RESUMEN
OBJECTIVES: The aim of this review is to summarize studies investigating subjective and psychological well-being in patients with Parkinson's disease (PD). MATERIALS AND METHODS: A systematic and integrative review according to PRISMA criteria was performed with a literature search from inception up to September 2017 in multidisciplinary databases (PubMED, Scopus, Web of Knowledge) by combining together key words related to PD and well-being. Studies were included if: their full-text was available; they involved PD patients; focused on the selected positive dimensions; written in English. Case studies, conference proceedings, abstract, dissertations, book chapters, validation studies and reviews were excluded. Data extracted from the studies included sample characteristics, the positive dimension investigated, type of measure, study aims, design and results. One reviewer extracted details and commented results with other reviewers. The studies' quality was assessed following Kmet, Lee, and Cook. RESULTS: Out of 1425 studies extracted, 12 studies (9 quantitative, 2 qualitative, 1 mixed methods) involving 2204 patients with PD were included. Most of the studies had a cross-sectional design and/or evaluated the effect of physical rehabilitation on well-being. Articles documented that the illness could impair well-being for its progressive impact on patients' motor autonomy. Preserving motor and musculoskeletal functioning facilitate patients' experience of well-being, social contribution and the maintenance of their job. CONCLUSIONS: Research on positive resources in PD is still scarce compared to other chronic illnesses. The few available investigations suggest the need of preserving motor abilities by proper rehabilitation programs for maintaining and/or promoting patients' well-being and life engagement.
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Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/psicología , Calidad de Vida , Estudios Transversales , HumanosRESUMEN
Production of lactate even in the presence of sufficient levels of oxygen (aerobic glycolysis) seems the prevalent energy metabolism pathway in cancer cells. The analysis of altered expression of effectors causing redirection of glucose metabolism would help to characterize this phenomenon with possible therapeutic implications. We analyzed mRNA expression of the key enzymes involved in aerobic glycolysis in normal mucosa (NM), primary tumor (PT) and liver metastasis (LM) of colorectal cancer (CRC) patients (pts) who underwent primary tumor surgery and liver metastasectomy. Tissues of 48 CRC pts were analyzed by RT-qPCR for mRNA expression of the following genes: hexokinase-1 (HK-1) and 2 (HK-2), embryonic pyruvate kinase (PKM-2), lactate dehydrogenase-A (LDH-A), glucose transporter-1 (GLUT-1), voltage-dependent anion-selective channel protein-1 (VDAC-1). Differences in the expression of the candidate genes between tissues and associations with clinical/pathologic features were studied. GLUT-1, LDH-A, HK-1, PKM-2 and VDAC-1 mRNA expression levels were significantly higher in PT/LM tissues compared with NM. There was a trend for higher expression of these genes in LM compared with PT tissues, but differences were statistically significant for LDH-A expression only. RAS mutation-positive disease was associated with high GLUT-1 mRNA expression levels only. Right-sided colon tumors showed significantly higher GLUT-1, PKM-2 and LDH-A mRNA expression levels. High glycolytic profile was significantly associated with poor prognosis in 20 metastatic, RAS-mutated pts treated with first-line chemotherapy plus Bevacizumab. Altered expression of effectors associated with upregulated glucose uptake and aerobic glycolysis occurs in CRC tissues. Additional analyses are warranted for addressing the role of these changes in anti-angiogenic resistance and for developing novel therapeutics.
