ABSTRACT
New-onset benign anal disorders (NBADs) represent a potential complication following bariatric surgery, although their incidence in this population is not well studied. The preoperative characteristics, weight loss, bowel habits and NBADs data of 196 patients with bariatric surgery were collected by telephone interviews and medical records review and evaluated retrospectively. Ninety-nine patients had undergone gastric bypass (GBP) and 97 had a modified biliopancreatic diversion (MBPD). Fifty-nine patients were excluded. The mean follow-up of the remaining 137 patients was 87.8 months, and 51 of them (37.2%) developed NBADs. Haemorrhoids were the most common diagnosis and 27.5% of the patients that developed NBADs were treated surgically. Patients who developed NBADs had a longer follow-up time (92.5 vs. 85.1 months, P = 0.003), and those with an abnormal bowel habit (diarrhoea or constipation) had a higher percentage of NBADs (54.5 vs. 28.3%, P = 0.003). NBADs were more frequent after MBPD (52.9%) than after GBP (21.7%) (P < 0.001). Multivariate analysis found that only an abnormal bowel habit was associated with NBADs, with an odds ratio of 3.2 (95% CI: 1.5-6.9, P = 0.003). As NBADs are a common complication after bariatric surgery, further studies should be performed to find the reasons for these complications.
Subject(s)
Anus Diseases/epidemiology , Bariatric Surgery/adverse effects , Obesity/surgery , Anus Diseases/diagnosis , Anus Diseases/physiopathology , Anus Diseases/therapy , Humans , Incidence , Obesity/epidemiology , Retrospective Studies , Risk Factors , Spain/epidemiology , Time Factors , Treatment OutcomeABSTRACT
An interdisciplinary panel of specialists met in Mallorca in the first European Symposium on Morbid Obesity entitled; "Morbid Obesity, an Interdisciplinary Approach". During the two and half days of the meeting, the participants discussed several aspects related to pathogenesis, evaluation, and treatment of morbid obesity. The expert panel included basic research scientists, dietitians and nutritionists, exercise physiologists, endocrinologists, psychiatrists, cardiologists, pneumonologists, anesthesiologists, and bariatric surgeons with expertise in the different weight loss surgeries. The symposium was sponsored by the Balearic Islands Health Department; however, this statement is an independent report of the panel and is not a policy statement of any of the sponsors or endorsers of the Symposium. The prevalence of morbid obesity, the most severe state of the disease, has become epidemic. The current recommendations for the therapy of the morbidly obese comes as a result of a National Institutes of Health (NIH) Consensus Conference held in 1991 and subsequently reviewed in 2004 by the American Society for Bariatric Surgery. This document reviews the work-up evaluation of the morbidly obese patient, the current status of the indications for bariatric surgery and which type of procedure should be recommended; it also brings up for discussion some important real-life clinical practice issues, which should be taken into consideration when evaluating and treating morbidly obese patients. Finally, it also goes through current scientific evidence supporting the potential effectiveness of medical therapy as treatment of patients with morbid obesity.
Subject(s)
Bariatric Surgery , Obesity, Morbid/surgery , Obesity, Morbid/therapy , Practice Guidelines as Topic/standards , Consensus Development Conferences, NIH as Topic , Europe , Humans , United StatesABSTRACT
No disponible
Subject(s)
Humans , Colorectal Neoplasms/pathology , Deoxycholic Acid/adverse effects , Colorectal Neoplasms/epidemiology , Endoscopy, Digestive System , Carcinogens , Genetic Predisposition to DiseaseABSTRACT
Locally advanced gastric adenocarcinoma has a poor outcome. Neoadjuvant treatment is being tested in locally advanced non-resectable tumours and in those resectable tumours with a high risk of recurrence. Efforts to identify prognostic factors and more active and less toxic preoperative regimens are being searched for. We report the case of a patient achieving a complete histopathological complete response following docetaxel- based neoadjuvant chemotherapy.
