RESUMO
BACKGROUND: It was hitherto common practice to analyse each removed gallbladder for the presence of gall bladder cancer (GBC) although this approach may be questioned. The aim of this study was to determine whether a policy of selective histopathological analysis (Sel-HPA) is oncologically safe and cost effective. METHODS: This retrospective study was conducted in a single Dutch teaching hospital. Immediately following cholecystectomy, the surgeon decided on the basis of inspection and palpation whether histological examination was indicated. The Dutch Comprehensive Cancer Organisation (IKNL) registry was used to identify the number of GBC during this time period. RESULTS: Of 2271 patients who underwent a cholecystectomy in our institution between January 2012 and December 2017, 1083 (47.7%) were deemed indicated for histopathological analysis. Sixteen pathological gallbladders (1.5%) were identified in that period (intestinal metaplasia, nâ¯=â¯3; low grade dysplasia nâ¯=â¯7; carcinoma nâ¯=â¯6). During follow-up, no patient was found to have GBC recurrence in the population whose gallbladder was not sent for pathology (52.3%, nâ¯=â¯1188, median 49 months of follow up). The percentage of gallbladders that were analysed decreased over the six years of observation from 83% to 38%. Our policy of Sel-HP saved over 65 000. CONCLUSIONS: A policy of selective histopathology after cholecystectomy is oncologically safe and reduces costs.
Assuntos
Carcinoma/diagnóstico , Colecistectomia , Doenças da Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/diagnóstico , Vesícula Biliar/patologia , Pólipos/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/diagnóstico por imagem , Carcinoma/patologia , Colecistectomia Laparoscópica , Colecistite Aguda/cirurgia , Colecistolitíase/cirurgia , Análise Custo-Benefício , Feminino , Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/patologia , Humanos , Masculino , Metaplasia , Pessoa de Meia-Idade , Países Baixos , Seleção de Pacientes , Pólipos/diagnóstico por imagem , Pólipos/patologia , Estudos Retrospectivos , Adulto JovemRESUMO
The present study was conducted on 200 male mice for the detection of the effect of Atorvastatin on Cryptosporidium spp. infection versus the commercially used drug Nitazoxanide in experimentally immunosuppressed mice. Atorvastatin was used alone at low dose (20 mg/kg), high dose (40 mg/kg), and combined with Nitazoxanide (1000 mg/kg) with either the low dose or high dose for five consecutive days. Parasitological assessment of the drug effect was done using Modified Z-N staining of stool samples collected from mice. Results revealed a reduction of the number of oocysts shed with percentage of reduction on the 21st day post infection by 53.7%, 67.2%, 70.1% &77.5%, respectively, compared to the infected untreated group. The Nitazoxanide treated group showed 52.7% reduction. In addition, examination of small and large intestinal contents after mice scarification revealed reduced numbers of oocysts by 56.2%-58.8%, 65.1%-65.3%, 70.6%-73.9% and 77.8%-79.9%, respectively, compared to 51.2%-54.1% in Nitazoxanide treated group. The histopathological examination of sections from duodenum, jejunum, ileum, colon, stomach and lungs also revealed a significant improvement of the histopathological changes in Atorvastatin treated groups and more remarkable improvement in the groups treated with combined drugs as compared to infected untreated group. Accordingly, the combination of Atorvastatin and Nitazoxanide showed a synergistic effect through reduction of the number of oocysts shed and improvement of the histopathological changes induced by Cryptosporidium spp. infection in the small intestine, colon, stomach and lungs of infected immunosuppressed mice in comparison to that induced by either Nitazoxanide or Atorvastatin alone.
Assuntos
Antiparasitários/uso terapêutico , Atorvastatina/uso terapêutico , Criptosporidiose/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Tiazóis/uso terapêutico , Animais , Antiparasitários/administração & dosagem , Atorvastatina/administração & dosagem , Colo/parasitologia , Colo/patologia , Criptosporidiose/imunologia , Criptosporidiose/patologia , Sinergismo Farmacológico , Duodeno/parasitologia , Duodeno/patologia , Fezes/parasitologia , Vesícula Biliar/patologia , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Íleo/parasitologia , Íleo/patologia , Terapia de Imunossupressão , Jejuno/parasitologia , Jejuno/patologia , Pulmão/patologia , Masculino , Camundongos , Nitrocompostos , Estômago/patologia , Comprimidos , Tiazóis/administração & dosagemRESUMO
Currently, there is no validated therapeutic target for biliary tract cancer (BTC). This study aimed to investigate the pre-clinical and clinical implication of HER2 as a therapeutic target in BTC. We established two novel HER2-amplified BTC cell lines, SNU-2670 and SNU-2773, from gallbladder cancer patients. SNU-2670 and SNU-2773 cells were sensitive to trastuzumab, dacomitinib, and afatinib compared with nine HER2-negative BTC cell lines. Dacomitinib and afatinib led to G1 cell cycle arrest in SNU-2773 cells and apoptosis in SNU-2670 cells. Furthermore, dacomitinib, afatinib, and trastuzumab showed synergistic cytotoxicity when combined with some cytotoxic drugs including gemcitabine, cisplatin, paclitaxel, and 5-fluorouracil. In a SNU-2670 mouse xenograft model, trastuzumab demonstrated a good anti-tumor effect as a monotherapy and in combination with gemcitabine increasing apoptosis. In our clinical data, 13.0% of patients with advanced BTC were defined as HER2-positive. Of these, three patients completed HER2-targeted chemotherapy. Two of them demonstrated a partial response, and the other one showed stable disease for 18 weeks. In summary, these pre-clinical and clinical data suggest that HER2 could be a therapeutic target, and that a HER2-targeting strategy should be developed further in patients with HER2-positive advanced BTC.
