RESUMO
Afferent loop syndrome (ALS) is a debilitating complication of recurrent gastric cancer. Surgical intervention is usually not feasible in the face of poor general performance, presence of advanced peritoneal carcinomatosis and limited survival of the patients. Non-surgical approaches include internal drainage by stenting at the stenotic or anastomotic site and external drainage via the percutaneous routes. Percutaneous transhepatic duodenal drainage (PTDD) has been shown to provide effective palliation for ALS, but long-term catheterization is usually inevitable. We hereby present two cases of recurrent gastric cancer whose ALS was successfully treated with PTDD followed by weekly 24-h infusion of high-dose 5-fluorouracil and leucovorin (HDFL). PTDD rapidly ameliorated the incapacitating symptoms of ALS, and the effective, low-toxicity chemotherapy subsequently led to tumor regression, restoration of bowel patency and removal of the drainage tube. At present, both patients have remained ALS-free and drainage-free for 16 and 17 months, respectively. Our results indicate that this non-surgical approach with PTDD followed by weekly HDFL could serve as a safe and effective treatment for ALS in recurrent gastric cancer complicated by peritoneal carcinomatosis.
Assuntos
Síndrome da Alça Aferente/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carcinoma/terapia , Recidiva Local de Neoplasia/terapia , Cuidados Paliativos , Doenças Peritoneais/terapia , Neoplasias Peritoneais/terapia , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirurgia , Síndrome da Alça Aferente/diagnóstico , Síndrome da Alça Aferente/etiologia , Idoso , Carcinoma/diagnóstico , Carcinoma/etiologia , Terapia Combinada , Relação Dose-Resposta a Droga , Drenagem/métodos , Fluoruracila/administração & dosagem , Seguimentos , Gastrectomia/métodos , Humanos , Infusões Intravenosas , Leucovorina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/complicações , Recidiva Local de Neoplasia/patologia , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/etiologia , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/etiologia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia , Resultado do TratamentoRESUMO
We have constructed a physical map of the human genome by using a panel of 90 whole-genome radiation hybrids (the TNG panel) in conjunction with 40,322 sequence-tagged sites (STSs) derived from random genomic sequences as well as expressed sequences. Of 36,678 STSs on the TNG radiation hybrid map, only 3604 (9.8%) were absent from the unassembled draft sequence of the human genome. Of 20,030 STSs ordered on the TNG map as well as the assembled human genome draft sequence and the Celera assembled human genome sequence, 36% of the STSs had a discrepant order between the working draft sequence and the Celera sequence. The TNG map order was identical to one of the two sequence orders in 60% of these discrepant cases.
