1,721,013 research outputs found
Ruolo delle metodiche avanzate di Imaging nel follow-up del cancro del retto extraperitoneale
No full textIl carcinoma o cancro del retto è un tumore maligno che rappresenta il 30-35% di tutti i tumori del grosso intestino che a loro volta rappresentano il 10% di tutti i cancri. L'80% dei pazienti con CRC presenta una malattia suscettibile di intervento chirurgico curativo (R0) . Purtroppo,circa il 40% di questi pazienti svilupperà una recidiva, soprattutto entro i primi tre anni. Per il cancro del retto,soprattutto in quello del retto extraperitoneale la recidiva pelvica rimane un problema significativo, che si verifica nel 3-47% dei pazienti. Per tale motivo oggetto dello studio sono stati pazienti affetti da cancro del retto medio-distale. La maggior parte delle recidive locali provengono dal letto tumorale, ciò sottolinea l'importanza della visualizzazione diretta del tessuto rettale perimurale come focus del follow-up post-operatorio.Ad oggi non sono stati condotti studi randomizzati su larga scala documentanti l’efficacia di un programma standard di monitoraggio post-chirurgico. Il follow-up post-operatorio dovrebbe essere rivolto in primo luogo alla diagnosi di recidive loco regionali potenzialmente resecabili.L'obiettivo di questo studio è quello di revisionare lo stato attuale delle metodiche avanzate di Imaging per la rilevazione di recidiva del cancro rettale in base alla letteratura recente ed alla nostra esperienza personale. Riportiamo i risultati dell’analisi dell’outcome postoperatorio in una casistica di pazienti high risk operati per carcinoma del retto extraperitoneale. I pazienti che presentavano uno stadio T1/2 erano 8 (42%) contro i restanti 11(58%) con uno stadio T3/4; un interessamento linfonodale c’era nel 26% (5) dei pazienti;gli interventi chirurgici eseguiti sono stati 14 R.U.B.,una R.A.,4 AAPsec. Miles.Per tale motivo, oltre agli esami routinari , secondo i protocolli internazionali , tutti i nostri pazienti sottoposti a follow-up intensivo hanno eseguito almeno una TC tb come indagine di primo livello. Sono stati riscontrati 6 recidive locoregionali(31,5%) e 2 metastasi a distanza; Una paziente è deceduta per complicanze non oncologiche;un paziente ha avuto pluricomplicanze benigne( stenosi attinica ed ascessi multipli). Il tasso di sopravvivenza libera da malattia e’ stato 47% con un follow-up variabile tra almeno 2 e 5 anni ed una sopravvivenza globale di poco <80%. Tutti i pazienti con immagine TC e/o endoscopiche dubbie per ripresa neoplastica sono stati candidati ad imaging di secondo livello(RM,PET ,PET/TC). L’imaging per la sorveglianza da operati per CRC dovrebbe avere la potenzialità per distinguere tra cicatrice e recidiva extraluminale,e naturalmente,rilevare recidive anastomotiche. Dei nostri pazienti la conferma di malignita’ per 2 era la progressione di malattia ed in 4 l’istologia post-rechirurgia.Mettendo a confronto le varie metodiche la TC riportava una sensibilità del 42% ,una specificità dell’82% ed un’accuratezza diagnostica del 67%; la RM mostrava una sensibilità del 100% ed un’accuratezza del 67%;infine la PET una sensibilità del 71%, specificità del 50% ed accuratezza del 64%. Tali dati sono piu o meno sovrapponibili a quelli riscontrati dalle piu recenti review della letteratura.La risonanza magnetica grazie alla sua eccellente risoluzione dei tessuti molli ed alla sua multiplanarità fornisce dettagliate informazioni anatomiche e rispetto alla TC, la distinzione di tessuto eteroplastico all'interno di una cicatrice chirurgica è più accurato. Questa peculiarità si basa sulle differenze dell'intensità del segnale tra tumore e fibrosi con sequenze T2-pesate e tecniche di imaging contrast-enhanced.I benefici della metodica sono pero’ gravati da costi elevati e casi frequenti di falsi positivi rendendo l’esame meno specifico.La FDG-PET risulta essere molto sensibile e specifica per le recidive locali ed ancor di piu per quelle a distanza.L’integrazione con scansioni TC ne migliora ulteriormente la precisione. Limite e’ anche in questo caso il costo elevato ,risoluzione spaziale non <4-6mm,una discreta percentuale di falsi positivi in special modo post-radioterapia.Ad oggi percio’ e’ dibattuto su quale procedura di imaging dovrebbe essere parte di un programma di sorveglianza post-operatorio evidence-based. Vi è la necessità di ben disegnati trials clinici;una opzione può essere adattare al rischio i follow-up.Requisito fondamentale sarà un approccio multidisciplinare che sensibilizzi chirurghi,oncologi e radiologi per una sua corretta esecuzione al fine di ridurre in futuro il tasso di recidiva ed aumenti la sopravvivenza globale.La TC e’ un indagine meno costosa e di piu facile esecuzione ma gravata da una bassa sensibilita’. Percio’ andrebbe sempre eseguita solo come esame di primo livello perché nei casi sospetti e’ poco dirimente.In futuro quindi sarà completamente sostituita con metodiche di imaging avanzate(RM,PET e/o PET-TC) gravate da costi piu elevati ma con sensibilita’ ed accuratezza globale più elevata
