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2.
Oncology ; 98(1): 29-34, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31509833

RESUMO

PURPOSE: Neoadjuvant chemotherapy (NAC) followed by surgery is a promising treatment strategy for patients with advanced gastric cancer. Severe toxicity associated with the treatment may reduce the dose intensity of chemotherapy, resulting in the effect of chemotherapy being attenuated. Recently, skeletal muscle mass has been reported to be associated with the treatment outcomes of cancer patients. The purpose of this study was to clarify whether pretreatment skeletal muscle mass is a predictor of adverse events as well as the relationship between changes in skeletal muscle mass and adverse events during NAC. METHODS: This study included 41 advanced gastric cancer patients who were treated with NAC followed by surgery. Body composition was assessed before and after NAC. The relationship between the pre-NAC body composition and adverse events was investigated as well as the relationship between changes in body composition and adverse events. RESULTS: Univariate and multivariate analyses revealed that low pre-NAC skeletal muscle mass was the only factor significantly associated with severe diarrhea (p = 0.03). There was no significant difference in body weight before and after NAC, but skeletal muscle mass was significantly reduced after NAC (-5.93 ± 7.69%, p < 0.01). Furthermore, patients who experienced severe diarrhea showed significantly greater relative skeletal muscle decrease than those who did not (p = 0.03). CONCLUSIONS: Pre-NAC low skeletal muscle mass was a useful predictor of severe diarrhea. Prevention of severe adverse events may contribute to maintaining the skeletal muscle mass.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Músculo Esquelético/patologia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/patologia , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores , Composição Corporal , Quimioterapia Adjuvante , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Estado Nutricional , Tamanho do Órgão , Neoplasias Gástricas/tratamento farmacológico
3.
Khirurgiia (Mosk) ; (12): 111-120, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825351

RESUMO

Gastrointestinal neuroendocrine tumors are rare neoplasms. Currently, incidence of gastric neuroendocrine tumors (gNETs) is being significantly increased. There are 3 groups of gNETs: types I, II and III. Each type has important features regarding clinical picture, prognosis and treatment strategy. Type I is the most common (70-80%) and associated with chronic atrophic gastritis including autoimmune gastritis and Helicobacter associated atrophic gastritis. Type II (5-6%) is associated with multiple endocrine neoplasia type I and Zollinger-Ellison syndrome (MEN I - ZES). Both types are characterized by hypergastrinemia and small tumor dimension. These neoplasms are multiple and mostly benign. On the contrary, NETs type III (10-15%) is not associated with hypergastrinemia and represented by single large neoplasms. Tumors are malignant as a rule. Therefore, surgical resection and chemotherapy are preferred for these tumors. Endoscopic surgery followed by observation is acceptable for almost all NETS type I and II. At the same time, this approach is advisable only for small and highly differentiated neoplasms type III.


Assuntos
Tumores Neuroendócrinos/classificação , Tumores Neuroendócrinos/cirurgia , Neoplasias Gástricas/classificação , Neoplasias Gástricas/cirurgia , Gastrite Atrófica/complicações , Gastrite Atrófica/cirurgia , Humanos , Neoplasia Endócrina Múltipla Tipo 1/complicações , Neoplasia Endócrina Múltipla Tipo 1/cirurgia , Tumores Neuroendócrinos/complicações , Prognóstico , Neoplasias Gástricas/complicações , Síndrome de Zollinger-Ellison/complicações , Síndrome de Zollinger-Ellison/cirurgia
4.
Medicine (Baltimore) ; 98(47): e17991, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764811

