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1.
Tech Coloproctol ; 28(1): 74, 2024 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-38926191

RESUMO

BACKGROUND: Large tissue defects following pelvic exenteration (PE) fill with fluid and small bowel, leading to the empty pelvis syndrome (EPS). EPS causes a constellation of complications including pelvic sepsis and reduced quality of life. EPS remains poorly defined and cannot be objectively measured. Pathophysiology of EPS is multifactorial, with increased pelvic dead space potentially important. This study aims to describe methodology to objectively measure volumetric changes relating to EPS. METHODS: The true pelvis is defined by the pelvic inlet and outlet. Within the true pelvis there is physiological pelvic dead space (PDS) between the peritoneal reflection and the inlet. This dead space is increased following PE and is defined as the exenteration pelvic dead space (EPD). EPD may be reduced with pelvic filling and the volume of filling is defined as the pelvic filling volume (PFV). PDS, EPD, and PFV were measured intraoperatively using a bladder syringe, and Archimedes' water displacement principle. RESULTS: A patient undergoing total infralevator PE had a PDS of 50 ml. A rectus flap rendered the pelvic outlet watertight. EPD was then measured as 540 ml. Therefore there was a 10.8-fold increase in true pelvis dead space. An omentoplasty was placed into the EPD, displacing 130 ml; therefore, PFV as a percentage of EPD was 24.1%. CONCLUSIONS: This is the first reported quantitative assessment of pathophysiological volumetric changes of pelvic dead space; these measurements may correlate to severity of EPS. PDS, EPD, and PFV should be amendable to assessment based on perioperative cross-sectional imaging, allowing for potential prediction of EPS-related outcomes.


Assuntos
Exenteração Pélvica , Pelve , Humanos , Exenteração Pélvica/efeitos adversos , Exenteração Pélvica/métodos , Feminino , Complicações Pós-Operatórias/etiologia , Síndrome , Pessoa de Meia-Idade , Omento/cirurgia
2.
Rev. colomb. cir ; 39(1): 85-93, 20240102. tab, fig
Artigo em Espanhol | LILACS | ID: biblio-1526823

RESUMO

Introduction. Perforated peptic ulcer remains one of the critical abdominal conditions that requires early surgical intervention. Leakage after omental patch repair represents one of the devastating complications that increase morbidity and mortality. Our study aimed to assess risk factors and early predictors for incidence of leakage. Methods. Retrospective analysis of data of the patients who underwent omental patch repair for perforated peptic ulcer in the period between January 2019 and January 2022 in Mansoura University Hospital, Egypt. Pre, intra and postoperative variables were collected and statistically analyzed. Incriminated risk factors for leakage incidence were analyzed using univariate and multivariate analysis. Results. This study included 123 patients who met inclusion criteria. Leakage was detected in seven (5.7%) patients. Although associated comorbidities (p=0.01), postoperative intensive care unit admission (p=0.03), and postoperative hypotension (p=0.02) were significant risk factors in univariate analysis, septic shock (p=0.001), delayed intervention (p=0.04), preoperative hypoalbuminemia (p=0.017), and perforation size >5mm (p= 0.04) were found as independent risk factors for leakage upon multivariate analysis. Conclusion. Delayed presentation in septic shock, preoperative hypoalbuminemia, prolonged perforation, operation interval, and large perforation size > 5mm were detected as independent risk factors for leakage. Postoperative tachypnea and tachycardia with increased levels of C-reactive protein and total leucocytic count are alarming signs for incidence of leakage


