Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 10.071
Filtrar
1.
Gut ; 69(2): 311-316, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31040168

RESUMO

OBJECTIVE: The impact of a screening programme on colorectal cancer (CRC) incidence in its target population depends on several variables, including coverage with invitations, participation rate, positivity rate of the screening test, compliance with an invitation to second-level assessment and endoscopists' sensitivity. We propose a synthetic indicator that may account for all the variables influencing the potential impact of a screening programme on CRC incidence. DESIGN: We defined the 'rate of advanced adenoma on the target population' (AA-TAP) as the rate of patients who received a diagnosis of advanced adenoma within a screening programme, divided by the programme target population. We computed the AA-TAP for the CRC Italian screening programmes (biennial faecal immunochemical test, target population 50-69 year olds) using the data of the Italian National Survey from 2003 to 2016, overall and by region, and assessed the association between AA-TAP and CRC incidence fitting a linear regression between the trend of regional CRC incidence rates in 50-74 year old subjects and the cumulative AA-TAP. RESULTS: In 2016, the AA-TAP at a national level was 105×100 000, whereas significant differences were observed between the northern and central regions (respectively 126 and 149×100 000) and the South and Islands (36×100 000). The cumulative AA-TAP from 2004 to 2012 was significantly correlated with the difference between CRC incidence rates in 2013-2014 and those in 2003-2004 (p=0.009). CONCLUSION: The AA-TAP summarises into a single indicator the potential impact of a screening programme in reducing CRC incidence rates.


Assuntos
Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Adenoma/diagnóstico , Adenoma/epidemiologia , Idoso , Colonoscopia , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Sangue Oculto , Cooperação do Paciente/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/métodos
2.
HNO ; 68(1): 55-58, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31531685

RESUMO

Adenomas are very rare tumors of the middle ear. They are benign neoplasms originating from the glandular components of the mucous membrane of the middle ear. The middle ear adenoma was first described by Hyams and Michaels in 1976, which was named an adenomatous tumor. This article reports the case of a 50-year-old female patient, who presented with recurrent right-sided dull otalgia and pulse synchronous tinnitis, which began 1 year prior to presentation, with the suspected diagnosis of a glomus tympanicum tumor. Following the otorhinolaryngological examination and imaging an unclear mesotympanal space-occupying lesion was detected. A transmeatal endoscopic complete removal of the tumor was carried out. The histopathological investigations enabled the diagnosis of an adenoma of the middle ear. Adenomas are a rare differential diagnosis of tumors of the middle ear. In cases with a suitable localization an adequate exposure and removal of this rare tumor can be achieved by a transmeatal endoscopic access.


Assuntos
Adenoma , Neoplasias da Orelha , Adenoma/diagnóstico , Adenoma/patologia , Adenoma/terapia , Neoplasias da Orelha/diagnóstico , Neoplasias da Orelha/patologia , Neoplasias da Orelha/terapia , Orelha Média , Endoscopia , Feminino , Humanos , Pessoa de Meia-Idade , Osso Temporal
3.
Equine Vet J ; 52(1): 83-90, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30980730

RESUMO

BACKGROUND: Primary hyperparathyroidism is uncommon in equids. OBJECTIVES: To describe the diagnostic findings and efficacy of treatment in equids with primary hyperparathyroidism. STUDY DESIGN: Retrospective case series describing 16 horses and one mule. METHODS: Cases were identified by retrospective review of records at Cornell University and via an ACVIM listserv query. Inclusion criteria were an equid with hypercalcemia, normal renal function and high parathyroid hormone (PTH) or histopathological diagnosis of a parathyroid adenoma. Equids with normal PTH and PTH-related protein (PTHrP) in the face of hypercalcemia were included as suspect cases. RESULTS: The most common presenting complaints were weight loss (12/17) and hypercalcemia (10/17). PTH was above reference range in 12/17 cases. Suspected parathyroid tumours were localised in 12/14 equids imaged using ultrasonography alone (2/3), technetium 99m Tc sestamibi scintigraphy alone (1/1) or both modalities (9/10). Three horses did not have imaging performed. Surgical exploration successfully excised tumours in six of 10 cases. Five were located at the thoracic inlet, and surgery resulted in complete cure. One tumour was excised from the thyroid lobe, and the horse remained hypercalcemic. Four other cases explored surgically, four treated medically and three that were not treated also remained hypercalcemic. MAIN LIMITATIONS: The small study size prohibited statistical analysis. CONCLUSIONS: Parathyroid adenomas in equids can be successfully localised with ultrasonography and scintigraphy. Surgical excision appears more likely to be successful for single gland disease at the thoracic inlet.