Assuntos
Adenocarcinoma/tratamento farmacológico , Antineoplásicos/farmacologia , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Neoplasias da Vesícula Biliar/tratamento farmacológico , Receptor ErbB-2/antagonistas & inibidores , Adenocarcinoma/diagnóstico , Adenocarcinoma/genética , Adenocarcinoma/patologia , Adulto , Idoso , Animais , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Apoptose/efeitos dos fármacos , Linhagem Celular Tumoral , Avaliação Pré-Clínica de Medicamentos , Feminino , Fluordesoxiglucose F18/administração & dosagem , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/genética , Neoplasias da Vesícula Biliar/patologia , Amplificação de Genes , Humanos , Imuno-Histoquímica , Metástase Linfática , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Pessoa de Meia-Idade , Terapia de Alvo Molecular/métodos , Tomografia por Emissão de Pósitrons , Receptor ErbB-2/genética , Receptor ErbB-2/metabolismo , Transdução de Sinais/efeitos dos fármacos , Resultado do Tratamento , Ensaios Antitumorais Modelo de XenoenxertoRESUMO
BACKGROUND: Selenium status is suboptimal in many Europeans and may be a risk factor for the development of various cancers, including those of the liver and biliary tract. OBJECTIVE: We wished to examine whether selenium status in advance of cancer onset is associated with hepatobiliary cancers in the EPIC (European Prospective Investigation into Cancer and Nutrition) study. DESIGN: We assessed prediagnostic selenium status by measuring serum concentrations of selenium and selenoprotein P (SePP; the major circulating selenium transfer protein) and examined the association with hepatocellular carcinoma (HCC; n = 121), gallbladder and biliary tract cancers (GBTCs; n = 100), and intrahepatic bile duct cancer (IHBC; n = 40) risk in a nested case-control design within the EPIC study. Selenium was measured by total reflection X-ray fluorescence, and SePP was determined by a colorimetric sandwich ELISA. Multivariable ORs and 95% CIs were calculated by using conditional logistic regression. RESULTS: HCC and GBTC cases, but not IHBC cases, showed significantly lower circulating selenium and SePP concentrations than their matched controls. Higher circulating selenium was associated with a significantly lower HCC risk (OR per 20-µg/L increase: 0.41; 95% CI: 0.23, 0.72) but not with the risk of GBTC or IHBC. Similarly, higher SePP concentrations were associated with lowered HCC risk only in both the categorical and continuous analyses (HCC: P-trend ≤ 0.0001; OR per 1.5-mg/L increase: 0.37; 95% CI: 0.21, 0.63). CONCLUSION: These findings from a large prospective cohort provide evidence that suboptimal selenium status in Europeans may be associated with an appreciably increased risk of HCC development.