Introducción. La úlcera péptica perforada es una de las afecciones abdominales críticas que requiere una intervención quirúrgica temprana. La fuga después de la reparación con parche de epiplón representa una de las complicaciones más devastadoras, que aumentan la morbilidad y la mortalidad. Nuestro estudio tuvo como objetivo evaluar los factores de riesgo y los predictores tempranos de fugas. Métodos. Análisis retrospectivo de los datos de los pacientes sometidos a reparación con parche de epiplón por úlcera péptica perforada, en el período comprendido entre enero de 2019 y enero de 2022, en el Hospital Universitario de Mansoura, Egipto. Se recogieron y analizaron estadísticamente variables pre, intra y postoperatorias. Los factores de riesgo asociados a la incidencia de fugas se analizaron mediante análisis univariado y multivariado. Resultados. Este estudio incluyó 123 pacientes que cumplieron con los criterios de inclusión. Se detectó fuga en siete (5,7 %) pacientes. Aunque las comorbilidades asociadas (p=0,01), el ingreso postoperatorio a la unidad de cuidados intensivos (p=0,03) y la hipotensión postoperatoria (p=0,02) fueron factores de riesgo en el análisis univariado, el shock séptico (p=0,001), el retraso en la intervención (p=0,04), la hipoalbuminemia preoperatoria (p=0,017) y el tamaño de la perforación mayor de 5 mm (p=0,04) se encontraron como factores de riesgo de fuga independientes en el análisis multivariado. Conclusión. Se detectaron como factores de riesgo independientes de fuga la presentación tardía en shock séptico, la hipoalbuminemia preoperatoria, la perforación prolongada, el intervalo operatorio y el tamaño de la perforación mayor de 5 mm. La taquipnea posoperatoria y la taquicardia con niveles elevados de proteína C reactiva y recuento leucocitario total son signos de alarma sobre la presencia de fuga.


Assuntos
Humanos , Úlcera Péptica Perfurada , Complicações Pós-Operatórias , Omento , Fatores de Risco
3.
Clin Transl Sci ; 16(7): 1121-1126, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37073441

RESUMO

Recently, the field of regenerative medicine has made great strides in the development of new treatments for various organ dysfunctions. One of the most promising new approaches is the use of three-dimensional (3D) printing and autologous tissues. In this study, we evaluated the safety of a 3D-printed autologous omentum patch to kidneys using large animals. A total of seven micropigs underwent transplantation of the 3D-printed autologous omentum patch. Twelve weeks after transplantation, the safety was evaluated by measuring body weight, blood, and the renal resistive index. In addition, biopsy samples were histologically analyzed. The results showed no surgical complications, renal functional hematological changes, or inflammatory responses. Therefore, this study provides important insights into direct therapy to kidneys with a 3D-printed patch made of autologous tissue. Furthermore, it has the potential for the development of new therapies for various organ dysfunction.


Assuntos
Rim , Omento , Animais , Omento/cirurgia , Rim/diagnóstico por imagem , Rim/cirurgia , Impressão Tridimensional , Medicina Regenerativa
4.
Diagn Cytopathol ; 50(2): 57-63, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34870898

RESUMO

BACKGROUND: The aim of this study is to assess the efficacy of cytology in omental or peritoneal lesions. METHODS: A retrospective review of the pathology database for cytology cases of peritoneal or omental nodules over a 3-year period (2016-2018) was conducted. The cases consisted of either FNA only (FO); FNA and Core biopsy (FCB) or Touch prep and core biopsy (TCB). Cases were further divided based on the prior history of carcinoma. Concordance rates of cytologic diagnosis with histologic diagnosis were studied. RESULTS: Out of 104 cytology cases reviewed, 60 (57.7%) had prior history of cancer (PHC) and 44 (42.3%) had no prior history of cancer (NPHC). Of the cases with PHC, 43(71.66%) were recurrence, 10 (16.66%) were second cancer, and 7 (11.66%) were non-neoplastic lesions. Of the cases with NPHC, 38 (86.4%) had a second cancer diagnosis, while 6 (13.6%) were non-neoplastic. For FO only cases, 11 of 35 (31.4%) had follow up and 9 of 11 (81.8%) were concordant. For FCB cases, 6 out of 39 (15.4%) had follow up and 6 (100%) were concordant. For TCB cases, 9 out of 30 (30%) had follow up and 9 (100%) were concordant. A definite diagnosis was reached in 30/35, 39/39, and 29/30 cases in FO, FCB, and TCB, respectively. CONCLUSION: In summary, cytologic evaluation of omental lesions is an effective tool in providing accurate diagnosis and guiding further management. Also, the results based on our study show that the combined techniques are superior at reaching a definitive diagnosis.


