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1.
J BUON ; 19(3): 633-42, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25261645

RESUMO

PURPOSE: Both vitamin D and estrogens play an important role in breast cell growth and differentiation. Therefore, we hypothesized that FokI polymorphism in the Vitamin D Receptor (VDR) gene, as well as PvuII polymorphism in the Estrogen Receptor (ESR) gene might be associated with progression of breast cancer. The aim of this study was to prospectively examine the association of these polymorphisms with histopathological features and prognosis among women with histologically proven breast cancer. METHODS: Patient characteristics, tumor histopathology, and genotyping of one VDR polymorphism variant (FokI) and one ER polymorphism variant (PvuII) were recorded. Patients were also routinely followed up. RESULTS: There was a significant difference regarding nodal stage (p<0.001) between the different genotypes of FokI polymorphisms (FF, Ff, ff), even though a trend was also detected in the frequency between ductal and lobular type, as well as tumor size (p=0.077). When further analysis was performed regarding patients whose polymorphism included the f allele, we found statistically significant differences in tumor size (p<0.001), nodal stage (p=0.03), tumor grade (p=0.04) and lymphovascular invasion (p<0.001), while no differences in nodal status, distant metastases and tumor stage were noticed. No significant associations were found between any of the PvuII polymorphism variants and tumor histopathology and stage. No statistical significance was proven between FokI polymorphism's variants or f allele and overall or progression-free survival. Statistically significant associations between overall and progression- free survival and PvuII polymorphism's variants was demonstrated (p<0.001). CONCLUSION: The f allele was associated with the presence of lymphovascular invasion and poorly differentiated tumors, whereas the PP genotype was associated with increased overall and progression-free survival, suggesting that this variant is related to a more favorable prognosis.


Assuntos
Neoplasias da Mama/genética , Polimorfismo Genético , Receptores de Calcitriol/genética , População Branca/genética , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , DNA-Citosina Metilases , Desoxirribonucleases de Sítio Específico do Tipo II , Feminino , Humanos , Estadiamento de Neoplasias , Estudos Prospectivos
2.
Surg Laparosc Endosc Percutan Tech ; 22(5): 429-32, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23047387

RESUMO

The treatment of acute biliary pancreatitis during pregnancy remains controversial. We present our experience of treating 7 pregnant women with acute biliary pancreatitis and verified or suspected choledocholithiasis, by using magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and sphincterotomy followed by laparoscopic cholecystectomy. MRCP was performed in all patients to confirm the presence of common bile duct stones, their size and number. ERCP and sphincterotomy were performed without the use of radiation. The procedure was terminated only when all stones (the number clarified at MRCP), were retrieved into the duodenum. All patients underwent laparoscopic cholecystectomy the following day. Neither post-ERCP nor postoperative major complications were noted. All but one patient reached a healthy natural-term labor. One patient had a planned cesarean section on 35th week. The combination of MRCP, nonradiation ERCP, and immediate laparoscopic cholecystectomy provides definite treatment and seems to put both mother and fetus at lower risk than presumed.


Assuntos
Colecistectomia Laparoscópica/métodos , Colelitíase/complicações , Pancreatite/etiologia , Complicações na Gravidez , Esfinterotomia Endoscópica/métodos , Doença Aguda , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Colangiopancreatografia por Ressonância Magnética , Colelitíase/diagnóstico , Colelitíase/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Pancreatite/diagnóstico , Pancreatite/cirurgia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
3.
Cancers (Basel) ; 3(1): 636-51, 2011 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-24212633

RESUMO

Despite all improvements in both surgical and other conservative therapies, pancreatic cancer is steadily associated with a poor overall prognosis and remains a major cause of cancer mortality. Radical surgical resection has been established as the best chance these patients have for long-term survival. However, in most cases the disease has reached an incurable state at the time of diagnosis, mainly due to the silent clinical course at its early stages. The role of palliative surgery in locally advanced pancreatic cancer mainly involves patients who are found unresectable during open surgical exploration and consists of combined biliary and duodenal bypass procedures. Chemical splanchnicectomy is another modality that should also be applied intraoperatively with good results. There are no randomized controlled trials evaluating the outcomes of palliative pancreatic resection. Nevertheless, data from retrospective reports suggest that this practice, compared with bypass procedures, may lead to improved survival without increasing perioperative morbidity and mortality. All efforts at developing a more effective treatment for unresectable pancreatic cancer have been directed towards neoadjuvant and targeted therapies. The scenario of downstaging tumors in anticipation of a future oncological surgical resection has been advocated by trials combining gemcitabine with radiation therapy or with the tyrosine kinase inhibitor erlotinib, with promising early results.

