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1.
Clin. transl. oncol. (Print) ; 23(12): 2482-2488, dec. 2021.
Artigo em Inglês | IBECS | ID: ibc-224105

RESUMO

Introduction Stage IV rectal cancer with resectable disease presents challenging issues, as the radical treatment of the whole disease is difficult. Surgery and chemotherapy (CT) play an unquestionable role, but the contribution of pelvic radiotherapy (RT) is not very clear. Methods In 2009, we established a prospective treatment protocol that included CT, short-course preoperative radiotherapy (SCRT) with surgery of the primary tumour and all metastatic locations. Results Forty patients were included. Eight (20%) patients did not receive CT due to significant comorbidities. Radical surgery treatment was possible in 22 (55%) patients. The mean follow-up was 42.81 months (3.63–105.97). Overall survival at 24 and 36 months was 71.4% and 58.2%, respectively. There was good local control of the disease, as 97.2% of pelvic surgeries were R0 and there were no local recurrences. Conclusion In stage IV with resectable metastatic disease, the proposed therapeutic regimen seems very appropriate in well selected patients able to tolerate the treatment. We bet on the role of pelvic RT, due to the good local control of the disease in our series (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adenocarcinoma/radioterapia , Radioterapia/métodos , Neoplasias Retais/radioterapia , Estudos Prospectivos , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Terapia Combinada , Seguimentos , Metástase Linfática , Prognóstico , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Análise de Sobrevida
2.
Clin Transl Oncol ; 23(12): 2482-2488, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34081292

RESUMO

INTRODUCTION: Stage IV rectal cancer with resectable disease presents challenging issues, as the radical treatment of the whole disease is difficult. Surgery and chemotherapy (CT) play an unquestionable role, but the contribution of pelvic radiotherapy (RT) is not very clear. METHODS: In 2009, we established a prospective treatment protocol that included CT, short-course preoperative radiotherapy (SCRT) with surgery of the primary tumour and all metastatic locations. RESULTS: Forty patients were included. Eight (20%) patients did not receive CT due to significant comorbidities. Radical surgery treatment was possible in 22 (55%) patients. The mean follow-up was 42.81 months (3.63-105.97). Overall survival at 24 and 36 months was 71.4% and 58.2%, respectively. There was good local control of the disease, as 97.2% of pelvic surgeries were R0 and there were no local recurrences. CONCLUSION: In stage IV with resectable metastatic disease, the proposed therapeutic regimen seems very appropriate in well selected patients able to tolerate the treatment. We bet on the role of pelvic RT, due to the good local control of the disease in our series.


Assuntos
Adenocarcinoma/radioterapia , Neoplasias Pélvicas/radioterapia , Cuidados Pré-Operatórios , Radioterapia/métodos , Neoplasias Retais/radioterapia , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasias Pélvicas/secundário , Neoplasias Pélvicas/cirurgia , Prognóstico , Estudos Prospectivos , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Taxa de Sobrevida
3.
Rev Esp Anestesiol Reanim (Engl Ed) ; 68(2): 114-116, 2021 Feb.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33371977
4.
Artigo em Espanhol | IBECS | ID: ibc-196755
5.
Clin Transl Gastroenterol ; 11(6): e00162, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32568477

RESUMO

INTRODUCTION: To date, we do not know the best therapeutic scheme in locally advanced rectal cancer when patients are older or have comorbidities. METHODS: In 2009, we established a prospective treatment protocol that included short-course preoperative radiotherapy (RT) with standard surgery +/- chemotherapy in frail patients, mostly older than 80 years or with comorbidities. RESULTS: We included 87 patients; the mean follow-up was 43.5 months (0.66-106.3). Disease-specific survival and disease-free survival at 36 months were 86.3% and 82.8%; at 60 months, they were 78.2% and 78%, respectively, with a local recurrence rate of 2.5%. The rate of late radiotoxicity was 9% in the form of sacral insufficiency fracture and small bowel obstruction with one death. The interval before surgery varied according to the involvement of the mesorectal fascia, but it was less than 2 weeks in 45% of cases. The rate of R0 was 95%. Surgical complications included abdominal wound dehiscence (3.5%), anastomotic leak (2.4%), and reoperations (11.5%). Downstaging was observed in 51% of the cases, regardless of the interval before surgery. DISCUSSION: Therapeutic outcomes in our group of elderly patients and/or patients with comorbidities with neoadjuvant short-course RT are such as those of the general population treated with neoadjuvant RT-chemotherapy, all with acceptable toxicity. Therefore, this treatment scheme, with short-course preoperative RT, would be the most appropriate in this group of patients.


