RESUMEN
The safety and efficacy of gemcitabine and concurrent radiation to the upper abdomen followed by weekly gemcitabine in patients with resected pancreatic cancer was determined. Patients with resected adenocarcinoma of the pancreas were treated with intravenous gemcitabine administered twice-weekly (40 mg m(-2)) for 5 weeks concurrent with upper abdominal radiation (50.4 Gy in 5(1/2) weeks). At the completion of the chemoradiation, patients without disease progression were given gemcitabine (1000 mg m(-2)) weekly for two cycles. Each cycle consisted of 3 weeks of treatment followed by 1 week without treatment. Forty-seven patients were entered, 46 of whom are included in this analysis. Characteristics: median age 61 years (range 35-79); 24 females (58%); 73% stage T3/T4; and 70% lymph node positive. Grade III/IV gastrointestinal or haematologic toxicities were infrequent. The median survival was 18.3 months, while the median time to disease recurrence was 10.3 months. Twenty-four percent of patients were alive at 3 years. Only six of 34 patients with progression experienced local regional relapse as a component of the first site of failure. These results confirm the feasibility of delivering adjuvant concurrent gemcitabine and radiation to the upper abdomen. This strategy produced good local regional tumour control.
Asunto(s)
Adenocarcinoma/cirugía , Desoxicitidina/análogos & derivados , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/radioterapia , Adulto , Anciano , Quimioterapia Adyuvante , Terapia Combinada , Desoxicitidina/efectos adversos , Desoxicitidina/uso terapéutico , Progresión de la Enfermedad , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/terapia , Neoplasias Pancreáticas/cirugía , Recurrencia , Tasa de Supervivencia , Resultado del Tratamiento , GemcitabinaRESUMEN
BACKGROUND AND AIMS: This prospective study compared jejunoileal length in patients with Crohn's disease (CD) and the general population to determine whether this parameter can be related to outcome and management of CD complications. PATIENTS AND METHODS: Small bowel (SB) length was measured during abdominal surgery prior to bowel resection in 93 patients with CD and 92 patients without inflammatory or small bowel disease. RESULTS: SB length was shown to be shorter in patients with CD (462 vs. 567 cm) and was correlated to sex and height. There was no correlation of SB length to clinical expression (perforating or nonperforating), site, or outcome. SB length is not a prognosis factor of postoperative relapse. The presence of perineal disease and systemic abnormalities seem to be the only prognostic factors of surgical recurrence. Sex, age at onset, time of first surgery, site of disease, and mode of onset are not predictive of surgical recurrence. CONCLUSION: We recommend minimal intestinal resection when surgical treating CD complications in patients at high risk of surgical relapse and initial short SB. We advise using stricturoplasty or leaving asymptomatic intestinal lesions to reduce short bowel syndrome occurrence when performing iterative surgery.
Asunto(s)
Enfermedad de Crohn/patología , Intestino Delgado/patología , Adulto , Enfermedades del Ano/patología , Estatura , Estudios de Casos y Controles , Enfermedad de Crohn/cirugía , Femenino , Humanos , Intestino Delgado/cirugía , Masculino , Persona de Mediana Edad , Perineo/patología , Pronóstico , Estudios Prospectivos , Recurrencia , Caracteres SexualesRESUMEN
INTRODUCTION: Digestive localisation of sarcoidosis is rare. OBSERVATION: A 35 year-old man presented with sarcoidosis revealed by a mediastinal hilum lymphadenopathy 13 years earlier. Epigastric pain led to oeso-gastroduodenal fibroscopy and biopsies, showing inflammatory mucosa and numerous giant-cell epithelioid granulomas, without concomitant necrosis or fibrosis. COMMENTS: The clinical manifestations and endoscopic profile of gastric localisations of sarcoidosis are not specific. Diagnosis relies on several elements: presence of epithelioid granulomas without necrosis, history of sarcoidosis or the simultaneous existence of other localisations, evocative biological signs and the absence of elements evoking any other diagnosis. Treatment relies on corticosteroid therapy and sometimes requires endoscopic or surgical management.
