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1.
PLoS One ; 14(12): e0225796, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31851674

RESUMO

Dandruff is a skin condition that affects the scalp of up to half the world's population, it is characterised by an itchy, flaky scalp and is associated with colonisation of the skin by Malassezia spp. Management of this condition is typically via antifungal therapies, however the precise role of microbes in the aggravation of the condition are incompletely characterised. Here, a combination of 454 sequencing and qPCR techniques were used to compare the scalp microbiota of dandruff and non-dandruff affected Chinese subjects. Based on 454 sequencing of the scalp microbiome, the two most abundant bacterial genera found on the scalp surface were Cutibacterium (formerly Propionibacterium) and Staphylococcus, while Malassezia was the main fungal inhabitant. Quantitative PCR (qPCR) analysis of four scalp taxa (M. restricta, M. globosa, C. acnes and Staphylococcus spp.) believed to represent the bulk of the overall population was additionally carried out. Metataxonomic and qPCR analyses were performed on healthy and lesional buffer scrub samples to facilitate assessment of whether the scalp condition is associated with differential microbial communities on the sampled skin. Dandruff was associated with greater frequencies of M. restricta and Staphylococcus spp. compared with the healthy population (p<0.05). Analysis also revealed the presence of an unclassified fungal taxon that could represent a novel Malassezia species.


Assuntos
Caspa , Dermatomicoses/microbiologia , Malassezia , Microbiota , Couro Cabeludo/microbiologia , Pele/microbiologia , Adolescente , Adulto , Idoso , China , Caspa/epidemiologia , Caspa/microbiologia , Feminino , Humanos , Malassezia/classificação , Malassezia/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Propionibacteriaceae/isolamento & purificação , Staphylococcus/isolamento & purificação , Adulto Jovem
2.
Clin Microbiol Rev ; 32(4)2019 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-31366612

RESUMO

Microbiomes associated with human skin and the oral cavity are uniquely exposed to personal care regimes. Changes in the composition and activities of the microbial communities in these environments can be utilized to promote consumer health benefits, for example, by reducing the numbers, composition, or activities of microbes implicated in conditions such as acne, axillary odor, dandruff, and oral diseases. It is, however, important to ensure that innovative approaches for microbiome manipulation do not unsafely disrupt the microbiome or compromise health, and where major changes in the composition or activities of the microbiome may occur, these require evaluation to ensure that critical biological functions are unaffected. This article is based on a 2-day workshop held at SEAC Unilever, Sharnbrook, United Kingdom, involving 31 specialists in microbial risk assessment, skin and oral microbiome research, microbial ecology, bioinformatics, mathematical modeling, and immunology. The first day focused on understanding the potential implications of skin and oral microbiome perturbation, while approaches to characterize those perturbations were discussed during the second day. This article discusses the factors that the panel recommends be considered for personal care products that target the microbiomes of the skin and the oral cavity.


Assuntos
Qualidade de Produtos para o Consumidor , Cosméticos/normas , Microbiota/fisiologia , Boca/microbiologia , Pele/microbiologia , Educação , Humanos
4.
J Surg Case Rep ; 2016(11)2016 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-27887019

RESUMO

Penile metastases are rare in colorectal cancer. We report the first case of such a recurrence in a patient who had undergone an extralevator abdominoperineal resection with vertical rectus abdominis myocutaneous flap perineal reconstruction. The patient was treated with curative intent by total penectomy.

5.
FEMS Microbiol Ecol ; 91(1): 1-11, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25764539

RESUMO

The human foot provides an ideal environment for the colonization and growth of bacteria and subsequently is a body site associated with the liberation of odour. This study aimed to enumerate and spatially map bacterial populations' resident across the foot to understand any association with odour production. Culture-based analysis confirmed that Staphylococci were present in higher numbers than aerobic corynebacteria and Gram-positive aerobic cocci, with all species being present at much higher levels on the plantar sites compared to dorsal sites. Microbiomic analysis supported these findings demonstrating that Staphylococcus spp. were dominant across different foot sites and comprised almost the entire bacterial population on the plantar surface. The levels of volatile fatty acids, including the key foot odour compound isovaleric acid, that contribute to foot odour were significantly increased at the plantar skin site compared to the dorsal surface. The fact that isovaleric acid was not detected on the dorsal surface but was present on the plantar surface is probably attributable to the high numbers of Staphylococcus spp. residing at this site. Variations in the spatial distribution of these microbes appear to be responsible for the localized production of odour across the foot.


