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1.
Medicine (Baltimore) ; 99(8): e19261, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080134

RESUMO

Barrett's esophagus has 0.5% to 7% risk of progression to esophageal adenocarcinoma. The method of obtaining biopsies to diagnose Barrett's is challenging. Seattle protocol has been considered as the gold standard, however its difficulty limits its applicability in practice. Narrow band imaging guided biopsy has been proposed as an alternative.To investigate the accuracy, sensitivity, specificity and applicability of Narrow band guided biopsy as a screening tool for Barret's esophagus in gastroesophageal reflux patients.Endoscopy was done in 2 different sessions 2 weeks apart for 100 patients in Alexandria, Egypt. Patients had at least one of the following: Chronic Gastroesophageal reflux disease, frequent Gastroesophageal reflux disease, or two or more risk factors for Barrett's esophagus. All patients with known Barrett's esophagus were excluded.Seventeen patients had Barrett's esophagus either by one of the two techniques or by both, 4 patients by both methods, 7 patients by narrow band imaging alone and 6 patients by Seattle protocol alone (P < .001, κ = 0.461). Sensitivity, specificity, negative predictive value and positive predictive value for Seattle protocol were 58.8%, 100%, 92.2%, 100% vs 76.5%, 100%, 95.4%, 100% respectively for narrow band imaging. A mean of 7.73 samples/patient was taken in Seattle protocol vs 3.42 samples in narrow band imaging (P < .001). A mean of 8.63 minutes was consumed in Seattle protocol vs 2.65 minutes in narrow band imaging (P < .001).Narrow band imaging guided biopsy might have higher accuracy, sensitivity and negative predictive value as well as fewer number of biopsies and shorter time of the procedure compared to Seattle protocol which might increases its applicability as screening protocol for Barrett's esophagus. However, further larger multicentric studies are needed.


Assuntos
Esôfago de Barrett/diagnóstico , Esofagoscopia , Esôfago/diagnóstico por imagem , Esôfago/patologia , Biópsia Guiada por Imagem , Imagem de Banda Estreita , Adolescente , Adulto , Idoso , Biópsia , Egito , Feminino , Refluxo Gastroesofágico/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Fatores de Tempo , Adulto Jovem
2.
Anticancer Res ; 40(2): 1071-1077, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014956

RESUMO

BACKGROUND/AIM: Severe benign cicatricial stricture (SBCS) is a major complication after definitive chemoradiation therapy (dCRT) for esophageal squamous cell carcinoma (ESCC). This study was conducted to investigate risk factors of SBCS in patients with localized ESCC. PATIENTS AND METHODS: This study included 197 patients with clinical stage (cSt) II/III ESCC with T3 primary tumor, treated with dCRT between 2000 and 2011. SBCS was defined as the inability to pass a 9-mm diameter endoscope or the presence of symptoms requiring treatment. RESULTS: Complete response was obtained in 87 patients (44%). Multivariate analysis revealed that hypoalbuminemia (hazard ratio=5.65; 95% confidence interval=1.50-21.28; p=0.010) and the inability to pass an endoscope (hazard ratio=5.90; 95% confidence interval=1.52-22.85; p=0.010) were risk factors of SBCS. CONCLUSION: The inability to pass an endoscope and hypoalbuminemia were identified as risk factors of SBCS in patients with cSt II/III ESCC with T3 primary tumor.


Assuntos
Quimiorradioterapia/efeitos adversos , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Neoplasias Esofágicas/complicações , Esôfago/patologia , Adulto , Idoso , Biomarcadores , Quimiorradioterapia/métodos , Constrição Patológica/epidemiologia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/terapia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Índice de Gravidade de Doença , Análise de Sobrevida
3.
Forensic Sci Int ; 306: 110066, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31765884

RESUMO

In forensic evaluation of charred corpses, internal detrimental signs may result as more significant of those observed during external examination and is often arduous to state if a victim was exposed to fire before or after death. When the histological analysis of the remaining internal viscera is necessary, the massive destruction caused by the lesion, the charring and the coarctation of the samples don't allow to give further information or to determine the remaining organic components of the viscera. This limit is determined by the intrinsic characteristics of this thermal lesivity of self-maintenance even after the exitus of the subject, worsening the initial detrimental framework. The Authors, with the purpose of improving the microscopic visualization of the samples collected from cadavers with peculiar deterioration, as in case of carbonization, suggest the use of a specific technical protocol based on the use of Sandison's rehydrating solution since the samples treated with this solution showed, at microscopic examination, a substantial histological-morphological improvement.


