ABSTRACT
BACKGROUND: The therapeutic modalities for nonmetastatic rectal cancer are presently undergoing major changes. The standard treatment is multidisciplinary, combining radiotherapy, chemotherapy, and surgery. The aim of this minireview is to provide an update on the place of organ preservation in the treatment of nonmetastatic rectal cancer in 2022. MAIN TEXT: The multimodal strategy based on initial radiochemotherapy followed by radical surgery with excision of the mesorectum has improved oncological results but at the expense of morbidity and sequelae altering life quality. The strategy of rectal preservation has been proposed since the 2000s after the publication of the results of the Brazilian study that proposed a simple surveillance after radiochemotherapy without surgery in good responders. In fact, preoperative radiochemotherapy was able to obtain a complete histological response in 10 to 30% of case. In view of this non-negligible percentage of tumor sterilization, which may well increase with the standardization of total neoadjuvant treatment, a strategy of organ preservation can be proposed in these patients to avoid morbidity and postoperative sequelae. SHORT CONCLUSION: This nonoperative approach is currently widely studied in certain patients who have a complete response (clinical, endoscopic, and radiological). However, the selection of these patients is not simple and still complex.
Subject(s)
Organ Preservation , Rectal Neoplasms , Humans , Rectal Neoplasms/pathology , Chemoradiotherapy , Neoadjuvant Therapy/methods , Treatment Outcome , Neoplasm Recurrence, Local/drug therapyABSTRACT
INTRODUCTION: Viral hepatitis represents a serious public health problem in the world especially in the Maghreb where the prevalence of the 5 viruses A, B, C, D, and E remains high and varies from one Maghreb country to another, there is few published studies on these infections in our Maghreb countries. METHOD OF STUDY: Our work is a review of the literature about prevalence, the most common mode of transmission, and the most exposed population for these viruses in the Maghreb countries through published studies between 2011 and 2017. RESULT: It has been found that the Maghreb countries are endemic for the five viruses with variable prevalence from one country to another, with sometimes heterogeneous data in the same country. For hepatitis B, Mauritania is the Maghreb country most affected by this infection unlike the rest of the Maghreb countries which are moderately endemic for this virus, the lowest prevalence of VHB was noted in Morocco, the genotype the most common is the D for the majority of Maghreb countries, and the precore mutant profile is also the most common. For hepatitis C the prevalence of infection does not vary much from one Maghreb country to another, but it remains slightly higher in Mauritania. The population most exposed to the virus C in the five countries is hemodialysis patients. The most common genotype in all Maghreb countries is genotype 1 except for Libya, where genotype 4 remains the most common probably related to its borders with Egypt. For hepatitis D, Mauritania is the only Maghreb country with a high endemicity for the virus. Tunisia has the lowest prevalence for hepatitis A and E compared to the rest of the Maghreb countries, all of which are endemic for these two viruses with fecal-oral transmission. CONCLUSION: The management of these viral hepatitis is costly for the health economy and to reduce their prevalence, prevention measures must be followed like vaccination and improving hygiene conditions.
Subject(s)
Hepatitis, Viral, Human/epidemiology , Africa, Northern/epidemiology , Algeria/epidemiology , Genotype , Hepacivirus/classification , Hepacivirus/genetics , Hepatitis, Viral, Human/diagnosis , Hepatitis, Viral, Human/therapy , Hepatitis, Viral, Human/virology , Humans , Libya/epidemiology , Mauritania/epidemiology , Morocco/epidemiology , Prevalence , Tunisia/epidemiologySubject(s)
Cecal Diseases/complications , Ileal Diseases/complications , Intestinal Obstruction/complications , Intestinal Volvulus/complications , Sigmoid Diseases/complications , Adult , Cecal Diseases/diagnosis , Cecal Diseases/diagnostic imaging , Emergencies , Humans , Ileal Diseases/diagnosis , Ileal Diseases/diagnostic imaging , Intestinal Obstruction/diagnosis , Intestinal Obstruction/diagnostic imaging , Intestinal Volvulus/diagnosis , Intestinal Volvulus/diagnostic imaging , Laparotomy , Male , Sigmoid Diseases/diagnosis , Sigmoid Diseases/diagnostic imaging , Sigmoid Diseases/surgery , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Acute rejection is still a common complication of hepatic transplantation. The diagnosis, based on the histological examination of the graft, may be difficult to confirm in the setting of combined hepatitis C virus infection. The presence of C4d in the portal capillaries could facilitate differentiation between acute rejection and relapsed hepatitis C. The deposit of C4d provides evidence of activation of humoral immunity. To attempt to confirm this hypothesis, we searched for the presence of C4d in posttransplant hepatic biopsies. METHODS: Thirty-six biopsies from 34 patients were analyzed retrospectively. The samples had been requested for one of the following reasons: suspected rejection, relapsed hepatitis C infection, or systematic check-up 1 year after the transplant. RESULTS: C4d expression was common in biopsies classified as acute rejection (33%) and chronic rejection (100%). C4d was never detected in the event of recurrent hepatitis C infection without rejection. CONCLUSION: These results, which are comparable to recently published data, give credence to the theory that C4d could be used as a marker for rejection following hepatic transplantation.
