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1.
Endoscopy ; 42(8): 677-80, 2010 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-20593344

RESUMEN

Standard endoscopic mucosal resection (EMR) is limited with regard to lesions below or involving the ileocecal valve. We describe the treatment and outcomes when using cap-assisted EMR (EMR-C) to remove large laterally spreading tumors (LSTs) with ileal infiltration in seven patients (median age 74 years). Each LST (median size 40 mm) was successfully resected in one session (median procedure time 50 minutes). Intraprocedural and early bleeding occurred in two patients, and delayed hemorrhage in one. Circumferential resection of the ileum caused asymptomatic strictures in six patients, with regression during follow-up for five. We conclude that the novel EMR-C method is a potentially effective treatment for cecal LST involving the distal ileum. Serious complications such as perforation or symptomatic strictures of the ileocecal valve were not observed and any procedure-related bleeding was easily controlled.


Asunto(s)
Neoplasias del Ciego/patología , Neoplasias del Ciego/cirugía , Colonoscopía/métodos , Neoplasias del Íleon/patología , Neoplasias del Íleon/cirugía , Válvula Ileocecal/patología , Válvula Ileocecal/cirugía , Mucosa Intestinal/patología , Mucosa Intestinal/cirugía , Pólipos Intestinales/patología , Pólipos Intestinales/cirugía , Adenoma Velloso/patología , Adenoma Velloso/cirugía , Anciano , Anciano de 80 o más Años , Colonoscopía/efectos adversos , Femenino , Humanos , Íleon/patología , Íleon/cirugía , Masculino , Persona de Mediana Edad , Estudios Prospectivos
2.
Dis Esophagus ; 23(7): 590-6, 2010 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-20545980

RESUMEN

Self-expanding metal stents (SEMS) are used to treat obstructive malignancies of the esophagus or esophagogastric junction; however, a potential complication is recurrent dysphagia because of tissue in/overgrowth. The placement of a second SEMS is one strategy to re-establish patency of the esophageal lumen. We evaluated the safety and efficacy of an alternative and likely less costly approach: placing a self-expanding plastic stent (SEPS) to manage relapsing dysphagia in patients previously treated with a partially covered SEMS. From December 2007 to January 2009, 13 patients previously treated with a SEMS for malignant dysphagia underwent treatment by inserting a SEPS to palliate relapsing dysphagia, as a result of tissue in/overgrowth. Stenosis was located in the upper esophagus in one patient, in the middle in four patients, and in the lower esophagus in eight patients. Clinical evaluation was performed at the time of stent placement, after 1 week, and then, monthly until death. The SEPS was successfully placed in a single treatment session for all patients. No preliminary dilation was required, and no further treatment was necessary for any patient. Before stenting, the median dysphagia score was 4 (range 3-4), and 1 week later the score was 0 for all patients. The resolution of dysphagia persisted until patient death (from tumor progression). The mean survival after the SEPS insertion was 4 months (range 3-8). This case series supports the use of a SEPS to palliate dysphagia from tissue in/overgrowth of a SEMS. Future clinical trials with larger patient samples are warranted.


Asunto(s)
Neoplasias Esofágicas/cirugía , Cuidados Paliativos , Stents , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Plásticos , Estudios Prospectivos , Diseño de Prótesis
3.
Gastroenterol Clin Biol ; 34(6-7): 367-70, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20576382

RESUMEN

Endoscopic mucosal resection (EMR) is a minimally invasive technique for effective treatment of early stage colorectal lesions with no invasive potential. However, the high frequency of local recurrence after piecemeal EMR for large lesions is considered a serious problem. In contrast, endoscopic submucosal dissection (ESD) allows en-bloc resection, irrespective of the lesion's size. ESD has been established as a standard method for the endoscopic removal of early cancers in the upper gastrointestinal tract in Japan. Although the use of ESD for colorectal lesions has been studied clinically, ESD is not yet established as a standard therapeutic method. We define the indications for en-bloc resection, based on extensive clinicopathological analyses, as a laterally spreading tumor (LST) non-granular type (LST-NG) lesion greater than 20 mm and an LST granular (LST-G) type lesion greater than 40 mm. Both of these lesions had a high submucosal invasion rate. Especially, LST-NG type lesions greater than 20 mm are technically difficult to remove completely even by piecemeal EMR and are considered a "definite indication for en-bloc resection". The ESD procedure is undoubtedly an ideal method to achieve en-bloc resection, however, the prevalences of suitable lesions among all neoplastic lesions and among all early cancers were not high (1.0% and 5.0%, respectively). Therefore, it is crucial to master more fundamental therapeutic techniques and have knowledge of surveillance strategy after endoscopic treatment.