Assuntos
Ácidos Graxos Voláteis/biossíntese , Pé/microbiologia , Odorantes , Pele/microbiologia , Corynebacterium , Hemiterpenos , Humanos , Ácidos Pentanoicos , Staphylococcus/metabolismo
6.
J Dermatol Sci ; 73(1): 23-30, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24076068

RESUMO

BACKGROUND: A single nucleotide polymorphism (SNP), 538G→A, leading to a G180R substitution in the ABCC11 gene results in reduced concentrations of apocrine derived axillary odour precursors. OBJECTIVE: Determine the axillary odour levels in the SNP ABCC11 genotype variants and to investigate if other parameters associated with odour production are affected. METHODS: Axillary odour was assessed by subjective quantification and gas chromatography headspace analysis. Metabolite profiles, microbiome diversity and personal hygiene habits were also assessed. RESULTS: Axillary odour in the A/A homozygotes was significantly lower compared to the G/A and G/G genotypes. However, the perception-based measures still detected appreciable levels of axillary odour in the A/A subjects. Metabolomic analysis highlighted significant differences in axillary skin metabolites between A/A subjects compared to those carrying the G allele. These differences resulted in A/A subjects lacking specific volatile odourants in the axillary headspace, but all genotypes produced odoriferous short chain fatty acids. Microbiomic analysis revealed differences in the relative abundance of key bacterial genera associated with odour generation between the different genotypes. Deodorant usage indicated a high level of self awareness of axillary odour levels with A/A individuals less likely to adopt personal hygiene habits designed to eradicate/mask its presence. CONCLUSIONS: The SNP in the ABCC11 gene results in lower levels of axillary odour in the A/A homozygotes compared to those carrying the G allele, but A/A subjects still produce noticeable amounts of axillary odour. Differences in axillary skin metabolites, bacterial genera and personal hygiene behaviours also appear to be influenced by this SNP.


Assuntos
Transportadores de Cassetes de Ligação de ATP/genética , Odorantes , Polimorfismo de Nucleotídeo Único , Higiene da Pele , Pele/metabolismo , Transportadores de Cassetes de Ligação de ATP/metabolismo , Adolescente , Adulto , Glândulas Apócrinas/metabolismo , Glândulas Apócrinas/microbiologia , Conscientização , Axila , Desodorantes , Feminino , Frequência do Gene , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Heterozigoto , Homozigoto , Humanos , Masculino , Fenótipo , Pele/microbiologia , Adulto Jovem
7.
Metabolism ; 62(8): 1065-9, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23598085

RESUMO

OBJECTIVE: Studies have started to question whether a specific component or combinations of metabolic syndrome (MetS) components may be more important in relation to cardiovascular disease risk. Our aim was to examine the impact of the presence of raised fasting glucose as a MetS component on postprandial lipaemia. METHODS: Men classified with the MetS underwent a sequential test meal investigation, in which blood samples were taken at regular intervals after a test breakfast (t=0 min) and lunch (t=330 min). Lipids, glucose and insulin were measured in the fasting and postprandial samples. RESULTS: MetS subjects with 3 or 4 components were subdivided into those without (n=34) and with (n=23) fasting hyperglycaemia (≥5.6 mmol/l), irrespective of the combination of components. Fasting lipids and insulin were similar in the two groups, with glucose significantly higher in the men with glucose as a MetS component (P<0.001). Following the test meals, there were higher maximum concentration (maxC), area under the curve (AUC) and incremental AUC (P ≤0.016) for the postprandial triacylglycerol (TAG) response in men with fasting hyperglycaemia. Greater glucose AUC (P<0.001) and insulin maxC (P=0.010) were also observed in these individuals after the test meals. Multiple regression analysis revealed fasting glucose to be an important predictor of the postprandial TAG and glucose response. CONCLUSION: Our data analysis has revealed a greater impairment of postprandial TAG than glucose response in MetS subjects with raised fasting glucose. The worsening of postprandial lipaemic control may contribute to the greater CVD risk reported in individuals with MetS component combinations which include hyperglycaemia.


