RESUMO
Over a 4-year period in a chemoprevention trial on large bowel neoplasia, 58 patients with familial adenomatous polyposis were treated with 4 g of ascorbic acid (vitamin C)/day plus 400 mg of alpha-tocopherol (vitamin E)/day alone or with a grain fiber supplement (22.5 g/day). In this randomized, double-blind, placebo-controlled study, we determined the effects of these supplements on rectal polyps in these patients. Analysis by intent to treat suggested that the high-fiber supplement had a limited effect. Analysis adjusted for patient compliance showed a stronger benefit from the high-fiber supplement during the middle 2 years of the trial. The results provide evidence for inhibition of benign large bowel neoplasia by grain fiber supplements in excess of 11 g/day in this study population. The findings are consistent with the hypothesis that dietary grain fiber and total dietary fat act as competing variables in the genesis of large bowel neoplasia.
Assuntos
Polipose Adenomatosa do Colo/complicações , Ácido Ascórbico/uso terapêutico , Fibras na Dieta/uso terapêutico , Pólipos/dietoterapia , Doenças Retais/dietoterapia , Triticum , Vitamina E/uso terapêutico , Adulto , Ensaios Clínicos como Assunto , Dieta , Fibras na Dieta/efeitos adversos , Método Duplo-Cego , Humanos , Cooperação do Paciente , Placebos , Pólipos/tratamento farmacológico , Pólipos/etiologia , Distribuição Aleatória , Doenças Retais/tratamento farmacológico , Doenças Retais/etiologiaRESUMO
A patient with watery diarrhea, hypokalemia, hypochlorhydria, and a non-beta islet cell carcinoma of the pancreas (Verner-Morrison syndrome) was found to have an elevated vasoactive intestinal peptide (VIP) concentration in the plasma as well as in the tumor. Treatment with streptozocin resulted in a dramatic subjective and objective tumor response in this patient. Plasma VIP concentration fell into the normal range after four courses of treatment, diarrhea ceased after the third course of therapy, and measurable tumor mass markedly decreased during that same period of time. The patient remains in clinical remission with no evidence of tumor regrowth 18 months after the beginning of treatment. In this patient, plasma VIP measurements were an excellent marker of tumor activity and correlated well with objective disease measurements and clinical response.
Assuntos
Adenoma de Células das Ilhotas Pancreáticas/tratamento farmacológico , Diarreia/tratamento farmacológico , Hipopotassemia/tratamento farmacológico , Neoplasias Pancreáticas/tratamento farmacológico , Gastropatias/tratamento farmacológico , Estreptozocina/uso terapêutico , Adenoma de Células das Ilhotas Pancreáticas/ultraestrutura , Diarreia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Pancreáticas/ultraestrutura , Síndrome , Peptídeo Intestinal Vasoativo/sangue , Peptídeo Intestinal Vasoativo/fisiologiaRESUMO
From 1968 to January 1, 1977, 44 patients with initially unresectable colorectal carcinoma were treated with preoperative radiotherapy and surgery. On presentation, unresectability was determined either clinically (26 patients) or by preradiotherapy laparotomy (18 patients). Preoperative irradiation consisted of 4500-5000 rad. After radiotherapy, 33 of 44 lesions were considered resectable. Seven of 33 patients underwent incomplete resection with mean survival of 17 months. Resection was complete in 26 of the 33 patients. Of the latter group (26), 18 patients are alive with no evidence of disease with minimum follow-up of 36 months. Detailed results are discussed.
Assuntos
Neoplasias do Colo/radioterapia , Neoplasias Retais/radioterapia , Adulto , Idoso , Neoplasias do Colo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Cuidados Pré-Operatórios , Neoplasias Retais/cirurgiaRESUMO
Ophthalmic examinations were performed on 56 patients with validated familial adenomatous polyposis (FAP) for hyperpigmented defects of the retinal pigment epithelium. Such lesions were seen bilaterally in 29 patients (52%) and unilaterally in 8 patients (14%). Of the 56 patients, 33 had one or more of the extracolonic expressions associated with Gardner syndrome. We found retinal lesions in 8 patients without any of the expressions of Gardner syndrome. No association was found between Gardner syndrome and the retinal lesions when these patients were compared to patients without any stigmata of Gardner syndrome, nor was any significant association found when each of the expressions was compared individually with the presence of the pigmented retinal lesions. The presence or absence of eye findings were seen to cluster within families. There was no association with sex. Fundus lesions are apparently a variable expression of the FAP gene and are not specifically associated with Gardner syndrome.