Assuntos
Técnicas Citológicas , Atenção à Saúde , Omento/patologia , Neoplasias Peritoneais/patologia , Biópsia por Agulha Fina , Seguimentos , Humanos , Omento/cirurgia , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/cirurgia
5.
Vet Surg ; 50(6): 1267-1275, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33929768

RESUMO

OBJECTIVE: To report the use of nylon cable ties (NCT) for omentectomy in the horse. STUDY DESIGN: Experimental study. ANIMALS: Eight healthy adult horses. METHODS: Horses underwent nylon cable tie (NCT) ligation of the greater omentum after ventral midline celiotomy. The time required to complete the omentectomy was recorded. Horses were recovered for 14 days before repeat celiotomy, adhesions assessment, and histological examination of the omentectomy site using a proposed histologic grading scheme. The total time for omentectomy procedure and histologic score was assessed for normality. Data are expressed as mean ± standard deviation. RESULTS: NCT ligation provided sufficient hemostasis to complete the omentectomy (28 ± 15 s), without rescue ligation. No gross evidence of intra-abdominal adhesion or morbidity was associated with the omentectomy site 14 days after surgery. NCT were intact at the site of application, covered with smooth fibrous connective tissue. Adiponecrosis with minimal inflammation and fibrovascular occlusion of omental vessels was present at the surgical site. Mild inflammation was present at the NCT-tissue interface. CONCLUSION: The use of NCT resulted in fast and effective omentectomy in healthy horses without short-term evidence of inflammatory reaction or intra-abdominal adhesion. CLINICAL SIGNIFICANCE: The described technique provides an alternative for omentectomy in healthy adult horses.


Assuntos
Doenças dos Cavalos , Nylons , Omento , Aderências Teciduais , Abdome , Animais , Doenças dos Cavalos/cirurgia , Cavalos/cirurgia , Omento/cirurgia , Aderências Teciduais/veterinária
6.
Int J Colorectal Dis ; 34(11): 1963-1970, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31686200

RESUMO

PURPOSE: This study was designed to examine the impact of an omentoplasty and its quality on pelviperineal morbidity after abdominoperineal resection (APR) for rectal cancer. METHODS: This was a retrospective single-centre study of consecutive patients undergoing APR for primary or recurrent rectal cancer between 2000 and 2018. Quality of omentoplasty was categorised (sufficient vs insufficient) based on postoperative CT scans. Main study endpoints were perineal wound healing and perineal hernia. RESULTS: This study included 100 patients: 16 with a sufficient omentoplasty, 16 with an insufficient omentoplasty, and 68 without omentoplasty. Rate of pelviperineal complications within 30 days was 44%, 69% and 64% (P = 0.283), and delayed wound healing at 3 months was 19%, 54% and 27%, respectively (P = 0.109). Sufficient omentoplasty was not significantly associated with less delayed healing in multivariable analysis (OR 0.597; 95% CI 0.149-2.397). An insufficient omentoplasty demonstrated significantly higher rates of delayed healing at 6 months (46% vs 14%; P = 0.016) and chronic perineal sinus at 12 months (31% vs 3%; P = 0.008) compared with no omentoplasty. CONCLUSION: This relatively small series suggest that even a sufficient omentoplasty, as determined by postoperative imaging, does not reduce pelviperineal morbidity after APR for rectal cancer. The methodology of CT-based assessment of an omentoplasty as well as the correlation with postoperative outcomes has to be validated in future studies.


Assuntos
Omento/diagnóstico por imagem , Omento/cirurgia , Períneo/patologia , Períneo/cirurgia , Tomografia Computadorizada por Raios X , Cicatrização , Idoso , Feminino , Hérnia/etiologia , Humanos , Obstrução Intestinal/etiologia , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Omento/patologia , Períneo/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Modelos de Riscos Proporcionais , Retalhos Cirúrgicos
7.
Tech Coloproctol ; 23(8): 723-728, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31432336

RESUMO

BACKGROUND: During creation of a pedicled omentoplasty, blood flow to segments of the omentum might become compromised. If unrecognized, this can lead to omental necrosis. The purpose of this study was to investigate the potential added intra-operative value of the use of fluorescence angiography (FA) with indocyanine green (ICG) to assess omental perfusion. METHODS: All consecutive patients undergoing a pedicled omentoplasty in a 6-month period (April 1 2018-October 1 2018) in a University hospital were included. The primary outcome was change in management due to FA. Secondary outcomes included the amount of additionally resected omentum, added surgical time, and quantitative fluorescent values (time to fluorescent enhancement, contrast quantification). RESULTS: Fifteen patients had pelvic surgery with omentoplasty and FA. Change in management occurred in 12 patients (80%) and consisted of resecting a median of 44 g (range 12-198 g) of poorly perfused omental areas that were not visible by conventional white light. The median added surgical time for the use of FA and subsequent management was 8 min (range 3-39 min). The first fluorescent signal in the omental tissue appeared after a median of 20 s (range 9-37 s) after injection of ICG. The median signal-to-baseline ratio was 23.7 (interquartile range 12.2-29.7) in well perfused and 2.5 (interquartile range 1.7-4.0) in poorly perfused tissue. CONCLUSIONS: FA of a pedicled omentoplasty allows a real-time assessment of omental perfusion and leads to change in management in 80% of the cases in this pilot study. These findings support the conduct of larger studies to determine the impact on patient outcome in this setting.