Assuntos
Adenocarcinoma/terapia , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/epidemiologia , Radioterapia Conformacional , Neoplasias Retais/terapia , Adenocarcinoma/diagnóstico , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Comorbidade , Intervalo Livre de Doença , Idoso Fragilizado , Humanos , Estimativa de Kaplan-Meier , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Protectomia , Estudos Prospectivos , Planejamento da Radioterapia Assistida por Computador , Neoplasias Retais/diagnóstico , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Reto/diagnóstico por imagem , Reto/patologia , Reto/efeitos da radiação , Reto/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios X
6.
Int J Surg Open ; 26: 30-35, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-34568610

RESUMO

BACKGROUND: In the oncological patient, an COVID-19-Infection, whether symptomatic or asymptomatic, a surgical procedure may carry a higher postoperative morbidity and mortality. The aim of this study was to describe the impact on clinical practice of sequential preoperative screening for COVID-19-infection in deciding whether to proceed or postpone surgery. METHODS: Prospective, cohort study, based on consecutive patients' candidates for an oncological surgical intervention. Sequential preoperative screening for COVID-19-infection: two-time medical history (telematic and face-to-face), PCR and chest CT, 48 h before of surgical intervention. COVID-19-infection was considered positive if the patient had a suggestive medical history and/or PCR-positive and/or CT of pneumonia. RESULTS: Between April 15th and May 4th, 2020, 179 patients were studied, 97 were male (54%), mean (sd) age 66.7 (13,6). Sequential preoperative screening was performed within 48 h before to surgical intervention. The prevalence of preoperative COVID-19-infection was 4.5%, 95%CI:2.3-8.6% (8 patients). Of the operated patients (171), all had a negative medical history, PCR and chest CT. The complications was 14.8% (I-II) and 2.5% (III-IV). There was no mortality. The hospital stay was 3.1 (sd 2.7) days.In the 8 patients with COVID-19-infection, the medical history was suggestive in all of them, 7 presented PCR-positive and 5 had a chest CT suggestive of pneumonia. The surgical intervention was postponed between 15 and 21 days. CONCLUSION: Preoperative screening for COVID-19-infection using medical history and PCR helped the surgeon to decide whether to go ahead or postpone surgery in oncological patients. The chest CT may be useful in unclear cases.

7.
Rev. Soc. Esp. Dolor ; 25(1): 13-20, ene.-feb. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-170625

RESUMO

Introduction: Epidural analgesia is an effective technique for postoperative pain relief. Our aim in this retrospective study was to assess the postoperative pain control and complications relating to epidural technique in laparoscopic radical prostatectomy (LRP). Material and methods: A retrospective analysis of 193 patients who underwent LRP, in which epidural analgesia was the postoperative pain approach, was performed. The procedure is generally performed under combined anesthesia. Data collected was postoperative pain data; appearance of neurological disorders (Bromage scale was used for motor weakness assessment); data related to the epidural technique and possible difficulties when performing it; data on epidural infusion; catheter-related complications; hospital stay, postoperative complications, and outcome. Results: Firstly, average VAS at rest was 1.2 ± 1.6; and upon movement, average VAS was 1.9 ± 1.8 during the hospital stay. Secondly, complications related to epidural technique appeared in 37 % of patients. There were 3 cases of hematic puncture; 3 accidental catheter disconnections; 1 dural puncture, and 1 subdural block. As for neurological secondary effects of local anesthetics in the epidural technique, 56 patients (30.1 %) presented with motor block of one or both lower extremities after surgery, and 5 (2.7 %) with paresthesia. Statistical analysis showed that motor weakness was not related to age, weight, type of local anesthetic used, infusion rate, level of epidural puncture nor length of catheter within the epidural space (p > 0.05). Conclusion: Postoperative epidural analgesia offers excellent analgesic quality but it can be associated with several complications secondary to the use of local anesthetics, which could disagree with the terms of Fast-track surgery. New techniques like the TAP block could offer the same analgesic quality, without the epidural's technique potential complications (AU)


