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1.
Khirurgiia (Mosk) ; (6): 118-120, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32573543

RESUMO

Small bowel tumor causes gastrointestinal bleeding in 1-4% of cases. Gastrointestinal bleeding from metastases of renal cell carcinoma is a rare and little-known manifestation of this disease. We report a rare clinical case of a solitary metastasis of clear cell renal cell carcinoma into small bowel in 5 years after nephrectomy. The first symptom was intestinal bleeding. This example emphasizes the need for more thorough examination of patients with symptoms of latent and anamnestic blood loss.


Assuntos
Carcinoma de Células Renais/secundário , Hemorragia Gastrointestinal/etiologia , Neoplasias Intestinais/secundário , Neoplasias Renais/patologia , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Intestinais/complicações , Intestino Delgado , Neoplasias Renais/cirurgia , Nefrectomia
4.
J UOEH ; 42(1): 83-88, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32213746

RESUMO

A 68-year-old male with abdominal pain and vomiting was brought to our hospital by ambulance. Computed tomography showed multiple intussusceptions with pseudokidney signs in the jejunum and ileocecum, and a tumor of 5 cm in diameter in the left lower lobe of the lung. We performed an emergent operation, as a release of multiple intussusceptions was difficult by conservative treatment. There were two intussusceptions, in the jejunum and the ileocecum. We performed a partial resection of the jejunum and a resection of the ileocecum. Histopathological examination of the resected specimens and a biopsy specimen collected by bronchoscopy allowed us to diagnose multiple intussusceptions due to small intestine metastases from a pleomorphic carcinoma of the lung. This case is presented here, with a review of the literature.


Assuntos
Carcinoma/complicações , Carcinoma/secundário , Neoplasias Intestinais/complicações , Neoplasias Intestinais/secundário , Intussuscepção/etiologia , Neoplasias Pulmonares/patologia , Idoso , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Humanos , Intussuscepção/cirurgia , Masculino
5.
Medicine (Baltimore) ; 99(6): e18590, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028388

RESUMO

RATIONALE: The specific pathogenesis of the diffuse large B-cell lymphoma(DLBCL)is still indefinite and argumentative. It is known that DLBCL is the most common type of non-Hodgkin's lymphomas (NHL). A lot of cases of DLBCL such as primary gastric diffuse large B-cell lymphoma(PG-DLBCL) are reported. However, primary intestinal diffuse large B-cell lymphoma(PI-DLBCL) is unusual. PATIENT CONCERNS: We present a case of a 57-year-old male diagnosed in the Gastroenterology Department, which presented a bleeding duodenal ulcer with irregular borders. DIAGNOSES: The immunohistochemical staining showed: CD20(+++), CD10(+) and Ki-67>40%. INTERVENTIONS: The patient was successfully treated by Poly-chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vindesine and prednisolone). OUTCOMES: After 6 courses of chemotherapy treatment, the duodenal ulcer was completely healed by reviewing the UGIE. LESSONS: Our report might give further strength to avoiding the erroneous and missed diagnosis for PI-DLBCL which is different from common duodenal ulcer.


Assuntos
Úlcera Duodenal/etiologia , Neoplasias Intestinais/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ciclofosfamida/uso terapêutico , Diagnóstico Diferencial , Doxorrubicina/uso terapêutico , Humanos , Imuno-Histoquímica , Neoplasias Intestinais/complicações , Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Intestinais/tratamento farmacológico , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Rituximab/uso terapêutico , Vincristina/uso terapêutico
6.
Chin J Integr Med ; 26(5): 382-387, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31134466

