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1.
Cochrane Database Syst Rev ; 3: CD013348, 2021 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-33661538

RESUMO

BACKGROUND: Cervical cancer ranks as the fourth leading cause of death from cancer in women. Historically, women with metastatic or recurrent cervical cancer have had limited treatment options. New anti-angiogenesis therapies, such as vascular endothelial growth factor (VEGF) targeting agents, offer an alternative strategy to conventional chemotherapy; they act by inhibiting the growth of new blood vessels, thereby restricting tumour growth by blocking the blood supply. OBJECTIVES: To assess the benefits and harms of VEGF targeting agents in the management of persistent, recurrent, or metastatic cervical cancer. SEARCH METHODS: We performed searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, online registers of clinical trials, and abstracts of scientific meetings up until 27 May 2020. SELECTION CRITERIA: We examined randomised controlled trials (RCTs) that evaluated the use of VEGF targeting agents alone or in combination with conventional chemotherapy or other VEGF targeting agents. DATA COLLECTION AND ANALYSIS: Three review authors independently screened the results of search strategies, extracted data, assessed risk of bias, and analysed data according to the standard methods expected by Cochrane. The certainty of evidence was assessed via the GRADE approach. MAIN RESULTS: A total of 1634 records were identified. From these, we identified four studies with a total of 808 participants for inclusion. We also identified two studies that were awaiting classification and nine ongoing studies. Bevacizumab plus chemotherapy versus chemotherapy Treatment with bevacizumab plus chemotherapy may result in lower risk of death compared to chemotherapy alone (hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.62 to 0.95; 1 study, 452 participants; low-certainty evidence). However, there are probably more specific adverse events when compared to chemotherapy alone, including gastrointestinal perforations or fistulae (risk ratio (RR) 18.00, 95% CI 2.42 to 133.67; 1 study, 440 participants; moderate-certainty evidence); serious thromboembolic events (RR 4.5, 95% CI 1.55 to 13.08; 1 study, 440 participants; moderate-certainty evidence); and hypertension (RR 13.75, 95% CI 5.07 to 37.29; 1 study, 440 participants; moderate-certainty evidence). There may also be a higher incidence of serious haemorrhage (RR 5.00, 95% CI 1.11 to 22.56; 1 study, 440 participants; low-certainty evidence). In addition, the incidence of serious adverse events is probably higher (RR 1.44, 95% CI 1.16 to 1.79; 1 study, 439 participants; moderate-certainty evidence). The incremental cost-effectiveness ratio was USD 295,164 per quality-adjusted life-year (1 study, 452 participants; low-certainty evidence). Cediranib plus chemotherapy versus chemotherapy Treatment with cediranib plus chemotherapy may or may not result in similar risk of death when compared to chemotherapy alone (HR 0.94, 95% CI 0.53 to 1.65; 1 study, 69 participants; low-certainty evidence). We found very uncertain results for the incidences of specific adverse events, including gastrointestinal perforations or fistulae (RR 3.27, 95% CI 0.14 to 77.57; 1 study, 67 participants; very low-certainty evidence); serious haemorrhage (RR 5.45, 95% CI 0.27 to 109.49; 1 study, 67 participants; very low-certainty evidence); serious thromboembolic events (RR 3.41, 95% CI 0.14 to 80.59; 1 study, 60 participants; very low-certainty evidence); and serious hypertension (RR 0.36, 95% CI 0.02 to 8.62; 1 study, 67 participants; very low-certainty evidence). In addition, there may or may not be a similar incidence of serious adverse events compared to chemotherapy alone (RR 1.15, 95% CI 0.75 to 1.78; 1 study, 67 participants; low-certainty evidence). Apatinib plus chemotherapy or chemotherapy/brachytherapy versus chemotherapy or chemotherapy/brachytherapy Treatment with apatinib plus chemotherapy or chemotherapy/brachytherapy may or may not result in similar risk of death compared to chemotherapy alone or chemotherapy/brachytherapy alone (HR 0.90, 95% CI 0.51 to 1.60; 1 study, 52 participants; low-certainty evidence). However, hypertension events may occur at a higher incidence