Objetivos: La analgesia epidural es una técnica eficaz para el control del dolor postoperatorio. Nuestro objetivo en este estudio retrospectivo fue evaluar el control del dolor postoperatorio mediante la escala visual analógica del dolor (EVA) y las complicaciones relacionadas con la técnica epidural, en la prostatectomía radical laparoscópica (PRL). Material y métodos: Llevamos a cabo un análisis retrospectivo de 193 pacientes sometidos a PRL, en los que se realizó la técnica epidural analgésica para el control del dolor postoperatorio. El procedimiento se hizo bajo una anestesia combinada. Registramos los datos relacionados con el dolor postoperatorio; la aparición de sintomatología neurológica (la escala de Bromage se utilizó para evaluar la debilidad motora); datos relacionados con la técnica epidural y posibles dificultades al realizarla; datos sobre la infusión epidural, como tipo de anestésico local utilizado; complicaciones relacionadas con el catéter y complicaciones postoperatorias asociadas al mismo, estancia hospitalaria y resultado. Resultados: En primer lugar, durante la estancia hospitalaria de los pacientes, el EVA promedio en reposo fue 1,2 ± 1,6; y durante el movimiento, el EVA promedio fue de 1,9 ± 1,8. En segundo lugar, las complicaciones relacionadas con la técnica epidural aparecieron en el 37 % de los pacientes. Hubo 3 casos de punción hemática; 3 desconexiones accidentales del catéter, 1 punción dural y 1 bloqueo subdural. En cuanto a las complicaciones neurológicas debidas a los efectos secundarios de los anestésicos locales en la técnica epidural, 56 (30,1 %) pacientes presentaron bloqueo motor de una o ambas extremidades inferiores después de la cirugía y 5 (2,7 %) refirieron parestesias. No hubo ninguna complicación neurológica que persistiese tras el alta hospitalaria. El análisis estadístico mostró que la debilidad motora no estaba relacionada con la edad, el peso, el tipo de anestésico local utilizado, la velocidad de infusión, el nivel de punción epidural ni la longitud del catéter en el espacio epidural (p > 0,05). Conclusión: La analgesia epidural postoperatoria ofrece una excelente calidad analgésica, pero puede estar asociada a varias complicaciones secundarias al uso de anestésicos locales, lo que podría estar en contraposición con las tendencias actuales de cirugía fastrack. Las nuevas técnicas emergentes podrían ofrecer la misma calidad analgésica evitando las potenciales complicaciones de la técnica epidural (AU)


Assuntos
Humanos , Masculino , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Analgesia Epidural/métodos , Dor Pós-Operatória/tratamento farmacológico , Laparoscopia/métodos , Estudos Retrospectivos , Resultado do Tratamento , Injeções Epidurais/efeitos adversos
9.
Arch. Soc. Esp. Oftalmol ; 89(11): 439-446, nov. 2014. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-129701

RESUMO

OBJETIVO: Evaluar a pacientes 24 meses después de ser intervenidos mediante esclerectomía profunda no perforante (EPNP) con implante supraciliar y determinar la existencia de factores predictivos de la eficacia de la técnica mediante la exploración biomicroscópica (BMU). MATERIAL Y MÉTODOS: Se incluyen 26 ojos de 23 pacientes explorados con UBM 24 meses después de ser intervenidos mediante EPNP con implante de hema supraciliar. RESULTADOS: Se ha encontrado un descenso significativo de la presión intraocular (PIO) de 25,6 ± 6,4 mmHg a 16,2 ± 3,4 mmHg y en el número de medicaciones antiglaucomatosas de 2,5 ± 0,6 por paciente a 0,5 ± 0,5 (p < 0,001). No se evidenciaron cambios significativos en la agudeza visual. Mediante BMU no se ha podido correlacionar la PIO con el diámetro horizontal (r = −0,05; p = 0,71) ni vertical (r = −0,1; p = 0,63) del lago intraescleral, su altura (r = 0,28; p = 0,25) ni volumen (r = −0,08; p = 0,79), el grosor de la MBTD (r = −0,07; p = 0,73) ni su longitud (r = 0,39; p = 0,13), la presencia de ampolla filtrante (p = 0,3) ni de un área hipogénica en el espacio supracoroideo (p = 0,2). CONCLUSIONES: La inserción del implante de hema en el espacio supraciliar durante la cirugía no perforante del glaucoma es segura y efectiva en el glaucoma de ángulo abierto (GAA) pero no hemos podido establecer factores