Assuntos
Fogo , Patologia Legal/métodos , Soluções para Reidratação , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta/patologia , Encéfalo/patologia , Cadáver , Dura-Máter/patologia , Esôfago/patologia , Feminino , Humanos , Intestino Delgado/patologia , Rim/patologia , Fígado/patologia , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Pele/patologia , Baço/patologia , Adulto Jovem
4.
J Surg Res ; 245: 537-543, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470334

RESUMO

BACKGROUND: After an esophageal resection, continuity is commonly restored by a gastric tube reconstruction and an intrathoracic anastomosis to the remaining proximal esophagus. Ischemia of the anastomotic region is considered to play a pivotal role in anastomotic leakage. Microdialysis (µD) is an excellent method to measure local biochemical substances and parameters in a specific organ or compartment aiming at early detection of ischemia. This animal study evaluates ischemia of the gastric tube reconstruction using a novel method-µD on organ surfaces. This promising method may have the potential to detect an anastomotic leakage before clinical symptoms develop. METHODS: Anesthetized normoventilated pigs were used. Surface microdialysis (S-µD) catheters and an intraparenchymal oxygen tension catheter were placed on the stomach. A gastric tube was made and the gastroepiploic artery was divided halfway along the greater curvature to produce severe ischemia at the top of the gastric tube. µD data from four locations (gastric tube, ileum and peritoneal cavity) were recorded every 20 min during the experiment. Tissue samples from all catheter sites underwent histopathological analysis. Intraparenchymal oxygen partial pressure, systemic blood tests, and hemodynamic parameters were recorded. RESULTS: S-µD data showed values indicating severe ischemia at the top of the gastric tube and intermediate ischemia at the level of transection of the gastroepiploic artery. Ischemia was verified by histopathological analysis of tissue samples and intraparenchymal oxygen tension data. CONCLUSIONS: S-µD can detect and grade severity of local ischemia in real time, in an animal model.


Assuntos
Fístula Anastomótica/diagnóstico , Esofagectomia/efeitos adversos , Esôfago/irrigação sanguínea , Isquemia/diagnóstico , Microdiálise/métodos , Anastomose Cirúrgica/efeitos adversos , Animais , Modelos Animais de Doenças , Esôfago/patologia , Esôfago/cirurgia , Humanos , Isquemia/etiologia , Isquemia/patologia , Oxigênio/análise , Índice de Gravidade de Doença , Sus scrofa
5.
Adv Gerontol ; 32(4): 606-613, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31800191

RESUMO

The structure and cytoarchitecture of the structures of the wall of the esophagus was studied by histological and morphometric methods. We investigated the upper, middle and lower third of the esophagus in people 1 and 2 of the mature, elderly and senile age. It was established that in old age comes the destruction of the epithelial lining, the muscular propria of the mucous membrane. The number of lymphocytes, neutrophilic leukocytes and eosinophils in the epithelium increases by 2-3 times. The content of cells of the fibroblastic and lymphoid series increases in lamina propria and glands. Infiltrates appear in the mucous membrane, microerosions appear. Particularly vulnerable areas are the papillas of lamina propria. In the places of their location the most frequent accumulations of lymphocytes are noted. Among mast cells, the processes of degranulation increase, the number of mast cells with a small amount of granules increases. Inflammation is often found in the lower sections. Age-related changes in the wall of the esophagus depend on the individual characteristics of a person.


