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1.
Dig Dis Sci ; 49(6): 914-9, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15309877

RESUMO

Antioxidants may protect against the development of esophageal adenocarcinoma. Blood samples and endoscopic biopsies (squamous, Barrett's, and gastric mucosa) were obtained from 48 Barrett's esophagus (BE) patients, while 48 age- and sex-matched controls provided blood samples only. Plasma concentrations of vitamins A, C, and E were measured in all subjects, while vitamin C was measured in relation to the type of mucosa. Plasma total vitamin C level, but not vitamin A or E, was lower in BE patients compared to controls (P = 0.014). Tissue levels of total vitamin C were significantly lower in Barrett's compared with squamous mucosa (P = 0.047). A positive association was observed between plasma vitamin C and dietary intake of vitamin C, while there was an inverse association with alcohol consumption. The lower levels of vitamin C in plasma of BE patients and in Barrett's mucosa compared with squamous mucosa are consistent with oxidative stress being of importance in the pathogenesis and neoplastic progression of BE.


Assuntos
Antioxidantes/metabolismo , Ácido Ascórbico/metabolismo , Esôfago de Barrett/metabolismo , Dieta , Esôfago/metabolismo , Mucosa Gástrica/metabolismo , Adulto , Idoso , Antioxidantes/administração & dosagem , Ácido Ascórbico/administração & dosagem , Estudos de Casos e Controles , Esôfago/patologia , Feminino , Humanos , Masculino , Metaplasia/metabolismo , Pessoa de Meia-Idade , Vitamina A/sangue , Vitamina E/sangue
2.
Br J Surg ; 91(8): 997-1003, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15286961

RESUMO

BACKGROUND: Surveillance programmes for Barrett's oesophagus have been implemented in an effort to detect oesophageal adenocarcinoma at an earlier and potentially curable stage. The aim of this study was to examine the impact of endoscopic surveillance on the clinical outcome of patients with adenocarcinoma complicating Barrett's oesophagus. METHOD: Consecutive patients who underwent oesophageal resection for high-grade dysplasia or adenocarcinoma arising from Barrett's oesophagus were studied retrospectively. The pathological stage and survival of patients identified as part of a surveillance programme were compared with those of patients presenting with symptomatic adenocarcinoma. RESULTS: Seventeen patients in the surveillance group and 74 in the non-surveillance group underwent oesophagectomy. Disease detected in the surveillance programme was at a significantly earlier stage: 13 of 17 versus 11 of 74 stage 0 or I, three versus 26 stage II, and one versus 37 stage III or IV (P < 0.001). Lymphatic metastases were seen in three of 17 patients in the surveillance group and 42 of 74 who were not under surveillance (P = 0.004). Three-year survival was 80 and 31 per cent respectively (P = 0.008). CONCLUSION: Patients with surveillance-detected adenocarcinoma of the oesophagus are diagnosed at an earlier stage and have a better prognosis than those who present with symptomatic tumours.


Assuntos
Adenocarcinoma/cirurgia , Esôfago de Barrett/patologia , Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/cirurgia , Adenocarcinoma/patologia , Idoso , Diagnóstico Precoce , Neoplasias Esofágicas/patologia , Esofagectomia/métodos , Esofagoscopia/métodos , Feminino , Gastrectomia/métodos , Humanos , Metástase Linfática , Masculino , Estadiamento de Neoplasias , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
3.
Dis Esophagus ; 15(2): 155-9, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12220424

RESUMO

The failure of adjuvant therapy to significantly improve the prognosis of patients undergoing esophago-gastrectomy for cancer may be because of poor patient selection. We sought prognostic factors that would identify those patients who could benefit from adjuvant therapy. Data on 15 possible prognostic factors were prospectively collected on 225 patients undergoing esophago-gastrectomy at a single institution, and univariate and multivariate analyzes performed. T, N, M and overall UICC stage, differentiation, involvement of the circumferential resection margin and number of metastatic of lymph nodes were identified as significant prognostic factors by univariate analysis. Multivariate analysis revealed that the completeness of resection (R-category), ratio of metastatic to total nodes resected and the presence of vascular invasion were independently significant prognostic factors. Following R0 or R1 resection, patients with a metastatic to total lymph node ratio > 0.2 and /or the presence of vascular invasion have a poor prognosis, and the effects of adjuvant therapy in these patients should be studied.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia , Seleção de Pacientes , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , Feminino , Gastrectomia , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Invasividade Neoplásica , Prognóstico , Radioterapia Adjuvante
4.
Br J Surg ; 89(9): 1150-5, 2002 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12190681