as compared to chemotherapy alone or chemotherapy/brachytherapy alone (RR 5.14, 95% CI 1.28 to 20.73; 1 study, 52 participants; low-certainty evidence). Pazopanib plus lapatinib versus lapatinib Treatment with pazopanib plus lapatinib may result in higher risk of death compared to lapatinib alone (HR 2.71, 95% CI 1.16 to 6.31; 1 study, 117 participants; low-certainty evidence). We found very uncertain results for the incidences of specific adverse events, including gastrointestinal perforations or fistulae (RR 2.00, 95% CI 0.19 to 21.59; 1 study, 152 participants; very low-certainty evidence); haemorrhage (RR 2.00, 95% CI 0.72 to 5.58; 1 study, 152 participants; very low-certainty evidence); and thromboembolic events (RR 3.00, 95% CI 0.12 to 72.50; 1 study, 152 participants; very low-certainty evidence). In addition, the incidence of hypertension events is probably higher (RR 12.00, 95% CI 2.94 to 49.01; 1 study, 152 participants; moderate-certainty evidence). There may or may not be a similar incidence of serious adverse events as compared to lapatinib alone (RR 1.45, 95% CI 0.94 to 2.26; 1 study, 152 participants; low-certainty evidence). Pazopanib versus lapatinib Treatment with pazopanib may or may not result in similar risk of death as compared to lapatinib (HR 0.96, 95% CI 0.67 to 1.38; 1 study, 152 participants; low-certainty evidence). We found very uncertain results for the incidences of specific adverse events, including gastrointestinal perforations or fistulae (RR 1.03, 95% CI 0.07 to 16.12; 1 study, 150 participants; very low-certainty evidence); haemorrhage (RR 1.03, 95% CI 0.31 to 3.40; 1 study, 150 participants; very low-certainty evidence); and thromboembolic events (RR 3.08, 95% CI 0.13 to 74.42; 1 study, 150 participants; very low-certainty evidence). In addition, the incidence of hypertension events is probably higher (RR 11.81, 95% CI 2.89 to 48.33; 1 study, 150 participants; moderate-certainty evidence). The risk of serious adverse events may or may not be similar as compared to lapatinib (RR 1.31, 95% CI 0.83 to 2.07; 1 study, 150 participants; low-certainty evidence). AUTHORS' CONCLUSIONS: We found low-certainty evidence in favour of the use of bevacizumab plus chemotherapy. However, bevacizumab probably increases specific adverse events (gastrointestinal perforations or fistulae, thromboembolic events, hypertension) and serious adverse events. We found low-certainty evidence that does not support the use of cediranib plus chemotherapy, apatinib plus chemotherapy, apatinib plus chemotherapy/brachytherapy, or pazopanib monotherapy. We found low-certainty evidence suggesting that pazopanib plus lapatinib worsens outcomes. The VEGF inhibitors apatinib and pazopanib may increase the probability of hypertension events.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Antineoplásicos/uso terapêutico , Recidiva Local de Neoplasia/tratamento farmacológico , Neoplasias do Colo do Útero/tratamento farmacológico , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Adulto , Idoso , Idoso de 80 Anos ou mais , Inibidores da Angiogênese/efeitos adversos , Antineoplásicos/efeitos adversos , Bevacizumab/efeitos adversos , Bevacizumab/uso terapêutico , Viés , Braquiterapia/efeitos adversos , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Intervalos de Confiança , Feminino , Fístula Gástrica/induzido quimicamente , Hemorragia Gastrointestinal/induzido quimicamente , Humanos , Hipertensão/induzido quimicamente , Indazóis , Fístula Intestinal/induzido quimicamente , Perfuração Intestinal/induzido quimicamente , Lapatinib/efeitos adversos , Lapatinib/uso terapêutico , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/irrigação sanguínea , Recidiva Local de Neoplasia/mortalidade , Intervalo Livre de Progressão , Piridinas/efeitos adversos , Piridinas/uso terapêutico , Pirimidinas/efeitos adversos , Pirimidinas/uso terapêutico , Qualidade de Vida , Quinazolinas/efeitos adversos , Quinazolinas/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Sulfonamidas/efeitos adversos , Sulfonamidas/uso terapêutico , Tromboembolia/induzido quimicamente , Neoplasias do Colo do Útero/irrigação sanguínea , Neoplasias do Colo do Útero/mortalidade , Adulto Jovem
2.
Medicine (Baltimore) ; 98(48): e18142, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770250

