RESUMO
Development of cancer surgery in recent decades occurs on a background of continuing scientific and technical progress. New technologies after the completion of clinical trials maximally quickly are included in the routine practice of specialized medical centers. At present an escalation of indications for extensive advanced and combined operations in locally advanced and even metastatic tumors goes in parallel with the introduction of minimally invasive interventions, search categories of patients, for whom the radicalism of treatment can be achieved without significant surgical aggression. The study of modern trends of this process will allow seeing the promising areas of scientific research, assuming the image of the future of surgery for cancer.
Assuntos
Endoscopia Gastrointestinal , Neoplasias Gastrointestinais/cirurgia , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Endoscopia Gastrointestinal/métodos , Endoscopia Gastrointestinal/tendências , Humanos , Laparoscopia/métodos , Laparoscopia/tendências , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/tendênciasRESUMO
The main treatment option for rectal cancer is surgery, which "gold standard" is the total mesorectumectomy. There are presented literature review and the results of own research devoted to comparative analysis of outcomes of laparoscopic and open total mesorectumectomy. Current data and own experience show the oncological adequacy and safety of laparoscopic approach however the controversy of some results reveal the necessity of further investigation.
Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/instrumentação , Laparoscopia , Neoplasias Retais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cirurgia Colorretal/instrumentação , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparotomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Gravação em VídeoRESUMO
Locally-advanced gastric cancer features predominance of prognostically unfavorable histological patterns (infiltrative growth--in 87.9%, tumor grades II-IV--69.5%). Tumor invasion into two adjacent organs or more frequently occurs in totally-involved stomach (65.2+/-9.7%), poorly-differentiated (grade Ill) tumors (44.9+/-4.5%) under-differentiated ones (grade IV) (45.9+/-8.2%). Invasion into one adjacent organ is significantly predominant (pAssuntos
Linfonodos/patologia
, Neoplasias Gástricas/patologia
, Adulto
, Idoso
, Feminino
, Humanos
, Metástase Linfática
, Masculino
, Pessoa de Meia-Idade
, Invasividade Neoplásica
, Estadiamento de Neoplasias
, Prognóstico
RESUMO
Results of surgical treatment of 223 patients with locally advanced gastric cancer (2000-2005) are presented. Postoperative complications rate was 25.6 +/- 2.5%, mortality--5.8 +/- 0.7%, overall survival--17.9 +/- 2.6%, median survival--12 months. Survival rates were higher following palliative treatment. Groups of patients in which RO resections failed to improve the end results were identified. That in turn calls for working out differentiated surgical strategies.
Assuntos
Gastrectomia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Gastrectomia/mortalidade , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cuidados Paliativos , Prognóstico , Fatores de Risco , Neoplasias Gástricas/mortalidade , Análise de Sobrevida , Resultado do TratamentoRESUMO
In this review, the authors discuss immunologic targets and events in T cells that are dysregulated by commonly used immunosuppressive agents. These include a description of glucocortcoid receptors as well as targets of glucocorticoids, targets of cyclosporine and FK506, and the mammalian target of rapamycin. In addition, novel antibody-based targets on T cells and antigen-presenting cells including the IL-2 receptor and costimulatory molecules are described. Finally, the authors provide a rationale for an optimal approach to immunosuppression in pediatrics. Because many of the newer immunosuppressive agents are currently in clinical trials, the "optimal" immunosuppressive strategy for the next decade is forthcoming.
Assuntos
Rejeição de Enxerto/imunologia , Imunossupressores/uso terapêutico , Criança , Rejeição de Enxerto/prevenção & controle , Humanos , Imunossupressores/efeitos adversos , Imunossupressores/farmacologia , Transplante de Rim , Receptores de Glucocorticoides/efeitos dos fármacos , Receptores de Glucocorticoides/imunologia , Linfócitos T/imunologiaRESUMO
In this review, we discuss the role of the allograft endothelium in the recruitment and activation of leukocytes during acute and chronic rejection. We discuss associations among endothelial activation responses, the expression of adhesion molecules, chemokines and chemokine receptors, and rejection; and we propose that endothelial vascular cellular adhesion molecule-1 (VCAM-1) may be used as a surrogate marker of acute rejection and allograft vasculopathy. In addition, we describe potential mechanistic interpretations of persistent endothelial cell (EC) expression of major histocompatibility complex (MHC) class II molecules in allorecognition. The graft endothelium may provide an antigen-specific signal to transmigrating, previously activated, T cells and may induce B7 expression on locally transmigrating leukocytes to promote costimulation. Taken together, these functions of the EC provide it with a potent regulatory role in rejection and in the maintenance of T-cell activation via the direct and/or the indirect pathways of allorecognition.