Assuntos
Neoplasias do Sistema Biliar/etiologia , Carcinoma Hepatocelular/etiologia , Deficiências Nutricionais/complicações , Neoplasias Hepáticas/etiologia , Estado Nutricional , Selênio/deficiência , Selenoproteína P/sangue , Idoso , Ductos Biliares/patologia , Neoplasias do Sistema Biliar/sangue , Carcinoma Hepatocelular/sangue , Estudos de Casos e Controles , Deficiências Nutricionais/sangue , Deficiências Nutricionais/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Vesícula Biliar/patologia , Humanos , Fígado/patologia , Neoplasias Hepáticas/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Fatores de Risco , Selênio/sangueRESUMO
BACKGROUND: Capsaicin, which is the major pungent principle in chili peppers, is able to induce satiety and reduce caloric intake. The exact mechanism behind this satiating effect is still unknown. We hypothesized that capsaicin induces satiety through the release of gastrointestinal peptides, such as glucagon-like peptide-1 (GLP-1) and peptide YY (PYY), from enteroendocrine cells in the small intestine. OBJECTIVE: We investigate the effects of an intraduodenal capsaicin infusion (1.5 mg pure capsaicin) in healthy volunteers on hunger, satiety, and gastrointestinal symptoms and the release of GLP-1 and PYY. DESIGN: Thirteen participants (7 women) [mean ± SEM age: 21.5 ± 0.6 y; body mass index (in kg/m(2)): 22.8 ± 0.6] participated in this single-blind, randomized, placebo-controlled crossover study with 2 different treatments. During test days, an intraduodenal infusion of either capsaicin or a placebo (physiologic saline) was performed with the use of a nasoduodenal catheter over a period of 30 min. Visual analog scale scores were used to measure hunger, satiety, and gastrointestinal symptoms. Blood samples were drawn at regular intervals for GLP-1 and PYY. Gallbladder volumes were measured with the use of real-time ultrasonography. RESULTS: The intraduodenal capsaicin infusion significantly increased satiety (P-treatment effect < 0.05) but also resulted in an increase in the gastrointestinal symptoms pain (P-treatment × time interaction < 0.0005), burning sensation (P-treatment × time interaction < 0.0001), nausea (P-treatment × time interaction < 0.05), and bloating (P-treatment × time interaction < 0.001) compared with the effects of the placebo infusion. Satiety scores had a positive correlation with all gastrointestinal symptoms. No differences in GLP-1 and PYY concentrations and gallbladder volumes were observed after the capsaicin infusion compared with after the placebo infusion. CONCLUSIONS: An intraduodenal infusion of capsaicin significantly increases satiety but does not affect plasma concentrations of GLP-1 and PYY. Rather, the effect on satiety seems related to gastrointestinal stress as shown by the associations with pain, burning sensation, nausea, and bloating scores. This trial was registered at clinicaltrials.gov as NCT01667523.
Assuntos
Depressores do Apetite/efeitos adversos , Capsaicina/efeitos adversos , Suplementos Nutricionais/efeitos adversos , Enterite/etiologia , Peptídeo 1 Semelhante ao Glucagon/metabolismo , Peptídeo YY/metabolismo , Resposta de Saciedade , Dor Abdominal/etiologia , Adulto , Depressores do Apetite/administração & dosagem , Biomarcadores , Capsaicina/administração & dosagem , Estudos Cross-Over , Enterite/metabolismo , Enterite/patologia , Enterite/fisiopatologia , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/metabolismo , Vesícula Biliar/patologia , Peptídeo 1 Semelhante ao Glucagon/sangue , Humanos , Intubação Gastrointestinal , Náusea/etiologia , Tamanho do Órgão , Medição da Dor , Peptídeo YY/sangue , Método Simples-Cego , Ultrassonografia , Adulto JovemRESUMO
The experience of treatment in the clinic of 47 patients with acute calculous cholecystitis was analysed. The removal of the gallbladder found brown pigment stones. The clinical course of the disease in such patients, ultrasound data and instrumental methods were described. The triple antibiotic therapy application helped to reduce the risk of infection of bile, the elimination of the inflammatory process.
Assuntos
Antibacterianos/farmacologia , Infecções Bacterianas/prevenção & controle , Colecistectomia/métodos , Colecistite Aguda/cirurgia , Vesícula Biliar/cirurgia , Cálculos Biliares/cirurgia , Bile/microbiologia , Ceftriaxona/farmacologia , Clorofila/farmacologia , Colecistite Aguda/diagnóstico por imagem , Colecistite Aguda/patologia , Cor , Combinação de Medicamentos , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/patologia , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/patologia , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Metronidazol/farmacologia , Tomografia Computadorizada Multidetectores , Pigmentos Biológicos/análise , Extratos Vegetais/farmacologia , UltrassonografiaRESUMO
El abordaje laparoscópico es el tratamiento de elección para la cirugía de vesícula, sin embargo, algunos pacientes requieren una conversión de la técnica, lo que origina en ellos un dolor postoperatorio moderado-severo. Tradicionalmente los opioides han sido utilizados para tratar dicho dolor, pero sus efectos secundarios han llevado a la búsqueda de nuevas alternativas (administración de anestésicos locales en plexos, fascias, nervios o herida). Presentamos 4 casos clínicos a los que se realizó el bloqueo ecoguiado de las ramas cutáneas de los nervios intercostales en la línea axilar media de T6 a T12 con levobupivacaína como alternativa analgésica en cirugía abierta de vesícula, con unos buenos resultados (AU)