Assuntos
Células Epiteliais , Esôfago , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Células Epiteliais/citologia , Células Epiteliais/patologia , Epitélio/patologia , Esôfago/citologia , Esôfago/patologia , Humanos , Pessoa de Meia-Idade , Membrana Mucosa/citologia , Membrana Mucosa/patologia
6.
Medicine (Baltimore) ; 98(41): e17511, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593121

RESUMO

Acute esophageal necrosis (AEN) is a serious disease which can causes gastrointestinal bleeding and death. Although black color change is not essential factor of organ necrosis, AEN is also known as "black esophagus." Because of its rarity, there are limited studies regarding risk factors of mortality and recurrence. Thus, we conducted a multicenter retrospective study in order to evaluate the clinical characteristics of AEN. Method Clinical datum of AEN patients from 7 tertiary hospitals located in Daejeon-Choongcheong province were evaluated based on medical records. Our primary endpoint was risk factors for mortality and the secondary endpoint was risk factors for recurrence and clarifying whether "black esophagus" is a right terminology.Fourty one patients were enrolled. Thirty six patients were male, mean age was 69.5 years. Nine patients had died, and 4 patients showed recurrence. Sepsis and white color change in endoscopy were related to high mortality (Chi-Squared test, P < .05). Old age, high pulse rate, low hemoglobin, and low albumin were also related to high mortality. Unexpectedly, heavy drinking showed favorable a mortality. Septic condition and high pulse rate showed poor mortality in logistic regression test (P < .05). Coexisting duodenal ulcer was related to recurrence (Chi-Squared test, P < .05). There was no difference in the underlying condition except patients with a coexisting cancer and white-form displayed lower hemoglobin level. Conclusion: Our results imply that white color change, septic condition, high pulse rate, and low hemoglobin & albumin are poor prognostic factors in AEN. Further evaluation may help clarify the findings of our study.


Assuntos
Doenças do Esôfago/mortalidade , Hemorragia Gastrointestinal/mortalidade , Necrose/diagnóstico por imagem , Necrose/mortalidade , Doença Aguda , Idoso , Albuminas/análise , Úlcera Duodenal/epidemiologia , Endoscopia do Sistema Digestório/métodos , Doenças do Esôfago/diagnóstico por imagem , Doenças do Esôfago/patologia , Esôfago/irrigação sanguínea , Esôfago/patologia , Feminino , Hemorragia Gastrointestinal/etiologia , Hemoglobinas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/complicações , Necrose/patologia , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de Risco , Sepse/epidemiologia , Sepse/etiologia , Sepse/mortalidade
7.
Medicine (Baltimore) ; 98(43): e17531, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651855

RESUMO

Lymph node metastasis (LNM) of esophageal squamous cell carcinoma (ESCC) has important prognostic significance. In this study, we examined the correlations between lymph node metastatic sites and prognosis in patients with resectable ESCC.A total of 960 patients who received curative esophagectomy with systemic lymphadenectomy between 1996 and 2014 were included in the retrospective analysis. The Kaplan-Meier method and log-rank test were used to perform the survival analysis. The prognostic significance of LNM site was evaluated by Cox regression analysis.The LNM in middle paraesophageal (P < .001), subcarinal (P < .001), lower paraesophageal (P < .001), recurrent laryngeal nerve (P = .012), paratracheal (P = .014), and perigastric (P < .001) sites were associated with poor prognosis in univariate analysis. In multivariate analysis, only middle paraesophageal LNM (MPLNM, P = .017; HR, 1.33; 95%CI, 1.05-1.67) was the independent factor for worse prognosis. Additionally, patients with MPLNM had a lower 5-year survival rate (15.6%) than those with LNM at other sites. Furthermore, upper or middle tumor location and relatively late pN stage were associated with increased risk of MPLNM.Our findings suggested MPLNM could be a characteristic indicating the worst prognosis. Preoperative examinations should identify the existences of MPLNM, especially on patients with risk factors. And patients with MPLNM should be considered for more aggressive multidisciplinary therapies.


Assuntos
Neoplasias Esofágicas/mortalidade , Carcinoma de Células Escamosas do Esôfago/mortalidade , Esofagectomia/mortalidade , Excisão de Linfonodo/mortalidade , Linfonodos/patologia , Idoso , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/patologia , Esôfago/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Linfonodos/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
8.
Thorac Surg Clin ; 29(4): 387-394, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31564395

RESUMO

Failure to recognize a short esophagus during paraesophageal hernia repair can lead to poor functional outcomes and increased recurrence rates. Diagnosis is usually done intraoperatively when less than 2 to 3 cm of esophagus lie in the intraabdominal position. If aggressive esophageal mediastinal mobilization is unable to lengthen the esophagus, the surgeon should perform an esophageal lengthening procedure. A modified Collis gastroplasty is most commonly used and can be performed through a variety of transabdominal or transthoracic approaches. These procedures are safe, durable, and associated with good long-term outcomes. Patient selection and safe surgical technique are key in avoiding complications.


