreatic cancer.


Assuntos
Adenocarcinoma/imunologia , Autoanticorpos/sangue , Diabetes Mellitus Tipo 1/etiologia , Diabetes Mellitus Tipo 1/imunologia , Insulina/imunologia , Ilhotas Pancreáticas/imunologia , Neoplasias Pancreáticas/imunologia , Adenocarcinoma/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 1/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/sangue , Prognóstico
14.
Dis Colon Rectum ; 38(7): 739-45, 1995 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-7607036

RESUMO

PURPOSE: The expression of 70,000-Da heat shock protein (HSP 70) and HLA-DR molecules on cancer cells influences immunologic mechanisms that may be of some prognostic significance. The purpose of this study was to examine the relationship among immunohistochemical HSP 70, HLA-DR expression, and clinicopathologic tumor variables, as well as patient survival in a series of 128 colorectal carcinomas. METHOD: A three-step immunoperoxidase staining technique was undertaken for detection of both markers. RESULTS: Of the examined carcinomas 77.3 percent were HSP 70-positive and 74.2 percent were HLA-DR-positive. Increased HSP 70-positive expression correlated significantly with low differentiation (P < 0.05), showed a tendency to characterize advanced stages of disease, and was clearly associated with worse overall survival (P < 0.05). The highest rate of HLA-DR positivity was demonstrated in early stages and was significantly associated with more favorable prognosis (P < 0.001). HSP 70-positive/HLA-DR-negative patients had worse overall survival compared with the rest (P < 0.001). CONCLUSIONS: The resulting opposite effects on prognosis of examined markers seem to be related to different pathophysiologic functional roles on tumor immunology.


Assuntos
Neoplasias Colorretais/imunologia , Neoplasias Colorretais/mortalidade , Antígenos HLA-DR/análise , Proteínas de Choque Térmico HSP70/análise , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Prognóstico , Taxa de Sobrevida
15.
Horm Metab Res ; 27(6): 275-8, 1995 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-7557838

RESUMO

This study was undertaken to investigate and compare in vitro and in vivo immune parameters between female and male rats. We analysed the T-cell proliferative responses to syngeneic and allogeneic cellular antigens (syngeneic and allogeneic mixed lymphocyte reaction), as well as the IgG levels in the sera of our study groups. It has also been studied the influence of gonadectomy and the effect of testosterone administration pre- and postnatally on the above parameters. Our findings showed that hormonal manipulations, can alter the differences observed in immune response between female and male rats. In addition, it is demonstrated that pre- and postnatal sexual steroid manipulations could provoke long lasting immunological effects.


Assuntos
Animais Recém-Nascidos/imunologia , Sistema Imunitário/efeitos dos fármacos , Efeitos Tardios da Exposição Pré-Natal , Testosterona/farmacologia , Animais , Linfócitos B/efeitos dos fármacos , Linfócitos B/imunologia , Feminino , Imunoglobulina G/análise , Imunoglobulina G/imunologia , Teste de Cultura Mista de Linfócitos , Depleção Linfocítica/efeitos adversos , Macrófagos/efeitos dos fármacos , Macrófagos/imunologia , Masculino , Orquiectomia , Ovariectomia , Gravidez , Ratos , Ratos Wistar
16.
Eur J Surg Oncol ; 21(3): 251-3, 1995 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-7781791

RESUMO

A three-step immunoperoxidase staining technique was used in order to estimate the immunohistochemical expression of K-ras, c-fos, c-myc and c-erbB-2 oncoproteins, in paraffin sections of 20 patients, with histologically proven adenocarcinoma of the pancreas. The two oncogenes that were found to be associated with pancreatic adenocarcinoma were K-ras and c-erbB-2. in 15 patients (75%) and four patients (20%), respectively. Positive immunostaining was intense, cytoplasmic and was noted in a great percentage of cancer cells. The same model of expression was observed in the examined cases of metastatic tissue from liver and lymph node metastases. The expression of myc and fos oncogenes was nuclear, weak and was observed in a small number of patients.