Asunto(s)
Neoplasias Colorrectales/cirugía , Endoscopía Gastrointestinal , Neoplasias Colorrectales/patología , Humanos , Mucosa Intestinal/cirugía , Invasividad Neoplásica
5.
Eur J Clin Nutr ; 71(8): 980-986, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-28488688

RESUMEN

BACKGROUND/OBJECTIVES: Only a few papers have treated of the relationship between Barrett's esophagus (BE) or erosive esophagitis (E) and coffee or tea intake. We evaluated the role of these beverages in BE and E occurrence. SUBJECTS/METHODS: Patients with BE (339), E (462) and controls (619) were recruited. Data on coffee and tea and other individual characteristics were collected using a structured questionnaire. RESULTS: BE risk was higher in former coffee drinkers, irrespective of levels of exposure (cup per day; ⩽1: OR=3.76, 95% CI 1.33-10.6; >1: OR=3.79, 95% CI 1.31-11.0; test for linear trend (TLT) P=0.006) and was higher with duration (>30 years: OR=4.18, 95% CI 1.43-12.3; TLT P=0.004) and for late quitters, respectively (⩽3 years from cessation: OR=5.95, 95% CI 2.19-16.2; TLT P<0.001). The risk of BE was also higher in subjects who started drinking coffee later (age >18 years: OR=6.10, 95% CI 2.15-17.3). No association was found in current drinkers, but for an increased risk of E in light drinkers (<1 cup per day OR =1.85, 95% CI 1.00-3.43).A discernible risk reduction of E (about 20%, not significant) and BE (about 30%, P<0.05) was observed in tea drinkers. CONCLUSIONS: Our data were suggestive of a reduced risk of BE and E with tea intake. An adverse effect of coffee was found among BE patients who had stopped drinking coffee. Coffee or tea intakes could be indicative of other lifestyle habits with protective or adverse impact on esophageal mucosa.


Asunto(s)
Esófago de Barrett/prevención & control , Café , Esofagitis/prevención & control , Alimentos Funcionales , , Adulto , Anciano , Esófago de Barrett/diagnóstico por imagen , Esófago de Barrett/epidemiología , Esófago de Barrett/etiología , Estudios de Casos y Controles , Café/efectos adversos , Endoscopía Gastrointestinal , Mucosa Esofágica/diagnóstico por imagen , Esofagitis/diagnóstico por imagen , Esofagitis/epidemiología , Esofagitis/etiología , Femenino , Humanos , Incidencia , Italia/epidemiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Autoinforme , Té/efectos adversos , Tés de Hierbas/efectos adversos
7.
Crit Rev Oncol Hematol ; 37(2): 127-35, 2001 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-11166586

RESUMEN

Biliary obstructions, due to pancreatic cancer and cholangiocarcinoma, have an ominous prognosis. At the time of diagnosis, most patients are beyond any curative treatment. Palliative therapies, such as transhepatic biliary drainage, bypass surgery, and endoscopy, have an established role in the management of such patients. Endoscopic retrograde cholangio-pancreatography (ERCP) plays a key role, allowing diagnosis, collection of cytologic and bioptic specimens, and insertion of large-bore biliary stents. The major drawback of plastic stents is the high rate of clogging, requiring frequent stent exchange. In the 1990s, self-expanding metal stents (SEMS) were developed and randomized studies have shown their superiority over plastic stents. SEMS can be successfully used in patients with hilar tumors. Duodenal obstruction due to biliopancreatic neoplasms can also be managed endoscopically. ERCP can be performed on an outpatient basis in selected patients, reducing costs related to hospitalization. A team approach is mandatory to obtain the best results.