Assuntos
Esôfago/patologia , Fundoplicatura/métodos , Gastroplastia/métodos , Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Humanos , Laparoscopia , Mediastino , Tamanho do Órgão , Seleção de Pacientes
9.
Korean J Gastroenterol ; 74(3): 159-162, 2019 Sep 25.
Artigo em Coreano | MEDLINE | ID: mdl-31554031

RESUMO

Mucoepidermoid carcinoma is a malignant tumor that occurs mainly in the salivary glands of adults and children, but rarely in the esophagus. A surgical resection is the primary treatment for mucoepidermal carcinoma, and the prognosis has been reported to be poor. A 61-year-old man was diagnosed with an esophageal nodule in upper gastrointestinal endoscopy for the purpose of a medical examination without any special symptoms and an endoscopic resection was performed for an accurate diagnosis. An endoscopic mucosal resection was performed using a band ligation for a complete resection and continuous follow-up with no evidence of recurrence or metastasis. The unknown prognosis of endoscopic resection makes it necessary to follow the patient carefully.


Assuntos
Carcinoma Mucoepidermoide/diagnóstico , Neoplasias Esofágicas/diagnóstico , Carcinoma Mucoepidermoide/patologia , Carcinoma Mucoepidermoide/cirurgia , Endoscopia do Sistema Digestório , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Esôfago/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Membrana Mucosa/cirurgia
10.
Pathol Res Pract ; 215(10): 152602, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31472995

RESUMO

BACKGROUND AND AIMS: Carcinoma cuniculatum (CC) is a rare variant of an extremely well-differentiated squamous cell carcinoma. The most commonly involved site is the skin, with a preference for the sole. Only 15 cases of esophageal CC have been reported so far. Based on published data, the clinical behavior of CC has not been clearly defined. We describe the clinical-pathologic features of two cases of esophageal CC, and provide a review of the available literature, to shed more light on this unusual tumor. METHODS: A detailed gross and histologic analysis was performed on two cases of surgically treated esophageal CC. The patients were followed-up after surgery. A systematic search was also done concerning studies focused on esophageal CC. A search of the electronic databases MEDLINE-PubMed was conducted using the following research terms: (esophagus) AND (cuniculatum carcinoma). RESULTS: Both patients were alive at last follow-up at six and nine months from surgery without any recurrence. Concerning the fifteen cases reported from the systematic review, median follow-up after surgery was very long as compared to common esophageal cancers (4.0 years), with only one recurrence observed. CONCLUSION: CC shows an indolent clinical behavior, with a low recurrence rate after radical surgery. The diagnosis of this rare tumor is typically made after surgery. An aggressive approach is required with curative intents.


Assuntos
Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/patologia , Recidiva Local de Neoplasia/patologia , Idoso , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/cirurgia , Esofagectomia , Esôfago/patologia , Esôfago/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
12.
R I Med J (2013) ; 102(6): 41-43, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31398968

RESUMO

Acute esophageal necrosis (AEN) is a rare condition that impacts the distal esophagus after a vascular insult. In this case report, we describe a patient with multiple comorbid conditions presenting with shock from gastroenteritis who subsequently developed AEN complicated by refractory strictures.