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of topical delivery of modified Da-Cheng- Qi Decoction (, MDCQD) by low-frequency ultrasound sonophoresis (LFUS) in patients with refractory metastatic malignant bowel obstruction (MBO) using an objective performance criteria (OPC) design. METHODS: Fifty patients with refractory metastatic MBO were enrolled in this open-label single-arm clinical trial. Alongside fasting, gastrointestinal decompression, glycerol enema, intravenous nutrition and antisecretory therapy, a 50 g dose of MDCQD (prepared as a hydrogel) was applied through topical delivery at the site of abodminal pain or Tianshu (S 25) using LFUS for 30 min, twice daily for 5 consecutive days. The overall outcome was the remission of intestinal obstruction, and improvement on abdominal pain, abdominal distention, nausea and vomiting scores. Indicators of safety evaluation included liver and renal function as well as blood coagulation indicators. RESULTS: Among 50 patients, 5 patients (10%) showed complete remission of intestinal obstruction and 21 patients (42%) showed improvement of intestinal obstruction. The overall remission rate of bowel obstruction was 52%. The results of the symptom score, based on the severity and frequency of the episode, are as follows: 26 patients (52%) showed improvment on symptom scores, 20 patients (40%) did not respond to treatment, and 4 patients (8%) discontinued treatment due to intolerance. No serious adverse effects or abnormal changes on liver and renal function or blood coagulation were observed. CONCLUSION: Topical delivery of MDCQD at 100 g/day using LFUS can improve the treatment response in patients with refractory metastatic MBO.


Assuntos
Medicamentos de Ervas Chinesas/administração & dosagem , Neoplasias Intestinais/complicações , Obstrução Intestinal/tratamento farmacológico , Terapia por Ultrassom/métodos , Administração Cutânea , Adulto , Idoso , Feminino , Humanos , Neoplasias Intestinais/secundário , Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade
7.
BMJ Case Rep ; 12(11)2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31748358

RESUMO

Oral cancers rarely metastasize to the small intestines. In a previously operated case of squamous cell carcinoma of buccal mucosa without any known preoperative distant metastases, we report a case of solitary ileal perforation 3 months after the surgery. The edge of the ileal perforation was positive for squamous cell carcinoma on histopathology. It is important to remember metastases as a cause of acute abdomen in the prior history of oral malignancies.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Intestinais/complicações , Neoplasias Intestinais/secundário , Perfuração Intestinal/cirurgia , Neoplasias Bucais/complicações , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Carcinoma de Células Escamosas/patologia , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Intestinais/patologia , Perfuração Intestinal/etiologia , Intestino Delgado/patologia , Laparotomia/métodos , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Neoplasias Bucais/patologia , Terapia Neoadjuvante/métodos , Gradação de Tumores , Tomografia por Emissão de Pósitrons/métodos
8.
BMJ Support Palliat Care ; 9(4): 381-388, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31597626

RESUMO

OBJECTIVE: Malignant bowel obstruction (MBO) is a complication of advanced malignancy and is associated with a short prognosis. MBO can infrequently be reversed by surgery or stenting. The focus of treatment is usually symptomatic management, of which percutaneous venting gastrostomy/gastrojejunostomy (PVG) is one consideration. There is little data considering the impact of PVG on quality of life; we therefore aimed to explore this. METHODS: We identified patients with a PVG inserted for MBO and those who consented to participate were interviewed. The interviews were audio recorded, transcribed and analysed using Framework. Alongside patient interviews, a data collection tool was designed and used to record patient demographics and medical information, enabling us to contextualise individual patients' experiences. RESULTS: 11 patients were interviewed and 10 patients' data were analysed (1 patient withdrew). No patients regretted having a PVG and many benefitted symptomatically and psychosocially. Challenges encountered included practical issues, pain and PVG tube complications. CONCLUSIONS: The analysis provided a detailed insight into the impact of PVG insertion and demonstrated that each patient's experience is shaped by a complex interplay of individual factors, thereby highlighting the need to improve referral criteria and individualise patient selection. Other service improvements include enhancing information provision for patients and training for healthcare professionals, thus aiming to mitigate the challenges experienced. Our study is the first in-depth exploration of patients' experiences of PVG at a tertiary cancer centre. Ensuring that the insights from this study are fed back to guide future service provision is critical in enhancing future patient experiences.


Assuntos
Derivação Gástrica/métodos , Gastrostomia/métodos , Neoplasias Intestinais/complicações , Obstrução Intestinal/cirurgia , Adulto , Idoso , Feminino , Derivação Gástrica/psicologia , Gastrostomia/psicologia , Humanos , Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Qualidade de Vida , Resultado do Tratamento
9.
Eur J Surg Oncol ; 45(12): 2319-2324, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31378418

RESUMO

INTRODUCTION: Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction. METHODS: A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori. RESULTS: 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity. CONCLUSIONS: Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups.