Laparoscopic cholecystectomy has become the standard treatment for gallbladder diseases. However, there are still some patients for whom conversion to open surgery is required. This surgery can produce significant post-operative pain. Opioids drugs have traditionally been used to treat this pain, but side effects have led to seeking alternatives (plexus, nerve or fascia blocks or wound). The cases are presented of 4 patients subjected to ultrasound-guided intercostal branches blocks in the mid-axillary line from T6 to T12 with levobupivacaine as an analgesic alternative in open surgery of gallbladder, with satisfactory results (AU)
Assuntos
Idoso de 80 Anos ou mais , Idoso , Feminino , Humanos , Masculino , Bloqueio de Ramo/tratamento farmacológico , Bloqueio de Ramo/terapia , Nervos Intercostais , Colecistectomia/métodos , Dor Pós-Operatória/complicações , Dor Pós-Operatória/tratamento farmacológico , Bupivacaína/uso terapêutico , Vesícula Biliar , Vesícula Biliar , Vesícula Biliar/patologia , Vesícula Biliar/cirurgia , Síndrome Pós-Colecistectomia/complicações , Síndrome Pós-Colecistectomia/tratamento farmacológico , Acetaminofen/uso terapêutico , Cetoprofeno/uso terapêutico , Anestesia LocalAssuntos
Adenocarcinoma Mucinoso/secundário , Neoplasias do Colo/patologia , Neoplasias Peritoneais/secundário , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/tratamento farmacológico , Adenocarcinoma Mucinoso/metabolismo , Adenocarcinoma Mucinoso/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cetuximab/administração & dosagem , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/cirurgia , Terapia Combinada , Diagnóstico Diferencial , Feminino , Fluoruracila/administração & dosagem , Vesícula Biliar/patologia , Genes ras , Humanos , Hipertermia Induzida , Intestinos/patologia , Leucovorina/administração & dosagem , Pessoa de Meia-Idade , Terapia Neoadjuvante , Omento/patologia , Compostos Organoplatínicos/administração & dosagem , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/secundário , Neoplasias Ovarianas/cirurgia , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/metabolismo , Neoplasias Peritoneais/cirurgia , Indução de Remissão , Ligamentos Redondos/patologia , Cirurgia de Second-LookRESUMO
The purpose of the present work was to study the level of microelements and vitamins in adolescents with diffuse nontoxic goiter. It has been shown that comorbid biliary dyskinesia leads to significant dysregulation of vitamin and mineral metabolism: the level of essential elements was decreased and the level of toxic elements was increased. Comorbid biliary dyskinesia in adolescents with diffuse nontoxic goiter was accompanied by a disbalance of vitamins. The changes found in micronutrients have sex differences.
Assuntos
Discinesia Biliar/metabolismo , Vesícula Biliar/metabolismo , Bócio Endêmico/metabolismo , Glândula Tireoide/metabolismo , Adolescente , Discinesia Biliar/complicações , Discinesia Biliar/diagnóstico por imagem , Discinesia Biliar/patologia , Cádmio/metabolismo , Criança , Cobalto/metabolismo , Diterpenos , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/patologia , Bócio Endêmico/complicações , Bócio Endêmico/diagnóstico por imagem , Bócio Endêmico/patologia , Cabelo/química , Humanos , Ferro/sangue , Chumbo/metabolismo , Masculino , Ésteres de Retinil , Riboflavina/urina , Selênio/metabolismo , Fatores Sexuais , Tiamina/urina , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Tireotropina/sangue , Tiroxina/sangue , Ultrassonografia , Vitamina A/análogos & derivados , Vitamina A/sangue , Zinco/sangue , alfa-Tocoferol/sangueRESUMO
OBJECTIVE: To describe the CT and MRI features of hepatic sinusoidal obstruction syndrome (HSOS) caused by herbal medicine Gynura segetum. MATERIALS AND METHODS: The CT and MRI features of 16 consecutive Gynura segetum induced HSOS cases (12 men, 4 women) were analyzed. Eight patients had CT; three patients had MRI, and the remaining five patients had both CT and MRI examinations. Based on their clinical presentations and outcomes, the patients were classified into three categories: mild, moderate, and severe. The severity of the disease was also evaluated radiologically based on the abnormal hepatic patchy enhancement in post-contrast CT or MRI images. RESULTS: Ascites, patchy liver enhancement, and main right hepatic vein narrowing or occlusion were present in all 16 cases. Hepatomegaly and gallbladder wall thickening were present in 14 cases (87.5%, 14/16). Periportal high intensity on T2-weighted images was present in 6 cases (75%, 6/8). Normal liver parenchymal enhancement surrounding the main hepatic vein forming a clover-like sign was observed in 4 cases (25%, 4/16). The extent of patchy liver enhancement was statistically associated with clinical severity classification (kappa = 0.565). CONCLUSION: Ascites, patchy liver enhancement, and the main hepatic veins narrowing were the most frequent signs of herbal medicine induced HSOS. The grade of abnormal patchy liver enhancement was associated with the clinical severity.
