RESUMEN
Estimates of the colon cancer burden associated with hereditary nonpolyposis colorectal cancer (HNPCC) vary from less than 1 % to more than 5 %. Amsterdam criteria fulfilled within a kindred (classic Amsterdam and Amsterdam II criteria) are widely used to identify patients prone to HNPCC. The present study was initiated to assess the frequency of the Amsterdam criteria within a regional German cohort of 207 patients with a history of colorectal cancer (CRC). Data on individual and family cancer histories were available in 154 patients (73 women, 81 men; mean age at diagnosis 62.4 +/- 13.3 years). A total of 843 first degree relatives have been identified within the kindreds of whom 121 had verified cancers. In 28 of 154 families (18 %), at least one first degree relative of the index patient had CRC. With respect to a typical family history, five kindreds (3.2 %) were likely to suffer from HNPCC on a clinical basis (4 kindreds met the classic Amsterdam criteria and one kindred the Amsterdam II criteria). Testing for microsatellite instability could additionally be performed in 4 of 5 patients who met the Amsterdam criteria and revealed DNA instability in 3 cases. Moreover, a missense mutation of MSH2 (Gly965Asp) was detected in one patient with microsatellite instability. Based on the classic Amsterdam and Amsterdam II criteria approximately 3 % of a regional German cohort of patients with CRC are likely to suffer from HNPCC. However, the final diagnosis of HNPCC can only be established by detection of pathogenic germline mutations within the DNA mismatch repair genes.
Asunto(s)
Neoplasias Colorrectales Hereditarias sin Poliposis/genética , Proteínas de Unión al ADN , Pruebas Genéticas/métodos , Adulto , Anciano , Anciano de 80 o más Años , Disparidad de Par Base/genética , Estudios de Cohortes , Neoplasias Colorrectales Hereditarias sin Poliposis/diagnóstico , Reparación del ADN/genética , Femenino , Frecuencia de los Genes/genética , Alemania , Humanos , Masculino , Persona de Mediana Edad , Proteína 2 Homóloga a MutS , Mutación Missense/genética , Proteínas Proto-Oncogénicas/genética , Medición de RiesgoRESUMEN
In this prospective, randomized trial, bleeding gastroduodenal ulcers in the Forrest I and II stages were treated endoscopically with injection of either fibrin glue or polidocanol. After exclusion of four patients for various reasons, 38 patients were treated with fibrin glue (mean: 5.4 ml) and 41 patients with polidocanol (mean: 12.1 ml) with control endoscopies routinely performed on days 1, 3, and 7 after treatment. The two groups were comparable with regard to age, sex, ulcer location and Forrest classification. Recurrent bleeding was observed in five cases in the fibrin group and in ten cases in the polidocanol group; three and two patients in the fibrin and polidocanol groups, respectively, had to undergo surgery. We conclude that fibrin glue injection is an effective method for the treatment of bleeding gastroduodenal ulcers.
Asunto(s)
Úlcera Duodenal/complicaciones , Adhesivo de Tejido de Fibrina/administración & dosificación , Hemostasis Endoscópica , Úlcera Péptica Hemorrágica/terapia , Polietilenglicoles/administración & dosificación , Úlcera Gástrica/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Endoscopía Gastrointestinal , Femenino , Humanos , Inyecciones Intralesiones , Masculino , Persona de Mediana Edad , Proyectos Piloto , Polidocanol , Estudios ProspectivosRESUMEN
Fibrin glue was injected into or near the site of needle biopsy puncture in 33 patients (38 laparoscopically guided liver biopsies), 21 with histologically confirmed liver cirrhosis, to arrest post-puncture bleeding. A special double-lumen needle was introduced, suitable for multiple injections. Fibrin-glue injection was successful in 37 instances, but in one case it failed because the injection needle could not be optimally placed. The method thus seems to be a reliable and sensible means of obtaining haemostasis if compression and electrocoagulation have failed.