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Biomarcadores de Tumor/genética , Neoplasias Colorrectales/genética , Glucólisis/genética , Neoplasias Hepáticas/genética , Anciano , Inhibidores de la Angiogénesis/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Colectomía , Neoplasias Colorrectales/enzimología , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/terapia , Progresión de la Enfermedad , Resistencia a Antineoplásicos/genética , Femenino , Perfilación de la Expresión Génica , Regulación Enzimológica de la Expresión Génica , Regulación Neoplásica de la Expresión Génica , Predisposición Genética a la Enfermedad , Hepatectomía , Humanos , Italia , Estimación de Kaplan-Meier , Neoplasias Hepáticas/enzimología , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Masculino , Metastasectomía/métodos , Mutación , Farmacogenética , Variantes Farmacogenómicas , Fenotipo , ARN Mensajero/genética , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
In gastric cancer, available clinical studies focusing on the activated hepatocyte growth factor (HGF)/MET pathway are limited to surgical and often heterogeneous series. MET copy number gain (CNG) and an activating truncation in the HGF promoter (deoxyadenosine tract element, DATE+) were studied in tumors of 95 patients with advanced gastric cancer treated with palliative chemotherapy. Associations with overall survival (OS) and the pattern of metastatic disease were studied. Median OS was 9.7 months in 80 MET CNG <5 copies cases (MET-), and 6.4 months in 15 MET CNG was ⩾5 copies cases (MET+) (P=0.001). MET+ status confirmed the adverse prognostic effect in the multivariate model. A significantly different distribution of MET+/DATE+ and MET-/DATE- cases was observed between patients with and without peritoneal carcinomatosis (PC). MET+ status confirms its adverse prognostic role in advanced gastric cancer patients. The activated MET/HGF axis seems to be associated with PC. These findings are relevant to the development of anti-MET/HGF compounds.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Factor de Crecimiento de Hepatocito/metabolismo , Cuidados Paliativos , Proteínas Proto-Oncogénicas c-met/metabolismo , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/metabolismo , Anciano , Femenino , Factor de Crecimiento de Hepatocito/genética , Humanos , Masculino , Proteínas Proto-Oncogénicas c-met/genética , Estudios Retrospectivos , Neoplasias Gástricas/genética , Tasa de SupervivenciaRESUMEN
BACKGROUND: Myeloscopy is a useful approach for both diagnosis and treatment of back pain. However clinicians have underestimated its potential. From the nineties myeloscopy has been used only as a diagnostic tool, without any improvement of the technique. Racz's method is nowadays still used for the lysis of adherence by applying medical solutions without a direct vision inside the spinal channel. In 1998 we showed the limitations of Racz's approach, and in 1999 we developed a new technique, introducing a Fogarty balloon to remove the occlusions of the spinal canal and the resaflex for the lysis of adherence at low temperature (Raffaeli-Righetti technique). In this paper we report a general review of our experience with periduroscopy for the treatment of failed back surgery syndrome (FBSS) and spinal stenosis. METHOD: A Fogarty balloon was used to remove fat and/or mild fibrosis occluding the spinal canal, reducing by 50% the volume of the saline solution used in periduroscopy. The Resaflex was subsequently used to lyse adherence and to allow reaching the site of pain origin, using a low temperature (> 50°C). FINDINGS: the fibrosis morphologies of epidural space (ES) were grouped on the basis of common macroscopic and organizational characteristics, which were revealed during myeloscopy. A year after myeloscopy, 59% of FBSS patients, and 67% of patients with stenosis reported a general improvement of their painful pathology, with a pain reduction above 50 in 56% of patients. Forty-eight percent of patients used minor analgesics and 67% of patients went back to work. Only few complications were observed (4%). CONCLUSIONS: myeloscopy technique enlightens pain-triggering mechanisms otherwise unrevealed; it has specific therapeutic value, whereas on the diagnostic side it has not revealed relevant pathologies. Its effectiveness in FBSS patients is high, with the advantage of its relatively easy implementation, limited invasiveness and repeatability.