Assuntos
Neoplasias Abdominais/complicações , Neoplasias Intestinais/complicações , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado , Neoplasias Abdominais/mortalidade , Idoso , Feminino , Humanos , Neoplasias Intestinais/mortalidade , Obstrução Intestinal/mortalidade , Masculino , Complicações Pós-Operatórias , Estudos Prospectivos , Reino Unido
10.
Pathology ; 51(6): 593-599, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466863

RESUMO

An association of well-differentiated gastroenteropancreatic neuroendocrine tumours (WD GEP NETs) with metabolic syndrome (MetS) was recently described. Yet no molecular mechanisms linking the two conditions are known. This study's aim was to identify putative molecular signatures linking WD GEP NETs and MetS to gain further insight into potential mechanisms for this association. Patients with WD GEP NETs (n=39), pancreatic (panNET) and gastro-intestinal (GI-NET), were clinically evaluated for presence of MetS. WD GEP NETs immunohistochemistry staining for Forkhead box protein M1 (FOXM1), insulin growth factor 1 receptor (IGF1R), Ki-67 and interleukin 6 (IL-6) was performed and quantified by computerised morphometric analysis. FOXM1, Ki-67, IGF1R or IL-6 expression in WD GEP NETs was not influenced by the presence of MetS. IL-6 peritumoural expression was higher in GI-NETs of patients with low HDL cholesterol (0.018±0.005% vs 0.030±0.005%, p=0.02). In GI-NETs, a higher IL-6 expression was also associated with disease progression (0.026±0.004% vs 0.016±0.002%, p=0.03). In WD GEP-NETs, MetS did not influence FOXM1, IGF1R and IL-6 expression. In GI-NETs, IL-6 expression was influenced by the MetS feature low HDL, and positively associated with disease progression. These data suggest that local and systemic inflammatory status can potentially modulate GI-NET behaviour.


Assuntos
Interleucina-6/metabolismo , Neoplasias Intestinais/metabolismo , Síndrome Metabólica/metabolismo , Tumores Neuroendócrinos/metabolismo , Neoplasias Pancreáticas/metabolismo , Neoplasias Gástricas/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Humanos , Neoplasias Intestinais/complicações , Neoplasias Intestinais/patologia , Antígeno Ki-67/genética , Masculino , Síndrome Metabólica/complicações , Síndrome Metabólica/patologia , Pessoa de Meia-Idade , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/patologia , Receptor IGF Tipo 1/metabolismo , Neoplasias Gástricas/complicações , Neoplasias Gástricas/patologia
11.
Pancreas ; 48(8): 961-972, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31425482

RESUMO

Neuroendocrine tumors (NETs) arise from enterochromaffin cells found in neuroendocrine tissues, with most occurring in the gastrointestinal tract. The global incidence of NETs has increased in the past 15 years, likely due to better diagnostic methods. Small-bowel NETs are frequently associated with carcinoid syndrome (CS). Carcinoid syndrome diarrhea occurs in 80% of CS patients and poses a substantial symptomatic and economic burden. Patients with CS diarrhea frequently suffer from diarrhea and flushing and report corresponding impairment in quality of life, requiring substantial changes in daily activities and lifestyle. Treatment paradigms range from surgical debulking to liver-directed therapies to treatment with somatostatin analogs, nonspecific anti-diarrheal agents, and a tryptophan hydroxylase inhibitor. Other causes of diarrhea, including steatorrhea, short bowel syndrome, and bile acid malabsorption, should be considered in NET patients with refractory diarrhea. More therapeutic options are needed for symptomatic management of patients with NETs, and better understanding of the pathophysiology can empower clinicians with improved patient care.