RESUMO

The present study aimed to investigate the safety and short-term outcome of laparoscopy-assisted distal radical gastrectomy in treating gastric cancer among obese patients.Perioperative outcomes were compared between 67 gastric cancer patients with a body mass index (BMI) ≥25 kg/m (obese group) and 198 ones with BMI <25 kg/m (non-obese group). All the cases underwent laparoscopic radical resection between April 2009 and October 2013.The value of BMI was 27.3 ±â€Š2.67 kg/m in the obese group and 21.3 ±â€Š2.64 kg/m in non-obese group. There were no significant differences between 2 groups in age, sex, presence of diabetes, tumor size, number of metastatic lymph nodes, or metastatic lymph node ratio. Postoperative complications did not differ between the 2 groups (P > .05). There were significant differences between the 2 groups in operation time (non-obese: [234.2 ±â€Š67.1] minutes vs obese group: [259.4 ±â€Š78.5]; P = .017), postoperative hospital stay (obese group [19.7 ±â€Š14.8] day vs non-obese [15.4 ±â€Š7.1], P = .002), and retrieved lymph nodes ([27.6 ±â€Š11.0] day vs non-obese [31.9 ±â€Š12.5] day, P = .002).Obesity may prolong operation time and postoperative hospital stay, and cause less retrieved lymph nodes, but does not increase the incidence of postoperative complications. The experienced center can properly conduct laparoscopic assisted radical gastrectomy in obese patients.


Assuntos
Gastrectomia/métodos , Laparoscopia , Neoplasias Gástricas/cirurgia , Feminino , Gastrectomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Estudos Retrospectivos , Neoplasias Gástricas/complicações , Fatores de Tempo , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(48): e18153, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770257

RESUMO

RATIONALE: Migration of endoclips and stitches into the duodenum after laparoscopic hepatectomy is incredibly rare with a poorly understood mechanism. PATIENT CONCERNS: A 56-year-old woman who underwent laparoscopic left hepatectomy and cholecystectomy in August 2016 was admitted to our hospital with nausea and vomiting in December 2017. DIAGNOSES: Abdominal computed tomography (CT) scan showed high density shades in duodenal ampulla. Esophagogastroduodenoscopy showed deformation of the duodenal ampulla into two lumens; hem-o-lock clips and stitches were detected in the upper lumen. Contrast enhanced CT scan revealed gastric cancer with liver metastasis (GCLM). INTERVENTIONS: The hem-o-lock clips and stitches were present in the wall of the duodenum; therefore, no attempt was made to remove them. High quality liquid diet, partial parenteral nutrition, and chemotherapy were administered to the patient. OUTCOMES: In September 2018, the patient died of hepatic failure caused by GCLM. LESSONS: This rare complication of the migration of endoclips and stitches into the duodenum after laparoscopic hepatectomy can cause epigastric pain and duodenal obstruction. The complication could be potentially avoided using absorbable endoclips and stitches or by performing of ultrasonic dissection by a skilled operator.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Obstrução Duodenal , Migração de Corpo Estranho , Hepatectomia/efeitos adversos , Complicações Pós-Operatórias , Instrumentos Cirúrgicos/efeitos adversos , Colecistectomia Laparoscópica/métodos , Tratamento Conservador/métodos , Obstrução Duodenal/diagnóstico por imagem , Obstrução Duodenal/etiologia , Obstrução Duodenal/fisiopatologia , Obstrução Duodenal/terapia , Endoscopia do Sistema Digestório/métodos , Feminino , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/diagnóstico , Migração de Corpo Estranho/fisiopatologia , Hepatectomia/métodos , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Administração dos Cuidados ao Paciente/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
9.
Rev Med Suisse ; 15(660): 1502-1505, 2019 Aug 28.
Artigo em Francês | MEDLINE | ID: mdl-31496174

RESUMO

In 2019, gastric cancer still has high mortality. Gastric intestinal metaplasia (IGM) is an intermediate step in the process of carcinogenesis of intestinal adenocarcinoma. Gastroscopy with biopsies can detect the presence of MIG. Characterization in terms of intensity and distribution allows to stratify the risks and to target the population in which surveillance endoscopies are indicated for the purpose of detecting endoscopic resectable neoplasia in endoscopy.


Assuntos
Adenocarcinoma , Gastroscopia , Metaplasia , Lesões Pré-Cancerosas , Neoplasias Gástricas , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico , Biópsia , Humanos , Metaplasia/complicações , Metaplasia/diagnóstico , Lesões Pré-Cancerosas/complicações , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/patologia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/diagnóstico
10.
Medicina (B Aires) ; 79(4): 295-298, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31487252

RESUMO

The infiltration of the bone marrow y non-hematopoietic cells is called myelophthisis. In patients with gastric cancer, this invasion is extremely infrequent and the survival is usually less than three months. We present the case of a 35-year-old man with bone marrow involvement secondary to diffuse gastric carcinoma of signet ring cells.


