RESUMO
In the Fresco, "Faith and Its Fight Against Heresy (1611, Church of Saints Eusebio and Vittore, Peglio, Como)" is depicted as an old woman with 'scattered and steep hairs', ugly and physically in poor condition, also due to the presence of a voluminous goiter.
Assuntos
Bócio , Santos , Feminino , HumanosRESUMO
Simone Peterzano mostly known as the master of Caravaggio executed frescoes in the presbytery of Garegnano Charterhouse. One fresco details a shepherd with a goiter.
Assuntos
Bócio , Medicina nas Artes , Pinturas , Bócio/terapia , HumanosRESUMO
In a large fresco, which narrates brutal episodes of torture against Cirtercian monks, in the right corner of the background an ugly aggressor with a huge goiter, symbol of evil and sin, attacks a monk with a sword.
Assuntos
Bócio , Medicina nas Artes , Pinturas , Humanos , ItáliaRESUMO
We provide an example of representation of thyroid swelling in the artwork of Ulrich Boner's Der Edelstein Codices Palatini Germanici 794.
Assuntos
Livros Ilustrados , Bócio/patologia , Medicina na Literatura , Aforismos e Provérbios como Assunto/história , Livros Ilustrados/história , Alemanha , Bócio/história , História Medieval , Humanos , Masculino , Medicina na Literatura/história , Medicina nas Artes/história , Glândula Tireoide/patologiaRESUMO
PURPOSE: There are many of the representations in iconography of individuals with goiters reported in the literature. METHODS: The article describe a unique representation of goiter, as observed by the authors in a sculpture in Italy. RESULTS: In a Nativity, in the upper part of the altar of the Church of the Annunciata, Boccioleto (Val Sermenza, Piedmont, Italy), a horn player with a huge goiter, gladdens the Holy Family. Wooden work by Francesco Antonio d'Alberto, 1694. CONCLUSION: This is an appropriate example of the iconography of "real goiter," since in this case the sculptor had the aim of showing person with goiter.
Assuntos
Bócio/história , Medicina nas Artes/história , Música/história , Escultura/história , História do Século XVI , Humanos , ItáliaAssuntos
Bócio/patologia , Medicina nas Artes , Pinturas , Santos , Bócio/história , História Medieval , Humanos , Masculino , Medicina nas Artes/história , Pinturas/história , Religião e Medicina , Santos/história , SuíçaRESUMO
The advent of combined antiretroviral therapy (cART) dramatically changed the view of human immunodeficiency virus (HIV) infection as an exclusion criterion for solid organ transplantation, resulting in worldwide reports of successful transplants in HIV-infected individuals. However, there are few reports on simultaneous pancreas-kidney transplant in HIV-positive recipients detailing poor outcomes. A series of four pancreas-kidney transplant performed on HIV-infected individuals between 2006 and 2009 is presented. All recipients reached stably undetectable HIV-RNA after transplantation. All patients experienced early posttransplant infections (median day 30, range 9-128) with urinary tract infections and bacteremia being most commonly observed. In all cases, surgical complications led to laparotomic revisions (median day 18, range 1-44); two patients underwent cholecystectomy. One steroid-responsive acute renal rejection (day 79) and one pancreatic graft failure (month 64) occurred. Frequent dose adjustments were required due to interference between cART and immunosuppressants. At a median follow-up of 45 months (range, 26-67) we observed 100% patient survival with CD4 cell count >300 cells/mm(3) for all patients. Although limited by its small number, this case series represents the largest reported to date with encouraging long-term outcomes in HIV-positive pancreas-kidney transplant recipients.
Assuntos
Rejeição de Enxerto/mortalidade , Infecções por HIV/cirurgia , HIV/patogenicidade , Transplante de Rim/mortalidade , Transplante de Pâncreas/mortalidade , Complicações Pós-Operatórias , Adulto , Terapia Antirretroviral de Alta Atividade , Feminino , Seguimentos , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto , Infecções por HIV/mortalidade , Infecções por HIV/virologia , Soropositividade para HIV/mortalidade , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Taxa de SobrevidaRESUMO
Rectal cancer continues to be one of the most common tumors worldwide. Its prognosis mainly depends on early diagnosis and precise stage evaluation in order to choose the most effective treatment. In recent years, new and promising technologies have been proposed and are now available in daily practice. Each rectal cancer patient should be considered individually, choosing the diagnostic pretreatment exams that are appropriate for that single clinical case mainly related to the tumor and the available instruments. Clinicians must be informed about the efficacy of these technologies and be aware of any cause of mistake in tumor staging in order to reduce the risk of both improper use and inaccurate staging.