4.
Ann Vasc Surg ; 24(6): 827.e1-3, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20471202

RESUMO

Giant hepatic hemangiomas are benign tumors that measure more than 4 cm and are usually asymptomatic. Pulmonary embolism (PE) is an extremely rare manifestation of giant hepatic hemangiomas. We report a case of a 44-year-old woman who suffered of recurrent pulmonary emboli that, after thorough work up, were attributed to thrombi formation inside a giant hepatic hemangioma. A right hepatectomy under vascular exclusion was performed and the hemangioma, measuring 17 cm, was resected. Two years later the patient remains asymptomatic. The report highlights the value of investigating giant liver hemangiomas in case of PE. In such cases, the hemangioma should be resected preferably under occlusion of the venous outflow of the liver to avoid PE intraoperatively.


Assuntos
Hemangioma/cirurgia , Hepatectomia , Veias Hepáticas/cirurgia , Neoplasias Hepáticas/cirurgia , Sistema Porta/cirurgia , Embolia Pulmonar/prevenção & controle , Adulto , Biópsia , Feminino , Hemangioma/irrigação sanguínea , Hemangioma/complicações , Hemangioma/diagnóstico , Humanos , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico , Angiografia por Ressonância Magnética , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Recidiva , Resultado do Tratamento
5.
JOP ; 11(3): 270-2, 2010 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-20442526

RESUMO

CONTEXT: Von Hippel-Lindau disease is an inherited syndrome of multiorgan neoplasia caused by a germline mutation in the von Hippel-Lindau gene and can include central nervous system tumors, renal cell carcinomas and benign pancreatic cystic tumors. CASE REPORT: We report the case of a 56-year-old patient who had a past history of cerebellar hemangioblastoma and presented with abdominal pain. Imaging revealed renal tumors and multiple pancreatic tumors which caused duodenal and pancreatic duct compression. The patient was treated with a combination of radical right nephrectomy, total pancreaticoduodenectomy and splenectomy. Pathology identified a multifocal unilateral clear cell renal carcinoma which interestingly coexisted with multiple large pancreatic serous microcystic adenomas with infiltration of the fibrous capsule. CONCLUSION: In past cases of von Hippel-Lindau disease, pancreatic adenomas with malignant transformation have not been reported. In our case, the infiltration of the fibrous capsule by parenchymal cells may indicate malignant transformation.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Nefrectomia/métodos , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Doença de von Hippel-Lindau/cirurgia , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adenoma/cirurgia , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Esplenectomia , Tomografia Computadorizada por Raios X , Doença de von Hippel-Lindau/diagnóstico por imagem , Doença de von Hippel-Lindau/patologia
6.
Pancreas ; 38(7): e177-82, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19730152

RESUMO

OBJECTIVES: To evaluate the impact of the length of the isolated jejunal loop and the type of pancreaticojejunostomy on pancreatic leakage after pancreaticoduodenectomy. METHODS: One hundred thirty-two consecutive patients who underwent a pancreaticoduodenectomy were studied according to the length of the isolated jejunal loop (short loop, 20-25 cm vs long loop, 40-50 cm) and the type of pancreaticojejunostomy (invagination vs duct to mucosa). RESULTS: The use of the long isolated jejunal loop was associated with a significantly lower pancreatic leakage rate compared with the use of a short isolated jejunal loop (4.34% vs 14.2%, P < 0.05). In addition, the use of duct-to-mucosa technique was associated with significantly lower incidence of postoperative pancreatic fistula compared with the invagination technique (4.2% vs 14.5%, P < 0.05). Finally, patients with a short isolated jejunal loop compared with patients with a long loop had increased morbidity (50.7% vs 27.5%, P < 0.05) and prolonged hospital stay (16.3 +/- 1.9 days vs 10.2 +/- 2.3 days, P < 0.05). Overall mortality rate was 1.5%. CONCLUSIONS: The use of a long isolated jejunal loop and a duct-to-mucosa pancreaticojejunostomy is associated with decreased pancreatic leakage rate after pancreaticoduodenectomy.