Assuntos
Anemia Mielopática/diagnóstico , Carcinoma de Células em Anel de Sinete/diagnóstico , Neoplasias Gástricas/diagnóstico , Adulto , Anemia Mielopática/etiologia , Carcinoma de Células em Anel de Sinete/complicações , Carcinoma de Células em Anel de Sinete/tratamento farmacológico , Evolução Fatal , Humanos , Masculino , Neoplasias Gástricas/complicações , Neoplasias Gástricas/tratamento farmacológico
11.
BMJ Case Rep ; 12(8)2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31401584

RESUMO

Pulmonary tumour thrombotic microangiopathy (PTTA) is a rare but lethal cause of pulmonary hypertension (PHT). Its underlying mechanism is believed to be fibrocellular intimal proliferation and microthrombosis. It has been reported in association with gastric adenocarcinoma and breast, pancreatic and lung cancers. The diagnosis is often made on postmortem examination due to the absence of diagnostic criteria and its rare occurrence. We describe the case of a middle-aged man who presented with rapidly progressive PHT. He deteriorated into multiorgan failure despite aggressive medical therapy and died 4 weeks after his initial presentation. A postmortem examination confirmed the diagnosis of PTTA in addition to the finding of signet cell gastric adenocarcinoma. This case highlights the lethal nature of this rare condition, the ongoing challenges in making an antemortem diagnosis, and the importance of postmortem examination in determining the cause of death to provide closure for both, the treating physician and the family.


Assuntos
Hipertensão Pulmonar/etiologia , Neoplasias Pulmonares/complicações , Neoplasias Gástricas/complicações , Microangiopatias Trombóticas/complicações , Autopsia , Carcinoma de Células em Anel de Sinete/diagnóstico , Evolução Fatal , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/patologia , Microangiopatias Trombóticas/patologia
12.
Oxid Med Cell Longev ; 2019: 5813985, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31396300

RESUMO

Background: The mechanisms of crosstalk between depression and gastric cancer (GC) remain ill defined. Given that reactive oxygen species (ROS) is involved in the pathophysiology of both GC and depression, we try to explore the activities of ROS in the development of GC and GC-related depression. Methods: 110 patients with newly diagnosed GC were recruited in our study. The clinical characteristics of these patients were recorded. Inflammation and oxidative stress markers were detected by ELISA. The depression status of patients with GC was assessed during follow-up. The association between ROS, ABL1, and inflammation factors was evaluated in H2O2-treated GC cell lines and The Cancer Genome Atlas (TCGA) database. The effect of ABL1 on inflammation was detected with Imatinib/Nilotinib-treated GC cell lines. A chronic mild stress- (CMS-) induced patient-derived xenograft (PDX) mice model was established to assess the crosstalk between depression and GC. Results: Depression was correlated with poor prognosis of patients with GC. GC patients with depression were under a high level of oxidative status as well as dysregulated inflammation. In the CMS-induced GC PDX mice model, CMS could facilitate the development of GC. Additionally, tumor bearing could induce depressive-like behaviors of mice. With the treatment of ROS, the activities of ABL1 and inflammatory signaling were enhanced both in vitro and in vivo, and blocking the activities of ABL1 inhibited inflammatory signaling. Conclusions: ROS-activated ABL1 mediates inflammation through regulating NF-κB1 and STAT3, which subsequently leads to the development of GC and GC-related depression.


Assuntos
Depressão/etiologia , Proteínas Proto-Oncogênicas c-abl/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais , Neoplasias Gástricas/diagnóstico , /sangue , Animais , Antineoplásicos/farmacologia , Comportamento Animal/efeitos dos fármacos , Linhagem Celular Tumoral , Movimento Celular/efeitos dos fármacos , Depressão/metabolismo , Modelos Animais de Doenças , Transição Epitelial-Mesenquimal/efeitos dos fármacos , Humanos , Mesilato de Imatinib/farmacologia , Mediadores da Inflamação/metabolismo , Masculino , Camundongos , Camundongos Nus , Prognóstico , Transdução de Sinais/efeitos dos fármacos , Neoplasias Gástricas/complicações
13.
BMC Cancer ; 19(1): 842, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455250