Assuntos
Glicemia/metabolismo , Hiperglicemia/metabolismo , Síndrome Metabólica/metabolismo , Período Pós-Prandial/fisiologia , Triglicerídeos/sangue , Adulto , Idoso , Área Sob a Curva , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Jejum/metabolismo , Ácidos Graxos não Esterificados/sangue , Feminino , Humanos , Insulina/sangue , Lipídeos/sangue , Masculino , Síndrome Metabólica/sangue , Pessoa de Meia-Idade , Análise de Regressão
8.
Environ Sci Technol ; 46(23): 12823-31, 2012 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-23126670

RESUMO

Jarosites are produced during metallurgical processing, on oxidized sulfide deposits, and in acid mine drainage environments. Despite the environmental relevance of jarosites, few studies have examined their biogeochemical stability. This study demonstrates the simultaneous reduction of structural Fe(III) and aqueous As(V) during the dissolution of synthetic Pb-As jarosite (PbFe(3)(SO(4),AsO(4))(2)(OH)(6)) by Shewanella putrefaciens using batch experiments under anaerobic circumneutral conditions. Fe(III) reduction occurred immediately in inoculated samples while As(V) reduction was observed after 72 h. XANES spectra showed As(III) (14.7%) in the solid phase at 168 h coincident with decreased aqueous As(V). At 336 h, XANES spectra and aqueous speciation analysis demonstrated 20.2% and 3.0% of total As was present as As(III) in the solid and aqueous phase, respectively. In contrast, 12.4% of total Fe was present as aqueous Fe(II) and was below the detection limits of XANES in the solid phase. TEM-EDS analysis at 336 h showed secondary precipitates enriched in Fe and O with minor amounts of As and Pb. Based on experimental data and thermodynamic modeling, we suggest that structural Fe(III) reduction was thermodynamically driven while aqueous As(V) reduction was triggered by detoxification induced to offset the high As(V) (328 µM) concentrations released during dissolution.


Assuntos
Arsênio/metabolismo , Compostos Férricos/metabolismo , Chumbo/metabolismo , Shewanella putrefaciens/metabolismo , Sulfatos/metabolismo , Poluentes Químicos da Água/metabolismo , Arsênio/química , Biodegradação Ambiental , Compostos Férricos/química , Chumbo/química , Oxirredução , Solubilidade , Sulfatos/química , Termodinâmica , Poluentes Químicos da Água/química
9.
BMC Bioinformatics ; 13: 172, 2012 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-22823282

RESUMO

BACKGROUND: Increasingly biological text mining research is focusing on the extraction of complex relationships relevant to the construction and curation of biological networks and pathways. However, one important category of pathway - metabolic pathways - has been largely neglected.Here we present a relatively simple method for extracting metabolic reaction information from free text that scores different permutations of assigned entities (enzymes and metabolites) within a given sentence based on the presence and location of stemmed keywords. This method extends an approach that has proved effective in the context of the extraction of protein-protein interactions. RESULTS: When evaluated on a set of manually-curated metabolic pathways using standard performance criteria, our method performs surprisingly well. Precision and recall rates are comparable to those previously achieved for the well-known protein-protein interaction extraction task. CONCLUSIONS: We conclude that automated metabolic pathway construction is more tractable than has often been assumed, and that (as in the case of protein-protein interaction extraction) relatively simple text-mining approaches can prove surprisingly effective. It is hoped that these results will provide an impetus to further research and act as a useful benchmark for judging the performance of more sophisticated methods that are yet to be developed.


Assuntos
Mineração de Dados/métodos , Redes e Vias Metabólicas , Algoritmos , Software
10.
Atherosclerosis ; 220(1): 237-43, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22019448

