Gastric cancer induces systemic inflammatory reaction (SIR) manifesting with changes in counts of white blood cell fractions and concentrations of acute phase proteins, clotting factors and albumins. Thus, protein-based scores or blood cell ratios (neutrophil to lymphocyte ratio (NLR); platelet to lymphocyte ratio (PLR)) are used to evaluate SIR. SIR tests are biologically justified by multiple clinically important and fascinating events including bone marrow activation, development of immune-suppressing immature myeloid cells, generation of pre-metastatic niches and neutrophil extracellular trap formation from externalised DNA network in bidirectional association with platelet activation. Despite biological complexity, clinical SIR assessment is widely available, patient-friendly and economically feasible. Here we present concise review on NLR, PLR, Glasgow prognostic score and fibrinogen -parameters that have prognostic role regarding overall, cancer-free and cancer-specific survival in early and advanced cases. Tumour burden can be predicted helping in preoperative detection of serosal or lymph node involvement. Practical consequences abound, including selection of surgical approach in respect to tumour burden, adjustments in treatment intensity by prognosis or evaluation of chemotherapy response. The chapter also scrutinises main controversies including different cut-off levels. Future developments should include elaboration of complex scores as described here. SIR parameters should be wisely incorporated in patients' treatment.
SummaryMultiple synchronous primary tumours can cause diagnostic difficulties regarding primary origin versus metastatic spread. Greater awareness of concurrent carcinogenesis is necessary as more frequent occurrence of multiple primary cancers can be expected in future due to the growing tumour burden in the aging world population along with improved treatment efficacy. Here we report a 58-year-old male patient, who was diagnosed with two rare synchronous tumours: hepatocellular carcinoma and renal clear cell carcinoma. Both tumours were radically removed by simultaneous liver and kidney resection. AIM OF THE DEMONSTRATIONThe aim of our report is to show a case of two synchronous malignant tumours in the liver and kidney in order to increase the awareness about multiple primary cancers and the related diagnostic approach. CASE REPORTA 58-year-old male was admitted to a university hospital for surgical treatment of malignant tumour within kidney and liver. Metastatic spread was suspected. By upper laparotomy approach, the liver segments S5 and S6 were resected. Cholecystectomy and right kidney resection was performed simultaneously. The removed liver segment, gall bladder and kidney segment were sent for histological examination. Grossly, the liver segment measured 11.5x12.5x7.0 cm. A grey, relatively well-demarcated, homogeneous lesion was detected within the removed liver tissue 1.0 cm apart from resection line. Multiple tissue sections were submitted for microscopic evaluation and measurements. Microscopically, an invasive hepatocellular carcinoma was found (Figure 1). The tumour displayed trabecular structure and moderate cellular atypia. Although clear cell areas were present, the cytoplasmic fat vacuoles and rich presence of Mallory hyaline were suggestive of hepatocellular origin. The clear cell areas also contained Mallory hyaline. Areas of typical morphology were present as well. Gall bladder was also removed during the course of operation. It measured 9.0x3.7cm; and the thickness of wall was 0.4 cm. Only tiny cholesterol polyps were identified in the mucosa. There were no signs of malignancy within the gall bladder. Kidney segment grossly measured 6.0x5.4x5.5 cm. At grossing, the resection surface was inked by Alcian blue. In the cross section, a tumour mass 3.4x3.7x4.8 cm was observed. The tumour was soft, yellow with extensive haemorrhage and greyish areas. Multiple sections were submitted for microscopic evaluation yielding invasive renal carcinoma, clear cell type. The malignant tumour cells had irregular morphology, clear cytoplasm, dark and round central nuclei and small nucleoli visible at high magnification corresponding to grade II by Fuhrman (Figure 1).Within tumour mass, secondary changes were presentlarge areas of necrosis and haemorrhages. Tumour was surrounded with fibrous pseudocapsule which was focally penetrated by tumour cells spreading to renal parenchyma. There was no evidence of invasion into perirenal or hilar fat, or large blood vessels. By immunohistochemistry, hepatocellular car...
Цель работы: представить обзор современной отечественной и зарубежной литературы по теме «Нарушения сердечного ритма и проводимости при заболеваниях пищевода и желудочно-кишечного тракта». Изучены отечественные и зарубежные литературные источники за последние 10 лет по кардиальным проявлениям, характерным для заболеваний пищевода и желудочно-кишечного тракта, особое внимание уделено аритмиям и нарушениям проводимости. Нарушения сердечного ритма и проводимости являются одними из проявлений висцерокардиальных синдромов и носят транзиторный характер. Наиболее часто при заболеваниях пищевода и желудочно-кишечного тракта фиксируются наджелудочковые аритмии (наджелудочковая экстрасистолия и фибрилляция предсердий), из нарушений проводимости -неполная блокада правой ножки пучка Гиса. При заболеваниях органов пищеварения установлена закономерная связь между показателями вариабельности сердечного ритма и дисбалансом симпато-вагусного равновесия: повышение активности симпатической нервной системы ведет к снижению показателей вариабельности сердечного ритма, что, соответственно, является триггером для возникновения аритмий, в том числе и фатальных. Эффективность в нивелировании симптомов, входящих в структуру висцерокардиальных синдромов, отмечена, по данным разных авторов, у препаратов из группы ингибиторов протонной помпы, а дозозависимый проаритмогенный эффект выявлен у некоторых прокинетиков (донперидона). Нарушения сердечного ритма и проводимости можно расценивать как проявление висцерокардиальных синдромов в тех случаях, когда данные явления возникают или усугубляются при дебюте или обострении заболеваний органов пищеварения. Правильно расставить акценты в лечении нарушений сердечного ритма и проводимости у коморбидного пациента помогает своевременное выявление висцерокардиальных синдромов. Для достижения максимального эффекта в терапии данной категории пациентов лечение и последующее динамическое наблюдение должны проводиться кардиологами совместно с гастроэнтерологами. Ключевые слова: экстрасистолия, фибрилляция предсердий, гастроэзофагеальная рефлюксная болезнь, язвенная болезнь.