Assuntos
Diarreia/terapia , Neoplasias Intestinais/terapia , Síndrome do Carcinoide Maligno/terapia , Tumores Neuroendócrinos/terapia , Neoplasias Pancreáticas/terapia , Somatostatina/uso terapêutico , Neoplasias Gástricas/terapia , Análise Custo-Benefício , Diagnóstico Diferencial , Diarreia/etiologia , Humanos , Neoplasias Intestinais/complicações , Neoplasias Intestinais/diagnóstico , Síndrome do Carcinoide Maligno/complicações , Síndrome do Carcinoide Maligno/diagnóstico , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/diagnóstico , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Qualidade de Vida , Somatostatina/análogos & derivados , Somatostatina/economia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/diagnóstico
12.
Cancer Med ; 8(9): 4149-4158, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31197969

RESUMO

BACKGROUND AND OBJECTIVES: Whether gastrointestinal (GI) bleeding indicates gastrointestinal stromal tumor (GIST) rupture and impacts prognosis is unclear. We examined the prognostic value of GI bleeding in GIST. METHODS: Primary GIST patients with (GB group) or without (NGB group) initial symptoms of GI bleeding were retrospectively studied. Propensity score matching (PSM) was conducted to reduce confounders. RESULTS: Eight hundred patients were enrolled. Male gender [odds ratio (OR) = 1.517, P = 0.011], tumors in the small intestine (OR = 2.539, P < 0.001), and tumor size 5-10 cm (OR = 2.298, P = 0.004) increased the odds of GI bleeding; age >60 years decreased the odds (OR = 0.683, P = 0.031). After PSM, 444 patients were included (222 in each group). Relapse-free survival (RFS) (P = 0.001) and overall survival (OS) (P = 0.002) were both superior in the GB group. In subgroup analysis, the GB group achieved a superior RFS (P = 0.005) and OS (P = 0.007) in patients with small intestine GIST, but not stomach or colorectal GIST. CONCLUSIONS: GIST patients with age <60, male gender, tumors located in the small intestine, and tumors 5-10 cm in size had a higher risk of GI bleeding. GIST patients with GI bleeding had a superior RFS and OS. This difference was statistically significant only in small intestine GIST.


Assuntos
Hemorragia Gastrointestinal/epidemiologia , Tumores do Estroma Gastrointestinal/patologia , Neoplasias Intestinais/patologia , Adulto , Fatores Etários , Idoso , Estudos de Casos e Controles , Feminino , Hemorragia Gastrointestinal/mortalidade , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/mortalidade , Humanos , Neoplasias Intestinais/complicações , Neoplasias Intestinais/mortalidade , Intestino Delgado/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Pontuação de Propensão , Estudos Retrospectivos , Análise de Sobrevida , Carga Tumoral
13.
Ulus Travma Acil Cerrahi Derg ; 25(3): 268-280, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31135942

RESUMO

BACKGROUND: Acute mechanical bowel obstruction (AMBO) is still a major surgical problem for emergency departments. The aim of this study was to evaluate AMBO in terms of etiology, management, and survival. METHODS: Data of the age, sex, etiology, management, and survival of patients who were hospitalized for bowel obstruction between January 2014 and December 2018 were evaluated retrospectively. Adhesions, tumors, hernias and peritoneal carcinomatosis were evaluated in detail. RESULTS: A total of 735 patients were included in the study. The obstruction was located in the small bowel (AMSBO) in 60% and in the large bowel (AMLBO) in 40%. The mean patient age was 59.9+-16.02 years and 52.9% of the patients were male. Adhesion, tumor, and hernia were the most common etiologies of the overall AMBO group (43.3%, 26.2%, and 6%, respectively). The most common etiology for AMSBO was an adhesion (69.3%), while it was a tumor for AMLBO cases (61.6%). The most common management of AMBO patients was a conservative approach (53.2%; adhesions: 76.7%). Surgical palliation was performed in 24.9% (peritoneal carcinomatosis: 65.7%), and resection was performed in 21.9% (volvulus: 61.9%). The mortality rate in the group was 8.6%. The most common etiology was colorectal surgery (51.4%) for adhesions, colorectal cancer (93.8%) for tumors, and incisional hernia (47.7%) in cases of hernia-related AMBO. CONCLUSION: Adhesions, tumors, and hernias are the most common etiologies of AMBO. The incidence of femoral/inguinal hernia have decreased while that of incisional hernia has increased, and it was further observed that peritoneal carcinomatosis has now become as common as hernia as a cause.