Assuntos
Doenças do Esôfago/patologia , Esôfago/patologia , Doença Aguda , Idoso , Endoscopia Gastrointestinal , Doenças do Esôfago/complicações , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Necrose
13.
World J Gastroenterol ; 25(30): 4213-4221, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31435174

RESUMO

BACKGROUND: Clinically, tracheoesophageal fistula (TEF) is lack of effective surgical strategies. One reason is due to the lack of appropriate animal models of acquired TEF, which is usually complex and difficult. Recently, the magnetic compression technique has been applied for digestive tract anastomosis or vascular anastomosis in animals. In this study, an animal model of TEF in dogs was developed by using the magnetic compression technique, hoping to provide a new method for mimicking TEF. AIM: To establish a TEF model in dogs by using the magnetic compression technique. METHODS: Six male beagles were used as models with two Nd-Fe-B permanent magnets for TEF. The parent magnet and the daughter magnet were placed in the cervical esophagus and trachea, respectively. The anterior wall of the esophagus and the posterior wall of the trachea were compressed when the two magnets coupled. After 4-6 d, the necrotic tissue between the two magnets fell off and the parent and daughter magnets disengaged from the target location, leaving a fistula. Gastroscopy/bronchoscopy, upper gastrointestinal contrast study, and histological analysis were performed. RESULTS: The establishment of the TEF model in all six beagles was successful. The average time of magnet placement was 4.33 ± 1.11 min (range, 3-7 min). Mean time for the magnets to disengage from the target location was 4.67 ± 0.75 d (range, 4-6 d). TEFs were observed by gastroscopy/bronchoscopy and esophageal angiography. The gross anatomical structure of the esophagus and the trachea was in good condition. There was no esophageal mucosa or pseudostratified ciliated columnar epithelium at the site of the fistula according to histological analysis. CONCLUSION: It is simple, feasible, and minimally invasive to use the magnetic compression technique for the establishment of the TEF model in dogs.


Assuntos
Modelos Animais de Doenças , Esôfago/patologia , Traqueia/patologia , Fístula Traqueoesofágica/patologia , Animais , Cães , Esôfago/cirurgia , Humanos , Imãs , Masculino , Pressão/efeitos adversos , Traqueia/cirurgia , Fístula Traqueoesofágica/etiologia , Fístula Traqueoesofágica/cirurgia , Resultado do Tratamento
14.
Acta Clin Croat ; 58(1): 23-28, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31363321

RESUMO

Higher expression of the mucin 2 (MUC2) glycoprotein and vascular endothelial growth factor (VEGF) in Barrett's mucosa may be associated with a higher risk of esophageal adenocarcinoma development. Thirty-six patients diagnosed with Barrett's esophagus (BE), short-segment, were included in the study due to unsuccessful treatment with proton pump inhibitors. The diagnosis was confirmed by histopathologic analysis of the tissue obtained by esophagogastric junction biopsy. Expression of MUC2 and VEGF was determined by immunohistochemistry. We found four patients in early stage of adenocarcinoma and 32 patients with BE; five of them had indication for argon plasma coagulation treatment, one for radiofrequency ablation and one for endoscopic mucosal resection; 25 patients were treated with proton pump inhibitors. Regression of BE occurred in 25 (69.44%) patients. MUC2 positivity is unique for goblet cells in patients with BE, but it is not the only marker. VEGF is an indicator of angiogenesis in the mucosa of patients with BE and adenocarcinoma.


Assuntos
Adenocarcinoma/metabolismo , Esôfago de Barrett/metabolismo , Neoplasias Esofágicas/metabolismo , Esôfago/metabolismo , Mucina-2/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Adenocarcinoma/patologia , Idoso , Esôfago de Barrett/patologia , Biópsia , Transformação Celular Neoplásica , Neoplasias Esofágicas/patologia , Esôfago/patologia , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Membrana Mucosa/patologia
15.
Anticancer Res ; 39(8): 4399-4403, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366536

RESUMO

BACKGROUND: An esophagorespiratory fistula (ERF) is a fatal complication for patients with tracheobronchial invasion by esophageal cancer. We report the case of a long-term esophageal cancer survivor treated by esophageal bypass operation for ERF after chemoradiotherapy (CRT). CASE REPORT: A 44-year-old man was treated with definitive CRT (i.e. 66 Gy radiotherapy, chemotherapy with cisplatin, and 5-fluorouracil) for unresectable locally advanced esophageal cancer with massive invasion of the left main bronchus. Although a complete clinical response was obtained, the patient developed pneumonia due to an ERF. Esophageal bypass operation was performed for symptomatic relief. The patient's symptoms improved and oral ingestion became possible. No recurrence has been seen for 12 years. CONCLUSION: Esophageal bypass surgery can help in relieving symptoms and might be associated with long-term survival for esophageal cancer patients with ERF after good response to CRT. Thus, bypass surgery is a useful option in the treatment for esophageal cancer with ERF.