Asunto(s)
Neoplasias del Sistema Biliar/cirugía , Endoscopía Gastrointestinal , Neoplasias Pancreáticas/cirugía , Humanos
8.
Cancer Epidemiol Biomarkers Prev ; 5(7): 559-65, 1996 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-8827361

RESUMEN

Barrett's Esophagus (BE) is a complication of gastroesophageal reflux in which the normal squamous epithelium of the lower esophagus is replaced by metaplastic tissue. The clinical significance of this condition is the associated predisposition to adenocarcinomas (ADCs). Three types of BE have been characterized: the gastric fundic (F) type, the gastric cardial (C) type, and the intestinal (I) type. The latter is the most closely associated with the development of ADCs; the causes of this bias remain unknown. To determine whether p53 and/or K-ras gene alterations (a) are present in preneoplastic lesions and (b) are associated with a specific histotype, we performed PCR-based denaturing gradient gel electrophoresis (DGGE) analysis of exon 1 (codons 12-13) of K-ras gene and of exons 5-8 of the p53 gene in biopsies obtained from 30 patients with BE of the I type (9 patients), combined I type (I + C +/- F; 10 patients) and non-I type (C, F, or C + F; 11 patients). None of the cases under study revealed K-ras mutations, whereas biopsies from 12 patients showed at least one p53 DGGE variant. Four patients showed the exact same variants in leukocytes also (polymorphisms), whereas eight cases revealed specific DGGE variants only in biopsies. The molecular characterization of these variants revealed that four of them showed a single base pair substitution, and four showed multiple mutations. Of 17 somatic mutations, all but 1 were base pair substitutions located mainly in exons 7 and 8. The majority of these mutations were GC targeted (13 of 16; 81%), 54% (7 of 13) of which were transitions occurring at CpG sites. All somatic mutations were found in BE with at least one I component. The association with the histotype was statistically significant (P < 0.03; pure I type versus non-I type; P < 0.04, combined I type versus non-I type; Fisher's exact test). Loss of heterozygosity in the vicinity of the p53 locus was evaluated by PCR using a highly polymorphic variable number of tandem repeats marker on 25 out of 30 cases. Ninety-two % of the cases analyzed were informative, and none of them showed LOH. In conclusion, we showed that p53 mutations are frequently observed in specimens from BE patients of the I-type, whereas no involvement of K-ras (exon 1) mutational activation was observed. In light of the key roles that the p53 protein plays in controlling cell cycle and cell diploidy, this result may suggest why this type of metaplasia is the most closely associated to the development of ADCs.


Asunto(s)
Esófago de Barrett , Neoplasias Esofágicas/etiología , Genes p53 , Genes ras , Lesiones Precancerosas/patología , Adulto , Anciano , Anciano de 80 o más Años , Esófago de Barrett/genética , Esófago de Barrett/patología , Biopsia , Transformación Celular Neoplásica/genética , Técnicas de Cultivo , Neoplasias Esofágicas/patología , Esofagoscopía , Femenino , Genes p53/fisiología , Genes ras/fisiología , Humanos , Intestinos/patología , Masculino , Persona de Mediana Edad , Mutación , Reacción en Cadena de la Polimerasa , Sensibilidad y Especificidad
9.
Eur J Cancer ; 31A(7-8): 1160-5, 1995.
Artículo en Inglés | MEDLINE | ID: mdl-7577013

RESUMEN

Photodynamic therapy (PDT) produces localised necrosis with light after prior administration of a photosensitising drug. As PDT lesions in the gastrointestinal tract heal so well, the technique is suitable for repeated endoscopic use. In this study, PDT was used to treat large polyps (four duodenal and two colorectal) unsuitable for surgery in 6 patients with familial adenomatous polyposis (FAP). Patients were sensitised with 60 mg/kg 5-aminolaevulinic acid (ALA) orally or intravenous (i.v.) 2.0 mg/kg Photofrin. Laser treatment was performed 6 h after ALA or 48 h after Photofrin using a gold vapour laser. Necrosis was only superficial (up to 1.8 mm) using ALA but much deeper using Photofrin. The one malignant polyp (8 mm diameter in the colon) showed a complete response using Photofrin. All healed safely with no complications. Photofrin worked better, but caused cutaneous photosensitivity lasting up to 3 months. ALA cleared within 2 days, but its use is limited by the superficial effect. Better results with ALA may be obtained using higher drug doses or modified light dosimetry. Fluorescence microscopy showed no evidence of selectivity of photosensitisation between neoplastic and normal tissue. PDT is a promising treatment for inoperable polyps in patients with FAP, but further work is required to optimise the treatment conditions.