OBJETIVE: To evaluate patients 24 months after deep sclerectomy (DE) with supraciliary implant, and identify any predictive success factors by examination with ultrasound biomicroscopy (UBM). MATERIAL AND METHODS: This study included 26 eyes of 23 patients evaluated by UBM 24 months after a deep sclerectomy with a supraciliary hema implant. RESULTS: There was a significant reduction in intraocular pressure (IOP), changing from a preoperative mean of 25.6 ± 6.4 mmHg to a postoperative mean of 16.2 ± 3.4 mmHg (P<.001). The number of preoperative glaucoma medications also decreased from 2.5 ± 0.6 drugs per patient to 0.5 ± 0.5 (P<.001). No change was observed in the best-corrected visual acuity. The anatomical characteristics of the surgical area, and its relationship with IOP were examined using UBM. There was no correlation between the level of IOP at the time of UBM and the horizontal (r=−.05: P=.71) and vertical diameter (r=−.1; P=.63), the height (r=.28; P=.25) and the volume of intrascleral space (r=−.08; P=.79), the thickness (r=−.07;P=.73) and the length (r=.39; P=.13) of trabeculo-Descemet's membrane (TDM), the presence of filtering bleb (P=.30) and the hypoechoic area in the supraciliary space (P=.24). CONCLUSIONS: The insertion of a hema implant in the supraciliary space is an effective and safe surgery for patients with open angle glaucoma (OAG). No predictive success factors for supraciliary implant were found using the UBM study


Assuntos
Humanos , Doenças da Esclera/cirurgia , Escleroplastia/métodos , Glaucoma/cirurgia , Corpo Ciliar/cirurgia , Microscopia/métodos , Complicações Pós-Operatórias/diagnóstico , Malha Trabecular/fisiologia , Úvea/fisiologia
10.
Arch Soc Esp Oftalmol ; 89(11): 439-46, 2014 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25060783

RESUMO

OBJECTIVE: To evaluate patients 24 months after deep sclerectomy (DE) with supraciliary implant, and identify any predictive success factors by examination with ultrasound biomicroscopy (UBM) MATERIAL AND METHODS: This study included 26 eyes of 23 patients evaluated by UBM 24 months after a deep sclerectomy with a supraciliary hema implant. RESULTS: There was a significant reduction in intraocular pressure (IOP), changing from a preoperative mean of 25.6 ± 6.4 mmHg to a postoperative mean of 16.2 ± 3.4 mmHg (P<.001). The number of preoperative glaucoma medications also decreased from 2.5 ± 0.6 drugs per patient to 0.5 ± 0.5 (P<.001). No change was observed in the best-corrected visual acuity. The anatomical characteristics of the surgical area, and its relationship with IOP were examined using UBM. There was no correlation between the level of IOP at the time of UBM and the horizontal (r=-.05: P=.71) and vertical diameter (r=-.1; P=.63), the height (r=.28; P=.25) and the volume of intrascleral space (r=-.08; P=.79), the thickness (r=-.07; P=.73) and the length (r=.39; P=.13) of trabeculo-Descemet's membrane (TDM), the presence of filtering bleb (P=.30) and the hypoechoic area in the supraciliary space (P=.24). CONCLUSIONS: The insertion of a hema implant in the supraciliary space is an effective and safe surgery for patients with open angle glaucoma (OAG). No predictive success factors for supraciliary implant were found using the UBM study.


Assuntos
Implantes para Drenagem de Glaucoma , Glaucoma/diagnóstico por imagem , Microscopia Acústica , Esclera/cirurgia , Idoso , Humor Aquoso , Terapia Combinada , Feminino , Seguimentos , Glaucoma/tratamento farmacológico , Glaucoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas/uso terapêutico , Reologia
11.
Leukemia ; 28(10): 1993-2004, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24618734

RESUMO

Chronic lymphocytic leukemia (CLL) cells located in proliferation centers are constantly stimulated by accessory cells, which provide them with survival and proliferative signals and mediate chemotherapy resistance. Herein, we designed an experimental strategy with the aim of mimicking the microenvironment found in the proliferative centers to specifically target actively proliferating CLL cells. For this, we co-cultured CLL cells and bone marrow stromal cells with concomitant CD40 and Toll-like receptor 9 stimulation. This co-culture system induced proliferation, cell-cycle entry and marked resistance to treatment with fludarabine and bendamustine. Proliferating CLL cells clustered together showed a typical morphology of activated B cells and expressed survivin protein, a member of the inhibitor of apoptosis family that is mainly expressed by CLL cells in the proliferation centers. With the aim of specifically targeting actively proliferating and chemoresistant CLL cells, we investigated the effects of treatment with YM155, a small-molecule survivin inhibitor. YM155 treatment suppressed the co-culture-induced survivin expression and that was sufficient to inhibit proliferation and effectively induce apoptosis particularly in the proliferative subset of CLL cells. Interestingly, sensitivity to YM155 was independent from common prognostic markers, including 17p13.1 deletion. Altogether, these findings provide a rationale for clinical development of YM155 in CLL.