RESUMO

OBJECTIVE: To examine the impact of increasing numbers of metabolic syndrome (MetS) components on postprandial lipaemia. METHODS: Healthy men (n=112) underwent a sequential meal postprandial investigation, in which blood samples were taken at regular intervals after a test breakfast (0min) and lunch (330min). Lipids, glucose and insulin were measured in the fasting sample, with triacylglycerol (TAG), non-esterified fatty acids and glucose analysed in the postprandial samples. RESULTS: Subjects were grouped according to the number of MetS components regardless of the combinations of components (0/1, 2, 3 and 4/5). As expected, there was a trend for an increase in body mass index, blood pressure, fasting TAG, glucose and insulin, and a decrease in fasting high-density lipoprotein cholesterol with increasing numbers of MetS components (P≤0.0004). A similar trend was observed for the summary measures of the postprandial TAG and glucose responses. For TAG, the area under the curve (AUC) and maximum concentration (maxC) were significantly greater in men with ≥3 than <3 components (P<0.001), whereas incremental AUC was greater in those with 3 than 0/1 and 2, and 4/5 compared with 2 components (P<0.04). For glucose, maxC after the test breakfast (0-330min) and total AUC (0-480min) were higher in men with ≥3 than <3 components (P≤0.001). CONCLUSIONS: Our data analysis has revealed a linear trend between increasing numbers of MetS components and magnitude (AUC) of the postprandial TAG and glucose responses. Furthermore, the two meal challenge discriminated a worsening of postprandial lipaemic control in subjects with ≥3 MetS components.


Assuntos
Hiperlipidemias/sangue , Síndrome Metabólica/sangue , Período Pós-Prandial , Triglicerídeos/sangue , Adulto , Idoso , Análise de Variância , Biomarcadores/sangue , Glicemia/metabolismo , Pressão Sanguínea , Índice de Massa Corporal , Inglaterra , Ácidos Graxos não Esterificados/sangue , Humanos , Hiperlipidemias/diagnóstico , Insulina/sangue , Modelos Lineares , Masculino , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/fisiopatologia , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Fatores de Tempo
12.
Atherosclerosis ; 208(1): 246-52, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19640535

RESUMO

OBJECTIVE: To examine the impact of age and the natural menopause on the postprandial triacylglycerol (TAG) response in healthy women. METHODS AND RESULTS: Thirty-seven premenopausal and sixty-one postmenopausal women underwent a sequential meal postprandial investigation, in which blood samples were taken at regular intervals after a test breakfast and lunch given at 0 and 330 min respectively. Lipids and glucose were measured in the fasting sample, with TAG analysed in the postprandial samples. Postmenopausal women were shown to have higher fasting total cholesterol, low density lipoprotein cholesterol (LDL-C) and glucose (P<0.02). Marked differences in the postprandial TAG response were evident between the groups, with a greater incremental area under the curve (IAUC) and maximum TAG concentration in the postmenopausal women (P<0.04). Multivariate regression analysis revealed both age and fasting TAG to be independently associated with the summary measures of the postprandial TAG response in the premenopausal women only. Interestingly, sub-division of the women into both younger and older pre- and postmenopausal subgroups, showed the most marked difference in TAG-IAUC to be between the younger and the older premenopausal women, whereas differences in fasting LDL-C were most evident between the older premenopausal and the younger postmenopausal women. CONCLUSIONS: Our results suggest a divergence in the relationship of age and menopausal status with fasting LDL-C and postprandial TAG which may reflect differences in the metabolic effects of age and the menopause on these lipid risk markers or a greater impact of early oestrogen decline on pathways of TAG rather than LDL metabolism.


Assuntos
Menopausa/metabolismo , Período Pós-Prandial , Triglicerídeos/sangue , Adulto , Fatores Etários , Feminino , Humanos , Pessoa de Meia-Idade
13.
J Biol Chem ; 283(9): 5486-95, 2008 Feb 29.
Artigo em Inglês | MEDLINE | ID: mdl-18166528

RESUMO

A non-synonymous single nucleotide polymorphism in the human SLC24A5 gene is associated with natural human skin color variation. Multiple sequence alignments predict that this gene encodes a member of the potassium-dependent sodium-calcium exchanger family denoted NCKX5. In cultured human epidermal melanocytes we show using affinity-purified antisera that native human NCKX5 runs as a triplet of approximately 43 kDa on SDS-PAGE and is partially localized to the trans-Golgi network. Removal of the NCKX5 protein through small interfering RNA-mediated knockdown disrupts melanogenesis in human and murine melanocytes, causing a significant reduction in melanin pigment production. Using a heterologous expression system, we confirm for the first time that NCKX5 possesses the predicted exchanger activity. Site-directed mutagenesis of NCKX5 and NCKX2 in this system reveals that the non-synonymous single nucleotide polymorphism in SLC24A5 alters a residue that is important for NCKX5 and NCKX2 activity. We suggest that NCKX5 directly regulates human epidermal melanogenesis and natural skin color through its intracellular potassium-dependent exchanger activity.