Asunto(s)
Poliposis Adenomatosa del Colon/tratamiento farmacológico , Fotoquimioterapia , Adenoma/tratamiento farmacológico , Adulto , Ácido Aminolevulínico/uso terapéutico , Antineoplásicos/uso terapéutico , Neoplasias del Colon/tratamiento farmacológico , Éter de Dihematoporfirina/uso terapéutico , Neoplasias Duodenales/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fotoquimioterapia/efectos adversos , Proyectos Piloto , Neoplasias del Recto/tratamiento farmacológico
10.
Aliment Pharmacol Ther ; 16(5): 893-8, 2002 May.
Artículo en Inglés | MEDLINE | ID: mdl-11966497

RESUMEN

AIM: To assess the oesophageal manometric characteristics and 24-h pH profiles of patients with both short-segment and long-segment Barrett's oesophagus and compare them with those of patients with reflux oesophagitis and controls. METHODS: Seventy-nine patients who had undergone upper digestive endoscopy were recruited: 16 had short-segment Barrett's oesophagus, 13 had long-segment Barrett's oesophagus, 25 had grade III oesophagitis according to the Savary-Miller classification and 25 were used as controls. The diagnosis of Barrett's oesophagus was based on the histological detection of specialized intestinal metaplasia, which extended < 3 cm into the oesophagus in patients with short-segment disease and > 3 cm in patients with long-segment disease. All subjects underwent oesophageal manometry and basal 24-h oesophageal pH monitoring. RESULTS: The lower oesophageal sphincter pressure was significantly lower in patients with reflux oesophagitis and short-segment and long-segment Barrett's oesophagus than in controls (P=0.0004-0.0001), but there was no difference among the three reflux groups. The peristaltic wave amplitude of patients with long-segment Barrett's oesophagus was significantly lower than that of controls (P=0.002) and patients with short-segment Barrett's oesophagus (P=0.02), but was no different from that of patients with reflux oesophagitis. The percentage of non-propagated wet swallows was significantly higher in patients with reflux oesophagitis and short-segment and long-segment Barrett's oesophagus when compared with that of controls (P=0.0004-0.0001). The total percentage of time the oesophagus was exposed to pH < 4.0 was significantly higher in patients with reflux oesophagitis and short-segment and long-segment Barrett's oesophagus (P=0.0001) than in controls, and was higher in patients with long-segment disease than in those with short-segment disease (P=0.01). CONCLUSIONS: Long-segment Barrett's oesophagus is characterized by a greater impairment of peristaltic wave amplitude and a higher oesophageal acid exposure than is short-segment Barrett's oesophagus. However, both forms are linked to increased acid reflux.


Asunto(s)
Esófago de Barrett/fisiopatología , Reflujo Gastroesofágico/fisiopatología , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Manometría , Persona de Mediana Edad
11.
Eur J Cancer Prev ; 10(6): 483-7, 2001 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-11916346

RESUMEN

Barrett's oesophagus is a precancerous condition in which the normal squamous epithelium is replaced by intestinal metaplasia (IM). IM can then progress through increasingly severe dysplasia to oesophageal adenocarcinoma (EAC). In the gastric cardia the normal gastric mucosa, when inflamed (carditis), can be replaced by IM and can then progress to gastric adenocarcinoma (GAC). The same histopathological sequence can take place on either side of the oesophagogastric junction. Since the location of that junction can be uncertain this can result in confused diagnosis between EAC and GAC. In this review, the diagnostic criteria, incidence and risk factors for Barrett's oesophagus and carditis are discussed, together with the factors determining the risk of progression to adenocarcinoma of the oesophagus or cardia. The risk factors include familial/genetic, environmental and dietary characteristics. Finally, these risk factors are discussed within the context of cancer prevention.