Assuntos
Antineoplásicos/química , Resistencia a Medicamentos Antineoplásicos , Proteínas Inibidoras de Apoptose/metabolismo , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Apoptose , Linfócitos B/efeitos dos fármacos , Linfócitos B/metabolismo , Cloridrato de Bendamustina , Células da Medula Óssea/citologia , Antígenos CD40/metabolismo , Ciclo Celular , Proliferação de Células , Técnicas de Cocultura , Feminino , Deleção de Genes , Humanos , Imidazóis/química , Leucócitos Mononucleares/citologia , Masculino , Pessoa de Meia-Idade , Naftoquinonas/química , Compostos de Mostarda Nitrogenada/química , Células Estromais/citologia , Survivina , Receptor Toll-Like 9/metabolismo , Vidarabina/análogos & derivados , Vidarabina/química
12.
Clin. transl. oncol. (Print) ; 14(10): 715-720, oct. 2012. ilus
Artigo em Inglês | IBECS | ID: ibc-127006

RESUMO

Endometrial cancer (EC) is the most common gynecologic malignancy of the female genital tract and the fourth most common neoplasia in women. In EC, myometrial invasion is considered one of the most important prognostic factors. For this process to occur, epithelial tumor cells need to undergo an epithelial to mesenchymal transition (EMT), either transiently or stably, and to differing degrees. This process has been extensively described in other types of cancer but has been poorly studied in EC. In this review, several features of EMT and the main molecular pathways responsible for triggering this process are investigated in relation to EC. The most common hallmarks of EMT have been found in EC, either at the level of E-cadherin loss or at the induction of its repressors, as well as other molecular alterations consistent with the mesenchymal phenotype-like L1CAM and BMI-1 up-regulation. Pathways including progesterone receptor, TGFβ, ETV5 and microRNAs are deeply related to the EMT process in EC (AU)


Assuntos
Humanos , Feminino , Neoplasias do Endométrio/metabolismo , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/diagnóstico , Neoplasias do Endométrio/genética
14.
Oncogene ; 31(45): 4778-88, 2012 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-22266854

RESUMO

Endometrial carcinoma (EC) is the most frequent among infiltrating tumors of the female genital tract, with myometrial invasion representing an increase in the rate of recurrences and a decrease in survival. We have previously described ETV5 transcription factor associated with myometrial infiltration in human ECs. In this work, we further investigated ETV5 orchestrating downstream effects to confer the tumor the invasive capabilities needed to disseminate in the early stages of EC dissemination. Molecular profiling evidenced ETV5 having a direct role on epithelial-to-mesenchymal transition (EMT). In particular, ETV5 modulated Zeb1 expression and E-Cadherin repression leading to a complete reorganization of cell-cell and cell-substrate contacts. ETV5-promoted EMT resulted in the acquisition of migratory and invasive capabilities in endometrial cell lines. Furthermore, we identified the lipoma-preferred partner protein as a regulatory partner of ETV5, acting as a sensor for extracellular signals promoting tumor invasion. All together, we propose ETV5-transcriptional regulation of the EMT process through a crosstalk with the tumor surrounding microenvironment, as a principal event initiating EC invasion.


Assuntos
Proteínas de Ligação a DNA/metabolismo , Neoplasias do Endométrio/metabolismo , Transição Epitelial-Mesenquimal , Proteínas com Domínio LIM/metabolismo , Transdução de Sinais , Fatores de Transcrição/metabolismo , Caderinas/metabolismo , Adesão Celular/genética , Linhagem Celular Tumoral , Movimento Celular/genética , Núcleo Celular/metabolismo , Proteínas de Ligação a DNA/genética , Neoplasias do Endométrio/genética , Transição Epitelial-Mesenquimal/genética , Feminino , Regulação Neoplásica da Expressão Gênica , Proteínas de Homeodomínio/genética , Humanos , Regiões Promotoras Genéticas , Transporte Proteico , Fatores de Transcrição/genética , Transcrição Gênica , Homeobox 1 de Ligação a E-box em Dedo de Zinco
16.
Oncogene ; 30(18): 2087-97, 2011 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-21297668

RESUMO

p16(Ink4a) is a protein involved in regulation of the cell cycle. Currently, p16(Ink4a) is considered a tumor suppressor protein because of its physiological role and downregulated expression in a large number of tumors. Intriguingly, overexpression of p16(Ink4a) has also been described in several tumors. This review attempts to elucidate when and why p16(Ink4a) overexpression occurs, and to suggest possible implications of p16(Ink4a) in the diagnosis, prognosis and treatment of cancer.