Assuntos
Angiofluoresceinografia/métodos , Raios Infravermelhos , Monitorização Intraoperatória/métodos , Omento/irrigação sanguínea , Doenças Peritoneais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Corantes , Feminino , Humanos , Verde de Indocianina , Masculino , Pessoa de Meia-Idade , Omento/diagnóstico por imagem , Omento/cirurgia , Pelve/cirurgia , Doenças Peritoneais/diagnóstico por imagem , Projetos Piloto , Estudos Retrospectivos , Adulto Jovem
8.
Int J Gynecol Pathol ; 38(3): 230-240, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-29750700

RESUMO

A chemotherapy response score (CRS) system was recently described to assess the histopathologic response and prognosis of patients with tubo-ovarian high-grade serous carcinoma (HGSC) receiving neoadjuvant chemotherapy. The current study was performed as an independent assessment of this CRS system. We retrospectively identified advanced stage HGSC patients who received neoadjuvant chemotherapy and underwent interval debulking. If available, a hemotoxylin and eosin slide from the omentum and the adnexa was selected for the study. Slides were independently scored by 13 pathologists using the 3-tiered CRS system. Reviewers then received web-based training and rescored the slides. Overall survival and progression-free survival were estimated using the Kaplan-Meier method and compared using the log-rank test. A total of 68 patients with omental (n=65) and/or adnexal (n=59) slides were included in the study. Interobserver reproducibility was moderate for omentum (κ, 0.48) and poor for adnexa (κ, 0.40), which improved for omentum (κ, 0.62) but not for adnexa (κ, 0.38) after online training. For omental slides, a consensus CRS of 1/2 was associated with a shorter median progression-free survival (10.9 mo; 95% confidence interval, 9-14) than a CRS of 3 (18.9 mo; 95% CI, 18-24; P=0.020). In summary, a 3-tiered CRS system of hemotoxylin and eosin-stained omental deposits can yield prognostic information for HGSC patients receiving neoadjuvant chemotherapy, and web-based training improved reproducibility but did not alter determination of clinical outcomes. The CRS system may allow oncologists to identify potential nonresponders and triage HGSC patients for heightened observation and/or clinical trials.


Assuntos
Carcinoma/tratamento farmacológico , Neoplasias Ovarianas/tratamento farmacológico , Anexos Uterinos/patologia , Anexos Uterinos/cirurgia , Idoso , Carcinoma/diagnóstico , Carcinoma/patologia , Carcinoma/cirurgia , Procedimentos Cirúrgicos de Citorredução , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Terapia Neoadjuvante , Variações Dependentes do Observador , Omento/patologia , Omento/cirurgia , Sistemas On-Line , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
9.
J Laparoendosc Adv Surg Tech A ; 29(2): 248-255, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30351216

RESUMO

INTRODUCTION: Peptic ulcer disease (PUD) is a rare condition in children. Perforated peptic ulcer (PPU), a complication of PUD has an estimated mortality between 1.3% and 20%. We evaluate incidence and outcomes of PPU in children using an administrative database, perform a review of the literature, and report our technique for laparoscopic omental patch repair for PPU in two pediatric patients. MATERIALS AND METHODS: Kids' inpatient database (KID's) was analyzed for demographics, incidence, and outcomes. Incidence for each year was calculated based on the reported pediatric population in the United States for 2000, 2003, 2006, 2009, and 2012 by the U.S. Census Bureau. Additionally, we present two PPU cases, accompanied by a comprehensive review of the literature. RESULTS: The annual number of primary discharge diagnosis of PPU in the KID was 178 cases for 2000, 252 for 2003, 255 for 2006, 299 for 2009, and 266 for 2012. An increase trend over time was noted between 2000 and 2009; however, it was not statistically significant (0.05). PPU appears to be more common in Caucasian teenage boys. The mean length of stay was 8.02 days and with a statistically significant increase in healthcare charges ($33,187 versus $78,142, P = .002) when comparing year 2000-2012. DISCUSSION: PPU is a rare cause of abdominal pain in children, but still a PUD complication that requires surgery. PPU should be included in the differential diagnosis in patients presenting with acute abdominal pain of uncertain etiology and pneumoperitoneum. Laparoscopy is both diagnostic and therapeutic. Laparoscopic omental patch repair is a safe and effective treatment for PPUs.