New food approaches to reduce and/or eliminate increased gastric acidity related to gastroesophageal pathologies
No full textObjectives: Gastroesophageal reflux disease (GERD) is very common in industrialized countries, and it is rapidly and significantly increasing, even in developing countries. Unlike reported to date in the scientific literature, in this study aims to assess the ability of reduced-carbohydrate diets and foods enriched with acid pH (lemon and tomato) to quickly and exponentially reduce the symptoms related to conditions such as gastritis and gastroesophageal reflux that are unrelated to Helicobacter pylori.
Methods: Following the administration of an anamnestic test, 130 subjects were selected, including 73 women and 57 men, aged 21 to 67, with a gastritis diagnosis for 92 subjects (including 56 women and 36 men) and reflux gastritis for 38 subjects (17 women and 21 men). Study participants followed 3 dietary treatments in succession. Each treatment lasted two weeks, and treatments were separated by two weeks of washout. The subjects followed a diet, consisting primarily of proteins and fats, that included the exponential reduction of glycides (simple and complex). In addition, the treatment provided for the daily intake of the juice of two lemons and approximately 100 g of fresh orange tomato without seeds eaten either raw or cooked and peeled.
Results: During the treatment and at the end of two weeks of treatment, the subjects reported significant improvements, including an almost total disappearance of symptoms related to the disease in question.
Conclusions: This study shows that a carbohydrate-free diet and/or highly hypoglycidal diet enriched with acid pH foods seems to lead to a decrease in the pH of the gastric contents, thus inhibiting further production of hydrochloric acid with a reduction or disappearance of heartburn symptoms typical of gastroesophageal diseases
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Intraperitoneal dedifferentiated liposarcoma showing MDM2
Full text linkBackground: Liposarcoma is the most common type of soft tissue sarcoma (STS). It is divided into five groups according to histological pattern: well-differentiated, myxoid, round cell, pleomorphic, and dedifferentiated. Dedifferentiated liposarcoma most commonly occurs in the retroperitoneum, while an intraperitoneal location is extremely rare. Only seven cases have been reported in literature. Many pathologists recognize that a large number of intra-abdominal poorly differentiated sarcomas are dedifferentiated liposarcomas. We report a case initially diagnosed as undifferentiated sarcoma that was reclassified as intraperitoneal dedifferentiated liposarcoma showing an amplification of the MDM2 gene.
Case presentation: A 59-year-old woman with abdominal pain and constipation was referred to the Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy, in November 2012. On physical examination, a very large firm mass was palpable in the meso-hypogastrium. Computed tomography (CT) scan showed a heterogeneous density mass (measuring 10 x 19 cm) that was contiguous with the mesentery and compressed the third part of the duodenum and jejunum. At laparotomy, a large mass occupying the entire abdomen was found, adhering to the first jejunal loop and involving the mesentery. Surgical removal of the tumor along with a jejunal resection was performed because the first jejunal loop was firmly attached to the tumor. Macroscopic examination showed a solid, whitish, cerebroid, and myxoid mass, with variable hemorrhage and cystic degeneration, measuring 26 x 19 x 5 cm. Microscopic examination revealed two main different morphologic patterns: areas with spindle cells in a myxoid matrix and areas with pleomorphic cells. The case was initially diagnosed as undifferentiated pleomorphic sarcoma. Histological review showed areas of well-differentiated liposarcoma. Fluorescence in situ hybridization (FISH) analysis was performed and demonstrated an amplification of the MDM2 gene. Definitive diagnosis was intraperitoneal dedifferentiated liposarcoma. No adjuvant therapy was given, but 5 months after laparotomy, the patient presented with a locoregional recurrence and chemotherapy with high-dose ifosfamide was started.
