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1.
Dis Esophagus ; 26(5): 479-86, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22816598

RESUMO

Several complications after esophagectomy with gastric pull-up are associated with ischemia within the gastric conduit. The aim of this study is to assess the feasibility of laparoscopic ischemic preconditioning of the stomach prior to thoracotomy, esophagectomy, and gastric pull-up with an intrathoracic anastomosis. A retrospective review of 24 consecutive patients between October 2008 and July 2011 with esophageal adenocarcinoma (stage I-III) undergoing laparoscopic gastric ischemic conditioning prior to esophagectomy was conducted. Conditioning included laparoscopic ligation of the left and short gastric arteries, celiac node dissection, and jejunostomy tube placement. Formal resection and reconstruction was then performed 4-10 days later. Of the 24 patients, 88% received neoadjuvant chemotherapy/radiation therapy. Twenty-three of the 24 patients underwent successful laparoscopic ischemic conditioning and subsequent esophagectomy. Total mean number of lymph nodes harvested was 21.8 (±8.0), and a mean of 5.3 (±2.4) celiac lymph nodes identified. There were no conversions to an open procedure. Length of stay was 3.8 (±4.8) days with a median length of stay of 2 (1-24) days. Three patients experienced anastomotic leak, six patients experience delayed gastric emptying, and two patients developed anastomotic stricture. There were no surgical site infections. R0 resection was achieved in all patients who underwent laparoscopic ischemic conditioning followed by esophagectomy. Laparoscopic ischemic conditioning of the gastric conduit has been shown to be feasible and safe.


Assuntos
Adenocarcinoma/terapia , Artérias/cirurgia , Neoplasias Esofágicas/terapia , Esofagectomia/métodos , Esôfago/cirurgia , Precondicionamento Isquêmico/métodos , Excisão de Linfonodo , Estômago/irrigação sanguínea , Estômago/cirurgia , Adenocarcinoma/patologia , Idoso , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Artéria Celíaca , Quimioterapia Adjuvante , Constrição Patológica/etiologia , Nutrição Enteral , Neoplasias Esofágicas/patologia , Estudos de Viabilidade , Feminino , Esvaziamento Gástrico , Humanos , Jejunostomia , Laparoscopia , Tempo de Internação , Ligadura , Masculino , Pessoa de Meia-Idade , Radioterapia Adjuvante , Estudos Retrospectivos
2.
J Surg Oncol ; 102(5): 539-42, 2010 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-20812264

RESUMO

Bevacizumab (Avastin™; rhuMab VEGF), a monoclonal antibody targeting vascular endothelial growth factor (VEGF), has seen increased use in the perioperative treatment of colorectal and pancreatic cancer. Little is known, however, regarding its impact on surgical outcomes in patients undergoing resection. The objective of this review was to examine if the addition of bevacizumab to existing neoadjuvant regimens increases morbidity after cancer resection.


Assuntos
Inibidores da Angiogênese/efeitos adversos , Anticorpos Monoclonais/efeitos adversos , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Pancreáticas/tratamento farmacológico , Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Humanizados , Bevacizumab , Neoplasias Colorretais/cirurgia , Humanos , Terapia Neoadjuvante , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias , Resultado do Tratamento
3.
J Clin Invest ; 91(1): 53-60, 1993 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-7678609

RESUMO

Activation of the tyrosine kinase of the c-src gene product, pp60c-src, has been shown to occur in nearly every primary colorectal carcinoma, and is found as early as in polyps of high malignant potential. However, no studies have addressed potential pp60c-src changes which occur during progression. To examine this question, we have studied kinase activity and protein levels in 7 colonic polyps, 19 primary lesions, and 19 liver metastases relative to normal colonic mucosa. Significant increases in tyrosine kinase activity were seen as early as in colonic polyps of high malignant potential. Further increases were observed in activity and level in primary tumors. However, the greatest increases in activity and protein levels were observed in liver metastases. Additionally, six metastatic lesions were obtained in which synchronous primary tumor was resected. In each of these liver metastases, pp60c-src activity and level were significantly increased relative to the corresponding primary tumor, as well as to normal colonic mucosa. Our results demonstrate that progression of colon primary tumors to liver metastases correlates with increased pp60c-src kinase activity and protein level.