Assuntos
Adenoma/veterinária , Equidae , Hiperparatireoidismo/veterinária , Neoplasias das Paratireoides/veterinária , Adenoma/diagnóstico , Adenoma/cirurgia , Animais , Cálcio/sangue , Hiperparatireoidismo/diagnóstico , Hiperparatireoidismo/cirurgia , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/cirurgia , Estudos Retrospectivos
4.
Medicine (Baltimore) ; 98(50): e18293, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852107

RESUMO

RATIONALE: Ectopic thyroid is most common in the tongue. Here we reported a rare case of thyroid tissue located in the gallbladder wall, accompanied with adenoma and a cyst lined with pseudostratified ciliated columnar epithelium in the neck region of gallbladder neck. PATIENT CONCERNS: A 39-year-old female presented with recurrent upper abdominal pain and radiating back pain. DIAGNOSES: Based on ultrasonography, gallbladder polyps and calculous cholecystitis were suspected. INTERVENTIONS: The patient was treated by laparoscopic cholecystectomy, and thyroid tissue located in the gallbladder wall was found. Histopathological examination showed no features of papillary thyroid neoplasm. OUTCOMES: The patient had no thyroid nodules or suspicious enlarged lymph nodes, and no other symptoms or complications by follow-up for 2.5 years up to September 2019. LESSONS: We should pay attention to the rare location of ectopic thyroid tissue in the gallbladder and rule out primary thyroid malignancy to avoid unnecessary overtreatment.


Assuntos
Adenoma/diagnóstico , Coristoma/diagnóstico , Neoplasias da Vesícula Biliar/diagnóstico , Vesícula Biliar , Doenças da Glândula Tireoide/diagnóstico , Adenoma/complicações , Adenoma/cirurgia , Adulto , Biópsia , Colecistectomia Laparoscópica/métodos , Coristoma/cirurgia , Diagnóstico Diferencial , Feminino , Neoplasias da Vesícula Biliar/complicações , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Doenças da Glândula Tireoide/complicações , Doenças da Glândula Tireoide/cirurgia
5.
Medicina (B Aires) ; 79(5): 419-423, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31671397

RESUMO

We present the case of a patient who, during studies for fertility and subsequent pregnancy, showed an altered thyroid profile with elevated levels of free T4 and normal TSH. After ruling out a thyrotropic adenoma and in the absence of clinical symptoms of hyperthyroidism, the possibility of analytical interference in the immunoassays used to measure hormones was investigated. Interferences caused by heterophile antibodies, macro TSH, anti-thyroid antibodies, biotin, and to a lesser extent anti-streptavidin and anti-ruthenium antibodies have been described. The analysis of the patient was carried out in a self-analyzer whose platform uses the streptavidin-biotin system that is very susceptible to several interferents. A proposed algorithm includes a series of simple tests to perform and interpret that allow detecting or ruling out the presence of interferents. Accordingly, a comparison was made with a different analytical platform (which does not use the streptavidin-biotin system), serial dilutions, precipitation with polyethylene glycol 6000 and treatment with microparticles coated with streptavidin. Results obtained confirmed the presence of anti-streptavidin antibodies in the patient's serum. In the case of disagreements between clinical manifestations and laboratory results, the possibility of methodological interferences should be investigated in order to avoid the potential iatrogenic risk involved in an erroneous biochemical interpretation.


Assuntos
Adenoma/diagnóstico , Anticorpos Anti-Idiotípicos/imunologia , Hipertireoidismo/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Estreptavidina/imunologia , Adenoma/imunologia , Adulto , Erros de Diagnóstico , Feminino , Humanos , Hipertireoidismo/imunologia , Neoplasias Hipofisárias/imunologia , Gravidez , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina/sangue
6.
Pan Afr Med J ; 33: 238, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692695

RESUMO

Multiple endocrine neoplasia type 1 (MEN1) is a rare disease, defined as a tumor developing in at least two endocrine glands including the anterior pituitary gland, the parathyroid glands and the duodenopancreatic endocrine tissue. This disorder, inherited in an autosomal dominant pattern, is caused by mutations in the MEN1 gene encoding the tumor suppressor menin and located on chromosome 11q13. However, sporadic cases account for 8-14%. The first endocrine lesion may be solitary in approximately 75% of cases. However, all major alterations can be inaugural. We here report a case of multiple endocrine neoplasia type 1 revealed by aggressive somatoprolactinic pituitary adenoma which didn't respond to conventional treatment. The detection of primary hyperparathyroidism as well as neuroendocrine tumor of the pancreas seven years later make this a very particular case. Therapeutic options are discussed within the multidisciplinary team specialized in endocrine diseases.