Assuntos
Adenocarcinoma/metabolismo , Proteínas Oncogênicas/análise , Neoplasias Pancreáticas/metabolismo , Proto-Oncogenes , Adenocarcinoma/genética , Adenocarcinoma/cirurgia , Idoso , Sequência de Aminoácidos , Feminino , Expressão Gênica , Genes erbB-2 , Genes fos , Genes myc , Genes ras , Humanos , Técnicas Imunoenzimáticas , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/secundário , Linfonodos/metabolismo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/cirurgia
17.
J Surg Oncol ; 58(3): 176-83, 1995 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-7898114

RESUMO

Estrogen receptors (ERs) have recently been reported to be present in carcinomas of stomach, an organ that has so far been considered as nontarget for sex hormones. Cathepsin D is an estrogen-regulated lysosomal protease that has been overexpressed in breast cancer. ER and cathepsin D immunohistochemical expression were studied in this research in order to estimate their association to known histopathological and clinical parameters and their possible prognostic significance as well. Sixty-two patients with gastric adenocarcinomas were included in this study. The cancers were studied immunohistochemically concerning ER positivity in tumor cell nuclei and cathepsin D cytoplasmic expression. Nuclear ER staining was detected in tumor cells of 25% of male and 27% of female patients. ER positivity was demonstrated mainly in the well and moderately differentiated carcinomas; 87.5% of ER(+) tumors were also characterized as cathepsin D positive and a significant correlation between ER and cathepsin D positive expression was demonstrated (P < 0.05). Cytoplasmic cathepsin D expression was observed in carcinomatous cells of 70.9% of gastric tumors. Early tumor stage and good differentiation were significantly associated with increased cathepsin D expression (P < 0.05, P < 0.001). Histologic type, degree of differentiation and tumor stage were significantly correlated to survival (P < 0.05, P < 0.001 and P < 0.001). The patients who were cathepsin D(+) had a significant prognostic advantage over the cathepsin D(-) patients (P < 0.001). The presence of ER and estrogen-regulated cathepsin D indicates the involvement of sex hormonal factors in these tumors and cathepsin D positive expression in tumor cells seems to be related to better prognosis. Their biological, clinical, and prognostic roles remain to be further elucidated.


Assuntos
Adenocarcinoma/química , Biomarcadores Tumorais/análise , Catepsina D/análise , Receptores de Estrogênio/análise , Neoplasias Gástricas/química , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalos de Confiança , Citoplasma/química , Citoplasma/patologia , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Taxa de Sobrevida
18.
Mt Sinai J Med ; 62(1): 71-6, 1995 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-7739590

RESUMO

In the 11 years 1980 through 1990, we performed a total of 273 operations for hydatid disease of the liver in 252 patients, including 35 patients who were over the age of 75 years. Cysts were multiple in 24.6%, calcified in 17.9%, and ruptured to adjacent viscera in 12.3% of cases. Ruptured cysts were small as well as large. Coexisting gallstone disease was found in 14.3% of cases. Reoperations for recurrence were performed in 6.4% of cases. We believe that once the diagnosis is made, the treatment should be surgical, without regard to cyst size, the age of the patient, or the presence or absence of symptoms. Total pericystectomy, which eradicates the parasitic disease and thus minimizes the risk of recurrence, is the procedure of choice (17.3% in this series). When total pericystectomy is not feasible and the cysts are large and deeply placed, subtotal pericystectomy, in which only a small piece of the cystic wall is preserved, is a successful alternative (12.5% in this series). For complicated cysts, external drainage of the cystic cavity is necessary despite the known morbidity this procedure entails. In patients in this series undergoing external drainage, infection of the residual cavity and postoperative biliary fistula were the main causes of morbidity.


