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1.
Surg Today ; 38(4): 366-70, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18368331

RESUMO

Postoperative enteroenteric intussusception is a rare complication in adult patients with Crohn's disease. We treated two patients with Crohn's disease accompanied by an ileal obstruction, each of whom underwent an elective resection. In both, the upper left quadrant of the abdoment became progressively distended following ileocecal resection and each required surgical treatment after diagnosis of postoperative enteroenteric intussusception by abdominal computed tomography scanning, as the intussusception could not be reduced by conservative treatment. There were no Crohn's lesions found in the intussuscepted specimens, and the condition was thought to have been caused by a segment of thickened and fibrotic intestine that had developed because of long-standing bowel dilatation from obstructive Crohn's lesions. In one of the patients, the intussusceptum was irreducibly incarcerated and required a resection, whereas it was able to be manually reduced in the other.


Assuntos
Colectomia/efeitos adversos , Doença de Crohn/cirurgia , Intussuscepção/etiologia , Doenças do Jejuno/etiologia , Adulto , Doença de Crohn/complicações , Diagnóstico Diferencial , Seguimentos , Humanos , Intussuscepção/diagnóstico , Intussuscepção/cirurgia , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/cirurgia , Laparotomia/métodos , Masculino , Complicações Pós-Operatórias , Radiografia Abdominal , Tomografia Computadorizada por Raios X
2.
World J Surg Oncol ; 6: 17, 2008 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-18257933

RESUMO

BACKGROUND: Desmoid tumours or fibromatoses are rare entities characterized by the benign proliferation of fibroblasts, which can be life-threatening due to their locally aggressive properties. Surgery is widely accepted as the first line of treatment for extra-abdominal desmoids; however, it is not recommended for intra-abdominal desmoids because of the high-risk of recurrence and difficulties with the operation. Here, we report on a patient with sporadic intra-abdominal desmoid tumours, who showed partial response following the intake of non-steroidal anti-inflammatory drugs. CASE PRESENTATION: A 73-year-old man presented with swelling and pain of the right leg. Computed tomography showed an abnormal multilocular soft-tissue mass (95 x 70 mm) in the right pelvis, which was revealed by biopsy to be a desmoid tumour. Immunohistochemical analysis showed that the tumour cells expressed vimentin, but not smooth-muscle actin, CD34, or desmin. Very few Ki-67-positive cells were found. Non-cytotoxic treatment with etodolac (200 mg/day) was chosen because of the patient's age, lack of bowel obstruction, and the likelihood of prostate cancer. Two years after the commencement of non-steroidal anti-inflammatory drug administration, computed tomography showed a decrease in tumour size (63 x 49 mm), and the disappearance of intratumoural septa. CONCLUSION: Our case report suggests that non-steroidal anti-inflammatory drug treatment should be taken into consideration for use as first-line treatment in patients with sporadic intra-abdominal desmoid tumours.


Assuntos
Neoplasias Abdominais/tratamento farmacológico , Anti-Inflamatórios não Esteroides/uso terapêutico , Fibromatose Abdominal/tratamento farmacológico , Fibromatose Agressiva/tratamento farmacológico , Idoso , Humanos , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
Gan To Kagaku Ryoho ; 34(4): 631-4, 2007 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-17431355

RESUMO

The prognosis of a colorectal cancer patient with unresectable hepatic metastases is extremely poor. To improve the prognosis, when the hepatic metastases were initially unresectable, we performed second-look hepatectomy (s-l hepatectomy) after neoadjuvant hepatic arterial 5-FU infusion plus UFT (HAI-PMC). Here, we report the case of a sigmoid colon cancer patient with initially unresectable hepatic metastases showing a prolonged survival (6.5 years) by second-look operation after HAI-PMC. A 57-year-old woman was diagnosed with sigmoid colon cancer with unresectable liver metastases. Sigmoidectomy and hepatic arterial catheterization were performed in the initial operation, and HAI-PMC was performed 6 months after. Metastatic foci of the liver had shrunk (90.9%), but solitary metastatic lung cancer was detected during HAI. As no other metastatic lesion was observed, partial resection of the liver and lung was performed as a second-look operation, 6 months after the initial operation. The woman continued venous infusion chemotherapy as an outpatient, and she survived for 6.5 years after the initial operation. This result suggests that strategic multidisciplinary treatment utilizing s-l hepatectomy after neoadjuvant chemotherapy can lead to better prognosis for colorectal cancer patients with hepatic metastases.