Assuntos
Neoplasia Endócrina Múltipla Tipo 1/diagnóstico , Tumores Neuroendócrinos/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Adenoma/diagnóstico , Adenoma/patologia , Adulto , Humanos , Hiperparatireoidismo Primário/diagnóstico , Masculino , Neoplasia Endócrina Múltipla Tipo 1/patologia , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/patologia , Neoplasias Hipofisárias/patologia , Prolactina/metabolismo
7.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(11): 1162-1165, 2019 Nov 06.
Artigo em Chinês | MEDLINE | ID: mdl-31683406

RESUMO

This study analyzed the distribution of high-risk population, the compliance and detected lesions of colorectal cancer screening from the Cancer Screening Program in urban areas of Kunming,Yunnan Province from 2014 to 2017. A total of 127 960 residents were included,of which 14 791 (11.70%) cases were diagnosed with high risk of colorectal cancer by the National Cancer Center High Risk Population Assessment System. A total of 3 484 cases completed colonoscopy clinical screening and the rate of participation was 23.55%. The screening results showed that 592 positive cases were detected, and the positive rate was 17.17%. The detection rates of polyps,adenomas,advanced adenomas,precancerous lesions and colorectal cancer were 16.27%,13.12%,7.18%,7.63% and 0.26%, with 567, 457, 250, 266 and 9 cases, respectively.


Assuntos
Adenoma/diagnóstico , Pólipos do Colo/epidemiologia , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer , Lesões Pré-Cancerosas/diagnóstico , Adenoma/epidemiologia , Adenoma/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Pólipos do Colo/etiologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/patologia , Fatores de Risco , Adulto Jovem
8.
Medicine (Baltimore) ; 98(42): e17629, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626147

RESUMO

The potential relationship between coronary artery calcium (CAC) and colorectal adenoma has been widely indicated. This study aimed to investigate the relationship between the risk of colorectal adenoma and CAC progression in asymptomatic Korean adults who underwent serial assessments by colonoscopy and CAC scan.A total of 754 asymptomatic participants, who had undergone serial CAC scans and colonoscopies for screening, were enrolled. Changes in CAC were assessed according to the absolute change between baseline and follow-up results. CAC progression was defined using Multi-Ethnic Study of Atherosclerosis method. Risk for adenoma at follow-up colonoscopy was determined using hazard ratio (HR) by Cox regression. The area under the receiver operating characteristic (ROC) curve was measured.The mean follow-up duration was 3.4 ± 2.5 years. CAC progression was found in 215 participants (28.5%). Participants with adenoma at index colonoscopy showed a higher rate of CAC progression than those without (38.8% vs 23.6%, P < .01). In participants with adenoma at index colonoscopy, CAC progression significantly increased the cumulative risk for adenoma at follow-up colonoscopy (HR = 1.48, 95% confidence interval [CI] 1.06-2.06, log-rank P = .021). In multivariate analysis, male sex (HR = 2.57, 95% CI 1.22-5.42, P = .013), ≥3 adenomas at index colonoscopy (HR = 2.60, 95% CI 1.16-5.85, P = .021), and CAC progression (HR = 2.74, 95% CI 1.48-5.08, P = .001) increased the risk of adenoma at follow-up colonoscopy. In participants without adenoma at index colonoscopy, neither baseline CAC presence nor CAC progression increased the risk of adenoma at follow-up colonoscopy. The interaction between CAC progression and adenoma at index colonoscopy was significant in multivariable model (P = .005). In the ROC analysis, AUC of CAC progression for adenoma at follow-up colonoscopy was 0.625 (95% CI 0.567-0.684, P < .001) in participants with adenoma at index colonoscopy.Participants with CAC progression, who are at high risk of coronary atherosclerosis, may need to be considered for follow-up evaluation of colorectal adenoma, especially those with adenoma at index colonoscopy.


