RESUMO
In order to evaluate the relevance of protooncogene alterations in gastric cancer and to specifically relate these alterations to types and stages of the neoplasia, we studied oncogenes of possible interest in gastric tumors with different clinical parameters. Fifty DNAs from primary gastric adenocarcinoma were analyzed, by the Southern blotting technique, for the presence of amplification or rearrangements of seven different protooncogenes: c-myc, c-erbB2, c-Ki-ras, c-Ha-ras, c-N-ras, hst, and c-mos. All the tumors analyzed were histologically classified and staged. Amplification of the following genes was found: c-myc (2 of 50), hst (3 of 50), c-erbB2 (3 of 50), and c-Ki-ras (5 of 50). The simultaneous amplification of hst (3 cases), c-myc (1 of 3), or c-Ki-ras (2 of 3) was observed. Analysis of DNAs from atrophic and metaplastic gastric mucosa (which can be regarded as preneoplastic lesions) of the 10 patients showing gene amplification demonstrated that this was limited to neoplastic cells. Considering protooncogene amplification in general (i.e., involving different genes and occurring to different degrees) and clinical parameters of tumors, we found a statistically significant association between amplification and both tumor progression and presence of metastases. Therefore, at least for the genes analyzed, amplification is a relatively infrequent phenomenon and represents a late event in the temporal development of gastric cancer.
Assuntos
Adenocarcinoma/genética , Amplificação de Genes , Proto-Oncogenes , Neoplasias Gástricas/genética , Adenocarcinoma/patologia , Atrofia , DNA de Neoplasias/genética , DNA de Neoplasias/isolamento & purificação , Mucosa Gástrica/patologia , Humanos , Metaplasia , Metástase Neoplásica , Estadiamento de Neoplasias , Hibridização de Ácido Nucleico , Mapeamento por Restrição , Neoplasias Gástricas/patologiaRESUMO
Long-term clinical outcome was analysed in a series of 337 patients with early gastric cancer (EGC) at a median follow-up of 8 years. Tumours were classified according to the macroscopic and microscopic criteria proposed by the Japanese society of gastroenterological endoscopy (JSGE) and Lauren, respectively. Type of penetration (PEN) was classified according to Kodama. Overall survival rate was 92% at 5 years and 88% at 8 years and was significantly related to depth, type of penetration, lymph node status and tumour size. A significantly lower 5-year survival (p<0.05) was observed for patients with lymph node metastases and PEN A type EGC (55%) or for those with node-positive tumours and submucosal wall penetration (58%) than for the other pathologic subgroups. Therefore, these two subgroups should be considered as advanced gastric cancer patients from the prognostic point of view. Moreover, multivariate analysis by Cox regression model showed the degree of lymph node involvement and Kodama's type PEN A as the only independent prognostic factors.