Assuntos
Polipose Adenomatosa do Colo/patologia , Epitélio Pigmentado Ocular/patologia , Pigmentos da Retina/análise , Polipose Adenomatosa do Colo/genética , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Eighty consecutive emergency and urgent colectomies for ulcerative colitis were performed. One-stage total proctocolectomy was performed in 37 patients, with a 9.1% mortality; ileostomy with subtotal colectomy was performed in 43, with a 7.0% mortality. The overall mortality was 7.5%. Postoperative morbidity after total proctocolectomy (mean postoperative hospitalization, 27.6 days; nonseptic complication rate, 29.4%; septic complication rate, 29.4%) was not substantially different from that after subtotal colectomy (postoperative hospitalization, 33.3 days; nonseptic complications, 45.0%; septic complications, 35.0%). Survivors of subtotal colectomy required abdominal-perineal resection of the colorectal remnant in 75.7% of patients, and no patient had successful subsequent ileorectal anastomosis. It is suggested that one-stage total proctocolectomy be adopted as the surgical procedure of choice in emergency or urgent operations for ulcerative colitis.
Assuntos
Colectomia/métodos , Colite Ulcerativa/cirurgia , Emergências , Abdome , Abscesso/etiologia , Anemia/etiologia , Sedimentação Sanguínea , Colite Ulcerativa/complicações , Colite Ulcerativa/mortalidade , Diarreia/etiologia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Ileostomia , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Tempo de Internação , Megacolo Tóxico/cirurgia , Melena/etiologia , Pelve , Complicações Pós-Operatórias , Recidiva , Estudos Retrospectivos , Sepse/etiologia , Infecção da Ferida Cirúrgica , Taquicardia/etiologiaRESUMO
A comparison of the in vivo biochemical actions of the psychotomimetic central stimulants, d-amphetamine (d-AMPH) and amfonelic acid (AFA), on the metabolism of rat striatal newly synthesized [3H]dopamine (DA) was made by pulse labeling with [3H]tyrosine. No evidence for the formation of the alcoholic DA metabolites [3H]3-methoxy-4-hydroxyphenylethanol (MOPET) or [3H]3,4-dihydroxyphenylethanol (DOPET) was found in control or drug-treated animals. Both [3H]3,4-dihydroxyphenylacetic acid (DOPAC) and [3H]homovanillic acid (HVA) concentrations were increased by AFA in the presence of haloperidol, while [3H]DA content was decreased. In contrast, d-AMPH, in the presence of haloperidol, decreased [3H]DOPAC and increased [3H]DA, even in monoamine oxidase-blocked rats. Thus monoamine oxidase inhibition did not appear to be a major factor in the action of amphetamine to increase [3H]DA, but cannot be excluded as a contributing factor to the lowering of [3H]DOPAC. Similar actions of d-AMPH were seen on preformed DA. Amphetamine may release newly synthesized DA in such a way that some of the released DA enters the neuronal storage system.
Assuntos
Estimulantes do Sistema Nervoso Central/farmacologia , Corpo Estriado/metabolismo , Dextroanfetamina/farmacologia , Dopamina/metabolismo , Naftiridinas/farmacologia , Ácido 3,4-Di-Hidroxifenilacético/metabolismo , 3-Metoxi-4-Hidroxifeniletanol/metabolismo , Animais , Haloperidol/farmacologia , Ácido Homovanílico/metabolismo , Ácido Nalidíxico/análogos & derivados , Ratos , Ratos Endogâmicos , Tirosina 3-Mono-Oxigenase/metabolismoRESUMO
Of forty-nine consecutive patients who underwent subtotal colectomy for inflammatory disease of the colon, 73.5 per cent required subsequent combined abdominoperineal resection of the retained rectum and only two patients had successful ileoproctostomy. For the patient whose rectum is substantially diseased along with the rest of the colon, one-stage total proctocolectomy is the preferred operation.