Assuntos
Envelhecimento/genética , Inibidor p16 de Quinase Dependente de Ciclina/genética , Genes Supressores de Tumor , Neoplasias/genética , Humanos
18.
Case Rep Med ; 2009: 340603, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19718431

RESUMO

Uterine lipomas are very uncommon with symptoms that are similar to leiomyomas. Their diagnosis is always histological although some radiological methods may suggest their existence prior to surgery. They are sometimes associated with endometrial pathology, but there are no previous reported cases related to ovarian thecoma. Their prognosis is excellent. Clinical, radiological, morphologic, and immunohistochemical findings are shown which correspond to uterine lipoma associated with endometrial polyps and ovarian thecoma.

19.
Int J Colorectal Dis ; 24(9): 1011-8, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19396451

RESUMO

PURPOSE: We evaluate the safety and efficacy of a spinal anesthesia with lidocaine versus a local anesthesia of pudendal block with ropivacaine combined with intravenous sedation in the hemorrhoidectomy procedure and also we compared the short- and long-term efficacy of conventional diathermy versus Ligasure diathermy hemorrhoidectomy. METHODS: Seventy-four patients of grade III or IV hemorrhoids were randomized to conventional diathermy hemorrhoidectomy under spinal (n = 19) or local anesthesia (n = 18) and Ligasure diathermy hemorrhoidectomy under spinal (n = 17) or local anesthesia (n = 20). Time of follow-up was 12 months. RESULTS: Patients operated under local anesthesia had less pain (p < 0.01), less analgesic requirements (p < 0.001), shorter hospital stay (p < 0.01), and less postoperative complications (p < 0.05). A shorter operating time (p < 0.001) and less complications at 4 months postoperatively (p < 0.05) was observed in the Ligasure group, but differences at 12 months were not found. CONCLUSIONS: Hemorrhoidectomy under local anesthesia with pudendal block with ropivacaine and sedation reduced postoperative pain, analgesic requirements, and postoperative complications, and can be performed as day-case procedure. Ligasure diathermy hemorrhoidectomy reduced operating time and was equally effective than conventional diathermy in long-term symptom control.


Assuntos
Diatermia/métodos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Hemorroidas/cirurgia , Adulto , Idoso , Amidas/administração & dosagem , Analgésicos , Raquianestesia/métodos , Anestésicos Locais/administração & dosagem , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Seguimentos , Hemorroidas/complicações , Humanos , Tempo de Internação , Lidocaína/administração & dosagem , Ligadura/efeitos adversos , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Dor Pós-Operatória , Complicações Pós-Operatórias , Ropivacaina , Resultado do Tratamento , Adulto Jovem
20.
Clin Transl Oncol ; 9(5): 272-7, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17525037

RESUMO

Endometrial carcinoma is the most common gynaecological malignancy in the western world and the most frequent among infiltrating tumours of the female genital tract. Despite the characterisation of molecular events associated with the development of endometrial carcinoma, those associated with the early steps of infiltration and invasion in endometrial cancer are less known. Deep myometrial invasion correlates with more undifferentiated tumours, lymph-vascular invasion, node affectation and decreased global survival. In this review we present an overview of the molecular pathology of myometrial infiltration that defines the initial steps of invasion in endometrial cancer. Down-regulation of E-cadherin as a main player of epithelial to mesenchymal transition, as well as modifications on other molecules involved in cell-cell contacts, render cells with a migratory phenotype. In addition, altered signalling pathways and transcription factors associate with myometrial invasion, histologic grade and metastasis.


Assuntos
Neoplasias do Endométrio/etiologia , Neoplasias do Endométrio/patologia , Moléculas de Adesão Celular/fisiologia , Neoplasias do Endométrio/genética , Feminino , Expressão Gênica , Humanos , Invasividade Neoplásica
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