Assuntos
Hepatopatia Veno-Oclusiva/diagnóstico , Imageamento por Ressonância Magnética , Fitoterapia/efeitos adversos , Tomografia Computadorizada por Raios X , Adulto , Idoso , Ascite/diagnóstico , Asteraceae/química , Colecistografia , Feminino , Vesícula Biliar/patologia , Veias Hepáticas/diagnóstico por imagem , Veias Hepáticas/patologia , Hepatopatia Veno-Oclusiva/induzido quimicamente , Hepatomegalia/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Alcaloides de Pirrolizidina/efeitos adversos , Índice de Gravidade de Doença , Adulto JovemRESUMO
OBJECTIVES: To evaluate the clinical and imaging features of molecular target therapies (MTT)-associated gallbladder complications. METHODS: The clinical presentation, imaging features, management, and outcome in six consecutive patients, who developed gallbladder complications while on monotherapy with MTT, were studied. RESULTS: Imaging features included gallbladder distension, edema, hyperemia, pericholecystic fluid, and stranding. Two of the six patients were asymptomatic and continued the drug due to good response. Four of the six patients developed acute cholecystitis and required drug discontinuation temporarily or permanently with 2/4 patients requiring surgery. CONCLUSION: MTT can be associated with gallbladder complications that may need temporary or permanent discontinuation of the associated drug.
Assuntos
Doenças da Vesícula Biliar/induzido quimicamente , Doenças da Vesícula Biliar/diagnóstico , Indóis/efeitos adversos , Terapia de Alvo Molecular/efeitos adversos , Niacinamida/análogos & derivados , Compostos de Fenilureia/efeitos adversos , Pirróis/efeitos adversos , Doença Aguda , Adulto , Idoso , Colecistectomia , Colecistite/diagnóstico , Colecistite/etiologia , Colecistite Aguda/induzido quimicamente , Colecistite Aguda/patologia , Colecistite Aguda/cirurgia , Edema/induzido quimicamente , Feminino , Vesícula Biliar/irrigação sanguínea , Vesícula Biliar/patologia , Doenças da Vesícula Biliar/patologia , Doenças da Vesícula Biliar/cirurgia , Humanos , Isquemia/patologia , Masculino , Pessoa de Meia-Idade , Necrose/patologia , Niacinamida/efeitos adversos , Estudos Retrospectivos , Sorafenibe , SunitinibeRESUMO
OBJECTIVE: To describe the CT and MRI features of hepatic sinusoidal obstruction syndrome (HSOS) caused by herbal medicine Gynura segetum. MATERIALS AND METHODS: The CT and MRI features of 16 consecutive Gynura segetum induced HSOS cases (12 men, 4 women) were analyzed. Eight patients had CT; three patients had MRI, and the remaining five patients had both CT and MRI examinations. Based on their clinical presentations and outcomes, the patients were classified into three categories: mild, moderate, and severe. The severity of the disease was also evaluated radiologically based on the abnormal hepatic patchy enhancement in post-contrast CT or MRI images. RESULTS: Ascites, patchy liver enhancement, and main right hepatic vein narrowing or occlusion were present in all 16 cases. Hepatomegaly and gallbladder wall thickening were present in 14 cases (87.5%, 14/16). Periportal high intensity on T2-weighted images was present in 6 cases (75%, 6/8). Normal liver parenchymal enhancement surrounding the main hepatic vein forming a clover-like sign was observed in 4 cases (25%, 4/16). The extent of patchy liver enhancement was statistically associated with clinical severity classification (kappa = 0.565). CONCLUSION: Ascites, patchy liver enhancement, and the main hepatic veins narrowing were the most frequent signs of herbal medicine induced HSOS. The grade of abnormal patchy liver enhancement was associated with the clinical severity.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Ascite/diagnóstico , Asteraceae/química , Colecistografia , Vesícula Biliar/patologia , Veias Hepáticas/patologia , Hepatopatia Veno-Oclusiva/induzido quimicamente , Hepatomegalia/diagnóstico , Imageamento por Ressonância Magnética , Fitoterapia/efeitos adversos , Alcaloides de Pirrolizidina/efeitos adversos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios XRESUMO
AIM: To investigate the prevalence and risk factors of polypoid lesions of the gallbladder (PLGs) in petrochemical employees in Ningbo, Zhejiang Province, China. METHODS: All active and retired employees aged 20-90 years (n = 11098) of a refinery and chemical plant in eastern China were requested to participate in a health survey. The participants were subjected to interview, physical examination, laboratory assessments and ultrasonography. All the participants were invited to have a physical examination after a face-to-face interview. Fasting blood samples were obtained from the antecubital vein, and the samples were used for the analysis of biochemical values. Abdominal ultrasonography was conducted. RESULTS: A total of 10461 (7331 men and 3130 women) current and former petrochemical employees attended for screening. The overall prevalence of post-cholecystectomy, gallstones and PLGs was 0.9%, 5.2% and 7.4%, respectively. Compared with the increased prevalence of either gallstones or post-cholecystectomy in older persons, PLGs were more common in the middle-aged, peaking in those aged 40-59 years. Excluding the patients with gallstones, gallstones mixed with PLGs, or those who had undergone cholecystectomy, in the remaining 9828 participants, the prevalence of PLGs in men (8.9%) was significantly higher than that in women (5.5%, P < 0.001). The analyzed risk factors with increased OR for the development of PLGs were male gender (OR = 1.799, P < 0.001), age ≥ 30 years (OR = 2.699, P < 0.001) and hepatitis B surface antigen (HBsAg) positivity (OR = 1.374, P = 0.006). CONCLUSION: PLGs are not rare among Chinese petrochemical employees. Male gender, HBsAg positivity, and middle age are risk factors for developing PLGs.