Assuntos
Colectomia , Colite Ulcerativa/cirurgia , Colite/cirurgia , Doença Granulomatosa Crônica/cirurgia , Disfunção de Fagócito Bactericida/cirurgia , Reto/cirurgia , Adolescente , Adulto , Idoso , Carcinoma/complicações , Criança , Doença Crônica , Colite/complicações , Colite Ulcerativa/complicações , Neoplasias do Colo/complicações , Feminino , Doença Granulomatosa Crônica/complicações , Humanos , Ileostomia , Masculino , Pessoa de Meia-Idade , Períneo/cirurgia , Complicações Pós-Operatórias , Proctocolite/complicações , Prognóstico , Recidiva , Fatores de TempoRESUMO
Percutaneous needle localization should be performed before biopsy of a nonpalpable breast lesion, thereby eliminating the need for blind biopsy. With small cancers, transoperative localization is just as important to confirm excision of the lesion and ensure that representative sections are obtained from the area in question for histologic study.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Feminino , Humanos , Métodos , Radiografia , SuturasRESUMO
Experience with 17 children in one kindred with familial medullary carcinoma of the thyroid and pheochromocytoma has demonstrated the utility and validity of periodic provocative testing by calcium infusion or pentagastrin injection in the identification of children with early medullary carcinoma of the thyroid or its premalignant precursor, C-cell hyperplasia. In these 17 patients with two consecutive elevations of calcitonin levels greater than 0.55 ng/ml after stimulation all but one have had MTC or CCH at operation. Total thyroidectomy has been well tolerated and can be performed with an acceptably low incidence of complications in this group of patients.
Assuntos
Carcinoma/genética , Neoplasias da Glândula Tireoide/genética , Tireoidectomia , Adolescente , Adulto , Carcinoma/patologia , Carcinoma/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Cuidados Pós-Operatórios , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgiaAssuntos
Encéfalo/enzimologia , Dextroanfetamina/farmacologia , Inibidores da Monoaminoxidase , 2-etil-1,3,4,6,7,11b-hexaidro-3-isobutil-9,10-dimetoxi-2H-benzo(a)quinolizin-2-ol/farmacologia , Ácido 3,4-Di-Hidroxifenilacético/metabolismo , Anfetamina/farmacologia , Animais , Cocaína/farmacologia , Corpo Estriado/metabolismo , Haloperidol/farmacologia , Masculino , Fenelzina/farmacologia , RatosAssuntos
Bromodesoxiuridina/farmacologia , Aberrações Cromossômicas/efeitos da radiação , Efeitos da Radiação , Animais , Bromodesoxiuridina/metabolismo , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Aberrações Cromossômicas/efeitos dos fármacos , Cricetinae , DNA/biossíntese , Diploide , Feminino , Mitose , Ovário , Doses de Radiação , Radiossensibilizantes/farmacologia , Timidina/metabolismo , TrítioAssuntos
Aberrações Cromossômicas , Cromossomos/efeitos da radiação , Mitose/efeitos da radiação , Efeitos da Radiação , Animais , Benzocicloeptenos/farmacologia , Divisão Celular/efeitos dos fármacos , Cromossomos/efeitos dos fármacos , Cricetinae , Técnicas de Cultura , Pulmão , Masculino , Radiometria , Fatores de Tempo , TrítioAssuntos
Calcitonina/metabolismo , Carcinoma/genética , Neoplasias da Glândula Tireoide/genética , Adulto , Idoso , Calcitonina/sangue , Calcitonina/urina , Cálcio/farmacologia , Carcinoma/diagnóstico , Carcinoma/metabolismo , Carcinoma/patologia , Carcinoma/cirurgia , Feminino , Humanos , Isótopos de Iodo , Metástase Linfática , Masculino , Metástase Neoplásica , Neoplasias Primárias Múltiplas , Feocromocitoma/complicações , Complicações Pós-Operatórias , Radioimunoensaio , Cintilografia , Tecnécio , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/metabolismo , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgiaAssuntos
Antibacterianos/farmacologia , Microssomos Hepáticos/metabolismo , Fenobarbital/metabolismo , Aminopirina/metabolismo , Animais , Compostos Azo/metabolismo , Cicloexanos/farmacologia , Cicloeximida/farmacologia , Remoção de Radical Alquila , Feminino , Técnicas In Vitro , Microssomos Hepáticos/efeitos dos fármacos , Microssomos Hepáticos/enzimologia , Naftalenos/metabolismo , Oxirredução , Piperidonas/farmacologia , Biossíntese de Proteínas , Ratos , Sulfonamidas/metabolismo , Ácidos Sulfônicos/metabolismoRESUMO