Asunto(s)
Sarcoidosis/complicaciones , Vasculitis del Sistema Nervioso Central/patología , Corticoesteroides/uso terapéutico , Adulto , Diagnóstico Diferencial , Endoscopía , Humanos , Inflamación , Mucosa Intestinal/patología , Masculino , Dolor/etiología , Vasculitis del Sistema Nervioso Central/diagnóstico , Vasculitis del Sistema Nervioso Central/etiologíaRESUMEN
PURPOSE: Chronic radiation proctitis, a well described complication of pelvic radiation therapy, can result in severe bleeding that is refractory to conventional treatment. Argon plasma coagulation is an effective treatment for hemorrhagic lesions of the gastrointestinal tract. The aim of this study was to assess the efficacy and safety of argon plasma coagulation in the management of severe radiation proctitis resistant to medical treatment. METHODS: Eleven patients (10 males) aged between 54 and 86 years (mean +/- standard error of the mean, 73 +/- 3 years), with chronic radiation proctitis after radiotherapy for prostate (n = 9), uterine (n = 1) or rectal (n = 1) cancer were enrolled in this prospective study. Traditional therapies had failed including mainly topical steroids, 5-aminosalicylic acid and sometimes sucralfate. All patients had active bleeding from diffuse telangiectasias responsible for chronic anemia and seven of them required blood transfusions. The mean duration of the sessions was 20 minutes and one to five sessions (mean, 3.2 +/- 0.4), usually without anesthesia, were required to stop bleeding. Mean follow-up time was 19 +/- 2 (range, 7-30) months. RESULTS: Rectal bleeding disappeared in nine patients and was greatly reduced in two. All the patients were free of transfusions during the mean follow-up of 19 months. The mean hemoglobin level was 7.7 +/- 2.8 g/dl at the first session and increased significantly (P = 0.003) to 11.5 +/- 2.6 g/dl after treatment. In two patients, a rectal stenosis appeared 7 and 11 months after the first session. CONCLUSION: Argon plasma coagulation is a simple, inexpensive and effective treatment for severe refractory radiation proctitis with telangiectasias. Follow-up supervision is in progress to evaluate long term benefits and the risk of rectal stenosis.
Asunto(s)
Hemorragia Gastrointestinal/cirugía , Coagulación con Láser/métodos , Proctitis/cirugía , Traumatismos por Radiación/cirugía , Anciano , Anciano de 80 o más Años , Argón/uso terapéutico , Enfermedad Crónica , Femenino , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Persona de Mediana Edad , Proctitis/etiología , Estudios Prospectivos , Traumatismos por Radiación/etiología , Recto , Resultado del TratamientoAsunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Cetoprofeno/efectos adversos , Enfermedad Aguda , Adulto , Alanina Transaminasa , Aspartato Aminotransferasas/sangre , Dolor de Espalda/tratamiento farmacológico , Bilirrubina/sangre , Biopsia , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Enfermedad Hepática Inducida por Sustancias y Drogas/metabolismo , Femenino , Humanos , Ictericia/inducido químicamente , Náusea/inducido químicamente , Vómitos/inducido químicamenteRESUMEN
Metastatic colorectal cancer has long been considered as a short-term, poor prognosis, chemoresistant disease. Until the early 1990s, the impact of systemic chemotherapy on patient outcome was debated. Recently, the emergence of new therapeutic modalities (5-FU modulations and associations with oxaliplatin and irinotecan) has led to a significant improvement in tumor response rates and patient survival. Thus, the indications of curative surgery of visceral metastases, frequently preceded and followed by chemotherapy, systemic or intra-arterial or both, have become more frequent. In this paper we will review and comment on the results of the major clinical trials published in the past 5 years and propose some decision strategies regarding the main clinical situations met in daily practice.
Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/patología , Fluorouracilo/uso terapéutico , Metástasis de la Neoplasia/tratamiento farmacológico , Antimetabolitos Antineoplásicos/uso terapéutico , Antineoplásicos/farmacocinética , Camptotecina/análogos & derivados , Camptotecina/uso terapéutico , Ensayos Clínicos como Asunto , Neoplasias Colorrectales/cirugía , Quimioterapia Combinada , Fluorouracilo/farmacocinética , Humanos , Infusiones Intraarteriales , Irinotecán , Leucovorina/uso terapéutico , Metotrexato/uso terapéutico , Metástasis de la Neoplasia/patología , Compuestos Organoplatinos/uso terapéutico , OxaliplatinoAsunto(s)
Bacterias/aislamiento & purificación , Bacterias/metabolismo , Carcinógenos , Colon/microbiología , Neoplasias del Colon/etiología , Adenoma/etiología , Adenoma/microbiología , Animales , Ácidos y Sales Biliares/biosíntesis , Ácido Butírico/análisis , Carcinógenos/análisis , Neoplasias del Colon/microbiología , Neoplasias Colorrectales/etiología , Neoplasias Colorrectales/microbiología , Heces/microbiología , Vida Libre de Gérmenes , Humanos , Hidrólisis , Mutágenos/análisis , Probióticos , Proteínas/metabolismo , Ratas , Factores de RiesgoRESUMEN
Hereditary nonpolyposis colorectal cancer (HNPCC) is a syndrome characterized by familial predisposition to colorectal carcinoma and extracolonic cancers of the gastrointestinal, urological, and female reproductive tracts. This dominant disorder is caused by germline defects in one of at least five DNA mismatch repair (MMR) genes: hMLH1, hMSH2, hPMS1, hPMS2, and hMSH6 (GTBP). Germline mutations of hMSH2 and hMLH1 are also frequently identified in families not fulfilling all the Amsterdam criteria, thereby demonstrating that the involvement of these genes is not confined to typical HNPCC. To evaluate the respective involvement of the various MMR genes in typical and incomplete HNPCC syndromes, we have performed an analysis of the hMLH1, hMSH2, hPMS1, hPMS2, and hMSH6 genes in a large series of French kindreds (n=75) with colorectal tumors and/or aggregation of extracolonic cancers belonging to the HNPCC spectrum. Mutational analysis has been performed in all families, without preselection for the tumor phenotype. We have detected 26 pathogenic germline mutations of the hMLH1 and hMSH2 genes and several novel variants of the hPMS1, hPMS2, and hMSH6 genes. Our data confirm that, regardless of the type of families and the tumor phenotype, hPMS1, hPMS2, and hMSH6 germline mutations are rare in familial aggregation of colorectal cancers. Furthermore, they suggest that the presence of multiple primary malignancies in a single individual and the observation of extracolonic tumors in relatives of a colorectal cancer patient should be included among the guidelines for referring patients for genetic testing.
Asunto(s)
Adenosina Trifosfatasas , Neoplasias Colorrectales Hereditarias sin Poliposis/genética , Enzimas Reparadoras del ADN , Mutación de Línea Germinal , Proteínas de Neoplasias/genética , Proteínas Proto-Oncogénicas/genética , Proteínas Adaptadoras Transductoras de Señales , Adolescente , Adulto , Edad de Inicio , Proteínas Portadoras , Neoplasias del Colon/genética , Proteínas de Unión al ADN/genética , Francia , Eliminación de Gen , Pruebas Genéticas , Humanos , Persona de Mediana Edad , Endonucleasa PMS2 de Reparación del Emparejamiento Incorrecto , Homólogo 1 de la Proteína MutL , Proteínas MutL , Proteína 2 Homóloga a MutS , Proteínas Nucleares , Ácidos Nucleicos Heterodúplex , Mutación Puntual , Prevalencia , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Neoplasias Gástricas/genética , Neoplasias Urológicas/genéticaRESUMEN
OBJECTIVES: A 1993-1995 three year epidemiological survey of home parenteral nutrition was performed through in France in approved centers for adults. METHODS: Data were retrospectively collected each year on a standardized questionnaire focussing on indications and short term outcome. RESULTS: All centers (n = 14) participated in the study and 524 new adult patients were recruited. The overall incidence was unchanged at 3.75 patients/10(6) adults. Indications for AIDS rose (8 to 18%) whereas other indications were stable. Prevalence increased by 19%: 4.40 adults/10(6) patients at 01.01.1996. At six months, the probability to stay on treatment was 19.5% for AIDS and cancer indications but 52% for others, whereas death rates were 59% and 9% respectively. CONCLUSIONS: For both cancer and AIDS indications, short-term treatment was due to a poor prognosis. For other diagnosis, complicated with a short bowel in 51% of cases, prognosis was excellent but associated with treatment dependency. The latter point focuses on the need for additional treatments in irreversible intestinal failure.