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Endoscopía/métodos , Espacio Epidural/patología , Síndrome de Fracaso de la Cirugía Espinal Lumbar , Estenosis Espinal , Analgésicos/uso terapéutico , Espacio Epidural/efectos de los fármacos , Espacio Epidural/cirugía , Síndrome de Fracaso de la Cirugía Espinal Lumbar/diagnóstico , Síndrome de Fracaso de la Cirugía Espinal Lumbar/tratamiento farmacológico , Síndrome de Fracaso de la Cirugía Espinal Lumbar/cirugía , Fibrosis/patología , Humanos , Imagen por Resonancia Magnética/métodos , Estudios Prospectivos , Estudios Retrospectivos , Método Simple Ciego , Canal Medular/efectos de los fármacos , Canal Medular/cirugía , Estenosis Espinal/diagnóstico , Estenosis Espinal/tratamiento farmacológico , Estenosis Espinal/cirugía , Tomografía Computarizada por Rayos X/métodosRESUMEN
OBJECTIVE: To assess the reliability of anal endosonography (AES) in the diagnosis of anal fistulae and abscesses. MATERIAL AND METHODS: 86 patients with different types of anal fistulae and abscesses were prospectively examined with a 7.0 MHz transducer. Type of anal fistulae, differentiation between simple and complex tracts, and location of their internal openings were defined. In 66 cases with permeable external opening, hydrogen peroxide solution was introduced into the fistula tract. Reliability of AES was defined after surgical treatment of all cases. RESULTS: 74 anal fistulae, including 43 transsphincteric, 11 intersphincteric, 6 suprasphincteric, 3 superficial, and 11 ano-vaginal were found on AES. 27 fistulae were complex, and 47 simple fistulae. In 10 patients a coexisting abscess was found; the remaining 12 abscesses were without any fistula. Surgery confirmed the type of anal fistula in 64 patients (86.5%), and location of internal openings in 60 cases (81.1%). All abscesses were confirmed. CONCLUSION: AES showed high accuracy in diagnosing anal fistulae and abscesses.
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Absceso/diagnóstico por imagen , Enfermedades del Ano/diagnóstico por imagen , Endosonografía , Fístula Rectal/diagnóstico por imagen , Absceso/cirugía , Adolescente , Adulto , Anciano , Canal Anal/diagnóstico por imagen , Enfermedades del Ano/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Fístula Rectal/cirugíaRESUMEN
In the second part of the paper, we present advantages and drawbacks of transanal endosonography with the use of axial endoprobe in the diagnostics of perianal and perirectal abscesses and fistulas and also for tumours of the rectum. Typical images of the fistula nad abscess were shown. Ultrasonographic staging for the rectum malignancies was presented together with possibilities of assessment perirectal lymph nodes involvement by ultrasonography. Diagnosis of local recurrence by anal endosonography was presented and compared with other methods.
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Cirugía Colorrectal , Endoscopía/métodos , Enfermedades del Recto/diagnóstico , Humanos , Ultrasonografía/métodosRESUMEN
Fecal incontinence affects up to 2% of the general population. The major cause of it is related to the birth trauma of the anal sphincters. In this paper the possibilities of transanal endosonography in the assessment of the anal canal muscles defects after deliveries were presented. Anal canal sonographic anatomy together with the technique of the examination with the use of rotating endoprobe were presented. Transanal rotating endoprobe was compared with exoanal probes for visualization of the anal canal. Ultrasonic images of internal and external anal sphincters defects were shown with specific patterns of defects allowing differentiation between morphological and neurological damages of the sphincters. Anal endosonography was compared with clinical examination, electromyography and manometry in the assessment of the integrity of the anal sphincters.
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Canal Anal/diagnóstico por imagen , Canal Anal/lesiones , Incontinencia Fecal/etiología , Complicaciones del Trabajo de Parto/diagnóstico por imagen , Adulto , Electromiografía , Endosonografía , Femenino , Humanos , Manometría , Embarazo , Rotura/complicaciones , Rotura/diagnóstico por imagenRESUMEN
On the basis of literature and own experience, the usefulness of endosonographic examination with the use of axial endoprobe was presented. The first part was devoted to the description of the endosonographic anatomy of normal rectum, examination technique and its usefulness in diagnosis of anal sphincters disorders. The endosonographic examinations have been performed in Poland for many years, mainly for prostate diagnostics with the use of multiplane transducers. We present a diagnostic possibilities of axial endoprobe of high frequency equipped with hard plastic cone and water balloon.
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Enfermedades del Ano/diagnóstico por imagen , Endosonografía/métodos , Canal Anal/diagnóstico por imagen , Diseño de Equipo , Humanos , Masculino , Enfermedades de la Próstata/diagnóstico por imagen , Recto/anatomía & histología , Recto/diagnóstico por imagen , Valores de Referencia , TransductoresRESUMEN
This paper presents the usefulness of rectal endosonography in the diagnostics of the rectal wall and anorectal lesions in patients with inflammatory bowel diseases, mainly with Crohn's disease. Value of endosonography, computed tomography and magnetic resonance imaging were compared.