Assuntos
Omento/transplante , Úlcera Péptica Perfurada/epidemiologia , Úlcera Péptica Perfurada/cirurgia , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Preços Hospitalares , Humanos , Incidência , Lactente , Recém-Nascido , Laparoscopia , Tempo de Internação , Masculino , Úlcera Péptica Perfurada/economia , Úlcera Péptica Perfurada/etnologia , Fatores Sexuais , Resultado do Tratamento , Estados Unidos/epidemiologia
10.
Rev Esp Patol ; 51(4): 216-223, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-30269772

RESUMO

Peritoneal carcinomatosis (PC) is a malignant entity with a high rate of morbimortality. It is considered an end-stage common to several abdominal and pelvic malignant tumours, such as epithelial ovarian, fallopian tubal and peritoneal cancer. Although many of these tumors have a good response to chemotherapy, prognosis is poor due to the high rate of recurrence. Surgeons, gynecologists and oncologists are increasingly concerned with improving the survival. The surgical technique described by Sugarbaker in the eighties is a plausible option. It aims for a complete resection of macroscopic carcinomatosis (cytoreductive surgery) followed by intraoperative or perioperative intraperitoneal chemotherapy. This therapeutic option necessarily involves specific multidisciplinary units; histopathology of specimens from this surgical technique is now more frequent in our department. We describe our initial experience with PC originating from epithelial ovarian, tubal and peritoneal cancer treated with the modified Sugarbaker surgery employed in our hospital. We outline our protocol designed to achieve uniformity in procedure, and summarize the initial results.


Assuntos
Carcinoma/secundário , Procedimentos Cirúrgicos de Citorredução , Neoplasias das Tubas Uterinas/patologia , Neoplasias Ovarianas/patologia , Patologia Cirúrgica/métodos , Neoplasias Peritoneais/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Carcinoma/tratamento farmacológico , Carcinoma/patologia , Carcinoma/cirurgia , Protocolos Clínicos , Colo/patologia , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/métodos , Neoplasias das Tubas Uterinas/tratamento farmacológico , Neoplasias das Tubas Uterinas/cirurgia , Feminino , Humanos , Infusões Parenterais , Fígado/patologia , Linfonodos/patologia , Pessoa de Meia-Idade , Omento/patologia , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/cirurgia , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/cirurgia , Peritônio/patologia , Estudos Retrospectivos , Manejo de Espécimes , Estômago/patologia
11.
J Surg Oncol ; 118(1): 109-112, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29920683

RESUMO

BACKGROUND AND OBJECTIVE: Vascularized omentum lymphatic transplant (VOLT) for treatment of lymphedema has become popular because of no risk of iatrogenic lymphedema and abundant lymphatic tissue. However, perfusion to the omentum can be difficult to assess clinically. The purpose of this study was to clarify the incidence and degree of ischemia in the omentum. METHODS: A retrospective study was conducted to review indocyanine green perfusion findings on patients undergoing VOLT. Patients were placed into 4 categories based on the percentage surface area of omentum that was ischemic: normal, less than 25%, between 25% and 50%, and greater than 50% ischemic. Spearman correlation was performed to determine whether an association exists between prior abdominal surgery and the presence of ischemia. RESULTS: Twenty-six patients underwent VOLT for treatment of extremity lymphedema. Twelve (46.2%) patients had normal perfusion, 8 patients (30.8%) had less than 25% ischemia, and 6 patients (23.1%) had 25% to 50% ischemia. Prior abdominal surgery was not significantly associated with the presence of ischemia. CONCLUSIONS: Normal flap perfusion is a requisite for successful VOLT harvest. However, over half the patients had some degree of abnormal perfusion irrespective of prior abdominal surgery. Indocyanine green angiography is an important tool in ensuring a healthy lymphatic reconstruction.