RESUMO

BACKGROUND: Helicobacter pylori (H. pylori) is thought to have an oncogenic effect on the development of gastric malignancies. However, the effect of H. pylori status on the prognosis of gastric diffuse large B-cell lymphoma (DLBCL) remains unconfirmed. This study aimed to identify the prognostic importance of H. pylori infection in de novo gastric DLBCL. METHODS: One hundred and twenty-nine patients diagnosed with primary de novo gastric DLBCL at the West China Hospital of Sichuan University from 1st January 2009 to 31st May 2016 were included. The clinical features of the patients were documented. H. pylori status was assessed via urease breath tests and histologic examinations. The prognostic value of H. pylori was verified via univariate and multivariate analyses. RESULTS: Over a median follow-up of 52.2 months (range 4-116), the 5-year overall survival (OS) for all patients was 78.7%. Patients with H. pylori infections had significantly better 5-year PFS and OS than did the H. pylori-negative subgroup (5-year PFS, 89.3% vs. 74.1%, P = 0.040; 5-year OS, 89.7% vs. 71.8%, P = 0.033). Negative H. pylori status and poor ECOG performance were independent negative prognostic indicators for both PFS and OS (PFS, P = 0.045 and P = 0.001, respectively; OS, P = 0.021 and P < 0.001, respectively). CONCLUSIONS: H. pylori status in de novo gastric DLBCL can be a promising predictor of disease outcome, and patients with negative H. pylori status require careful follow-up since they tend to have a worse outlook.


Assuntos
Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/etiologia , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/epidemiologia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Feminino , Humanos , Estimativa de Kaplan-Meier , Linfoma Difuso de Grandes Células B/metabolismo , Linfoma Difuso de Grandes Células B/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Vigilância em Saúde Pública , Estudos Retrospectivos , Neoplasias Gástricas/metabolismo , Adulto Jovem
14.
BMC Surg ; 19(1): 114, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429742

RESUMO

BACKGROUND: In gastrectomy, postoperative elevation of C-reactive protein (CRP) is thought to be useful for predicting complications. Laparoscopic gastrectomy (LG) is less invasive than laparotomy and the elevation of CRP is also mild. Postoperative complications such as anastomotic leakage not only increase the severity of the condition, but also carry a poor prognosis when treatment is delayed. Early treatment is therefore necessary. METHOD: This retrospective study examined the relationship between occurrence of complications and the ratio of CRP levels on postoperative days 1 and 3 (CRP ratio) for 449 gastric cancer patients who underwent LG in the Department of Gastrointestinal Surgery at Osaka City University Hospital between 2006 and 2016. RESULTS: We observed that factors associated with postoperative complications were preoperative renal failure and CRP ratio. No significant associations with surgical procedure, operation time, bleeding volume, age, obesity, measured CRP concentration, or white blood cell count were evident. The optimal cut-off for CRP ratio to predict postoperative complications from the receiver operating characteristic curve was 2.13. CONCLUSION: Our results suggested that the risk of severe postoperative complications after LG could be predicted using the CRP ratio.


Assuntos
Proteína C-Reativa/metabolismo , Gastrectomia/efeitos adversos , Laparoscopia/efeitos adversos , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Feminino , Gastrectomia/métodos , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Curva ROC , Insuficiência Renal/complicações , Estudos Retrospectivos , Neoplasias Gástricas/sangue , Neoplasias Gástricas/complicações
15.
Rev Med Liege ; 74(7-8): 431-435, 2019 Jul.
Artigo em Francês | MEDLINE | ID: mdl-31373460

RESUMO

We report the case of a 67 years old patient with a history of gastric adenocarcinoma who died in a context of severe dyspnea and whose autopsy will confirm the diagnosis of a Pulmonary Tumor Thrombotic Microangiopathy (PTTM). PTTM is a fatal pulmonary complication associated to multiple cancers. It starts with an acute or subacute respiratory failure quickly evolving towards fatal thrombo-embolic pulmonary hypertension and right heart failure. Pre-mortem diagnosis is difficult and not frequent because the pathology is rare, the underlying neoplastic disease is not always known, clinical and radiological signs are not specific and progression is fast. When made soon enough, PTTM diagnosis avoids useless and sometimes harmful medication. In some cases, an improvement of patient's symptoms and comfort is observed. Some studies described several months of extended survival.