Subject(s)
Adenocarcinoma/drug therapy , Antineoplastic Agents/therapeutic use , Stomach Neoplasms/drug therapy , Taxoids/therapeutic use , Adult , Chemotherapy, Adjuvant , Disease Progression , Docetaxel , Humans , Male , Neoadjuvant TherapyABSTRACT
Locally advanced gastric adenocarcinoma has a poor outcome. Neoadjuvant treatment is being tested in locally advanced non-resectable tumours and in those resectable tumours with a high risk of recurrence. Efforts to identify prognostic factors and more active and less toxic preoperative regimens are being searched for. We report the case of a patient achieving a complete histopathological complete response following docetaxel- based neoadjuvant chemotherapy (AU)
No disponible
Subject(s)
Humans , Male , Adult , Adenocarcinoma/drug therapy , Antineoplastic Agents/therapeutic use , Stomach Neoplasms/drug therapy , Taxoids/therapeutic use , Chemotherapy, Adjuvant/methods , Chemotherapy, AdjuvantABSTRACT
La cirugía es el pilar sobre el que descansa el tratamiento de los tumores neuroendocrinos gastroenteropancreáticos. Son tumores que, en general, presentan un buen pronóstico y que muchas veces el único problema al que dan lugar son los síntomas derivados de su secreción endocrina, que se pueden tratar médicamente. Estos hechos han de considerarse siempre que se afronte un tratamiento quirúrgico, que puede ser de agresividad desproporcionada para tan benigna evolución; pero no hay que olvidar que, si existe posibilidad de curación, ésta pasa invariablemente por la exéresis del tumor. No es contraindicación para la resección la presencia de enfermedad a distancia, ya que, por una parte, la cirugía citorreductora tiene un valor indudable y, por otra, existe la posibilidad de resección de las metástasis sin renunciar a la curación, y al menos con la intención de prolongar la supervivencia sin síntomas. El trasplante hepático es controvertido, ya que aunque puede incrementar la supervivencia, la escasez de órganos y la carcinogénesis secundaria a la inmunosupresión cuestionan su utilidad. Recientemente se han diseñado otros tipos de ablación tumoral apoyados por el avance de las técnicas de radiodiagnóstico, que consiguen igualmente buenos resultados para el tratamiento de este tipo peculiar de neoplasias (AU)
Surgery is the cornerstone of the treatment of gastroenteropancreatic tumors. These neoplasms usually have a good prognosis. Endocrine symptoms are often the only problem noticed by the patient and these can be treated pharmacologically. Surgical indication must be considered carefully, as this type of therapy may be too aggressive for benign tumors; on the other hand, the only chance for cure is tumoral resection. Surgery is not contraindicated in cases of distant metastases, as both cytoreductive surgery and metastases resection are associated with an increase in symptom-free survival and, in the latter, to overall survival and sometimes curation. Liver transplantation is controversial; although it can increase survival, its usefulness is limited by the shortage of donors and by carcinogenesis secondary to immunosuppression. Recently, new ablative techniques have been introduced, such as radiofrequency ablation or cryotherapy, both of which achieve good results mainly in the treatment of metastatic disease (AU)
Subject(s)
Humans , Pancreatic Neoplasms/surgery , Gastrointestinal Neoplasms/surgery , Neuroendocrine Tumors/surgery , Multiple Endocrine Neoplasia/surgery , Colorectal Neoplasms/surgery , Appendiceal Neoplasms/surgery , Hepatectomy , Neoplasm MetastasisABSTRACT
AIM: The aim of the present study is to evaluate the prognostic influence of loss of heterozygosity on 2p, 3p, 5q, 17p and 18q, and c-myc overexpression on surgically treated sporadic colorectal carcinoma. METHODS: Tumor and non-tumor tissue samples from 153 patients were analyzed. Fifty-one percent of patients were male, and mean age in the series was 67 years. Tumors were located in the proximal colon in 37 cases, in the distal bowel in 37, and in the rectum in 79 patients. c-myc overexpression was studied by means of Northern blot analysis, and loss of heterozygosity through microsatellite analysis. RESULTS: c-myc overexpression was detected in 25% of cases, and loss of heterozygosity in at least one of the studied regions in 48%. There was no association between clinical and pathologic features, and genetic alterations. The disease-free interval was significantly shorter for patients with both genetic alterations; the presence of both events was an independent prognostic factor for poor outcome in the multivariate analysis (RR: 4.34, p < 0.0001). CONCLUSIONS: The presence of both loss of heterozygosity and overexpression of the c-myc oncogene separates a subset of colorectal carcinoma patients who have a shorter disease-free interval after curative-intent surgery.