Assuntos
Angiofluoresceinografia , Verde de Indocianina , Vasos Linfáticos , Linfedema/cirurgia , Omento , Retalhos Cirúrgicos/irrigação sanguínea , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
J Vasc Interv Radiol ; 28(11): 1569-1576, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28916344

RESUMO

PURPOSE: To assess biopsy technique, technical success rate, and diagnostic yield of image-guided percutaneous biopsy of omental and mesenteric lesions. MATERIALS AND METHODS: This retrospective study included 186 patients (89 men, 97 women; mean [SD] age, 63 [13.8] y) who underwent percutaneous image-guided biopsy of omentum and mesentery between March 2007 and August 2015. Biopsies were performed with computed tomography (CT) (n = 172) or ultrasound (US) (n = 14) guidance using coaxial technique yielding core and fine-needle aspiration (FNA) specimens. Biopsy results were classified as diagnostic (neoplastic or nonneoplastic) or nondiagnostic based on histopathology and cytology. Technical success rate and diagnostic yield of omental and mesenteric lesions were calculated. RESULTS: There were 186 image-guided percutaneous biopsies of omental (n = 95) and mesenteric (n = 91) lesions performed. Technical success rate was 99.5% for all biopsies, 100% for omental biopsies, and 98.9% for mesenteric biopsies. Overall sensitivity was 95.5%, specificity was 100%, negative predictive value was 78.3%, and positive predictive value was 100%, which was comparable for omental and mesenteric biopsies. Core biopsies had higher diagnostic yields compared with FNA: 98.4% versus 84% overall, 99% versus 88% for omental biopsies, and 97.7% versus 80% for mesenteric biopsies. Spearman rank correlation showed no correlation between lesion size and diagnostic yield (P = .14) and lesion depth and diagnostic yield (P = .29) for both groups. There were 5 complications. CONCLUSIONS: Image-guided percutaneous omental and mesenteric biopsies have high technical success rates and diagnostic yield regardless of lesion size or depth from the skin for both omental and mesenteric specimens.


Assuntos
Biópsia Guiada por Imagem/métodos , Mesentério/patologia , Omento/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Radiografia Intervencionista , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Ultrassonografia de Intervenção
13.
J Gynecol Oncol ; 28(6): e73, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28758379

RESUMO

OBJECTIVE: The chemotherapy response score (CRS) system based on histopathological examination has been recently proposed for tubo-ovarian high-grade serous carcinoma (HGSC) to assess response to neoadjuvant chemotherapy (NAC). This study was aimed at validating the CRS system in an external cohort of tubo-ovarian HGSC patients. METHODS: This study included 110 tubo-ovarian HGSC patients who underwent NAC followed by interval debulking surgery. The 3-tiered CRS of the omental and adnexal tissue sections was determined by 3 independent pathologists. Differences in patient outcomes according to CRS were analyzed. RESULTS: The CRS system was highly reproducible among the 3 pathologists. Fleiss' kappa value and Kendall's coefficient of concordance for the omental CRS were 0.656 and 0.669, respectively. The omental CRS significantly predicted progression-free survival (PFS). The median PFS of patients whose tumors exhibited the omental CRS 1-2 (15 months) was significantly shorter than that of patients with an omental CRS of 3 (19 months; p=0.016). In addition, after adjusting for age, stage, and debulking status, the omental CRS was an independent prognostic factor for PFS of tubo-ovarian HGSC patients who were treated with NAC (adjusted hazard ratio [HR]=1.74; 95% confidence interval [CI]=1.05-2.87). CONCLUSION: The CRS system for assessing NAC response was a reproducible prognostic tool in our cohort. The application of the CRS system after NAC can improve survival estimation in HGSC patients.