Assuntos
Adenoma/complicações , Cálcio/metabolismo , Neoplasias Colorretais/complicações , Doença da Artéria Coronariana/etiologia , Vasos Coronários/diagnóstico por imagem , Medição de Risco/métodos , Calcificação Vascular/etiologia , Adenoma/diagnóstico , Doenças Assintomáticas , Colonoscopia , Neoplasias Colorretais/diagnóstico , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Vasos Coronários/metabolismo , Progressão da Doença , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Curva ROC , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Calcificação Vascular/diagnóstico , Calcificação Vascular/epidemiologia
9.
Pan Afr Med J ; 33: 92, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489070

RESUMO

Isolated involvement of the hypothalamic-pituitary axis in patients with sarcoidosis is rare. Only a few cases have been reported in the literature. We report the clinical case of a 50-years old female patient who had undergone total thyroidectomy followed by replacement therapy because of goitre 4 years before. She complained of chronic headaches persisting for 6 months and resistant to all appropriate therapies, with concomitant decrease in visual acuity. Clinical examination showed optochiasmatic syndrome with extensive visual field defect and common oculomotor nerve palsy in the right eye with ptosis. Brain MRI objectified pathological process to the sellar region with heterogeneous tissue signal intensity extending to the pituitary stalk with thickening in the latter. Preoperative hormonal assessment showed mild thyrotropic deficiency. The patient underwent wide transnasal endoscopic transsphenoidal resection of fibrous and little bleeding tumor. Postoperative outcome was marked by the occurrence of diabetes insipidus and CSF fistula two days after surgery. Patient's outcome was good under medical treatment with spinal drainage. Thoracoabdominal CT scan and cardiac ultrasound were performed which showed no other site of occurrence of sarcoidosis. Dose of converting enzyme was normal. The patient received corticosteroid therapy for the treatment of systemic disease. Neurosarcoidosis is a criterion of poor prognosis in a patient with sarcoidosis. Hypothalamopituitary involvement is rare resulting in complications which are more frequent than those of other neurological and systemic disorders. This requires multidisciplinary long term management.


Assuntos
Adenoma/diagnóstico , Doenças da Hipófise/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Sarcoidose/diagnóstico , Doenças do Sistema Nervoso Central/diagnóstico , Doenças do Sistema Nervoso Central/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Doenças da Hipófise/patologia , Prognóstico , Sarcoidose/patologia , Tomografia Computadorizada por Raios X
10.
No Shinkei Geka ; 47(8): 901-907, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31477634

RESUMO

OBJECTIVES: Intracranial chordomas are thought to arise from remnants of the notochord and usually occur at the parasellar region. We present a case of a primary intrasellar chondroid chordoma in a patient who was initially diagnosed with a pituitary adenoma. CASE: A 77-year-old woman had a history of two surgeries for a tumor in the sella turcica(17 months after the 1st surgery). On initial MRI, the intrasellar mass showed low signal intensity on T1WI, very high signal intensity on T2WI, and inhomogeneous enhancement. On bone reconstructive CT, the sellar floor was thin, and no abnormalities were observed at the top of the clivus. Transsphenoidal surgery was performed. The pathological diagnosis was pituitary adenoma in both cases. Seventy-two months after the 1st(31 months after the 2nd)surgery, she developed right-sided oculomotor and abducent nerve palsies again. Since recurrence occurred during the relatively short period, the surgical specimens obtained from the 1st and 2nd surgeries were reexamined. Reexamination of the previously obtained specimen demonstrated areas of chondroid tissue that were embedded in a mucoid stroma and tumor cells that were composed of round or pleomorphic nuclei with vacuolated cytoplasm(physaliphorus cells)that were compatible with chondroid chordoma. The third surgery was performed. Postoperatively, her symptoms improved, and cyber knife therapy was administered for the residual part of the tumor. CONCLUSIONS: Although intrasellar chondroid chordomas are extremely rare, they should be considered in the differential diagnosis of tumors located in the sella turcica.


Assuntos
Adenoma , Cordoma , Neoplasias Hipofisárias , Adenoma/diagnóstico , Adenoma/cirurgia , Idoso , Cordoma/diagnóstico , Cordoma/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Recidiva Local de Neoplasia , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/cirurgia , Sela Túrcica/patologia
11.
Gastroenterology ; 157(6): 1494-1505, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31472152