Assuntos
Adenocarcinoma/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Hepatectomia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasias do Colo Sigmoide/tratamento farmacológico , Adenocarcinoma/secundário , Combinação de Medicamentos , Feminino , Fluoruracila/administração & dosagem , Artéria Hepática , Humanos , Infusões Intra-Arteriais , Neoplasias Hepáticas/cirurgia , Pessoa de Meia-Idade , Terapia Neoadjuvante , Cirurgia de Second-Look , Neoplasias do Colo Sigmoide/patologia , Neoplasias do Colo Sigmoide/cirurgia , Sobreviventes , Tegafur/administração & dosagem , Uracila/administração & dosagem
4.
World J Gastroenterol ; 12(36): 5884-9, 2006 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-17007058

RESUMO

AIM: To investigate the possible role of polysaccharide-K (PSK) -related markers in predicting distant metastasis and in the clinical outcome of colorectal cancer (CRC). METHODS: Firstly, we used protein microarrays to analyze the in vitro expression profiles of potential PSK-related markers in the human colorectal adenocarcinoma cell line SW480, which carries a mutant p53 gene. Then, we investigated the clinical implications of these markers in the prognosis of CRC patients. RESULTS: ECA39, a direct target of c-Myc, was identified as a candidate protein affected by the anti-metastatic effects of PSK. Immunohistochemistry revealed that ECA39 was expressed at significantly higher levels in tumor tissues with distant metastases compared to those without (P<0.00001). Positive ECA39 expression was shown to be highly reliable for the prediction of distant metastases (sensitivity: 86.7%, specificity: 90%, positive predictive value: 86.7%, negative predictive value: 90%). A significantly higher cumulative 5-yr disease free survival rate was observed in the ECA39-negative patient group (77.3%) compared with the ECA39-positive patient group (25.8%) (P<0.05). CONCLUSION: Our results suggest that ECA39 is a dominant predictive factor for distant metastasis in patients with advanced CRC and that its suppression by PSK might represent a useful application of immunotherapy as part of a program of integrated medicine.


Assuntos
Adenocarcinoma/metabolismo , Biomarcadores Tumorais/metabolismo , Neoplasias Colorretais/metabolismo , Metástase Neoplásica/genética , Transaminases/metabolismo , Adenocarcinoma/genética , Adenocarcinoma/patologia , Antibióticos Antineoplásicos/farmacologia , Biomarcadores Tumorais/genética , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Regulação Neoplásica da Expressão Gênica/genética , Humanos , Mutação/genética , Valor Preditivo dos Testes , Prognóstico , Proteoglicanas/farmacologia , Sensibilidade e Especificidade , Transaminases/genética , Proteína Supressora de Tumor p53/genética , Proteína Supressora de Tumor p53/metabolismo
5.
J Clin Oncol ; 24(1): 102-5, 2006 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-16382119