Assuntos
Carcinoma/tratamento farmacológico , Neoplasias das Tubas Uterinas/tratamento farmacológico , Terapia Neoadjuvante , Neoplasias Císticas, Mucinosas e Serosas/tratamento farmacológico , Neoplasias Ovarianas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/patologia , Procedimentos Cirúrgicos de Citorredução , Intervalo Livre de Doença , Neoplasias das Tubas Uterinas/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Neoplasias Císticas, Mucinosas e Serosas/patologia , Omento/cirurgia , Neoplasias Ovarianas/patologia , Ovariectomia , Modelos de Riscos Proporcionais , Reprodutibilidade dos Testes , Estudos Retrospectivos , Salpingectomia , Resultado do Tratamento
14.
Gynecol Oncol ; 145(1): 27-31, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28209497

RESUMO

OBJECTIVE: To assess the ability of preoperative computed tomography scan and CA-125 to predict gross residual disease (RD) at primary cytoreduction in advanced ovarian cancer. METHODS: A prospective, non-randomized, multicenter trial of patients who underwent primary debulking for stage III-IV epithelial ovarian cancer previously identified 9 criteria associated with suboptimal (>1cm residual) cytoreduction. This is a secondary post-hoc analysis looking at the ability to predict any RD. Four clinical and 18 radiologic criteria were assessed, and a multivariate model predictive of RD was developed. RESULTS: From 7/2001-12/2012, 350 patients met eligibility criteria. The complete gross resection rate was 33%. On multivariate analysis, 3 clinical and 8 radiologic criteria were significantly associated with the presence of any RD: age≥60years (OR=1.5); CA-125≥600U/mL (OR=1.3); ASA 3-4 (OR=1.6); lesions in the root of the superior mesenteric artery (OR=4.1), splenic hilum/ligaments (OR=1.4), lesser sac >1cm (OR=2.2), gastrohepatic ligament/porta hepatis (OR=1.4), gallbladder fossa/intersegmental fissure (OR=2); suprarenal retroperitoneal lymph nodes (OR=1.3); small bowel adhesions/thickening (OR=1.1); and moderate-severe ascites (OR=2.2). All ORs were significant with p<0.01. A 'predictive score' was assigned to each criterion based on its multivariate OR, and the rate of having any RD for patients who had a total score of 0-2, 3-5, 6-8, and ≥9 was 45%, 68%, 87%, and 96%, respectively. CONCLUSIONS: We identified 11 criteria associated with RD, and developed a predictive model in which the rate of having any RD was directly proportional to a predictive score. This model may be helpful in treatment planning.


Assuntos
Antígeno Ca-125/sangue , Procedimentos Cirúrgicos de Citorredução , Neoplasias Císticas, Mucinosas e Serosas/cirurgia , Neoplasias Epiteliais e Glandulares/cirurgia , Neoplasias Ovarianas/cirurgia , Parede Abdominal/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Ascite/epidemiologia , Carcinoma Epitelial do Ovário , Humanos , Linfonodos/patologia , Artéria Mesentérica Superior/patologia , Pessoa de Meia-Idade , Análise Multivariada , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasia Residual , Neoplasias Císticas, Mucinosas e Serosas/sangue , Neoplasias Císticas, Mucinosas e Serosas/diagnóstico por imagem , Neoplasias Císticas, Mucinosas e Serosas/patologia , Neoplasias Epiteliais e Glandulares/sangue , Neoplasias Epiteliais e Glandulares/diagnóstico por imagem , Neoplasias Epiteliais e Glandulares/patologia , Razão de Chances , Omento/patologia , Neoplasias Ovarianas/sangue , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/patologia , Estudos Prospectivos , Espaço Retroperitoneal , Baço , Aderências Teciduais/epidemiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Aesthet Surg J ; 37(5): 603-613, 2017 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-27927612

RESUMO

Background: The results of experimental studies indicate that grafting of autologous adipose tissue may induce tumorigenesis at the recipient site, but clinical results do not support a carcinogenic effect of fat grafting to the breast. Objectives: The authors assessed cancer risk following transplantation of autologous fat into murine mammary tissue. Methods: In this animal study, mammary tissues from 54 breasts of 9 female rats were either grafted with autologous subcutaneous fat, grafted with autologous omental fat, or unmanipulated. Tissues were harvested and processed for histologic and immunohistochemical analyses, and the mRNA expression levels of specific genes were determined. Results: No atypia or changes in lobular structures were observed in lipofilled breasts compared with controls. The numbers of ductal cell layers and terminal ductal units were similar for lipofilled and control breasts. Macrophage concentrations also were similar for the 3 groups. The localization and magnitude of plasminogen activator inhibitor 1 were similar for lipofilled and unmanipulated breast tissue. The percentages of cells expressing Ki67 or estrogen receptor (ER) and the ER/Ki67 balance were similar for the 3 groups. Gene expression was not altered in lipofilled breasts, compared with controls. Conclusions: No theoretical risk of cancer was detected in the microenvironment of the lipofilled rat breast.