RESUMO

BACKGROUND & AIMS: Quantitative fecal immunochemical tests (FITs) for hemoglobin are commonly used for colorectal cancer (CRC) screening. We aimed to quantify the change in CRC and advanced adenoma detection and number of positive test results at different positivity thresholds and by sex and age. METHODS: We searched MEDLINE and EMBASE, selecting articles of FIT for CRC detection in asymptomatic adults undergoing screening. We calculated sensitivity and specificity, as well as detected number of cancers, advanced adenomas, and positive test results at positivity thresholds ≤10 µg hemoglobin/g feces, 10 to ≤20 µg/g, 20 to ≤30 µg/g, and >30 µg/g. We also analyzed results from stratified by patient sex, age, and reference standard. RESULTS: Our meta-analysis comprised 46 studies with 2.4 million participants and 6478 detected cancers. Sensitivity for detection of CRC increased from 69% (95% confidence interval [CI], 63%-75%) at thresholds >10 µg/g and ≤20 µg/g to 80% (95% CI, 76%-83%) at thresholds ≤10 µg/g. At these threshold values, sensitivity for detection of advanced adenomas increased from 21% (95% CI, 18%-25%) to 31% (95% CI, 27%-35%), whereas specificity decreased from 94% (95% CI, 93%-96%) to 91% (95% CI, 89%-93%). In 3 studies stratified by sex, sensitivity of CRC detection was 77% in men (95% CI, 75%-79%) and 81% in women (95% CI, 60%-100%) (P = .68). In 3 studies stratified by age groups, sensitivity of CRC detection was 85% for ages 50-59 years (95% CI, 71%-99%) and 73% for ages 60-69 years (95% CI, 71%-75%) (P = .10). All studies with colonoscopy follow-up had similar sensitivity levels for detection of CRC to studies that analyzed 2-year registry follow-up data (74%; 95% CI, 68%-78% vs 75%; 95% CI, 73%-77%). CONCLUSIONS: In a meta-analysis of studies that analyzed detection of CRC and advanced adenomas at different FIT positivity thresholds, we found the sensitivity and specificity of detection to vary with positive cutoff value. It might be possible to decrease positive threshold values for centers with sufficient follow-up colonoscopy resources. More research is needed to precisely establish FIT thresholds for each sex and age subgroup. PROTOCOL: PROSPERO CRD42017068760.


Assuntos
Adenoma/diagnóstico , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/normas , Programas de Rastreamento/normas , Sangue Oculto , Fatores Etários , Colonoscopia , Detecção Precoce de Câncer/métodos , Hemoglobinas/análise , Humanos , Programas de Rastreamento/métodos , Padrões de Referência , Sensibilidade e Especificidade , Fatores Sexuais
12.
J. coloproctol. (Rio J., Impr.) ; 39(3): 197-202, June-Sept. 2019. tab, graf, ilus
Artigo em Inglês | LILACS | ID: biblio-1040329

RESUMO

ABSTRACT Background and aim: Right colon adenomas can easily missed with significant adenoma miss rate particularly when they are located behind the haustral folds and anatomical flexures. The aim of this study was to assess the significance of retroflexion technique in the right colon for improving adenoma detection rates compared with forward-view technique. Methods: A total of 200 patients scheduled for elective colonoscopy were recruited. During the standard forward-view examination, the colonoscope was withdrawn from the cecum to the hepatic flexure while under meticulous observation. Subsequently, the cecum was reintubated and the right side of the colon was assessed in the retroflexed-view to the hepatic flexure. The primary outcome of this study was comparison of the adenoma detection rates and adenoma miss rate of the retroflexed-view versus forward-view examination of the right colon. Results: Of the 200 enrolled patients, retroflexion was successful in 182 (91%). Forward-view examination of the right colon detected 88 polyps, of which 66 were adenomas yielding a polyp and adenoma detection rates of 25.5% and 19%, respectively. Additionally, retroflexion detected a further 30 polyps of which 23 were adenomas, accordingly improving the polyp and adenoma detection rates to 29.5% and 25%, respectively. Furthermore, the polyp and adenoma miss rate in the right colon was 24.1% and 25.8% respectively. Conclusion: Colonoscopy with right-sided retroflexion after forward-view examination significantly increases the detection of adenomas compared with standard forward-view examination with a high success rate and small risk of adverse events.


RESUMO Antecedentes e objetivo: Os adenomas do cólon direito podem não ser diagnosticados, apresentando uma elevada taxa de não detecção de adenoma, especialmente quando estão localizados atrás das pregas haustrais e flexões anatômicas. O objetivo deste estudo foi comparar, no cólon direito, a técnica de visualização retroflexionada com a técnica de visualização frontal quanto à taxa de detecção de adenoma. Métodos: Um total de 200 pacientes agendados para colonoscopia eletiva foram recrutados para o presente estudo. Durante o exame de visualização frontal padrão, o colonoscópio foi retirado do ceco em direção à flexão hepática sob observação meticulosa. Posteriormente, o ceco foi reintubado e o lado direito do cólon foi avaliado na visualização retroflexionada em direção à flexão hepática. O objetivo primário deste estudo foi comparar a taxa de detecção de adenoma e a taxa de não detecção de adenoma do exame de visualização retroflexionada e visualização frontal do cólon direito. Resultados: Dos 200 pacientes inscritos, a retroflexão foi bem sucedida em 182 (91%). A visualização frontal do cólon direito detectou 88 pólipos, dos quais 66 eram adenomas, com uma taxa de detecção de pólipos e taxa de detecção de adenoma de 25,5% e 19%, respectivamente. Além disso, a visualização retroflexionada detectou mais 30 pólipos, dos quais 23 eram adenomas, aumentando a taxa de detecção de pólipos e adenoma para 29,5% e 25%, respectivamente. Além disso, a taxa não detecção de pólipos e a taxa de não detecção de adenoma no cólon direito foram de 24,1% e 25,8%, respectivamente. Conclusão: A colonoscopia com visualização retroflexionada direita após visualização frontal aumenta significativamente a detecção de adenomas em comparação com a visualização frontal padrão, com uma alta taxa de sucesso e baixo risco de eventos adversos.