Asunto(s)
Adenocarcinoma/patología , Esófago de Barrett/patología , Cardias/patología , Neoplasias Esofágicas/patología , Unión Esofagogástrica/patología , Neoplasias Gástricas/patología , Adenocarcinoma/epidemiología , Adenocarcinoma/etiología , Esófago de Barrett/epidemiología , Esófago de Barrett/etiología , Progresión de la Enfermedad , Endoscopía , Neoplasias Esofágicas/epidemiología , Neoplasias Esofágicas/etiología , Reflujo Gastroesofágico/complicaciones , Humanos , Incidencia , Metaplasia , Factores de Riesgo , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/etiología
12.
Anticancer Res ; 12(3): 705-8, 1992.
Artículo en Inglés | MEDLINE | ID: mdl-1622127

RESUMEN

The aim of this study was to verify the presence of androgen receptors (AR) in human colorectal adenomas and in normal adjacent mucosa, and to determine whether there is any difference in AR tissue content between females and males. Our data show higher levels of nuclear AR in normal mucosa than in adenomas (p less than 0.001). A significant difference was also present in males between normal and pathological tissue both in cytosolic (p less than 0.05) and nuclear receptors (p less than 0.01). In female subjects this difference was also evident, but not significant. Our results seem to support the hypothesis of protective effects of androgens in colonic mucosa.


Asunto(s)
Adenoma/química , Núcleo Celular/química , Neoplasias Colorrectales/química , Mucosa Intestinal/química , Receptores Androgénicos/análisis , Adenoma/patología , Núcleo Celular/ultraestructura , Neoplasias Colorrectales/patología , Citosol/química , Citosol/ultraestructura , Femenino , Humanos , Mucosa Intestinal/patología , Masculino , Persona de Mediana Edad , Caracteres Sexuales
13.
Int J Biol Markers ; 3(2): 95-100, 1988.
Artículo en Inglés | MEDLINE | ID: mdl-3243982

RESUMEN

Serum concentrations of the CA 19-9 tumour marker were determined in 35 patients with histologically proven bilio-pancreatic malignancies associated with obstructive jaundice and in 35 patients with benign extrahepatic jaundice due to choledocholithiasis. At a cut-off level of 37 U/ml the sensitivity of this assay was 82.8%, but the specificity was very low (45.7%). Thus CA 19-9 can not be employed to differentiate between malignant and benign extrahepatic jaundice. Serial samples of CA 19-9 were achieved in 7 patients with benign and in 6 patients with malignant biliary obstruction, before and after the disappearance of jaundice. Serum concentrations of this tumour-antigen returned to normal concurrently with the bilirubin values only in patients with benign obstruction, remaining unchanged in all cases of malignancies. The data suggest that patients with extrahepatic jaundice should be evaluated by other examinations or by collecting serial samples for this assay.


Asunto(s)
Adenocarcinoma/diagnóstico , Antígenos de Carbohidratos Asociados a Tumores/análisis , Neoplasias del Sistema Biliar/diagnóstico , Biomarcadores de Tumor/sangre , Colestasis/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Adenocarcinoma/complicaciones , Neoplasias del Sistema Biliar/complicaciones , Colestasis/etiología , Diagnóstico Diferencial , Reacciones Falso Negativas , Reacciones Falso Positivas , Humanos , Metástasis de la Neoplasia , Neoplasias Pancreáticas/complicaciones , Radioinmunoensayo
14.
Eur J Gastroenterol Hepatol ; 9(9): 881-5, 1997 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-9355787

RESUMEN

BACKGROUND: Barrett's oesophagus is a premalignant condition leading to adenocarcinoma. The incidence of adenocarcinoma of the oesophagus and the gastrooesophageal junction is rapidly increasing in the USA, northern and central Europe. Data from southern Europe are still unavailable. OBJECTIVE: To evaluate the incidence of oesophageal adenocarcinoma in a large cohort of Italian patients with Barrett's oesophagus. METHODS: A total of 344 patients (253 males and 91 females, age range 19-75 years) with histologically proven Barrett's oesophagus (length of metaplasia > or = 3 cm) were enrolled from November 1987 to June 1995. Endoscopic and histological examinations were scheduled at yearly intervals. RESULTS: One hundred and eighty-seven patients complied with the follow-up. The mean duration of the follow-up period was 36 months (total follow-up 562 patient-years; range 12-90 months). Low grade dysplasia was found in five patients at the initial examination. During the surveillance period, dysplasia increased in frequency as well as in severity and was found exclusively in the intestinal type of Barrett's oesophagus. In all, dysplastic changes were found in seven patients (five low grade and two high grade) and adenocarcinoma developed in three patients during the follow-up. In a single case, both adenocarcinoma and specialized columnar epithelium developed without any evidence of dysplasia or intestinal metaplasia at the previous follow-up examination. This prospective study shows an incidence of adenocarcinoma in Barrett's oesophagus of 1/187 patient-years. When only patients with specialized columnar epithelium were considered, the risk of adenocarcinoma was 1/88 patient-years. CONCLUSION: The present report shows that the incidence of adenocarcinoma in Italian Barrett's oesophagus patients is in the range of that reported from other Western countries.