Assuntos
Equinococose Hepática/cirurgia , Hepatectomia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colelitíase/diagnóstico , Colelitíase/cirurgia , Diagnóstico por Imagem , Drenagem , Equinococose Hepática/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Recidiva , Reoperação , Ruptura Espontânea , Resultado do Tratamento
19.
Hepatogastroenterology ; 41(6): 542-5, 1994 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-7721240

RESUMO

This study was undertaken to evaluate the incidence and severity of postoperative alkaline reflux gastritis in 798 symptomatic duodenal ulcer patients who had undergone vagotomy. The condition was identified on the basis of the unique endoscopic and histological findings in 116 (14.5%) of them. It was more frequent and severe in patients with truncal vagotomy and gastrojejunostomy than in those with truncal vagotomy and pyloroplasty, while it was not at all observed in cases with proximal gastric vago-tomy, the symptoms depended on the preoperative history of the ulcer disease and the patient's age at the time of surgery, but did not always correspond with the degree of histological findings. The location of the gastrojejunostomy and the size of the pyloroplasty stoma had an influence on the incidence of the syndrome. Helicobacter pylori was found more frequently in biopsy specimens from patients with severe symptoms (30.3%), but was present in only 14.6% of the total number of the patients with postoperative alkaline reflux gastritis after vagotomy.


Assuntos
Úlcera Duodenal/cirurgia , Refluxo Duodenogástrico/etiologia , Gastrite/etiologia , Vagotomia Troncular/efeitos adversos , Adulto , Fatores Etários , Idoso , Álcalis/metabolismo , Refluxo Duodenogástrico/diagnóstico , Refluxo Duodenogástrico/metabolismo , Refluxo Duodenogástrico/microbiologia , Endoscopia Gastrointestinal , Feminino , Gastrite/diagnóstico , Gastrite/metabolismo , Gastrite/microbiologia , Gastrostomia , Infecções por Helicobacter , Helicobacter pylori , Humanos , Jejunostomia , Masculino , Pessoa de Meia-Idade , Piloro/cirurgia , Índice de Gravidade de Doença , Vagotomia Gástrica Proximal
20.
Dis Colon Rectum ; 37(11): 1083-9, 1994 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-7956574

RESUMO

PURPOSE: Proliferating cell nuclear antigen immunohistochemical expression and flow cytometry techniques were used in this study to estimate the proliferation tendency and biologic aggressiveness in benign and malignant epithelial tumors of the colon and rectum. METHODS: Thirty-five adenomas and 60 adenocarcinomas were studied immunohistochemically concerning proliferating cell nuclear antigen positivity in tumor cell nuclei. In addition, flow cytometry techniques were used to estimate the DNA content and percentage of tumor cells in the S-phase. RESULTS: The mean proliferating cell nuclear antigen score for adenomas was 38 percent compared with a mean score of 50.4 percent for adenocarcinomas that were studied (P < 0.05). In dysplastic areas of malignantly transformed adenomas (n = 5), the highest proliferating cell nuclear antigen score (80 percent) was focally observed. Taking flow cytometry parameters into account, we found out that proliferating cell nuclear antigen can be used as an indirect indicator of the number of cells in the S-phase (SPF) but not as an independent prognostic factor. Statistical significance was found between Type III (aneuploid carcinomas) and increased proliferating cell nuclear antigen expression (proliferating cell nuclear antigen score > or = 60 percent). Furthermore, aneuploidy was especially found on cancer located on the left colon (44 percent vs. 14 percent of right colon neoplasms). Considering DNA ploidy of the above neoplasms, the aneuploid adenocarcinomas had a tendency for poorer prognosis especially if they were related to Dukes Stage C female patients. CONCLUSIONS: The comparative assessment of the above parameters might be of considerable importance in the study of the proliferation activity of any form of colorectal neoplasia.


Assuntos
Adenocarcinoma/genética , Adenoma/genética , Neoplasias Colorretais/genética , DNA de Neoplasias/análise , Citometria de Fluxo , Regulação Neoplásica da Expressão Gênica , Imuno-Histoquímica , Antígeno Nuclear de Célula em Proliferação/biossíntese , Adenocarcinoma/diagnóstico , Adenocarcinoma/epidemiologia , Adenoma/diagnóstico , Adenoma/epidemiologia , Idoso , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Índice Mitótico , Estadiamento de Neoplasias , Ploidias , Prognóstico , Antígeno Nuclear de Célula em Proliferação/análise , Fase S
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