Assuntos
Biópsia por Agulha Fina/métodos , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/secundário , Endossonografia/métodos , Biópsia Guiada por Imagem/métodos , Neoplasias Renais/patologia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/secundário , Idoso , Carcinoma de Células Renais/patologia , Citodiagnóstico/métodos , Feminino , Humanos , Neoplasias Pancreáticas/patologiaAssuntos
Colectomia/efeitos adversos , Doença de Crohn/cirurgia , Drenagem/métodos , Endossonografia/métodos , Mucocele/cirurgia , Doenças Retais/cirurgia , Adulto , Colonoscopia , Diagnóstico Diferencial , Feminino , Humanos , Mucocele/diagnóstico , Mucocele/etiologia , Doenças Retais/diagnóstico , Doenças Retais/etiologia , Tomografia Computadorizada por Raios XRESUMO
Achalasia is a rare primary motility disorder of esophagus; treatments include endoscopic balloon dilatation (EBD) and laparoscopic Heller's cardiomyotomy (LC). This study compared EBD versus LC for treatment of achalasia with focus on quality of life (QoL) and prevalence of post-treatment gastroesophageal reflux disease. This was a retrospective cohort study of all patients diagnosed with achalasia older than 16 treated with either EBD or LC from January 1998 to April 2008. Patients' demographic data, comorbidities, postintervention GERD symptoms, QoL, recurrence of dysphagia, reintervention rate, hospital stay, and time to resumption of diet were collected. Sixty-eight patients were recruited into the study (EBD n= 50; LC n= 18). A significant improvement in QoL was found in patients undergoing LC (0.917 vs. 0.807, P= 0.006). A higher proportion of patients treated with EBD developed post-treatment gastroesophageal reflux symptoms (60.5% vs. 43.8%) when compared with LC, although statistically insignificant (P= 0.34). Patients treated with balloon dilatation had a greater percentage of recurrence of dysphagia (55.1% vs. 26.7%; P= 0.235) and need of reintervention (42.1% vs. 9.1%; P= 0.045). However, these patients had a shorter median hospital stay (1d [range 0-4]) and earlier resumption of diet (0d [range 0-3]). Although EBD is associated with a quicker perioperative recovery, LC accomplished a better QoL, lower incidence of recurrence of dysphagia, and need of reintervention after treatment for achalasia.
Assuntos
Cárdia/cirurgia , Cateterismo/métodos , Transtornos de Deglutição/prevenção & controle , Acalasia Esofágica/cirurgia , Esofagoscopia/métodos , Laparoscopia/métodos , Qualidade de Vida , Adulto , Estudos de Coortes , Dieta , Dilatação/métodos , Acalasia Esofágica/psicologia , Acalasia Esofágica/terapia , Feminino , Seguimentos , Refluxo Gastroesofágico/etiologia , Hospitalização , Humanos , Tempo de Internação , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Recidiva , Retratamento , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: The aim of this study was to report on the 5-year survival outcomes of patients with resectable esophageal carcinoma who were treated by definitive chemoradiotherapy (CRT) or standard esophagectomy. PATIENTS AND METHODS: Between July 2000 and December 2004, 81 patients with resectable squamous cell carcinoma of the mid- or lower thoracic esophagus were randomized to receive esophagectomy or definitive CRT. The primary outcome was the overall survival and secondary outcomes included disease-free survival, morbidities and mortalities. RESULTS: Forty-five patients received esophagectomy and 36 patients were treated by definitive CRT. The overall 5-year survival favors CRT but the difference did not reach statistical significance (surgery 29.4% and CRT 50%, P=0.147). A trend to improved 5-year survival was observed for patients suffering from node-positive disease (P=0.061). The 5-year disease-free survival also showed a trend to significance favoring CRT (P=0.068), particularly for patients suffering from node-positive disease (P=0.017). Both the stage of the disease and albumin level were significant predictors to mortality and disease-free survival. CONCLUSIONS: Definitive CRT for squamous esophageal carcinoma resulted in comparable long-term survival to surgery. Further large-scale studies would be required to further investigate the role of CRT in node-positive patients. Clinicaltrials.gov identifier: NCT01032967.