Asunto(s)
Encuestas de Atención de la Salud , Nutrición Parenteral en el Domicilio , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adolescente , Adulto , Anciano , Certificación , Francia , Humanos , Persona de Mediana Edad , Neoplasias/complicaciones , Nutrición Parenteral en el Domicilio/normas , Pronóstico , Calidad de la Atención de Salud , Estudios RetrospectivosAsunto(s)
Adenocarcinoma/radioterapia , Neoplasias Pancreáticas/radioterapia , Adenocarcinoma/mortalidad , Adenocarcinoma/cirugía , Adulto , Anciano , Terapia Combinada , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/mortalidad , Neoplasias Pancreáticas/cirugía , Tasa de SupervivenciaRESUMEN
In the last decade, adjuvant chemotherapy has led to significant improvement in survival for large bowel cancer patients. The association of 5-FU plus levamisole was the first described and demonstrated its efficacy in stage Dukes C (T1,2,3,4 N1 M0) completely-resected adenocarcinoma. Recently, chemotherapy with 5-FU and folinic acid was recommended on the basis of randomized trials. Advances in adjuvant chemotherapy may result in increasing 5-FU doses as described in metastatic colorectal carcinomas, and in use of new drugs such as oxaliplatin or raltitrexed, whose activity has been well-studied in Dukes D (M1) carcinomas. Immunotherapy, intraperitoneal and intraportal infusion of chemotherapy are promising approaches but still in evaluation. The main difficulty for the future is to define the best therapeutic regimen in order to reach the highest improvement in survival.
Asunto(s)
Adenocarcinoma/tratamiento farmacológico , Neoplasias del Colon/tratamiento farmacológico , Adenocarcinoma/cirugía , Adenocarcinoma/terapia , Quimioterapia Adyuvante , Neoplasias del Colon/cirugía , Neoplasias del Colon/terapia , Humanos , Inmunoterapia , Periodo PosoperatorioRESUMEN
There is a body of clinical, epidemiological, biologic, histological and therapeutic data suggesting that type I hypersensitivity plays a role in the pathogenesis and maintenance of ulcerative colitis. Contradictory evidence from different studies on the pathogenic mechanisms may simply mean that there is not one but several types of ulcerative colitis. Chronic inflammation of the intestine would cover a heterogeneous group of conditions. Genetic susceptibility controlling one of more anomalies of the immune system would be triggered by external factors such as respiratory or food allergies, viral or bacterial infections or other factors including smoking or stress. The wide range of factors involved would explain the variety of findings reported by different groups searching for a single pathogenic mechanism. Finally, as emphasized by other authors, screening for subgroups of patients with allergy among the ulcerative colitis population would be useful in adapting treatment and developing a more specific therapeutic strategy not only for acute phases but perhaps also for preventive treatment.
Asunto(s)
Colitis Ulcerosa/etiología , Hipersensibilidad a los Alimentos/complicaciones , Hipersensibilidad Inmediata/complicaciones , Hipersensibilidad a la Leche/complicaciones , Úlcera Péptica Hemorrágica/etiología , Hipersensibilidad Respiratoria/complicaciones , Corticoesteroides/uso terapéutico , Antiasmáticos/uso terapéutico , Colitis Ulcerosa/inmunología , Colitis Ulcerosa/terapia , Cromolin Sódico/uso terapéutico , Femenino , Hipersensibilidad a los Alimentos/inmunología , Hipersensibilidad a los Alimentos/terapia , Humanos , Hipersensibilidad Inmediata/inmunología , Hipersensibilidad Inmediata/terapia , Inmunoglobulina E/análisis , Masculino , Hipersensibilidad a la Leche/inmunología , Hipersensibilidad a la Leche/terapia , Úlcera Péptica Hemorrágica/inmunología , Úlcera Péptica Hemorrágica/terapia , Hipersensibilidad Respiratoria/inmunología , Hipersensibilidad Respiratoria/terapiaRESUMEN
BACKGROUND: Mesalamine provides a new therapeutic approach in treating Crohn's disease. METHODS: To assess the efficacy and safety of slow-release mesalamine (Pentasa) in maintaining remission in Crohn's disease, 161 patients with inactive disease were randomized to receive either Pentasa (2 g/day) or placebo in a 2-year double-blind, multicenter trial. Two strata were defined according to the duration of their remission: < 3 months (n = 64) or 3-24 months (n = 97), presumed to be high and low relapse risk strata, respectively. RESULTS: The probability of relapse was higher in the short-remission placebo group than in the three other groups (p < 0.003), showing there was a significant benefit from Pentasa in the high relapse risk stratum. In this stratum, the 2-year on-going remission rate was of 29% +/- 9% and 45% +/- 11% (mean +/- SD) in the placebo and Pentasa groups, respectively. The incidences of side effects were similar in both groups. CONCLUSION: Pentasa (2 g/day for 2 years) is a safe and effective maintenance treatment for Crohn's disease when given within 3 months of achieving remission.
