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1.
Colorectal Dis ; 18(6): O175-84, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27128602

RESUMO

AIM: Nodal stage is a strong prognostic factor of oncological outcome of rectal cancer. To compensate for the variation in total number of harvested nodes, calculation of the lymph node ratio (LNR) has been advocated. The aim of the study was to compare the impact, on the long-term oncological outcome, of the LNR with other predictive factors, including the quality of total mesorectal excision (TME) and the state of the circumferential resection margin. METHOD: Consecutive patients having elective surgery for nonmetastatic rectal cancer were extracted from a prospectively maintained database. Retrospective uni- and multivariate analyses were performed based on patient-, surgical- and tumour-related factors. The prognostic value of the LNR on overall survival (OS) and on overall recurrence-free survival (ORFS) was assessed and a cut-off value was determined. RESULTS: From 1998 to 2013, out of 456 patients, 357 with nonmetastatic disease were operated on for rectal cancer. Neoadjuvant radiochemotherapy was administered to 66.7% of the patients. The mean number of lymph nodes retrieved was 12.8 ± 8.78 per surgical specimen. A lower lymph node yield was obtained in patients who received neoadjuvant chemoradiotherapy (11.8 vs 14.2; P = 0.014). The 5-year ORFS was 71.8% and the 5-year OS was 80.1%. Multivariate analysis confirmed LNR, the quality of TME and age to be independent prognostic factors of OS. LNR, age and perineural infiltration were independently associated with ORFS. Low- and high-risk patients could be discriminated using an LNR cut-off value of 0.2. CONCLUSION: LNR is an independent prognostic factor of OS and ORFS. In line with the principles of optimal surgical management, the quality of TME and lymph node yield are essential technical requirements.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/normas , Excisão de Linfonodo/normas , Linfonodos/patologia , Estadiamento de Neoplasias/normas , Neoplasias Retais/cirurgia , Reto/cirurgia , Idoso , Bases de Dados Factuais , Procedimentos Cirúrgicos do Sistema Digestório/mortalidade , Procedimentos Cirúrgicos Eletivos/mortalidade , Procedimentos Cirúrgicos Eletivos/normas , Feminino , Humanos , Linfonodos/cirurgia , Masculino , Mesentério/patologia , Mesentério/cirurgia , Pessoa de Meia-Idade , Prognóstico , Qualidade da Assistência à Saúde , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Reto/patologia , Estudos Retrospectivos , Análise de Sobrevida
2.
J S Afr Vet Assoc ; 80(2): 79-83, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19831267

RESUMO

In order to determine the analgesic and cardiovascular effects of the combination of epidural ketamine and lidocaine, 6 sedated cats were studied. Six healthy, young cats were used in a prospective randomised study. Each cat underwent 3 treatments, at least 1 week apart, via epidural injection: (1) ketamine (2.5 mg/kg), (2) lidocaine (4.0 mg/kg), and (3) ketamine (2.5 mg/kg) plus lidocaine (4.0 mg/kg). Epidural injections were administered through the lumbosacral space. Analgesia, motor block, sedation, heart rate, arterial blood pressure, respiratory rate and arterial oxygen saturation were measured. Rectal temperature was compared before and after sedation as well as after epidural administration of the drugs. Epidural administration of the ketamine/lidocaine combination induced prolonged analgesia extending from the coccygeal to the T13-L1 dermatomes, leading to severe ataxia. Cardiovascular effects were significant in all treatments: heart rate decreased, but there was a minimal reduction in arterial pressure. It was concluded that adding a dose of ketamine to epidural lidocaine in cats is feasible and effective.


Assuntos
Analgesia Epidural/veterinária , Analgésicos/administração & dosagem , Anestésicos Locais/administração & dosagem , Gatos/fisiologia , Ketamina/administração & dosagem , Lidocaína/administração & dosagem , Agonistas alfa-Adrenérgicos/administração & dosagem , Animais , Estudos Cross-Over , Combinação de Medicamentos , Frequência Cardíaca/fisiologia , Bloqueio Nervoso/veterinária , Estudos Prospectivos , Xilazina/administração & dosagem
3.
Int Urol Nephrol ; 32(4): 629-34, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11989553

RESUMO

We present a case of retroperitoneal fibrosis treated with a renal autotransplantation in a patient inicially treated with endourologic measures and corticotherapy without success. The extense ureteral affectation was the indication to carry out an autotransplant. The follow-up is of nine years, with the function of the renal unity still preserved. We checked the literature for the therapeutic possibilities, medical as much as surgical, of the retroperitoneal fibrosis with special attention to the usage of the refractory IRF to other treatments.


Assuntos
Transplante de Rim , Fibrose Retroperitoneal/cirurgia , Seguimentos , Humanos , Hidronefrose/diagnóstico por imagem , Hidronefrose/etiologia , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Fibrose Retroperitoneal/complicações , Transplante Autólogo , Ureter/diagnóstico por imagem
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