Assuntos
Humanos , Masculino , Feminino , Adenoma/diagnóstico , Colonoscopia , Pólipos , Colo/patologia , Neoplasias do Colo
13.
BMJ Case Rep ; 12(8)2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31383684

RESUMO

Respiratory epithelial adenomatoid hamartoma (REAH) is a rare lesion in nasal cavity first reported by Wenig and Heffner in 1995. Most commonly seen in men in third to ninth decade of life. Majority of cases presents as a polypoidal mass in one or both nasal cavities. We experienced such a case of REAH originating from the nasal septum, in posterior aspect, treated by endoscopic approach. It is important to differentiate REAH from other sinonasal pathologies like inverted papilloma and low grade sinonasal adenocarcinoma. Complete surgical resection is the treatment of choice.


Assuntos
Adenoma/diagnóstico , Hamartoma/diagnóstico , Pólipos Nasais/diagnóstico , Neoplasias Epiteliais e Glandulares/diagnóstico , Neoplasias Nasais/diagnóstico , Adenoma/patologia , Diagnóstico Diferencial , Hamartoma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/patologia , Pólipos Nasais/complicações , Neoplasias Epiteliais e Glandulares/etiologia , Neoplasias Nasais/etiologia
14.
Medicine (Baltimore) ; 98(32): e16819, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393413

RESUMO

To investigate effects of bowel preparation, experience level of colonoscopists, and colonoscopy withdrawal time (CWT) on the quality of an individual opportunistic screening colonoscopy, according to adenoma detection rate (ADR).Data were retrospectively analyzed from opportunistic screening colonoscopies (n = 16,951) at 4 hospitals of various care levels in China.The ADR positively correlated with the experience level of the colonoscopist. The individualized CWT varied, depending on the quality of bowel preparation and the number of colonoscopies performed previously by the colonoscopist. In a setting of adequate bowel preparation, the mean CWT decreased with the increased experience of the colonoscopist. With poor and inadequate bowel preparation, no colonoscopist at any level of experience could obtain a satisfactory ADR.For adequately prepared colonoscopies, minimum CWTs have been determined. Repeat colonoscopy is strongly recommended for patients with poor bowel preparation, regardless of the colonoscopist's experience.


Assuntos
Adenoma/diagnóstico , Catárticos/normas , Competência Clínica , Colonoscopia/normas , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/normas , Adulto , Idoso , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
15.
Best Pract Res Clin Endocrinol Metab ; 33(2): 101309, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31405752

RESUMO

Pituitary diseases are rare conditions with severe chronic multiorgan and multisystemic morbidity requiring complex multidisciplinary treatment and usually life-long drug treatment. Most cases are caused by functioning or non-functioning pituitary adenoma. From the patient's perspective, the burden of disease is caused by the tumour itself and associated compression symptoms, interventions, hormone excess and deficiencies, systemic manifestations of these endocrine abnormalities and general psychosocial issues that can manifest in patients with a chronic condition. In this review, patient burden is classified according to classic endocrine syndromes, with burden at diagnosis and after long-term remission, and also within the framework of value-based health care and the conceptual model of wellbeing. The recently developed patient-reported outcome measurement tool that helps to evaluate burden of patients is also discussed.