Assuntos
Adenocarcinoma/enzimologia , Adenocarcinoma/patologia , Adenoma/enzimologia , Adenoma/patologia , Neoplasias do Colo/enzimologia , Neoplasias do Colo/patologia , Pólipos do Colo/enzimologia , Pólipos do Colo/patologia , Proteínas Tirosina Quinases/metabolismo , Proteínas Proto-Oncogênicas pp60(c-src)/metabolismo , Neoplasias Retais/enzimologia , Neoplasias Retais/patologia , Complexo Antígeno-Anticorpo , Humanos , Immunoblotting , Mucosa Intestinal/citologia , Mucosa Intestinal/enzimologia , Mucosa Intestinal/patologia , Neoplasias Hepáticas/enzimologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Metástase Neoplásica , Estadiamento de Neoplasias , Fosfopiruvato Hidratase/metabolismo , Fosforilação , Proteínas Quinases/análise , Proteínas Quinases/metabolismo , Valores de Referência
4.
Surgery ; 142(4): 529-34; discussion 534-7, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17950345

RESUMO

PURPOSE: To evaluate the experience with pancreatectomy for intraductal papillary mucinous neoplasm (IPMN) at a single academic institution. METHODS: A prospective pancreatic database was reviewed and identified 43 patients with IPMN who were managed operatively. Clinicopathologic features and predictors of outcome were examined. The World Health Organization pathologic classification of IPMN was utilized. RESULTS: IPMN was diagnosed in 21% of patients who underwent pancreatic resection for solid or cystic mass lesions. Ninety-five percent of patients were symptomatic. Patients were managed with total pancreatectomy, pancreaticoduodenectomy, distal pancreatectomy, central pancreatectomy, or enucleation. Nine patients had adenomas, 14 had borderline neoplasms, 10 had carcinoma in situ, and 9 had invasive carcinoma. Overall, 23 patients (53%) had lesions with main duct involvement. Frozen section transection margins were positive for malignancy in 2 patients. With a mean follow-up of 17 months, the 5-year disease-specific survival for patients with main duct involvement was 67%. The 5-year disease-specific survival for patients with benign lesions was 100%, and 61% for patients with malignant lesions (P = .02). The presence of symptoms, increased CA 19-9, and tumor size were not predictive of malignancy. Increased serum bilirubin concentrations were predictive of malignancy (P = .03). Main duct involvement was also associated with malignancy (P < .02). CONCLUSIONS: Cancer is found in 65% of patients with IMPN involving the main duct. Based on our data, patients with symptomatic, main duct involvement, especially those with an increased serum bilirubin, should be offered resection. Alternatively, patients with side branch IPMN may be managed conservatively.


Assuntos
Adenocarcinoma Mucinoso/cirurgia , Carcinoma Ductal Pancreático/cirurgia , Carcinoma Papilar/cirurgia , Pancreatectomia/estatística & dados numéricos , Neoplasias Pancreáticas/cirurgia , Adenocarcinoma Mucinoso/patologia , Idoso , Carcinoma Ductal Pancreático/patologia , Carcinoma Papilar/patologia , Bases de Dados Factuais , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/patologia , Resultado do Tratamento
5.
Hernia ; 21(4): 619-622, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28343314