Assuntos
Adenocarcinoma , Neoplasias Pulmonares , Neoplasias Gástricas , Microangiopatias Trombóticas , Adenocarcinoma/complicações , Idoso , Humanos , Neoplasias Pulmonares/complicações , Células Neoplásicas Circulantes , Neoplasias Gástricas/complicações , Microangiopatias Trombóticas/complicações
16.
BMC Cancer ; 19(1): 833, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31443699

RESUMO

BACKGROUND: This study was designed to evaluate the impact of postoperative major complications on long-term survival following curative gastrectomy. METHODS: This retrospective study included 239 patients with gastric cancer undergoing gastrectomy at the Beijing Cancer Hospital from February 2012 to January 2013. Survival curves were compared between patients with major complications (mC group) and those without major complications (NmC group). Multivariate analysis was conducted to identify independent prognostic factors. RESULTS: Postoperative complication and mortality rates were 24.7 and 0.8%, respectively. The severity of complications was graded in accordance with the Clavien-Dindo classification. The incidence of minor complications (grades I-II) and major complications (grades III-V) was 9.2 and 15.5%, respectively. The 3-year overall survival (OS) and disease-free survival (DFS) rates were better in the NmC group than in the mC group (p = 0.014, p = 0.013). Multivariate analysis identified major complications as an independent prognostic factor for OS and DFS. After stratification by pathological stage, this trend was also observed in stage II patients. CONCLUSIONS: Postoperative major complications adversely affect OS and DFS. The prevention and early diagnosis of complications are essential to minimize the negative effects of complications on surgical safety and long-term patient survival.


Assuntos
Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Feminino , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Neoplasias Gástricas/complicações , Neoplasias Gástricas/diagnóstico , Análise de Sobrevida , Resultado do Tratamento
17.
Anticancer Res ; 39(8): 4297-4303, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366521

RESUMO

BACKGROUND/AIM: The aim of this study was to evaluate the impact of sarcopenia diagnosed by the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm on long-term outcome after gastrectomy. PATIENTS AND METHODS: A total of 90 elderly gastric cancer patients without distant metastasis aged 65 years or older who underwent gastrectomy at the Osaka National Hospital between July 2012 and January 2015 were included in the current analysis. RESULTS: The sarcopenic group (n=19) had a poorer overall survival (OS) (p<0.0001) compared to the non-sarcopenic group (n=79). OS after recurrence was also worse in the sarcopenic group. Multivariate analysis indicated that sarcopenia was an independent risk factor for worse OS after gastrectomy (hazard ratio(HR)=2.92; 95% confidence interval(CI)=1.15-7.75; p=0.025), along with N stage ≥2, age ≥75 years, and presence of severe postoperative complications. CONCLUSION: Sarcopenia is a potential target for preoperative intervention in elderly gastric cancer patients to improve prognosis after gastrectomy. (UMIN-CTR: R000041532).


Assuntos
Gastrectomia , Prognóstico , Sarcopenia/patologia , Neoplasias Gástricas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia/patologia , Complicações Pós-Operatórias/patologia , Fatores de Risco , Sarcopenia/etiologia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/patologia
18.
BMJ Case Rep ; 12(7)2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31296623

RESUMO

Primary gastric squamous cell carcinoma (SCC) is rare, and the simultaneous Helicobacter pylori infection has not been reported in the literature. Here, we presented a patient with concurrent H. pylori gastritis and primary gastric SCC. A 54-year-old Hispanic man presented with diarrhoea, chills, night sweats and weight loss of 16 lbs for the previous 6 weeks. Abdominal CT revealed large exophytic mass from the stomach infiltrating multiple organs. Biopsy was performed and histology showed squamoid features. Immunohistochemistry stain was positive for p40, CK5/6, CK7 and Helicobacter type organisms. Patient was diagnosed with primary gastric SCC and has been receiving chemotherapy. We also reviewed the diagnosis, prognosis and treatment of primary gastric SCC.