Asunto(s)
Ácidos Aminosalicílicos/uso terapéutico , Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/prevención & control , Administración Oral , Adulto , Ácidos Aminosalicílicos/administración & dosificación , Ácidos Aminosalicílicos/efectos adversos , Enfermedad de Crohn/patología , Método Doble Ciego , Tolerancia a Medicamentos , Femenino , Humanos , Masculino , Mesalamina , Cooperación del Paciente , Placebos , Factores de RiesgoRESUMEN
Applying the Hughes' pathogenic classification of ano-perineal lesions of Crohn's disease, this study was conducted to find out its possible prognostic value in perianal fistulas. Thirty-eight patients with ano-perianal fistulas were included; primary specific lesions (condyloma, cavitating ulcer, fissure) were found in 22 patients (group 1) and were absent in the other 16 patients (group 2). Patients of group 1 underwent more abdominal surgical interventions (G 1: 68%; G 2: 31% - P = 0.05), as well as proctological interventions (G 1: 2.95 operations/patient vs 1.35 in G 2 - P = 0.01). Perfect continence was recorded ultimately in 31.8% patients of G 1 compared to 62.5% of G 2. This study shows the very poor prognosis of ano-perianal fistulas in Crohn's disease.
Asunto(s)
Enfermedad de Crohn/complicaciones , Fístula Rectal/clasificación , Adolescente , Adulto , Anciano , Niño , Enfermedad de Crohn/patología , Enfermedad de Crohn/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Fístula Rectal/etiología , Fístula Rectal/patología , Fístula Rectal/cirugíaRESUMEN
BACKGROUND: Mesalamine provides a new therapeutic approach in treating Crohn's disease. METHODS: To assess the efficacy and safety of slow-release mesalamine (Pentasa; Ferring AS, Vanløse, Denmark) in maintaining remission in Crohn's disease, 161 patients with inactive disease were randomized to receive either Pentasa (2 g/day) or placebo in a 2-year double-blind, multicenter trial. Two strata were defined according to the duration of their remission: < 3 months (n = 64) or 3-24 months (n = 97), presumed to be high and a low relapse risk strata, respectively. RESULTS: The probability of relapse was higher in the short-remission placebo group than in the three other groups (P < 0.003), showing there was a significant benefit from Pentasa in the high relapse risk stratum. In this stratum, the 2-year ongoing remission rate was of 29% +/- 9% and 45% +/- 11% (mean +/- SD) in the placebo and Pentasa groups, respectively. The incidences of side effects were similar in both groups. CONCLUSIONS: Pentasa (2 g/day for 2 years) is a safe and effective maintenance treatment for Crohn's disease when given within 3 months of achieving remission.
Asunto(s)
Ácidos Aminosalicílicos/uso terapéutico , Enfermedad de Crohn/tratamiento farmacológico , Administración Oral , Adulto , Ácidos Aminosalicílicos/efectos adversos , Preparaciones de Acción Retardada/efectos adversos , Preparaciones de Acción Retardada/uso terapéutico , Método Doble Ciego , Femenino , Humanos , Masculino , Mesalamina , Persona de Mediana Edad , Cooperación del Paciente , Resultado del TratamientoRESUMEN
The authors report the case of a 51-year-old woman who was hospitalized for severe acute colitis. Sub-total colectomy was performed, due to clinical deterioration and resistance to treatment. The examination of the surgery specimen revealed a herpes-virus type 2 as the responsible pathogen agent. Complementary aciclovir treatment cured the patient.