Asunto(s)
Adenocarcinoma/epidemiología , Esófago de Barrett/epidemiología , Neoplasias Esofágicas/epidemiología , Adulto , Anciano , Estudios de Cohortes , Endoscopía , Femenino , Humanos , Italia , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Estudios Prospectivos
15.
Eur J Gastroenterol Hepatol ; 11(8): 891-6, 1999 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-10514123

RESUMEN

BACKGROUND: Epidemiological data on acute pancreatitis are poorly defined. AIMS: To prospectively evaluate the aetiology of acute pancreatitis and to assess the benefits of intensive investigations. METHODS: In a prospective, 1-year study all cases of acute pancreatitis in the Nice catchment area were enrolled. Subjects underwent routine (serum calcium, phosphate and triglycerides; abdominal ultrasonography and CT scan) and additional, delayed intensive investigations (ERCP with bile sampling and/or endoscopy ultrasonography). RESULTS: One hundred and twenty-one cases were included. After routine investigations, a biliary, alcoholic, miscellaneous or unknown origin was diagnosed in 43%, 31.4%, 9.9% and 15.7%, respectively. In subjects with biliary pancreatitis, 43% had no previous history of biliary disease. In the alcohol-related subgroup, pancreatitis recurred in 18.5% during 114.5 days mean follow-up. In subjects with a first episode of alcoholic pancreatitis, delayed supplemental investigations revealed underlying chronic pancreatitis in 92.8%. After routine investigations, a diagnosis of pancreatitis of unknown origin was made in 15.7% (n = 19) of subjects. Additional investigations revealed an underlying cause in 57.8% of these patients (n = 11), including malignancy (n = 3) and biliary disease (n = 4), reducing the overall rate of pancreatitis with no apparent cause to 6.6%. CONCLUSIONS: Investigative techniques, particularly ERCP, will reveal the underlying aetiology of pancreatitis in the majority of patients presenting with 'idiopathic' pancreatitis and should be considered when routine tests are negative.


Asunto(s)
Pancreatitis Alcohólica/epidemiología , Pancreatitis/epidemiología , Pancreatitis/etiología , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/efectos adversos , Enfermedades de las Vías Biliares/complicaciones , Enfermedades de las Vías Biliares/diagnóstico , Colangiopancreatografia Retrógrada Endoscópica , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pancreatitis/diagnóstico , Pancreatitis/mortalidad , Pancreatitis Alcohólica/diagnóstico , Pancreatitis Alcohólica/mortalidad , Estudios Prospectivos , Factores Sexuales
16.
Gastrointest Endosc Clin N Am ; 9(1): 71-92, 1999 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-9834318

RESUMEN

Approximately 5% of all patients with gastrointestinal hemorrhage, and up to 38% of subjects with iron deficiency anemia without overt gastrointestinal bleeding, do not have a bleeding site identified after routine evaluation by esophagogastroduodenoscopy and colonoscopy. The source of bleeding in these subjects is often the small intestine. Most vascular lesions of the small bowel present as chronic gastrointestinal bleeding, which may severe in some cases. Depending on the underlying disease, other systemic signs and symptoms may be present. The diagnosis and often therapy are heavily dependent upon endoscopic techniques, and in some cases nonendoscopic methods.