Gastric cancer is one of the most common gastrointestinal malignancies, known also for its dismal prognosis, except early cases. Despite the advances in systemic therapy, surgery remains the cornerstone of treatment. The majority of gastric cancers are carcinomas, while neuroendocrine tumours and gastrointestinal stromal tumours (GISTs) rank next by frequency. Tumour biology, disease course and prognosis differ amongst the aforementioned gastric cancers; thus, surgical treatment has to be adjusted as well. Accumulation of evidence ensures an individualised approach in all aspects of surgical treatment. Specific criteria are set to choose the best surgical treatment while maintaining postoperative function and acceptable life quality. Minimally invasive techniques continue to gain acceptance, while usage is still highly variable. Endoscopic resection is suitable for very early adenocarcinomas, whereas more advanced tumours require standard gastrectomy. Despite the initial concerns, subtotal gastrectomy (SG) is feasible and safe, especially for distal adenocarcinomas. In recent years, D2 lymphadenectomies have become more frequent in Western countries, and evidence supports this tendency. Surgery for gastric neuroendocrine tumours is type-specific and will be discussed in detail. Gastrointestinal stromal tumours are treated by local resection without wide margins or extensive lymph node dissection. Novel targeted therapy can aid surgical treatment by downstaging larger GISTs.
Цель работы -представить обзор современной отечественной и зарубежной литературы по теме: трудности диагностики тромбоэмболии легочной артерии как осложнения постоянной электрокардиостимуляции. Изучены отечественные и зарубежные литературные источники за последние 10 лет по осложнениям электрокардиостимуляции, особое внимание уделено тромбоэмболии легочной артерии. Постоянная электрокардиостимуляция может сопровождаться ранними и поздними осложнениями, в 5,7-12,4% и в 7,5-19,7% случаев соответственно. У 15-50% пациентов с имплантированными электрокардиостимуляторами встречается тромбоэмболия легочной артерии, которая характеризуется стертостью и полиморфизмом клинической картины вследствие эмболизации мелких ветвей легочной артерии. В настоящее время диагностика тромбоэмболии легочной артерии проводится с помощью шкал клинической вероятности Wells и Geneva, а также современных лабораторных и инструментальных методов исследований. Рассмотрена тактика ведения пациентов в зависимости от риска летальности на основании рекомендаций Европейского общества кардиологов 2014 года. Тромбоэмболия легочной артерии у пациентов с постоянной электрокардиостмуляциейдостаточно распространенное осложнение, часто имеет латентное, а также рецидивирующее течение, что затрудняет ее верификацию, в связи с чем необходимо использовать современные диагностические алгоритмы ранней диагностики и эффективного лечения. Ключевые слова: электрокардиостимуляция, тромбоэмболия легочной артерии, шкалы клинической вероятности Wells и Geneva, пероральные антикоагулянты. PULMONARY EMBOLISM IN PATIENTS WITH PERMANENT ELECTROCARDIOSTIMULATION: DIAGNOSTIC DIFFICULTIES The purpose of the work: to present a review of modern domestic and foreign literature on the topic: difficulties in diagnosing pulmonary embolism as a complication of constant electrocardiostimulation. Domestic and foreignliterature sources for the last 10 years on complications of electrocardiostimulation have been studied, special attention is paid to pulmonary embolism. Permanent electrocardiostimulation may be accompanied by early and late complications, in 5.7-12.4% and 7.5-19.7% of cases, respectively. In 15-50% of patients with implanted pacemakers, pulmonary embolism occurs, which is characterized by Erasure and polymorphism of the clinical picture due to embolization of small branches of the pulmonary artery. Currently, diagnosis of pulmonary embolism is performed using the Wells and Geneva clinical probability scales, as well as modern laboratory and instrumental research methods. We consider the tactics of managing patients depending on the risk of mortality based on the recommendations of the European society of Cardiology in 2014. Pulmonary embolism in patients with permanent electrocardiostmulation is a fairly common complication, often has a latent and recurrent course, which makes it difficult to verify it, and therefore it is necessary to use modern diagnostic algorithms for early diagnosis and effective treatment.
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