Assuntos
Endossonografia , Imageamento por Ressonância Magnética , Neoplasias Retais/patologia , Humanos , Linfonodos/patologia , Metástase Linfática , Estadiamento de Neoplasias , Reto/patologiaRESUMO
AIM OF THE STUDY: The purpose of this study is to evaluate the sensitivity and specificity of free circulating DNA (CFDNA) as a potential tumour marker in patients suffering from colorectal cancer (CRC). MATERIALS AND METHODS: The quantification of plasma DNA was determined through the use of real-time quantitative polymerase chain reaction (PCR) amplification of the RNAse P gene. We studied patients undergoing surgery for primary CRC, at different stages of disease and a cohort of comparable healthy donors. Data were statistically analysed using Student's t-test. RESULTS: The mean DNA index of the tumour samples was 4771 ng/ml, about 50 times higher in comparison with healthy donors (mean value 0.85 ng/ml). In contrast the carcinoembryonic antigen (CEA) value of these patients was altered in only 47% of cases. CONCLUSION: This study shows that circulating free DNA levels in plasma of patients with CRC are significantly higher compared to healthy subjects, and suggest a new, non-invasive, approach for colon cancer detection and to identify high risk individuals for CRC screening.
Assuntos
Neoplasias Colorretais/sangue , DNA de Neoplasias/sangue , Idoso , Biomarcadores Tumorais/sangue , Estudos de Casos e Controles , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Masculino , Reação em Cadeia da PolimeraseRESUMO
INTRODUCTION: Colorectal cancer is still one of the many factors of death both in males and in females. To date, the most important prognostic factors are mainly related to the pathological stage of the disease. AIM OF THE STUDY: The purpose of this study was to analyze the possible role of tumor circumferential localization on the colonic wall (mesenteric (M) or antimesenteric (AM)) as a possible prognostic factor. In this study, we compare the localization of the tumor with patient's survival. The hypothesis of this study is that M tumors, closer to blood and lymphatic vessels, should be more aggressive in terms of hematogenous and lymphatic spread compared to the AM tumors. PATIENTS AND METHODS: All patients undergoing curative resection for colorectal cancer were enrolled in this study; there was no statistical difference for age, sex and co-morbidity. The histopathological examination was carried out in the standard manner. Next, we have taken care to survival of neoplastic patients by examining of our 5-year follow-up archive: we divided patients in different groups concerning the different tumor stage and we compare these results with the different localizations of tumor at the operation. RESULTS: In 45% of cases, we were able to distinguish the different localizations M (160 patients) or AM (47 patients) and this difference is statistically significant (P<0.0001, Pearson Chi-Square-test (PCS-t)). The number of metastatic nodes is statistically higher in the M group compared to the AM group one (P=0.003949). Medium time of follow-up was 36.54 months; AM and M patients have a rather similar survival, only at the end the two curves seem to change but not in a significant manner. Only if we consider the difference between the two groups comparing T3 tumor can we observe a statistically significant difference (P<0.005). CONCLUSIONS: In conclusion, the localization of M or AM colorectal cancer is feasible in 45% of cases. M tumors have significantly more lymph nodes metastases but a better 5-year survival than AM tumors. A possible explanation for such results might be the different pattern of diffusion of cancer cells.
Assuntos
Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Linfonodos/cirurgia , Mesentério/cirurgia , Neoplasias Colorretais/terapia , Seguimentos , Humanos , Linfonodos/patologia , Metástase Linfática , Mesentério/patologia , Terapia Neoadjuvante , PrognósticoRESUMO
Since the first report in 1991 the laparoscopic resection of colon cancer is progressing slowly and just in the last 2-3 years is becoming more popular. The resistance to its use by some general and colo-rectal surgeons is receding. The explanations are that technology is evolving quickly and there is a worldwide diffusion of more sophisticated surgical instruments. Moreover several randomized trials have been published showing that the outcomes of laparoscopic colon surgery are similar or better than those of conventional surgery and the early reports suggesting the tumour dissemination were not confirmed. The revolution in oncological surgery that we are observing in these last decades with the introduction and diffusion of mini-invasive approach is comparable to that regarding conventional surgery during the period of Halsted. Therefore the principles of surgery accepted during the years must not be forgotten.