Conclusions: No guidelines are available for the management of intraperitoneal dedifferentiated liposarcoma. We report this case to permit the collection of a larger number of cases to improve understanding and management of this tumor. Moreover, this study strongly suggests that poorly differentiated sarcomas should prompt extensive sampling to demonstrate a well-differentiated liposarcoma component and, if possible, FISH analysis
Epidemiological and clinical aspects of hepatitis B virus infection in Italy over the last 50 years
Full text linkA relevant gradual reduction of both the incidence rate of acute hepatitis B (AHB) and prevalence of chronic hepatitis B has occurred in Italy in the last 50 years, due to substantial epidemiological changes: Improvement in socioeconomic and hygienic conditions, reduction of the family unit, accurate screening of blood donations, abolition of re-usable glass syringes, hepatitis B virus (HBV)-universal vaccination started in 1991, use of effective well tolerated nucleo(t)side analogues able to suppress HBV replication available from 1998, and educational mediatic campaigns against human immunodeficiency virus infection focusing on the prevention of sexual and parenteral transmission of infections. As an example, AHB incidence has gradually decreased from 10/100000 inhabitants in 1985 to 0.21 in 2020. Unfortunately, the coronavirus disease 2019 (COVID-19) pandemic has interrupted the trend towards HBV eradication. In fact, several HBV chronic carriers living in the countryside have become unable to access healthcare facilities for screening, diagnosis, clinical management, and nucleo(t)side analogue therapy in the COVID-19 pandemic, mainly for anxiety of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), movement restrictions, and reduced gains from job loss. In addition, one-third of healthcare facilities and personnel for HBV patients have been devolved to the COVID-19 assistance
Rare multiple primary malignancies among surgical patients-a single surgical unit experience
Full text linkBACKGROUND:
A remarkable number of patients presents with multiple primary malignancies (MPM) over their lifetimes. In most cases inherited syndromes, iatrogenic, or viral factors are implicated, while in some cases it is not possible to ascertain a clear aetiopathogenesis.
METHODS:
Starting from a series of 315 patients with MPM, we focused our attention on those with extremely infrequent combinations of tumours. We retrospectively analysed patients' characteristics, type of first and second tumour and the interval between the two tumours. We made a comparison between our own data and data from surveillance, epidemiology, and end results cancer registries, the largest global series on this topic.
RESULTS:
Six patients presented with unusual associations, namely, central nervous system (CNS)/colon, testis/stomach, colon/CNS, CNS/kidney, uterus/soft tissue, and bone/breast. The median age was 50.5 years at the diagnosis of second neoplasm and the male:female ratio was 1:1. All six patients underwent surgery for both tumours. The median interval between the first and the second tumour was 11.3 years (range 1-36 years). Five patients were given chemotherapy as adjuvant systemic treatment, and two of them with CNS tumours also received radiotherapy.
DISCUSSION:
We analysed the behaviour of these rare tumours as first and second neoplasms. More frequent combinations and possible aetiological factors were evaluated.
CONCLUSIONS:
Follow-up for patients recovering from a first tumour must be strict, as there is the risk of developing MPM, even after a long time period. Advancement in biomolecular knowledge and cooperation among different specialists are strongly needed to reduce mortality related to MPM and to foresee their occurrenc
Simultaneous quadruple carcinoma of the colon:case report and literature review
No full textINTRODUCTION: Multiple primary malignancies can arise in the large bowel as simultaneous, synchronous and/or metachronous. All tumors must be distant from each other to be considered as primitive, none have to be the result of metastasis from other tumors.
CASE REPORT: We present a case of a 71 years old woman who was admitted to our hospital for a 3-year history of not well defined abdominal pain and hematochezia. The patient had no family history of cancer. Colonoscopy revealed 4 simultaneous tumors located at 4 and 20 cm from the ileocecal valve and at 23,2 and 19 cm from the anal verge. At CT scan there were no distant metastases, neither lymphonode node involvement. A quadruple adenocarcinoma of the colon was confirmed by the pathologist. Patient was operated on total colectomy with ileo-rectal anastomosis.
DISCUSSION: Two or three synchronous tumors of the colon have been already described in literature in about 1,8-14% of cases, but the presence of four simultaneous cancers, as in our case, is very interesting and unusual without an history of FAP or familiar cancer.
CONCLUSION: Comprehensive preoperative study, extensive intraoperative exploration, and radical resection can improve surgical results and survival rate, remaining unquestioned the caus
Is day-surgery laparoscopic cholecystectomy contraindicated in the elderly? Results from a retrospective study and literature review
No full text- …