RESUMO

PURPOSE: Although many outcomes have been compared between a midline and chevron incision, this is the first study to examine rectus abdominis atrophy after these two types of incisions. METHODS: Patients undergoing open pancreaticobiliary surgery between 2007 and 2011 at our single institution were included in this study. Rectus abdominis muscle thickness was measured on both preoperative and follow-up computed tomography (CT) scans to calculate percent atrophy of the muscle after surgery. RESULTS: At average follow-up of 24.5 and 19.0 months, respectively, rectus abdominis atrophy was 18.9% greater in the chevron (n = 30) than in the midline (n = 180) group (21.8 vs. 2.9%, p < 0.0001). Half the patients with a chevron incision had >20% atrophy at follow-up compared with 10% with a midline incision [odds ratio (OR) 9.0, p < 0.0001]. No significant difference was observed in incisional hernia rates or wound infections between groups. CONCLUSION: In this study, chevron incisions resulted in seven times more atrophy of the rectus abdominis compared with midline incisions. The long-term effects of transecting the rectus abdominis and disrupting its innervation creates challenging abdominal wall pathology. Atrophy of the abdominal wall can not be readily fixed with an operation, and this significant side effect of a transverse incision should be factored into the surgeon's decision-making process when choosing a transverse over a midline incision.


Assuntos
Parede Abdominal/cirurgia , Laparotomia/efeitos adversos , Atrofia Muscular/etiologia , Reto do Abdome/patologia , Idoso , Atrofia , Feminino , Hérnia Ventral , Humanos , Hérnia Incisional , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Atrofia Muscular/diagnóstico por imagem , Atrofia Muscular/patologia , Reto do Abdome/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
6.
Biochim Biophys Acta ; 1493(3): 319-24, 2000 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-11018256

RESUMO

One of the tight junction components, zonula occludens protein 2 (ZO-2), is expressed as two isoforms, ZO-2A and ZO-2C, in normal epithelia. In pancreatic adenocarcinoma of the ductal type ZO-2A is absent, but none of the common mechanisms of gene inactivation is responsible for lack of ZO-2A expression. In the current study, we report the complete organization of the human zo-2 gene (tjp-2), its alternative splicing, and its expression in normal and neoplastic tissues of several organ sites. In addition to pancreatic adenocarcinoma, ZO-2 was found to be de-regulated in breast adenocarcinoma, but not in colon or prostate adenocarcinoma. The latter are considered to be of acinar rather than ductal type. Thus, our data indicate the importance of zo-2 (tjp-2) gene regulation in ductal cancer development and should help to understand the defects of intercellular interactions, critical for suppressing the malignant phenotype.


Assuntos
Regulação Neoplásica da Expressão Gênica , Proteínas de Membrana/genética , Éxons , Íntrons , Proteínas de Membrana/biossíntese , Dados de Sequência Molecular , Isoformas de Proteínas/biossíntese , Células Tumorais Cultivadas , Proteína da Zônula de Oclusão-2
7.
J Clin Oncol ; 18(19): 3384-9, 2000 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-11013279

RESUMO

PURPOSE: We performed a phase I trial of protracted venous infusion (PVI) fluorouracil (5-FU) plus weekly gemcitabine with concurrent radiation therapy in patients with locally advanced pancreas cancer to determine the maximum-tolerated dose of gemcitabine that could be safely administered. We also sought to identify the toxicities associated with this treatment protocol. PATIENTS AND METHODS: Seven patients with locally advanced pancreas cancer were treated with planned doses of radiation (59.4 Gy) and PVI of 5-FU (200 mg/m(2)/d) with gemcitabine doses of 50 to 100 mg/m(2)/wk. RESULTS: Two of three patients at the 100-mg/m(2)/wk dose level experienced dose-limiting toxicity (DLT), as did three of four at the 50-mg/m(2)/wk dose level. One patient experienced a mucocutaneous reaction described as a Stevens-Johnson syndrome that was attributed to chemotherapy. Three patients developed gastric or duodenal ulcers with severe bleeding requiring transfusion. One patient developed severe thrombocytopenia lasting longer than 4 weeks. Three of the five episodes of DLT developed at radiation doses < or = 36 Gy. CONCLUSION: Based on this experience, we cannot recommend further investigation of regimens incorporating gemcitabine into regimens of radiation with PVI 5-FU. The mechanism of this synergistic toxicity remains to be determined.