Assuntos
Fístula Brônquica/cirurgia , Fístula Esofágica/cirurgia , Neoplasias Esofágicas/cirurgia , Recidiva Local de Neoplasia/cirurgia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Fístula Brônquica/tratamento farmacológico , Fístula Brônquica/patologia , Quimiorradioterapia , Cisplatino/administração & dosagem , Terapia Combinada , Fístula Esofágica/complicações , Fístula Esofágica/patologia , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/patologia , Esôfago/patologia , Esôfago/cirurgia , Fluoruracila/administração & dosagem , Humanos , Masculino , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia
16.
Ulus Travma Acil Cerrahi Derg ; 25(4): 317-323, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31297780

RESUMO

BACKGROUND: In developing countries, esophageal burns are quite common. They are caused by the ingestion of corrosive substances that may lead to esophageal perforation in the short-term and stricture formation in the long-term. Prevention of stricture progression in the esophagus is the main aim of the treatment for corrosive esophageal burns. We aimed to investigate the protective and anti-inflammatory effects of methylene blue (MB) treatment on corrosive esophageal burns. METHODS: Twenty-eight rats were used in the study and randomly divided into four equal groups; group 1 (Sham), group 2 (control), group 3 (topical treatment), and group 4 (topical plus systemic treatment). Except for group 1 (Sham group), all three groups received sodium hydroxide (NaOH) in order to generate esophageal burns. In addition, group 2 was given normal saline, group 3 topical MB, and group 4 topical and systemic MB. RESULTS: Hydroxyproline levels were found to be lower in each of the treatment groups as compared to the control group (p=0.005 for group 3 and p=0.009 for group 4). There were no differences in the tumor necrosis factor-α (TNF-α) levels between the groups. The stenosis index (SI) in the treatment groups was also lower than the control group (p=0.016 for group 3 and p=0.015 group 4). The histopathologic damage score (HDS) was prominently lower in group 4 as compared to the control group (p=0.05). CONCLUSION: MB is effective in treating tissue damage caused by corrosive esophageal burns and in preventing esophageal stenosis. Complication rates of corrosive esophageal burns may be decreased by using MB in the initial treatment stage.


Assuntos
Anti-Inflamatórios/uso terapêutico , Queimaduras Químicas/tratamento farmacológico , Estenose Esofágica/induzido quimicamente , Esôfago/lesões , Azul de Metileno/uso terapêutico , Animais , Cáusticos , Modelos Animais de Doenças , Inibidores Enzimáticos/uso terapêutico , Estenose Esofágica/prevenção & controle , Esôfago/efeitos dos fármacos , Esôfago/patologia , Hidroxiprolina/análise , Distribuição Aleatória , Ratos , Ratos Wistar , Fator de Necrose Tumoral alfa/análise
17.
World J Gastroenterol ; 25(24): 3021-3029, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31293338

RESUMO

Esophageal cancer is known as one of the malignant cancers with poor prognosis. To improve the outcome, combined multimodality treatment is attempted. On the other hand, advances in genomics and other "omic" technologies are paving way to the patient-oriented treatment called "personalized" or "precision" medicine. Recent advancements of imaging techniques such as functional imaging make it possible to use imaging features as biomarker for diagnosis, treatment response, and prognosis in cancer treatment. In this review, we will discuss how we can use imaging derived tumor features as biomarker for the treatment of esophageal cancer.


Assuntos
Quimiorradioterapia Adjuvante , Neoplasias Esofágicas/terapia , Esofagectomia , Esôfago/diagnóstico por imagem , Medicina de Precisão/métodos , Imagem de Difusão por Ressonância Magnética , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/genética , Esôfago/patologia , Humanos , Imagem de Perfusão , Tomografia por Emissão de Pósitrons , Medicina de Precisão/tendências , Prognóstico , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
World J Gastroenterol ; 25(24): 3069-3078, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31293342