Seventeen patients with carcinoma confined to the pancreas and the peripancreatic area received preoperative radiation therapy in an attempt to increase the resectability rate and to reduce the incidence of recurrence. The tumors were considered either unresectable or of borderline resectability. The radiation dose ranged between 4000--5000 rads, the majority of patients (75%) receiving 4400--4600 rads in 4 1/2--5 weeks. After a period averaging six weeks the patients were reevaluated for surgery. Eleven patients were explored and six underwent radical resection. Two patients remained disease free after five years. Pancreatic resection is feasible following a course of preoperative radiotherapy to a moderately high dose. It is suggested that the response of the primary tumor to radiotherapy be used as a criterion for selecting patients for reexploration and resection.
Assuntos
Adenocarcinoma/radioterapia , Neoplasias Pancreáticas/radioterapia , Adenocarcinoma/cirurgia , Idoso , Relação Dose-Resposta à Radiação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia/radioterapia , Neoplasias Pancreáticas/cirurgia , PrognósticoRESUMO
Chromosomal aberrations induced by x-rays in synchronized Chinese hamster cells correlated well with mortality as the radiosensitivity was made to vary by a factor of 4 by treating the cells with colcemid or 5-bromodeoxyuridine and by irradiating the cells in different parts of the cell cycle. 37% survival was observed when the cells sustained about one aberration per cell. Furthermore, the positive correlation was observed during repair of damage. Repair was measured by the reduction in damage observed either as the incubation period between two doses was increased (repair of sublethal lesions), or as the cells were held at 20 degrees C after a single dose of radiation (repair of potentially lethal lesions). Repair of both sublethal and potentially lethal lesions occurred with a half-time of about 12 min and was inhibited at 0 degrees C. These correlations strongly support the hypothesis that x-ray-induced cell death results from damage in chromatin structures.
Assuntos
Aberrações Cromossômicas , Cromossomos/efeitos da radiação , Animais , Linhagem Celular/efeitos da radiaçãoRESUMO
The results of all 53 pancreatoduodenectomies performed at one hospital were reviewed for operative mortality, accuracy of operative diagnosis and long term survival. Although carcinomas of the ampulla are much more rare than those of the pancreas, the number of patients in our operative series with adenocarcinoma of the ampulla approached the number with adenocarcinoma of the pancreas, indicating that only those with small, early lesions of the head of the pancreas were considered to be appropriate candidates for pancreatoduodenectomy. Six of the 21 patients with carcinomas of the pancreas had histologically favorable tumors (three papillary adenocarcinomas, two cystadenocarcinomas and one islet cell carcinoma), although only one of these was correctly diagnosed preoperatively or intraoperatively. Eight patients had benign conditions, half of whom underwent planned resections for chronic pancreatitis. The over-all operative mortality for our series was 13.2 per cent. The operative diagnosis was incorrect in seven patients. Excluding cystadenocarcinomas and islet cell carcinomas, four patients with carcinoma of the pancreas survived five years and six patients with carcinoma of the ampulla survived five years, with corresponding survival periods of 2.5 and 5.1 years following pancreatoduodenectomy. We conclude that: 1, pancreatoduodenectomy should be used in a highly selective manner by surgeons experienced with such operations; 2, the high diagnostic error rate and the occurrence of histologically favorable tumors of the pancreas make the arbitrary exclusion of all tumors of the pancreas for resectional therapy an unsound policy, and 3, pancreatoduodenectomy remains the best therapy for resectable tumors of the periampullary region.