Assuntos
Antiporters/metabolismo , Complexo de Golgi/metabolismo , Melaninas/biossíntese , Melanócitos/metabolismo , Pigmentação/fisiologia , Polimorfismo de Nucleotídeo Único , Animais , Antiporters/genética , Cálcio/metabolismo , Linhagem Celular Tumoral , Complexo de Golgi/genética , Humanos , Transporte de Íons/fisiologia , Masculino , Melaninas/genética , Melanócitos/citologia , Camundongos , Potássio/metabolismo , Sódio/metabolismo , Trocador de Sódio e Cálcio/genética , Trocador de Sódio e Cálcio/metabolismo
14.
Aviat Space Environ Med ; 79(1): 54-7, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18225780

RESUMO

INTRODUCTION: It has been reported that many aircrew who experience hypoxia-related incidents are able to recognize hypoxia because of similarity to symptoms they experienced during hypoxia awareness training. This study aimed to explore the degree of similarity between symptoms reported after acute hypoxia and those remembered from previous hypoxia awareness training. METHODS: An English-Arabic questionnaire listing 22 symptoms of hypoxia was distributed to aircrew during aviation physiology training at the beginning of the hypoxia lecture and again after hypoxia awareness training. RESULTS: Cognitive and psychomotor impairment dominated the symptoms reported after acute hypoxia, as well as the symptoms remembered from previous hypoxia training. Aircrew reported a mean of 16 hypoxia symptoms on both surveys. During acute hypoxia, 65% of aircrew experienced the five symptoms they remembered to be dominant from previous training; 57% of aircrew remembered from previous training the symptoms that dominated their experience of acute hypoxia. CONCLUSIONS: The level of agreement between the symptoms aircrew describe after acute hypoxia and the symptoms they remember several years later suggests that hypoxia awareness training is an effective method of allowing aircrew to recognize their personal manifestation of hypoxia (their 'hypoxia signature').


Assuntos
Medicina Aeroespacial/educação , Hipóxia/diagnóstico , Militares/educação , Fisiologia/educação , Adulto , Altitude , Humanos , Hipóxia/psicologia , Rememoração Mental , Inquéritos e Questionários
15.
Aviat Space Environ Med ; 78(10): 979-84, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17955948

RESUMO

INTRODUCTION: Helicopter aircrew have reported features of hypoxia below 3048 m (10,000 ft). The aim of this study was to examine the effect of physical activity below 3048 m on the development of hypoxia. METHODS: Six subjects exercised at 30 W and 60 W for 4 min at sea level, 610 m, 2134 m, and 2743 m (2000 ft, 7000 ft, and 9000 ft). RESULTS: There was an abrupt decrease in Spo2 once physical activity was commenced. This was small at sea level (1%) and 610 m (2.2%), however, the Spo2 fell by 4.3% at 2134 m and 5.5% at 2743 m (to Spo2 88.1% and 85.7%, respectively). Spo2 returned to near-resting values within 3 min of stopping exercise. Symptoms of hypoxia were reported significantly more frequently during activity than rest at each of the altitudes. DISCUSSION: Helicopter aircrew should be aware that physical activity as low as 2134 m can produce hypoxemia and symptoms of hypoxia similar to that which would normally be expected in a person resting at approximately 3658-4572 m (12,000-15,000 ft).


Assuntos
Medicina Aeroespacial , Aeronaves , Altitude , Hipóxia/fisiopatologia , Militares , Doença Aguda , Adulto , Austrália , Confusão , Coleta de Dados , Tontura , Humanos , Descrição de Cargo , Masculino , Pessoa de Meia-Idade , Oximetria , Tempo de Reação
16.
J Clin Oncol ; 25(21): 3061-8, 2007 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-17634484