Assuntos
Obstrução Intestinal , Adulto , Idoso , Feminino , Hérnia Femoral/complicações , Hérnia Inguinal/complicações , Humanos , Neoplasias Intestinais/complicações , Obstrução Intestinal/etiologia , Obstrução Intestinal/mortalidade , Obstrução Intestinal/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Aderências Teciduais/complicações , Turquia/epidemiologia
14.
Rev Gastroenterol Peru ; 39(1): 27-37, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31042234

RESUMO

Objetive: To describe our experience with single balloon enteroscopy in the management of small bowel disease in British American Hospital, Lima - Perú. MATERIAL AND METHODS: Descriptive and prospective study. We include all patients that come to perform a single balloon enteroscopy in small bowel unit of British American Hospital within December 2012 to December 2018. RESULTS: We performed 80 procedures of single balloon enteroscopy, 49 were done by oral approach, 31 by rectal approach. Mean age were 60.78 years-old (20 - 88 years). 48 patients (60%) were male. The mean insertion time for oral approach was 80 minutes (55-141 minutes), and for rectal approach was 110 minutes (55-180 minutes). The main indication for single balloon enteroscopy was obscure gastrointestinal bleeding. 6 enteroscopies were performed in patients with altered surgical anatomy (7.5%). 70 of 80 procedures (87.5%) were performed with gastroenterology-administered sedation, using midazolam, pethidine and propofol, without any respiratory or hemodinamic complication. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure. CONCLUSION: Obscure gastrointestinal bleeding was the main indication for single balloon enteroscopy. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure.


Assuntos
Enteropatias/diagnóstico , Intestino Delgado/patologia , Enteroscopia de Balão Único , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiodisplasia/complicações , Angiodisplasia/diagnóstico , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Unidades Hospitalares/estatística & dados numéricos , Humanos , Cooperação Internacional , Enteropatias/terapia , Neoplasias Intestinais/complicações , Neoplasias Intestinais/diagnóstico , Pseudo-Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Peru , Estudos Prospectivos , Estudos Retrospectivos , Enteroscopia de Balão Único/efeitos adversos , Adulto Jovem
17.
BMC Gastroenterol ; 19(1): 45, 2019 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-30917787

RESUMO

BACKGROUND: Small bowel adenocarcinoma (SBA) is a rare neoplasm, which can occur in a sporadic form or can be associated with a number of predisposing conditions such as hereditary syndromes and immune-mediated intestinal disorders, e.g. celiac disease (CD). However, the features of SBA in the context of CD remain only partly understood. This study was aimed to show the main clinical features, diagnostic procedures and management options of SBA cases detected in a large cohort of celiac patients diagnosed in a single tertiary care center. METHODS: We retrospectively reviewed all the SBA cases detected in a cohort of 770 CD patients (599 females; F / M ratio: 3.5:1; median age at diagnosis 36 years, range 18-80 years), diagnosed at the Celiac Disease Referral Center of our University Hospital (Bologna, Italy) from January 1995 to December 2014. RESULTS: Five (0.65%) out of our 770 CD patients developed SBA. All of them were female with a mean age of 53 years (range 38-72 years). SBA, diagnosed at the same time of the CD diagnosis in three cases, was localized in the jejunum in four cases and in the duodenum in one case. The clinical presentation of SBA was characterized by intestinal sub-occlusion in two cases, while the predominant manifestation of the remaining three cases was iron deficiency anaemia, abdominal pain and acute intestinal obstruction, respectively. All the patients were referred to surgery, and three cases with advanced stage neoplasia were also treated with chemotherapy. The overall survival rate at 5 years was 80%. CONCLUSIONS: Although in a limited series, herein presented CD-related SBA cases were characterized by a younger age of onset, a higher prevalence in female gender and a better overall survival compared to sporadic, Crohn- and hereditary syndrome-related SBA.


