No abstract

Achalasia of the cardia is associated with an increased risk of esophageal carcinoma. The real burden of achalasia at the malignancy genesis is still a controversial issue. Therefore, there are no generally accepted recommendations on follow-up evaluation for achalasia patients. This study aims to estimate the risk of esophageal adenocarcinoma and squamous cell carcinoma in achalasia patients. We searched for association between carcinoma and esophageal achalasia in databases up to January 2017 to perform a systematic review and meta-analysis. A total of 1,046 studies were identified from search strategy, of which 40 were selected for meta-analysis. A cumulative number of 11,978 esophageal achalasia patients were evaluated. The incidence of squamous cell carcinoma was 312.4 (StDev 429.16) cases per 100,000 patient-years at risk. The incidence of adenocarcinoma was 21.23 (StDev 31.6) cases per 100,000 patient-years at risk. The prevalence for esophageal carcinoma was 28 carcinoma cases in 1,000 esophageal achalasia patients (CI 95% 2, 39). The prevalence for squamous cell carcinoma was 26 cases in 1,000 achalasia patients (CI 95% 18, 39) and for adenocarcinoma was 4 cases in 1,000 achalasia patients (CI 95% 3, 6).The absolute risk increase for squamous cell carcinoma was 308.1 and for adenocarcinoma was 18.03 cases per 100,000 patients per year. To the best of our knowledge, this is the first meta-analysis estimating the burden of achalasia as an esophageal cancer risk factor. The high increased risk rate for cancer in achalasia patients points to a strict endoscopic surveillance for these patients. Also, the increased risk for developing adenocarcinoma in achalasia patients suggests fundoplication after myotomy, to avoid esophageal reflux and Barret esophagus, a known risk factor for adenocarcinoma.

No abstract

Among nonmotor symptoms observed in Parkinson's disease (PD) dysfunction in the visual system, including hallucinations, has a significant impact in their quality of life. To further explore the visual system in PD patients we designed two fMRI experiments comparing 18 healthy volunteers with 16 PD patients without visual complaints in two visual fMRI paradigms: the flickering checkerboard task and a facial perception paradigm. PD patients displayed a decreased activity in the primary visual cortex (Broadmann area 17) bilaterally as compared to healthy volunteers during flickering checkerboard task and increased activity in fusiform gyrus (Broadmann area 37) during facial perception paradigm. Our findings confirm the notion that PD patients show significant changes in the visual cortex system even before the visual symptoms are clinically evident. Further studies are necessary to evaluate the contribution of these abnormalities to the development visual symptoms in PD.

No abstract

Context: Ocluzia intestinală de cauză malignă este o complicaţie frecventă la pacienţii cu cancer în stadii avansate. Prognosticul este slab, cu o rată medie de supravieţuire mai mică de 3 luni. Tratamentul clinic, procedurile endoscopice sau chirurgicale sunt opţiuni pentru managementul obstrucţiei intestinale maligne. Nu există o strategie de management general acceptată. Obiective: Evaluarea factorilor de prognostic ai pacienţilor cu obstrucţie intestinală malignă care au fost supuşi unui tratament chirurgical. Metode: A fost efectuată o analiză retrospectivă incluzând pacienţii unei singure instituţii medicale, cu diagnostic de obstrucţie intestinală malignă. Au fost evaluate datele demografice, perioada de internare, complicaţiile postoperatorii şi supravieţuirea globală. Regresia logistică a fost utilizată pentru evaluarea factorilor prognostici asociaţi. Rezultate: Două sute treizeci şi trei de intervenţii chirurgicale au fost efectuate datorită suspiciunii de obstrucţie intestinală malignă pe o perioadă de şapte ani. Acest diagnostic a fost confirmat în cazul a 210 intervenţii chirurgicale (90,1%). Principalele cauze ale obstrucţiei maligne au fost cancerul colorectal (49,5%) şi cancerul ginecologic (21,9%). Rata complicaţiilor severe a fost de 11,42%. Rata mortalităţii intraspitaliceşti a fost de 40,95% (interval de încredere 95%: 34,16-47,74%). Deficienţa funcţională, ureea serică crescută şi nivelurile scăzute de albumină au fost asociate cu o rată mai mare a mortalităţii. Concluzie: Obstrucţia intestinală malignă implică prognostic slab, cu o rată ridicată a mortalităţii intraspitaliceşti şi complicaţii postoperatorii severe. Decizia privind gestionarea obstrucţiei intestinale maligne trebuie să fie multimodală şi individualizată, în funcţie de factorii de prognostic individuali.

No abstract

Background: Achalasia and other esophageal dysmotility disorders mimicking achalasia can be associated with cancer. This study aimed to review the main mechanisms for which cancer may develop in esophageal dysmotility disorder patients. Methods: A narrative review was performed. Results: The mechanism for developing squamous cell carcinoma and adenocarcinoma are discussed. Besides, achalasia-like syndromes related to familial KIT-gene mutation and pseudoachalasia are discussed. Conclusions: Knowing the main mechanism for which achalasia can be related to cancer is essential for clinicians to conduct the proper investigation, surveillance, and treatment.