Assuntos
Neoplasias Colorretais/cirurgia , Laparoscopia , Ensaios Clínicos como Assunto , Colectomia/métodos , Humanos , Recidiva Local de NeoplasiaRESUMO
INTRODUCTION: Several randomized controlled trials demonstrated that laparoscopic colon resection is a safe and effective technique for colon and rectum diseases. In fact mini-invasive procedure required an adequate learning curve to safely perform it. Many studies confirm there is a comparatively long learning curve in laparoscopic surgery, with demonstrable decrease in conversion and complication rates with increasing experience. AIMS OF THE STUDY: In this study we want to demonstrate feasibility of laparoscopic colon resection performed by a junior surgeon, referring to short-term outcomes as primary end point. RESULTS: A total of 163 patients underwent colorectal resections of whom 88 were enrolled in the laparoscopic (LCR) and 75 in the open group, respectively. The mean operative time was 183.4 min in the LCR group and 151.2 min in the open group. The mean number of lymph nodes collected was 21.3 in the LCR group and 22.1 in the open group. 10.5% who underwent LCR developed postoperative complications compared with 16% of open group; this difference was statistically significant. Postoperative death occurred in one patient for each group. CONCLUSIONS: Our study demonstrate that results obtained by an under 35-year-old surgeon, fully trained in laparoscopic surgery but with limited overall experience in colorectal resections, can be at least as good as the ones obtained in open surgery. This seems to be true both in term of intra-postoperative complications as well as for oncological results.
Assuntos
Competência Clínica , Enteropatias/cirurgia , Laparoscopia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Colectomia , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral , Complicações Pós-Operatórias , Estudos Prospectivos , Recuperação de Função Fisiológica , ReoperaçãoRESUMO
The utility of antibiotic prophylaxis for colorectal surgery has been assessed and largely confirmed worldwide. There is homogeneous consensus that the antibiotic chosen for prophylaxis must cover both aerobic and anaerobic bacteria, that the toxicity should be minimal and it should be cost effective. Recent studies have questioned the role of preoperative bowel cleansing, which is considered by many surgeons as a widely established practice prior to elective colorectal procedures. New clinical trials are needed to resolve these key questions such as the efficacy of bowel preparation and how to obtain effective timing of antimicrobial prophylaxis.
Assuntos
Antibioticoprofilaxia , Neoplasias Colorretais/cirurgia , Enema , Cuidados Pré-Operatórios , Catárticos/administração & dosagem , Humanos , Infecção da Ferida Cirúrgica/prevenção & controle , Irrigação TerapêuticaRESUMO
Microsatellite instability (MSI) is observed in approximately 13% of colorectal cancers. Genes containing a mononucleotide microsatellite in the coding sequence are particularly prone to inactivation in MSI tumourigenesis, and much work has been conducted to identify genes with high repetitive tract mutation rates in these tumours. MSI caused by deficient DNA mismatch-repair functions is a hallmark of cancers associated with the hereditary non-polyposis colorectal cancer syndrome but is also found in about 15% of all sporadic tumours.
Assuntos
Neoplasias Colorretais/genética , Instabilidade de Microssatélites , Proteínas Adaptadoras de Transdução de Sinal/genética , Metilação de DNA , Genes APC , Humanos , Proteína 1 Homóloga a MutL , Proteínas MutL , Mutação , Proteínas de Neoplasias/genética , Proteínas Nucleares/genéticaRESUMO
Colorectal cancer is a major cause of morbidity and mortality. Both genetic and environmental factors contribute to cancer aetiology. About 15-20% of all colorectal cancers are familial. Approximately 6% of colorectal cancers can be attributed to recognizable heritable germline mutations. The discovery of genes responsible for inherited forms of colorectal cancer have the potential to improve cancer risk assessment and counselling. Genetic testing for hereditary forms of colorectal cancer can confirm or reject diagnoses at the molecular level, determine surveillance intervals for at-risk persons, decrease the cost of surveillance by risk stratification, aid in surgical and chemoprevention decision-making, and help patients in family and career planning. This paper reviews the genetics behind genes and molecular study of the hereditary colorectal cancer. This may help the medical professionals especially internists, gastroenterologists, and oncologists to update their knowledge in this field.