Assuntos
Carcinoma de Células Escamosas/complicações , Gastrite/complicações , Infecções por Helicobacter/complicações , Helicobacter pylori , Neoplasias Gástricas/complicações , Biópsia , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Gastrite/diagnóstico por imagem , Infecções por Helicobacter/diagnóstico por imagem , Infecções por Helicobacter/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estômago/diagnóstico por imagem , Estômago/patologia , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologia , Tomografia Computadorizada por Raios X
19.
Korean J Gastroenterol ; 74(1): 17-29, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31344769

RESUMO

Background/Aims: The aim of this study was to determine the risk factors of multiple gastric polyps according to the histological classification of gastric polyps. Methods: Subjects with multiple gastric polyps (at least three) during endoscopy were enrolled prospectively. They were assigned to a fundic gland polyp (FGP) group and hyperplastic polyp (HP) group based on a histological classification of gastric polyps. Helicobacter pylori (H. pylori) was confirmed by its histology. Serum gastrin was measured using the radioimmunoassay method. A questionnaire was taken regarding the intake of proton pump inhibitor and nonsteroidal anti-inflammatory drugs, alcohol, smoking history, and diet. Results: Among the 60 subjects enrolled from 2015 to 2018 at Seoul National University Bungdang Hospital, 47 and 13 subjects were assigned to the FGP and HP groups, respectively. The H. pylori infection rate was 12.8% in the FGP group, which is lower than that in the HP group (69.2%, p<0.001). The gastrin level was higher in the HP group (194.7 pg/dL, range 50.6-387.8 pg/dL) than in the FGP group (57.4 pg/dL, range 24.8-79.0 pg/dL) (p=0.007). Histologically, neutrophil infiltration in the antrum and body of the stomach were higher in the HP group than in the FGP group (p=0.022 and p=0.030, respectively). In contrast, monocyte infiltration in the antrum and body of the stomach were higher in the FGP group than in the HP group (p=0.018 and p<0.001, respectively). Conclusions: HPs arise from inflammation caused by H. pylori. On the other hand, the FGP was not associated with H. pylori or environmental factors.


Assuntos
Pólipos Adenomatosos/patologia , Neoplasias Gástricas/patologia , Pólipos Adenomatosos/classificação , Pólipos Adenomatosos/complicações , Adulto , Idoso , Estudos de Coortes , Endoscopia do Sistema Digestório , Feminino , Mucosa Gástrica/imunologia , Mucosa Gástrica/patologia , Gastrinas/sangue , Infecções por Helicobacter/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infiltração de Neutrófilos/imunologia , Estudos Prospectivos , Inibidores da Bomba de Prótons/administração & dosagem , Fatores de Risco , Neoplasias Gástricas/classificação , Neoplasias Gástricas/complicações
20.
J Laparoendosc Adv Surg Tech A ; 29(9): 1105-1110, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31334672

RESUMO

Background: There is little evidence regarding appropriate therapeutic modalities for ulcerative-type early gastric cancer (EGC) because the risks and implications of lymph node metastasis are unclear. The indication for endoscopic submucosal dissection (ESD) was investigated for ulcerative-type EGC. Methods: We retrospectively analyzed 192 patients with differentiated ulcerative-type EGC who underwent radical gastrectomy with D2 lymph node dissection. Lymph node metastasis (LNM) risk factors were evaluated using multivariate logistic regression. Results: The LNM rate was 15.1% overall, 0% for mucosa-confined lesions, and 28.2% for submucosa-infiltrating lesions. On multivariate analysis, only lymphovascular invasion (P < .001) was significantly associated with LNM. Among patients with minute submucosal invasion and no lymphovascular invasion, LNM was only observed for tumor sizes ≥2.1 cm. Conclusions: Because LNM risks are negligible, curative ESD could be considered in patients with ulcerative EGC that is confined to the mucosa and histologically differentiated, irrespective of tumor size. In addition, ESD can be attempted for ulcerative EGC with minute submucosal invasion and tumor size <2.1 cm.


Assuntos
Gastrectomia/métodos , Excisão de Linfonodo/métodos , Neoplasias Gástricas/cirurgia , Úlcera Gástrica/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Neoplasias Gástricas/complicações , Neoplasias Gástricas/secundário , Úlcera Gástrica/diagnóstico , Úlcera Gástrica/etiologia , Resultado do Tratamento
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