RESUMEN
We present the case of a 79-year-old man who presents falciform ligament thrombosis after umbilical vein recanalization as an uncommon complication of acute pancreatitis. The performance of abdomino-pelvic CT with contrast, allowed its diagnosis, as well as the establishment of an adequate treatment with favorable evolution.
RESUMEN
Pancreatic cancer surveillance can improve outcomes in high-risk individuals. However, little is known about its applicability and findings in routine clinical practice. Our aim was to evaluate findings on screening tests in high-risk individuals in a clinical practice setting and to analyze factors associated with the presence of relevant pancreatic lesions. We developed a prospective observational study of pancreatic cancer high risk patients that meet criteria of surveillance from the International Cancer of the Pancreas Screening Consortium. The demographic variables, other risk factors and imaging findings are collected. Patients with significant findings are compared to those without noteworthy findings. Of 70 high-risk individuals, 25 fitted the criteria for pancreatic cancer surveillance. The most frequent condition was hereditary breast and ovarian cancer syndrome (60%). We identified eleven abnormal imaging findings (44%) and three of them (12%) were relevant: two intraductal papillary mucinous neoplasms and one localized pancreatic neoplasm. BRCA2 mutation was more frequent in patients with significant lesions (66.7% vs 30%, p=0.376) but smoking and diabetes were not associated with relevant findings (0 vs 18 %, p=0.578 and 0 vs 4.5%, p=0.880 respectively). Screening test could detect early-stage or resectable lesions in a significant in a significant percentage of the selected high-risk population. The most relevant findings were in patients belonging to hereditary breast and ovarian cancer syndrome.
Asunto(s)
Carcinoma Ductal Pancreático , Síndrome de Cáncer de Mama y Ovario Hereditario , Neoplasias Pancreáticas , Femenino , Humanos , Carcinoma Ductal Pancreático/diagnóstico , Carcinoma Ductal Pancreático/genética , Carcinoma Ductal Pancreático/patología , Detección Precoz del Cáncer/métodos , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patología , Neoplasias PancreáticasAsunto(s)
Neoplasias Colorrectales Hereditarias sin Poliposis/genética , Mutación , Anciano , Femenino , Humanos , Proteína Homóloga de MRE11/genética , Persona de Mediana Edad , Homólogo 1 de la Proteína MutL/genética , Proteínas Proto-Oncogénicas B-raf/genética , Síndrome , Proteínas Supresoras de Tumor/genética , Ubiquitina-Proteína Ligasas/genéticaRESUMEN
Mixed cryoglobulinemia (MC) is a small-vessel systemic vasculitis characterized by the presence of cryoglobulins, immunoglobulin complexes that precipitate at low temperatures ( < 37 ºC) inducing the inflammatory process. The most frequent etiology is hepatitis C infection (HCV) (1). Rituximab (RTX), an anti-CD20 monoclonal antibody, has recently emerged as the treatment of choice for severe MC (2). We present a case of severe hepatitis C virus-induced MC that was controlled and maintained in remission with RTX for 26 months, a remarkable prolonged period of time.
Asunto(s)
Anticuerpos Monoclonales de Origen Murino/uso terapéutico , Antivirales/uso terapéutico , Crioglobulinemia/tratamiento farmacológico , Crioglobulinemia/etiología , Hepacivirus , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/tratamiento farmacológico , Femenino , Humanos , Persona de Mediana Edad , RituximabAsunto(s)
Pólipos Adenomatosos/diagnóstico , Neoplasias del Colon/diagnóstico , Neoplasias Duodenales/diagnóstico , Ganglioneuroma/diagnóstico , Síndrome de Hamartoma Múltiple/diagnóstico , Pólipos Intestinales/diagnóstico , Adenoma/cirugía , Pólipos Adenomatosos/genética , Pólipos Adenomatosos/patología , Adulto , Neoplasias del Colon/genética , Neoplasias del Colon/patología , Colonoscopía , Diagnóstico Diferencial , Neoplasias Duodenales/genética , Neoplasias Duodenales/patología , Exones/genética , Ganglioneuroma/genética , Ganglioneuroma/patología , Gastroscopía , Síndrome de Hamartoma Múltiple/complicaciones , Síndrome de Hamartoma Múltiple/genética , Síndrome de Hamartoma Múltiple/patología , Humanos , Hiperpigmentación/etiología , Pólipos Intestinales/genética , Pólipos Intestinales/patología , Masculino , Megalencefalia/etiología , Neoplasia Endocrina Múltiple Tipo 2a/diagnóstico , Mutación Missense , Fosfohidrolasa PTEN/genética , Enfermedades del Pene/etiología , Mutación Puntual , Neoplasias de la Tiroides/cirugía , TiroidectomíaRESUMEN
Surgical resection is the first-line curative treatment of hepatocellular carcinoma (HCC). However most patients are unable to undergo surgical resection because of advanced tumoral stage, severe liver dysfunction or poor clinical status. Therefore, image-guided tumor ablation techniques have been introduced for the treatment of unresectable HCC. Among them, radiofrequency ablation (RFA) has been demonstrated to be an effective alternative curative therapy. However, local ablative therapy for tumors located close to structures such as the diaphragm or gastrointestinal tract is technically challenging because of the risk of collateral thermal damage to nearby structures or incomplete treatment of the HCC resulting from poor visibility on sonography. The introduction of artificial ascites can separate adjacent organs from the tumor and improve the sonic window. The aim of this study was to evaluate the feasibility, safety and efficacy of RFA with artificial ascites for HCC adjacent to the diaphragm.