Assuntos
Doenças da Vesícula Biliar/epidemiologia , Vesícula Biliar/patologia , Cálculos Biliares/epidemiologia , Saúde Ocupacional , Pólipos/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , China/epidemiologia , Indústrias Extrativas e de Processamento , Feminino , Vesícula Biliar/diagnóstico por imagem , Doenças da Vesícula Biliar/diagnóstico por imagem , Inquéritos Epidemiológicos , Antígenos de Superfície da Hepatite B , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional , Razão de Chances , Petróleo , Pólipos/diagnóstico por imagem , Prevalência , Fatores de Risco , Inquéritos e Questionários , Ultrassonografia , Adulto JovemRESUMO
AIM: Gemcitabine has been increasingly prescribed for the treatment of gallbladder cancer. However, the response rate is low. The aim of this study is to determine whether icariin, a flavonoid isolated from Epimedi herba, could potentiate the antitumor activity of gemcitabine in gallbladder cancer. METHODS: Human gallbladder carcinoma cell lines GBC-SD and SGC-996 were tested. Cell proliferation and apoptosis were analyzed using MTT assay and flow cytometry, respectively. The expression of apoptosis- and proliferation-related molecules was detected with Western blotting. Caspase-3 activity was analyzed using colorimetric assay, and NF-κB activity was measured with ELISA. A gallbladder cancer xenograft model was established in female BALB/c (nu/nu) mice. The mice were intraperitoneally administered gemcitabine (125 mg/kg) in combination with icariin (40 mg/kg) for 2 weeks. RESULTS: Icariin (40-160 µg/mL) dose-dependently suppressed cell proliferation and induced apoptosis in both GBC-SD and SGC-996 cells, with SGC-996 cells being less sensitive to the drug. Icariin (40 µg/mL) significantly enhanced the antitumor activity of gemcitabine (0.5 µmol/L) in both GBC-SD and SGC-996 cells. The mice bearing gallbladder cancer xenograft treated with gemcitabine in combination with icariin exhibited significantly smaller tumor size than the mice treated with either drug alone. In GBC-SD cells, icariin significantly inhibited both the constitutive and gemcitabine-induced NF-κB activity, enhanced caspase-3 activity, induced G(0)-G(1) phase arrest, and suppressed the expression of Bcl-2, Bcl-xL and surviving proteins. CONCLUSION: Icariin, by suppressing NF-κB activity, exerts antitumor activity, and potentiates the antitumor activity of gemcitabine in gallbladder cancer. Combined administration of gemcitabine and icariin may offer a better therapeutic option for the patients with gallbladder cancer.
Assuntos
Anti-Inflamatórios/farmacologia , Antineoplásicos/farmacologia , Desoxicitidina/análogos & derivados , Flavonoides/farmacologia , Neoplasias da Vesícula Biliar/tratamento farmacológico , Vesícula Biliar/efeitos dos fármacos , NF-kappa B/antagonistas & inibidores , Animais , Anti-Inflamatórios/uso terapêutico , Antineoplásicos/uso terapêutico , Apoptose/efeitos dos fármacos , Pontos de Checagem do Ciclo Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Desoxicitidina/farmacologia , Desoxicitidina/uso terapêutico , Sinergismo Farmacológico , Medicamentos de Ervas Chinesas/farmacologia , Medicamentos de Ervas Chinesas/uso terapêutico , Feminino , Flavonoides/uso terapêutico , Vesícula Biliar/imunologia , Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/imunologia , Neoplasias da Vesícula Biliar/patologia , Humanos , Camundongos , Camundongos Endogâmicos BALB C , NF-kappa B/imunologia , GencitabinaRESUMO
BACKGROUND AND AIM: The increasing prevalence of cholesterol gallstone (CG) disease has become an economic burden to the healthcare system. Ursodeoxycholic acid (UDCA) is the only established medical agent used to dissolve gallstones. In investigating novel therapeutics for CG, we assessed the preventive effects of n-3 polyunsaturated fatty acids (n-3PUFA) on the formation of CG induced by feeding a lithogenic diet (LD) containing high cholesterol levels to mice. METHODS: Mice were divided into the following six groups: (A) regular diet (RD); (B) RD+n-3PUFA; (C) LD; (D) LD+n-3PUFA; (E) LD+UDCA; (F) LD+n-3PUFA+UDCA. After RD/LD feeding for 2 weeks, n-3PUFA or UDCA was administered orally and the diet maintained for 8 weeks. The levels of phospholipids and cholesterol in bile, CG formation, gallbladder wall thickness, MUC gene expression in gallbladder were analyzed. RESULTS: No stone or sludge was evident in the RD groups (Groups A, B). Mice in the n-3PUFA treatment (Groups D, F) showed significantly lower stone formation than the other LD groups (Groups C, E). The combination treatment of n-3PUFA and UDCA suppressed stone formation more than mono-therapy with n-3PUFA or UDCA. Bile phospholipid levels were significantly elevated in the Group F. Hypertrophy of the gallbladder wall was evident in mice fed LD. MUC 2, 5AC, 5B and 6 mRNA expression levels were significantly elevated in the LD-fed group, and this was suppressed by n-3PUFA with or without UDCA. CONCLUSIONS: N-3PUFA attenuated gallstone formation in mouse, through increasing the levels of bile phospholipids and suppressing bile mucin formation.