Subject(s)
Colorectal Neoplasms/genetics , Genes, myc , Adult , Aged , Aged, 80 and over , Colorectal Neoplasms/surgery , Female , Gene Expression , Humans , Loss of Heterozygosity , Male , Middle Aged , PrognosisABSTRACT
We report the characterization of the novel human protein MDGA1 encoded by MDGA1 (MAM domain containing glycosylphosphatidylinositol anchor-1) gene, firstly termed as GPIM. MDGA1 has been mapped to 6p21 and it is expressed in human tissues and tumors. The deduced polypeptide consists of 955 amino acids and exhibits structural features found in different types of cell adhesion molecules (CAMs), such as the presence of both immunoglobulin domains and a MAM domain or the capacity to anchor to the cell membrane by a GPI (glycosylphosphatidylinositol) motif. Our results demonstrate that human MDGA1 (hMDGA1) is localized in the membrane of eukaryotic cells. The protein follows the secretion pathway and finally it is retained in the cell membrane by a GPI anchor, susceptible to be cleavaged by phospholipase C (PI-PLC). Moreover, our results reveal that hMDGA1 is localized specifically into membrane microdomains known as lipid rafts. Finally, as other proteins of the secretory pathway, hMDGA1 undergoes other post-translational modification consisting of N-glycosylation.
Subject(s)
Cell Adhesion Molecules/chemistry , Cell Adhesion Molecules/metabolism , Glycosylphosphatidylinositols/chemistry , Glycosylphosphatidylinositols/metabolism , Membrane Microdomains/metabolism , Amino Acid Motifs , Amino Acid Sequence , Animals , COS Cells , Cell Membrane/chemistry , Chlorocebus aethiops , Chromosome Mapping , Chromosomes, Human, Pair 6 , Cloning, Molecular , GPI-Linked Proteins , Gene Expression , Genes , Glycosylation , HeLa Cells , Humans , Membrane Proteins/metabolism , Molecular Sequence Data , Neural Cell Adhesion Molecules , Protein Processing, Post-Translational , Protein Structure, Tertiary , Transfection , Type C Phospholipases/metabolismABSTRACT
Patients undergoing malabsoprtive operations for bariatric surgery are prone to disturbances of bone metabolism, but this does not commonly lead to clinical symptoms. We present a morbidly obese patient who had undergone the biliopancreatic diversion of Larrad, and presented clinical symptoms of severe hypocalcemia and tetany after total thyroidectomy. Very high doses of i.v. calcium and calcitriol and 10 days of hospitalization were required to control the symptoms and correct plasma levels. The physiological aspects that contribute to this situation are discussed.
Subject(s)
Biliopancreatic Diversion , Hypocalcemia/etiology , Thyroidectomy/adverse effects , Adult , Calcitriol/therapeutic use , Calcium/therapeutic use , Carcinoma, Papillary/surgery , Female , Humans , Hypocalcemia/drug therapy , Obesity, Morbid/surgery , Tetany/etiology , Thyroid Neoplasms/surgeryABSTRACT
Objetivo: el objetivo del presente trabajo es evaluar la importanciapronóstica de la pérdida de heterozigosidad en las regiones2p, 3p, 5q, 17p y 18q y de la sobreexpresión del genc-myc en el carcinoma colorrectal esporádico, mediante el estudiode la supervivencia libre de enfermedad tras cirugía potencialmentecurativa.Métodos: se han analizado muestras tumorales y no tumoralesde mucosa colónica de 153 pacientes. El 51% de los pacienteseran varones y la edad media de la serie fue 67 años. Los tumoresfueron proximales en 37 casos, distales en 37 y localizados enrecto en 79. Se analizó la sobreexpresión del RNA de c-myc porNorthern blot, y la presencia de pérdida de heterozigosidad en lasdiferentes regiones consideradas por análisis de microsatélites.Resultados: se detectó sobreexpresión de c-myc en el 25%de los casos, y pérdida de heterozigosidad en alguna de las regionesestudiadas en el 48%. No hubo asociación entre las variablesclínicas o patológicas y las alteraciones génicas. Se encontró unintervalo libre de enfermedad más corto para los pacientes conpérdida de heterozigosidad y sobreexpresión de c-myc, y este factortuvo valor pronóstico independiente en el análisis multivariante(RR: 4.34, p < 0,0001).Conclusiones: la coexistencia de pérdida de heterozigosidady sobreexpresión del oncogén c-myc distingue un grupo de pacientescon recurrencia más precoz tras cirugía curativa por carcinomacolorrectal