Assuntos
Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/radioterapia , Análise de Sobrevida , Carcinoma de Células Escamosas/cirurgia , Terapia Combinada , Neoplasias Esofágicas/cirurgia , Humanos , Estudos ProspectivosAssuntos
Colo Transverso , Diarreia/etiologia , Endoscopia Gastrointestinal/instrumentação , Migração de Corpo Estranho/diagnóstico , Gastrostomia/instrumentação , Idoso de 80 Anos ou mais , Migração de Corpo Estranho/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada por Raios XAssuntos
Cistadenocarcinoma Mucinoso/diagnóstico , Neoplasias de Tecido Muscular/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Neoplasias Gástricas/diagnóstico , Endoscopia do Sistema Digestório , Endossonografia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias de Tecido Muscular/patologia , Neoplasias Gástricas/patologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Airway microcirculation is abnormal in asthma but the role of vascular changes in asthma deteriorations remains poorly defined. We prospectively assessed the vascular changes accompanying worsening of asthma control by using an inhaled corticosteroid (ICS) dose-reduction model. OBJECTIVES: To evaluate airway vascularity, vascular permeability and expression of vascular endothelial growth factor (VEGF) in early asthma deterioration induced by ICS back-titration. METHODS: Twenty mild-to-moderate persistent symptomatic asthmatics on low-to-moderate ICS were recruited and treated with 4 weeks of high-dose fluticasone propionate (1000 microg/day) to achieve symptom control. This was followed by dose reduction to half of the pre-study doses for 4-8 weeks until the symptoms began to return. Endobronchial biopsy and bronchoalveolar lavage (BAL) samples were obtained after both treatment periods. RESULTS: Vascularity as measured by the number and size of blood vessels, as well as VEGF expression did not change following ICS reduction. Even on high-dose ICS, perivascular albumin staining and BAL microalbumin levels in asthmatic subjects, as markers of permeability, were elevated when compared with normal subjects and both further increased significantly after ICS reduction. There was a significant association between changes in vascular leakiness and clinical deterioration. Increases in airway albumin correlated with previously reported increases in airway wall infiltration with T lymphocytes. CONCLUSIONS: Our results suggest that airway vascular leakage is a major pathophysiologic feature of early asthma deterioration, occurring before recrudescence of cellular inflammation.
Assuntos
Androstadienos/administração & dosagem , Asma/metabolismo , Asma/patologia , Broncodilatadores/administração & dosagem , Permeabilidade Capilar/efeitos dos fármacos , Adulto , Asma/tratamento farmacológico , Asma/fisiopatologia , Biomarcadores/metabolismo , Líquido da Lavagem Broncoalveolar , Feminino , Fluticasona , Humanos , Inflamação/tratamento farmacológico , Inflamação/metabolismo , Inflamação/patologia , Inflamação/fisiopatologia , Masculino , Pessoa de Meia-Idade , Albumina Sérica/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismoRESUMO
BACKGROUND: The aim of this retrospective review was to assess the clinical outcomes of laparoscopic cholecystectomy for acute cholecystitis since the conclusion of a randomized controlled trial in 1997. METHODS: Records of all patients admitted for acute cholecystitis in whom early laparoscopic cholecystectomy was attempted between July 1997 and December 2004 were reviewed. RESULTS: A total of 209 patients were recruited to this study. Forty-three surgeons performed the procedures. The conversion rate increased significantly in the early period after the trial from 21 per cent to 42 per cent (39 of 92 patients) and decreased significantly to 24 per cent (13 of 54 patients) in the later period. The proportion of operations performed by higher surgical trainees increased significantly from 17 per cent in the early period to 56 per cent in the later period. This increase was associated with a fall in conversion rate without any significant increase in duration of operation or complication rate. CONCLUSION: This study has demonstrated that the results achieved in a randomized trial can be translated into clinical practice by the entire surgical unit. A structured training programme with the inclusion of an experienced surgeon assisting both trainees and specialists should minimize this learning curve.
Assuntos
Colecistectomia Laparoscópica , Colecistite Aguda/cirurgia , Competência Clínica/normas , Educação Médica Continuada/organização & administração , Prática Profissional/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/educação , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Análise de Regressão , Estudos Retrospectivos , Resultado do TratamentoRESUMO
A case of transitional cell carcinoma of the bladder with symptomatic liver metastases is presented. When conventional chemotherapy failed, a lipiodol CT scan demonstrated avid uptake by the tumours, which has implications for targeted cancer therapy.