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Endosonografía , Enfermedades Inflamatorias del Intestino/diagnóstico , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Humanos , Enfermedades Inflamatorias del Intestino/diagnóstico por imagenRESUMEN
BACKGROUND: The purpose of this study was to evaluate the usefulness of color Doppler imaging (CDI) in suspected cases of acute cholecystitis. METHODS: Twenty-two patients suspected of having acute cholecystitis were prospectively evaluated over a 12-month period using gray-scale and color Doppler technique. Gallbladder wall thickness was greater than 2 mm in all patients included in the study. Pathologic correlation was obtained in 17 patients, with clinical or sonographic follow-up in five for a period of 6-/011001/months. CDI was considered positive only if the mid to fundal wall demonstrated flow. Sonographic Murphy's sign and laboratory values were recorded. RESULTS: Eight patients had acute cholecystitis. All had positive color Doppler flow. Wall thickness in these patients ranged between 4 and 10 mm. Three patients with necrotizing acute cholecystitis had no flow within 6-8-mm walls. Six patients with pathologically proven chronic cholecystitis had no evidence of increased flow within thickened walls. Five patients with presumed chronic cholecystitis (thickened wall without increased color flow) were treated medically, and their symptoms resolved. CDI was more sensitive in predicting acute cholecystitis than was the sonographic Murphy's sign and/or laboratory values. CONCLUSION: CDI demonstrates hyperemic changes in thickened gallbladder walls and is an important adjunct in the diagnosis of acute cholecystitis.
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Colecistitis/diagnóstico por imagen , Vesícula Biliar/diagnóstico por imagen , Ultrasonografía Doppler en Color , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Colecistitis/patología , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Vesícula Biliar/patología , Humanos , Hiperemia/diagnóstico por imagen , Hiperemia/patología , Leucocitosis/patología , Masculino , Persona de Mediana Edad , Necrosis , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
The development of the transvaginal technique has allowed for high-resolution, detailed evaluation of the female pelvis. Although not previously emphasized, gut pathology can also be recognized with this technique. We report two cases of sigmoid diverticulitis which were prospectively diagnosed using endovaginal sonography. In both patients, pelvic sonogram was the first imaging study performed for evaluation of nonspecific abdominal pain.
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Colon Sigmoide/diagnóstico por imagen , Diverticulitis del Colon/diagnóstico por imagen , Anciano , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , UltrasonografíaRESUMEN
A longitudinal linguistic analysis of aphasic disorder in a 15-year-old boy affected by Landau-Kleffner syndrome followed since the age of 6 is reported. The phonological, morphosyntactic and lexical levels of verbal deficits have been evaluated by means of collected samples of spontaneous language and a battery of linguistic tests. The clinical course has fluctuated with improvement and worsening of aphasia and epilepsy; at the end of the follow-up the boy was seizure-free and a medium-degree disturbance in language production and comprehension was present. The results of the linguistic evaluation suggest that the aphasic disturbance was related to a deficiency in phonological decoding which leads to phonological, morphosyntactic and lexical disturbances. A temporal relationship between the electroclinical picture and the aphasia has been observed: the persistent improvement in linguistic performances took place only after the disappearance of the seizures and of the EEG epileptic anomalies during sleep.