Assuntos
Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico , Doença Celíaca/complicações , Neoplasias Intestinais/complicações , Neoplasias Intestinais/diagnóstico , Intestino Delgado , Dor Abdominal/etiologia , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Adolescente , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Anemia Ferropriva/etiologia , Feminino , Humanos , Neoplasias Intestinais/patologia , Neoplasias Intestinais/terapia , Obstrução Intestinal/etiologia , Intestino Delgado/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Fatores Sexuais , Resultado do Tratamento , Adulto Jovem
19.
Curr Opin Gastroenterol ; 35(3): 235-242, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30865041

RESUMO

PURPOSE OF REVIEW: Strictures of the small bowel are an underdiagnosed entity with significant morbidity because of obstruction and risk of perforation and penetrating disease. RECENT FINDINGS: Recent advances in imaging, enteroscopy, and therapeutic advances particularly in Crohn's disease have enabled gastroenterologists to target and individualize management of small bowel strictures, preventing untimely surgery and complications. SUMMARY: All patients with obstructive symptoms, suspected small bowel disease, and negative panendoscopy should be evaluated for small intestinal strictures with cross-sectional imaging and considered for capsule endoscopy. Furthermore, the role of device-assisted enteroscopy, initially employed as a diagnostic tool, has evolved into triaging and delivering further medical and interventional treatments.


Assuntos
Constrição Patológica/diagnóstico , Enteropatias/diagnóstico , Intestino Delgado , Adenocarcinoma/complicações , Adenocarcinoma/terapia , Anti-Inflamatórios/uso terapêutico , Anti-Inflamatórios não Esteroides/efeitos adversos , Enteroscopia de Balão , Síndrome de Behçet/complicações , Síndrome de Behçet/terapia , Endoscopia por Cápsula , Constrição Patológica/etiologia , Constrição Patológica/terapia , Doença de Crohn/complicações , Doença de Crohn/terapia , Dilatação , Humanos , Imunossupressores/uso terapêutico , Enteropatias/etiologia , Enteropatias/terapia , Neoplasias Intestinais/complicações , Neoplasias Intestinais/terapia , Obstrução Intestinal , Perfuração Intestinal , Imagem por Ressonância Magnética , Tuberculose Gastrointestinal/complicações , Tuberculose Gastrointestinal/terapia
20.
Endokrynol Pol ; 70(2): 213-217, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30742299

RESUMO

Acromegaly is associated with increased growth hormone (GH) and insulin-like growth factor-I (IGF-I) secretion which may support tumour development and growth. A 68-year-old woman was diagnosed with acromegaly due to typical clinical and hormonal characteristics. While contrast-enhanced MRI at diagnosis did not reveal a pituitary adenoma, a 5-mm lesion was identified on repeat scanning 13 months later. Abdominal and chest CT showed tumours of the stomach, right adrenal gland, and right lung. The CT also showed a hypodense lesion in the liver and heterogeneous echostructure of the thyroid gland with left lobe solid-cystic tumour. Somatostatin receptor scintigraphy revealed increased tracer accumulation in the right thyroid lobe. No tracer accumulation was noted at the location of the other tumours. The resected stomach, adrenal, chest, and thyroid lesions did not show GH secretion. The patient refused pituitary surgery, and her acromegaly is currently well-controlled with somatostatin analogue therapy. A CT scan 19 months later revealed a contrast-enhancing left kidney tumour that was a G1-grade clear cell carcinoma. Four years after the acromegaly diagnosis multiple myeloma were diagnosed with secondary renal amyloidosis. Genetic screening for a paraganglioma gene panel, AIP, MEN1, and CDKN1B mutations were negative. A next-generation cancer panel containing 94 cancer genes did not identify any possible unifying gene abnormality in her germline DNA. Coexistence of acromegaly and numerous other tumours suggests a common aetiology of these disorders. However, no genetic abnormality could be identified with the tests that have been performed.


Assuntos
Acromegalia/complicações , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias Intestinais/complicações , Neoplasias Renais/complicações , Neoplasias Pulmonares/complicações , Neoplasias Primárias Múltiplas/complicações , Tumores Neuroendócrinos/complicações , Neoplasias Pancreáticas/complicações , Neoplasias Gástricas/complicações , Acromegalia/patologia , Neoplasias das Glândulas Suprarrenais/patologia , Idoso , Feminino , Humanos , Neoplasias Intestinais/patologia , Neoplasias Renais/patologia , Neoplasias Pulmonares/patologia , Neoplasias Primárias Múltiplas/patologia , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/patologia , Neoplasias Gástricas/patologia
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