RESUMO

PURPOSE: The aim of the current study is to report the long-term outcomes after laparoscopic-assisted surgery compared with conventional open surgery within the context of the UK MRC CLASICC trial. Results from randomized trials have indicated that laparoscopic surgery for colon cancer is as effective as open surgery in the short term. Few data are available on rectal cancer, and long-term data on survival and recurrence are now required. METHODS: The United Kingdom Medical Research Council Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer (UK MRC CLASICC; clinical trials number ISRCTN 74883561) trial study comparing conventional versus laparoscopic-assisted surgery in patients with cancer of the colon and rectum. The randomization ratio was 2:1 in favor of laparoscopic surgery. Long-term outcomes (3-year overall survival [OS], disease-free survival [DFS], local recurrence, and quality of life [QoL]) have now been determined on an intention-to-treat basis. RESULTS: Seven hundred ninety-four patients were recruited (526 laparoscopic and 268 open). Overall, there were no differences in the long-term outcomes. The differences in survival rates were OS of 1.8% (95% CI, -5.2% to 8.8%; P = .55), DFS of -1.4% (95% CI, -9.5% to 6.7%; P = .70), local recurrence of -0.8% (95% CI, -5.7% to 4.2%; P = .76), and QoL (P > .01 for all scales). Higher positivity of the circumferential resection margin was reported after laparoscopic anterior resection (AR), but it did not translate into an increased incidence of local recurrence. CONCLUSION: Successful laparoscopic-assisted surgery for colon cancer is as effective as open surgery in terms of oncological outcomes and preservation of QoL. Long-term outcomes for patients with rectal cancer were similar in those undergoing abdominoperineal resection and AR, and support the continued use of laparoscopic surgery in these patients.


Assuntos
Causas de Morte , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/cirurgia , Laparoscopia/métodos , Laparotomia/métodos , Recidiva Local de Neoplasia/mortalidade , Adulto , Fatores Etários , Idoso , Carcinoma/mortalidade , Carcinoma/patologia , Carcinoma/cirurgia , Colectomia/métodos , Neoplasias Colorretais/patologia , Intervalos de Confiança , Feminino , Seguimentos , Humanos , Laparoscopia/efeitos adversos , Laparotomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Estadiamento de Neoplasias , Probabilidade , Modelos de Riscos Proporcionais , Medição de Risco , Fatores Sexuais , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Reino Unido
17.
Lancet ; 365(9472): 1718-26, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-15894098

RESUMO

BACKGROUND: Laparoscopic-assisted surgery for colorectal cancer has been widely adopted without data from large-scale randomised trials to support its use. We compared short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer to predict long-term outcomes. METHODS: Between July, 1996, and July, 2002, we undertook a multicentre, randomised clinical trial in 794 patients with colorectal cancer from 27 UK centres. Patients were allocated to receive laparoscopic-assisted (n=526) or open surgery (n=268). Primary short-term endpoints were positivity rates of circumferential and longitudinal resection margins, proportion of Dukes' C2 tumours, and in-hospital mortality. Analysis was by intention to treat. This trial has been assigned the International Standard Randomised Controlled Trial Number ISRCTN74883561. FINDINGS: Six patients (two [open], four [laparoscopic]) had no surgery, and 23 had missing surgical data (nine, 14). 253 and 484 patients actually received open and laparoscopic-assisted treatment, respectively. 143 (29%) patients underwent conversion from laparoscopic to open surgery. Proportion of Dukes' C2 tumours did not differ between treatments (18 [7%] patients, open vs 34 [6%], laparoscopic; difference -0.3%, 95% CI -3.9 to 3.4%, p=0.89), and neither did in-hospital mortality (13 [5%] vs 21 [4%]; -0.9%, -3.9 to 2.2%, p=0.57). Apart from patients undergoing laparoscopic anterior resection for rectal cancer, rates of positive resection margins were similar between treatment groups. Patients with converted treatment had raised complication rates. INTERPRETATION: Laparoscopic-assisted surgery for cancer of the colon is as effective as open surgery in the short term and is likely to produce similar long-term outcomes. However, impaired short-term outcomes after laparoscopic-assisted anterior resection for cancer of the rectum do not yet justify its routine use.


Assuntos
Neoplasias Colorretais/cirurgia , Laparoscopia , Idoso , Feminino , Humanos , Complicações Intraoperatórias , Laparoscopia/efeitos adversos , Masculino , Complicações Pós-Operatórias , Qualidade de Vida
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