Management of rectal cancer has markedly evolved over the last two decades. New technologies of staging have allowed a more precise definition of tumor extension. Refinements in surgical concepts and techniques have resulted in higher rates of sphincter preservation and better functional outcome for patients with this malignancy. Although, preoperative chemoradiotherapy followed by total mesorectal excision has become the standard of care for locally advanced tumors, many controversial matters in management of rectal cancer still need to be defined. These include the feasibility of a non-surgical approach after a favorable response to neoadjuvant therapy, the ideal margins of surgical resection for sphincter preservation and the adequacy of minimally invasive techniques of tumor resection. In this article, after an extensive search in PubMed and Embase databases, we critically review the current strategies and the most debatable matters in treatment of rectal cancer.
IntroductionFunctional foods are health promoters and their use is associated with reduced
risk of chronic degenerative and non-transmissible diseases. Examples are
symbiotic. The association of one (or more) probiotic with a one (or more)
prebiotic is called symbiotic, being the prebiotics complementary and probiotics
synergistic, thus presenting a multiplicative factor on their individual
actions.ObjectiveTo assess the evidences on the benefits of the use of symbiotics in the treatment
of clinical and surgical situations.MethodsThe headings symbiotic, probiotic and prebiotic were searched in Pubmed/Medline in
the last 15 years, and were selected 25 articles, used for database.ResultsThe use of symbiotic may promote an increase in the number of bifidobacteria,
glycemic control, reduction of blood cholesterol, balancing the intestinal flora
which aids in reducing constipation and/or diarrhea, improves intestinal
permeability and stimulation of the immune system. Clinical indications for these
products has been expanded, in order to maximize the individual's physiological
functions to provide greater. So, with the high interest in the clinical and
nutritional control of disease, many studies have been conducted demonstrating the
effectiveness of using symbiotic in improving and/or preventing various and/or
symptoms of gastrointestinal diseases.ConclusionSymbiotic behave differently and positively in various pathological
situations.
Primary epidermoid carcinoma of the breast presenting as a breast abscess and sepsisresUMo CONTEXTO: O carcinoma de células escamosas da mama é um câncer extremamente raro, representando cerca de 0,04% dos tumores malignos da mama. Até o momento, apenas um número limitado de casos da doença foi relatado, a maioria se apresentando clinicamente como um carcinoma de mama usual. RELATO DE CASO: Paciente feminina de 39 anos de idade se apresentando com grande abscesso de mama e sinais de sepse. Após debridamento cirúrgico da lesão, o exame histopatológico da cápsula do abscesso revelou a presença de carcinoma de células escamosas da mama. O tratamento definitivo do tumor foi uma mastectomia radical modificada com ressecção da lesão residual na mama direita. CONCLUSÃO: O presente caso, de apresentação incomum, demonstra como uma lesão aparentemente benigna, como um abscesso mamário, pode estar relacionada a uma neoplasia maligna oculta. Uma revisão da literatura a respeito do carcinoma de células escamosas de mama é apresentada.I MD, PhD. Attending Physician,
The aim of the present study was to investigate the presence of human papillomavirus (HPV) in surgical specimens of esophageal squamous cell carcinoma. One hundred and sixty-five paraffin-embedded specimens of esophageal carcinoma were analyzed through high-sensitivity auto-nested polymerase chain reaction (PCR) using the consensus GP5+/GP6+ primer. Twenty-six specimens of esophageal mucosa without malignant disease were also studied as a control group. Two different specific primer sets targeting the E6 region of the HPVs 16 and 18 were used for typing. Direct DNA sequence analysis was conducted to confirm positive PCR results. HPV DNA was detected in 26 esophageal carcinomas (15.75%), but in none of the benign esophageal specimens (P < 0.05). Out of the 26 positive cases, 24 were HPV-16 and one was HPV-18. One tumor contained both HPV-16 and -18 DNA. Positive PCR results were confirmed by the amplified viral sequences. Our findings suggest that the presence of either HPV-16 or -18 might be related to development of the malignant phenotype in the esophagus.
-Context -Management of complex anal fistulas is associated with the risk of sphincter injury and fecal incontinence.In recent years, fibrin glue has emerged as an alternative sphincter-preserving treatment for anal fistulas. To date, however, there is no consensus about the efficacy of the method. Objective -To specifically evaluate the fibrin glue injection in the management of complex cryptoglandular anal fistulas. Methods -We studied a series of patients with complex anal fistulas treated with fibrin glue between January 2005 and January 2007. Only patients with fistulas of cryptoglandular origin were analyzed. Patients with fistulas related to Crohn's disease, HIV or previous surgery were excluded from the study. Under spinal anesthesia, the fistulas were curetted and injected with fibrin glue. After treatment, patients were followed-up for 12 months. Results -Thirty-two patients were enrolled in the study. Two patients were lost to follow-up and were excluded. Out of the remaining 30 patients, only three healed successfully (10%). Among the 27 patients who failed to heal, 9 (33.3%) were diagnosed within the first postoperative month. In 13 patients (48.1%) the failure of treatment occurred in the period between 1 and 3 months, in 3 patients (11.1%) between 3 and 6 months, and in 2 patients (7.4%) between 6 and 9 months after surgery. No treatment-related complications were observed. Conclusions -In this series, fibrin glue treatment for complex cryptoglandular anal fistulas achieved a very low healing rate. Our results do not support the use of fibrin glue as a first-line treatment for patients with this type of fistula. HEADINGS -Rectal fistula. Fibrin tissue adhesive. Tissue adhesives.
RESUMO: A disseminação metastática endotraqueal e endobrônquica do câncer de cólon é um evento raro. Os autores relatam o caso de um paciente com manifestação aguda de doença metastática endotraqueal e endobrônquica, 10 anos após o tratamento do tumor primário.
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