Assuntos
Colesterol na Dieta/uso terapêutico , Ácidos Graxos Ômega-3/uso terapêutico , Cálculos Biliares/prevenção & controle , Mucinas/biossíntese , Animais , Bile/metabolismo , Colagogos e Coleréticos/farmacologia , Colagogos e Coleréticos/uso terapêutico , Colesterol/metabolismo , Colesterol na Dieta/farmacologia , Quimioterapia Combinada , Ácidos Graxos Ômega-3/farmacologia , Vesícula Biliar/patologia , Expressão Gênica/efeitos dos fármacos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Mucina-5AC/genética , Mucina-2/genética , Mucina-5B/genética , Mucina-6/genética , Mucinas/efeitos dos fármacos , Mucinas/genética , Mucosa/patologia , Fosfolipídeos/metabolismo , RNA Mensageiro/metabolismo , Estatísticas não Paramétricas , Ácido Ursodesoxicólico/farmacologia , Ácido Ursodesoxicólico/uso terapêuticoRESUMO
OBJECTIVE: Evaluation of the efficacy of black tea as the negative oral contrast agent in MRCP. MATERIALS AND METHODS: MRCP was performed before and 5 and 15 min after tea consumption for 35 patients. Depiction of the gall bladder (GB), cystic duct (CD), proximal and distal parts of the common bile duct (CBD), intrahepatic ducts (IHD), ampulla of vater (AV), main pancreatic duct (MPD) and signal loss of stomach and three different segments of the duodenum were investigated according to VAS and Likert scores. RESULTS: Twenty-one of the patients (60%) were female (mean age, 50.3 ± 19.2 years). Regarding visibility of different anatomical parts of the pancreatobiliary tree, the post procedure images were better visualized in the distal part of CBD, AV and MPD in Likert and VAS scoring (all P ≤ 0.001). Regarding obliteration of high signal in the stomach and three different parts of the duodenum, all post procedure images showed significant disappearance of high signal in Likert and VAS scoring systems (all Ps ≤ 0.001). CONCLUSION: Black tea is a simple and safe negative oral contrast agent which reduces the signal intensity of gastrointestinal tract fluid and provides improved depiction of the MPD, the distal CBD and the ampulla during MRCP. Key Points â¢Tea is an effective negative oral contrast agent for gastrointestinal MRI â¢Ingestion of black tea improves conspicuity of the distal CBD in MRCP.
Assuntos
Doenças Biliares/diagnóstico , Colangiopancreatografia por Ressonância Magnética , Meios de Contraste , Pancreatopatias/diagnóstico , Chá , Ductos Biliares Intra-Hepáticos/patologia , Doenças Biliares/patologia , Camellia sinensis , Colangiopancreatografia por Ressonância Magnética/métodos , Ducto Colédoco/patologia , Ducto Cístico/patologia , Feminino , Vesícula Biliar/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatopatias/patologia , Ductos Pancreáticos/patologiaRESUMO
OBJECTIVE: To investigate the therapeutic effect and safety of acupuncture at points of The Liver and Gallbladder Meridians for treatment of migraine. METHODS: Multi-central, randomized and controlled trial was used and 253 cases of migraine were divided into an acupuncture group and a western medicine group. The acupuncture group was treated with acupuncture at points of The Liver and Gallbladder Channels with Taichong (LR 3), Yang-lingquan (GB 34), Fengchi (GB 20), Ququan (LR 8) selected as main points, and the western medicine group with oral administration of Flunarizine tablets for 4 therapeutic courses. The total therapeutic effects 3 and 6 months after the treatment, the scores of various symptoms of migraine before and after treatment, and the stability of therapeutic effect in one-year following-up survey were observed in the two groups. RESULTS: After treatment, mean times and duration of the headache attack were significantly improved in the two groups (all P < 0.01) with the acupuncture group better than the western medicine group (P < 0.05). The total effective rates for stopping pain after treatment, 3 months and 6 months after treatment in the acupuncture group were 93.0%, 93.0% and 87.7%, respectively, which were better than 85.6%, 86.5% and 69.2% in the western medication group (all P < 0.01). One year later, the stability of the therapeutic effect in the acupuncture group was better than that in the western medicine group (P < 0.05); the adverse reaction and the compliance in the acupuncture group were significantly superior to those in the western medicine group. CONCLUSION: Acupuncture at points of The Liver and Gallbladder Meridians for treatment of migraine is safe, effective, and with stable long-term therapeutic effect.
