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1.
Proc (Bayl Univ Med Cent) ; 31(4): 462-464, 2018 Oct.
Article in English | MEDLINE | ID: mdl-30948980

ABSTRACT

Patients with a malignant large bowel obstruction are often late in seeking medical attention and are usually in poor health by the time a complete blockage is apparent. Emergency surgery in this setting, particularly in a patient with significant comorbidities, often requires the creation of an ostomy and can result in postoperative complications that delay the administration of adjuvant chemotherapy. This recent case at our center illustrates how the use of a colon stent, as a bridge to surgery, can help patients avoid the need for a stoma and reduce surgical complications.

2.
Dis Colon Rectum ; 47(8): 1305-9, 2004 Aug.
Article in English | MEDLINE | ID: mdl-15484343

ABSTRACT

PURPOSE: Before the development of highly active antiretroviral therapy for the treatment of HIV infection, HIV patients diagnosed with invasive squamous-cell carcinoma of the anal canal carried a very poor prognosis. This study was designed to determine the outcome in a similar group of patients in the era of highly active antiretroviral therapy. METHODS: HIV-positive patients treated for invasive squamous-cell carcinoma of the anal canal at the University of Texas Medical Center affiliated hospitals from 1980 to 2001 were identified from operative data and cancer registries. We reviewed these records and collected data regarding age, CD4 count, highly active antiretroviral therapy, cancer treatment, complications, and survival. The patients were divided into two groups based on the presence or absence of highly active antiretroviral therapy and compared using a Kaplan-Meier approach. RESULTS: Fourteen patients with HIV and invasive squamous-cell carcinoma of the anal canal were identified. Six were in the prehighly active antiretroviral therapy group and eight in the highly active antiretroviral therapy group. All were considered for treatment with chemotherapy and radiation. In the prehighly active antiretroviral therapy group, one patient refused therapy and three were unable to complete the squamous-cell carcinoma therapy as planned because of complications. Four of eight highly active antiretroviral therapy patients were unable to complete the squamous-cell carcinoma therapy as planned. The prehighly active antiretroviral therapy patients had a mean age of 40 years and a mean CD4 count of 190 at the time of diagnosis. The highly active antiretroviral therapy patients had a mean age of 44 years and a mean CD4 count of 255 at the time of diagnosis. The 24-month survival was 17 percent in the prehighly active antiretroviral therapy group and 67 percent in the highly active antiretroviral therapy group (P = 0.0524). All six patients in the prehighly active antiretroviral therapy group died with active squamous-cell carcinoma vs. two in the highly active antiretroviral therapy group. Four of the remaining six patients had no evidence of active squamous-cell carcinoma at the last follow-up visit. CONCLUSIONS: A review of patients with HIV and invasive squamous-cell carcinoma of the anal canal suggests a trend toward a higher CD4 count at the time of diagnosis and improved survival in patients receiving highly active antiretroviral therapy. In this new era, HIV-positive patients should be on highly active antiretroviral therapy. If not, highly active antiretroviral therapy should be initiated, and standard multimodality therapies for invasive squamous-cell carcinoma of the anal canal are recommended.


Subject(s)
Antiretroviral Therapy, Highly Active , Anus Neoplasms/pathology , Anus Neoplasms/therapy , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/therapy , HIV Infections/complications , Adult , Anus Neoplasms/etiology , CD4 Lymphocyte Count , Carcinoma, Squamous Cell/etiology , Combined Modality Therapy , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Survival Analysis , Treatment Outcome
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