Assuntos
Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/radioterapia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Desoxicitidina/análogos & derivados , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/radioterapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Terapia Combinada , Desoxicitidina/administração & dosagem , Desoxicitidina/efeitos adversos , Relação Dose-Resposta a Droga , Relação Dose-Resposta à Radiação , Esquema de Medicação , Feminino , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Radioterapia/efeitos adversos , Análise de Sobrevida , Gencitabina
8.
Int J Radiat Oncol Biol Phys ; 35(4): 745-9, 1996 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-8690640

RESUMO

PURPOSE: A prospective clinical trial was performed to assess the response and toxicity associated with the use of high dose radiation therapy, 5-fluorouracil, and cisplatin in patients with anal cancer. METHODS AND MATERIALS: Patients with anal cancer without distant metastasis were eligible for this study. Radiation therapy consisted of 59.4 Gy in 33 fractions; a 2 week break in treatment was taken after 36 Gy had been given. A treatment of 5-fluorouracil, 1,000 mg/m2 per day intravenously, was given for the first 4 days of radiation therapy, and cisplatin, 75 mg/m2 intravenously, was given on day 1 of radiation therapy. A second course of 5-fluorouracil and cisplatin was given after 36 Gy of radiation, when the radiation therapy was resumed. RESULTS: Nineteen patients entered this study and received treatment. Thirteen (68%) had a complete response, 5 (26%) had a partial response, and 1 (5%) had stable disease. The patient with stable disease and one of the patients with a partial response had complete disappearance of tumor more than 8 weeks after completion of radiation therapy. Fifteen patients had toxicity of Grade 3 or higher: the worst toxicity was Grade 3 in eight patients, Grade 4 in six patients, and Grade 5 in one patient. The most common form of toxicity of Grade 3 or higher was hematologic. The one lethal toxicity was due to pseudomembranous colitis, which was a complication of antibiotic therapy for a urinary tract infection. CONCLUSION: Radiation therapy, cisplatin, and 5-fluorouracil resulted in an overall response rate of 95%. Significant toxicity occurred, an indication that this regimen is near the maximal tolerated dose. A Phase III clinical trial is planned in which radiation therapy, cisplatin, and 5-fluorouracil will be used as an experimental arm.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Ânus/radioterapia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias do Ânus/tratamento farmacológico , Cisplatino/administração & dosagem , Terapia Combinada , Fluoruracila/administração & dosagem , Humanos , Estudos Prospectivos , Radioterapia/efeitos adversos
9.
Surgery ; 126(4): 666-71; discussion 671-2, 1999 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-10520913

RESUMO

BACKGROUND: Free jejunal transfer has become the standard technique for reconstruction of the proximal pharynx and hypopharynx. Gastric tube interposition is an effective alternative when resection extends below the thoracic inlet. This study was done to determine current indications, review morbidity and mortality rates, and to define clinical and pathologic determinants of survival associated with this procedure. METHODS: We reviewed the records of 32 patients who underwent gastric tube interposition for reconstruction of the pharyngoesophagus from 1987 to 1997. RESULTS: The overall complication rate was 50%. Complications were more frequent in the reoperative group (22% vs 66%, P < .05). The overall fistula rate was 31%. The overall mortality rate was 12%. Ultimately, 71% of patients resumed oral feedings. The 5-year actuarial survival rate was 22%. Unfavorable prognostic factors associated with significantly reduced survival (P < . 05) included margin positive resection, positive lymph node involvement, and operations done for recurrent tumor CONCLUSIONS: Reconstruction of the pharyngoesophagus with gastric tube interposition is indicated for primary tumors of the hypopharynx and cervical esophagus with inferior extension below the thoracic inlet and recurrent tumors or benign strictures in which free jejunal transfer is not feasible or has failed. It can be done with acceptable morbidity and mortality and provides reasonable expectations for long-term survival and resumption of oral intake.