Assuntos
Gordura Intra-Abdominal/transplante , Mamoplastia/efeitos adversos , Neoplasias Mamárias Experimentais/etiologia , Gordura Subcutânea/transplante , Transplante de Tecidos/efeitos adversos , Microambiente Tumoral , Animais , Mama/química , Mama/cirurgia , Carcinogênese , Feminino , Humanos , Imuno-Histoquímica , Gordura Intra-Abdominal/química , Gordura Intra-Abdominal/patologia , Antígeno Ki-67/análise , Omento , Inibidor 1 de Ativador de Plasminogênio/análise , Ratos , Ratos Sprague-Dawley , Medição de Risco , Gordura Subcutânea/patologia , Transplante Autólogo/efeitos adversos
19.
Epigenetics ; 9(5): 678-84, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24518816

RESUMO

We present a systematic assessment of RainDrop BS-seq, a novel method for large-scale, targeted bisulfite sequencing using microdroplet-based PCR amplification coupled with next-generation sequencing. We compared DNA methylation levels at 498 target loci (1001 PCR amplicons) in human whole blood, osteosarcoma cells and an archived tumor tissue sample. We assessed the ability of RainDrop BS-seq to accurately measure DNA methylation over a range of DNA quantities (from 10 to 1500 ng), both with and without whole-genome amplification (WGA) following bisulfite conversion. DNA methylation profiles generated using at least 100 ng correlated well (median R = 0.92) with those generated on Illumina Infinium HumanMethylation450 BeadChips, currently the platform of choice for epigenome-wide association studies (EWAS). WGA allowed for testing of samples with a starting DNA amount of 10 and 50 ng, although a reduced correlation was observed (median R = 0.79). We conclude that RainDrop BS-seq is suitable for measuring DNA methylation levels using nanogram quantities of DNA, and can be used to study candidate epigenetic biomarker loci in an accurate and high-throughput manner, paving the way for its application to routine clinical diagnostics.


Assuntos
Análise de Sequência de DNA/métodos , Sulfitos/química , Neoplasias Ósseas/genética , Carcinoma Neuroendócrino/genética , Carcinoma Neuroendócrino/secundário , Ilhas de CpG , Metilação de DNA , Humanos , Indicadores e Reagentes , Omento/patologia , Osteossarcoma/genética , Neoplasias Peritoneais/genética , Neoplasias Peritoneais/secundário , Células Tumorais Cultivadas
20.
Vestn Khir Im I I Grek ; 171(3): 98-101, 2012.
Artigo em Russo | MEDLINE | ID: mdl-22880443

RESUMO

In 52 rabbits a morphological assessment was made of regeneration of wounds of the liver and kidneys after their plasty with a seromuscle flap of the stomach on the vascular pedicle (26 rabbits), of hepatorhaphy and omentonephroplasty (26 rabbits) within the period from 1 to 360 days and was compared with literature data concerning reparation of the liver and kidney of the rabbit with the application of bio- and polymer materials for covering their wounds. The influence of plastic properties of the materials used on the productivity of the inflammatory-reparative process was established. In suturing the wounds of parenchymatous organs it is necessary to use plastic materials stimulating regeneration. The application of seromuscle flap of the stomach for these purposes improves the inflammatory-reparative process making it more productive as compared with bio- and polymer materials.


Assuntos
Materiais Biocompatíveis/uso terapêutico , Retalhos de Tecido Biológico , Rim , Fígado , Omento/transplante , Estômago/transplante , Animais , Retalhos de Tecido Biológico/efeitos adversos , Retalhos de Tecido Biológico/patologia , Retalhos de Tecido Biológico/fisiologia , Rim/lesões , Rim/cirurgia , Fígado/lesões , Fígado/cirurgia , Modelos Animais , Monitorização Fisiológica , Necrose/etiologia , Necrose/prevenção & controle , Coelhos , Transplante Autólogo/métodos , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/efeitos adversos , Cicatrização
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