Assuntos
Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Idoso , Anastomose Cirúrgica/métodos , Feminino , Humanos , Mucosa Intestinal/cirurgia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Ductos Pancreáticos/cirurgia , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia/métodos , Pancreaticojejunostomia/métodos , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/cirurgia , Taxa de Sobrevida , Resultado do Tratamento
7.
World J Gastroenterol ; 13(8): 1279-81, 2007 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-17451215

RESUMO

Gastrointestinal duplication is a congenital rare disease entity. Gastric duplication cysts seem to appear even more rarely. Herein, two duplications cysts of the stomach in a 46 year-old female patient are presented. Abdominal computed tomography demonstrated a cystic lesion attached to the posterior aspect of the gastric fundus, while upper gastrointestinal endoscopy was negative. An exploratory laparotomy revealed a non-communicating cyst and a smaller similar cyst embedded in the gastrosplenic ligament. Excision of both cysts along with the spleen was performed and pathology reported two smooth muscle coated cysts with a pseudostratified ciliated epithelial lining (respiratory type).


Assuntos
Cistos/patologia , Mucosa Respiratória/patologia , Estômago/anormalidades , Feminino , Humanos , Pessoa de Meia-Idade , Estômago/patologia
8.
World J Gastroenterol ; 12(44): 7210-2, 2006 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-17131490

RESUMO

A 53-year-old male patient with a large hydatid cyst of the left hemidiaphragm and smaller secondary cysts located in the left thoracic cavity and upper left abdominal quadrant presented with two progressively enlarging lipoma-like masses in the left hypochondrium and under the left scapulae respectively. Total excision of all the cysts was performed through a bilateral subcostal incision, with the left hemidiaphragm near totally excised and replaced by a synthetic bilayer mesh.


Assuntos
Diafragma/patologia , Equinococose/patologia , Tela Subcutânea/patologia , Abdome/patologia , Abdome/cirurgia , Diafragma/cirurgia , Equinococose/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tela Subcutânea/cirurgia , Toracotomia , Tórax/patologia
9.
Liver Transpl ; 12(12): 1825-31, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17031827

RESUMO

Hepatectomies performed under selective hepatic vascular exclusion are associated with a series of events culminating in ischemia/reperfusion injury, a state that shares common characteristics with situations known to result in global or regional hyperlactatemia. Accordingly, we sought to determine whether lactate is released by the liver during hepatic resections performed under blood flow deprivation and what relation this has to a possible systemic hyperlactatemic state. After ethical approval, 14 consecutive patients with resectable liver tumors subjected to hepatectomy under inflow and outflow occlusion of the liver were studied. Lactate concentrations were assessed in simultaneously drawn arterial, portal venous, and hepatic venous blood before liver dissection and 50 minutes postreperfusion. Moreover, the transhepatic lactate gradient (hepatic vein - portal vein) was calculated to see if there was net production or consumption of lactate. Before hepatic dissection, the transhepatic lactate gradient was negative, suggesting consumption by the liver. Fifty minutes after reperfusion, this gradient became significantly positive, demonstrating release of lactate by the liver (0.12 +/- 0.31 vs. -0.38 +/- 0.30 mmol/L, P < 0.05). The magnitude of lactate release correlated with systemic arterial lactate levels at the same time point (r(2) = 0.63, P < 0.001). A weaker but significant correlation was demonstrated between the transhepatic lactate gradient postreperfusion and systemic arterial lactate levels 24 hours postoperatively (r(2) = 0.41, P = 0.013). A strong correlation between the transhepatic lactate gradient postreperfusion and peak postoperative aspartate aminotransferase values was also demonstrated (r(2) = 0.73, P < 0.001). The liver becomes a net producer of lactate in hepatectomies performed under blood flow deprivation. This lactate release can explain some of the systemic hyperlactatemia seen in this context and relates to the extent of ischemia/reperfusion injury.


Assuntos
Hepatectomia , Ácido Láctico/sangue , Fígado/irrigação sanguínea , Traumatismo por Reperfusão/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Humanos , Fígado/patologia , Fígado/cirurgia , Circulação Hepática , Masculino , Pessoa de Meia-Idade , Traumatismo por Reperfusão/etiologia
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