Assuntos
Adenoma , Efeitos Psicossociais da Doença , Neoplasias Hipofisárias , Acromegalia/epidemiologia , Acromegalia/etiologia , Acromegalia/psicologia , Acromegalia/terapia , Adenoma/diagnóstico , Adenoma/epidemiologia , Adenoma/psicologia , Adenoma/terapia , Humanos , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/epidemiologia , Neoplasias Hipofisárias/psicologia , Neoplasias Hipofisárias/terapia , Qualidade de Vida
16.
J Cancer Res Clin Oncol ; 145(10): 2423-2432, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31456088

RESUMO

PURPOSE: The mortality of colorectal cancer ranked fifth in China according to cancer statistics in 2015. Cancer screening had been repeatedly proved to play a vital role in decreasing the incidence and mortality of colorectal cancer, but the existing screening methods could not meet the requirements. So it is of urgent need to develop a non-invasive, convenient and accurate screening method. METHODS: In this study, stool samples were collected from 102 colorectal cancer, 20 colorectal adenoma, 6 hyperplastic polyps patients and 105 normal controls, and stool DNA was extracted for detection of methylation (BMP3, NDRG4, SDC2 and SFRP2) and KRAS mutations. Meanwhile, hemoglobin in stool samples was detected by immunoassays. Then, the logistic regression model used for classification was built with these biomarkers, and a ROC curve was drawn to evaluate the performance of each biomarker and the panel of them. Meanwhile, conventional serum biomarkers were detected for the comparison of positive rate in colorectal cancer between serum biomarkers and stool DNA biomarkers. RESULTS: As a result, a classification model built with methylation of SDC2 and SFRP2, KRAS mutations and hemoglobin showed a sensitivity of 91.4% for colorectal cancer and 60% for adenoma with the specificity of 86.1%. Compared with it, most of the conventional serum biomarkers showed a sensitivity of less than 20% for colorectal cancer which was significantly lower than stool DNA biomarkers. CONCLUSIONS: A novel panel comprised of stool DNA biomarkers was of much higher sensitivity and specificity in early screening of colorectal neoplasms than conventional serum biomarkers.


Assuntos
Biomarcadores Tumorais , Neoplasias Colorretais/genética , DNA de Neoplasias , Fezes/química , Adenoma/diagnóstico , Adenoma/genética , China/epidemiologia , Pólipos do Colo/diagnóstico , Pólipos do Colo/genética , Colonoscopia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Metilação de DNA , Detecção Precoce de Câncer , Feminino , Humanos , Masculino , Programas de Rastreamento , Mutação , Estadiamento de Neoplasias , Proteínas Proto-Oncogênicas p21(ras)/genética , Curva ROC , Sensibilidade e Especificidade
17.
Best Pract Res Clin Endocrinol Metab ; 33(2): 101299, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31431397

RESUMO

In this paper, the currently used and well evaluated techniques for the surgery of pituitary tumors will be reviewed. Since the first surgical approaches to pituitary tumors more than 100 years have elapsed. Various surgical techniques have been developed, refined and standardized. Most of these tumors are to date treated via transsphenoidal approaches. Many pituitary adenomas, particularly, smaller, enclosed ones, can be completely excised and a selective adenomectomy is usually attempted. It leads to remission of hormonal oversecretion and also to recovery of pituitary function in many patients. The resection of pseudocapsule around the adenoma seems to improve the operative results further. Transcranial approaches, employing craniotomies, are still needed in some patients with pituitary adenomas and in many of those harbouring craniopharyngiomas. The operative techniques will be described and briefly commented. Moreover, the application and usefulness of several technical developments will be reviewed, such as the use of the endoscope, magnetic resonance imaging, fluorenscent dyes and neuronavigation. The use of the intraoperative Doppler probe, ultrasound and the value of intraoperative hormonal measurements will be briefly discussed. There is sufficient evidence that the best and optimal outcome in terms of tumor resection and correction of hormonal oversecretion as well as the lowest rate of complications are obtained in centers of excellence with sufficiently experienced, specialized surgeons and a high patient load.


Assuntos
Adenoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias Hipofisárias/cirurgia , Adenoma/diagnóstico , Adenoma/epidemiologia , Humanos , Imagem por Ressonância Magnética , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/normas , Hipófise/cirurgia , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
18.
Medicine (Baltimore) ; 98(34): e16940, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441886

RESUMO

BACKGROUND: The clinical significance of Raman spectroscopy (RS) in colorectal cancer (CRC) patients still remains underestimated. We performed this meta-analysis to elucidate the diagnostic value in CRC patients. METHODS: We systematically searched electronic databases for published articles. Fixed effect model and random effect model were used to calculate the pooled sensitivity, specificity, diagnostic accuracy, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and positive posttest probability (PPP) of CRC. Meta-regression and subgroup analysis were conducted to assess potential source of heterogeneity. We also used Egger linear regression tests to assess risk of publication bias. RESULTS: Thirteen studies had been included (679 patients: 186 with premalignant lesions and 493 with malignant lesions). The pooled sensitivity, specificity, diagnostic accuracy, PLR, NLR, DOR and PPP for CRC screening using RS were 0.94 (0.92-0.96), 0.94 (0.88-0.97), 0.96 (0.94-0.98), 16.44 (7.80-34.63), 0.062 (0.043-0.090), 263.65 (99.03-701.96) and 86%, respectively. CONCLUSION: RS is a potentially useful tool for future CRC screening. It also offers potentially early detection for CRC patients.