Aim: the aim of the present study is to evaluate the prognosticinfluence of loss of heterozygosity on 2p, 3p, 5q, 17p and 18q,and c-myc overexpression on surgically treated sporadic colorectalcarcinoma.Methods: tumor and non-tumor tissue samples from 153 patientswere analyzed. Fifty-one percent of patients were male, andmean age in the series was 67 years. Tumors were located in theproximal colon in 37 cases, in the distal bowel in 37, and in therectum in 79 patients. c-myc overexpression was studied bymeans of Northern blot analysis, and loss of heterozigositythrough microsatellite analysis.Results: c-myc overexpression was detected in 25% of cases,and loss of heterozygosity in at least one of the studied regionsin 48%. There was no association between clinical andpathologic features, and genetic alterations. The disease-freeinterval was significantly shorter for patients with both geneticalterations; the presence of both events was an independentprognostic factor for poor outcome in the multivariate analysis(RR: 4.34, p < 0.0001).Conclusions: the presence of both loss of heterozygosity andoverexpression of the c-myc oncogene separates a subset of colorectalcarcinoma patients who have a shorter disease-free intervalafter curative-intent surgery
Subject(s)
Adult , Aged , Aged, 80 and over , Humans , Genes, myc , Colorectal Neoplasms/genetics , Gene Expression , Loss of Heterozygosity , Colorectal Neoplasms/surgeryABSTRACT
The main aim of this study was to evaluate the clinical relevance of Gelatinases in colorectal cancer (CRC). Ninety-five CRCs and their paired normal tissues were investigated to detect total levels of MMP-9, MMP-2, and the tissue inhibitors TIMP-1 and TIMP-2. Also, pro-MMP and MMP activity, and potential associations with clinical parameters were estimated. MMP-9, MMP-2 and TIMP-1 levels were greater in CRCs than in normal tissues, differences being significant for MMP-9 and TIMP-1. However, TIMP-2 showed significantly lower levels in tumour samples. Moreover, significant differences in the state of activation between gelatinases were found. TIMP-1 low levels were significantly associated with poor clinical outcome of patients. According to these data, different roles have to be attributed to MMP-2 and MMP-9 in CRC progression. Moreover, TIMP-1 level evaluation emerges as the main prognostic factor in relation to Gelatinases A and B activity in CRC.
Subject(s)
Colorectal Neoplasms/diagnosis , Matrix Metalloproteinase 2/metabolism , Matrix Metalloproteinase 9/metabolism , Tissue Inhibitor of Metalloproteinase-1/metabolism , Tissue Inhibitor of Metalloproteinase-2/metabolism , Adenocarcinoma/diagnosis , Adenocarcinoma/enzymology , Adenocarcinoma/metabolism , Aged , Colorectal Neoplasms/enzymology , Colorectal Neoplasms/metabolism , Down-Regulation , Female , Humans , Male , Matrix Metalloproteinase 2/analysis , Matrix Metalloproteinase 9/analysis , Middle Aged , Prognosis , Tissue Inhibitor of Metalloproteinase-1/analysis , Tissue Inhibitor of Metalloproteinase-2/analysis , Up-RegulationABSTRACT
3p deletions and telomerase reactivation are two of the most frequent events described in relation to non-small-cell lung cancer (NSCLC) pathogenesis. Moreover, a number of genes that map on 3p have been proposed as candidates to tumour-suppressor genes of importance in the lung cancer process. In this work, we analysed deletions at different 3p loci in relationship to telomerase activity in 66 NSCLCs obtained from patients who had suffered potentially curative surgery. Also, we evaluated prognostic implications. DNA samples were analysed for 3p deletions using five different polymorphic human dinucleotide repeat DNA markers (D3S1619 at 3p22.2, D3S3623 at 3p22.1, D3S1260 at 3p21.33, D3S3697 at 3p14.3, and D3S3722 at 3p21.2). Telomerase activity was investigated by a TRAP-based method. Possible correlations between the different molecular markers and distributions of disease-free survival were estimated. Our data revealed a significant correlation between telomerase activity and losses of heterozygosity (LOH) on D3S3697 (P=0.040), since all of the tumours showing deletion at this locus were positives for telomerase. Moreover, our results revealed clear associations with poor prognosis of patients, in the case of LOH at D3S1260 and D3S3697 (P=0.005 and 0.005, respectively). According to our data, potential repressors for telomerase may be located in chromosome 3p.
