RESUMO
Nerves are emerging promoters of cancer progression, but the innervation of esophageal cancer and its clinicopathologic significance remain unclear. In this study, nerves were analyzed by immunohistochemistry in a cohort of 260 esophageal cancers, including 40 matched lymph node metastases and 137 normal adjacent esophageal tissues. Nerves were detected in 38% of esophageal cancers and were more associated with squamous cell carcinomas (P = 0.04). The surrounding or invasion of nerves by cancer cells (perineural invasion) was detected in 12% of esophageal cancers and was associated with reduced survival (P = 0.04). Nerves were found to express the following receptors for nerve growth factor (NGF): neurotrophic receptor tyrosine kinase 1 and nerve growth factor receptor. An association was suggested between high production of NGF by cancer cells and the presence of nerves (P = 0.02). In vitro, NGF production in esophageal cancer cells was shown by Western blot, and esophageal cancer cells were able to induce neurite outgrowth in the PC12 neuronal cells. The neurotrophic activity of esophageal cancer cells was inhibited by anti-NGF blocking antibodies. Together, these data suggest that innervation is a feature in esophageal cancers that may be driven by cancer cell-released NGF.
Assuntos
Neoplasias Esofágicas/patologia , Invasividade Neoplásica/patologia , Fator de Crescimento Neural/metabolismo , Nervos Periféricos/patologia , Adulto , Idoso , Neoplasias Esofágicas/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Microambiente TumoralRESUMO
Nerve growth factor (NGF) and its receptors, the neurotrophic receptor tyrosine kinase 1 (NTRK1/TrkA) and the common neurotrophin receptor (NGFR/p75NTR), are increasingly implicated in cancer progression, but their clinicopathological significance in oesophageal cancer is unclear. In this study, the expression of NGF, NTRK1 and NGFR were analysed by immunohistochemistry in a cohort of 303 oesophageal cancers versus 137 normal adjacent oesophageal tissues. Immunostaining was digitally quantified and compared to clinicopathological parameters. NGF and NGFR staining were found in epithelial cells and at similar levels between oesophageal cancers and normal oesophageal tissue. NGFR staining was slightly increased with grade (p=0.0389). Interestingly, NTRK1 staining was markedly higher in oesophageal squamous cell carcinoma (OR 2.31, 95%CI 1.13-4.38, p<0.0001) and significantly lower in adenocarcinoma (OR 0.50, 95%CI 0.44-0.63, p<0.0001) compared to normal oesophageal tissue. In addition, NTRK1 staining was decreased in grade 2 and grade 3 (OR 0.51, 95%CI 0.21-1.40, p<0.0001) compared to grade 1, suggesting a preferential involvement of this receptor in the more differentiated forms of oesophageal carcinomas. Together, these data point to NTRK1 as a biomarker and a candidate therapeutic target in oesophageal squamous cell carcinoma.
Assuntos
Neoplasias de Cabeça e Pescoço/metabolismo , Fator de Crescimento Neural/metabolismo , Proteínas do Tecido Nervoso/metabolismo , Receptor trkA/metabolismo , Receptores de Fator de Crescimento Neural/metabolismo , Carcinoma de Células Escamosas de Cabeça e Pescoço/metabolismo , Biomarcadores/metabolismo , Estudos de Coortes , Células Epiteliais/metabolismo , Células Epiteliais/patologia , Esôfago/metabolismo , Esôfago/patologia , Feminino , Regulação Neoplásica da Expressão Gênica , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Fator de Crescimento Neural/genética , Proteínas do Tecido Nervoso/genética , Receptor trkA/genética , Receptores de Fator de Crescimento Neural/genética , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/terapia , Análise Serial de TecidosAssuntos
Fístula Brônquica/etiologia , Diverticulose Esofágica/complicações , Doenças do Esôfago/patologia , Fístula Esofágica/etiologia , Idoso , Fístula Brônquica/diagnóstico por imagem , Broncoscopia/métodos , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Dilatação/efeitos adversos , Diverticulose Esofágica/patologia , Fístula Esofágica/diagnóstico por imagem , Gastrostomia/métodos , Humanos , Jejunostomia/métodos , Masculino , Stents/efeitos adversos , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Traditional management of choledocholithiasis has been supraduodenal choledochotomy, duct exploration and insertion of a T-tube. This study reviews the complications associated with T-tube use and assesses whether laparoscopic procedures are associated with an increase in complications relating to T-tube use. METHODS: Case records from two large public hospitals in New South Wales (Australia) were analysed retrospectively for a 10-year period using a standardized data collection form. Morbidity, mortality and potential factors influencing the complication rate after choledochotomy and T-tube insertion were recorded. All complications were reviewed by an experienced biliary surgeon. RESULTS: T-tubes were inserted in 274 patients, with 42 patients (15.3%) experiencing a total of 60 complications relating to T-tube use. Morbidity occurring while the tube was in situ included fluid and electrolyte disturbance (five patients), sepsis (10 patients), premature dislodgement (three patients) and bile leakage (six patients). Complications resulting after planned tube removal included localized pain (13 patients), biliary peritonitis (seven patients), a prolonged biliary fistula (seven patients) and a late bile duct stricture (one patient). T-tube complications resulted in a prolonged hospital stay (19 days vs 13 days, P = 0.005), 10 additional abdominal operations and two deaths. Complications related to T-tubes were constant over the study period and were similar between laparoscopic and open cases (13.8% vs 15.5%, P = 0.81). CONCLUSIONS: Although this retrospective review is likely to have underestimated the incidence of T-tube complications, it has demonstrated significant morbidity associated with T-tube use. The incidence of these complications has been constant and is unrelated to a laparoscopic approach.
Assuntos
Coledocostomia/efeitos adversos , Cálculos Biliares/cirurgia , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias , Próteses e Implantes/efeitos adversos , Colangiografia , Feminino , Cálculos Biliares/diagnóstico por imagem , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Falha de Prótese , Estudos Retrospectivos , Fatores de TempoRESUMO
BACKGROUND: Splenectomy is associated with a lifelong increase in the risk of sepsis. The aim of this study was to determine the level of knowledge of patients who have undergone splenectomy within an Australian area health service. METHODS: Adults undergoing a splenectomy between 1994 and 2004 within the Hunter Area Health Service were invited to participate in the study. Consenting participants were contacted by telephone and a standardized questionnaire completed. RESULTS: More than 50% of participants displayed a good active knowledge of the risk of infection post-splenectomy and an understanding of the role of vaccinations in reducing the risk of infection. Few participants (11.3%) had standby antibiotics readily available. Knowledge of travel precautions and risk of sepsis following animal bites was poor. CONCLUSION: Although most participants displayed a good knowledge of infection risk post-splenectomy, deficiencies in knowledge were identified. We propose the development of a splenectomy protocol and patient briefing to improve patient education.
Assuntos
Sepse/etiologia , Esplenectomia/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Protocolos Clínicos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Fatores de Risco , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Hemorrhage-related mortality (HRM) associated with pelvic fractures continues to challenge trauma care. This study describes the management and outcome of hemodynamically unstable patients with a pelvic fracture, with emphasis on primary intervention for hemorrhage control and HRM. METHODS: Blunt trauma patients [Injury Severity Score (ISS) >or=16] with a major pelvic fracture (Abbreviated Injury Score, pelvis >or=3) and hemodynamic instability [admission systolic blood pressure (SBP)