Asunto(s)
Carcinoma Hepatocelular/cirugía , Ablación por Catéter , Hepatectomía/métodos , Neoplasias Hepáticas/cirugía , Adulto , Anciano , Carcinoma Hepatocelular/etiología , Carcinoma Hepatocelular/terapia , Diafragma , Femenino , Hepatitis C Crónica/complicaciones , Humanos , Infusiones Parenterales , Cirrosis Hepática/complicaciones , Cirrosis Hepática Alcohólica/complicaciones , Neoplasias Hepáticas/etiología , Neoplasias Hepáticas/terapia , Masculino , Persona de Mediana Edad , Cirugía Asistida por Computador , Adherencias Tisulares/complicacionesRESUMEN
AIM: The risk of presenting synchronous or metachronous neoplasm, either adenoma or carcinoma, increases after an initial colonic lesion develops. It is known as tumor multicentricity and constitutes the rationale for surveillance programs. This study was designed to identify the clinical, pathologic, and molecular features related to previous or synchronous colorectal cancer (CRC) in patients with advanced adenomas (AA) or serrated polyps (SP). PATIENTS AND METHODS: We carried out a prospective analysis of 4143 colonoscopies performed at our medical department between 1 September 2014 and 30 September 2015. Patients with AA/SP associated with previous or synchronous CRC are compared with patients with solitary AA/SP. We also performed immunohistochemical for the mismatch repair proteins in 120 AA or SP, 60 of them related to CRC. RESULTS: Three-hundred and seventy-nine AA or SP were removed. Among these, 66 (17.3%) were associated with a previous (n=31) or synchronous CRC (n=35). Age older than or equal to 65 years (odds ratio: 1.15, 95% confidence interval: 1.05-1.26, P=0.002) and male sex (odds ratio: 2.13, 95% confidence interval: 1.3-3.49, P=0.003) were found to be independent predictive factors for CRC in patients with AA/SP by multivariate analysis. Only one of the 120 AA/SP available for immunohistochemical testing showed loss of staining and it was not related to CRC. CONCLUSION: In patients with AA or SP, it is possible to identify a subgroup that is more likely to be associated with CRC and then prone to tumor multicentricity. These results have potential implications for establishing criteria for a more targeted surveillance.
Asunto(s)
Pólipos Adenomatosos/patología , Pólipos del Colon/patología , Colonoscopía , Neoplasias Colorrectales/patología , Detección Precoz del Cáncer/métodos , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Secundarias/patología , Pólipos Adenomatosos/química , Pólipos Adenomatosos/genética , Pólipos Adenomatosos/cirugía , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/análisis , Biomarcadores de Tumor/genética , Biopsia , Pólipos del Colon/química , Pólipos del Colon/genética , Pólipos del Colon/cirugía , Neoplasias Colorrectales/química , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples/química , Neoplasias Primarias Múltiples/genética , Neoplasias Primarias Múltiples/cirugía , Neoplasias Primarias Secundarias/química , Neoplasias Primarias Secundarias/genética , Neoplasias Primarias Secundarias/cirugía , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Factores de Riesgo , EspañaAsunto(s)
Errores Diagnósticos , Endometriosis/diagnóstico , Enfermedades del Sigmoide/diagnóstico , Neoplasias del Colon Sigmoide/diagnóstico , Adulto , Biopsia , Colectomía , Pólipos del Colon/diagnóstico , Colonoscopía , Diagnóstico Diferencial , Endometriosis/epidemiología , Endometriosis/patología , Endometriosis/cirugía , Femenino , Humanos , Obstrucción Intestinal/etiología , Enfermedades del Sigmoide/epidemiología , Enfermedades del Sigmoide/patología , Enfermedades del Sigmoide/cirugíaRESUMEN
El cribado de cáncer de páncreas en población de alto riesgo puede mejorar la supervivencia. Sin embargo, hay pocas referencias sobre su aplicabilidad y hallazgos en la práctica clínica habitual. Nuestro objetivo es evaluar los hallazgos de las pruebas de cribado de cáncer de páncreas en individuos de alto riesgo en la práctica clínica y describir las variables asociadas a la presencia de lesiones relevantes. Este es un estudio observacional prospectivo en el que se seleccionaron pacientes con alto riesgo de cáncer de páncreas, según los criterios del Consorcio Internacional de Cribado de Cáncer de Páncreas. Se analizaron variables demográficas, presencia de factores de riesgo de cáncer páncreas y los hallazgos de las pruebas. Posteriormente se compararon pacientes que presentan lesiones relevantes con aquellos sin hallazgos. De 70 pacientes de alto riesgo, 25 cumplieron los criterios de cribado. El síndrome hereditario más frecuente fue el cáncer de mama y ovario hereditario (60%). En once individuos (44%) se identificaron hallazgos y en tres (12%) fueron relevantes: dos tumores papilares mucinosos intraductales y un tumor sólido localizado. La mutación en BRCA2 fue la más frecuente en lesiones significativas (66,7% vs 30%, p=0,376) sin encontrar asociación con diabetes ni tabaquismo (0 vs 18 %, p=0,578 y 0 vs 4,5%, p=0,880 respectivamente). En conclusión, las pruebas de cribado permiten detectar lesiones en estadio precoz o resecables en un importante porcentaje de población de alto riesgo seleccionada. Los hallazgos más relevantes fueron en los pacientes pertenecientes al síndrome de cáncer de mama y ovario hereditario.