RESUMO

BACKGROUND: The Physiogical and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) has been used to produce a numerical estimate of expected mortality and morbidity after a variety of general surgical procedures. The aim of this study was to evaluate the ability of POSSUM to predict mortality and morbidity in patients undergoing oesophagectomy. METHODS: POSSUM predictor equations for morbidity and mortality were applied retrospectively to 204 patients who had undergone oesophagectomy for cancer. Observed morbidity and mortality rates were compared with rates predicted by POSSUM using the Hosmer-Lemeshow goodness-of-fit test. Evaluation of the discriminative capability of POSSUM predictor equations was performed using receiver-operator characteristic (ROC) curve analysis. RESULTS: The observed and predicted mortality rates were 12.7 and 19.1 per cent respectively, and the respective morbidity rates were 53.4 and 62.3 per cent. However, the POSSUM model showed a poor fit with the data both for the observed 30-day mortality (chi2 = 16.26, P = 0.002) and morbidity (chi2 = 63.14, P < 0.001) using the Hosmer-Lemeshow test. ROC curve analysis revealed that POSSUM had poor predictive accuracy both for mortality (area under curve 0.62) and morbidity (area under curve 0.55). CONCLUSION: These data suggest that POSSUM does not accurately predict mortality and morbidity in patients undergoing oesophagectomy and must be modified.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Esofágicas/mortalidade , Esofagectomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Análise de Sobrevida
5.
Surg Endosc ; 16(1): 84-7, 2002 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11961611

RESUMO

BACKGROUND: Controversy surrounds the choice of laparoscopic cardiomyotomy as the primary treatment for achalasia or a second-line treatment following the failure of nonsurgical treatment. Laparoscopic cardiomyotomy can be more difficult technically following pneumatic dilatations. The aim of this study was to compare the outcome obtained with primary laparoscopic cardiomyotomy to that achieved when the procedure is performed following failed pneumatic dilatation. METHODS: Laparoscopic cardiomyotomy was performed in seven patients following a median of four pneumatic dilatations (group A) and in five patients as their primary treatment (group B). Outcome was measured using manometry, a modified DeMeester symptom scoring system, and a quality-of-life questionnaire. RESULTS: There were no significant differences between groups A and B in sex, age, preoperative modified DeMeester score, or mean barrier pressure. Six of seven group A patients had evidence of periesophageal and submucosal fibrosis at surgery, but this condition was not seen in group B patients. The operative time was slightly longer in group A patients. There was no difference in complication rates (one primary hemorrhage in group A and one esophageal perforation in group B), and both groups had a significantly improved modified DeMeester score at 6 weeks and at long-term follow-up (median, 26 months). Eleven of 12 patients said that they would choose laparoscopic cardiomyotomy as their primary treatment if newly diagnosed with achalasia. CONCLUSIONS: Laparoscopic cardiomyotomy is safe and effective as a primary or second-line treatment following pneumatic dilatations in patients with achalasia.


Assuntos
Cárdia/cirurgia , Cateterismo/efeitos adversos , Fundoplicatura/métodos , Laparoscopia/métodos , Adulto , Idoso , Cateterismo/métodos , Acalasia Esofágica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
6.
Surg Technol Int ; 5: 115-9, 1996.
Artigo em Inglês | MEDLINE | ID: mdl-15858726

RESUMO

The worldwide explosion of Iaparoscopic surgery within general surgery began in the late 1980sand early 1990s.From its inception, surgeons have expected the image on the video monitor to resemble closely the . image obtained in similar open surgery.The monitor image, however, is presented in two dimensions- height and width. Orientation of the surgeon to the anatomy is more difficult and requires a sound knowl- edge of anatomy, the relationships of organs to each other, and an understanding of the individual patient's unique structures. Adding a third dimension, depth, to imitate natural vision in open surgery may provide surgeons with the confidence to perform more advanced procedures. In addition, trainee surgeons, without the experience of open surgery which their senior colleagues have gained, may more rapidly appreciate orientation of the anatomy and learn the surgical task more quickly.

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