RESUMO

PURPOSE: Desmoid tumors are locally aggressive and can be fatal in familial adenomatous polyposis (FAP) patients if they are not suitable for surgery or radiation therapy. Here, we prospectively investigated the efficacy of a chemotherapeutic regimen involving doxorubicin (DOX) and dacarbazine (DTIC) for inoperable FAP-associated desmoid tumors. PATIENTS AND METHODS: From an initial group of 120 FAP patients, seven of the 11 individuals with symptomatic unresectable desmoid tumors that were unresponsive to conventional hormone therapy were enrolled onto this study. The general chemotherapy regimen comprised four or five cycles of DOX (20 mg/m2 daily) plus DTIC (150 mg/m2 daily) throughout 4 days of drip intravenous infusion (day 1 through 4) every 28 days, followed by the cyclooxygenase-2 inhibitor meloxicam (10 mg/m2). The primary end point was relapse-free survival. The secondary end points included toxicity, clinical improvement, and tumor regression according to computed tomography. RESULTS: Significant tumor regression was observed clinically and radiologically in all seven patients. Three patients showed a complete response. The average progression-free survival period was 74.0 months (range, 32.5 to 107.5 months). Three patients showed grade 3 adverse events with no treatment-related mortality. All seven patients survived and remained without tumor progression. An adenomatous polyposis coli germline-mutation analysis revealed no mutations in the specified regions. CONCLUSION: A chemotherapeutic regimen of DOX plus DTIC followed by meloxicam is an effective and safe treatment for FAP-associated desmoid tumors. This modality should be considered for use as first-line chemotherapy in symptomatic desmoid tumors that are unresponsive to conventional medical therapy, due to the absence of useful presymptomatic markers.


Assuntos
Polipose Adenomatosa do Colo/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Fibromatose Agressiva/tratamento farmacológico , Polipose Adenomatosa do Colo/mortalidade , Adulto , Dacarbazina/administração & dosagem , Doxorrubicina/administração & dosagem , Feminino , Fibromatose Agressiva/diagnóstico por imagem , Fibromatose Agressiva/mortalidade , Genes APC , Mutação em Linhagem Germinativa , Humanos , Masculino , Meloxicam , Estudos Retrospectivos , Tiazinas/administração & dosagem , Tiazóis/administração & dosagem , Tomografia Computadorizada por Raios X
6.
Oncol Rep ; 13(4): 627-32, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15756434

RESUMO

Colorectal cancer patients with central venous catheters (CVC) for pharmacokinetic modulating chemotherapy (PMC) have a substantial risk of venous thromboembolism (VTE). PMC, designed as a hybrid of lower metronomic and higher shorter plasma 5-FU concentrations, has been clinically successful. To determine the effectiveness and safety of D-dimer tests and multidetector-row CT (MDCT) for diagnosis in cancer patients with suspected VTE, we carried out a clinical outcome study on PMC outpatients. Patients received a D-dimer test before and after commencing the PMC regimen. MDCT was performed additionally if the D-dimer test appeared positive or showed signs of VTE. When CT results were positive for thromboembolism, anticoagulation was started. The overall prevalence of VTE in PMC patients was 2.0% (7 of 350 patients). In this study, 34 out of 102 colorectal cancer patients gave a positive D-dimer test (33.3%). CT identified venous thrombi in 2 of the 102 patients (2.0%), mural thrombosis on catheterized veins in another 3 patients (2.9%), and endothelial hyperplasia on catheterized veins in 8 patients (7.8%). The catheters of these patients did not show any significant abnormalities. Patients with negative D-dimer tests showed no signs or symptoms of VTE. In colorectal cancer patients receiving continuous 5-FU infusion via CVC, a D-dimer test can be safely used as the primary diagnostic test for ruling out VTE. We suggest 7.0 microg/ml as the D-dimer cut-off value. Thromboprophylaxis should be considered in the patients showing values >7.0 microg/ml.


Assuntos
Neoplasias Colorretais/complicações , Fluoruracila/farmacocinética , Trombose Venosa/complicações , Adulto , Idoso , Anticoagulantes/farmacologia , Antimetabólitos Antineoplásicos/efeitos adversos , Antimetabólitos Antineoplásicos/farmacocinética , Antineoplásicos/efeitos adversos , Antineoplásicos/farmacocinética , Cateterismo Venoso Central , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/biossíntese , Fluoruracila/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Tromboembolia/complicações , Tromboembolia/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Trombose Venosa/diagnóstico
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