RESUMO

BACKGROUND: Esophageal adenocarcinoma (EAC) and high-grade dysplasia (HGD) may appear in young patients with Barrett's esophagus (BE). However, characteristics of Barrett's-related neoplasia in this younger population remain unknown. AIM: To identify clinical characteristics that differ between young and old patients with early-stage Barrett's-related neoplasia. METHODS: We conducted a retrospective analysis of a prospectively maintained database comprised of consecutive patients with early-stage EAC (pT1) and HGD at a tertiary-referral center between 2001 and 2017. Baseline characteristics, drug and risk factor exposures, clinicopathological staging of EAC/HGD and treatment outcomes [complete eradication of neoplasia (CE-N), complete eradication of intestinal metaplasia (CE-IM), recurrence of neoplasia and recurrence of intestinal metaplasia] were retrieved. Multivariate analyses were performed to identify factors that differed significantly between older and younger (≤ 50 years) patients. RESULTS: We identified 450 patients with T1 EAC and HGD (74% and 26%, respectively); 45 (10%) were ≤ 50 years. Compared to the older group, young patients were more likely to present with ongoing gastroesophageal reflux disease (GERD) symptoms (55% vs 38%, P = 0.04) and to be obese (body mass index > 30, 48% vs 32%, P = 0.04). Multivariate logistic regression analysis showed that young patients were significantly more likely to have ongoing GERD symptoms [odds ratio (OR) 2.00, 95% confidence interval (CI) 1.04-3.85, P = 0.04] and to be obese (OR 2.06, 95%CI 1.07-3.98, P = 0.03) whereas the young group was less likely to have a smoking history (OR 0.39, 95%CI 0.20-0.75, P < 0.01) compared to the old group. However, there were no significant differences regarding tumor histology, CE-N, CE-IM, recurrence of neoplasia and recurrence of intestinal metaplasia (mean follow-up, 44.3 mo). CONCLUSION: While guidelines recommend BE screening in patients > 50 years of age, younger patients should be considered for screening endoscopy if they suffer from obesity and GERD symptoms.


Assuntos
Adenocarcinoma/epidemiologia , Esôfago de Barrett/diagnóstico por imagem , Neoplasias Esofágicas/epidemiologia , Esôfago/patologia , Lesões Pré-Cancerosas/diagnóstico por imagem , Adenocarcinoma/patologia , Adenocarcinoma/prevenção & controle , Fatores Etários , Esôfago de Barrett/epidemiologia , Esôfago de Barrett/patologia , Comorbidade , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/prevenção & controle , Esofagoscopia/normas , Esôfago/diagnóstico por imagem , Feminino , Seguimentos , Refluxo Gastroesofágico/epidemiologia , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Obesidade/epidemiologia , Guias de Prática Clínica como Assunto , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/patologia , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco
19.
Pathol Int ; 69(6): 319-330, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31290583

RESUMO

Barrett's esophagus is considered a precancerous lesion of esophageal adenocarcinoma (EAC). Long-segment Barrett's esophagus, which is generally associated with intestinal metaplasia, has a higher rate of carcinogenesis than short-segment Barrett's esophagus, which is mainly composed of cardiac-type mucosa. However, a large number of cases reportedly develop EAC from the cardiac-type mucosa which has the potential to involve intestinal phenotypes. There is no consensus regarding whether the definition of Barrett's epithelium should include intestinal metaplasia. Basic researches using rodent models have provided information regarding the origins of Barrett's epithelium. Nevertheless, it remains unclear whether differentiated gastric columnar epithelium or stratified esophageal squamous epithelium undergo transdifferentiation into the intestinal-type columnar epithelium, transcommittment into the columnar epithelium, or whether the other pathways exist. Reflux of duodenal fluid including bile acids into the stomach may occur when an individual lies down after eating, which could cause the digestive juices to collect in the fornix of the stomach. N-nitroso-bile acids are produced with nitrites that are secreted from the salivary glands, and bile acids can drive expression of pro-inflammatory cytokines via EGFR or the NF-κB pathway. These steps may contribute significantly to carcinogenesis.


Assuntos
Esôfago de Barrett/patologia , Esôfago/patologia , Refluxo Gastroesofágico/fisiopatologia , Metaplasia/patologia , Esôfago de Barrett/complicações , Carcinogênese/patologia , Humanos , Estômago/patologia
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