Assuntos
Neoplasias Gástricas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Probabilidade , Prognóstico , Fatores de Risco , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida , Fatores de TempoRESUMO
UNLABELLED: A substantial number of duodenal ulcer (DU) patients relapse despite maintenance treatment with antisecretory drugs. The influence of certain risk factors and the heterogeneity of the disease could explain such behavior. The present prospective, open study compares the one-year clinical outcome (with upper GI endoscopy at the beginning of the study, at 6 and 12 months, and at every symptomatic relapse) of four groups of DU subjects, consecutively recruited from December 1987 to December 1988, separated in accordance with whether or not a bleeding DU episode had previously occurred, and whether or not an evaluation of gastric acid secretion had been made. Thus, Group I (17 patients; 12 males, 5 females) included heavy smokers and/or gastric acid hypersecretors; Group II (13 patients; 12 males, 1 female) non- or light smokers non-hypersecretors; Group III (34 patients; 22 males, 12 females) subjects with unknown gastric acid secretion; Group IV (33 patients; 30 males, 3 females) previously bleeding DU patients. All patients, except those in Group II (who were left untreated), were given ranitidine 150 mg at bedtime. The outcome of Groups I+II was compared with that of Group III (considered as "standard therapy") and Group IV patients, the latter presumably with a low risk of relapse because of the low prevalence of smokers. STATISTICS: Chi-square test, Fisher's exact test, analysis of variance and the logrank test. During the year of follow-up, 27/97 patients withdrew from the study, while 18 had a DU relapse (remission rates 82.1% +/- 7.4% in Groups I+II, 70.5% +/- 8.4% in Group III, 87.5% +/- 5.9% in Group IV).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Úlcera Duodenal/tratamento farmacológico , Adulto , Idoso , Úlcera Duodenal/fisiopatologia , Feminino , Seguimentos , Ácido Gástrico/metabolismo , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Recidiva , Fatores de Risco , Fumar/fisiopatologia , Fatores de TempoRESUMO
The frequency of gastrointestinal haemorrhage due to gastric ulcer has been assessed in 254 personally observed patients suffering from this endoscopically verified pathology. 56 patients, namely 22% of the cases, presented haematemesis and/or melena of the ulcerative lesion. This subgroup was compared with 65 patients with endoscopically verified gastric ulcer without previous bleeding episodes from the lesion in their clinical history, in respect of certain epidemiological, clinical and biohumoral features. The purpose of the study was to check the possible existence of clinical and/or physiopathological differences between subjects with bleeding gastric ulcer and the population of non-bleeding ulcer patients. In 80% of patients studied, the gastric ulcerous disease started with digestive haemorrhage and it was not accompanied by dyspeptic-painful symptomatology in 20% of cases. The pain symptomatology does not appear to be influenced by the intake of non-steroid anti-phlogistic drugs. No significant difference emerges between the two groups considered as regards epidemiological features and biohumoral data (PG I, gastrin, B.A.O. and M.A.O.).
Assuntos
Úlcera Péptica Hemorrágica/epidemiologia , Úlcera Gástrica/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastroscopia , Hematemese/diagnóstico , Hematemese/epidemiologia , Hematemese/etiologia , Hematemese/fisiopatologia , Humanos , Incidência , Itália/epidemiologia , Masculino , Melena/diagnóstico , Melena/epidemiologia , Melena/etiologia , Melena/fisiopatologia , Pessoa de Meia-Idade , Úlcera Péptica Hemorrágica/diagnóstico , Úlcera Péptica Hemorrágica/fisiopatologia , Úlcera Gástrica/diagnóstico , Úlcera Gástrica/epidemiologia , Úlcera Gástrica/fisiopatologiaRESUMO
The adrenal glands are often the site of metastases. However, there is much discussion as to the benefits of surgical resection. Personal experience of surgical treatment in 4 patients, one of whom died postoperatively after bilateral adrenalectomy for metachronous metastases, is reported. Surgery achieved pain relief in all patients, average survival was 30 months and 1 patient is still alive after 68 months. The present study shows that surgery is advisable in patients who present the following characteristics: 1) the primary tumor has been resected or is radically resectable, 2) there is no evidence of other metastatic lesions, 3) the adrenal metastasis is unilateral and complete resection is possible, 4) the patient's general physical condition is good.
Assuntos
Neoplasias das Glândulas Suprarrenais/secundário , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia , Idoso , Humanos , Masculino , Resultado do TratamentoRESUMO
Aims. The assessment of limitations in social capacities can be done with the Mini-ICF-APP, a rating scale built in reference to the International Classification of Functioning, Disability and Health (ICF). The aim of this study was to assess the reliability and the convergent validity of the Italian version of this scale. Methods. We recruited 120 consecutive patients diagnosed with schizophrenia, major depression, bipolar I disorder and anxiety disorders. Included measures were the Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impression Scale (CGI-S), the Personal and Social Performance Scale (PSP) and the Social and Occupational Functioning Assessment Scale (SOFAS). Results. The median CGI-S and BPRS scores were 5 and 16.5. Mean Mini-ICF-APP total score was 18.1. Schizophrenics' Mini-ICF-APP score was higher, while that of anxious patients was lower than in the other diagnoses. Intra-class correlations (ICC) revealed a significant inter-rater agreement for total score (ICC 0.987) and for each item of the Mini-ICF-APP. The test-retest agreement was also highly significant (ICC 0.993). The total score of the Mini-ICF-APP obtained good negative correlations with PSP (r s = -0.767) and with SOFAS scores (r s = -0.790). The distribution items of the Mini-ICF-APP showed some skewness, indicating that self-care (item 12) and mobility (item 13) were amply preserved in most patients. The Mini-ICF-APP total score was significantly correlated with both CGI-S (r s = 0.777) and BPRS (r s = 0.729). Conclusions. As a short instrument, the Mini-ICF-APP scale seems to be well suited to everyday psychiatric practice as a means of monitoring changes in psychosocial functioning, in particular in schizophrenic patients.
Assuntos
Transtorno Depressivo Maior , Reprodutibilidade dos Testes , Transtorno Bipolar , Humanos , Idioma , Esquizofrenia/diagnósticoAssuntos
Anastomose Cirúrgica , Gastrectomia , Humanos , Métodos , Complicações Pós-Operatórias , ReoperaçãoAssuntos
Megacolo , Adolescente , Criança , Pré-Escolar , Seguimentos , Humanos , Lactente , Recém-Nascido , Megacolo/diagnóstico , Megacolo/cirurgia , Complicações Pós-OperatóriasAssuntos
Hemorragia Gastrointestinal/etiologia , Divertículo Ileal/diagnóstico por imagem , Tecnécio , Adolescente , Criança , Feminino , Hemorragia Gastrointestinal/diagnóstico por imagem , Humanos , Masculino , Divertículo Ileal/complicações , Divertículo Ileal/cirurgia , Cintilografia , Úlcera/etiologiaAssuntos
Neoplasias Renais/patologia , Pelve Renal/patologia , Tumor de Wilms/patologia , Feminino , Humanos , LactenteRESUMO
The histamine H2-receptor antagonists, cimetidine, ranitidine, famotidine and nizatidine are effective in promoting the healing of both gastric and duodenal ulcer. Unfortunately the recurrence rate after withdrawal of the therapy does not appear modified and many studies indicate an increased rate of relapse after antisecretory treatment. The difference between various H2-blockers in terms of duration of acid inhibition and then increasing in gastrin levels may play a role in explaining the phenomenon, the exception represented by the last H2-blocker, nizatidine. It is reasonable, therefore, to analyze the different therapeutical approaches proposed for ulcer relapse prevention, such as continuous maintenance therapy, seasonal on demand, intermittent, week-end therapy, association of drugs with different mechanisms of action, etc. Four categories of patients can be characterized both for gastric and duodenal localization: 1. Subjects with low rate of relapses, i.e. less than one each fifteen months; 2. Subjects with episodic relapses, i.e.; one or two per year; 3. Subjects with frequent relapses, i.e. more than three per year; 4. Subjects with complications (bleeding, perforation).
Assuntos
Úlcera Duodenal/prevenção & controle , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Úlcera Gástrica/prevenção & controle , Humanos , Assistência de Longa Duração , RecidivaRESUMO
Cystic lesions of the spleen are unusual. They are classified essentially as: parasitic or nonparasitic, based on their etiology, and true or pseudo based on the presence or absence of lining epithelium. The pathogenesis of true cysts is unknown and numerous hypotheses are given by different Authors. After a short review of the literature, the Authors describe the clinical and pathological data of a case of epithelial (epidermoid) splenic cyst occurs in a 12-year-old woman. The Authors put forward some personal observations on pathogenesis, still doubtful, by means of histochemical and immunohistochemical study.