Asunto(s)
Endoscopía Gastrointestinal , Enfermedades Intestinales/diagnóstico , Intestino Delgado/irrigación sanguínea , Enfermedades Vasculares/diagnóstico , Anciano , Niño , Endoscopía , Estudios de Seguimiento , Humanos , Lactante , Enfermedades Intestinales/cirugía , Intestino Delgado/patología , Intestino Delgado/cirugía , Persona de Mediana Edad , Estudios Retrospectivos , Seguridad , Enfermedades Vasculares/cirugía
17.
Neoplasma ; 42(3): 109-13, 1995.
Artículo en Inglés | MEDLINE | ID: mdl-7637818

RESUMEN

5-Aminolaevulinic acid (ALA) is a promising agent for photodynamic therapy (PDT) sensitization as it can be given orally and only causes skin photosensitivity for 1-2 days. In fluorescence and photodynamic studies 26 patients with benign and malignant gastrointestinal tumors were given 30-60 mg ALA orally (single or divided doses) and biopsies were taken of tumor and normal tissue at 1-24 hours for fluorescence microscopy. With 30 mg/kg, highest protoporphyrin IX (PPIX) levels were seen in esophagus, duodenum and less in colon, but without tumor selectivity. Better tumor selectivity was seen in colon after 60 mg/kg (5:1). Six patients had transient rises in transaminases and five mild nausea. Sixteen patients were later treated (after further ALA) with red light (628 nm, bare or diffuser fibre, 50-100 J at 50 mW at each site). All but two showed subsequent necrosis, but only 0.5-1.5 mm of depth. PDT with ALA is simple, safe and promising for tumors in the gastrointestinal tract. Modification of treatment parameters may make it suitable for larger lesions.


Asunto(s)
Ácido Aminolevulínico/farmacocinética , Ácido Aminolevulínico/uso terapéutico , Neoplasias Gastrointestinales/tratamiento farmacológico , Fotoquimioterapia , Protoporfirinas/farmacocinética , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Ácido Aminolevulínico/efectos adversos , Biotransformación , Femenino , Neoplasias Gastrointestinales/metabolismo , Humanos , Masculino , Microscopía Fluorescente , Persona de Mediana Edad , Proyectos Piloto , Protoporfirinas/metabolismo , Distribución Tisular
18.
Neoplasma ; 45(3): 157-61, 1998.
Artículo en Inglés | MEDLINE | ID: mdl-9717528

RESUMEN

Photodynamic therapy (PDT) produces localized necrosis with light after prior administration of a photosensitizing drug. As PDT lesions in the gastrointestinal tract heal well, the technique is suitable for repeated endoscopic use. In this study we used PDT to treat benign and malignant gastrointestinal tumors in esophagus, duodenum and rectum in 22 patients, who refused or were not suitable for surgery. Patients were sensitized with 0.15 mg/kg of body weight with mesotetrahydroxyphenylchlorin i.v. m-THPc (2 patients), with 2.0 mg/kg Photofrin i.v. (4 patients) or 60 mg/kg 5-aminolevulinic acid orally ALA (which is converted in vivo to active derivate protoporphyrin IX-PRIX) in fractionated doses (16 patients). Laser treatment was performed 2 days after Photofrin, 2 and 4 days after mTHPc and 4 hours after ALA, using a metal vapour laser (628 nm, 50-150 J/cm2 for ALA and Photofrin, 650 nm and 10-15 J/cm2 for mTHPc). Using ALA, the necrosis was only superficial (up to 1.8 mm depth). Four patients treated with Photofrin showed deeper necrosis, in one case of 8 mm colon cancer complete response, in three cases 1-1.5 cm adenomatous polyps involving the ampulla Vateri 50% longer term reduction in size-seen endoscopically. Two patients with rectal villous adenomas treated with mTHPc showed 60-80% reduction in size (observed endoscopically) within few days after PDT, with better effects for treatment carried out 4 rather than 2 days after the sensitization. In all patients the healing was without any complications. Photofrin and mTHPc work better, but cause cutaneous photosensitivity lasting 12 and 5 weeks, respectively. Better results with ALA are possible when using higher drug doses or modified light dosimetry. PDT is a promising treatment for small localized tumors in patients unsuitable for surgery, but further work is required to optimize the treatment conditions.