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Afasia/diagnóstico , Afasia/fisiopatología , Encefalopatías/fisiopatología , Trastornos del Desarrollo del Lenguaje/fisiopatología , Lingüística , Síndrome , Adolescente , Hormona Adrenocorticotrópica , Edad de Inicio , Electroencefalografía , Epilepsia/fisiopatología , Estudios de Seguimiento , Humanos , Pruebas del Lenguaje , Estudios Longitudinales , Masculino , Pruebas Neuropsicológicas , Sueño , Lóbulo Temporal/fisiopatología , VigiliaAsunto(s)
Cuello del Útero/diagnóstico por imagen , Vagina/diagnóstico por imagen , Agua , Administración Intravaginal , Adulto , Carcinoma in Situ/cirugía , Femenino , Humanos , Dispositivos Intrauterinos , Suturas , Ultrasonografía , Neoplasias del Cuello Uterino/cirugía , Agua/administración & dosificaciónRESUMEN
PURPOSE: To evaluate the natural history of nonpalpable interval breast cysts detected at mammography and diagnosed at sonography in an asymptomatic female population. MATERIALS AND METHODS: The imaging records of 5,000 consecutive patients (aged 35-77 years [mean, 51 years]) seen in one breast center over a 6-month period were reviewed. Serial studies of those patients with documented evidence of interval benign breast cysts were evaluated for the subsequent course of such lesions with regard to regression, stability, or enlargement seen at mammography. RESULTS: Interval cysts were found in 53 patients (68 cysts), approximately 1% of the studied population. More than half of these lesions spontaneously regressed in 1 year, most of them completely. By 2 years, nearly two-thirds had regressed. By 5 years, only 12% of the lesions had not shown regression. CONCLUSION: Interval breast cyst formation is not uncommon, and most of these benign lesions will undergo spontaneous regression or remain stable. Further intervention is not required for interval benign cysts.
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Enfermedad Fibroquística de la Mama/diagnóstico por imagen , Adulto , Anciano , Femenino , Enfermedad Fibroquística de la Mama/patología , Estudios de Seguimiento , Humanos , Mamografía , Persona de Mediana Edad , Remisión EspontáneaRESUMEN
BACKGROUND: Thyroid nodules are commonly identified on autopsy examination. There are relatively few descriptions, however, of the frequency with which thyroid nodules are encountered incidentally during the course of other investigations. METHOD: Prospective study to examine the prevalence of thyroid nodules in asymptomatic North American subjects, with palpation findings compared with findings on high-resolution ultrasonography. RESULTS: Palpable nodules were identified in 21 (21%) of 100 subjects, with nine solitary nodules (9%) and 12 multiple nodules (12%). In comparison, only 33 subjects were found to be free of any nodules by ultrasonography. Of the 67 subjects with abnormal ultrasound findings, 22 had solitary nodules (22%) and 45 had multiple nodules (45%). The prevalence of nodules was greater in women (72%) than in men (41%) (P < .02). A concordance rate of 49% was noted between ultrasound and findings by palpation. CONCLUSIONS: The data indicate that thyroid abnormalities are very common incidental findings, emphasizing the need for a conservative approach when such lesions are encountered incidentally.
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Nódulo Tiroideo/epidemiología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Palpación , Prevalencia , Nódulo Tiroideo/diagnóstico , Nódulo Tiroideo/diagnóstico por imagen , UltrasonografíaRESUMEN
OBJECTIVE: This study was undertaken to determine the feasibility of currently available tests to detect ovarian cancer at a curable stage. By studying women at risk for the disease on the basis of their family histories of cancer, we hope to gain insight into the genetics and biologic characteristics of ovarian cancer. STUDY DESIGN: Asymptomatic women with a family history of cancer are interviewed by geneticists to obtain accurate pedigree and epidemiologic data. Screening tests including transvaginal ultrasonography, color Doppler imaging, CA 125 measurement, and other investigative biomarkers are performed between cycle days 3 and 8 and repeated biannually. RESULTS: A total of 597 women without symptoms were screened between July 1991 and June 1992. Cystic or complex adnexal masses were detected in 6.2% of patients. A pulsatile index value < 1.0 was measured in 80% of premenopausal patients and 24% of postmenopausal patients, whereas a resistance index value < 0.4 occurred in 12% of premenopausal and 3% of postmenopausal patients. A CA 125 level > 35 U/ml was found in 11.4% of the study participants. To date, one stage IA borderline ovarian tumor and one endometrial carcinoma have been found. CONCLUSIONS: Ovarian cancer screening needs to be investigated in a controlled fashion to determine means that will ultimately improve the survival from the disease.