Assuntos
Polipose Adenomatosa do Colo/genética , Neoplasias Colorretais Hereditárias sem Polipose/genética , Polipose Adenomatosa do Colo/diagnóstico , Polipose Adenomatosa do Colo/cirurgia , Adenosina Trifosfatases/genética , Neoplasias Colorretais Hereditárias sem Polipose/diagnóstico , Neoplasias Colorretais Hereditárias sem Polipose/cirurgia , Enzimas Reparadoras do DNA/genética , Proteínas de Ligação a DNA/genética , Genes APC , Humanos , Programas de Rastreamento , Endonuclease PMS2 de Reparo de Erro de Pareamento , Proteínas MutL , Mutação , Proteínas de Neoplasias/genéticaRESUMO
Colorectal cancer is the second-leading cause of cancer-related death in the US. The prognosis of advanced colorectal cancer remains poor in spite of the advances obtained in recent years with new therapeutic agents, new approaches in surgical procedures and new diagnostic methods. Currently, colorectal cancer is the second most common cancer in Europe both in terms of incidence and mortality. Approximately 90% of all cancer deaths arise from the metastatic dissemination of primary tumors. It is a matter of vital importance whether perioperative blood transfusion promotes tumor recurrence and morbidity. This paper reviews the relevant medical literature published in English language on the theoretical background, methodological problems, results, as well as the possible clinical impact of blood transfusions in colorectal surgery with well-controlled trials. Searches were last update August 2007.
Assuntos
Transfusão de Sangue , Neoplasias Colorretais/cirurgia , Assistência Perioperatória , Intervalo Livre de Doença , Humanos , Recidiva Local de NeoplasiaRESUMO
INTRODUCTION: Bowel resection is now considered the "gold standard" treatment for severe endometriosis infiltrating the bowel. Laparoscopic colorectal resection can be considered a safe option in order to reduce surgical trauma and complications as well as to improve cosmetics. Transvaginal approach, used for several years to remove large specimens, can be an interesting approach also in case of colorectal resections. AIM OF THE STUDY: To present our experience on laparoscopic colorectal resection and transvaginal specimen extraction as treatment of severe endometriosis. RESULTS: Eleven patients (mean age 45+/-12 years) have been operated by a combined team of gynecologist and colorectal surgeons. There were no intra- or post-operative complications. In all cases, the transvaginal route was used to remove the specimen and prepare the bowel for anastomosis. Patients were allowed to free light diet on post-operative day 3+/-1 and discharged on day 5+/-2. The mean follow-up was 4+/-2 months and all patients are well with normal bowel function and symptoms free. CONCLUSIONS: Our preliminary experience demonstrates such approach is safe and feasible with excellent results in term of post-operative course.
Assuntos
Endometriose/cirurgia , Laparoscopia , Doenças Retais/cirurgia , Doenças Uterinas/cirurgia , Vagina/cirurgia , Anastomose Cirúrgica , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Pessoa de Meia-IdadeRESUMO
Primary colorectal lymphoma is an infrequent disease of unknown origin and with a growing incidence. Primary colorectal lymphoma accounts for only about 0.2% of large intestinal malignancies. The aim of this study is to review, identify and underline risk factors, presentation, treatment and prognosis of primary colorectal lymphoma, using the three most important studies made in the last years: the Chung-Wei Fan study from the division of colon and rectal surgery, in Taipei [Fan CW, Changchien CR, Wang JY. Primary colorectal lymphoma. Disease of the Colon and Rectum 2000;43:1277-82]; the Wong and Eu [Primary colorectal lymphomas. Colorectal Diseases 2006;8:586-91] study from the Department of colorectal surgery in Singapore and the study of Doolabh et al. [Primary colon lymphoma. Journal of Surgical Oncology 2000;74:257-62] University of Texas Southwestern Medical School, Dallas, Texas.
Assuntos
Neoplasias Colorretais/patologia , Neoplasias Colorretais/terapia , Linfoma/patologia , Linfoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica , Quimioterapia Adjuvante , Colectomia , Ciclofosfamida , Doxorrubicina , Humanos , Prednisona , Fatores de Risco , VincristinaRESUMO
Postoperative infectious complications still represent a relevant problem in colorectal surgery. They always results in suffering for the patients and often prolonged hospitalization. Furthermore, they result in additional expenses to cover the cost of antibiotics, blood derivates, total parenteral nutrition, nursing and additional surgical procedures. Prevention and control of hospital infections start with surveillance, which is an important means to constantly evaluate the local bacterial epidemiology. An infection surveillance program finalized to minimize the incidence of postoperative infections through the respect of available techniques leads to a better quality of work in each surgical unit, to a decrease in postoperative hospital stay and to cost reduction.