RESUMO

RATIONALE: Mucormycosis is a rare opportunistic fungal infection with poor prognosis. The incidence of mucormycosis has been increasing, and it is a threat to immunocompromised hosts. We present a case of gastric mucormycosis complicated by a gastropleural fistula during immunosuppressive treatment for adult-onset Still disease (AOSD). PATIENT CONCERNS: An 82-year-old woman diagnosed with AOSD who developed gastric ulcers during the administration of an immunosuppressive therapy with corticosteroids, cyclosporine, and tocilizumab complained of melena and epigastralgia. Esophagogastroduodenoscopy showed multiple ulcers covered with grayish or greenish exudates. DIAGNOSES: The patient diagnosed with mucormycosis based on culture and biopsy of the ulcers, which showed nonseptate hyphae branching at wide angles. Mucor indicus was identified using polymerase chain reaction. INTERVENTIONS AND OUTCOMES: Although liposomal amphotericin B was administered, gastric mucormycosis was found to be complicated by a gastropleural fistula. The patient died because of pneumonia due to cytomegalovirus infection, and autopsy revealed the presence of Mucorales around the fistula connecting the stomach and diaphragm. LESSONS: Gastric mucormycosis is refractory to treatment and fatal. Surgical resection, if possible, along with antifungal drugs can result in better outcomes.


Assuntos
Fístula Gástrica/microbiologia , Mucormicose/complicações , Infecções Oportunistas/complicações , Fístula do Sistema Respiratório/microbiologia , Úlcera Gástrica/microbiologia , Idoso de 80 Anos ou mais , Feminino , Fístula Gástrica/induzido quimicamente , Humanos , Imunossupressores/efeitos adversos , Mucormicose/induzido quimicamente , Mucormicose/microbiologia , Infecções Oportunistas/induzido quimicamente , Infecções Oportunistas/microbiologia , Pleura/microbiologia , Fístula do Sistema Respiratório/induzido quimicamente , Doença de Still de Início Tardio/tratamento farmacológico , Úlcera Gástrica/induzido quimicamente
3.
BMJ Case Rep ; 20172017 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-28433969

RESUMO

Gastrocolic fistulas in children are most commonly seen after placement of a percutaneous endoscopic gastrostomy. We present a 14-year-old girl who developed a gastrocolic fistula following accidental corrosive acid ingestion. On evaluation of her symptoms, a barium swallow identified the gastrocolic fistula. It healed spontaneously in 3 months. This was both unexpected and remarkable. To the best of our knowledge this is the first case of a gastrocolic fistula occurring following corrosive ingestion.


Assuntos
Ácidos/toxicidade , Doenças do Colo/diagnóstico , Fístula Gástrica/diagnóstico , Adolescente , Doenças do Colo/induzido quimicamente , Feminino , Fístula Gástrica/induzido quimicamente , Humanos
4.
Ann Ital Chir ; 872016 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-27456604

RESUMO

AIM: Gastro-splenic fistula is a rare entity in which malignant tumors are the primary cause, followed by perforated peptic ulcers and Crohn's disease. CASE REPORT: A 66 years old patient undergoing chemotherapy for gastric large cells B lymphoma presented fever, fatigue and worsening of general conditions. A CT scan showed the presence of an abdominal abscess resulting from a pathological communication between stomach and spleen. RESULTS: En - bloc splenectomy and gastric wedge resection was performed; gastric wall was sutured with a linear stapler. Postoperative stay was uneventful; alimentation was restarted 5 days after the surgical procedure, and the patient was discharged 2 days later CONCLUSION: We have described an unusual case of gastric fistula complicating chemotherapy early diagnosed and successfully treated. KEY WORDS: Chemothera Gastrosplenic fistula, Lymphoma, Surgery.


Assuntos
Antineoplásicos/efeitos adversos , Fístula/induzido quimicamente , Fístula Gástrica/induzido quimicamente , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Esplenopatias/induzido quimicamente , Idoso , Feminino , Humanos
10.
Gulf J Oncolog ; (3): 64-7, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20084800

RESUMO

Gastrosplenic fistula resulting from erosion of a primary splenic lymphoma is a very rare cause of massive upper gastrointestinal hemorrhage as compared to benign peptic ulcer disease, gastric Crohn's disease, gastric adenocarcinoma, and primary gastric and splenic lymphomas. This hemorrhage can be successfully managed by splenic artery embolization, followed by splenectomy and gastric resection. A 50-year-old patient developed a gastrosplenic fistula during a course of chemotherapy for differentiated histiocytic lymphoma. The fistula was demonstrated by CT scan with oral contrast. The fistula was followed endoscopically and noted to have closed spontaneously with confirmed closure at laparotomy. The clinical management of this complication is discussed, and the literature pertaining to this rare condition is reviewed.


Assuntos
Antineoplásicos/efeitos adversos , Fístula Gástrica/induzido quimicamente , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Esplenopatias/induzido quimicamente , Fístula Gástrica/cirurgia , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade , Esplenopatias/cirurgia , Tomografia Computadorizada por Raios X
11.
Rom J Gastroenterol ; 13(1): 39-41, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15054525

RESUMO

Gastrocolic fistula is rarely described in the literature. It has been associated with a variety of diseases and recently with benign gastric ulcers related to the use of nonsteroidal anti-inflammatory drugs (NSAIDs'). The present case represents the first report of gastrocolic fistula due to NSAIDs in a cirrhotic patient. This is in keeping with the established knowledge that cirrhotic patients constitute a high-risk group of patients when treated with NSAIDs'. Review of the literature shows that this condition warrants a complete diagnostic work-up to exclude more ominous underlined diseases.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Fístula Gástrica/induzido quimicamente , Fístula Intestinal/induzido quimicamente , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Fístula Gástrica/patologia , Humanos , Fístula Intestinal/patologia , Cirrose Hepática/complicações , Masculino , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias
15.
World J Surg ; 20(6): 703-6; discussion 706, 1996.
Artigo em Inglês | MEDLINE | ID: mdl-8662156

RESUMO

Gastric cicatrization is a well recognized late sequela of corrosive gastric injury, but the optimum timing and type of surgery for this complication are still unclear. Over a 7-year period (1988-1994) 34 patients underwent elective surgery for gastric lesions secondary to corrosive ingestion. A total of 18 (53%) patients had an associated esophageal stricture and presented with dysphagia, 15 (44%) patients had features of gastric outlet obstruction, 6 (18%) had diffuse gastric injury, and 28 (82%) had a segmental lesion. A tube jejunostomy was done in 23 (68%) patients to improve nutrition and resulted in a significant increase in weight and in the serum protein level after 8 weeks of tube feeding. Elective surgery was performed 3 to 24 months (average 7 months) after ingestion of the corrosive substance. Gastric resection was done in 20 (59%) patients and gastrojejunostomy (without vagotomy) in 11 (32%); at follow-up the latter group did not exhibit development of a stomal ulcer. In patients with an associated esophageal stricture, endoscopic dilatation was successful in 89% patients and simplified the surgical approach. In conclusion, the success of surgery for corrosive-induced gastric injury depends on selecting the right procedure and intervening at the appropriate time.


Assuntos
Ácidos/intoxicação , Queimaduras Químicas/cirurgia , Cicatriz/cirurgia , Estenose Esofágica/induzido quimicamente , Gastrectomia/métodos , Estômago/lesões , Adolescente , Adulto , Estenose Esofágica/cirurgia , Feminino , Seguimentos , Fístula Gástrica/induzido quimicamente , Fístula Gástrica/cirurgia , Obstrução da Saída Gástrica/induzido quimicamente , Obstrução da Saída Gástrica/cirurgia , Gastrostomia , Humanos , Masculino , Pessoa de Meia-Idade , Estômago/efeitos dos fármacos , Tentativa de Suicídio
16.
S D J Med ; 46(10): 358-60, 1993 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-8256126

RESUMO

Gastrocolic fistula is a rare complication of benign gastric ulcer disease. It has been associated more commonly, in the past, with marginal ulceration following gastrojejunostomy for peptic ulcer disease. We will describe a classic case of gastrocolic fistula as a complication of acetylsalicylic acid abuse in a middle aged female with a remote history of aspirin induced ulcer. Her presentation was classic and required a surgical approach with excellent recovery. We will describe the clinical, radiographic, endoscopic and surgical aspects of this interesting and unusual disorder.


Assuntos
Aspirina/efeitos adversos , Doenças do Colo/induzido quimicamente , Fístula Gástrica/induzido quimicamente , Fístula Intestinal/induzido quimicamente , Transtornos Relacionados ao Uso de Substâncias , Feminino , Humanos , Pessoa de Meia-Idade , Úlcera Gástrica/induzido quimicamente
17.
Radiology ; 187(2): 359-61, 1993 May.
Artigo em Inglês | MEDLINE | ID: mdl-8475272

RESUMO

Eight patients had gastrocolic fistulas depicted on barium studies at the authors' hospital during a 10-year period between 1982 and 1992. Seven of those patients (88%) had benign disease, including aspirin-induced gastric ulcers of the greater curvature (n = 4), granulomatous colitis (n = 1), tuberculosis (n = 1), and a penetrating anastomotic ulcer after partial gastrectomy (n = 1). The remaining patient had a malignant gastrocolic fistula caused by carcinoma of the transverse colon. Two patients (25%) experienced classic symptoms of gastrocolic fistulas (ie, feculent vomiting or foul-smelling eructations), but the other six (75%) experienced abdominal pain or other nonspecific clinical findings. In the four patients who were taking aspirin, upper gastrointestinal examinations revealed giant penetrating ulcers of the greater curvature that communicated with the superior border of the transverse colon via a fistula. Three of these patients exhibited marked clinical improvement after conservative medical treatment and did not need surgery. This experience suggests that aspirin-induced gastric ulcers of the greater curvature have become a more common cause of gastrocolic fistulas than is carcinoma of the stomach or transverse colon.


Assuntos
Aspirina/efeitos adversos , Doenças do Colo/induzido quimicamente , Fístula Gástrica/induzido quimicamente , Fístula Intestinal/induzido quimicamente , Adulto , Idoso , Feminino , Fístula Gástrica/diagnóstico por imagem , Fístula Gástrica/etiologia , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Úlcera Gástrica/induzido quimicamente
20.
Br J Clin Pract ; 44(12): 759-61, 1990 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-2102232

RESUMO

An unusual case is presented of a benign gastrocolic fistula occurring in a 70-year-old man treated with piroxicam for arthritis for a period of only two months. This report illustrates that significant upper gastrointestinal complications can occur, even with short-term treatment, with non-steroidal anti-inflammatory drugs (NSAIDs).


Assuntos
Doenças do Colo/induzido quimicamente , Fístula Gástrica/induzido quimicamente , Fístula Intestinal/induzido quimicamente , Piroxicam/efeitos adversos , Idoso , Humanos , Doença Iatrogênica , Masculino
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