Assuntos
Neoplasias Esofágicas/cirurgia , Neoplasias Faríngeas/cirurgia , Estômago/cirurgia , Adulto , Idoso , Anastomose Cirúrgica , Neoplasias Esofágicas/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Faríngeas/mortalidade , Complicações Pós-Operatórias/mortalidade , Prognóstico , Recidiva , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
10.
Surgery ; 126(4): 714-20; discussion 720-2, 1999 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-10520920

RESUMO

BACKGROUND: Evidence indicates that sentinel node (SN) biopsy can accurately predict axillary nodal status. Debate exists as to the optimal method of SN identification. METHODS: Patients with clinical T1 or T2 tumors and negative axillae were randomized to SN localization with blue dye (B) alone (n = 50) or blue dye plus radioactivity (B+R) (n = 42). Patients undergoing needle localization (n = 47) were assigned to blue dye. RESULTS: The SN was identified in 110 patients (79%) and contained metastases in 28. The SN predicted the axillary nodal status in 96% of cases. The SN identification rate did not differ between B (88%) or B+R (86%) but was significantly lower in patients requiring localization (64%). The time to SN identification also did not differ between B and B+R. The number of cases done by an individual surgeon was a significant predictor of SN identification. A stepwise logistic regression analysis of factors influencing the success of SN identification identified tumor location, needle localization, number of operations, and body mass index as significant predictors. CONCLUSIONS: Our study does not identify any advantage for the use of the more expensive and complex method of SN identification using B+R compared with B alone, even for surgeons learning the techniques.


Assuntos
Biópsia/métodos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Educação Médica Continuada , Linfonodos/patologia , Axila , Corantes , Feminino , Humanos , Modelos Logísticos , Corpo Clínico Hospitalar/educação , Pessoa de Meia-Idade , Palpação , Estudos Prospectivos , Cintilografia , Compostos Radiofarmacêuticos , Coloide de Enxofre Marcado com Tecnécio Tc 99m
11.
Surgery ; 128(4): 604-12, 2000 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11015094

RESUMO

BACKGROUND: This study was done to review the clinical presentation, surgical management, and prognostic factors for primary gastrointestinal sarcomas. METHODS: We reviewed medical records of 55 patients who were treated for primary gastrointestinal sarcomas from 1981 through 1996. Mean follow-up time was 32 months. RESULTS: Clinical findings included gastrointestinal bleeding (51%), palpable mass (36%), and abdominal pain (33%). The stomach was the most common site of disease (53%), followed by the small intestine (33%). Tumors were high grade in 76% of patients and low-grade in 24% of patients. Complete resection of all gross disease was accomplished in 35 patients (64%), incomplete resection in 17 patients (31%), and biopsy only in 3 patients (5%). Adjacent organ resection was required in 19 patients (35%). Overall actuarial survival was 22% (median survival, 32 months). Unfavorable prognostic factors were incomplete resection, high-grade histologic features, and tumor size of 5 cm or more (P<.05). En bloc resection of contiguous organs did not adversely effect survival. In patients with complete resections, tumor grade was the most important prognostic factor (median survival, 55 months vs 19 months for low-grade vs high-grade tumors; P<.05). CONCLUSIONS: Aggressive surgical resection, including en bloc resection of locally advanced tumors, appears warranted. Despite complete resections, patients with high-grade tumors remain at risk for recurrence.


Assuntos
Neoplasias Gastrointestinais/cirurgia , Sarcoma/cirurgia , Adulto , Idoso , Biópsia , Feminino , Neoplasias Gastrointestinais/mortalidade , Neoplasias Gastrointestinais/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Sarcoma/mortalidade , Sarcoma/patologia , Análise de Sobrevida , Resultado do Tratamento
12.
Surgery ; 130(4): 677-82; discussion 682-5, 2001 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11602899