Assuntos
Adenoma/diagnóstico , Neoplasias Colorretais/diagnóstico , Análise Espectral Raman , Diagnóstico Precoce , Feminino , Humanos , Masculino , Valor Preditivo dos Testes
19.
Arch Endocrinol Metab ; 63(4): 385-393, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31365626

RESUMO

INTRODUCTION: Gigantism is a rare pediatric disease characterized by increased production of growth hormone (GH) before epiphyseal closure, that manifests clinically as tall stature, musculoskeletal abnormalities, and multiple comorbidities. MATERIALS AND METHODS: Case series of 6 male patients with gigantism evaluated at the Endocrinology Service of Hospital de San José (Bogotá, Colombia) between 2010 and 2016. RESULTS: All patients had macroadenomas and their mean final height was 2.01 m. The mean age at diagnosis was 16 years, and the most common symptoms were headache (66%) and hyperhidrosis (66%). All patients had acral changes, and one had visual impairment secondary to compression of the optic chiasm. All patients underwent surgery, and 5 (83%) required additional therapy for biochemical control, including radiotherapy (n = 4, 66%), somatostatin analogues (n = 5, 83%), cabergoline (n = 3, 50%), and pegvisomant (n = 2, 33%). Three patients (50%) achieved complete biochemical control, while 2 patients showed IGF-1 normalization with pegvisomant. Two patients were genetically related and presented a mutation in the aryl hydrocarbon receptor-interacting protein (AIP) gene (pathogenic variant, c.504G>A in exon 4, p.Trp168*), fulfilling the diagnostic criteria of familial isolated pituitary adenoma. CONCLUSIONS: This is the largest case series of patients with gigantism described to date in Colombia. Transsphenoidal surgery was the first-choice procedure, but additional pharmacological therapy was usually required. Mutations in the AIP gene should be considered in familial cases of GH-producing adenomas.


Assuntos
Adenoma/terapia , Gigantismo/terapia , Neoplasias Hipofisárias/terapia , Adenoma/diagnóstico , Adolescente , Colômbia , Seguimentos , Gigantismo/diagnóstico , Hormônio do Crescimento/sangue , Adenoma Hipofisário Secretor de Hormônio do Crescimento/genética , Humanos , Fator de Crescimento Insulin-Like I/análise , Peptídeos e Proteínas de Sinalização Intracelular/genética , Masculino , Mutação/genética , Linhagem , Neoplasias Hipofisárias/diagnóstico , Estudos Retrospectivos , Distribuição por Sexo , Resultado do Tratamento , Adulto Jovem
20.
BMJ Case Rep ; 12(7)2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31326901

RESUMO

The elevation of thyroid hormone with a normal or elevated thyroid-stimulation hormone (TSH) occurs uncommonly. This set a diagnosis challenge between TSH-secreting pituitary adenoma and resistance to thyroid hormone (RTH). We report a case of a young female patient with palpitations, with elevated thyroid hormone and non-suppressed TSH. TSH receptor antibody was undetectable. Thyroid ultrasound revealed mild heterogeneous goitre, and MRI revealed a microadenoma with 7.5 mm length in pituitary's left lobe. Pituitary hormones were within normal ranges. The thyrotropin-releasing hormone stimulation test showed normal TSH elevation, consistent with RTH. The genetic test revealed a mutation in heterozygosity in THRB gene (G344R) confirming RTH-beta. No pituitary surgery or thyroidectomy was performed nor were prescribed any antithyroid drugs. Inappropriate secretion of TSH requires a high level of clinical suspicion and the proper laboratory, genetic and radiological studies to conduct a correct diagnosis and prevent unnecessary and potential harmful therapies.


Assuntos
Adenoma/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Síndrome da Resistência aos Hormônios Tireóideos/diagnóstico , Adenoma/genética , Diagnóstico Diferencial , Feminino , Testes Genéticos , Humanos , Imagem por Ressonância Magnética , Neoplasias Hipofisárias/genética , Receptores beta dos Hormônios Tireóideos/genética , Síndrome da Resistência aos Hormônios Tireóideos/genética , Hormônios Tireóideos/sangue , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA