ABSTRACT
BACKGROUND: Management of radiation proctitis presents a treatment challenge. Limited data exist on the management of symptomatic hemorrhoids in radiated patients. This study aims to present a practical approach to the management of radiation proctitis, particularly in patients with synchronous hemorrhoids. METHODS: A total of 52 consecutive cases of radiation proctitis managed between September 1999 and October 2017 were retrospectively reviewed. The primary treatment was formalin application, plus rubber band ligation in conjunction with formalin when hemorrhoids were a significant component of bleeding, and occasionally argon plasma coagulation. RESULTS: The primary indication for radiotherapy was for the treatment of prostate cancer (71%), anal squamous cell carcinoma (10%), and gynecological malignancies (18%). More than half of the patients (52%) presented with radiation proctitis and concomitant internal hemorrhoids. The hemorrhoids were managed with rubber band ligation (56%) and stapled hemorrhoidectomy (7%), at the same procedure as formalin application. At a median follow-up of 12 months, no recurrent rectal bleeding occurred, and no further treatment was needed for most patients. One patient experienced a short period of perianal pain, which was treated with analgesics. CONCLUSION: Formalin application has consistently demonstrated an excellent cure rate and safety profile comparable with the published results as a primary treatment for radiation proctitis. The prolapse of irradiated mucosa over the internal hemorrhoids appears to exacerbate bleeding. Local hemorrhoid treatment is often required as an adjunct in the management of these patients.
Subject(s)
Gastrointestinal Hemorrhage/therapy , Hemorrhoids/therapy , Proctitis , Radiation Injuries/therapy , Female , Gastrointestinal Hemorrhage/etiology , Hemorrhoids/complications , Hemorrhoids/surgery , Humans , Ligation , Male , Neoplasms/radiotherapy , Proctitis/etiology , Proctitis/therapy , Radiation Injuries/etiology , Radiotherapy/adverse effects , Rectum/radiation effects , Rectum/surgery , Retrospective StudiesABSTRACT
Members of the inhibitor of apoptosis protein family are involved not only in suppressing apoptosis, but also in signal transduction, cell division, and are associated with some types of cancers. Here we show that transgenic expression of the inhibitor of apoptosis protein OpIAP in murine T lymphocytes leads to a significant increase in T-cell receptor-induced cell activation, proliferation and cytokine production. Transgenic T lymphocytes expressing OpIAP have a lower proliferation threshold in response to T-cell receptor stimulation. Unstimulated OpIAP transgenic T lymphocytes show elevated nuclear levels of NF-kappaB transcription factor that increase after in vivo antigen peptide treatment. OpIAP transgenic animals present an exacerbated inflammatory response in an experimental contact hypersensitivity model, suggesting increased T-cell activation in vivo. These data indicate a new role for the inhibitor of apoptosis proteins in T-lymphocyte activation and proliferation.
Subject(s)
Inflammation Mediators/metabolism , Inflammation/metabolism , Lymphocyte Activation/genetics , T-Lymphocytes/metabolism , Viral Proteins/metabolism , Animals , Cell Division/genetics , Cells, Cultured , Cytokines/metabolism , Dermatitis, Contact/genetics , Disease Models, Animal , Female , Inflammation/immunology , Inflammation Mediators/immunology , Inhibitor of Apoptosis Proteins , Male , Mice , Mice, Transgenic , NF-kappa B/metabolism , Receptors, Antigen, T-Cell/genetics , Receptors, Antigen, T-Cell/metabolism , T-Lymphocytes/immunology , Up-Regulation/genetics , Viral Proteins/genetics , Viral Proteins/immunologyABSTRACT
Se presenta uno de los tres únicos casos publicados hasta la fecha de muerte con suspensión abdominal fatal: se trata de un hombre de edad adulta senil con importantes antecedentes médicos que vive en un centro de crónicos y aparece muerto con evidentes signos asfícticos. El mecanismo o forma en que se produce la muerte llega a cuestionar los sistemas de seguridad que el establecimiento tiene en las camas tipo hospital: se descubre el cadáver en la cama, colgando cabeza abajo y sujeto a la correa de seguridad por el abdomen. La autopsia médico-legal reveló la existencia de signos compatibles con una muerte por insuficiencia respiratoria aguda o asfixia, lo que unido a la postura en la que se encontró el cadáver, la ausencia de tóxicos y de patología que por sí sola explicase una muerte súbita, llevó a pensar en una asfixia posicional o postural.Se revisa la Bibliografía especializada en la que se discuten los diferentes mecanismos de muerte propuestos en estos casos y se resalta la importancia de realizar un estudio protocolizado y completo que incluya una investigación paso a paso de los testimonios; datos del levantamiento del cadáver; antecedentes médicos del sujeto y una autopsia judicial completa con analítica complementaria (análisis químico-toxicológico e histopatológico). De esta manera se podrá establecer la causa más probable de muerte y su etiología médico legal a través de los factores asociados, así como proponer medidas preventivas para evitar muertes en personas hospitalizadas y/o custodiadas (AU)
Subject(s)
Aged , Male , Aged, 80 and over , Humans , Asphyxia/diagnosis , Autopsy/methods , Posture , Cause of Death , Risk FactorsABSTRACT
El estudio de las lesiones cervicales en casos sospechosos de criminalidad, es una cuestión que no siempre está clara con el examen macroscópico de la autopsia y requiere ampliar información, confirmar o incluso descartar dichas lesiones, a través de análisis complementarios: el estudio histopatológico es uno de ellos. Se comenta la casuística de lesiones cervicales fatales estudiadas en el Instituto de Toxicología de Madrid, a lo largo de los últimos 5 años: un total de 302 casos que se dividen en 9 grupos, según los diferentes mecanismos de lesión, siendo el de las ahorcaduras el más numeroso (180 casos).Las muestras objeto de estudio son piel cervical, paquetes vasculares (arterias carótidas y venas yugulares internas), músculos esternocleidomastoideos y complejo hioides-laringe, siendo seccionadas seriadamente para su posterior inclusión en parafina y tinción con Hematoxilina-eosina, Weigert, Tricrómico de Masson y Poley. En algunos casos se realizaron técnicas de immunohistoquímica (anti-Actina y anti-Fibrinógeno) en muestras musculares. El estudio microscópico evalúa un conjunto de marcadores en cada una de las muestras para aportar solidez al diagnóstico de vitalidad: como son el aplastamiento cutáneo, metacromasia, hemorragias, degeneración fibrilar premortal (fibras opacas), desgarros carotídeos y fracturas con hemorragias asociadas (a nivel epi, intra o subperiostal/condral) en hioides y laringe. Se discute el valor relativo de cada uno de los marcadores y de la importancia del estudio conjunto de todos ellos, en relación a la Bibliografía y concluyendo con la gran utilidad del estudio histopatológico en relación a la búsqueda de marcadores de violencia cervical y diagnóstico de vitalidad (AU)
Subject(s)
Adolescent , Adult , Aged , Female , Male , Middle Aged , Aged, 80 and over , Humans , Neck Injuries/pathology , Autopsy , Neck Injuries/classificationABSTRACT
PURPOSE: To determine the epileptic response of gerbils to external shock stimulus, assessing blood cortisol levels as a parameter to determine stress conditions. METHODS: Five sets of two-month-old Mongolian gerbils were stimulated to elicit seizures by the clapping of a sheaf of papers. Stimulation was done once a week over a 10-week period to obtain a stable situation and a similar response in all the animals. Four of the sets were killed to collect blood samples: those not manipulated; those stimulated twice a day for 5 days; those stimulated once to obtain samples immediately after seizure recovery; and those stimulated once to obtain samples 30 min after seizure recovery. Blood samples from the fifth set of animals were taken in vivo from the retro-orbital plexus. RESULTS: Eliciting seizures with this stimulus, twice a day in a repetitive way, prevented further induced seizures from the second day of stimulation on. Changes in the gerbils' behavior--from exploratory to escape mode--were also observed. The blood cortisol levels found in the sets of animals killed without induced seizures were similar to the others, regardless of whether the animals had been subjected to repetitive stimulation. Additionally, significant decreases in blood cortisol levels were detected in the animals killed immediately and 30 min after recovering from an induced epileptic episode. CONCLUSIONS: The normal refractory period in gerbils can be estimated at 1 h. The lack of correlation between cortisol levels and the inhibition of seizure-elicitation through repetitive stimulation supports the environmental and exploratory hypothesis of seizure generation rather than a stress hypothesis.