Assuntos
Cisto Epidérmico/patologia , Esplenopatias/patologia , Criança , Feminino , HumanosRESUMO
BACKGROUND: Although lymph node metastases in patients with early gastric cancer (EGC) is an important prognostic factor, the prognostic relevance of lymph node micrometastases is still uncertain. METHODS: The authors studied 1488 lymph nodes, which were histologically confirmed as pN0, dissected from 139 patients who were treated for EGC between 1976-1994. Micrometastases were defined as a single or small cluster of neoplastic cells identifiable only by immunohistochemical methods. RESULTS: Lymph node micrometastases was observed in 24 of the 139 patients (17%). No significant correlation was observed between micrometastases and other clinicopathological characteristics. Analysis of overall survival showed no significant difference between the micrometastases positive and negative groups. CONCLUSION: The results of our study show that the presence of lymph node micrometastases in EGC does not have an influence on patient prognosis.
Assuntos
Linfonodos/patologia , Neoplasias Gástricas/patologia , Idoso , Distribuição de Qui-Quadrado , Intervalos de Confiança , Feminino , Humanos , Excisão de Linfonodo/métodos , Metástase Linfática , Masculino , Invasividade Neoplásica , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/sangueRESUMO
A retrospective study of 223 patients treated for early gastric cancer (EGC) is reported, representing 21.2 per cent of the 1051 patients with gastric cancer treated over the same period. Two main types of surgical procedure were used: subtotal resection of the stomach for EGC of the two lower thirds and total gastrectomy for lesions of the upper third. A lymphadenectomy of groups 1 and 2, according to the procedure of the Japanese Research Society for Gastric Cancer (R2 resection), was performed in all patients. The mean duration of follow-up was 7.5 years. Univariate analysis showed a significant difference in survival rates only between patients with and without involved nodes (log rank = 6.05, P = 0.0139). Other prognostic factors were not identified. A bivariate analysis was performed to evaluate the joint effect of node status and the Kodama classification: survival rates for patients with EGC of the penetrating (Pen) A type and node positive falls to around 57 per cent within 6 years. This group of patients has a tumour that should probably be considered as a 'non-early' lesion. To improve the survival of patients with a Pen A, node positive lesion, adjuvant chemotherapy may be appropriate.
Assuntos
Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Gastrectomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Prognóstico , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
A series of 98 patients with spontaneous nipple discharge, is reported. Diagnosis was based on: clinical examination, cytology of breast secretion, mammography and galactography. Surgical resection was recommended in the following cases: galactographic evidence of intraductal papilloma or papillomatosis, dubious or positive cytology, persisting hemorrhagic or sero-hemorrhagic secretion. The injection of vital staining before the operation allowed the precise location of the lesion. In the group of patients studied ten cases of ductal carcinomas (5 in situ and 5 smaller than 1 cm), 4 cases of atypical intraductal hyperplasia, 13 cases of solitary papilloma and 22 cases of multiple papillomatosis were diagnosed.
Assuntos
Neoplasias da Mama/cirurgia , Papiloma/cirurgia , Neoplasias da Mama/diagnóstico , Carcinoma in Situ/diagnóstico , Carcinoma Intraductal não Infiltrante/diagnóstico , Diagnóstico Diferencial , Feminino , Galactorreia/etiologia , Humanos , Hiperplasia/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Papiloma/diagnóstico , GravidezRESUMO
Inflammatory breast carcinoma is a dramatic tumour with a five-year survival rate of almost 3%. Various therapeutic approaches have been made for this neoplasia: surgery, radiotherapy and chemotherapy, alone or in combination. The best results were obtained with the use of a multidisciplinary approach. The authors developed a treatment in which chemotherapy and radiotherapy, together with surgery, are used. After three cycles of CMF (cyclophosphamide, methotrexate, 5-fluorouracil) the patients with partial remission, no change or disease progression were changed to adriamycin + vincristine plus radiotherapy. Surgery was performed on patients with complete remission or partial remission after chemo-radiotherapy. After surgery, maintenance chemotherapy was used with the more active drugs. The actuarial survival rate at 5 years was 30.65% and median survival 34 months.