Pancreatic cancer surveillance can improve outcomes in high-risk individuals. However, little is known about its applicability and findings in routine clinical practice. Our aim was to evaluate findings on screening tests in high-risk individuals in a clinical practice setting and to analyze factors associated with the presence of relevant pancreatic lesions. We developed a prospective observational study of pancreatic cancer high risk patients that meet criteria of surveillance from the International Cancer of the Pancreas Screening Consortium. The demographic variables, other risk factors and imaging findings are collected. Patients with significant findings are compared to those without noteworthy findings. Of 70 high-risk individuals, 25 fitted the criteria for pancreatic cancer surveillance. The most frequent condition was hereditary breast and ovarian cancer syndrome (60%). We identified eleven abnormal imaging findings (44%) and three of them (12%) were relevant: two intraductal papillary mucinous neoplasms and one localized pancreatic neoplasm. BRCA2 mutation was more frequent in patients with significant lesions (66.7% vs 30%, p=0.376) but smoking and diabetes were not associated with relevant findings (0 vs 18 %, p=0.578 and 0 vs 4.5%, p=0.880 respectively). Screening test could detect early-stage or resectable lesions in a significant in a significant percentage of the selected high-risk population. The most relevant findings were in patients belonging to hereditary breast and ovarian cancer syndrome.
Asunto(s)
Enfermedades Transmisibles Emergentes , Linfogranuloma Venéreo/diagnóstico , Adulto , Chlamydia trachomatis/clasificación , Chlamydia trachomatis/aislamiento & purificación , Sistemas de Computación , Condiloma Acuminado/complicaciones , Hemorragia Gastrointestinal/etiología , Infecciones por VIH/complicaciones , Humanos , Linfogranuloma Venéreo/complicaciones , Linfogranuloma Venéreo/epidemiología , Linfogranuloma Venéreo/microbiología , Masculino , Reacción en Cadena de la Polimerasa , Proctitis/complicaciones , Proctitis/microbiología , Serotipificación , España/epidemiología , Úlcera/etiologíaAsunto(s)
Reacción en Cadena de la Polimerasa/métodos , Tropheryma/aislamiento & purificación , Enfermedad de Whipple/diagnóstico , Adulto , Artritis Infecciosa/etiología , Biopsia , Colitis Microscópica/etiología , Diagnóstico Diferencial , Diarrea/etiología , Duodeno/microbiología , Heces/microbiología , Gastroenteritis/diagnóstico , Humanos , Yeyuno/microbiología , Masculino , Saliva/microbiología , Tropheryma/genética , Enfermedad de Whipple/microbiologíaAsunto(s)
Carcinoma de Células Escamosas/complicaciones , Infecciones por VIH/complicaciones , Neoplasias del Recto/complicaciones , Adulto , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirugía , Humanos , Masculino , Neoplasias del Recto/diagnóstico , Neoplasias del Recto/cirugíaAsunto(s)
Endoscopía Gastrointestinal/métodos , Migración de Cuerpo Extraño/terapia , Gastroplastia/efectos adversos , Obesidad Mórbida/cirugía , Elastómeros de Silicona/efectos adversos , Remoción de Dispositivos/métodos , Estudios de Seguimiento , Migración de Cuerpo Extraño/diagnóstico , Gastroplastia/instrumentación , Gastroplastia/métodos , Humanos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/diagnóstico , Falla de Prótesis , Medición de Riesgo , Resultado del TratamientoRESUMEN
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