Assuntos
Pontos de Acupuntura , Terapia por Acupuntura/métodos , Transtornos de Enxaqueca/terapia , Administração Oral , Adolescente , Adulto , Idoso , Feminino , Flunarizina/administração & dosagem , Flunarizina/uso terapêutico , Vesícula Biliar/patologia , Cefaleia/prevenção & controle , Antagonistas dos Receptores Histamínicos H1/administração & dosagem , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Humanos , Fígado/patologia , Masculino , Meridianos , Pessoa de Meia-Idade , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/patologia , Resultado do Tratamento , Adulto JovemRESUMO
Severe acute hepatitis of unknown etiology is difficult to treat and often progresses to subacute fulminant hepatitis or late-onset hepatic failure. A 45-year-old well-nourished, healthy man had progressive fatigue and his liver function tests showed severe liver dysfunction. The etiology of sever acute cholestatic hepatitis was unknown. The liver function tests normalized gradually, which excluded high persistent total bilirubin after starting on predonine. A liver biopsy showed chronic active hepatitis with mild fibrosis (A2, F1). Oral Inchinko-to, a Chinese herbal medicine, at 7.5 g daily was prescribed. The treatment was effective with no adverse effects. We present a successfully treated case and discuss hepatoprotective and choleretic effects of Inchinko-to.
Assuntos
Colestase Intra-Hepática , Medicina Tradicional Chinesa , Colagogos e Coleréticos/uso terapêutico , Colestase Intra-Hepática/tratamento farmacológico , Colestase Intra-Hepática/etiologia , Medicamentos de Ervas Chinesas , Vesícula Biliar/patologia , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
This paper presents a new approach to gallbladder ultrasonic image processing and analysis towards detection of disease symptoms on processed images. First, in this paper, there is presented a new method of filtering gallbladder contours from USG images. A major stage in this filtration is to segment and section off areas occupied by the said organ. In most cases this procedure is based on filtration that plays a key role in the process of diagnosing pathological changes. Unfortunately ultrasound images present among the most troublesome methods of analysis owing to the echogenic inconsistency of structures under observation. This paper provides for an inventive algorithm for the holistic extraction of gallbladder image contours. The algorithm is based on rank filtration, as well as on the analysis of histogram sections on tested organs. The second part concerns detecting lesion symptoms of the gallbladder. Automating a process of diagnosis always comes down to developing algorithms used to analyze the object of such diagnosis and verify the occurrence of symptoms related to given affection. Usually the final stage is to make a diagnosis based on the detected symptoms. This last stage can be carried out through either dedicated expert systems or more classic pattern analysis approach like using rules to determine illness basing on detected symptoms. This paper discusses the pattern analysis algorithms for gallbladder image interpretation towards classification of the most frequent illness symptoms of this organ.
Assuntos
Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/patologia , Processamento de Imagem Assistida por Computador/métodos , Reconhecimento Automatizado de Padrão/métodos , Ultrassonografia/métodos , Colecistite/diagnóstico por imagem , Colecistite/patologia , Colecistolitíase/diagnóstico por imagem , Colecistolitíase/patologia , Sistemas Inteligentes , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/patologia , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/patologia , Humanos , Bases de Conhecimento , Técnica de SubtraçãoRESUMO
OBJECTIVE: To observe the changes of intracellular free calcium level ([Ca(2+)]i) in gallbladder cells of guinea pigs with gallstones so as to study the mechanisms of gallstone formation and the prevention and treatment function of traditional Chinese herbs for nourishing the liver. METHODS: Eighty guinea pigs were randomly divided into four groups, which were normal control group, untreated group, nourishing-liver Chinese drug (NLCD) group and ursodeoxycholic acid (UDCA) group, with 20 guinea pigs in each group. Gallstones were induced in the guinea pigs of the latter 3 groups by the feed of diet inducing cholelithiasis with high cholesterol, while the corresponding medicines were used in NLCD group and UDCA group for prevention and treatment for 7 weeks. Then the state of the guinea pigs, the formation of gallstones, and the changes of [Ca(2+)]i in gallbladder cells were observed. RESULTS: The [Ca(2+)]i in gallbladder cells of guinea pigs in the untreated group was decreased significantly. NLCD improved the behavioral signs of the guinea pigs, significantly decreased the formative rate of gallstones and increased the [Ca(2+)]i in gallbladder cells. CONCLUSIONS: The [Ca(2+)]i in gallbladder cells is the important factor for contractile function of gallbladder and the information of gallstones. Traditional Chinese herbs for nourishing the liver may significantly increase the [Ca(2+)]i in gallbladder cells to facilitate contraction of the smooth muscle cells of gallbladder and relieve the cholestatis. It may be one of the mechanisms of traditional Chinese herbs for nourishing the liver in preventing and treating cholelithiasis.