RESUMO

BACKGROUND: We reviewed 36 patients with liver metastases from islet cell tumors of the pancreas (n = 18) and carcinoid tumors (n = 18) who were treated with surgical resection (n = 16) or hepatic chemoembolization (n = 20). METHODS: All resections were complete and included 4 lobectomies, 6 segmental resections, and 6 wedge resections. There were no operative deaths. RESULTS: Median survival has not yet been reached, and the actuarial 5-year survival rate is 70%. Prognostic variables associated with improved disease-free survival included prior resection of the primary tumor and 4 or fewer metastases resected (P <.05). With an average of 3 chemoembolization procedures per patient, 17 of 20 patients (90%) demonstrated either a significant radiographic response (n = 5), stabilization of tumor mass (n = 2), or improvement of clinical symptoms (n = 10). Factors related to a sustained response (more then 1 year) included surgical resection of the primary tumor, 4 or more chemoembolization procedures, and liver metastases of 5 cm or smaller. Median survival after treatment was 32 months (range, 7-63 months), and the actuarial 5-year survival rate was 40%. CONCLUSIONS: Surgical resection of metastatic neuroendocrine tumors provides the best chance for extended survival. Chemoembolization effectively improves clinical symptoms and, in selected patients, may provide sustained tumor control.


Assuntos
Adenoma de Células das Ilhotas Pancreáticas/terapia , Tumor Carcinoide/terapia , Quimioembolização Terapêutica , Neoplasias Gastrointestinais/terapia , Hepatectomia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Neoplasias Pancreáticas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida
13.
Arch Surg ; 125(8): 972-6; discussion 976-7, 1990 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-2378562

RESUMO

The cases of 42 consecutive patients with primary gastrointestinal lymphoma were reviewed to compare the risks and outcomes of different primary treatment modalities. Among patients with localized disease (stages I and II), 12 underwent complete tumor resection and 6 underwent radiation therapy; 5-year survival was 82% and 50%, respectively. Among patients with disseminated disease (stages III and IV), 6 underwent resection of the primary tumor followed by chemotherapy and 18 were treated with radiation and chemotherapy; 5-year survival was 81% and 6%, respectively. Five patients who did not undergo surgical resection before radiation therapy or chemotherapy developed severe life-threatening complications from their primary tumor. Surgical resection before the administration of other therapy should be performed when the patient is considered to be a surgical candidate and resection of the primary tumor is deemed feasible.


Assuntos
Neoplasias Gastrointestinais/cirurgia , Linfoma/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Hemorragia Gastrointestinal/etiologia , Neoplasias Gastrointestinais/complicações , Neoplasias Gastrointestinais/mortalidade , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/terapia , Humanos , Perfuração Intestinal/etiologia , Linfoma/complicações , Linfoma/mortalidade , Linfoma/patologia , Linfoma/terapia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Lesões por Radiação , Estudos Retrospectivos , Taxa de Sobrevida
14.
Arch Surg ; 130(10): 1048-54, 1995 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-7575115

RESUMO

OBJECTIVE: To review the classification, clinical behavior, and appropriate therapy for cystic neoplasms of the pancreas. We examined patient demographics, clinical parameters, preoperative imaging modalities, histologic findings, and tumor DNA content to determine which best predict outcome. DESIGN: Case series and survey of pathologic specimens. SETTING: Tertiary care center. PATIENTS: Twenty-two patients with cystic neoplasms of the pancreas treated at affiliates of Northwestern University Medical School, Chicago, Ill. MAIN OUTCOME MEASURES: Predictive value of preoperative testing, tumor DNA content, patient survival. RESULTS: In 20 patients undergoing computed tomographic scan, the tumor was visualized in every case. All other imaging studies evaluated were less likely to demonstrate the lesion. Eight of 10 patients with serous cystadenomas were alive with no evidence of disease at the time of this report; one patient was alive with local recurrence, and a second patient had died of unrelated causes. All patients with mucinous cystadenomas were alive with no evidence of disease. Three of seven patients with cystadenocarcinomas had aneuploid, high S-phase tumors, and one had a diploid, high S-phase tumor; all four died (mean survival, 4.8 months). Two patients with cystadenocarcinomas had diploid, low S-phase tumors; both were long-term survivors but died of their disease at 8.6 and 9.3 years. CONCLUSIONS: (1) Computed tomographic scan is the most valuable diagnostic imaging study for preoperative evaluation of these patients. (2) Precise preoperative determination of tumor type is not possible. (3) DNA flow cytometry may help identify patients with aggressive tumors who may benefit from adjuvant chemoradiation.


Assuntos
Cistadenocarcinoma/diagnóstico , Cistadenoma Mucinoso/diagnóstico , Cistadenoma Seroso/diagnóstico , DNA de Neoplasias/análise , Neoplasias Pancreáticas/diagnóstico , Análise Atuarial , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistadenocarcinoma/mortalidade , Cistadenocarcinoma/cirurgia , Cistadenoma Mucinoso/mortalidade , Cistadenoma Mucinoso/cirurgia , Cistadenoma Seroso/mortalidade , Cistadenoma Seroso/cirurgia , Feminino , Citometria de Fluxo , Seguimentos , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia , Pancreatectomia , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias , Valor Preditivo dos Testes , Estudos Retrospectivos , Fase S , Análise de Sobrevida
15.
Surg Oncol ; 6(2): 99-110, 1997 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-9436656

RESUMO

Advances in transgenic science have created powerful tools for the investigation of both genetic and protein regulatory systems. Recently, transgenic animals have been utilized in several vascular and transplantation research laboratories. The ability to specifically mutate genes important in oncologic and cardiovascular research is leading to a greater understanding of the role of gene and protein regulatory systems in cancer and cardiovascular disease. The expanding use of transgenic animals will undoubtedly increase our insight into complex problems in surgical research. This review briefly describes the various techniques utilized to create transgenic animals including: transgene design, gene-transfer utilizing transfection, microinjection and retroviral infection, as well as the use of embryonic stem cells, and methods for screening transgenic offspring.


Assuntos
Animais Geneticamente Modificados/cirurgia , Modelos Animais de Doenças , Engenharia Genética/métodos , Animais , Animais Geneticamente Modificados/genética , Técnicas Genéticas , Camundongos , Camundongos Transgênicos/genética , Camundongos Transgênicos/cirurgia , Ratos , Projetos de Pesquisa
16.
Radiol Clin North Am ; 35(2): 331-49, 1997 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-9087207

RESUMO

CT scan and EUS play complementary roles in staging gastric cancer. CT scan is initially performed to detect local and distant metastases. Depending on institutional expertise, EUS may be considered for local staging. Laparoscopic staging may also be helpful in select patients. It is hoped that further improvements in these techniques will improve the ability to stage gastric cancer and thereby optimize patient treatment and outcome.


Assuntos
Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologia , Terapia Combinada , Endossonografia , Humanos , Laparoscopia , Recidiva Local de Neoplasia , Neoplasias Gástricas/terapia , Tomografia Computadorizada por Raios X
17.
Am Surg ; 53(2): 102-4, 1987 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-3813214

RESUMO

Clinical reviews of sternal wound infections following open heart surgery indicate many predisposing factors including diabetes, low cardiac output, use of bilateral internal mammary grafts, and reoperation for excessive postoperative bleeding. This study was undertaken to determine the role of mediastinal re-exploration in the development of sternal wound complications. From a series of 2,271 patients undergoing median sternotomy for open-heart surgery between 1979 and 1984, 71 (3.1%) were re-explored for excessive bleeding. Nine of these patients died in the early postoperative period of noninfectious complications. The remaining patients were divided into two groups. Group 1 (54 patients) were re-explored without subsequent problems. Group 2 (8 patients) developed sternal and costochondral wound complications. Comparison of age, intercurrent and pre-existing disease, total bypass time, crossclamp time, and postoperative hemodynamic status showed no statistical difference. All patients bled an average rate of 247 ml/hr. However, the average time before re-exploration was 7.6 hours in group 1 compared to 13.8 hours in group 2 (P less than 0.001). Sternal wound complications may be minimized by a policy of early re-exploration for excessive postoperative bleeding (greater than 200 ml/hr for 4 hours).


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Hemotórax/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Reoperação/efeitos adversos , Deiscência da Ferida Operatória/etiologia , Fatores de Tempo
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