Subject(s)
Carcinoma, Non-Small-Cell Lung/genetics , Carcinoma, Non-Small-Cell Lung/pathology , Chromosomes, Human, Pair 3 , Lung Neoplasms/genetics , Lung Neoplasms/pathology , Telomerase/pharmacology , Aged , Female , Gene Deletion , Genes, Tumor Suppressor , Humans , Loss of Heterozygosity , Male , Middle Aged , Prognosis , Survival AnalysisABSTRACT
AIM: To analyze the pattern of recurrence of esophageal carcinoma after a curative-intention surgical resection. PATIENTS: Ninety-two patients with non-metastatic esophageal carcinoma were included. Ninety percent of patients were male, and the mean age of this series was 61 years. The most frequent histologic subtype was squamous cell carcinoma. Fifty percent of tumors were at or above the tracheal bifurcation. All patients were submitted for transthoracic subtotal esophagectomy plus two-field radical lymphadenectomy, leaving no apparent residual disease. No adjuvant therapy was applied to any patient. RESULTS: Follow-up was complete for 76 out of 80 patients surviving the operation. Thirty-four tumoral recurrences were detected for a disease-free survival af 39% at 9 years after surgery. All recurrences were detected during the first two years after treatment. Tumoral relapse was related to the presence of T3 or T4 tumors, with positive lymph nodes, squamous cell carcinoma subtype and supracarinal location. Nine percent of patients had a distant relapse, 15% had a locorregional relapse and 12% a combination of both. Distant relapse presented significantly earlier. There was no statistical association between type of recurrence and clinico-pathological or surgical features. CONCLUSIONS: After radical surgery for carcinoma of the esophagus, half of the patients relapse in the following two years. Distant metastases happen to appear earlier in the follow-up, but the most frequent recurrence is the locorregional one.
Subject(s)
Carcinoma, Squamous Cell/surgery , Esophageal Neoplasms/surgery , Neoplasm Recurrence, Local , Adult , Aged , Esophagectomy/methods , Female , Follow-Up Studies , Humans , Lymph Node Excision , Male , Middle Aged , Neoplasm Staging , Survival AnalysisABSTRACT
En el presente trabajo se describe el caso de una paciente que sufrió un síndrome de Claude Bernard-Horner derecho, parálisis recurrencial homolateral e insuficiencia respiratoria debidas a la presencia de un adenoma folicular tiroideo. La paciente fue tratada con éxito mediante intubación nasotraqueal, punción y evacuación de la masa tiroidea quística y cirugía diferida que consistió en hemitiroidectomía total derecha (AU)
Subject(s)
Aged , Female , Humans , Horner Syndrome , Adenoma , Thyroid Gland/surgery , Respiratory InsufficiencyABSTRACT
La intususcepción yeyunogástrica es una rara complicación de la cirugía gástrica, que puede acontecer en cualquier momento después de la intervención quirúrgica. Su presentación clínica de forma aguda constituye una urgencia quirúrgica grave y precisa una alta sospecha clínica y un diagnóstico precoz, generalmente realizado mediante endoscopia. Como opciones quirúrgicas se incluyen la reducción, la resección y la revisión y desmontaje de la anastomosis, sin que ninguna técnica haya demostrado ser la mejor para prevenir la recurrencia (AU)
Subject(s)
Aged , Male , Humans , Gastrectomy/adverse effects , Intussusception/etiologyABSTRACT
BACKGROUND: The aim of this prospective study was to compare the safety and efficacy of a new cephamycin, cefminox 2 g/12 h, to those of the usual regimen combining metronidazole 500 mg/8 h and gentamicin 80 mg/8 h (M+G). PATIENTS AND METHODS: 160 patients with clinically proven intra-abdominal infection were prospectively included in an open parallel randomized comparative multicenter trial. Antibiotics were started preoperatively and discontinued after clinical and laboratory evidence of resolution of the infection. Serum and peritoneal fluid levels and serum bactericidal activities were also studied. RESULTS: 150 patients were clinically evaluable. There was one failure in the cefminox group and three in the M+G group (not significant, RR: 1.07, 95% CI: 1-1.15). No differences were found in the number of wound infections, length of stay or duration of antibiotic therapy. Adverse effects were reported in 11 cases, all of them mild to moderate. Escherichia coli and Bacteroides fragilis were the most frequently found microorganisms. CONCLUSION: Cefminox is as effective and as safe as M+G in the treatment of intra-abdominal infections.