Asunto(s)
Neoplasias Gastrointestinales/tratamiento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotosensibilizantes/uso terapéutico , Adulto , Anciano , Ácido Aminolevulínico/uso terapéutico , Éter de Dihematoporfirina/uso terapéutico , Neoplasias Duodenales/tratamiento farmacológico , Neoplasias Esofágicas/tratamiento farmacológico , Femenino , Humanos , Rayos Láser , Masculino , Mesoporfirinas/uso terapéutico , Persona de Mediana Edad , Proyectos Piloto , Profármacos/uso terapéutico , Protoporfirinas/uso terapéutico , Neoplasias del Recto/tratamiento farmacológico
19.
Hepatogastroenterology ; 43(12): 1518-22, 1996.
Artículo en Inglés | MEDLINE | ID: mdl-8975958

RESUMEN

BACKGROUND/AIMS: The ideal treatment for patients with advanced rectal cancer and who cannot undergo a radical therapy is still undefined. The association between lasertherapy (LT) and internal radiotherapy (IRT) could affect both technical results and quality of life. This study was aimed at evaluating the association of LT and IRT in the palliative treatment of rectal cancer. MATERIAL AND METHODS: Between January and April 1994, 9 patients (2 males, 7 females) with rectal cancer underwent a combined treatment modality in order to control their symptoms. All patients were unfit for surgery and EUS showed an invasion of the whole muscular layer. After laser recanalization, brachytherapy was applied at a one week interval from last laser session. Two fractions of 10 Gy were administered at one week intervals. RESULTS: The mean number of laser sessions to obtain a complete recanalization was 3 (range:2-5) and no complications occurred. After IRT, we obtained a good result in 7/9 patients (79%) and 2 patients required further LT. The mean follow-up was 146 days (range:74-240): during this period no laser treatment was performed. Four patients complained of acute perineal pain and tenesmus after brachytherapy: in one patient, a colostomy was performed. CONCLUSION: We deem that the administration of two fractions of 10 Gy is not advisable, particularly for the treatment of non-circumferential lesions, due to the severe side effects we observed.


Asunto(s)
Adenocarcinoma/radioterapia , Adenocarcinoma/cirugía , Braquiterapia , Terapia por Láser , Cuidados Paliativos , Neoplasias del Recto/radioterapia , Neoplasias del Recto/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Femenino , Humanos , Masculino , Neodimio , Dosificación Radioterapéutica , Resultado del Tratamiento , Itrio
20.
Hepatogastroenterology ; 46(25): 272-7, 1999.
Artículo en Inglés | MEDLINE | ID: mdl-10228806

RESUMEN

BACKGROUND/AIMS: Self-expanding metal stents (SEMS) represent a major advancement in the palliative treatment of dysphagia caused by neoplasms of the esophagus. Malignant cervical stenoses are a challenge for palliative techniques, due to their close relationship with the cricopharynx. METHODOLOGY: Six patients with a malignant stricture of the upper esophagus, within 2 cm of the cricopharyngeal muscle, were treated with a self-expanding metal stent. All patients had a circumferential squamous cell carcinoma histologically proven. Patients were intubated under general anesthesia, and the procedure was carried out under simultaneous endoscopic and fluoroscopic control. RESULTS: All patients had a remarkable improvement of dysphagia and none of them reported a foreign body sensation. In 3 patients, an insufficient expansion of the stent, detected 24 hours later, required a balloon dilation in two of them, whereas, for the third patient, it was necessary to introduce a second stent. Neoplastic in- and overgrowth occurred in 4 (67%) patients after 1, 2, 4 and 8 months, respectively. These complications were managed by placing a second stent in 3 patients; in the fourth patient, a neoplastic involvement of the cricopharynx did not allow for an endoscopic examination. Improvement of dysphagia was observed only in the patient who received a covered Cook-Z stent. In the other 2 patients, a percutaneous endoscopic gastrostomy was performed. The only major complication occurred in the patient who received three metal stents, as he complained of severe cervical pain. CONCLUSIONS: Our experience shows that uncovered self-expanding metal stents provide a good palliation in this subgroup of patients. Tumour ingrowth, overgrowth, and the progressive impairment of the swallowing mechanism due to a proximal submucosal infiltration remain complications difficult to solve.


Asunto(s)
Carcinoma de Células Escamosas/complicaciones , Neoplasias Esofágicas/complicaciones , Cuidados Paliativos , Stents , Anciano , Anciano de 80 o más Años , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Estenosis Esofágica/etiología , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Resultado del Tratamiento
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